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Singhal S, Saadeh SS, Durani U, Kansagra A, Alkhateeb HB, Shah MV, Mangaonkar A, Kenderian S, Hashmi S, Patnaik MV, Litzow MR, Hogan WJ. Allogeneic Hematopoietic Stem Cell Transplantation in the Outpatient Setting: The Mayo Clinic Experience. Transplant Cell Ther 2023; 29:183.e1-183.e6. [PMID: 36584940 DOI: 10.1016/j.jtct.2022.12.016] [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: 06/18/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Hematopoietic stem cell transplantations (HSCT) are intensive and potentially curative modalities available for a variety of hematological diseases. Although alloHSCTs are typically performed in an inpatient setting, there has been increasing interest in moving them to the outpatient setting. AlloHSCTs are associated with a median length of hospital stay of 30 days. AlloHSCTs in the inpatient setting may increase patient exposure to nosocomial infections, drug-resistant organisms, rapid deconditioning with time spent in hospital beds, and loss of muscle mass. In this study, we aim to share outcomes of 856 consecutive alloHSCTs done in our institute over the past 2 decades. This is a single-center retrospective chart review encompassing 856 patients who underwent outpatient alloHSCTs between 2000 and 2017. Reduced-intensity conditioning, stem cell infusion, and much of the immediate follow-up in the early alloHSCT period was performed on an outpatient basis with daily evaluation, laboratory assessment, and intervention as needed. Rate of non-routine hospital admission was our primary outcome of interest. We also looked at various secondary outcomes, including causes of admission, median length of stay, and in-hospital mortality rate. Data analysis was performed using STATA statistical software Version 15. Descriptive statistics were used to summarize baseline demographic data and outcomes. Logistic regression modeling was used to identify predictors of hospital admission. We observed that about one third of our cohort never required admission to the hospital throughout the first 100 days after HSCT. Among those admitted, 6.6% experienced a direct admission to the intensive care unit, and the overall in hospital mortality was low at 5%. Furthermore, the median length of stay was noted to be decreased at 6 days compared to a median reported 30 days in existing literature. Overall, we observed favorable safety profile and outcomes with outpatient management of HSCTs.
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Affiliation(s)
- Sachi Singhal
- Department of Internal Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Salwa S Saadeh
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Urshila Durani
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Ankit Kansagra
- Department of Internal Medicine, UT Southwestern Medical Center, Texas
| | | | - Mithun V Shah
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Saad Kenderian
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Shahrukh Hashmi
- Department of Hematology, Mayo Clinic, Rochester, Minnesota; Department of Hematology/Oncology, Sheikh Shakhbout Medical City/ Mayo Clinic, Abu Dhabi
| | | | - Mark R Litzow
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
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Abdel-Razeq H, Saadeh SS, Malhis R, Yasser S, Abdulelah H, Eljaber R, Kleib A, Ismael R. Treatment of anemia in cancer patients undergoing chemotherapy with intravenous ferric carboxymaltose without erythropoiesis-stimulating agents. Ther Adv Med Oncol 2020; 12:1758835920953292. [PMID: 32952616 PMCID: PMC7485004 DOI: 10.1177/1758835920953292] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Anemia is commonly encountered in cancer patients receiving active
chemotherapy. Due to adverse events and presumed negative effects on
disease-progression and survival, erythropoiesis-stimulating agents are not
frequently used. In this study, we assess the efficacy and safety of
intravenous ferric carboxymaltose (FCM) to treat cancer-induced anemia
(CIA). Patients and Methods: We recruited adult cancer patients on active chemotherapy with a hemoglobin
(Hb) level ⩽11.0 g/dL. Based on serum ferritin (sFr) and transferrin
saturation (TSAT), patients were divided into 3 groups: group I (absolute
iron deficiency, n = 26) with sFr < 30 ng/mL and
TSAT < 20%; group II (functional iron deficiency,
n = 24) with sFr 30–800 ng/mL and TSAT < 20%; and
patients with TSAT ⩾ 20% were placed in group III as “others”
(n = 34). All patients were treated with intravenous
FCM. Serum hepcidin and C-reactive protein were used as biomarkers to
predict response. Results: A total of 84 patients with a median age (SD) of 53.8 (10.6) were recruited.
Baseline median Hb level was 10.2 (range: 8.3–11.0) gm/dL. At week 12, there
was a significant increment in Hb level for patients in groups I and II
(median increment: 2.35 and 1.5 gm/dL, respectively), with limited response
observed in group III, and most of the increment noted as early as week 3
(⩾1.0 g/dL). Responders tended to have lower levels of hepcidin. No
clinically significant adverse events were reported; however, asymptomatic
hypophosphatemia was observed in 39 (46.4%) patients. Conclusions: Intravenous FCM is a safe and effective treatment option for the management
of a subgroup of patients with CIA. The study was registered at ClinicalTrials.gov [Identifier: NCT04246021]
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Affiliation(s)
| | - Salwa S. Saadeh
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Razan Malhis
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Sameer Yasser
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Hazem Abdulelah
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Rana Eljaber
- Department of Pharmacy, King Hussein Cancer
Center, Amman, Jordan
| | - Amer Kleib
- Department of Nursing, King Hussein Cancer
Center, Amman, Jordan
| | - Rouba Ismael
- Office of Scientific Affairs and Research, King
Hussein Cancer Center, Amman, Jordan
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Alkharabsheh O, Saadeh SS, Patnaik MS, Alkhateeb H, Gangat N, Begna KH, Hogan WJ, Greipp PT, He R, Nguyen PL, Litzow MR, Al-Kali A. Impact of clone size with a single cytogenetic abnormality on the revised International Prognostic Scoring System in myelodysplastic syndromes. Am J Hematol 2018; 93:E398-E401. [PMID: 30218541 DOI: 10.1002/ajh.25287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Naseema Gangat
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | - Patricia T. Greipp
- Division of Laboratory Genetics and Genomics; Mayo Clinic; Rochester Minnesota
- Department of Clinical Genomics; Mayo Clinic; Rochester Minnesota
| | - Rong He
- Division of Hematopathology; Mayo Clinic; Rochester Minnesota
| | | | - Mark R. Litzow
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Aref Al-Kali
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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Mansour A, Saadeh SS, Abdel-Razeq N, Khozouz O, Abunasser M, Taqash A. Clinical Course and Complications of Catheter and Non-Catheter-Related Upper Extremity Deep Vein Thrombosis in Patients with Cancer. Clin Appl Thromb Hemost 2018; 24:1234-1240. [PMID: 30025472 PMCID: PMC6714774 DOI: 10.1177/1076029618788177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Patients with cancer have an increased risk of venous thromboembolism. Upper extremity venous system is a peculiar site, and little is known about the clinical course in patients with cancer. Electronic medical records were searched for patients with cancer with a diagnosis of upper extremity venous thrombosis. Individual patient data were reviewed. Eighty-seven patients were identified, and the median age was 52.4. The most common underlying malignancies were breast (23.0%), colorectal (18.4%), and gastroesophageal (18.4%). Median time from cancer diagnosis to upper extremity venous thromboembolism (UEDVT) was 3.44 months. Subclavian vein was the most common involved site (56.3%) and 54.0% patients had a central venous catheter; 50.6% of patients developed a complication; pulmonary embolism (PE) in 9.2%, superior vena cava (SVC) syndrome in 14.9%, and 26.4% had postthrombotic syndrome. In patients with isolated single vein thrombosis, complications were higher in the subset with internal jugular vein involvement compared to other sites (68.2% vs 52.2%) as were complications in patients with non-catheter-related thrombosis compared to patients with a central venous catheter in place (55% vs 27.7%). Median overall survival from time of cancer and UEDVT diagnoses was 29.6 and 13.25 months, respectively. In conclusion, UEDVT is an uncommon event. Around 50% developed a complication including PE, SVC or postthrombotic syndromes. Larger studies are needed to better identify risks associated with thrombosis and the best therapeutic approach and duration in this unique subset of patients with cancer.
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Affiliation(s)
- Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Salwa S. Saadeh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
- Salwa S. Saadeh, King Hussein Cancer Center, Queen Rania Al-Abdullah Street, Al-Jubaiha, Amman 11914, Jordan.
| | | | - Omar Khozouz
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Abunasser
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ayat Taqash
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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Abdel-Razeq H, Saadeh SS, Abu-Nasser M, Abdulelah H, Marie L, Salam M, Ali BAH, Ibrahim M, Rimawi D. Four cycles of adriamycin and cyclophosphamide followed by four cycles of docetaxel (NSABP-B27) with concomitant trastuzumab as neoadjuvant therapy for high-risk, early-stage, HER2-positive breast cancer patients. Onco Targets Ther 2018; 11:2091-2096. [PMID: 29695917 PMCID: PMC5905529 DOI: 10.2147/ott.s151821] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The majority of breast cancer patients in Jordan are diagnosed at a young age and present with metastatic or locally advanced disease. The National Surgical Adjuvant Breast and Bowel Project Protocol B27 (NSABP-B27) (four cycles of adriamycin and cyclophosphamide [AC] followed by four cycles of docetaxel) is a standard neoadjuvant regimen in our institution. In this study, we report the efficacy of adding trastuzumab to docetaxel in this regimen for high-risk human epidermal growth factor receptor 2 (HER2)-positive early-stage disease. Patients and methods Consecutive HER2-positive breast cancer patients treated with this regimen were included. Treatment was given at standard doses and schedules as reported in NSABP-B27. Trastuzumab was given with docetaxel and then continued for 1 year. Results A total of 121 patients (mean age 45.4 years) were included. The majority had high-risk features including large tumor size, positive axillary lymph nodes, and grade III disease. Three patients did not complete the planned cycles of AC due to a lack of response. Eight (6.6%) patients missed at least one cycle of docetaxel. Following neoadjuvant therapy, 119 patients underwent surgery, of whom 59 (49.6%) patients achieved pathological complete response. The response was higher in node-negative patients (64.0 vs 45.7%; P=0.03) and in hormone receptor-negative disease patients (69.7 vs 41.9%; P=0.018). Breast-conserving surgery was performed in 21.5% of the patients. The median disease-free survival (DFS) for the whole group was not reached while the 3- and 5-year DFS rates were 84.2 and 74.1%, respectively. Conclusion Trastuzumab added to the NSABP-B27 regimen is a unique combination. When used in high-risk patients, as in our study, outcomes similar to reported data were achieved without unexpected toxicities.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, University of Jordan, Amman, Jordan
| | - Salwa S Saadeh
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Abu-Nasser
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Hazem Abdulelah
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Lina Marie
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Murad Salam
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Basel Al-Haj Ali
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mohammad Ibrahim
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Dalia Rimawi
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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6
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Abdel-Razeq H, Mansour A, Saadeh SS, Abu-Nasser M, Makoseh M, Salam M, Abufara A, Ismael Y, Ibrahim A, Khirfan G, Ibrahim M. The Application of Current Proposed Venous Thromboembolism Risk Assessment Model for Ambulatory Patients With Cancer. Clin Appl Thromb Hemost 2018; 24:429-433. [PMID: 28183196 PMCID: PMC6714656 DOI: 10.1177/1076029617692880] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Venous thromboembolism (VTE) is a commonly encountered problem in patients with cancer. In recent years, cancer treatment paradigm has shifted with most therapy offered in ambulatory outpatient settings. Excess of half VTEs in patients with cancer occur in outpatient settings without prior hospitalization, where current practice guidelines do not recommend routine prophylaxis. Risk assessment models (RAMs) for VTE in such patients were recently introduced. This study aims to assess the practical application of one of these models in clinical practice. Medical records and hospital electronic database were searched for patients with cancer having VTE. Known risk factors were collected, and risk assessment was done using the Khorana RAM. Over a 10-year period, 346 patients developed VTE in ambulatory settings. Median age was 57 and 59.0% were females. Lower extremities were involved in 196 (56.6%), while 96 (27.7%) had pulmonary embolism. Most (76.6%) patients had stage IV disease, only 9.0% had stage I or II disease. Only 156 (45.1%) patients were on active chemotherapy, for whom Khorana risk assessment score was calculated. In these patients, high risk was identified in 31 (19.9%) patients, while 81 (51.9%) had intermediate risk and 44 (28.2%) had low risk. No patients were on prophylaxis prior to VTE. Most ambulatory patients with cancer who developed VTE were not on chemotherapy, and many of those who were on active treatment had low Khorana risk scores. This illustrates the need to modify the model or develop a new one that takes into consideration this group of patients.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Salwa S. Saadeh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Abu-Nasser
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mohammad Makoseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Murad Salam
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Alaa Abufara
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Yousef Ismael
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Alaa Ibrahim
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Ghaleb Khirfan
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mohammad Ibrahim
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
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Saadeh SS, Alkharabsheh O, Al-Kali A, Patnaik MM, Shah MV, Litzow MR, Hogan WJ, Alkhateeb HB. Outcome of Patients with Myelodysplastic Syndrome and a Monosomal Karyotype Following Allogeneic Stem Cell Transplant: Single Institution Experience. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
INTRODUCTION Allogeneic hematopoietic stem cell transplant (allo-HSCT) has an important role in management of acute lymphoblastic leukemia (ALL). Proper patient selection is central to ensure optimal outcomes. Areas covered: This review covers various aspects of HSCT in ALL patients, including indications, donor selection, conditioning regimens, and post-transplant management. Expert commentary: Allo-HSCT is important in post-remission management of ALL but proper risk-stratification is a major challenge. Incorporation of minimal residual disease (MRD) and molecular testing will improve patient allocation. Patients receiving pediatric-inspired induction who achieve molecular remission might not need allo-HSCT in first remission. Allo-HSCT should be considered in patients who don't achieve MDR negativity, didn't receive intensive induction, or have high risk cytogenetic and molecular features. Despite improved responses with tyrosine kinase inhibitors (TKIs) in Philadelphia positive (Ph+) ALL, allo-HSCT remains standard. Matched sibling donors are the optimal graft source, but other sources are valid alternatives. There is no single optimal conditioning regimen and retrospective studies found myeloablative and reduced intensity regimens to be comparable. Following allo-HSCT, there is no role for maintenance therapy in Philadelphia-negative ALL. In Ph+ ALL, maintenance TKIs improve outcomes. The integration of targeted and immunotherapies in the peri-transplant period holds potential for improved outcomes.
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Affiliation(s)
- Salwa S Saadeh
- a Division of Hematology and Bone Marrow Transplant , Mayo Clinic , Rochester , MN , USA
| | - Mark R Litzow
- a Division of Hematology and Bone Marrow Transplant , Mayo Clinic , Rochester , MN , USA
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Madanat WY, Alawneh KM, Smadi MM, Saadeh SS, Omari MM, Bani Hani AB, Yazici H. The prevalence of Behçet's disease in the north of Jordan: a hospital-based epidemiological survey. Clin Exp Rheumatol 2017; 35 Suppl 108:51-54. [PMID: 29224587] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To estimate the prevalence of Behçet's disease (BD) in Jordan, with the additional aim of comparing this prevalence among hospital workers in other geographical areas. METHODS In the first stage of our survey, 2,569 employees from 6 hospitals in north Jordan were interviewed using a screening questionnaire to identify individuals with recurrent oral ulcers (ROU), a previous diagnosis of BD (PDBD) and/or any major symptom related to BD. In the second stage, all individuals with ROU or PDBD identified at stage 1, were examined by 2 rheumatologists for the presence/confirmation of BD according to the International Study Group (ISG) criteria. Pathergy test was performed according to recommendations. RESULTS ROU were present in 210 (8.2%) individuals. BD was confirmed in 10 employees with PDBD. Seven more BD patients were found. Mean age of 17 BD patients was 38.6±10.7 (range 26-65 y). M: F was 2.4:1. Pathergy test was positive in 8/17. A family history of ROU or BD was noted in 9 (52%) and 3 (25.0%), respectively, compared to 227 (8.9%) and 62 (2.6%) in the whole group, excluding the BD patients (p<0.001 and 0.008, respectively). The prevalence rate of BD in the north of Jordan was estimated as 66:10.000 (95% CI 34.8 to 97.5:10000). CONCLUSIONS The results of this first ever survey indicated that the prevalence of BD in the north of Jordan is among the highest in the world. This prevalence can now be compared to hospital workers in other geographical areas.
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Affiliation(s)
- Wafa Y Madanat
- Medical Department, Jordan's Friends of Behçet's Disease Patients Society, Amman, Jordan.
| | - Khaldoon M Alawneh
- Department of Medicine, King Abdullah Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud M Smadi
- Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Salwa S Saadeh
- Department of Medicine, King Abdullah Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Muntasser M Omari
- Department of Medicine, King Abdullah Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Anas B Bani Hani
- Department of Medicine, King Abdullah Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Hasan Yazici
- Cerrahpaşa Hospital, University of Istanbul, Turkey
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Abdel-Razeq H, Marei L, Saadeh SS, Abdulelah H, Abu-Nasser M, Salam M, Daana W, Al-Haj Ali B, Taqash A. From clinical trials to clinical practice: outcome of NSABP-B27 neoadjuvant chemotherapy regimen for high-risk early-stage breast cancer. Breast Cancer Res Treat 2017; 165:771-777. [PMID: 28667456 DOI: 10.1007/s10549-017-4359-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/16/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Majority of Jordanian breast cancer patients present at a relatively young age and with locally advanced disease highlight the importance of neoadjuvant chemotherapy. This study evaluated the efficacy and safety of NSABP-B27 regimen in high-risk patients in daily clinical practice. METHODS Patients' medical records and hospital database were searched for all consecutive patients treated at our institution for breast cancer using neoadjuvant NSABP-B27 chemotherapy regimen. Chemotherapy was given at standard doses and schedule as originally reported in the NSABP-B27. RESULTS 346 female patients (median age 51 years) were treated using this regimen. Majority had high-risk features including larger tumor size (>4 cm in 68.5%), positive axillary lymph nodes (78.3%), and Grade III disease (47.4%). While most patients tolerated and completed planned chemotherapy, 41 (11.8%) patients failed to complete all four cycles of docetaxel. Following neoadjuvant chemotherapy, complete pathological response (pCR) was achieved in 84 (25.0%) evaluable patients; pCR was higher in hormone receptor-negative disease (40.0 vs. 22.1%, p = 0.002), in patient with tumor size ≤4 cm (28.3 vs. 23.5%, p = 0.024) and in patients with node-negative disease (41.2 vs. 20.7%, p = 0.002). Age (<50 vs. ≥50) had no effect, with pCR of 24.2 and 26.4%, respectively (p = 0.607). Breast-conserving surgery was performed in 85 (24.6%). CONCLUSIONS NSABP-B27 is an effective neoadjuvant regimen. Despite including higher risk patients, pCR is similar to the original NSABP-B27 and many other anthracycline-taxane-based regimens. Tumor size, LN status, hormone receptors status, but not age, were significant factors in achieving pCR.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan.
| | - Lina Marei
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Salwa S Saadeh
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Hazem Abdulelah
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Mahmoud Abu-Nasser
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Mourad Salam
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Walid Daana
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Basel Al-Haj Ali
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan
| | - Ayat Taqash
- Center of Research Shared Resources, King Hussein Cancer Center, Amman, Jordan
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Samrah SM, Saadeh SS, Alawneh KM. Resolution of intracardiac and pulmonary thrombi without anticoagulation in a patient with Behçet's disease: a case report. Clin Exp Rheumatol 2013; 31:90-92. [PMID: 23463899] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 01/17/2013] [Indexed: 06/01/2023]
Abstract
Intracardiac and pulmonary thrombi are rare but serious manifestations of Behçet's disease, the treatment of such cases is a challenge to the treating physician and use of anticoagulants can hold a great risk to some patients. We report a patient who was found to have multiple right intraventricular and bilateral pulmonary artery thrombi and was clinically diagnosed with Behçet's disease. Early in the course of his treatment, the patient developed massive haemoptysis which precluded the further use of anticoagulants. The patient was treated with immunosuppressants alone and had complete resolution of his symptoms and documented resolution of the thrombi. In a review of the literature, only 3 out of around 50 patients reported to have intracardiac thrombi complicating Behçet's disease were treated without anticoagulants (1, 2) even though there is no clear evidence to support the benefit of anticoagulation to treat arterial or thrombotic lesions (3). We conclude that intracardiac thrombi in patients with Behçet's disease may resolve with immunosuppressants without anticoagulation, which is especially important in patients with contraindication to anticoagulation.
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Affiliation(s)
- Shaher M Samrah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
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