Search

The Gruppo Romano Mielodisplasie (GROM) conducted a retrospective study in 543 patients with myelodysplastic syndromes (MDS) to evaluate the safety and efficacy of erythropoiesis-stimulating agents (ESAs) in "real-life" clinical practice. The 40.000-UI/week erythropoietin (EPO)-alpha and 30.000-UI/week EPO-beta starting dose were defined "standard," and 80,000 UI/week EPO-alpha and 60.000 UI/week EPO-beta were defined "high." Response was defined according to International Working Group (IWG) 2006 criteria. At ESA's start, median age was 74.2 years (interquartile range (IR) 67.8-79.5) and median hemoglobin was 8.9 g/dl (IR 8.2-9.6). Median time from diagnosis to ESAs start was 3.8 months (IR 0.8-13.2). ESA starting dose was "standard" in 361 patients (66.5 %) and "high" in 182 patients (33.5 %). Erythroid response was observed in 82/185 (44.3 %) transfusion dependent (TD) patients as compared with 226/329 (68.6 %) transfusion independent (TI) ones (p

We report on epidemiology, features, outcome, and domiciliary management of pain in patients with advanced hematological malignancies followed by an experienced hospital-based home care (HC) team. Out of 469 patients, 244 (52%) experienced a total of 284 pain syndromes. Pain intensity was rated from mild to moderate in 31% and from moderate to severe in 69% of them. The diagnosed pain mechanisms were deep somatic in 56%, superficial somatic in 15%, visceral 14%, mixed 8%, and neuropathic in 7% of pain syndromes, respectively. Incident pain was observed in 38% of all pain syndromes. In every diagnostic group, deep somatic pain was prevalent. Moreover, 85% of visceral pain syndromes were observed in patients affected by non-Hodgkin's lymphoma (NHL). In addition, out of 284 pain syndromes, 150 (51%) were caused by bone involvement. The most frequent recognized pain provocative mechanisms were bone marrow expansions, osteolysis, lymph node enlargement, and mucositis. In our experience, an approach based on the association of causal therapies and analgesics allows optimal control of most pain syndromes. Therefore, pain is a major problem in patients affected by advanced hematological malignancies, and its management can be effective and feasible when carried out by a skilled HC team.

not required pe er -0 05 94 49 3, v er si on 1 20 M ay 2 01 1 Author manuscript, published in "Annals of Hematology 90, 6 (2010) 719-720" DOI : 10.1007/s00277-010-1064-4

Dear Editor, High-dose (HD) chemotherapy with autologous stem cell transplantation (SCT) has demonstrated to improve the outcome of relapsed aggressive non-Hodgkin lymphoma (NHL) and represents the current option of choice in suitable patients although it is associated with considerable acute and chronic toxicities [1]. In patients with renal failure, the treatment approach to aggressive NHL has not been stated. Moreover, conditioning regimens prior autologous SCT generally include HD of agents, which are contraindicated in the presence of severe renal impairment. Therefore, the application of myeloablative treatments to this category of frail patients remains a challenging concern. The case of a patient submitted to autologous SCT following conditioning with adjusted doses of fludarabine and melphalan (Flu/Mel) is here reported together with the description of the dialysis regimen adopted during the transplantation procedure. A 69-year-old male presented a second relapse of [AU1]mantle cell lymphoma after a 3-year maintained complete remission (CR). He received the rituximab, dexametazone, cisplatin and high doses of cytarabine (R-DHAP) regimen as salvage treatment. Unfortunately, during the first course of HD chemotherapy, he developed severe and unrecoverable renal impairment due to cisplatin toxicity for which he required dialysis on regular basis. The treatment resulted in a CR, as demonstrated by a body computed tomography scan and by bone marrow trephine biopsies. However, given the high risk of relapse, autologous SCT as consolidation was offered. The patient was properly informed and gave his consent. Therefore, 2 months after the completion of HD chemotherapy, stem cells were then regularly mobilized and collected after adjusted doses of intravenous (IV) cyclophosphamide (3 g/m 2 , day +1), followed by daily filgrastim (5 μ gk g �1 day �1 from day +5). After the stem cell collection, the patient was soon transplanted. Flu/Mel regimen was administered as conditioning at adjusted doses according to the dialysis-dependent renal failure and the patient’ sl ow performance status (Karnofsky score of 60%). Therefore, he received IV fludarabine at the dose of 6 mg m �2 day �1 × 4 days followed by IV melphalan 100 mg/m 2 the fifth day of