scholarly journals THE ROLE OF CORTICOSTEROIDS IN ADULT RESPIRATORY DISTRESS SYNDROME CAUSED BY VIRIDANS GROUP STREPTOCOCCI BACTEREMIA IN NEUTROPENIC PATIENTS

2014 ◽  
Vol 6 (1) ◽  
pp. e2014055 ◽  
Author(s):  
Abraham Tareq Yacoub ◽  
Lysenia Mojica ◽  
Lily Jones ◽  
Andrea Knab ◽  
Sally Alrabaa ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Adverse Events ◽  
Cancer Patients ◽  
Hematologic Malignancy ◽  
Case Series ◽  
Cancer Center ◽  
Viridans Streptococci ◽  
Gram Positive ◽  
Neutropenic Patients ◽  
Gram Positive Cocci

IntroductionDuring the last decades, gram-positive bacteremia has increased dramatically. Gram-positive cocci are the most frequent cause of nosocomial bloodstream infections. Among Gram-positive cocci, Viridans streptococci are a common cause of bacteremia in cancer patients with neutropenia, causing serious complications such as pneumonia, septic shock, and ARDS [1-6]. We present a series of cases of VGS bacteremia complicated with ARDS; early initiation of corticosteroids resulted in complete recovery.Materials and MethodsA retrospective chart review of patients with hematologic malignancy diagnosed with VGS bacteremia admitted to the Moffitt Cancer Center in Tampa, Florida between 1/1/2001 and 4/1/2012 was completed. Data was collected about respiratory symptoms, diagnosis of adult respiratory syndrome, results of blood cultures, medications received and outcome.ResultsIn this study, 70 cases of VGS bacteremia in neutropenic patients were reviewed.  The most common adverse event of VGS bacteremia in this group of patients is the development of serious pulmonary complications such as ARDS. In our study, 7 patients developed ARDS. The most common identifies streptococcal species was Streptococcus mitis, isolated in 4 of 7 patients. All 7 patients received corticosteroids early with the onset of respiratory failure. The most commonly prescribed regimen was methylprednisolone 60 mg intravenously every 12 hour for an average of 3 days.  All patients received comparable supportive care, appropriate antibiotics, ventilation and hemodynamic support. All patients (100 %) recovered from respiratory failure after receiving corticosteroids. There were no significant adverse events attributable to steroids use.ConclusionStreptococcus mitis is the species most frequently isolated from the patients who have developed ARDS from Streptococcus viridans bacteremia. Our data suggest that the early administration of corticosteroids to neutropenic patients who develop early signs of respiratory failure with VGS bacteremia can prevent the progression of ARDS and improve mortality.  Moderate doses of steroids with short duration of administration were not associated with significant adverse events in our case series. While the use of corticosteroids in this setting has been described in the literature since the early 1990s, there remains a scarcity of data and our study help shed some light on this area. Moreover there is little recognition among clinicians of the association between ARDS and VGS bacteremia (particularly mitis species in neutropenic cancer patients) and thus this treatment modality is used late in the course of illness which may reduce benefit.  Further studies are warranted to validate these findings and to further examine the utility of preemptive use of corticosteroids in cancer patients who develop VGS bacteremia, in regards to ARDS incidence reduction.

scholarly journals Olaparib dose re‐escalation in ovarian cancer patients who experienced severe and/or uncommon adverse events: A case series

2021 ◽  
Vol 17 (S3) ◽  
pp. 3-11
Author(s):  
Siew‐Fei Ngu ◽  
Ka‐Yu Tse ◽  
Mandy M. Y. Chu ◽  
Hextan Y. S. Ngan ◽  
Karen K. L. Chan
Keyword(s):  
Ovarian Cancer ◽  
Adverse Events ◽  
Cancer Patients ◽  
Case Series

Characteristics and outcomes of cancer patients ≥80 years treated with chemotherapy at a comprehensive cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8548-8548
Author(s):  
P. Jiang ◽  
M. Choi ◽  
D. Smith ◽  
L. Heilbrun ◽  
S. M. Gadgeel
Keyword(s):  
Cancer Patients ◽  
Solid Tumors ◽  
Solid Tumor ◽  
Hematologic Malignancy ◽  
Survival Rates ◽  
The United States ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Tumor Patients ◽  
Hematologic Cancer

8548 Background: The percentage of cancer patients ≥ 80 years old is expected to rise in the United States. However data are limited on use of chemotherapy in this group of patients. Methods: Retrospective identification of patients who received systemic chemotherapy at our cancer center between 1/1/2000 to 12/31/2004 was performed using the computer generated pharmacy data and medical records. Patients who had diagnosis of cancer and ≥ 80 years were included in the study; patients receiving only supportive care, hormonal therapy, or oral chemotherapy were excluded. The protocol for this study was approved by the Wayne State University IRB. Results: A total of 133 patients ≥ 80 years who received chemotherapy was analyzed. The median age was 83 and 31% of the patients were ≥ 85 years. There were more females (61%) than males (39%). The gender distribution was more even (47% v. 53%) after excluding gender specific tumors. The racial distribution was diverse- Whites 65 (49%); Blacks 41 (31%); Other 18 (13%); Unknown 9 (7%). 16% of the patients had hematologic malignancy and 84% had solid tumors. Gynecological cancers (32%) followed by aerodigestive cancers (26%) were the most common solid tumors. Solid tumor patients primarily had regional (48%) or distant (45%) disease. During the first regimen, 512 cycles of chemotherapy was delivered with a median of 3 cycles per patient (range 1–24 cycles); 40% of patients received only 2 cycles of chemotherapy. 64% of patients were able to receive chemotherapy without 2nd cycle delay. The distribution of single or multidrug regimens was fairly similar; Solid tumors 52% v. 48%; Hematologic cancers 43% v. 57%. Carboplatin and paclitaxel (22%) was the most common regimen among solid tumor patients. 26% of all patients received a second regimen. The 1 year survival rates among hematologic cancer and solid tumor patients were 65% and 48%, respectively. Stage of disease was the only statistically significant factor predicting survival. Conclusions: In this diverse group of cancer patients ≥ 80 years old and selected for chemotherapy, the treatment was feasible. The survival outcomes in this elderly population were comparable to those of a younger patient population suggesting that the treatment is beneficial. No significant financial relationships to disclose.

Treatment of patients with metastatic renal cell carcinoma (RCC) and end-stage renal disease (ESRD) with targeted therapy (TT): A case series.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 453-453 ◽  
Author(s):  
Amber Flaherty ◽  
Marc Ryan Matrana ◽  
Bradley J. Atkinson ◽  
Nizar M. Tannir
Keyword(s):  
Adverse Events ◽  
Clear Cell ◽  
Case Series ◽  
Median Number ◽  
Cancer Center ◽  
Limited Data ◽  
Inclusion Criteria ◽  
Md Anderson ◽  
Stage Renal Disease ◽  
End Stage

453 Background: Studies have shown that RCC is more prevalent in patients with ESRD, and RCC outcomes in patients with ESRD differ from those of the general RCC population. There is limited data regarding the use of TT in patients with metastatic RCC (mRCC) who are maintained on dialysis for ESRD. Methods: We retrospectively reviewed records of patients with mRCC who were seen at UT MD Anderson Cancer Center and received TT (sunitinib, sorafenib, pazopanib, temsirolimus, everolimus, erlotinib, or bevacizumab) over the last eight years (2003-2011) and who also had ESRD and underwent hemodialysis (HD) or peritoneal dialysis (PD). Overall survival (OS) was determined from initiation of TT to death. Results: Eleven patients (6 males; 8 with clear cell, 3 with papillary) were identified who met the above inclusion criteria. Median age was 57.4 years. Comorbidities included hypertension in 10, diabetes in 4, and hyperlipidemia in 6. Median number of TT was 4 (range, 1-6). Median time on treatment (TOT) was 769 days (range, 73-1792), Seven patients have died. Seven patients were on both HD and TT for over 1 year. Median OS was 1075 days (95% CI, 722-1428). TT related adverse events (AEs) included hypertension (HTN), hand-foot skin reaction (HFS), fatigue, diarrhea, rash and pneumonitis [Table]. There were no treatment related deaths. Conclusions: In this small retrospective series of patients with mRCC and ESRD who were treated with TT, adverse events were acceptable, and relatively prolonged disease courses were noted. [Table: see text]

Point: Fluoroquinolone-Based Antibacterial Chemoprophylaxis in Neutropenic Cancer Patients Works for Defined Outcomes in Defined Populations, but Must Be Used Wisely

2004 ◽  
Vol 2 (5) ◽  
pp. 433-444 ◽  
Author(s):  
Eric J. Bow
Keyword(s):  
Viridans Streptococci ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Negative ◽  
Prescribing Behavior ◽  
Phase Ii Clinical Trials ◽  
Empirical Antibacterial Therapy ◽  
Invasive Infections ◽  
Neutropenic Patients ◽  
Related Mortality

Fluoroquinolone-based antibacterial chemoprophylaxis administered in situations in which the prevalence of fluoroquinolone-resistant Escherichia coli is low (<3% to 5%) can reliably reduce the risk for invasive gram-negative bacillary infection, and, if supplemented by gram-positive agents such as rifampin, penicillin, or macrolides, can reduce the risk of developing invasive infections caused by gram-positive microorganisms, including Viridans streptococci and coagulase-negative staphylococci. In the published literature, fluoroquinolone-based chemoprophylaxis does not reliably reduce the incidence of febrile neutropenic episodes, neutropenic episode-related mortality, or physician-initiated systemic antimicrobial prescribing behavior. Prophylaxis should only be prescribed in defined patient populations from the first day of cytotoxic therapy until neutrophil regeneration in environments in which the prevalence of gram-negative bacillary resistance to the prophylaxis strategy is low. Small phase II clinical trials suggest that empirical antibacterial therapy of unexplained fevers in neutropenic patients receiving effective fluoroquinolone-based prophylaxis under defined epidemiologic circumstances may be safely discontinued early. Better discriminators of infection in febrile neutropenic patients are needed.

Predictors of palliative care (PC) referral for advanced cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19613-e19613
Author(s):  
Kimberson Tanco ◽  
David Hui ◽  
Sun Hyun Kim ◽  
Jung Hye Kwon ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Neck Cancer ◽  
Hematologic Malignancy ◽  
Gynecologic Cancer ◽  
Cancer Center ◽  
Factors Associated

e19613 Background: We previously examined factors associated with delayed PC referral. Little is known about the actual proportion of patients referred to PC. We determined the proportion of patients who had a PC consultation at our cancer center and the predictors of referral. Methods: All adult patients in the Houston area who died of advanced cancer between 9/1/2009 and 2/28/2010 while under the care of our institution were included. We collected baseline demographics and data on PC referral. Multivariate logistic regression was used to examine factors associated with PC referral. Results: 386/912 (42%) decedents had a PC referral, and 179 (46%) were seen initially as outpatients. In multivariate analysis, PC referral was associated with younger age (odds ratio (OR) 0.98 per year; 95% confidence interval (CI) 0.97-0.99; P<0.001), married status (OR 1.5; 1.1-2.0; P=0.005), and gynecologic cancer (OR 1.9, 1.1-3.5, P=0.02 relative to lung). Among patients with a PC referral, outpatient consultation was more likely among patients with head and neck cancer (OR=5.5, 1.7-17.6, P=0.004 relative to lung). In contrast, hematologic malignancy was associated with decreased PC referral (OR=0.59, 0.36-0.97, P=0.04), fewer outpatient PC consultations (OR=0.3, 0.1-0.7, P=0.01) and less time from referral to death (Table). Conclusions: Younger, married patients and those with gynecologic cancer were more like to be referred to palliative care. Head and neck cancer patients were more often seen as PC outpatients. Patients with hematologic malignancies had fewer PC referrals and often late in the disease trajectory compared to patients with solid tumors. [Table: see text]

Abstract 17321: Aspirin Use is Associated With Improved Survival in Severely Thrombocytopenic Cancer Patients With Acute Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Attila Feher ◽  
Rekha Parameswaran ◽  
Eytan M Stein ◽  
Dipti Gupta
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cancer Patients ◽  
Major Bleeding ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Categorical Variables ◽  
Cancer Center ◽  
Rank Statistic ◽  
Severe Thrombocytopenia

Objective: Patients with hematologic malignancies are at risk for severe thrombocytopenia (sTP). The risk and benefit of aspirin therapy is not known in thrombocytopenic cancer patients who experience an acute myocardial infarction (AMI). Methods: Medical records of patients with hematologic malignancies diagnosed with AMI at Memorial Sloan Kettering Cancer Center during 2005-2014 were reviewed. sTP was defined as platelet count <50 cells k/μL within 7 days of AMI. Demographics, aspirin use, survival and bleeding outcomes were collected. T-tests and Fisher exact tests were used to compare continuous and categorical variables. Survival rates were calculated using the Kaplan-Meier product limit method; groups were compared with log-rank statistic. Results: 118 patients with hematologic malignancies had AMI. 58/118 (49%) had sTP. 25/58 (43%) of those with sTP received aspirin. Patients were mostly male (70%, n=83), mean age 69±11 years, mean follow up 3.6 years. Non-Hodgkin’s lymphoma was the most common hematologic diagnosis (36%, n=42). Survival was significantly worse in patients with sTP vs. no sTP (23% vs. 50% at 1 year, log rank p=0.008). When compared to no sTP with AMI, patients with sTP and AMI were less likely to receive aspirin (83% vs 43%, p=0.0001), thienopyridine (27% vs 3%, p=0.0005) and to undergo coronary angiography (30% vs. 5%, p=0.0005) and revascularization (17% vs. 3%, p=0.03). Cancer patients with sTP and AMI who received aspirin had improved survival when compared to those not treated with aspirin, (92% vs. 70% at 7 days, 72% vs. 33% at 30 days and 32% vs. 13% at 1 year, log rank p=0.008). No fatal bleeding events occurred. Thrombolysis in Myocardial Infarction (TIMI) major bleeding occurred in one patient without sTP. Conclusions: In hematologic malignancy patients with AMI and sTP the use of aspirin was associated with improved survival without increase in major bleeding.

scholarly journals Comparison of Activities of Broad-Spectrum β-Lactam Compounds against 1,128 Gram-Positive Cocci Recently Isolated in Cancer Treatment Centers

1999 ◽  
Vol 43 (4) ◽  
pp. 940-943 ◽  
Author(s):  
Daniel J. Diekema ◽  
Stacy L. Coffman ◽  
Steven A. Marshall ◽  
Mondell L. Beach ◽  
Kenneth V. I. Rolston ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Broad Spectrum ◽  
Empiric Therapy ◽  
Gram Positive ◽  
Gram Positive Cocci

ABSTRACT We report the in vitro activities of broad-spectrum β-lactam antimicrobials tested against 1,128 gram-positive pathogens recently isolated from cancer patients. Cefepime and imipenem were more active than ceftazidime and ceftriaxone against these organisms. Only vancomycin demonstrated reliable activity against oxacillin-resistant staphylococci, Enterococcus spp., andCorynebacterium spp. The spectrum of gram-positive organisms against which cefepime and imipenem have activity provides an advantage over ceftazidime as empiric therapy for cancer patients, potentially reducing the need for the empiric addition of glycopeptides.

scholarly journals ESCHERICHIA COLI: AN IMPORTANT PATHOGEN IN PATIENTS WITH HEMATOLOGIC MALIGNANCIES

2014 ◽  
Vol 6 (1) ◽  
pp. e2014068 ◽  
Author(s):  
Daniel Olson ◽  
Abraham Tareq Yacoub ◽  
Gelenis Domingo ◽  
John Norman Greene
Keyword(s):  
Hematologic Malignancy ◽  
Retrospective Chart Review ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Prophylactic Therapy ◽  
E Coli ◽  
Immunosuppressed Patients ◽  
Hospital Stays ◽  
Neutropenic Patients ◽  
Clinically Significant

AbstractBackgroundEscherichia coli (E. coli) is a pathogen of great concern in immunosuppressed patients.  While antimicrobial prophylactic therapy has become the standard, the emergence of resistant pathogens has some questioning its use.  This study describes our experience with E.coli as a pathogen in neutropenic patients with a hematologic malignancy, and addresses future directions of treatment for this patient population.MethodsA retrospective chart review of 245 E.coli bacteremia patients at Moffitt Cancer Center from 05/18/02 – 05/15/12 was conducted. Patients were identified via microbiology laboratory computerized records.ResultsThe included patients experienced clinically significant E.coli bacteremia resulting in a median hospital stay of 14.7 days.  Several patients developed severe sepsis requiring the use of pressor and ventilator therapy.ConclusionsE.coli is a major pathogen in these patient populations resulting in extended hospital stays and specialized treatment to overcome their E.coli bacteremia. The data supports the use of fluoroquinolone prophylactic therapy, however, earlier detection and treatment of neutropenic infection is needed.

scholarly journals 272. Invasive Pulmonary Aspergillosis: Comparative Analysis in cancer patients with Underlying Hematologic Malignancy vs. Solid Tumor

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S150-S150
Author(s):  
Rita Wilson Dib ◽  
Melissa Khalil ◽  
Johny Fares ◽  
Dima Dandachi ◽  
Ray Y Hachem ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Antifungal Therapy ◽  
Solid Tumor ◽  
Hematopoietic Cell Transplantation ◽  
Hematologic Malignancy ◽  
Invasive Pulmonary Aspergillosis ◽  
Response To Therapy ◽  
Attributable Mortality ◽  
Cancer Center ◽  
Pulmonary Aspergillosis

Abstract Background Over the years, the profile of patients with invasive pulmonary aspergillosis (IPA) has extended beyond the commonly associated population with hematologic malignancy (HM) and is now comprising patients with solid tumors and patients with lung diseases. We therefore aimed to compare the clinical characteristics, diagnostic approach and therapeutic outcome of IPA in cancer patients with hematologic malignancies vs. solid tumor (ST). Methods We conducted a retrospective study evaluating consecutive cases of proven and probable IPA from March 2004 to December 2016 in a tertiary cancer center. We included patients >18 years with an underlying ST, HM, or Hematopoietic Cell Transplantation (HCT) within 1 year of IPA diagnosis. Results A total of 311 patients were analyzed: 225 had HM including HCT and 86 ST. Patients with ST were more likely to have had COPD (33% vs. 8%, P > 0.01) or other underlying pulmonary diseases when compared with HM patients (76% vs. 43%, P < 0.01). Radiation therapy prior to the infection was also notably higher in the ST group than the HM group (48% vs. 14%, P < 0.01). Patients with HM were more likely to have received steroid (38% vs. 15%, P = 0.0001) and have concurrent neutropenia 37% vs. 2%, P < 0.0001). A. fumigatus was most commonly recovered in patients with ST than in patients with HM (66% vs. 38%, P < 0.01). Monotherapy and voriconazole-based primary antifungal therapy were more often prescribed in patients with ST than in patients with HM (87% vs. 56%, P < 0.0001 and 77% vs. 53%, P = 0.0002 respectively). Complete or partial successful response to therapy was recorded in 66% of patients with ST compared with 40% in the HM group (P = 0.0001). IPA attributable mortality within 12 weeks was significantly higher in the HM than in the ST group (30% vs. 18%, P = 0.04). Conclusion Monotherapy with voriconazole were more often prescribed in patients with ST than in patients with HM. Patients with ST had a better response to antifungal therapy and a lower IPA attributable mortality within 12 weeks compared with those with HM. Disclosures All authors: No reported disclosures.

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