BackgroundRituximab is a monoclonal antibody directed at CD20 positive B-lymphocytes and a potential therapeutic option in the treatment of multiple sclerosis. The safety of recurrent dosing is not established.ObjectivesThe objective of this work was to report the experience of long-term rituximab administration in a comprehensive multiple sclerosis care clinic.MethodsThis was a single-center retrospective observational analysis of patients receiving rituximab for the treatment of multiple sclerosis from 2004 to 2015. Different dosing regimens were reviewed to determine whether frequency or dose may affect safety. CD19 and CD20 counts were collected to evaluate B-cell suppression during therapy. Relapses, magnetic resonance imaging activity and rituximab-related adverse events were collected by chart review and prospective database entry.ResultsOf 107 patients included, the average duration of treatment was 33.2 months. Seventy-seven patients received recurrent rituximab dosing after initiation. CD19/20 reconstitution occurred in approximately 20% of patients at 6 months, regardless of dosing strategy. Despite CD19/20 counts of 0, three patients had relapses or magnetic resonance imaging activity. Mostly mild side effects in relation to therapy were seen, with the exception of three patients requiring hospitalization for urinary tract infections.ConclusionsIn our clinic population, rituximab was well tolerated and safe with recurrent administration.
To increase the number of organ donors in England, the government will implement Max and Keira's Law: all adults over the age of 18 living in the United Kingdom become potential organ donors a er their death, unless they choose to opt out. The law will be employed by spring 2020. Despite there being presumed consent for the retrieval of organs, families of the deceased will still be contacted to recheck consent, and ensure that family wishes are upheld.
OBJECTIVES: SCLC accounts for approximately 15% of all lung cancers. Owing to its aggressive nature, its prognosis is worse than other lung carcinomas. Treatment options remain limited, and real-world SCLC treatment outcomes are not clear. The aim of this study was to explore the real-world effectiveness and tolerability of SCLC treatments through an SLR. METHODS: Using the OVID search engine, an SLR was conducted across multiple databases. Searches were limited to English language studies published between January 2006 and February 2018, and included observational, non-interventional studies only. In total, 445 abstracts were retrieved and systematically screened for eligibility. Eligible studies included adult SCLC patients and presented effectiveness and tolerability outcomes from a predefined list of treatments. Additional grey-literature searches were conducted. RESULTS: 1st-line therapies were captured most frequently (n¼10). 2nd-line therapies and beyond were less common (n¼4). No data were captured in 3rd line. Chemo-and radiotherapy were the only therapies reported; overall survival (OS) was the most frequently reported outcome. Median reported OS at 1st line was 16 months (95% CI: 13e25.9) for cisplatin/etoposide/ifosfamide + radiotherapy, 15.7 months (95% CI: 14.0e17.5) for cisplatin/etoposide. Median reported OS in 2nd-line chemotherapy was 5.3 months (95% CI: 4.9e5.8) and 3.8 months (95% CI: 3.5e4.1) for platinum-sensitive and refractory SCLC, respectively. For palliative chemotherapy administered across all lines, median reported OS was 7.3 months (95% CI: 3.3e8.8). Tolerability was reported in eight studies across 1st and 2nd line, with hematological toxicities (neutropenia, leukopenia, thrombocytopenia and anemia) the most frequently reported. CONCLUSIONS: Real-world treatment effectiveness and tolerability data are limited, particularly in 2nd-line therapy and beyond. OS in SCLC remains poor and the incidence of adverse events with treatment increases the burden of the disease. Novel therapies, such as immune-checkpoint inhibitors, may offer a new direction in SCLC management.
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