Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ability to deliver the planned dose and intensity of chemotherapy (the amount of drug administered/unit of time) is important for tumour control and survival. In clinical practice, neutropenic events are the main limiting factors towards achieving this aim. We assessed the impact of neutropenic events [defined as either hospital admission due to febrile neutropenia (FN), dose delay > or =7 days due to neutropenia or dose reduction of > or =15% due to neutropenia] on dose intensity (DI) in a random sample of 50 patients with various solid tumours. Fifty patients who received systemic chemotherapy for solid tumours were assessed as part of this study. Using a pre-programmed data collection tool via computer, retrospective data were collected. The neutropenic events were defined before data collection. The patient characteristics are as follows: breast 26 patients (stage I-6; II-3; III-17), colorectal 16 patients (stage I-6; II-3; III-7) and others 8 patients [small cell lung cancer (SCLC), ovarian, peritoneal and oesophageal cancers]. The chemotherapy regimens used are Flourouracil, Epirubicin, cyclophosphamide (FEC) 14 patients (28%); 5 Flourouracil/folinic acid (5FU/FA) 12 patients (24%); Adriamycin, cyclophosphamide (AC) 11 patients (22%); other 13 patients (26%). Neutropenic events occurred in a significant proportion of patients (overall 40%; breast 26%; colorectal 56%; others 25% of patients) and in a significant number (21%) of chemotherapy cycles. Overall, dose delay was the most common neutropenic event, occurring in 30% of patients (breast 32%; colorectal 31%; others 25%% of patients). Dose reduction due to neutropenia was noted in 20% of patients (breast 12% colorectal 38% others 13%% of patients). Hospitalizations due to FN affected 8% of patients. Only two patients had granulocyte colony-stimulating factor (GCSF) as treatment for two cycles. Relative dose intensity (RDI) in patients with neutropenic events was 81% compared with 92% in patients without an event and the results were consistent for different cancers. In total, 65% of patients who experienced one neutropenic event were likely to experience subsequent events. In conclusion neutropenic events have a significant impact on the ability to deliver planned DI. Hence, proactive use of GCSF has the potential to improve adherence to the planned schedule of chemotherapy.
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PMID:Impact of neutropenia on delivering planned chemotherapy for solid tumours. 1818 87

Pegylated liposomal doxorubicin (Doxil, Caelyx) is associated with less frequent neutropenia, alopecia and cardiotoxicity than conventional doxorubicin and has an improved pharmacokinetic profile, allowing for intravenous administration over 1 hour. In the US and EU (as well as a number of other countries), pegylated liposomal doxorubicin is approved for use in combination with the proteasome inhibitor bortezomib for the treatment of patients with relapsed or refractory multiple myeloma. Results of the primary efficacy analysis of a large phase III trial in bortezomib-naive patients with relapsed or refractory multiple myeloma demonstrated that the combination of pegylated liposomal doxorubicin plus bortezomib significantly prolonged the time to progression (TTP) compared with bortezomib alone. In addition, pegylated liposomal doxorubicin plus bortezomib significantly increased TTP in most subgroup analyses, including in patients with or without previous anthracycline exposure. A number of secondary outcomes, including progression-free survival and overall survival at 15 months, were also improved with the combination compared with bortezomib alone in the overall study population. Pegylated liposomal doxorubicin plus bortezomib was associated with a higher incidence of grade 3 or 4 adverse events than bortezomib alone, which was mainly attributed to an increase in myelosuppression and gastrointestinal events with the combination. These events were predictable and often managed by dosage modifications and supportive therapy. The addition of pegylated liposomal doxorubicin to bortezomib treatment did not increase the incidence of cardiotoxicity or peripheral neuropathy, but did induce hand-foot syndrome in a proportion of patients. Pegylated liposomal doxorubicin plus bortezomib is now established as an additional standard of care in the treatment of patients with relapsed or refractory multiple myeloma who have received at least one prior therapy.
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PMID:Pegylated liposomal Doxorubicin: a review of its use in the treatment of relapsed or refractory multiple myeloma. 1901 77

A combination of Adriamycin (a.k.a. Doxorubicin), Bleomycin, Vinblastine, and Dacarbazine (ABVD) is the most commonly used chemotherapy regime for Hodgkin lymphoma. This highly effective treatment is associated with a significant risk of neutropenia. Various strategies are adopted to counter this commonly encountered problem, including dose modification, use of colony stimulating factors, and prophylactic or therapeutic use of antibiotics. Data to support these approaches is somewhat controversial, and in keeping with the paucity of definitive evidence, there is a wide disparity in the management of neutropenia in patients receiving ABVD chemotherapy. This paper summarizes the evidence for managing ABVD-related neutropenia during the treatment of Hodgkin lymphoma.
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PMID:Neutropenia and Neutropenic Complications in ABVD Chemotherapy for Hodgkin Lymphoma. 2168 49

The billions of cells that die in the adult human body daily release considerable amounts of fragmented chromatin in the form of mono- and oligonucleosomes into the circulation in normal individuals, and in higher quantities in many disease conditions. Recent results suggest that circulating chromatin fragments (Cfs) especially from abnormal cells can spontaneously enter into healthy cells to damage their DNA and induce genomic instability. Furthermore, Cfs isolated from cancer patients may induce oncogenic transformation in the recipients' cells. Thus, it follows that if such Cfs emanating from apoptotic cells could be prevented from reaching other cells, it could potentially inhibit pathological conditions, including cancer. Here we have developed pullulan based histone antibody nanoconjugates for the removal of Cfs. Nanoconjugates were developed and various physico-chemical characterizations were carried out. The efficacy of these nanoconjugates on removing Cfs was evaluated both in vitro and in vivo. Our results indicate that nanoconjugates may have therapeutic value in the efficient removal of Cfs, reducing inflammation and fatality in a mouse model of sepsis, and in preventing neutropenia following treatment with Adriamycin.
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PMID:Pullulan-histone antibody nanoconjugates for the removal of chromatin fragments from systemic circulation. 2374 56

There is little published information on effective treatment of Kaposi's sarcoma (KS) in children in low-income countries. We prospectively treated 12 patients with an institutional review board-approved protocol consisting of four monthly courses of doxorubicin (Adriamycin), bleomycin and vincristine sulphate (ABV), with highly active antiretroviral therapy (HAART) plus co-trimoxazole prophylaxis for those who were HIV-positive, with additional vincristine if remission was not achieved after 4 months. Maintenance HAART plus co-trimoxazole was given to all HIV-positive patients. A fine-needle aspirate and CD4+ count were done if possible, and staging was performed according to Mitsuyasu. Eight of ten HIV-positive patients with stage III - IVB disease, and both HIV-negative patients with stage I disease, were in remission after 473 - 1 490 (mean 939) days. One patient died after absconding during treatment, and one died from neutropenia-related pulmonary infection. ABV with or without HAART is an effective treatment option for children with KS.
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PMID:Kaposi's sarcoma: Good outcome with doxorubicin, bleomycin and vincristine sulphate (ABV) chemotherapy and highly active antiretroviral therapy. 2926 35

In patients receiving dose-dense chemotherapy, adverse effects such as neutropenia can be reduced by colony-stimulating factors. Pegfilgrastim, a colony-stimulating factor, has associated adverse effects, including bone pain, fever, and, rarely, hyperleukocytosis. We describe a 45-year-old woman with breast cancer receiving dose-dense Adriamycin and cyclophosphamide chemotherapy. She presented with hyperleukocytosis after receiving pegfilgrastim, which resulted in hospitalization. This case report reviews the strategy to minimize the risk of hyperleukocytosis from pegfilgrastim administered in dose-dense chemotherapy.
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PMID:Pegfilgrastim-induced hyperleukocytosis leading to hospitalization of a patient with breast cancer. 3119 Nov 48


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