1,720,972 research outputs found
Efficacy of new drugs as induction treatment before single or tandem autologous stem cell transplantation in newly diagnosed multiple myeloma patients: a single centre experience
Full text linkThe outcome of patients affected by Multiple Myeloma (MM) has markedly improved over the past decade, both in young and elderly patients. In the past years, conventional therapy, such as melphalan plus prednisone (MP), was the only active treatment against MM. Since the 1980s, high doses of chemotherapy plus autologous stem cell transplantation (ASCT) proved to be the most suitable option for young newly diagnosed multiple myeloma (YNDMM) patients. More recently, new active classes of drugs, such as proteasome inhibitors-PIs (e.g., bortezomib) and immunomodulatory drugs-IMiDs (e.g., thalidomide and lenalidomide) became the standard of care, alone or in association with the old agents, either for fırst-line therapy in the transplant and non-transplant settings, or for the treatment of relapsed disease.
Actually, three-drugs combinations, including at least bortezomib or lenalidomide in combination with dexamethasone, followed by ASCT is considered the optimal choice for all YNDMM.
Patients and Methods: we retrospectively analyzed our Centre experience in the last 25 years comparing the results obtained with old drugs- that is conventional chemotherapy- versus novel agents –such as lenalidomide and bortezomib- in YNDMM. We also performed an additional analysis on the effect of a single versus tandem ASCT either with old agents or with novel agents.
Results: Between August 1989 and May 2014, 258 YNDMM patients underwent ASCT. The median age was 54 years (range, 18-69), 137 were men. As induction treatment, between October 1988 and October 2008, 173/258 patients received old drugs, i.e. vincristine, doxorubicin and dexamethasone (VAD; n=167) or MP (n=6), while 85/258 patients, between February 2005 and November 2013, were treated with novel agents, i.e. velcade-based (n=67) or IMiD-based regimens (n=18). All 258 patients received high doses of melphalan and single (n=153) or tandem (n=105) ASCT. Overall, after induction, 67 patients (25.9%) achieved complete response (CR), near CR (nCR) or very good partial response (VGPR). More in detail, among patients treated with new drugs, a CR/nCR/VGPR was observed in 36/85 patients (42.3%) after induction, in 36/85 patients (42.3%) after single ASCT and in 27/50 patients (54%) after tandem ASCT. No differences were observed in terms of response and survival between IMiDs or bortezomib-based regimens. For patients treated with old drugs, a CR/nCR/VGPR was recorded in 31/173 (17.9%) after induction, in 50/173 patients (28.9%) after single ASCT and in 19/55 patients (34.5%) after tandem ASCT.
Overall survival (OS) and progression-free survival (PFS) at 10 years, for all 258 patients, was 44.4% and 22.5%, respectively. OS and PFS were better for patients in CR/nCR/VGPR after induction compared to those in partial response or stable disease (OS: 62.1% vs 40.7%, p=0.06 and PFS: 36.2% vs 17.2%, p=0.06). In addition, OS was slightly better for patients treated with new drugs than those treated with old drugs. In fact, OS at 8 years was 66.1% (IC 95%:53.5-81.7) for the first group vs 51.5% for the second group, respectively (p = 0.26 n.s.). PFS was significantly improved for patients treated with new drugs than those treated with old drugs. In fact, PFS at 8 years was 55% for the first group vs 25.3% for the second group, respectively (p = 0.0047).
Supposing that the impact on OS was influenced by the salvage treatments used after the progression of disease, we further analyzed patients that relapsed. Among our 258 patients, 144 presented a first relapse.
Our cohort of relapsed patients was divided in 4 different groups:
1) 51 patients treated with old agents as first and second line therapy (35.4%);
2) 79 patients treated with old agents for first line therapy and novel agents for second line therapy (54.8%);
3) 2 patients treated with novel agents in induction therapy and subsequent old agents in second line therapy for worsening clinical condition (1.4%);
4) 12 patients treated with novel agents both in first and second line treatment (8.3%).
Our analysis was focused on group 1 and 2. The group 3 was not considered for the small number of patients and because the choice of treatment was based exclusive on clinical worsening condition; the group 4 was not included for the small number of patients and because follow up is too short.
OS at 10 years for patients of group 2 was significantly higher than patients of group 1 (20.4 vs 2.4%; p < 0.0001). Also PFS at 10 years showed better results for patients of group 2 (10% vs 2.3%; p = 0.02). The PFS2 at 10 years, considered as the interval from the start of the first line treatment to progression after second-line therapy or death from any cause, showed better results for patients of group 2 than patients of group 1 (25.7% vs 9.2%; p = 0.0002).
Conclusions: Our experience confirmed that novel agents provide better outcome and deeper responses as induction treatment for YNDMM patients and tandem ASCT still improve the responses in these patients. Moreover, novel agents have also a significant impact in the subsequent lines of treatments, showing better results in terms of PFS2. In the light of the newer IMiDs and PIs, the challenge is to assess the exact role of ASCT in the modern setting; our next effort will be the evaluation of YNDMM patients treated with the new-generation agents (carfilzomib and others) in terms of outcome and safety, and the role of ASCT even in this setting, in a larger cohort of patients and with a appropriate follow up
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Clinical features and prognostic factors in solitary plasmacytoma
No full textThis study aimed to review the clinical features and outcome of 53 patients with solitary plasmacytoma managed at our Institution between 1976 and 2012. Thirty-five patients had bone solitary plasmacytoma and 18 extramedullary solitary plasmacytoma. Tumour sizes were larger in patients with bone involvement (P=0·003). Treatment consisted of local radiotherapy (n=26), radiotherapy+chemotherapy (n=15), surgery (n=4) and chemotherapy (n=8); the local control rate was 94·3%. Progression to multiple myeloma was recorded in 20/35 (57·1%) patients with bone involvement and in 1/18 (5·5%) patients with extramedullary disease (P=0·0003). The 5-year overall survival (OS) rate was 78·4%; bone solitary plasmacytoma patients had a significantly worse OS (71·9% vs. 88·2%, respectively; P=0·029) and 5-year progression-free survival (PFS; 53·0% vs. 88·5%; P=0·0003) compared to extramedullary solitary plasmacytoma patients. On univariate analysis, bone disease and size (≥5cm) impacted negatively on PFS (P=0·0027 and P=0·04, respectively). Bone disease also affected OS (P=0·04). In multivariate analysis bone location was the only independent prognostic factor for PFS (P=0·0041) and OS (P=0·021). Patients with bone solitary plasmacytoma have a significantly worse prognosis than extramedullary solitary plasmacytoma cases
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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