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Hyperammonemia Secondary to 5-Fluorouracil. 5-氟尿嘧啶继发高氨血症。
Pub Date : 2023-07-01 DOI: 10.6004/jadpro.2023.14.5.6
Ashley Scott, Sreenivas V Rao, Mary Lou Affronti

5-fluorouracil (5-FU) is one of the most common adjuvant antineoplastic agents used in the treatment of localized and metastatic colon cancer. Frequent side effects of 5-FU include myelosuppression, mucositis, nausea, vomiting, and diarrhea. However, hyperammonemic encephalopathy is a rare neurologic toxicity that can occur after 5-FU chemotherapy administration. Patients with 5-FU-induced hyperammonemic encephalopathy often exhibit symptoms of altered mental status with no radiologic abnormalities or laboratory abnormalities except for significantly elevated ammonia levels with occasional lactic acidosis and respiratory alkalosis. We report a case of a patient with stage IV colon adenocarcinoma who experienced altered state of consciousness due to hyperammonemia during the administration of palliative chemotherapy with 5-FU, bevacizumab, and leucovorin. On cycle 1 day 2 of chemotherapy, the patient became drowsy and confused at home, prompting a visit to the emergency department and ultimately hospital admission. Laboratory tests revealed an elevated blood ammonia level (838 μg/dL). After an extensive negative workup, his altered state of consciousness was thought to be secondary to 5-FU-induced hyperammonemia. Upon admission, 5-FU was immediately discontinued and the patient was treated with lactulose enemas, intravenous fluids, rifaximin, and continuous renal replacement therapy with gradual recovery to baseline mental status. It is crucial for advanced practitioners to be aware of this rare side effect to ensure prompt diagnosis and maximize treatment effectiveness.

5-氟尿嘧啶(5-FU)是最常用的辅助抗肿瘤药物之一,用于治疗局部和转移性结肠癌。5-FU的常见副作用包括骨髓抑制、粘膜炎、恶心、呕吐和腹泻。然而,高氨血症脑病是一种罕见的神经系统毒性,可发生在5-FU化疗后。5- fu诱导的高氨血症脑病患者通常表现出精神状态改变的症状,除了氨水平明显升高并偶有乳酸酸中毒和呼吸性碱中毒外,无放射学异常或实验室异常。我们报告一例IV期结肠腺癌患者,在使用5-FU、贝伐单抗和亚叶酸素姑息性化疗期间,由于高氨血症而经历意识状态改变。在化疗的第1周期第2天,患者在家中变得昏昏欲睡和困惑,促使前往急诊科并最终住院。实验室检查显示血氨水平升高(838 μg/dL)。在广泛的阴性检查后,他的意识状态改变被认为是继发于5- fu诱导的高氨血症。入院后立即停用5-FU,患者接受乳果糖灌肠、静脉输液、利福昔明和持续肾脏替代治疗,逐渐恢复至基线精神状态。对于高级从业人员来说,了解这种罕见的副作用是至关重要的,以确保及时诊断和最大限度地提高治疗效果。
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引用次数: 0
Polycythemia Vera: Thinking Beyond the Hematocrit. 维拉红细胞增多症:超越红细胞压积的思考。
Pub Date : 2023-07-01 DOI: 10.6004/jadpro.2023.14.5.5
Matthew Waggoner

Polycythemia vera is a Philadelphia chromosome-negative myeloproliferative neoplasm that results in increased myeloproliferation. It is a debilitating disease characterized by the overproduction of red blood cells, but it also can result in increased white blood cells and platelets. Patients experience a shortened overall survival due to an increased risk of thrombotic events, including stroke, myocardial infarction, pulmonary embolism, and deep vein thrombosis. Current treatment strategies in clinical practice are driven by mitigating the risk of these thrombotic events by reducing patients' hematocrit. In addition to thrombosis risk, polycythemia vera patients have constitutional symptoms such as fatigue, itching, bone pain, erythromelalgia, and splenomegaly. An increased risk of transformation of their disease to acute myeloid leukemia and/or myelofibrosis can also affect long-term survival in polycythemia vera. Additional research has identified other risk factors, such as increased white blood cells, increased platelet count, and cytokine levels, which can alter the prognosis of the disease. In this review, we will discuss the current treatment strategies in polycythemia vera and determine if incorporating additional biomarkers as endpoints is feasible in clinical practice.

真性红细胞增多症是一种费城染色体阴性的骨髓增生性肿瘤,可导致骨髓增生增加。这是一种以红细胞过度产生为特征的衰弱性疾病,但也会导致白细胞和血小板增加。由于血栓事件(包括中风、心肌梗死、肺栓塞和深静脉血栓形成)的风险增加,患者的总生存期缩短。目前临床实践中的治疗策略是通过降低患者的红细胞压积来降低这些血栓事件的风险。除了血栓形成风险外,真性红细胞增多症患者还有疲劳、瘙痒、骨痛、红细胞痛和脾肿大等体质症状。他们的疾病转变为急性髓细胞白血病和/或骨髓纤维化的风险增加也会影响真性红细胞增多症的长期生存。其他研究已经确定了其他风险因素,如白细胞增加、血小板计数增加和细胞因子水平,这些因素会改变疾病的预后。在这篇综述中,我们将讨论目前真性红细胞增多症的治疗策略,并确定将额外的生物标志物作为终点在临床实践中是否可行。
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引用次数: 1
Silent Conversations: Goals of Care and End-of-Life Quality in Relapsed High-Risk Leukemia. 沉默的对话:复发的高危白血病的护理目标和临终质量。
Pub Date : 2023-07-01 DOI: 10.6004/jadpro.2023.14.5.3
Lacy Jo Graham, Amy Hite, Jennifer Harris, Greg Belcher

Background: Advanced practice providers (APPs) affect high-quality health care through leadership, evidence-based practice implementation, and quality improvement projects. When planning solutions to clinical problems, leadership must solicit APP input to promote success. Hematology patients are more likely to receive poor-quality end-of-life (EOL) care than those with solid tumors. Regardless of disease, aggressive EOL care is increasing despite evidence that it is often inconsistent with patients' goals of care (GOC). Data regarding this phenomenon in hematology specifically is lacking. The distorted association of "end of life" with "goals of care" has "silenced" crucial goals discussions in patients with relapsed or refractory high-risk leukemia, which raises concerns for the provision of care that is inconsistent with patients' values and preferences. Hematologists may possess certain traits and distinct barriers leading to what one might call an aversion to GOC discussions in the inpatient setting.

Aims: (1) Quantify hematologists' rate of participation in a GOC pathway initiative during two separate months. (2) Explore the hematologists' definition of and barriers to having GOC discussions.

Design: This is a mixed-methods, explanatory sequential design (follow-up explanations variant).

Sample: Quantitative: Hematology inpatient admissions during two nonconsecutive months in 2021. Qualitative: Eighteen leukemia hematologists from one dedicated cancer center.

Results: During the 2 months, an average of 36% of admissions met the criteria for GOC pathway initiation, 19% of those had an appropriate initiation order, and < 1% had a properly documented and billed GOC discussion. Nine hematologists responded to a SurveyMonkey poll with two questions. All nine included clinical situation and communication in their definition of GOC discussions. Time limitations and prognostic uncertainty were the two most reported barriers.

Discussion: The findings demonstrate that the apprehension of hematologists to have GOC conversations is similarly seen in the APPs' reluctance to initiate a pathway intended to lead to GOC conversations. The percentage of eligible inpatient admissions meeting the specified criteria was similar between the 2 months; however, the number of appropriate referrals and documented or billed GOC discussions was higher in the earlier month, demonstrating temporal decline. Further research inquiry is needed to explore causation of this phenomenon.

背景:高级实践提供者(APPs)通过领导、循证实践实施和质量改进项目影响高质量的医疗保健。在规划临床问题的解决方案时,领导层必须征求APP的意见,以促进成功。血液病患者比实体瘤患者更容易接受低质量的临终关怀(EOL)。无论疾病如何,积极的EOL护理正在增加,尽管有证据表明它通常与患者的护理目标(GOC)不一致。关于血液学中这种现象的具体数据缺乏。“生命终结”与“护理目标”的扭曲关联,使复发或难治性高风险白血病患者的关键目标讨论“沉默”,这引起了人们对提供与患者价值观和偏好不一致的护理的担忧。血液学家可能具有某些特征和明显的障碍,导致人们可能会称之为对住院患者环境中GOC讨论的厌恶。目的:(1)量化血液学家在两个月内参与GOC途径倡议的比率。(2)探讨血液学家对GOC的定义和进行GOC讨论的障碍。设计:这是一个混合方法,解释性序列设计(后续解释变体)。样本:定量:2021年非连续两个月的血液科住院患者。定性:18名白血病血液学家来自一个专门的癌症中心。结果:在2个月期间,平均36%的入院患者符合GOC途径启动的标准,19%的患者有适当的启动顺序,不到1%的患者有适当的GOC记录和账单讨论。九位血液学家在SurveyMonkey的民意调查中回答了两个问题。所有9名患者在讨论GOC定义时都包括了临床情况和沟通。时间限制和预后不确定性是报道最多的两个障碍。讨论:研究结果表明,血液学家对GOC对话的担忧类似于app不愿启动旨在导致GOC对话的途径。两个月内符合指定标准的合格住院患者的百分比相似;然而,适当的转诊和记录或收费的GOC讨论的数量在前一个月较高,显示出时间上的下降。这一现象的成因还需要进一步的研究探究。
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引用次数: 0
Anti-Spike Antibody Responses in Allogeneic Stem Cell Transplant Recipients to Two Doses of COVID-19 mRNA Vaccination: A Retrospective, Single-Center Analysis. 同种异体干细胞移植受者对两剂COVID-19 mRNA疫苗接种的抗刺突抗体反应:回顾性单中心分析
Pub Date : 2023-07-01 DOI: 10.6004/jadpro.2023.14.5.2
Jaime L Shahan, Robert H Collins, Prapti Patel, Yazan F Madanat, Madhuri Vusirikala

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients were excluded from the initial SARS-CoV-2 mRNA vaccination efficacy trials. Suboptimal vaccine responses have been reported in immunocompromised cohorts such as patients with solid tumors or hematologic malignancies, suggesting the need for additional research. Widespread data on the antibody responses and vaccine efficacy in allo-HSCT recipients is limited. In our single-center, retrospective study, we analyzed the anti-spike IgG antibody responses in 75 allo-HSCT recipients who received a series of two doses of mRNA vaccination. We collected data on previous COVID-19 infection, B and T lymphocyte recovery, donor types, graft-vs.-host disease (GVHD), and immunosuppressive medications at the time of vaccination. With the original variant, a cutoff of 4,160 arbitrary units (AU)/mL has been correlated with a 0.95 probability of a viral neutralization. We also examined the number of allo-HSCT recipients who achieved this conservative threshold. To our knowledge, no correlate exists for the currently prevalent Omicron variant and viral neutralization. Despite 29.3% (22/75) of patients being on systemic immunosuppressive medications due to chronic GVHD, positive antibody responses > 50 AU/mL were seen in 96% of patients. However, only 48% (36/75) of patients were above the neutralizing antibody threshold. Those with previous COVID-19 infection had significantly higher antibody responses. Although encouraging, the variability of the responses underscores the concept of ongoing antibody monitoring as well as consideration of additional doses of the COVID-19 vaccine in this cohort.

同种异体造血干细胞移植(alloo - hsct)接受者被排除在最初的SARS-CoV-2 mRNA疫苗接种效果试验之外。据报道,在免疫功能低下的人群中,如实体瘤或血液恶性肿瘤患者,疫苗反应不佳,这表明需要进一步的研究。关于同种异体造血干细胞受体的抗体反应和疫苗效力的广泛数据是有限的。在我们的单中心回顾性研究中,我们分析了75名接受了两剂mRNA疫苗接种的同种异体造血干细胞受体的抗刺突IgG抗体反应。我们收集了既往COVID-19感染、B淋巴细胞和T淋巴细胞恢复、供体类型、移植物vs。-宿主病(GVHD)和免疫抑制药物在疫苗接种时。对于原始变异,4,160任意单位(AU)/mL的截止值与0.95的病毒中和概率相关。我们还检查了达到这个保守阈值的同种异体造血干细胞移植受者的数量。据我们所知,目前流行的欧米克隆变异和病毒中和没有相关性。尽管29.3%(22/75)的慢性GVHD患者正在接受全身免疫抑制药物治疗,但96%的患者抗体阳性反应> 50 AU/mL。然而,只有48%(36/75)的患者高于中和抗体阈值。之前感染过COVID-19的人的抗体反应明显更高。尽管令人鼓舞,但反应的可变性强调了持续抗体监测的概念,并考虑在该队列中增加COVID-19疫苗剂量。
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引用次数: 0
Management of Patients With Advanced Gastrointestinal Stromal Tumor: Emphasis on Fourth-Line Treatment With Ripretinib. 晚期胃肠道间质瘤患者的治疗:重点是利普雷替尼的一线治疗。
Pub Date : 2023-05-01 DOI: 10.6004/jadpro.2023.14.4.6
Sandra Brackert, Kathleen Polson

Gastrointestinal stromal tumors (GISTs) are considered rare, yet they represent the most common sarcomas of the gastrointestinal tract. The development of tyrosine kinase inhibitors (TKI) for the treatment of GISTs changed the way we treat patients and has greatly impacted outcomes. However, most patients who initially benefit from TKIs eventually develop disease progression and require subsequent therapies. Ripretinib is a switch-control TKI approved for the treatment of adult patients with advanced GIST who received prior treatment with three or more TKIs, including imatinib. Our objective was to review existing treatment options for patients with advanced GIST, focusing on management optimization for heavily pretreated patients receiving ripretinib. With the integration of ripretinib as a fourth-line therapy, the GIST treatment landscape continues to evolve. As the treatment paradigm becomes increasingly complex, successful management of adverse events and individualized supportive care remain crucial to maintaining effective treatment and patient quality of life. Additionally, we present a detailed case study of a heavily pretreated patient with advanced GIST who received ripretinib as fourth-line therapy. The information provided here should help inform advanced practitioners on the effective management of patients with GIST who have progressed on multiple therapies. Advanced practitioners are well positioned to provide the necessary supportive care to achieve optimal outcomes and drug compliance.

胃肠道间质瘤(gist)被认为是罕见的,但它们代表了最常见的胃肠道肉瘤。用于治疗gist的酪氨酸激酶抑制剂(TKI)的发展改变了我们治疗患者的方式,并极大地影响了结果。然而,大多数最初受益于tki的患者最终会发展为疾病进展并需要后续治疗。利普雷替尼是一种开关控制TKI,被批准用于治疗先前接受过三种或更多TKI治疗的成年晚期GIST患者,包括伊马替尼。我们的目的是回顾晚期GIST患者的现有治疗方案,重点关注接受利普雷替尼的重度预处理患者的管理优化。随着利普雷替尼作为第四线治疗的整合,GIST的治疗前景继续发展。随着治疗模式变得越来越复杂,不良事件的成功管理和个性化的支持护理仍然是维持有效治疗和患者生活质量的关键。此外,我们提出了一个详细的病例研究,重度预处理的晚期GIST患者接受了利普雷替尼作为第四线治疗。这里提供的信息应该有助于告知高级从业人员对经多种治疗进展的GIST患者的有效管理。高级从业人员能够很好地提供必要的支持性护理,以实现最佳结果和药物依从性。
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引用次数: 0
Heart Failure in a Patient With Metastatic Well-Differentiated Neuroendocrine Tumor. 转移性高分化神经内分泌肿瘤患者的心力衰竭。
Pub Date : 2023-05-01 DOI: 10.6004/jadpro.2023.14.4.8
Amy Henderson, Salwan Al Mutar

Patients with neuroendocrine malignancy with liver metastases are at risk for carcinoid heart disease which, if left unchecked, can lead to heart failure. This case study demonstrates a clinical situation in which an advanced practitioner performed a thorough workup consisting of lab work and imaging studies, including echocardiogram, cardiac MRI, and dotatate PET/CT, as well as outside record review and comprehensive physical exam. Early detection, intervention, and control of disease are paramount to prevent potentially life-limiting carcinoid heart disease.

神经内分泌恶性肿瘤伴肝转移的患者有患类癌性心脏病的危险,如果不加以控制,可导致心力衰竭。本案例研究展示了一个临床情况,其中一位高级医生进行了全面的检查,包括实验室工作和影像学检查,包括超声心动图、心脏MRI和原位PET/CT,以及外部记录审查和全面的体检。早期发现、干预和控制疾病对于预防可能限制生命的类癌性心脏病至关重要。
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引用次数: 0
Rethinking Medical Aid in Dying: What Does It Mean to 'Do No Harm?' 反思临终医疗救助:无伤害 "意味着什么?
Pub Date : 2023-05-01 DOI: 10.6004/jadpro.2023.14.4.5
Dallas R Lawry

Medical aid in dying is the act of prescribing lethal medications to a consenting patient who can self-ingest them with the intent of hastening their death. A majority of patients who utilize medical aid in dying are patients with terminal cancer. As oncology patients continue to choose deaths most suitable to them, it is critical that advanced practitioners in oncology be knowledgeable regarding this end-of-life decision. With 40 states denying patients access to medical aid in dying, the purpose of this end-of-life care review is not to persuade for or against medical aid in dying, active euthanasia, or other forms of dying with dignity, but rather to shed light on patient decisions and available end-of-life options for patients where medical aid in dying is not honored. One author has succinctly named this era as "Dying in the Age of Choice," and therefore the purpose of this article is to present the current state of medical aid in dying. The article presents case studies for the reader, as well as a comparison of California's statistics with the national average. Much like other controversial subjects that intersect morality, religion, and Hippocratic medical ethics, practitioners in the healing arts must remain unbiased and honor the wishes of patients even when they differ from their own. In serving the population with the highest utilization of medical aid in dying, advanced practitioners in oncology should be familiar with the legal specifications in their state or be abreast of solutions for guiding patients through end of life in the states where medical aid in dying remains illegal.

临终医疗救助是指在病人同意的情况下,为其开具致命药物,让其自行服用,以加速其死亡。大多数使用临终医疗救助的患者都是晚期癌症患者。随着肿瘤患者继续选择最适合自己的死亡方式,肿瘤科的高级执业医师必须了解这种临终决定。美国有 40 个州拒绝为患者提供临终医疗救助,因此本篇临终关怀综述的目的并不是劝说患者支持或反对临终医疗救助、积极安乐死或其他形式的有尊严的死亡,而是要阐明在临终医疗救助不被接受的情况下,患者的决定和可用的临终选择。一位作者简明扼要地将这个时代命名为 "选择时代的死亡",因此本文的目的是介绍临终医疗救助的现状。文章为读者提供了案例研究,并将加利福尼亚州的统计数据与全国平均水平进行了比较。与其他交织着道德、宗教和希波克拉底医学伦理的争议性话题一样,从事治疗艺术的从业者必须保持公正,尊重病人的意愿,即使这些意愿与他们自己的意愿不同。在为使用临终医疗救助最多的人群提供服务时,肿瘤学高级执业医师应熟悉所在州的法律规范,或了解在临终医疗救助仍属非法的州指导病人完成生命终结的解决方案。
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引用次数: 0
Value Assessment of Oncology Pharmacist Interventions. 肿瘤药师干预的价值评估
Pub Date : 2023-05-01 DOI: 10.6004/jadpro.2023.14.4.7
Mallika P Patel, Sally Y Barbour, Meredith T Moorman

A review of the published literature confirms the challenge in quantifying the value of oncology pharmacists. This editorial expands on a 2020 study by Meleis and colleagues published in the Journal of the Advanced Practitioner in Oncology and seeks to correlate pharmacist interventions to cost-saving and cost-avoidance measures to show the value of ambulatory oncology clinical pharmacists in patient care. A total of 4,686 interventions were reviewed. The 6-month intervention data demonstrate an annualized value of approximately $1.1 million dollars from nine ambulatory oncology clinical pharmacists showcasing the essential role of the clinical pharmacist in ambulatory oncology settings.

对已发表文献的回顾证实了量化肿瘤药剂师价值的挑战。这篇社论扩展了Meleis及其同事在《肿瘤学高级从业者杂志》上发表的2020年研究,并试图将药剂师干预与节省成本和避免成本的措施联系起来,以显示门诊肿瘤学临床药剂师在患者护理中的价值。总共审查了4,686项干预措施。6个月的干预数据显示,来自9名门诊肿瘤临床药剂师的年化价值约为110万美元,显示了临床药剂师在门诊肿瘤环境中的重要作用。
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引用次数: 0
Research Strategy for the Development of a Quality-of-Life Decision-Making Model for Older Patients With Acute Myeloid Leukemia. 为老年急性髓性白血病患者开发生活质量决策模型的研究策略。
Pub Date : 2023-05-01 DOI: 10.6004/jadpro.2023.14.4.2
Sara M Tinsley-Vance

Acute myeloid leukemia (AML) is a deadly cancer, especially for patients over 60 years of age who face the dilemma of choosing the best treatment during a time of crisis. Current research in the older AML population is focused on survival without addressing quality of life (QOL). Survival and QOL data are essential for patients to decide which treatment best aligns with their goals, whether for survival or improved QOL. Research aims: The aims of this study are to: (1) Describe differences in QOL among newly diagnosed older AML patients receiving intensive chemotherapy compared with nonintensive chemotherapy (at baseline, and days 30, 60, 90, and 180 post treatment); (2) Identify the individual clinical disease characteristics and patient factors of newly diagnosed AML patients that predict QOL among those receiving two treatment intensities; and (3) Design a patient decision-making model that integrates the significant clinical disease and patient factor predictors of QOL for newly diagnosed older AML patients. Methods: An exploratory observational design will be used to address aims 1 and 2. Data will be collected from 200 patients ≥ 60 years of age with newly diagnosed AML. Subjects will complete the Functional Assessment of Cancer Therapy-Leukemia, Brief Fatigue Inventory, and Memorial Symptom Assessment Short Form within 7 days of beginning new treatment and at days 30, 60, 90 and 180. Clinical disease characteristics will be completed by the health-care team. A patient decision-making model will be developed to provide survival and quality-of-life data for intensive and nonintensive chemotherapy.

急性髓性白血病(AML)是一种致命的癌症,尤其是对于 60 岁以上的患者来说,他们面临着在危机时刻选择最佳治疗方法的难题。目前针对老年急性髓细胞白血病患者的研究主要集中在生存率方面,而没有涉及生活质量(QOL)。生存期和生活质量数据对于患者决定哪种治疗方法最符合他们的目标(无论是生存期还是改善生活质量)至关重要。研究目的:本研究旨在(1)描述接受强化化疗与非强化化疗的新诊断老年 AML 患者在 QOL 方面的差异(基线以及治疗后第 30、60、90 和 180 天);(2)确定新诊断 AML 患者的个体临床疾病特征和患者因素,这些特征和因素可预测接受两种治疗强度的患者的 QOL;以及(3)设计一个患者决策模型,该模型整合了新诊断老年 AML 患者 QOL 的重要临床疾病和患者因素预测因素。研究方法:将采用探索性观察设计来实现目标 1 和 2。将收集 200 名年龄≥ 60 岁的新确诊急性髓细胞白血病患者的数据。受试者将在开始新治疗的 7 天内以及第 30、60、90 和 180 天时完成癌症治疗功能评估-白血病、简易疲劳量表和纪念症状评估简表。临床疾病特征将由医疗团队完成。将开发一个患者决策模型,提供强化和非强化化疗的生存期和生活质量数据。
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引用次数: 0
Management of Ocular Toxicity in Patients Receiving Belantamab Mafodotin. 贝兰他单-马弗多汀治疗患者眼毒性的处理。
Pub Date : 2023-05-01 DOI: 10.6004/jadpro.2023.14.4.4
Rebecca Lu, Ashley Morphey, Felicia Diaz, Jessica Chen, Azadeh Razmandi, Tiffany Richards
While significant strides have been made in the treatment of multiple myeloma, treatment options remain limited and definite, and most patients ultimately succumb to their disease. The urgency for more treatment modalities remains, as patients who are refractory to proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies have a median survival of only 5.8 to 13 months. Belantamab mafodotin, a first-in-class antibody-drug conjugate, was approved by the US Food and Drug Administration in 2020 for patients with relapsed or refractory myeloma who have received at least four prior therapies, including an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent. It produced an overall response rate of 31%, and the median progression-free survival was 2.9 months when administered as a single agent. While generally well tolerated, ocular toxicities were a notable adverse event reported. In this article, we discuss the response data, toxicity profile including ocular toxicities, and treatment management.
虽然多发性骨髓瘤的治疗取得了重大进展,但治疗方案仍然有限且明确,大多数患者最终死于疾病。由于对蛋白酶体抑制剂、免疫调节剂和抗cd38单克隆抗体难治的患者的中位生存期仅为5.8至13个月,因此迫切需要更多的治疗方式。Belantamab mafodotin是一种同类第一抗体-药物偶联物,于2020年被美国食品和药物管理局批准用于复发或难治性骨髓瘤患者,这些患者之前接受过至少四种治疗,包括抗cd38单克隆抗体、蛋白酶体抑制剂和免疫调节剂。总有效率为31%,单药治疗时的中位无进展生存期为2.9个月。虽然一般耐受性良好,但眼部毒性是一个值得注意的不良事件。在本文中,我们讨论了反应数据,毒性概况,包括眼毒性和治疗管理。
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引用次数: 0
期刊
Journal of the Advanced Practitioner in Oncology
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