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A single-center, prospective, non-randomized clinical study was performed to examine the safety and feasibility of early discharge in patients undergoing consolidation chemotherapy for acute leukemia, or autologous stem cell transplant for lymphoma or multiple myeloma. Patients were discharged into ambulatory care the day after the last chemotherapy administration and were subsequently seen at the ambulatory care unit three times a week. One hundred and one of 224 patients were ineligible for the program, mostly because of their medical situation, the lack of a caregiver or the travel time to the hospital. The remaining 123 patients were able to spend more than 70% of the time at home. In 44% of cycles they were never readmitted. This study demonstrates the safety, feasibility and benefits of managing carefully selected patients. Patients and their caregivers felt safe and comfortable at home, and the vast majority preferred home care to in-hospital treatment. [ABSTRACT FROM AUTHOR]

Abstract: Therapeutic monoclonal antibodies (MoAbs) have been the major breakthrough in the treatment of both indolent and aggressive B-cell non-Hodgkin’s lymphoma (NHL), and have become standard of care for these diseases. However, patients may not respond to antibody therapy, or resistance can develop. Radioimmunotherapy (RIT) makes use of continuous low dose radiation emitted by radioisotopes targeted directly to the lymphoma cells. Both the 131I-labeled murine CD20 MoAb tositumomab (Bexxar®) and 90Y-labeled ibritumomab-tiuxetan (Zevalin®) have been shown to be more effective than unlabeled MoAbs in terms of overall and complete response rates in follicular lymphoma (FL) patients, and both agents have a high response rate even in rituximab-resistant patients. Long-term responses, especially in complete responders, have been described in up to one third of the patients. In FL patients consolidation with 90Y-labeled ibritumomab-tiuxetan after first line treatment with chemotherapy has been shown to result in a high rate of conversion of partial to complete remissions, leading to a significant improvement in progression-free survival. Current (mostly phase II) clinical trials are investigating the role of RIT in induction or consolidation therapy after immunochemotherapy, and are incorporating RIT in high dose chemotherapy regimens followed by autologous stem cell rescue. However, phase III data are important to define the place of RIT in the treatment algorithm of patients with FL. [Copyright &y& Elsevier]

To identify which patient groups can be safely discharged early after high dose chemotherapy. Until recently, the standard of care for patients with haematological malignancies who have been treated with high dose chemotherapy has been to hospitalise them until neutrophil recovery and clinical improvement. Over the past years, a more liberal approach has resulted in a tendency to discharge patients earlier. However, currently it is unclear which clinical variables are important and which patient groups are most suitable to be discharged early. Prospective cohort study. The study group of 55 patients underwent 82 admission periods for a total of 2269 patient days, which could be classified into four categories: induction treatment, consolidation treatment and autologous or allogeneic stem cell transplantation. Different clinical variables potentially interfering with early discharge were subsequently analysed for their association with each treatment group. The median duration of admission was 27 days. The incidence of fever (82·9%) and use of intravenous antibiotics (79·3%) was high in all treatment groups. The only statistically significant differences between groups were found for performance status and mucositis. In the patient group undergoing consolidation chemotherapy for acute myeloid leukaemia, the performance status was better and mucositis was less severe. The decline in performance status and the severity of mucositis were as expected most obvious 10-14 days after the start of chemotherapy. Patients undergoing consolidation chemotherapy appear to be the most suitable candidates for early discharge, especially in the first-week postchemotherapy treatment. Early discharge can also be considered in patients with a good performance status in the autologous stem cell transplantation group, directly after transplantation. An important factor in developing an early discharge programme is a good infrastructure, both at home and in the hospital. [ABSTRACT FROM AUTHOR]

Background: The use of high-dose chemotherapy combined with autologous stem cell transplantation has improved the outcome of hematologic malignancies. Nevertheless, this treatment can cause persistent fatigue and a reduced global quality of life, role and physical function. Physical exercise interventions may be beneficial for physical fitness, fatigue and quality of life. However, the trials conducted so far to test the effects of physical exercise interventions in this group of patients were of poor to moderate methodological quality and economic evaluations are lacking. Hence there is need for a rigorous, appropriately controlled assessment of the effectiveness of exercise programs in these patients. The aims of the present study are (1) to determine the effectiveness of an individualized high intensity strength and interval training program with respect to physiological and psychological health status in patients with multiple myeloma or (non-)Hodgkin's lymphoma who have recently undergone high dose chemotherapy followed by autologous stem cell transplantation; and (2) to evaluate the cost-effectiveness of this program. Methods: A multicenter, prospective, single blind randomized controlled trial will be performed. We aim to recruit 120 patients within an inclusion period of 2 years at 7 hospitals in the Netherlands. The patients will be randomly assigned to one of two groups: (1) intervention plus usual care; or (2) usual care. The intervention consists of an 18-week individualized supervised high-intensity exercise program and counselling. The primary outcomes (cardiorespiratory fitness, muscle strength and fatigue) and secondary outcomes are assessed at baseline, at completion of the intervention and at 12 months follow-up. [ABSTRACT FROM AUTHOR]

The authors discuss a study by G. C. Caponetti and colleagues regarding the significance of a single regulator gene MYC aberration, and rearrangements of BLC2 and BLC6 proteins in diffuse large B-cell lymphoma (DLBCL). Topics include a meta-analysis on the effect the rearrangement of MYC on DLBCL's prognosis, the use of immunochemotherapy, and the gene regulation for cell proliferation and metabolism.