An exploratory study to identify risk factors for the development of capecitabine-induced palmar plantar erythrodysesthesia (PPE)

Aims: to identify pre-treatment risk factors for the development of Palmar Plantar Erythrodysesthesia in participants receiving capecitabine monotherapy. Specifically the hypothesis that avoidance of activities that cause friction and pressure cause Palmar Plantar Erythrodysesthesia was tested. Background. Previous literature showed contradictory evidence on the subject of predictors of chemotherapy-induced Palmar Plantar Erythrodysesthesia. There is a lack of empirical evidence to support the theory that Palmar Plantar Erythrodysesthesia is caused by damage to the microcapillaries due to everyday activities that cause friction or pressure to the hands or feet. Design. Prospective epidemiological study of risk factors. Methods. Prospective data collection. All patients prior to commencing capecitabine monotherapy between 11 June 2009–31 December 2010, were offered recruitment into the study and followed up for six cycles of treatment (n = 174). Data were collected during semi-structured interviews, from participants’ diaries, physical examination of the hands and feet and review of notes. Data relating to activities that cause friction, pressure or heat were collected. Data were analysed using bivariate (chi-square and independent groups Student’s t) tests where each independent variable was analysed against Palmar Plantar Erythrodysesthesia. Results. The only variables that were associated with an increased risk of Palmar Plantar Erythrodysesthesia were a tendency to have warm hands and pre-existing inflammatory disease. Conclusions. This study gives no support for the hypothesis that avoidance of activities that cause friction and pressure cause Palmar Plantar Erythrodysesthesia

Hand-Foot Syndrome with Scleroderma-like Change Induced by the Oral Capecitabine: A Case Report

Hand-foot syndrome (HFS) is a well-known adverse event associated with capecitabine, a prodrug of 5-Fluorouracil (5-FU). HFS manifests as acral erythema, with swelling and dysesthesia of the palms and plantar aspects of the feet, which in the absence of dosage reduction or drug cessation, progresses to moist desquamation and ulceration, resulting in serious infections and loss of function. We report a case of HFS, with scleroderma-like changes, apparently induced by capecitabine. In our case, capecitabine, given in the recommended dosage was observed to lead to hyperpigmentation of the palms and soles, followed by a distinct keratoderma-like thickening unfamiliar to usual cases of HFS. This case may provide important clues for revising the definition of HFS, and allow the formation of effective preventive strategies for this side effect of chemotherapy

Minimal residual disease program for acute lymphoblastic leukemia at Dhahran Health Center

Background and Objectives: Minimal residual disease (MRD) assays for monitoring acute lymphoblastic leukemia (ALL) during treatment are defined as assays with a limit of detection of at least 0.01% leukemic blasts per mononuclear cells or total nucleated cells. Settings and Design: We retrospectively reviewed out experience at Dhahran Health Center in monitoring adult and pediatric ALL patients with a MRD assay based on immunophenotyping by flow cytometry with a level of detection of 0.01% leukemic blasts per mononuclear cells and compute Kaplan–Meier survival analysis for overall survival (OS) and relapse-free survival (RFS). We also demonstrated the incorporation of an estimated measurement uncertainty for the reported MRD values based on metrological principles. Methods: A retrospective review of all cases diagnosed with ALL from 2006 to 2012 was undertaken and after applying exclusion criteria, 26 cases were identified and patient chart review was done. Results: Although the Kaplan–Meier survival analysis for OS and RFS do demonstrate a statistically significant difference between MRD positive and negative patients, none of the pediatric ALL MRD positive cases have relapsed till now. Conclusions: The detection of MRD in ALL opens up the opportunity to intensify or alter treatment for patients with detectable levels by a highly sensitive assay before clinical relapse

A Single Intravenous Dose of Murine Megakaryocyte Growth and Development Factor Potently Stimulates Platelet Production, Challenging the Necessity for Daily Administration

Abstract The thrombopoietic efficacy of recombinant forms of c-mplligand is being actively investigated in preclinical studies using daily dosing schedules. However, a comprehensive kinetic study of the thrombopoietic response to a single injection of recombinant c-mpl ligand has not been performed. Here, we present the results of a detailed kinetic analysis of the platelet response to a single intravenous administration of pegylated recombinant murine megakaryocyte growth and development factor (PEG-rmMGDF) in mice. In addition, we compare the efficacy of single versus daily dosing in stimulating platelet production. A single intravenous injection of PEG-rmMGDF produced a marked and dose-dependent elevation in platelet number and a moderate increase in mean platelet volume (MPV). After administration of 25 or 250 μg/kg of PEG-rmMGDF, platelet number was first increased on day 3 and peaked at 2.7-fold (25 μg/kg) and 5.7-fold of normal (250 μg/kg) on day 5. Thereafter, platelet number declined and returned to baseline by days 9 and 14, with the 25 and 250 μg/kg doses, respectively. MPV began to increase on day 2 after PEG-rmMGDF, reaching maximum values of 1.2-fold (25 μg/kg) and 1.5-fold of normal (250 μg/kg) on day 4. Subsequently, MPV declined and was downregulated on days 6 to 7 (25 μg/kg) and day 8 (250 μg/kg). Based on these results, we evaluated the platelet response to PEG-rmMGDF administered intravenously as a single dose versus daily for 5 days. A single administration of 100 μg/kg produced a higher platelet number on day 5 than daily administration of 100 or 20 μg/kg for 5 days. However, the thrombocytosis was less sustained after single versus daily dosing. The smaller platelet number increase on day 5 after daily dosing reflected the production of larger platelets, rather than suppression of thrombopoiesis. Our results indicate that PEG-rmMGDF administered as a single intravenous dose potently stimulates platelet production in mice, challenging the need for its daily administration. Adoption of an intermittent administration schedule of this cytokine could be more efficacious and is merited in future clinical trials.</jats:p

A Single Intravenous Dose of Murine Megakaryocyte Growth and Development Factor Potently Stimulates Platelet Production, Challenging the Necessity for Daily Administration

The thrombopoietic efficacy of recombinant forms of c-mplligand is being actively investigated in preclinical studies using daily dosing schedules. However, a comprehensive kinetic study of the thrombopoietic response to a single injection of recombinant c-mpl ligand has not been performed. Here, we present the results of a detailed kinetic analysis of the platelet response to a single intravenous administration of pegylated recombinant murine megakaryocyte growth and development factor (PEG-rmMGDF) in mice. In addition, we compare the efficacy of single versus daily dosing in stimulating platelet production. A single intravenous injection of PEG-rmMGDF produced a marked and dose-dependent elevation in platelet number and a moderate increase in mean platelet volume (MPV). After administration of 25 or 250 μg/kg of PEG-rmMGDF, platelet number was first increased on day 3 and peaked at 2.7-fold (25 μg/kg) and 5.7-fold of normal (250 μg/kg) on day 5. Thereafter, platelet number declined and returned to baseline by days 9 and 14, with the 25 and 250 μg/kg doses, respectively. MPV began to increase on day 2 after PEG-rmMGDF, reaching maximum values of 1.2-fold (25 μg/kg) and 1.5-fold of normal (250 μg/kg) on day 4. Subsequently, MPV declined and was downregulated on days 6 to 7 (25 μg/kg) and day 8 (250 μg/kg). Based on these results, we evaluated the platelet response to PEG-rmMGDF administered intravenously as a single dose versus daily for 5 days. A single administration of 100 μg/kg produced a higher platelet number on day 5 than daily administration of 100 or 20 μg/kg for 5 days. However, the thrombocytosis was less sustained after single versus daily dosing. The smaller platelet number increase on day 5 after daily dosing reflected the production of larger platelets, rather than suppression of thrombopoiesis. Our results indicate that PEG-rmMGDF administered as a single intravenous dose potently stimulates platelet production in mice, challenging the need for its daily administration. Adoption of an intermittent administration schedule of this cytokine could be more efficacious and is merited in future clinical trials.</jats:p