Hematological toxicity

  • 文章类型: Case Reports
    新诊断的晚期卵巢癌的治疗标准是手术细胞减灭术加铂类化疗;然而,治疗后经常发生复发性疾病。作为一线维持治疗的聚(ADP-核糖)聚合酶(PARP)抑制剂已被证明显著降低对一线铂基化疗有完全或部分反应的晚期卵巢癌患者的疾病进展或死亡风险。Niraparib是唯一的PARP抑制剂,与安慰剂相比,无论同源重组状态如何,在该患者人群中都能提供显着的无进展生存益处。然而,治疗反应的预测因素和剂量优化方法仍有待研究.在这项研究中,两名中国新诊断的晚期卵巢癌患者对尼拉帕尼治疗表现出长期反应,并通过剂量调整成功控制了血液学毒性。关于疗效的临床试验和现实世界经验的文献,耐受性,还回顾了尼拉帕尼治疗在西方和中国患者中的剂量个体化。未来的研究有必要确定尼拉帕尼治疗的“长期应答者”的特征。
    The standard of care for newly diagnosed advanced ovarian cancer is surgical cytoreduction plus platinum-based chemotherapy; however, recurrent disease frequently occurs after treatment. Poly(ADP-ribose) polymerase (PARP) inhibitors as first-line maintenance therapy have been demonstrated to significantly reduce the risk of disease progression or death in patients with advanced ovarian cancer who have a complete or partial response to first-line platinum-based chemotherapy. Niraparib is the only PARP inhibitor that offers a significant progression-free survival benefit compared with placebo in this patient population regardless of the homologous recombination status. However, predictive factors for treatment responses and approaches to dose optimization remain to be investigated. In this study, two Chinese patients with newly diagnosed advanced ovarian cancer exhibited long-term responses to niraparib treatment, and hematological toxicity was successfully managed by dose adjustment. The literature on clinical trials and real-world experience on the efficacy, tolerability, and dose individualization of niraparib treatment in Western and Chinese patients was also reviewed. Future research is warranted to identify the characteristics of \'long responders\' to niraparib treatment.
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  • 文章类型: Case Reports
    利奈唑胺(LZD)是第一个具有优异的安全性和功效的恶唑烷酮,可抵抗革兰氏阳性生物体引起的难治性感染。血液毒性,如血小板减少症,贫血,和白细胞减少症在LZD治疗中很常见;然而,LZD诱导的纯红细胞再生障碍(PRCA)很少见。一名被诊断为金黄色葡萄球菌引起的胸膜脓胸的83岁男性在对多种抗生素产生耐药性后接受了LZD。尽管LZD改善了他的感染相关症状,开始LZD治疗后发现进行性贫血.LZD管理开始八周后,血红蛋白水平为5.7g/dL,网织红细胞比例为0.36%,而他的白细胞和血小板计数自入院以来保持不变。骨髓检查显示红细胞生成明显减少,红细胞浆空泡化。LZD停止后14天,贫血消退。重要的是要提高临床医生对与LZD相关的潜在血液学影响的认识,特别是对于既往贫血且疗程超过14天的老年患者。为了检测骨髓抑制,包括PRCA,我们建议定期监测接受长期LZD治疗的患者的全血细胞计数和网织红细胞计数.
    Linezolid (LZD) is the first oxazolidinone with excellent safety and efficacy profiles against refractory infections caused by gram-positive organisms. Hematological toxicities such as thrombocytopenia, anemia, and leukocytopenia are common in LZD therapy; however, LZD-induced pure red cell aplasia (PRCA) is rare. An 83-year-old man diagnosed with pleural empyema caused by Staphylococcus aureus received LZD after developing resistance to multiple antibiotics. Although his infection-related symptoms were improved by LZD, progressive anemia was noticed after LZD therapy was initiated. Eight weeks after LZD administration began, his hemoglobin level was 5.7 g/dL and reticulocyte proportion was 0.36%, while his white blood cell and platelet counts remained unchanged since admission. Bone marrow examination revealed markedly decreased erythropoiesis with cytoplasmic vacuolation of erythroblasts. Anemia resolved by 14 days after cessation of LZD. It is important to increase the awareness among clinicians about the potential for the hematological effects associated with LZD, particularly for older patients with pre-existing anemia and treatment courses longer than 14 days. To detect bone marrow suppression, including PRCA, we suggest monitoring the complete blood count and reticulocyte count periodically in patients receiving long-term LZD therapy.
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