Research Week Abstract Book - Northern Health

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Haematology A RETROSPECTIVE EValuaTION OF HAEMAToloGICAL AND INFECTIVE COMPliCATIONS OF FLUDarabine, CYCloPhosPhamiDE AND RITUXIMAB (FCR) CombinaTion Chemo-immunoTheraPhy Ho P, Romero S, Grigg A and Tam C. Background Fludarabine, cyclophosphamide and rituximab (FCR) is commonly used for the treatment of chronic lymphocytic leukaemia (CLL). It is associated with infective and haematological complications with increasing anecdotal evidence of severe aplasia and death. However, the incidence and clinical significance of these complications remain unclear. Aim Determine the haematological and infective complications associated with FCR treatment. Methodology Retrospective analysis of patients receiving FCR treatment. Haematology complications were graded based on WHO classification. Late onset neutropenia (LON) was defined as grade III-IV neutropenia developing after four weeks following cessation of therapy. Patients were followed up for 12 months. Results 47 patients (33M, 14F) with median age 63 (40-83). 32 patients received FCR for CLL while 15 were treated for other non-Hodgkin lymphomas. Febrile neutropenia occurred in 20% of patients with a per cycle rate of 5.8%. Neutropenic complications were worse in later cycles. No severe aplasia or aplastic death were identified, however Grade I-II bi-cytopenia was not uncommon. 43% of patients developed grade III-IV LON (median 74 days; ANC = 0.5). Risk factors included female sex and increasing number of FCR cycles. Age and ANC during chemotherapy did not confer an increased risk. Opportunistic infection rates were low (1%) with no cases of pneumocystic jirovec pneumonia. Conclusion FCR chemotherapy appears to be well tolerated with a relatively low rate of febrile neutropenia, comparable to similar chemotherapy regimens. However, rituximab related late-onset neutropenia is more common with fludarabine based (43%) compared to non- fludarabine-based chemotherapy (3-25%). Further evaluation and data collection will be undertaken. 30 Research Week Abstract Book Northern Health 2013
Haematology HaematOLOGY Intermittent Granulocyte-Colony Stimulating FaCTor (G-Csf) Maintains Dose Intensity After ABVD Therapy Complicated By Neutropenia Ho P, Sherman P and Grigg A. Background G-CSF is commonly used to maintain dose-intensity in patients receiving ABVD for Hodgkin lymphoma (HL). However, some studies suggest that dose-intensity can be maintained without G-CSF, with minimal incidence of febrile neutropenia. Moreover, G-CSF is expensive (approximately A$1925 for pegfilgrastim and A$1050 for 7 days of 300ug filgrastim per cycle) and is associated with side-effects including bone pain and increased risk of bleomycin-related lung toxicity. Intermittent G-CSF may be an effective compromise, given that G-CSF effect on granulocyte precursors in-vitro persists for 4-5 days after administration and intermittent scheduling is effective in maintaining dose-intensity in breast cancer patients receiving adjuvant chemotherapy. After a promising pilot study using intermittent G-CSF for ABVD complicated by neutropenia, this schedule has been used at physician discretion at RMH. Aim To compare the efficacy of daily/pegylated versus intermittent G-CSF protocols between 1996 and 2009. Method Retrospective analysis of the incidence of neutropenia, treatment delays and febrile neutropenia in patients receiving different G-CSF schedules. Results 848 cycles in 85 patients (M:F 43:42; median age = 32 (range:14-71) years) with predominantly stage II/III HL were evaluated. The median neutrophil count when cycle 1B was due was 0.9 (range:0-18.7). Most patients(86%) received G-CSF, generally commencing during cycle 1B. Intermittent G-CSF (typically given on days 4,8,12) was used in 452 cycles compared with 99 cycles for daily/pegylated G-CSF. Febrile neutropenia occurred in 2 and 0 cycles respectively and no treatment delays due to neutropenia occurred in either group. After intermittent G-CSF, the median neutrophil count was 7.3 (range:1.4-47.1x10 9 /L) when chemotherapy was next due, similar to other G-CSF regimens. The cost difference between pegfilgrastim and three doses of 300ug filgrastim per cycle over 11 cycles ( i.e. cycles 1B-6B ) was A$16500. Conclusion Intermittent G-CSF is effective in maintaining dose-intensity in patients receiving ABVD, resulting in substantial cost savings. 31
Page 1 and 2: 2013 Research Week Abstract Book Br
Page 3 and 4: contents appointments contents at L
Page 5 and 6: Introduction Health Literacy And Cl
Page 7 and 8: Introduction cont’d IntRODUCTION
Page 9 and 10: Event Schedule cont’d event sched
Page 11 and 12: ABSTRACTS Abstracts 9
Page 13 and 14: Aged Care Aged Care Does physiother
Page 15 and 16: Aged Care Aged Care A COMParison OF
Page 17 and 18: Aged Care Aged Care FALLS TRENDS WI
Page 19 and 20: Aged Care 17
Page 21 and 22: Chronic Disease Management A SYSTEM
Page 23 and 24: Chronic Disease Management APProPri
Page 25 and 26: Chronic Disease Management INTRODUC
Page 27 and 28: CHROnIC DISEASE Management 25
Page 29 and 30: Haematology HaematOLOGY THE IMPleme
Page 31: Haematology HaematOLOGY HIGH-DOSE M
Page 35 and 36: HaematOLOGY 33
Page 37 and 38: Women’s Health and Paediatrics MU
Page 39 and 40: Women’s Health and Paediatrics TH
Page 41 and 42: Women’s Health and Paediatrics IM
Page 43 and 44: Women’s Health and Paediatrics SA
Page 45 and 46: Health Service Evaluation ESTablish
Page 47 and 48: Health Service Evaluation EValuaTIN
Page 49 and 50: Health Service Evaluation INNOVATIV
Page 51 and 52: Health Service Evaluation EMERGENCY
Page 53 and 54: Health Service Evaluation Northern
Page 55 and 56: Orthopaedics ORTHOPAEDICS DisTAL RA
Page 57 and 58: Orthopaedics ORTHOPAEDICS RETURNING
Page 59 and 60: Orthopaedics ORTHOPAEDICS THEATre S
Page 62: Broadmeadows Health Service 35 John

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