6 research outputs found
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 1.2015
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are different manifestations of the same disease, which are managed in the same way. The advent of novel monoclonal antibodies (ofatumumab and obinutuzumab) led to the development of effective chemoimmunotherapy regimens. The recently approved small molecule kinase inhibitors (ibrutinib and idelalisib) are effective treatment options for CLL in elderly patients with decreased tolerance for aggressive regimens and in patients with poor prognostic features who do not benefit from conventional chemoimmunotherapy regimens. This portion of the NCCN Guidelines for Non-Hodgkin's Lymphomas describes the recent specific to the incorporation of recently approved targeted therapies for the management of patients with newly diagnosed and relapsed or refractory CLL/SLL
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Chronic lymphocytic leukemia/small lymphocytic lymphoma, version 1.2015.
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are different manifestations of the same disease, which are managed in the same way. The advent of novel monoclonal antibodies (ofatumumab and obinutuzumab) led to the development of effective chemoimmunotherapy regimens. The recently approved small molecule kinase inhibitors (ibrutinib and idelalisib) are effective treatment options for CLL in elderly patients with decreased tolerance for aggressive regimens and in patients with poor prognostic features who do not benefit from conventional chemoimmunotherapy regimens. This portion of the NCCN Guidelines for Non-Hodgkin's Lymphomas describes the recent specific to the incorporation of recently approved targeted therapies for the management of patients with newly diagnosed and relapsed or refractory CLL/SLL
Non-Hodgkin’s Lymphomas, Version 4.2014
Non-Hodgkin's lymphomas (NHL) are a heterogeneous group of lymphoproliferative disorders originating in B lymphocytes, T lymphocytes, or natural killer cells. Mantle cell lymphoma (MCL) accounts for approximately 6% of all newly diagnosed NHL cases. Radiation therapy with or without systemic therapy is a reasonable approach for the few patients who present with early-stage disease. Rituximab-based chemoimmunotherapy followed by high-dose therapy and autologous stem cell rescue (HDT/ASCR) is recommended for patients presenting with advanced-stage disease. Induction therapy followed by rituximab maintenance may provide extended disease control for those who are not candidates for HDT/ASCR. Ibrutinib, a Bruton tyrosine kinase inhibitor, was recently approved for the treatment of relapsed or refractory disease. This manuscript discusses the recommendations outlined in the NCCN Guidelines for NHL regarding the diagnosis and management of patients with MCL
Effect of recombinant zoster vaccine on incidence of Herpes zoster after autologous stem cell transplantation : a randomized clinical trial
IMPORTANCE Herpes zoster, a frequent complication following autologous hematopoietic stem cell transplantation (HSCT), is associated with significant morbidity. A nonlive adjuvanted recombinant zoster vaccine has been developed to prevent posttransplantation zoster.
OBJECTIVE To assess the efficacy and adverse event profile of the recombinant zoster vaccine in immunocompromised autologous HSCT recipients.
DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, observer-blinded study conducted in 167 centers in 28 countries between July 13, 2012, and February 1, 2017, among 1846 patients aged 18 years or older who had undergone recent autologous HSCT.
INTERVENTIONS Participants were randomized to receive 2 doses of either recombinant zoster vaccine (n=922) or placebo (n=924) administered into the deltoid muscle; the first dose was given 50 to 70 days after transplantation and the second dose 1 to 2 months thereafter.
MAIN OUTCOMES AND MEASURES The primary end point was occurrence of confirmed herpes zoster cases.
RESULTS Among 1846 autologous HSCT recipients (mean age, 55 years; 688 [37%] women) who received 1 vaccine or placebo dose, 1735 (94%) received a second dose and 1366 (74%) completed the study. During the 21-month median follow-up, at least 1 herpes zoster episode was confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94 per 1000 person-years, respectively), an incidence rate ratio (IRR) of 0.32 (95% CI, 0.22-0.44; P<.001), equivalent to 68.2% vaccine efficacy. Of 8 secondary end points, 3 showed significant reductions in incidence of postherpetic neuralgia (vaccine, n=1; placebo, n=9; IRR, 0.1; 95% CI, 0.00-0.78; P=.02) and of other prespecified herpes zoster-related complications (vaccine, n=3; placebo, n=13; IRR, 0.22; 95% CI, 0.04-0.81; P=.02) and in duration of severe worst herpes zoster-associated pain (vaccine, 892.0 days; placebo, 6275.0 days; hazard ratio, 0.62; 95% CI, 0.42-0.89; P=.01). Five secondary objectives were descriptive. Injection site reactions were recorded in 86% of vaccine and 10% of placebo recipients, of which pain was the most common, occurring in 84% of vaccine recipients (grade 3: 11%). Unsolicited and serious adverse events, potentially immune-mediated diseases, and underlying disease relapses were similar between groups at all time points.
CONCLUSIONS AND RELEVANCE Among adults who had undergone autologous HSCT, a 2-dose course of recombinant zoster vaccine compared with placebo significantly reduced the incidence of herpes zoster over a median follow-up of 21 months.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0161041
Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell Transplantation A Randomized Clinical Trial
IMPORTANCE Herpes zoster, a frequent complication following autologous
hematopoietic stem cell transplantation (HSCT), is associated with
significant morbidity. A nonlive adjuvanted recombinant zoster vaccine
has been developed to prevent posttransplantation zoster.
OBJECTIVE To assess the efficacy and adverse event profile of the
recombinant zoster vaccine in immunocompromised autologous HSCT
recipients.
DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, observer-blinded
study conducted in 167 centers in 28 countries between July 13, 2012,
and February 1, 2017, among 1846 patients aged 18 years or older who had
undergone recent autologous HSCT.
INTERVENTIONS Participants were randomized to receive 2 doses of either
recombinant zoster vaccine (n=922) or placebo (n=924) administered into
the deltoid muscle; the first dose was given 50 to 70 days after
transplantation and the second dose 1 to 2 months thereafter.
MAIN OUTCOMES AND MEASURES The primary end point was occurrence of
confirmed herpes zoster cases.
RESULTS Among 1846 autologous HSCT recipients (mean age, 55 years; 688
[37%] women) who received 1 vaccine or placebo dose, 1735 (94%)
received a second dose and 1366 (74%) completed the study. During the
21-month median follow-up, at least 1 herpes zoster episode was
confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94
per 1000 person-years, respectively), an incidence rate ratio (IRR) of
0.32 (95% CI, 0.22-0.44; P<.001), equivalent to 68.2% vaccine
efficacy. Of 8 secondary end points, 3 showed significant reductions in
incidence of postherpetic neuralgia (vaccine, n=1; placebo, n=9; IRR,
0.1; 95% CI, 0.00-0.78; P=.02) and of other prespecified herpes
zoster-related complications (vaccine, n=3; placebo, n=13; IRR, 0.22;
95% CI, 0.04-0.81; P=.02) and in duration of severe worst herpes
zoster-associated pain (vaccine, 892.0 days; placebo, 6275.0 days;
hazard ratio, 0.62; 95% CI, 0.42-0.89; P=.01). Five secondary
objectives were descriptive. Injection site reactions were recorded in
86% of vaccine and 10% of placebo recipients, of which pain was the
most common, occurring in 84% of vaccine recipients (grade 3: 11%).
Unsolicited and serious adverse events, potentially immune-mediated
diseases, and underlying disease relapses were similar between groups at
all time points.
CONCLUSIONS AND RELEVANCE Among adults who had undergone autologous
HSCT, a 2-dose course of recombinant zoster vaccine compared with
placebo significantly reduced the incidence of herpes zoster over a
median follow-up of 21 months.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0161041
Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell Transplantation A Randomized Clinical Trial
IMPORTANCE Herpes zoster, a frequent complication following autologous
hematopoietic stem cell transplantation (HSCT), is associated with
significant morbidity. A nonlive adjuvanted recombinant zoster vaccine
has been developed to prevent posttransplantation zoster.
OBJECTIVE To assess the efficacy and adverse event profile of the
recombinant zoster vaccine in immunocompromised autologous HSCT
recipients.
DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, observer-blinded
study conducted in 167 centers in 28 countries between July 13, 2012,
and February 1, 2017, among 1846 patients aged 18 years or older who had
undergone recent autologous HSCT.
INTERVENTIONS Participants were randomized to receive 2 doses of either
recombinant zoster vaccine (n=922) or placebo (n=924) administered into
the deltoid muscle; the first dose was given 50 to 70 days after
transplantation and the second dose 1 to 2 months thereafter.
MAIN OUTCOMES AND MEASURES The primary end point was occurrence of
confirmed herpes zoster cases.
RESULTS Among 1846 autologous HSCT recipients (mean age, 55 years; 688
{[}37\%] women) who received 1 vaccine or placebo dose, 1735 (94\%)
received a second dose and 1366 (74\%) completed the study. During the
21-month median follow-up, at least 1 herpes zoster episode was
confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94
per 1000 person-years, respectively), an incidence rate ratio (IRR) of
0.32 (95\% CI, 0.22-0.44; P<.001), equivalent to 68.2\% vaccine
efficacy. Of 8 secondary end points, 3 showed significant reductions in
incidence of postherpetic neuralgia (vaccine, n=1; placebo, n=9; IRR,
0.1; 95\% CI, 0.00-0.78; P=.02) and of other prespecified herpes
zoster-related complications (vaccine, n=3; placebo, n=13; IRR, 0.22;
95\% CI, 0.04-0.81; P=.02) and in duration of severe worst herpes
zoster-associated pain (vaccine, 892.0 days; placebo, 6275.0 days;
hazard ratio, 0.62; 95\% CI, 0.42-0.89; P=.01). Five secondary
objectives were descriptive. Injection site reactions were recorded in
86\% of vaccine and 10\% of placebo recipients, of which pain was the
most common, occurring in 84\% of vaccine recipients (grade 3: 11\%).
Unsolicited and serious adverse events, potentially immune-mediated
diseases, and underlying disease relapses were similar between groups at
all time points.
CONCLUSIONS AND RELEVANCE Among adults who had undergone autologous
HSCT, a 2-dose course of recombinant zoster vaccine compared with
placebo significantly reduced the incidence of herpes zoster over a
median follow-up of 21 months.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0161041