Comanagement Strategy Between Academic Institutions and Community Practices to Reduce Induction Mortality in Acute Promyelocytic Leukemia.

Autor:	Jillella AP; Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, GA., Arellano ML; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Gaddh M; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Langston AA; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Heffner LT; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Winton EF; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., McLemore ML; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Zhang C; Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA., Caprara CR; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Simon KS; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Bolds SL; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., DeBragga S; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Karkhanis P; Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, GA., Krishnamurthy SH; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Tongol J; Phoebe Putney Cancer Center, Albany, GA., El Geneidy MM; South Carolina Oncology Associates, Columbia, SC., Pati A; Gibbs Cancer Center & Research Institute, Spartanburg, SC., Gerber JM; Department of Hematologic Oncology and Blood Disorders, The Levine Cancer Institute of Atrium Health, Charlotte, NC., Grunwald MR; Department of Hematologic Oncology and Blood Disorders, The Levine Cancer Institute of Atrium Health, Charlotte, NC., Cortes J; Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, GA., Bashey A; Blood & Marrow Transplant, Cellular Immunotherapy & Acute Leukemia Program at Northside Hospital and Blood and Marrow Transplant Group of Georgia, Atlanta, GA., Stuart RK; Hollings Cancer Institute at Medical University of South Carolina, Charleston, SC., Kota VK; Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, GA.
Jazyk:	angličtina
Zdroj:	JCO oncology practice [JCO Oncol Pract] 2021 Apr; Vol. 17 (4), pp. e497-e505. Date of Electronic Publication: 2020 Oct 30.
DOI:	10.1200/OP.20.00395
Abstrakt:	Purpose: Acute promyelocytic leukemia (APL) is a curable leukemia with > 90% survival in clinical trials. Population-based studies from Sweden and US SEER data have shown long-term survival rates of 62% and 65.7%, with the lower rate being from a higher percentage of early deaths. Methods: In this prospective, multicenter trial, we developed a simplified algorithm that focused on prevention and early treatment of the three main causes of death: bleeding, differentiation syndrome, and infection. All patients with a diagnosis of APL were included. The initial 6 months were spent educating oncologists about early deaths in APL. At the time of suspicion of an APL, an expert was contacted. The algorithm was made available followed by discussion of the treatment plan. Communication between expert and treating physician was frequent in the first 2 weeks, during which time most deaths take place. Results: Between September 2013 and April 2016, 120 patients enrolled in the study from 32 hospitals. The median age was 52.5 years, with 39% > 60 years and 25% with an age-adjusted Charlson comorbidity index > 4. Sixty-three percent of patients were managed at community centers. Two patients did not meet the criteria for analysis, and of 118 evaluable patients, 10 died, with an early mortality rate of 8.5%. With a median follow-up of 27.3 months, the overall survival was 84.5%. Conclusion: Induction mortality can be decreased and population-wide survival improved in APL with the use of standardized treatment guidelines. Support from experts who have more experience with induction therapy is crucial and helps to improve the outcomes. Competing Interests: Conflicts of Interest Statement:Accepted on September 22, 2020. Martha L. ArellanoConsulting or Advisory Role: Gilead SciencesResearch Funding: Cephalon (Inst) Manila GaddhConsulting or Advisory Role: Agios, PfizerResearch Funding: MedImmune (Inst), Apellis Pharmaceuticals (Inst), Celgene (Inst), Janssen Pharmaceuticals (Inst), Daiichi Sankyo (Inst)Travel, Accommodations, Expenses: Agios, Pfizer Amy A. LangstonResearch Funding: Chimerix (Inst), Astellas Pharma (Inst), Incyte (Inst), Takeda Pharmaceuticals (Inst), Jazz Pharmaceuticals (Inst), Kadmon (Inst), Novartis (Inst) Leonard T. HeffnerSpeakers’ Bureau: Kite PharmaResearch Funding: Pharmacyclics (Inst), Genentech (Inst), Kite Pharma (Inst), ADC Therapeutics (Inst), Astex Pharmaceuticals (Inst) Elliott F. WintonResearch Funding: Incyte, Sierra Oncology, Samus Therapeutics, Blueprint Medicines Asim PatiHonoraria: Aptitude Health, ITA Group, AstraZeneca, Bristol Myers Squibb, BeiGene Michael R. GrunwaldStock and Other Ownership Interests: MedtronicHonoraria: OncLive, Med Learning Group, Physicians’ Education ResourceConsulting or Advisory Role: Incyte, Cardinal Health, Pfizer, Agios, AbbVie, Trovagene, Daiichi Sankyo, Bristol-Myers Squibb, Premier, Astellas PharmaResearch Funding: Janssen Pharmaceuticals (Inst), FORMA Therapeutics (Inst), Incyte (Inst), Genentech (Inst), Roche (Inst)Travel, Accommodations, Expenses: Amgen, Incyte Jonathan M. GerberPatents, Royalties, Other Intellectual Property: US Patent No. 9,012,215, US Patent No. 10,222,376 Jorge CortesConsulting or Advisory Role: Bristol Myers Squibb, BioLineRx, Novartis, Pfizer, Amphivena Therapeutics, Daiichi Sankyo, Bio-Path Holdings, Astellas Pharma, Takeda Pharmaceuticals, Jazz PharmaceuticalsResearch Funding: Bristol Myers Squibb (Inst), Novartis (Inst), Pfizer (Inst), Astellas Pharma (Inst), Immunogen (Inst), Sun Pharma (Inst), Takeda Pharmaceuticals (Inst), Merus (Inst), Daiichi Sankyo (Inst), Tolero Pharmaceuticals (Inst), Trovagene (Inst), Jazz Pharmaceuticals (Inst) Robert K. StuartConsulting or Advisory Role: Ono PharmaceuticalResearch Funding: Ono Pharmaceutical, Agios, Astellas Pharma Vamsi K. KotaConsulting or Advisory Role: Pfizer, Novartis, AbbVieNo other potential conflicts of interest were reported.
Databáze:	MEDLINE
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