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Cost-utility analysis of idelalisib in combination with rituximab in relapsed or refractory chronic lymphocytic leukaemia.
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Cost-utility analysis of idelalisib in combination with rituximab in relapsed or refractory chronic lymphocytic leukaemia.

Eur J Haematol. 2017 Dec 11;:

Authors: Casado LF, Hernández JÁ, Jarque I, Echave M, Casado MA, Castro A

Abstract
OBJECTIVE: To evaluate the incremental cost-utility ratio (ICUR) of idelalisib in combination with rituximab (IR) versus rituximab monotherapy (R) in the treatment of patients with relapsed or refractory (R/R) chronic lymphocytic leukaemia (CLL), from the Spanish National Health System (NHS) perspective.
METHODS: A partitioned survival Markov model for a lifetime horizon (30 years) was developed to estimate costs (€, 2016) and quality-adjusted life years (QALY) with IR and R. Initial cohort included patients with CLL receiving a second or subsequent line (2L) of treatment with IR or R. Survival data was based on CLL clinical trial. Drug, administration, monitoring, adverse events, and clinical management of CLL costs were included in the model. Costs and outcomes were discounted using a 3% annually. Deterministic and probabilistic sensitivity analyses (PSA) were performed.
RESULTS: Compared to R, 2L IR treatment results in QALY gain of 3.147 (4.965 versus 1.818). Total costs were €118,254 for IR versus €23,874 for R. ICUR was €29,990/QALY gained with IR versus R. In the PSA, IR was cost-effective in 78% of iterations using a threshold of €45,000/QALY.
CONCLUSION: IR can be considered a cost-effective treatment compared to R, in the treatment of R/R CLL patients for the Spanish NHS. This article is protected by copyright. All rights reserved.

PMID: 29226472 [PubMed - as supplied by publisher]




Predictive value of 18 F-FDG PET/CT scanning in combination with clinical parameters in patients with newly diagnosed multiple myeloma.
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Predictive value of 18 F-FDG PET/CT scanning in combination with clinical parameters in patients with newly diagnosed multiple myeloma.

Eur J Haematol. 2017 Dec 11;:

Authors: Tu H, He Y, Huang T, Choe S, Lan X, Duan X, Sattar H, Li C, Zhou F

Abstract
OBJECTIVE: To evaluate the association of 18 F-2'-deoxy 2'-fluorodeoxyglucose (18 F-FDG) PET/CT with clinical parameters in predicting patients with newly diagnosed multiple myeloma (MM).
METHODS: 120 MM patients undergoing 18 F-FDG PET/CT scanning were analyzed in a retrospective cohort study.
RESULTS: Based on multivariate analysis, β2M, LDH, number of focal lesions (FLs) and SUVmax were significantly correlated with OS. These 4 variables were used to construct a new staging system (NSS) based on the number of risk factors. NSS provided a better discrimination of risk between stages III and II than International staging system (ISS) (p < 0.001 vs. p = 0.086). For OS, there was no significant difference among risk groups in Durie-Salmon (DS) stage (p > 0.05). Based on Spearman correlation analysis, presence of lesions in appendicular skeleton, number of FLs and SUVmax appeared to indicate advanced stage of MM. ROC curves which showed the combination of β2M with Calcium got a specificity of 96.3% for lesions in appendicular skeleton, and LDH alone had 100% specificity in predicting the number of FLs, although the sensitivity was only 50%.
CONCLUSIONS: 18 F-FDG PET/CT in combination with clinical parameters provided an accurate and simple method for risk stratification of patients with newly diagnosed MM. This article is protected by copyright. All rights reserved.

PMID: 29226428 [PubMed - as supplied by publisher]




Case Report: Treatment of Light Chain Amyloidosis with Daratumumab Monotherapy in Two Patients.
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Case Report: Treatment of Light Chain Amyloidosis with Daratumumab Monotherapy in Two Patients.

Eur J Haematol. 2017 Dec 11;:

Authors: Gran C, Gahrton G, Alici E, Nahi H

Abstract
Immunoglobulin light-chain amyloidosis (AL) affects multiple organs, most prominently the kidney and the heart. Renal and cardiac impairment are both associated with poor prognosis.(1) Typical treatment regimens for AL include proteasome inhibitors, alkylating agents, and steroids as well as autologous stem cell transplantation (ASCT) for younger, fit patients. Complete response after treatment is associated with a better outcome and can be measured by free light chain (FLC) reduction.(2, 3) Monoclonal antibodies such as daratumumab (Dara, human IgG1 anti-CD38) have shown promising efficacy for the treatment of relapsed and refractory multiple myeloma. Recently, encouraging results were reported on patients with AL who received Dara treatment.(4, 5). This article is protected by copyright. All rights reserved.

PMID: 29226427 [PubMed - as supplied by publisher]




Significance of thrombocytopenia in patients with primary and post-essential thrombocythemia/polycythemia vera myelofibrosis.
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Significance of thrombocytopenia in patients with primary and post-essential thrombocythemia/polycythemia vera myelofibrosis.

Eur J Haematol. 2017 Dec 11;:

Authors: Masarova L, Alhuraiji A, Bose P, Daver N, Pemmaraju N, Cortes J, Pierce S, Kantarjian H, Verstovsek S

Abstract
Severe thrombocytopenia (platelets <50 x109 /L) is associated with very poor outcome of patients with myelofibrosis (MF). Since patients with primary myelofibrosis (PMF) differ from patients with post-essential thrombocythemia (PET-MF) and post-polycythemia vera myelofibrosis (PPV-MF), we aimed to evaluate the significance of low platelets among these patients. We present clinical characteristics and outcome of patients with either PMF, PPV-MF, or PET-MF, and thrombocytopenia who presented to our institution between 1984 and 2015. Of 1269 patients (877 PMF, 212 PPV-MF, 180 PET-MF), 11% and 14% had platelets either <50 x109 /L or between 50-100 x109 /L, respectively. Patients with platelets <50 x109 /L were most anemic and transfusion dependent, had highest blast count and unfavorable karyotype. In general, their overall and leukemia free survival was the shortest with median time of 15 and 13 months, respectively; with incidence of acute leukemia almost twice as high as in the remaining patients (6.9 vs 3.6 cases per 100 person-years). Nevertheless, this observation remains mostly significant for patients with PMF, as those with PEV/PVT-MF have already significantly inferior prognosis with platelets <100 x 109 /L. This article is protected by copyright. All rights reserved.

PMID: 29226426 [PubMed - as supplied by publisher]