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Scheinberg P, Finelli C, Montaňo-Figueroa EH, Vallejo C, Norasetthada L, Calado RT, Turgut M, Peffault de Latour R, Kriemler-Krahn U, Haenig J, Clark J, Jang J. Activity and safety of eltrombopag in combination with cyclosporin A as first‑line treatment of adults with severe aplastic anaemia (SOAR): a phase 2, single-arm study. Lancet Haematol 2024; 11:e206-e215. [PMID: 38335978 DOI: 10.1016/s2352-3026(23)00395-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Antithymocyte globulin (ATG)-based immunosuppression is standard in front-line treatment for people with severe aplastic anaemia without a histocompatible donor or who are 40 years or older. However, ATG requires in-hospital administration, is associated with infusion-related toxicities and has limited availability worldwide. In this study, we investigated the activity and safety of an ATG-free regimen of eltrombopag with cyclosporin A as a potential treatment for patients with severe aplastic anaemia who might not have access to or cannot tolerate horse-ATG. METHODS SOAR was a multicentre, single-arm phase 2 trial investigating eltrombopag and cyclosporin in adult (≥18 years) patients with severe aplastic anaemia who were treatment-naive and had an Eastern Cooperative Oncology Group performance status of less than 2. Participants were recruited from 20 hospitals in ten countries. Eltrombopag was initiated at 150 mg (100 mg in patients of Asian ethnicity) and cyclosporin at 10 mg/kg per day (adjusted to a trough of 200-400 μg/L) orally from day 1 to 6 months. The primary outcome was an overall haematological response rate by 6 months in the intention-to-treat population. This is the final report of the primary analysis period. The trial was registered with ClinicalTrials.gov, NCT02998645, and has been completed. FINDINGS 54 patients were enrolled between May 11, 2017, and March 23, 2020. 34 (63%) patients were male and 20 (37%) were female. 22 (41%) were Asian, 22 (41%) were White, one (2%) was Native American or Alaska Native, one (2%) was Black or African American, and eight (15%) were other race or ethnicity. 35 patients (65%) completed 6 months of treatment with eltrombopag and cyclosporin and six (11%) completed the cyclosporin tapering period up to month 24. Overall haematological response rate by month 6 of treatment was 46% (25 of 54; 95% CI 33-60). The most reported adverse events were increased serum bilirubin (in 22 patients [41%]), nausea (16 [30%]), increased alanine aminotransferase concentration (12 [22%]), and diarrhoea (12 [22%]). Eight patients died on-treatment, but no deaths were considered related to the treatment. INTERPRETATION Eltrombopag and cyclosporin was active as front-line treatment of severe aplastic anaemia, with no unexpected safety concerns. This approach might be beneficial where horse-ATG is not available or not tolerated. FUNDING Novartis Pharmaceuticals.
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Affiliation(s)
- Phillip Scheinberg
- Division of Hematology, Hospital A Beneficência Portuguesa, São Paulo, Brazil.
| | - Carlo Finelli
- Department of Oncology and Hematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Institute of Hematology Seràgnoli, Bologna, Italy
| | | | - Carlos Vallejo
- Department of Hematology, Donostia University Hospital, San Sebastián, Spain; Clinic University Hospital, Santiago de Compostela, Spain
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rodrigo T Calado
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Mehmet Turgut
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayıs University, Samsun, Turkey
| | - Régis Peffault de Latour
- French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris Cité, Paris, France
| | | | | | | | - Junho Jang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Cooper N, Ghanima W, Vianelli N, Valcárcel D, Yavaşoğlu İ, Melikyan A, Ruiz EY, Haenig J, Somenzi O, Lee J, Clark J, Zhang Y, Zaja F. Sustained response off-treatment in eltrombopag-treated adult patients with ITP who are refractory or relapsed after first-line steroids: Primary, final, and ad-hoc analyses of the Phase II TAPER trial. Am J Hematol 2024; 99:57-67. [PMID: 38014779 DOI: 10.1002/ajh.27131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023]
Abstract
Immune thrombocytopenia (ITP) is characterized by reduced platelet count due to increased destruction and is categorized according to the time following diagnosis (newly diagnosed, persistent, chronic). First-line corticosteroid therapy is associated with transient response, high relapse rates, and considerable toxicity. TAPER (NCT03524612) is a Phase II, prospective, single-arm trial investigating whether eltrombopag can induce a sustained response off-treatment (SRoT) in adult patients with ITP after first-line corticosteroid failure. This study defines SRoT as an off-treatment period wherein platelet count remains above 30 × 109 /L in the absence of bleeding or rescue therapy. The primary endpoint was the proportion of patients who achieved SRoT until Month 12, which was 30.5% (n = 32/105; p < .0001 testing hypothesis H1: proportion >15%) following eltrombopag tapering and discontinuation, and median SRoT duration was ~8 months until Month 12. Median platelet count increased within 1 month of treatment and remained elevated until Month 12. Quality of life improved within 3 months and was maintained. Headache (21%) was the most common adverse event. None of the 4 deaths reported were considered treatment-related. In summary, ~one-third of patients achieved SRoT until Month 12 following eltrombopag tapering and discontinuation. An ad-hoc early-use analysis, stratified by ITP duration at baseline, assessed initial hematologic responses and safety. Results suggest that eltrombopag has similar efficacy in newly diagnosed and later stages of ITP. In follow-up until Month 24, a median SRoT duration of ~22 months was observed (n = 20). The safety profile was comparable across analyses and ITP duration groups and aligned with its well-established safety profile.
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Affiliation(s)
- Nichola Cooper
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, London, UK
| | - Waleed Ghanima
- Department of Haemato-Oncology, Østfold Hospital Trust, Kalnes, Grålum, Norway
- Department of Haematology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nicola Vianelli
- Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - David Valcárcel
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), University Hospital Vall d'Hebron, Barcelona, Spain
| | - İrfan Yavaşoğlu
- Department of Hematology, Adnan Menderes University, Aydın, Turkey
| | | | - Eduardo Yañez Ruiz
- Hematology-Oncology Unit, Department of Internal Medicine, School of Medicine, Universidad de La Frontera, Temuco, Chile
| | | | | | - James Lee
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Yifan Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Francesco Zaja
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
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Cuker A, Buckley B, Mousseau MC, Barve AA, Haenig J, Bussel JB. Early initiation of second-line therapy in primary immune thrombocytopenia: insights from real-world evidence. Ann Hematol 2023:10.1007/s00277-023-05289-0. [PMID: 37300567 DOI: 10.1007/s00277-023-05289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
To compare patients with primary immune thrombocytopenia (ITP) prescribed early (within 3 months of initial ITP treatment) second-line treatment (eltrombopag, romiplostim, rituximab, immunosuppressive agents, splenectomy) with or without concomitant first-line therapy to those who received only first-line therapy. This real-world retrospective cohort study of 8268 patients with primary ITP from a large US-based database (Optum® de-identified Electronic Health Record [EHR] dataset) combined electronic claims and EHR data. Outcomes included platelet count, bleeding events, and corticosteroid exposure 3 to 6 months after initial treatment. Baseline platelet counts were lower in patients receiving early second-line therapy (10‒28 × 109/L) versus those who did not (67 × 109/L). Counts improved and bleeding events decreased from baseline in all treatment groups 3 to 6 months after the start of therapy. Among the very few patients for whom follow-up treatment data were available (n = 94), corticosteroid use was reduced during the 3- to 6-month follow-up period in patients who received early second-line therapy versus those who did not (39% vs 87%, p < 0.001). Early second-line treatment was prescribed for more severe cases of ITP and appeared to be associated with improved platelet counts and bleeding outcomes 3 to 6 months after initial therapy. Early second-line therapy also appeared to reduce corticosteroid use after 3 months, although the small number of patients with follow-up data on treatment precludes any substantive conclusions. Further research is needed to determine whether early second-line therapy has an effect on the long-term course of ITP.
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Affiliation(s)
- Adam Cuker
- Department of Medicine and Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, 3 Dulles, 3400 Spruce Street, Philadelphia, PA, USA.
| | | | | | | | | | - James B Bussel
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
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Cuker A, Tkacz J, Manjelievskaia J, Haenig J, Maier J, Bussel JB. Overuse of corticosteroids in patients with immune thrombocytopenia (ITP) between 2011 and 2017 in the United States. EJHaem 2023; 4:350-357. [PMID: 37206283 PMCID: PMC10188501 DOI: 10.1002/jha2.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/04/2023] [Accepted: 03/17/2023] [Indexed: 05/21/2023]
Abstract
Corticosteroids (CSs) are standard first-line therapy for immune thrombocytopenia (ITP). Prolonged exposure is associated with substantial toxicity; thus guidelines recommend avoidance of prolonged CS treatment and early use of second-line therapies. However, real-world evidence on ITP treatment patterns remains limited. We aimed to assess real-world treatment patterns in patients with newly-diagnosed ITP, using two large US healthcare databases (Explorys and MarketScan) between January 1, 2011 and July 31, 2017. Adults with ITP, ≥12 months of database registration prior to diagnosis, ≥1 ITP treatment, and ≥1 month enrollment following initiation of first ITP treatment were included (n = 4066 Explorys; n = 7837 MarketScan). Information on lines of treatment (LoTs) was collected. As expected, CSs were the most common first-line treatment (Explorys, 87.9%; MarketScan, 84.5%). However, CSs remained by far the most common treatment (Explorys ≥77%; MarketScan ≥85%) across all subsequent LoTs. Second-line treatments such as rituximab (12.0% Explorys; 24.5% MarketScan), thrombopoietin receptor agonists (11.3% Explorys; 15.6% MarketScan), and splenectomy (2.5% Explorys; 8.1% MarketScan) were used much less frequently. CS use is widespread in the US in patients with ITP across all LoTs. Quality improvement initiatives are needed to reduce CS exposure and bolster use of second-line treatments.
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Affiliation(s)
- Adam Cuker
- Department of Medicine and Department of Pathology and Laboratory MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | | | | | | | - James B Bussel
- Pediatric Hematology/OncologyWeill Cornell MedicineNew YorkNew YorkUSA
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Cuker A, Lal L, Roy A, Elliott C, Carlyle M, Martin C, Haenig J, Viana R. Thrombopoietin receptor agonist discontinuation rates and reasons among patients with immune thrombocytopenia: a study of administrative claims linked with medical chart review. Ann Hematol 2022; 101:1915-1924. [PMID: 35849155 DOI: 10.1007/s00277-022-04888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/04/2022] [Indexed: 11/01/2022]
Abstract
Administrative claims provide a rich data source for retrospective studies of real-world clinical practice, yet some important data may be inconsistent or unavailable. This study explored factors influencing discontinuation of thrombopoietin receptor agonists (TPO-RAs) among patients with immune thrombocytopenia (ITP), by adding medical chart abstraction for additional details. Adult (≥ 18 years) patients with continuous commercial or Medicare Advantage with Part D health insurance coverage were included. Inclusion criteria were ≥ 1 claim for eltrombopag or romiplostim and ≥ 2 diagnoses of ITP between December 31, 2017, and January 1, 2020. Providers were asked to provide access to medical charts for abstraction. The analyses included only patients who discontinued TPO-RA and described patient characteristics, treatment patterns, platelet values, and reasons for discontinuation. Among 207 ITP patients treated with a TPO-RA, 137 (66%) discontinued treatment during the observation period. The mean TPO-RA treatment duration was 185 days. Mean platelet count at the time of discontinuation was 197 × 109/L. The most common reason for discontinuation was improvement of the patient's condition (42%). Other reasons included worsening of ITP/lack of response (12%), adverse events (12%), and cost-related or social reasons (23%). No reason was reported for 10%. Notably 26% of patients who discontinued remained off all ITP therapy for the remainder of the study, with a mean treatment-free period of 262 days. These results emphasize that some patients with ITP are able to discontinue TPO-RA therapy and achieve durable treatment-free periods.
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Affiliation(s)
- Adam Cuker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anuja Roy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Cooper N, Kruse A, Kruse C, Watson S, Morgan M, Provan D, Ghanima W, Arnold DM, Tomiyama Y, Santoro C, Michel M, Laborde S, Lovrencic B, Hou M, Bailey T, Taylor‐Stokes G, Haenig J, Bussel JB. Immune thrombocytopenia (ITP) World Impact Survey (iWISh): Patient and physician perceptions of diagnosis, signs and symptoms, and treatment. Am J Hematol 2021; 96:188-198. [PMID: 33170956 PMCID: PMC7898610 DOI: 10.1002/ajh.26045] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is now well-known to reduce patients' health-related quality of life. However, data describing which signs and symptoms patients and physicians perceive as having the greatest impact are limited, as is understanding the full effects of ITP treatments. I-WISh (ITP World Impact Survey) was an exploratory, cross-sectional survey designed to establish the multifaceted impact of ITP, and its treatments, on patients' lives. It focused on perceptions of 1507 patients and 472 physicians from 13 countries regarding diagnostic pathway, frequency and severity of signs and symptoms, and treatment use. Twenty-two percent of patients experienced delayed diagnosis (caused by several factors), 73% of whom felt anxious as a result. Patients rated fatigue among the most frequent, severe symptom associated with ITP at diagnosis (58% most frequent; 73% most severe), although physicians assigned it lower priority (30%). Fatigue was one of the few symptoms persisting at survey completion (50% and 65%, respectively) and was the top symptom patients wanted resolved (46%). Participating physicians were experienced at treating ITP, thereby recognizing the need to limit corticosteroid use to newly-diagnosed or first-relapse patients and espoused increased use of thrombopoietin receptor agonists and anti-CD20 after relapse in patients with persistent/chronic disease. Patient and physicians were largely aligned on diagnosis, symptoms, and treatment use. I-WISh demonstrated that patients and physicians largely align on overall ITP symptom burden, with certain differences, for example, fatigue. Understanding the emotional and clinical toll of ITP on the patient will facilitate shared decision-management, setting and establishment of treatment goals and disease stage-appropriate treatment selection.
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Affiliation(s)
- Nichola Cooper
- Department of Haematology Hammersmith Hospital, Imperial College London London UK
| | | | - Caroline Kruse
- Platelet Disorder Support Association Cleveland Ohio USA
| | - Shirley Watson
- Patient Representative for the UK ITP Forum Bolnhurst UK
| | | | - Drew Provan
- Academic Haematology Unit, Blizard Institute Barts and The School of Medicine and Dentistry London UK
| | - Waleed Ghanima
- Department of Medicine Østfold Hospital Trust Kalnes Norway
- Department of Hematology Institute of Clinical Medicine, University of Oslo Oslo Norway
| | - Donald M. Arnold
- Department of Medicine, McMaster Centre for Transfusion Research McMaster University Hamilton Ontario Canada
| | - Yoshiaki Tomiyama
- Department of Blood Transfusion Osaka University Hospital Osaka Japan
| | | | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris‐Est Créteil Créteil France
| | | | - Barbara Lovrencic
- Italian Association of Immune Thrombocytopenic Purpura Caprino Veronese Italy
| | - Ming Hou
- Department of Hematology Shandong University Jinan China
| | - Tom Bailey
- Bespoke Team Adelphi Real World Macclesfield UK
| | | | | | - James B. Bussel
- Division of Hematology/Oncology Weill Cornell Medicine New York New York USA
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Cooper N, Kruse A, Kruse C, Watson S, Morgan M, Provan D, Ghanima W, Arnold DM, Tomiyama Y, Santoro C, Michel M, Laborde S, Lovrencic B, Hou M, Bailey T, Taylor‐Stokes G, Haenig J, Bussel JB. Immune thrombocytopenia (ITP) World Impact Survey (I-WISh): Impact of ITP on health-related quality of life. Am J Hematol 2021; 96:199-207. [PMID: 33107998 PMCID: PMC7898815 DOI: 10.1002/ajh.26036] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 11/09/2022]
Abstract
Immune thrombocytopenia (ITP) has a substantial, multifaceted impact on patients' health-related quality of life (HRQoL). Data describing which aspects of ITP physicians and patients perceive as having the greatest impact are limited. The ITP World Impact Survey (I-WISh) was a cross-sectional survey, including 1507 patients and 472 physicians, to establish the impact of ITP on HRQoL and productivity from patient and physician perspectives. Patients reported that ITP reduced their energy levels (85% of patients), capacity to exercise (77%), and limited their ability to perform daily tasks (75%). Eighty percent of physicians reported that ITP symptoms reduced patient HRQoL, with 66% reporting ITP-related fatigue substantially reduced patient HRQoL. Patients believed ITP had a substantial impact on emotional well-being (49%) and 63% worried their condition would worsen. Because of ITP, 49% of patients had already reduced, or seriously considered reducing their working hours, and 29% had considered terminating their employment. Thirty-six percent of patients employed at the time of the survey felt ITP decreased their work productivity, while 51% of patients with high/very high symptom burden reported that ITP affected their productivity. Note, I-WISh demonstrated substantive impact of ITP on patients' HRQoL both directly for patients and from the viewpoint of their physicians. Patients reported reduced energy levels, expressed fears their condition might worsen, and those who worked experienced reduced productivity. Physicians should be aware not only of platelet counts and bleeding but also the multi-dimensional impact of ITP on patients' lives as an integral component of disease management.
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Affiliation(s)
- Nichola Cooper
- Department of HaematologyHammersmith Hospital, Imperial College LondonLondonUK
| | | | | | | | | | - Drew Provan
- Academic Haematology Unit, Blizard InstituteBarts and The School of Medicine and DentistryLondonUK
| | - Waleed Ghanima
- Department of MedicineØstfold Hospital TrustKalnesNorway
- Department of Hematology, Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Donald M. Arnold
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster UniversityHamiltonOntarioCanada
| | | | | | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult Immune CytopeniasHenri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris‐Est CréteilCréteilFrance
| | | | - Barbara Lovrencic
- Italian Association of Immune Thrombocytopenic PurpuraCaprino VeroneseItaly
| | - Ming Hou
- Department of HematologyShandong UniversityJinanChina
| | - Tom Bailey
- Bespoke TeamAdelphi Real WorldMacclesfieldUK
| | | | | | - James B. Bussel
- Division of Hematology/OncologyWeill Cornell MedicineNew YorkNew YorkUSA
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Borghi L, Galimberti S, Baratè C, Bonifacio M, Capochiani E, Cuneo A, Falzetti F, Iurlo A, Lunghi F, Minotto C, Orlandi EM, Rege-Cambrin G, Sica S, Supekar S, Haenig J, Vegni E. Chronic Myeloid Leukemia Patient's Voice About the Experience of Treatment-Free Remission Failure: Results From the Italian Sub-Study of ENESTPath Exploring the Emotional Experience of Patients During Different Phases of a Clinical Trial. Front Psychol 2019; 10:329. [PMID: 30842749 PMCID: PMC6391340 DOI: 10.3389/fpsyg.2019.00329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background: The main objective of this study is to gain further insights on how chronic myeloid leukemia (CML) patients involved in an interventional clinical trial with the purpose of reaching treatment free remission (TFR) phase, perceived and experienced TFR failure. TFR failure was defined for the individual patient as either not being eligible for drug discontinuation or as having relapse in the TFR phase with reintroduction of nilotinib treatment. Methods: Using a qualitative approach, out of 25 patients with CML who experienced TFR failure 14 were interviewed. Patients' views and experiences were explored using in-depth interviews, analyzed using the Interpretative Phenomenological Analysis (IPA). Results: The analysis of the interviews revealed that the experience of the diagnosis seems to have been lived as a traumatic break that has created a dichotomy, like an ambivalence in the ways in which CML patients perceived and experienced the whole disease journey, with contradictory feelings of both positive and negative emotions (e.g., a diagnosis of cancer, that is something distressing and of being afraid of, but also with a treatment and a life expectancies of which being grateful). This ambivalence of feelings was found to give meaning to the way in which patients cognitively and emotionally experienced the different steps of their disease history. Thus, four main issues, corresponding to different steps of the patients' journey, were identified: (1) the moment of the diagnosis, (2) the experience of the illness journey: disease and treatment, (3) the moment of "TFR failure," and (4) the impact of disease, treatment and relapse on the patient's life. Conclusion: This qualitative analysis helps in understanding patients' perspective, both in terms of getting access to the inner subjective experience of having CML and its strict relationship with the involvement in a trial or its cessation. Clinicians should consider that the way in which CML patients feel engaged in a clinical trial, create expectancies about TFR or experience the TFR failure is linked to the process of coping with the diagnosis, which is characterized by ambivalence.
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Affiliation(s)
- Lidia Borghi
- Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | | | | | - Antonio Cuneo
- Institute of Hematology, University of Ferrara, Ferrara, Italy
| | - Franca Falzetti
- Institute of Hematology, Centro di Ricerca Emato-Oncologico (CREO), University of Perugia, Perugia, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Minotto
- UOS Hematology, UOC Oncologiaed Ematologia Oncologica AULSS3, Mestre, Italy
| | | | - Giovanna Rege-Cambrin
- Division of Hematology and Internal Medicine, "San Luigi Gonzaga" University Hospital, Orbassano, University of Turin, Turin, Italy
| | - Simona Sica
- Fondazione Policlinico Universitario Agostino Gemelli - IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sharon Supekar
- Oncology Region Europe, Novartis Farma SpA, Origgio, Italy
| | - Jens Haenig
- Oncology Region Europe, Novartis Farma SpA, Origgio, Italy
| | - Elena Vegni
- Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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