Leukemia & lymphoma
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Leukemia & lymphoma · Mar 2020
Changing landscape of frontline therapy in chronic lymphocytic leukemia.
The therapeutic landscape for chronic lymphocytic leukemia has significantly evolved in recent years as our understanding of the biology of this disease has advanced. Chemoimmunotherapy has been the standard frontline treatment for patients of all age groups with chronic lymphocytic leukemia over the last decade. ⋯ The advent of novel small-molecule therapy for the treatment of chronic lymphocytic leukemia targeting the B-cell receptor signaling pathway has dramatically changed the therapeutic landscape with recent studies establishing ibrutinib, a Bruton's tyrosine kinase inhibitor, as the frontline treatment of choice regardless of patient's age, performance status or risk-category. Although these current advances along with the approval of other newer agents for the treatment of chronic lymphocytic leukemia is a significant step forward, newer challenges have emerged on how to best utilize these new treatment options.
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Leukemia & lymphoma · Oct 2019
Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia.
The aim of this study was to explore the predictive value of procalcitonin (PCT) in Gram-negative bloodstream infections (BSIs) in hematological patients with febrile neutropenia. A total of 1466 samples (396 blood culture (BC)-positive, 1052 BC-negative, and 18 contaminated specimens) were included, comprising 268 Gram-negative, 88 Gram-positive, 19 fungal, and 21 polymicrobial BSIs. ⋯ PCT levels were significantly higher in BSIs from multidrug-resistant (MDR) Gram-negative strains than from non-MDR (p < .01). This study confirms that elevated PCT may predict Gram-negative BSIs in hematological patients with febrile neutropenia, and demonstrates higher PCT levels in MDR Gram-negative BSIs in these patients.
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Leukemia & lymphoma · Jul 2019
Randomized Controlled Trial Multicenter StudyObinutuzumab plus chemotherapy followed by obinutuzumab monotherapy is cost-effective vs. rituximab plus chemotherapy followed by rituximab monotherapy for previously untreated follicular lymphoma patients in the United States.
The GALLIUM trial compared obinutuzumab (GA101, G)-based chemotherapy followed by G monotherapy (G + chemo) for up to two years to rituximab (R)-based chemotherapy followed by R monotherapy (R + chemo) for up to two years in previously untreated follicular lymphoma (FL) patients. We estimated the cost-effectiveness of G + chemo versus R + chemo utilizing GALLIUM trial data and published literature. G + chemo had increased drug costs (undiscounted: $135,200 versus $127,700 for R + chemo), representing a relative increase of 5.9%. ⋯ G + chemo led to increased quality-adjusted life years (QALYs) relative to R + chemo of 0.81 (95% credible range, [CR]: 0.22-1.37), and the overall discounted incremental cost was $1,900 (95% CR: -$7,400 to $8,900). The incremental cost-effectiveness ratio was ∼$2,300 per QALY gained, and the results were highly robust to sensitivity analyses. Treatment with G + chemo compared to R + chemo is cost-effective in previously untreated FL patients in the US.