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Search Results: 1 - 10 of 13497 matches for " maintenance therapy "
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The Efficacy and Safety of a 1.6 mg/m2 Increase in a Bortezomib Regimen  [PDF]
Sohsuke Meshitsuka, Kenshi Suzuki
Open Journal of Blood Diseases (OJBD) , 2015, DOI: 10.4236/ojbd.2015.51001
Abstract: We conducted a single-center, prospective clinical trial in which a subcutaneous bortezomib (Bor) regimen [1.6 mg/m2 per month (BD 1.6 mg/m2 therapy)] was administered to 22 multiple myeloma patients. All patients had been treated sufficiently with once-monthly subcutaneous Bor injections (BD 1.3 mg/m2therapy). Of the 22 patients, 13 had IgG-, 2 had IgA-, and 7 had Bence-Jones protein (BJP)-type multiple myeloma. The observation period for therapeutic effect determination ranged from 84 to 412 days (median: 400 days). Therapeutic effects were investigated in 15 patients during the increase in Bor from 1.3 to 1.6 mg/m2, and none achieved complete remission (CR), very good partial remission (VGPR), or partial remission (PR). Given the small number of patients, a significant conclusion must be reached carefully. However, the chance of stronger success with increases in Bor is low for patients who have already undergone long-term 1.3 mg/m2 Bor treatment. Furthermore, non-hematological toxicity was seen in 12 of 22 patients, so increasing Bor to 1.6 mg/m2 should be considered carefully. However, the statuses of patients in this study suggest that once-monthly Bor could inhibit disease progression. In future we should investigate low-frequency Bor maintenance therapy.
Acute Myeloid Leukemia (AML): The Role of Maintenance Chemo therapy
Thomas Büchner,Wolfgang Hiddemann,Wolfgang E. Berdel,Bernhard W?rmann
International Journal of Hematology-Oncology and Stem Cell Research , 2004,
Abstract: Maintenance treatment for patients with acute myeloid leukemia (AML) in remission has recently been controversially discussed and even abandoned by several groups. An analysis of 16 published multicenter trials, however, revealed the highest probabilities of relapse free survival (RFS) in the range of 35-42 % at 4-5 years only in patients assigned to maintenance treatment when adult age and intent-to-treat conditions were considered. After having demonstrated a superior RFS from 3 year maintenance following standard dose consolidation over that from consolidation alone (p<0.0001), the German AMLCG requestioned the effect of maintenance randomly compared with sequential high-dose AraC and Mitoxantrone (S-HAM) in patients having received intensified induction treatment. The RFS shows an advantage for maintenance with 32 % versus 25 % (p= .021). We conclude that maintenance treatment continues to substantially contribute to the management of adult patients with AML, even as part of recent strategies using intensified induction treatment, and thus appears necessary in these settings.
Completion of Maintenance Bacillus Calmette-Guerin Therapy Might Prolong Recurrence-Free Survival in Patients with Non Muscle Invasive Bladder Cancer  [PDF]
Zaher Bahouth, Ismail Masarwa, Ofer Nativ, Sarel Halachmi
Open Journal of Urology (OJU) , 2015, DOI: 10.4236/oju.2015.56012
Abstract: Objective: The aim of our study was to compare recurrence-free survival between patients who completed treatment with maintenance Bacillus Calmette-Guerin (BCG) and patients who did not complete the planned treatment. Materials and Methods: Data on 115 patients with intermediate- and high-risk Non-Muscle Invasive Bladder Cancer (NMIBC) who were treated with BCG were available for analysis. Patients were categorized into 4 groups based on treatment duration: patients who completed three years of maintenance treatment, patients who stopped treatment while on maintenance, patients who were still on-treatment and patients who were treated with induction course only. Results: Of 115 patients, 86 were men and 29 were women with mean age of 67.8 (range 40 - 93) years. 51% had high-grade tumors and 49% had low-grade tumors. Seventy-three patients (63%) had multiple tumors. Thirty patients (26%) were treated with induction-only, 18 patients (16%) are on-treatment, 14 patients (12%) finished maintenance protocol and 53 patients (46%) discontinued treatment. Reasons for stopping treatment were disease recurrence in 13 patients and toxicity in 40 patients. 5-year recurrence-free survival was 100%, 63%, 60% and 56% in patients who completed maintenance treatment, stopped during maintenance treatment, were on-treatment and those who received induction only therapy, respectively. Conclusions: Patients should be encouraged to adhere to maintenance BCG treatment because of its favorable effect on recurrence-free survival probability.
Successful Treatment of Low-Dose Lenalidomide Maintenance Therapy Followed by Second Autologous Peripheral Blood Stem Cell Transplantation in Heavily Treated Multiple Myeloma  [PDF]
Naohiro Sekiguchi, Naoki Takezako, Takashi Ishii, Akihisa Nagata, Satoshi Noto, Akiyoshi Miwa
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.32022
Abstract: Recently, the prognosis of multiple myeloma has been improved by using high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT), bortezomib, and immunomodulatory drugs including thalidomide and lenalidomide. On the other hand, treatment strategy remains difficult for refractory and relapse cases. Here, we report the successful treatment of low-dose lenalidomide maintenance therapy followed by salvage ASCT in a heavily treated patient with multiple myeloma. This 58-year-old woman with IgG-λ multiple myeloma had a 5th recurrence in June, 2011. It was 7 years post-diagnosis, and she had received conventional therapies such as VAD, MP therapy. Furthermore, the patient had already been treated with ASCT, bortezomib, and thalidomide therapy. At the 5th recurrence, she had extramedullary plasmacytoma in the left orbit. She initially received bortezomib and dexamethasone therapy as induction therapy. After peripheral blood stem cell collection, radiation therapy was performed. The patient then received a second ASCT. Three months later, the response was very good partial response. Finally, the patient was treated with 5 mg/day lenalidomide orally as a maintenance therapy, and she achieved stringent complete response after 2 months according to International Myeloma Working Group response criteria. Low-dose lenalidomide maintenance therapy might be also useful for ASCT as salvage therapy, although further studies are warranted.
Evaluation of the suicide risk factors among methadone maintenance treatment of opiate dependent individuals: A six month assessment  [PDF]
Naghmeh Mokhber, Reza Afshari, Fatemeh Farhoodi
Open Journal of Psychiatry (OJPsych) , 2012, DOI: 10.4236/ojpsych.2012.22013
Abstract: Background: Opiate abuse is a universal socio-medical problem and one of the most important risk factors for suicide, especially in accordance with other psychological disorders. This study designed to evaluate four important suicide risk factors in methadone maintenance therapy clinics within six months treatment. Method: In this cross-sectional study, a psychologist performed interviews with 82 patients who attended in methadone maintenance therapy (MMT) center of Hejazi and Ebnesina hospitals’ clinics, Mashhad, Iran. Five questionnaires including demographic characteristics, Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory (BDI) were completed at first visit and after six months treatment. Results: Eighty two individuals (68 male and 14 female) ranged between 20 to 44 years old (31.68 ± 4.93) abused mostly crystal (crystal heroein) (79.3%), opium (15.9%) then Shishe (methamphetamine) (4.9%). All studied characteristics of the patients decreased significantly after six month follow up (P < 0.01). As BAI, BHS and BSS and BDI were 33.06 ± 14.47, 6.64 ± 5.47, 3.37 ± 3.14 and 8.45 ± 6.17 respectively, before the study and 17.62 ± 8.5, 2.69 ± 2.65, 1.02 ± 1.17 and 5.81 ± 3.41 after the study period, respectively. Most of studied characteristics of the patients attempted suicide (BDI, BHS and BAI) weren’t significantly different between gender before and after the study period (P > 0.05), while BHS after MMT period decreased significantly in men (P = 0.028). Conclusion: The positive effect of methadone maintenance therapy on reduction of four important risk factors for suicide imply on another benefits of this treatment method and it is useful for reduction of suicide risk, among substance abusers.
Prevention of hospital-acquired hypokalemia in children receiving maintenance fluid therapy  [PDF]
Kazunari Kaneko, Ken Yoshimura, Takahisa Kimata, Kohsuke Ishii, Tetsuya Kitao, Sachiyo Tanaka, Shoji Tsuji
Open Journal of Pediatrics (OJPed) , 2012, DOI: 10.4236/ojped.2012.22023
Abstract: Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) production. To reduce its risk, the National Patient Safety Agency in UK issued alert 22 in 2007, of which recommendations were to use isotonic solutions for these children at risk of hyponatremia, instead of the previously most commonly used IVF (0.18% saline/ 4% dextrose) for maintenance fluid therapy. Recent observations, however, revealed that hypokalemia are also common in hospitalized patients who do not receive potassium in their IVF. This study was conducted to validate the potassium added IVF for the prevention of hospital-acquired hypokalemia in maintenance fluid therapy. Design: For maintenance fluid therapy, a commercially available IVF solution in Japan named as Solita-T2R (Na 84 mmol/L, K 20 mmol/L, Cl 66 mmol/L, glucose 3.2%) was infused for 41 sick children with a median age of 3.01 years. Its composition is close equivalent to 0.45% saline/5% dextrose (Na 77 mmol/L, K 0 mmol/L, Cl 77 mmol/L, dextrose 5%) except K content. The patients in states of AVP excess were excluded from the analysis. Results: Median serum potassium value did not drop significantly at a median interval of 48 hours (before IVF: 4.30 mmol/L, after IVF: 4.10 mmol/L, p > 0.05), whereas median serum sodium level significantly increased from 136.0 mmol/L to 139.0 mmol/L (p < 0.001). Conclusion: Potassium added (20 mmol/L) IVF solution reduces the risk of developing “hospital-acquired hypokalemia” in children who are not in states of AVP excess in maintenance fluid therapy. It is worthwhile to study prospectively in a larger number of sick children.
Modern Immunosuppressive Therapy in Kidney Transplantation  [PDF]
Rubin Zhang
Open Journal of Organ Transplant Surgery (OJOTS) , 2013, DOI: 10.4236/ojots.2013.32005
Abstract:

Immunosuppressive therapy is a key component for successful kidney transplantation. It is commonly believed that more intensive immunosuppression is needed initially to prevent rejection episodes and less immunosuppression is subsequently maintained to minimize the overall risk of infection and malignancy. The selection of drugs should be guided by a comprehensive assessment of the immunologic risk, patient comorbidities, financial cost, drug efficacy and adverse effects. Lymphocyte-depleting antibody induction is recommended for patients with high immunologic risk, while IL-2R antibody can be used for low or moderate risk patients. Patients with very low risk may be induced with intravenous steroids without using an antibody. A maintenance regimen typically consists of a low-dose of steroid combined with two of the four class drugs: calcineurin inhibitor (tacrolimus or cyclosporine), antimetabolite (mycophenolate mofetil or enteric coated mycophenolate sodium), mTOR inhibitor (sirolimus or everolimus) and costimulation blocker (belatacept). Currently in the USA, the most popular maintenance is the combination of corticosteroid, mycophenolic acid and tacrolimus. Steroid minimization, or calcineurin inhibitor free or withdrawal should be limited to the highly selected patients with low immunological risk. Recently, the novel biological agent belatacept-based maintenance has demonstrated a significantly better renal function and improved cardiovascular and metabolic profile, which may provide hope for an ultimate survival benefit.

Carbamazepine treatment of bipolar disorder: a retrospective evaluation of naturalistic long-term outcomes
Chia-Hui Chen, Shih-Ku Lin
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-47
Abstract: Bipolar patients diagnosed according to the DSM-IV system and treated with CBZ at the Taipei City Psychiatric Centre had their charts reviewed to evaluate the efficacy and side effects of this medication during an average follow-up period of 10?years.A total of 129 bipolar patients (45 males, mean age: 45.7?±?10.9?year) were included in the analysis of CBZ efficacy used alone (n?=?63) or as an add-on after lithium (n?=?50) or valproic acid (n?=?11), or the both of them (n?=?5). The mean age of disease onset was 24.6?±?9.5?years. The mean duration of CBZ use was 10.4?±?5.2?year. The mean dose used was 571.3?±?212.6?mg/day with a mean plasma level of 7.8?±?5.9?μg/mL. Mean body weight increased from 62.0?±?13.4?kg to 66.7?±?13.1?kg during treatment. The frequencies of admission per year before and after CBZ treatment were 0.33?±?0.46 and 0.14?±?0.30, respectively. The most common side effects targeted the central nervous system (24%), including dizziness, ataxia and cognitive impairment. Other common side effects were gastrointestinal disturbances (3.6%), tremor (3.6%), skin rash (2.9%), and blurred vision (2.9%). Eighty-eight patients (68.2%) were taking antipsychotics concomitantly. Ninety-six patients (74.4%) needed to use benzodiazepines concomitantly. Sixty-three (48.8%) patients had zero episodes in a 10-year follow-up period, compared to all patients having episodes prior to treatment. Using variable analysis, we found better response to CBZ in males than in females.CBZ is efficacious in the maintenance treatment of bipolar disorder in naturalistic clinical practice, either as monotherapy or in combination with other medications. CBZ is well tolerated by most patients in this patient group.Relapse in patients with bipolar disorder is a common problem. More than 90% of patients will have a recurrent episode, and it is also the cause of long-term morbidity and mortality [1,2]. Due to the chronic nature of this illness, there is a need for long-term maintenance tre
Maintenance of Photochemotherapy
Deniz Se?kin
Turkderm , 2010,
Abstract: Phototherapy and photochemotherapy are widely used effective treatment modalities for many skin diseases. The data regarding the efficacy of maintenance narrowband ultraviolet B (NB-UVB) and psoralen and UVA (PUVA) therapies, the most commonly used photo(chemo) therapy methods, in the literature are limited and controversial. In this review article, the data and guidelines in the literature regarding maintenance NB-UVB and PUVA therapy in psoriasis, mycosis fungoides and vitiligo, and maintenance photo(chemo)therapy applications in Ba kent University and other photo(chemo) therapy centers are presented. Prospective, double-blind, randomized, controlled, long-term multicenter studies using standard treatment protocols are needed to obtain the best data about the efficacy and safety of maintenance photo(chemo)therapy applications.
Effect of progesterone as maintenance tocolytic therapy on the prevention of recurrent preterm labor: a randomized clinical trial
Hajieh Borna,Sedigheh Borna,Soghra Khazardoust,Sedigheh Hantoushzadeh
Journal of Family and Reproductive Health , 2007,
Abstract: Objective: The study evaluated the efficacy and safety of vaginal progesterone on prevention of recurrent preterm labor.Materials and methods: Total number of 70 patients with preterm labor treated with intravenous magnesium sulfate in perinatology department of valiasr hospital entered to a randomized clinical trial. Treatment group after inhibition of preterm labor with magnesium sulfate received progesterone suppository (400 mg) daily until delivery and control group received no treatment. Latency until delivery, recurrence of preterm labor and neonatal outcomes were studied. Statistical significance was defined as p< 0.05.Results: Mean latency until delivery (p< 0.05), low birth weight (p< 0.05), birth weight (p< 0.01) were significantly different between the two groups. Recurrence of preterm labor was not significantly different between the groups.Conclusions: The use of vaginal progesterone suppository after successful parenteral tocolysis associated with a longer latency preceding delivery but failed to reduce the incidence of recurrent preterm labor.
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