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Tackling mantle cell lymphoma (MCL): Potential benefit of allogeneic stem cell transplantation.

Mantle cell lymphoma (MCL) is a type of non-Hodgkins lymphoma (NHL) associated with poor progression-free and overall survival. There is a high relapse rate with conventional cytotoxic chemotherapy. Intensive combination chemotherapy including rituximab, dose intense CHOP- (cyclophosphamide-doxorubicin-vincristine-prednisone) like regimens, high dose cytarabine, and/or consolidation with autologous stem cell transplant (autoSCT) have shown promise in significantly prolonging remissions. Data from phase II studies show that even in patients with chemotherapy refractory MCL, allogeneic stem cell

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… Table 1 First-line MCL regimens Abbreviations: COP, cyclophosphamide-vincristine-prednisone; CHOP, cyclophosphamide-doxorubicin-vincristine-prednisone; MCP, mitoxantrone-chlorambucil-prednisone; RR, response rate; CR, complete response; PFS, progression-free survival; TTF, time to treatment failure; … Combined cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) improves response rates but not survival and has lower hematologic toxicity compared with combined mitoxantrone, chlorambucil, and prednisone (MCP) in follicular and mantle cell lymphomas: results of a prospective randomized trial …

How I treat elderly patients with plasma cell dyscrasias.

Plasma cell dyscrasias are a rare heterogeneous group of hematological disorders which are more prevalent in the older part of the population. The introduction of novel agents, improved understanding of disease biology and better supportive management have improved outcomes considerably and in the era of the aging population the question of how to best manage older patients with plasma cell dyscrasias has never been more relevant. Data on how to treat these patients comes mostly from subgroup analysis as they are underrepresented in clinical trials. This review will cover issues, available evi

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… For the unfit patient oral fluradarabine for 6 cycles or chlorambucil for 12 cycles, DRC for 6 cycles and rituximab monotherapy are all acceptable options if disease burden is low. VR or ibrutinib are preferred for higher tumour burdens ( Figure 1 ). … Results of a randomized trial of chlorambucil versus fludarabine for patients with untreated Waldenström macroglobulinemia, marginal zone lymphoma, or lymphoplasmacytic lymphoma. …

A comprehensive survey of cancer medicines prices, availability and affordability in Ghana.

IntroductionIn Ghana, prices for cancer medicines are characterized by high retail markups, forex fluctuations and high variation in prices of medicines. Most patients cannot afford the cancer medicines. There is a problem of unaffordability and limited availability of essential cancer medicines which suggests potential inequity in patient access to cancer medicines. The study objective was to assess the prices, availability, and affordability of cancer medicines in Ghana. Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of thes

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… The lowest OB and LPG price variation was chlorambucil 2mg tablet (21.05%) and the highest was Epirubicin 50mg vial (44.23%) respectively, depicting that some OBs were more expensive than the LPGs. Cyclophosphamide 50mg tablets showed the highest negative price variation of-566.67%. … In the public hospitals, Chlorambucil 2mg tab was the most expensive requiring 201 days wages, followed by Gemcitabine 1000mg vial which required 176 days wages, whilst Leucovorin Calcium 50mg vial required 144 days wages. …

Cardiac Involvement in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.

Cardiac involvement of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is recognized extremely rarely. In addition, most CLL/SLL patients with heart infiltration are asymptomatic. In this review, we present the results of a literature search for English language articles concerning CLL/SLL or Richter transformation with symptomatic cardiac involvement. In total, 18 well-described cases with CLL/SLL and heart infiltration were identified. Only three patients were not diagnosed with CLL/SLL before the cardiac manifestation. In other patients, cardiac CLL/SLL was diagnosed betwe

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… Abbreviations: BM—bone marrow involvement, BR—bendamustine + rituximab, CBC—complete blood count, CLL—chronic lymphocytic leukemia, CT—computed tomography, Chl—chlorambucil, Obi—obinutuzumab, CT—computed tomography scan, ECG—electrocardiogram, FR—fludarabine + rituximab, G-CSF—granulocyte colony stimulating … However, an asymptomatic pericardial effusion subsequently recurred, and the patient received six cycles of chlorambucil and obinutuzumab, resulting in complete disappearance of the pericardial effusion without second pericardiocentesis [ 24 ]. …

Monoclonal Antibodies Approved for Cancer Therapy

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… These findings were essentially supported by a comparison of obinutuzumab and rituximab, each combined with chlorambucil, in a study of 781 randomly assigned patients with previously untreated CLL. Adverse events were seen more frequently with the obinutuzumab-chlorambucil treatment. … Grade 3 or 4 cytopenias may occur in patients given obinutuzumab in combination with chlorambucil; incidences of 34 % for neutropenia and 12 % for thrombocytopenia, respectively, were found in trials. …

State of the art biology, progression, and clinical management of monoclonal B-cell lymphocytosis (MBL): consensus report from the Intercepting Blood Cancers Workshop Committee.

In March 2023 and 2024, a panel of international experts convened at the first and second Intercepting Blood Cancers (IBC) Workshops, with the aim of better appreciating the diagnostic challenges, pathophysiology, and potential therapeutic interventions for precursor malignant hematology conditions. Here, we report a summary of the proceedings from the sessions focused on monoclonal B-cell lymphocytosis (MBL)/chronic lymphocytic leukemia (CLL). We highlight four main content areas: biology of MBL, clinical implications of MBL, progression of MBL and transformation from indolent CLL to aggressi

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… Both chemotherapy and chemoimmunotherapy approaches have been studied, including chlorambucil [ 46 ], fludarabine [ 47 ], and the combination regimen of fludarabine, cyclophosphamide, and rituximab (FCR) [ 48 ]. … Chlorambucil in indolent chronic lymphocytic leukemia. French Cooperative Group on chronic lymphocytic leukemia. N. Engl J Med 1998;338:1506–14.9593789 47. Hoechstetter MA, Busch R, Eichhorst B, Buhler A, Winkler D, Eckart MJ, et al. …

Multiple myeloma in Korea--clinical analysis and treatment results in 61 cases.

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… Current drugs shown to be effective as a single agent include alkylating agents (melphalan, cyclophosphamide, chlorambucil), nitrosoureas, procarbazine, and doxorubicin, each of which has a remission rate of about 20–50% 14 – 16) . …

British Association for Cancer Research 22nd Annual general meeting. 13-15 April 1981. Abstracts.

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… Pharmacokinetics and metabolism of chlorambucil in man: a preliminary report. Cancer Treat Rev. 1979 Jun;6 (Suppl):9–17. doi: 10.1016/s0305-7372(79)80005-5. Alberts D. S., Chen H. S., Mayersohn M., Perrier D., Moon T. E., Gross J. F. Bleomycin pharmacokinetics in man. II. …

Acquired Factor X Deficiency without Amyloidosis Presenting with Massive Hematuria: A Case Report and Review of the Literature.

Acquired factor X deficiency is a rare diagnosis, especially without the association of other co-existing conditions such as amyloidosis. The authors report the case of a 34-year-old male with severe frank hematuria found to have markedly prolonged prothrombin time and activated partial thromboplastin time. A mixing study showed correction utilizing normal plasma and a coagulation panel testing revealed decreased factor X activity. The patient was treated with multiple blood transfusions, fresh frozen plasma, high-dose pulse steroids, and rituximab. The patient's condition improved during his

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… In certain cases, rituximab, chlorambucil, and cyclophosphamide were added to the treatment regimen. The average length of recovery was between three and six weeks. In most reported cases, FX activity was markedly reduced to less than 5%, and patients presented with hemorrhagic symptoms. …

Cardiotoxicity after cancer treatment: a process map of the patient treatment journey.

Background/aimCardiotoxicity is a potential complication of anticancer therapy. While guidelines have been developed to assist practitioners, an effective, evidence based clinical pathway for the treatment of cardiotoxicity has not yet been developed. The aim of this study was to describe the journey of patients who developed cardiotoxicity through the healthcare system in order to establish baseline data to inform the development and implementation of a patient-centred, evidence-based clinical pathway.MethodsMixed-methods design with quantitative and qualitative components using process mappi

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… 100) Bile duct 1 (2) Breast 14 (30) Colon 1 (2) Hodgkin’s lymphoma 1 (2) Leukaemia 3 (7) Lung 1 (2) Lymphoma 7 (15) Non-Hodgkin’s 11 (24) Oesophagus 1 (2) Osteosarcoma 4 (9) Prostate 1 (2) Missing 1 (2) Agent Class Chemotherapy cycles b,c 5.2 (1–18) Alkylating Mean dose (mg) Carboplatin 520.0 2 (4) Chlorambucil … lymphoma | | 1 (2) Leukaemia | | 3 (7) Lung | | 1 (2) Lymphoma | | 7 (15) Non-Hodgkin’s | | 11 (24) Oesophagus | | 1 (2) Osteosarcoma | | 4 (9) Prostate | | 1 (2) Missing | | 1 (2) Agent Class Chemotherapy cycles b,c | 5.2 (1–18) | Alkylating | Mean dose (mg) | Carboplatin | 520.0 | 2 (4) Chlorambucil …

Abstracts

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Advances in Oncohematology Immunotherapy: Monoclonal Antibodies and CAR T-Cell Therapies.

The role of immunotherapy in oncohematology is well established. Monoclonal antibodies have undergone substantial development in recent years, targeting a wide range of molecules (including surface antigens, immune checkpoints, and cytokines) and have demonstrated clinical utility across various hematologic malignancies, including leukemias, lymphomas, and myelomas. The emergence of advanced therapy medicinal products (ATMPs), particularly chimeric antigen receptor (CAR) T cells, has provided an additional and promising therapeutic option. This rapidly evolving field continues to expand therap

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… Initially approved for refractory CLL, ofatumumab subsequently received additional indications in 2014, including first-line treatment in combination with chlorambucil and monotherapy for CLL refractory to both fludarabine and alemtuzumab [ 14 ]. … Patients receiving obinutuzumab plus chlorambucil achieved significantly longer progression-free survival than those treated with rituximab plus chlorambucil ( p < 0.001), as well as higher complete response rates (20.7% vs. 7.0%) [ 16 ]. …

Prodrugs in Oncology: Bioactivation and Impact on Therapeutic Efficacy and Toxicity.

A prodrug is a molecule that lacks pharmacological activity, but upon enzymatic bioactivation, it can generate a therapeutically active molecule. The primary reason behind the design of a prodrug is to help circumvent challenges associated with the physicochemical properties of a drug molecule, such as solubility, absorption, distribution, and instability. Chemotherapy has been at the forefront of cancer treatment for over 70 years due to its ability to target rapidly proliferating tumor cells. However, a major concern with conventional chemotherapy is the lack of selectivity and its associate

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… A prodrug containing oxidized cisplatin and chlorambucil can offer a promising strategy to circumvent lipophilicity issues and improve therapeutic efficacy, as both are antineoplastic agents attacking DNA. … After entering the cells, chlorambucil and cisplatin will be released from the prodrug formula with the help of reducing agents, such as ascorbic acid and glutathione. …

[Patient-reported outcome and its application in hematological neoplasm].

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… Health-related quality of life and patient-reported outcomes of ofatumumab plus chlorambucil versus chlorambucil monotherapy in the COMPLEMENT 1 trial of patients with previously untreated CLL[J] Acta Oncol. 2016;55(9-10):1115–1120. doi: 10.1080/0284186X.2016.1205217. 16. 于 露, 汪 海波, 江 倩. …

Hematology

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… Chemotherapy (cyclophosphamide, chlorambucil). Biological agents (rituximab, INFα). … leukemias in adulthood, mean age 65 mortality —1.5% of all cancers Risk Factors for AML family history —family history (3×), Down’s, Klinefelter, Fanconi syndrome, Bloom’s, ataxia telangiectasia, neurofibromatosis environmental —previous chemotherapy (alkylating agents [melphalan, cyclophosphamide, chlorambucil …

The Precision Revolution in Hematologic Malignancies: A Decade of Transformative Immunotherapies and Targeted Agents.

This review describes the dramatic transformation that has occurred in the last ten years in the therapeutic landscape for hematologic malignancies, such as leukemias, lymphomas, myelomas, and myelodysplastic syndromes. Treatment paradigms have quickly changed from depending solely on cytotoxic chemotherapy to embracing precision medicine, driven by a previously unprecedented understanding of disease biology and precise molecular changes. The development of powerful immunotherapies (such as CAR T-cell therapy and bispecific antibodies) and innovative targeted agents (like BTK inhibitors, BCL-2

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… The CLL14 study demonstrated that venetoclax plus obinutuzumab achieved superior progression-free survival compared to chlorambucil plus obinutuzumab in previously untreated CLL patients, with the additional benefit of fixed-duration therapy [ 45 ]. … Venetoclax plus Obinutuzumab versus Chlorambucil plus Obinutuzumab for Previously Untreated Chronic Lymphocytic Leukaemia (CLL14): Follow-up Results from a Multicentre, Open-Label, Randomised, Phase 3 Trial. Lancet Oncol. 2020;21:1188–1200. doi: 10.1016/S1470-2045(20)30443-5. 46. …

Myelomatous pleural effusion in a cat diagnosed with multiple myeloma.

CASE SUMMARY: A 10-year-old male castrated domestic shorthair cat was presented with a 3-day history of dyspnoea, chronic lethargy and inappetence. A bilateral pleural effusion was identified by thoracic ultrasound, and cytological examination revealed numerous atypical plasma cells. Biochemistry and serum protein electrophoresis revealed a severe hyperglobulinaemia associated with a monoclonal gammopathy. A moderate non-regenerative anaemia was also noted. Multiple bone lytic lesions were detected, and marked plasmacytosis was observed on bone marrow aspirates. Chemotherapy with cyclophospham

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… The expected response rate to chemotherapy in cats diagnosed with MM ranges between 50% and 83%, and most recent studies report median survival times ranging from 8 to 13 months with chemotherapy. 4 – 6 For our case, a rescue protocol with chlorambucil or COP was discussed with the owners, but they declined …

Shift in Epidemiology of Cryptococcal Infections in Ottawa with High Mortality in Non-HIV Immunocompromised Patients.

Cryptococcus neoformans is a fungus that can cause life-threatening infections. While human immunodeficiency virus (HIV)-positive status historically had the highest risk for cryptococcal infection and was associated with high mortality rates, there have been changes in HIV treatment and the epidemiology of other acquired immunodeficiencies, such as hematological malignancies. We conducted a retrospective case series analysis of patients who had cryptococcal infections documented at the Ottawa Hospital from 2005 to 2017. The Ottawa Hospital is a tertiary care hospital and provides complex care

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… years later from cancer | 33 months 43 | M | Acute myeloid leukemia | Cytarabine and idarubicin (1 cycle) | Sputum | Amphotericin B, and fluconazole | Resolved | 33 months 84 | M | Chronic lymphocytic leukemia | No documentation | Blood | None | Death | 7 days 72 | M | Chronic lymphocytic leukemia | Chlorambucil …

Targeting BTK in B Cell Malignancies: From Mode of Action to Resistance Mechanisms.

The B cell receptor (BCR) signaling pathway plays a crucial role in B cell development and contributes to the pathogenesis of B cell neoplasms. In B cell malignancies, the BCR is constitutively active through both ligand-dependent and ligand-independent mechanisms, resulting in continuous Bruton tyrosine kinase (BTK) signaling activation, which provides a survival and proliferation advantage to the neoplastic clone. Among B cell malignancies, those in which the most significant results were obtained by treatment with BTK inhibitors (BTKi) include chronic lymphocytic leukemia, mantle cell lymph

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… Additionally, as a frontline therapy, ibrutinib outperformed chlorambucil in terms of PFS and OS in the RESONATE-2 trial [ 61 ]. … Efficacy and safety in a 4-year follow-up of the ELEVATE-TN study comparing acalabrutinib with or without obinutuzumab versus obinutuzumab plus chlorambucil in treatment-naïve chronic lymphocytic leukemia Leukemia 2022 36 1171 1175 10.1038/s41375-021-01485-x 34974526 PMC8979808 65. Ghia P. …

Immunosuppression in Glomerular Diseases: Implications for SARS-CoV-2 Vaccines and COVID-19.

BackgroundGlomerular diseases (GD) are chronic conditions that often involve immune dysfunction and require immunosuppressive therapy (IST) to control underlying pathogenesis. Unfortunately, such diseases appear to heighten risks of severe outcomes in COVID-19 and predispose to other infections that may be life-threatening. Thus, averting preventable infections is imperative in GD patients.SummaryThe advent of vaccines demonstrated to be safe and efficacious against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has favorably impacted the COVID-19 pandemic epidemiology. However,

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… Two commonly used alkylating agents in GD are cyclophosphamide (CYP) and chlorambucil. … Beyond typically significant myelopenia and lymphopenia, alkylating agents including CYP and chlorambucil attenuate Dc recognition, processing, and presentation of antigens to Tc and Bc [ 46 ]. …