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1.
Thromb Res ; 228: 128-133, 2023 08.
Article in English | MEDLINE | ID: mdl-37327527

ABSTRACT

INTRODUCTION: In a recent interventional study of cancer patients with newly diagnosed venous thrombosis (VT), we found a high risk of arterial thrombotic events (AT) during treatment with therapeutic doses of apixaban. METHODS: Total 298 cancer patients with VT received apixaban as treatment and secondary prophylaxis for up to 36 months. AT was registered as a serious adverse event, and this is a post hoc analysis of risk factors for AT. Clinical risk factors and concomitant medication were assessed through odds ratios (OR) with 95 % confidence interval using multivariate logistic regression. Biomarkers were assessed by non-parametric testing. RESULTS: AT occurred in 16/298 patients (5.4 %, 95 % confidence interval (CI) 3.1-8.6 %). Median leucocyte count at baseline was higher in patients with AT compared with patients without AT (11 vs. 6.8·109/L, p < 0.01). Clinical factors associated with AT were pancreatic cancer (OR 13.7, 95 % CI 4.3-43.1), ovarian cancer (OR 19.3, 95 % CI 2.3-164.4), BMI <25 percentile (OR 3.1, 95 % CI 1.1-8.8) and previous VT (OR 4.4, 95 % CI 1.4-13.7). Pancreatic cancer had a cumulative incidence of AT of 36 % compared with 0.8 % for all other cancers at 6 months (p < 0.01). Non-steroidal anti-inflammatory drugs (OR 4.9, 95 % CI 1.0-26) and antiplatelet treatment (OR 3.8, 95 % CI 1.2-12.2) were associated with AT. CONCLUSION: In cancer patients with apixaban treated VT, pancreatic cancer was strongly associated with AT. In addition, ovarian cancer, BMI < 25 percentile, previous VT, antiplatelet treatment, non-steroidal anti-inflammatory drug use and high leucocyte count at baseline were associated with AT. The CAP study is registered with the unique identifier NCT02581176 in ClinicalTrials.gov.


Subject(s)
Ovarian Neoplasms , Pancreatic Neoplasms , Thrombosis , Venous Thrombosis , Humans , Female , Venous Thrombosis/drug therapy , Venous Thrombosis/epidemiology , Thrombosis/drug therapy , Pyridones/adverse effects , Ovarian Neoplasms/chemically induced , Ovarian Neoplasms/drug therapy , Pancreatic Neoplasms/drug therapy , Anti-Inflammatory Agents , Anticoagulants/therapeutic use
2.
Thromb Res ; 196: 238-244, 2020 12.
Article in English | MEDLINE | ID: mdl-32919178

ABSTRACT

INTRODUCTION: The direct oral anti-coagulants (DOAC) edoxaban and rivaroxaban are suggested treatment alternatives for cancer-associated venous thromboembolism (VTE) together with low molecular-weight heparins. New studies indicate that the DOAC apixaban also is an option for cancer-associated VTE. The current study assessed recurrent VTE, arterial thrombosis, bleedings and adverse events in a cohort of apixaban treated cancer patients with VTE. MATERIALS AND METHODS: Single-arm, interventional study of apixaban as treatment of cancer-associated VTE. Inclusion criteria were cancer with objectively verified VTE. Patients received apixaban 10 mg bid for seven days, then 5 mg bid for six months. Primary efficacy and safety outcomes were recurrent VTE and bleeding respectively. This trial is registered with ClinicalTrials.gov identifier NCT02581176. RESULTS: We recruited 298 cancer patients with VTE. During six months treatment, recurrent VTE or death related to VTE occurred in 12 patients (4.0%, 95% confidence interval (CI) 2.1-6.9%). Major bleeding occurred in 16 patients (5.4%, 95% CI 2.8-7.9), most frequently gastrointestinal bleeding. There were no overrepresentation of major bleedings among patients with gastrointestinal cancer (7/126, 5.5%, 95% CI 2.3-11%). Twenty-six patients experienced one or more clinically relevant non-major bleedings (8.9%, 95% CI 5.5-12%). Twelve patients had arterial thrombosis (4.0%, 95% CI 2.1-6.9%), of which the majority were strokes in patients with pancreatic cancer. Death occurred in 35 patients (12%, 95% CI 8.3-16%). CONCLUSION: The frequency of recurrent VTE and major bleedings are in line with other studies on apixaban in cancer-associated VTE. Arterial thrombosis was a frequent serious adverse event.


Subject(s)
Neoplasms , Thrombosis , Venous Thromboembolism , Administration, Oral , Anticoagulants/therapeutic use , Hemorrhage/chemically induced , Hemorrhage/drug therapy , Humans , Neoplasms/complications , Neoplasms/drug therapy , Pyrazoles , Pyridones/adverse effects , Thrombosis/drug therapy , Venous Thromboembolism/drug therapy
3.
Cancer Immunol Immunother ; 63(8): 757-77, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24997173

ABSTRACT

Extracorporeal photopheresis (ECP) is an immunomodulatory alternative for treatment of graft versus host disease (GVHD). The blood is then separated into its various components through apheresis; buffy coat cells are thereafter treated with 8-methoxypsoralen before exposure to ultraviolet light and finally reinfused into the patient. There is a general agreement that this treatment has an anti-GVHD effect, but the mechanisms of action behind this effect are only partly understood. However, altered maturation of dendritic cells (DC) and thereby indirect modulation of T-cell reactivity seems to be one important mechanism together with DC-presentation of antigens derived from apoptotic donor T cells and induction of regulatory T cells. The treatment has been best studied in patients with chronic GVHD (both pediatric and adult patients), but most studies are not randomized and it is difficult to know whether the treatment is more effective than the alternatives. The clinical studies of ECP in adults with acute GVHD are few and not randomized; it is not possible to judge whether this treatment should be a preferred second- or third-line treatment. There is no evidence for increased risk of leukemia relapse or suppression of specific graft versus leukemia reactivity by this treatment, so specific antileukemic immunotherapy may still be possible. Thus, even though the treatment seems effective in patients with GVHD, further clinical (especially randomized) as well as biological studies with careful standardization of the treatment are needed before it is possible to conclude how ECP should be used in acute and chronic GVHD.


Subject(s)
Graft vs Host Disease/immunology , Graft vs Host Disease/therapy , Photopheresis/methods , Stem Cell Transplantation/methods , Humans , Stem Cell Transplantation/adverse effects , Transplantation, Homologous
4.
Haematologica ; 91(10): 1428-9, 2006 Oct.
Article in English | MEDLINE | ID: mdl-17018397

ABSTRACT

We report a population-based investigation on adult acute precursor B lymphoblastic leukemia, Burkitt's lymphoma and T lymphoblastic lymphoma in a defined geographic area. The age-adjusted incidence rates for the three diagnostic groups were 0.47, 0.16 and 0.2 per 100,000 per year, respectively. Clinical characteristics and outcome following treatment are reported.


Subject(s)
Burkitt Lymphoma/epidemiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Burkitt Lymphoma/pathology , Burkitt Lymphoma/therapy , Female , Hematopoietic Stem Cells/pathology , Humans , Incidence , Male , Middle Aged , Norway/epidemiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
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