5 research outputs found
Preemptive and upfront plerixafor: Safe and effective strategy for patients undergoing autologous stem cell transplant and at high risk for mobilization failure
No full textIntroduction: Approximately 10%–30% of patients are unable to collect the minimum number of stem cells to support high-dose chemotherapy and autologous stem cell transplant (hematopoietic stem cell transplantation). Plerixafor alone or in combination with granulocyte colony-stimulating factor (G-CSF) has been shown to significantly increase the CD34 cell collection, especially in patients who failed their initial harvest strategy. This is a retrospective study of 17 preselected patients (relapsed lymphoma and myeloma), who were considered to have high risk of mobilization failure and who had undergone upfront and preemptive plerixafor mobilization. Patients and Methods: The mobilization protocol consisted of G-CSF (10–15 μg/kg) subcutaneously daily for 4 days before the initiation of plerixafor on evening of day 4. The patients then underwent apheresis on day 5. Results: Among 17 patients who underwent apheresis, 16 (93%) yielded the minimum required cell collection of ≥2 × 106 CD34+ cells/kg in a single apheresis session (2 days). Out of these 16 patients, 8 (53%) patients achieved the minimum target dose in a single day. Eight (50%) of all patients achieved the optimum target cell collection in a single apheresis session. Out of these eight patients, five (62%) patients collected optimum yield in a single day. Conclusion: Plerixafor is safe and effective if used upfront and preemptively for patients in whom mobilization of stem cells is considered to be a problem
Chemoradiation for Laryngeal Cancer: Present Scenario
No full textAbstractThe management of locally advanced squamous cell carcinoma of the larynx is complex. Data from recent clinical trials have refined the use of existing therapies, such as radiation therapy and chemotherapy, and providing new treatment options, such as cetuximab. Selecting the most appropriate treatment for an individual patient requires a multidisciplinary approach and careful assessment of the relative advantages and disadvantages of each treatment approach. Chemoradiation is more effective than conventional radiation therapy, but also more toxic. Cetuximab plus radiation therapy is more effective than radiation alone and does not substantially increase radiation-related toxicity. Multimodality approach for laryngeal cancer has shown better organ preservation rates and survival. Ideally, multidisciplinary teams should weigh all these factors when making individual treatment decisions. Data from current trials will help further optimize multimodality treatment for Laryngeal Cancer.</jats:p
The uses of silence : a twentieth-century preoccupation in the light of fictional examples, 1900-1950
No full textA striking feature of twentieth-century Western cultural history was a
preoccupation with silence. This thesis is a survey of the phenomenon across a
broad range of literary and theoretical discourses actively engaged in the period
in exploring and exploiting silence's expressive and philosophical potential. Its
focus, and unifying principle, is the dynamic resourcefulness of the motif-the
diversity of its uses and significations. The meaning of silence shifts according to
its context and the discourse deploying it. By analysing an array of novels and
theoretical formulations-by writers as diverse as James, Chopin, Conrad, H. D.,
Forster, Lawrence, Faulkner, and Wittgenstein, Benjamin, Blanchot, Hassan,
Macherey, Irigaray, Spivak, Derrida-the mobility of silence as a construct is
exposed.
Silence is identified in the fiction of the period 1900-1950, and its
implications are assessed in the light of the various ways in which its uses were
understood and interpreted by twentieth-century theorists. Theory provides a
heuristic device for the comprehension of the fiction selected for scrutiny whilst
further highlighting the extent of the past century's dedication to the motif.
Fiction and theory are regarded as two different manifestations of a fascination
with silence: fiction dramatizes a commitment to the motif which comes to be
formally registered in theoretical discourse as the century progresses.
After an introductory chapter outlining the expanse of the phenomenon to
be studied, the thesis is divided into two parts illustrating the discrete
implications attaching to the motif: 'Social Silences' and 'Ontological Silences'.
The project questions whether the multiplicity of silence's usage may work to
depotentiate its signifying power; in particular, whether its role in abstract
'ontological' formulations diminishes its force for emancipatory 'social'
discourses. In conclusion, by means of the synchronic organization of the thesis,
silence's import is shown to lie in its resourcefulness rather than in any intrinsic
characteristic it might be thought to possess
Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi studyResearch in context
No full textSummary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received
Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO:an international Delphi study
No full textBackground: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received.</p
