SlideShare uma empresa Scribd logo
1 de 1
Baixar para ler offline
SEARCH:    Blood (ASH Annual Meeting Abstracts) 2008 112: Abstract 4699
           © 2008 American Society of Hematology
Advanced
           Publication Only                                                                                     Services
                                                                                                     Email this article to a friend
           Health Services and Outcomes Research                                                     Download to citation manager
                                                                                                            Google Scholar
           Home Management of Unfit Patients with                                                    Articles by Alfieri, P.

           Multiple Myeloma: An Italian Single-Center                                                Articles by Torelli, G.
                                                                                                                PubMed
           Experience                                                                                Articles by Alfieri, P.
                                                                                                     Articles by Torelli, G.
           Pierluigi Alfieri1,*, Enzo Favale1,*, Giovanna Leonardi2,*,                                    Social Bookmarking
           Leonardo Ferrara3,*, Amedea Donelli2,*, Alessia Bari3,*,
           Franco Narni2,*, Roberto Marasca2 and Giuseppe Torelli2,*                                 What's this?

           1Hematology Home Care Service, A.I.L. (Italian Association against Leukemia-Lymphoma-Myeloma), Modena, Italy, 2 Division
           of Hematology, Modena University Hospital, Modena, Italy, 3 Division of Oncology, Modena University Hospital, Modena, Italy

           Abstract

           The majority of patients with multiple myeloma are not eligible for curative treatments because of advanced
           age at diagnosis or contraindications to high-dose chemotherapy. Several anti-myeloma agents and other
           supportive medications, generally provided on outpatient basis, have shown to improve overall survival and
           quality of life even in the setting of unfit and fragile patients. Frequent accesses to day-hospital or outpatient
           clinic may however cause discomfort and unease in myeloma patients presenting vertebral lesions, bone pain,
           severe immunodeficiency and comorbidities. In our department a hospital-based home care service supported
           by the fundraising organisation A.I.L. (Italian Association against Leukemia-Lymphoma-Myeloma) is active
           in order to assist hematology patients who have poor performance status and fulfil other inclusion criteria
           (appropriate home logistics, caregiver availability and trainability, distance from hospital within 20 km,
           cooperation with general practitioners, community nurses and on-call doctors). Through a 9-yrs period (July
           1999 – June 2008) 53 patients (male=26, female=27) affected by multiple myeloma have been enrolled in a
           domiciliary program of supportive and palliative care agreed by the hospital Division of Hematology, the
           Community Health Trust and the local section of the Italian Association against Leukemia-Lymphoma-
           Myeloma (A.I.L.).

           All patients were stage II or III according to Salmon-Durie classification. ECOG performance status was 2.8
           on average. Median age was 76 years (under 60 years=4 patients, between 60 and 70 yrs=11 pts, between 70
           and 80 yrs=17 pts, over 80 yrs=21 pts). At the time they were referred to the service, 14 patients were in
           terminal phase of disease with a life expectancy of about 3 months; 35 patients presented progressive disease
           after at least one previous therapy; there were also 4 patients undergoing transplant-based therapeutic
           programs and discharged early from the ward.

           Patients were generally followed-up on weekly-basis for collection of blood samples, clinical assessment and
           intravenous therapies (bisphosphonates, blood and platelet transfusions, anti-myeloma agents, antimicrobials,
           immunoglobulins). Median duration of a home care cycle was 323 days, with significant differences among
           the three groups of patients (in terminal phase=84 days, in progressive disease=466 days, in causal
           treatment=55 days). Excluding 4 ongoing patients, the end of home care resulted in 15 patients deceased at
           home (37%) and 26 died as inpatients (63%) while 8 patients were referred back to day hospital or ward.
           Urgent hospital admissions were 66, corresponding to an average of 1.25 admissions per home care cycle:
           main reasons were infection and fever, cardiopulmonary complications, renal failure, major bleeding and
           caregiver burnout. Once-monthly bisphosphonate treatment regarded 31 patients for a total of 332 infusions
           (pamidronate=191, zoledronic acid=141). Blood transfusions were provided to 22 patients for a total of 202
           erythrocyte units while 8 patients required platelet transfusions (82 bags). Although most patients were off-
           therapy or in treatment with oral drugs, several novel and conventional anti-myeloma agents were
           administered intravenously at home in monotherapy or in combination, such as bortezomib, dexamethazone,
           vincristine, cyclophosphamide, carmustine, doxorubicine. No serious adverse event was reported as direct
           consequence of home intravenous therapies.

           Home care has achieved a relevant role in the global management of patients with blood malignancies
           improving quality of life and reducing health care costs. Thanks to our operating model, characterized by the
           presence of a full-time specialist team and by a careful selection of patients, home care of unfit patients with
           multiple myeloma represents a valid integration to the standard in-hospital hematology services. Many issues
           remain open, such as cost analysis, quality-of-life assessment, legislation on domiciliary medications, role of
           fundraising organisations and recognition in public health system.

Mais conteúdo relacionado

Mais procurados

Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...Jacob Amofa
 
Understanding the needs of people with hemophilia A will enhance to overcome ...
Understanding the needs of people with hemophilia A will enhance to overcome ...Understanding the needs of people with hemophilia A will enhance to overcome ...
Understanding the needs of people with hemophilia A will enhance to overcome ...Aleksandar Smokovski, MD
 
Big 5 Personality Traits in FMS
Big 5 Personality Traits in FMSBig 5 Personality Traits in FMS
Big 5 Personality Traits in FMSPaul Coelho, MD
 
Getting a bioethics paper published
Getting a bioethics paper publishedGetting a bioethics paper published
Getting a bioethics paper publishedAlbertononi
 
Central mucoepidermoid carcinoma an up to-date analysis of 147 cases
Central mucoepidermoid carcinoma an up to-date analysis of 147 casesCentral mucoepidermoid carcinoma an up to-date analysis of 147 cases
Central mucoepidermoid carcinoma an up to-date analysis of 147 casesMNTan1
 
Adverse drug reactions among critically ill patients at cairo
Adverse drug reactions among critically ill patients at cairoAdverse drug reactions among critically ill patients at cairo
Adverse drug reactions among critically ill patients at cairoAlexander Decker
 
2010 revised criteria_classification_ra
2010 revised criteria_classification_ra2010 revised criteria_classification_ra
2010 revised criteria_classification_raOscar Jarava
 
Introduction to pathology
Introduction to pathologyIntroduction to pathology
Introduction to pathologyVandana Thakur
 
2010 rheumatoid arthritis classification criteria
2010 rheumatoid arthritis classification criteria2010 rheumatoid arthritis classification criteria
2010 rheumatoid arthritis classification criteriaTABATHA PAREDES
 
Gene therapy presentation
Gene therapy presentationGene therapy presentation
Gene therapy presentationMohammedRazi13
 

Mais procurados (17)

Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...
 
Understanding the needs of people with hemophilia A will enhance to overcome ...
Understanding the needs of people with hemophilia A will enhance to overcome ...Understanding the needs of people with hemophilia A will enhance to overcome ...
Understanding the needs of people with hemophilia A will enhance to overcome ...
 
Big 5 Personality Traits in FMS
Big 5 Personality Traits in FMSBig 5 Personality Traits in FMS
Big 5 Personality Traits in FMS
 
Getting a bioethics paper published
Getting a bioethics paper publishedGetting a bioethics paper published
Getting a bioethics paper published
 
Mesothelioma Help - Mesothelioma Prognosis Life Expectancy
Mesothelioma Help - Mesothelioma Prognosis Life ExpectancyMesothelioma Help - Mesothelioma Prognosis Life Expectancy
Mesothelioma Help - Mesothelioma Prognosis Life Expectancy
 
Central mucoepidermoid carcinoma an up to-date analysis of 147 cases
Central mucoepidermoid carcinoma an up to-date analysis of 147 casesCentral mucoepidermoid carcinoma an up to-date analysis of 147 cases
Central mucoepidermoid carcinoma an up to-date analysis of 147 cases
 
Mesotheliomahelp org treatment_faqs__wvideo=ssqfsbmb2
Mesotheliomahelp org treatment_faqs__wvideo=ssqfsbmb2Mesotheliomahelp org treatment_faqs__wvideo=ssqfsbmb2
Mesotheliomahelp org treatment_faqs__wvideo=ssqfsbmb2
 
The Effect of Multi Disciplinary Care 3.26.09
The Effect of Multi Disciplinary Care 3.26.09The Effect of Multi Disciplinary Care 3.26.09
The Effect of Multi Disciplinary Care 3.26.09
 
Adverse drug reactions among critically ill patients at cairo
Adverse drug reactions among critically ill patients at cairoAdverse drug reactions among critically ill patients at cairo
Adverse drug reactions among critically ill patients at cairo
 
Mesotheliomahelp org treatment
Mesotheliomahelp org treatmentMesotheliomahelp org treatment
Mesotheliomahelp org treatment
 
2010 revised criteria_classification_ra
2010 revised criteria_classification_ra2010 revised criteria_classification_ra
2010 revised criteria_classification_ra
 
Introduction to pathology
Introduction to pathologyIntroduction to pathology
Introduction to pathology
 
Ne smith et al.2009.sirs in the icu
Ne smith et al.2009.sirs in the icuNe smith et al.2009.sirs in the icu
Ne smith et al.2009.sirs in the icu
 
Mesotheliomahelp org treatment_chemotherapy
Mesotheliomahelp org treatment_chemotherapyMesotheliomahelp org treatment_chemotherapy
Mesotheliomahelp org treatment_chemotherapy
 
2010 rheumatoid arthritis classification criteria
2010 rheumatoid arthritis classification criteria2010 rheumatoid arthritis classification criteria
2010 rheumatoid arthritis classification criteria
 
Doctors’ Diaries - A PBS Documentary
Doctors’ Diaries - A PBS DocumentaryDoctors’ Diaries - A PBS Documentary
Doctors’ Diaries - A PBS Documentary
 
Gene therapy presentation
Gene therapy presentationGene therapy presentation
Gene therapy presentation
 

Destaque (8)

EHA 2008
EHA 2008EHA 2008
EHA 2008
 
SIES 2008
SIES 2008SIES 2008
SIES 2008
 
SIE 2009
SIE 2009SIE 2009
SIE 2009
 
AIOM 2008
AIOM 2008AIOM 2008
AIOM 2008
 
EHA 2009
EHA 2009EHA 2009
EHA 2009
 
Final dissertation School of Haematology
Final dissertation School of HaematologyFinal dissertation School of Haematology
Final dissertation School of Haematology
 
The Buyer's Journey - by Chris Lema
The Buyer's Journey - by Chris LemaThe Buyer's Journey - by Chris Lema
The Buyer's Journey - by Chris Lema
 
The Presentation Come-Back Kid
The Presentation Come-Back KidThe Presentation Come-Back Kid
The Presentation Come-Back Kid
 

Semelhante a ASH 2008

Chronic Pressure Injury
Chronic Pressure InjuryChronic Pressure Injury
Chronic Pressure InjuryLaura Anderson
 
The benefits of patient involvement in research and development (RE:ACT Congr...
The benefits of patient involvement in research and development (RE:ACT Congr...The benefits of patient involvement in research and development (RE:ACT Congr...
The benefits of patient involvement in research and development (RE:ACT Congr...jangeissler
 
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...MerqurioEditore_redazione
 
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...MerqurioEditore_redazione
 
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...MerqurioEditore_redazione
 
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...MerqurioEditore_redazione
 
Clinical analysis report 14
Clinical analysis report 14Clinical analysis report 14
Clinical analysis report 14Nikee McEyes
 
Nursesí practices and perception of delirium in the intensive care units of ...
Nursesí  practices and perception of delirium in the intensive care units of ...Nursesí  practices and perception of delirium in the intensive care units of ...
Nursesí practices and perception of delirium in the intensive care units of ...Alexander Decker
 
1365054600 salami342012 bjmmr2651
1365054600 salami342012 bjmmr26511365054600 salami342012 bjmmr2651
1365054600 salami342012 bjmmr2651Milaw Aregay
 
Sacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly PatientsSacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly Patientssemualkaira
 
Sacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly PatientsSacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly Patientssemualkaira
 
Sacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly PatientsSacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly Patientssemualkaira
 
Abstract_Book_OK_graciela edits 02-12- 2019.pdf
Abstract_Book_OK_graciela edits 02-12- 2019.pdfAbstract_Book_OK_graciela edits 02-12- 2019.pdf
Abstract_Book_OK_graciela edits 02-12- 2019.pdfByron Trujillo
 
Short Guide For the Management of Transfusion-Dependent Thalassaemia (2nd Edi...
Short Guide For the Management of Transfusion-Dependent Thalassaemia (2nd Edi...Short Guide For the Management of Transfusion-Dependent Thalassaemia (2nd Edi...
Short Guide For the Management of Transfusion-Dependent Thalassaemia (2nd Edi...Thalassaemia International Federation
 

Semelhante a ASH 2008 (20)

Chronic Pressure Injury
Chronic Pressure InjuryChronic Pressure Injury
Chronic Pressure Injury
 
The benefits of patient involvement in research and development (RE:ACT Congr...
The benefits of patient involvement in research and development (RE:ACT Congr...The benefits of patient involvement in research and development (RE:ACT Congr...
The benefits of patient involvement in research and development (RE:ACT Congr...
 
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
 
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
 
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
 
Studio italiano su 4187 pazienti
Studio italiano su 4187 pazientiStudio italiano su 4187 pazienti
Studio italiano su 4187 pazienti
 
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
Caratteristiche cliniche e patologiche del carcinoma differenziato della tiro...
 
Clinical analysis report 14
Clinical analysis report 14Clinical analysis report 14
Clinical analysis report 14
 
Nursesí practices and perception of delirium in the intensive care units of ...
Nursesí  practices and perception of delirium in the intensive care units of ...Nursesí  practices and perception of delirium in the intensive care units of ...
Nursesí practices and perception of delirium in the intensive care units of ...
 
1365054600 salami342012 bjmmr2651
1365054600 salami342012 bjmmr26511365054600 salami342012 bjmmr2651
1365054600 salami342012 bjmmr2651
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Sacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly PatientsSacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly Patients
 
Sacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly PatientsSacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly Patients
 
Sacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly PatientsSacral Neuromodulation in Elderly Patients
Sacral Neuromodulation in Elderly Patients
 
HELSINKI DECLARATION ON PATIENT SAFETY IN ANAESTHESIOLOGY
HELSINKI DECLARATION ON PATIENT SAFETY IN ANAESTHESIOLOGYHELSINKI DECLARATION ON PATIENT SAFETY IN ANAESTHESIOLOGY
HELSINKI DECLARATION ON PATIENT SAFETY IN ANAESTHESIOLOGY
 
Gene therapy
Gene therapyGene therapy
Gene therapy
 
Abstract_Book_OK_graciela edits 02-12- 2019.pdf
Abstract_Book_OK_graciela edits 02-12- 2019.pdfAbstract_Book_OK_graciela edits 02-12- 2019.pdf
Abstract_Book_OK_graciela edits 02-12- 2019.pdf
 
Short Guide For the Management of Transfusion-Dependent Thalassaemia (2nd Edi...
Short Guide For the Management of Transfusion-Dependent Thalassaemia (2nd Edi...Short Guide For the Management of Transfusion-Dependent Thalassaemia (2nd Edi...
Short Guide For the Management of Transfusion-Dependent Thalassaemia (2nd Edi...
 
ITI.06-19-2012
ITI.06-19-2012ITI.06-19-2012
ITI.06-19-2012
 
A Guide for the Haemoglobinopathy Nurse (2013)
A Guide for the Haemoglobinopathy Nurse (2013)A Guide for the Haemoglobinopathy Nurse (2013)
A Guide for the Haemoglobinopathy Nurse (2013)
 

Último

SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)MedicoseAcademics
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)1922Jaygohel
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthArthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthGokuldas Hospital
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 

Último (20)

SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)Transport across cell membrane (passive, active, vesicular)
Transport across cell membrane (passive, active, vesicular)
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)A presentation on Thermal gravimetry analysis (TGA)
A presentation on Thermal gravimetry analysis (TGA)
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthArthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 

ASH 2008

  • 1. SEARCH: Blood (ASH Annual Meeting Abstracts) 2008 112: Abstract 4699 © 2008 American Society of Hematology Advanced Publication Only Services Email this article to a friend Health Services and Outcomes Research Download to citation manager Google Scholar Home Management of Unfit Patients with Articles by Alfieri, P. Multiple Myeloma: An Italian Single-Center Articles by Torelli, G. PubMed Experience Articles by Alfieri, P. Articles by Torelli, G. Pierluigi Alfieri1,*, Enzo Favale1,*, Giovanna Leonardi2,*, Social Bookmarking Leonardo Ferrara3,*, Amedea Donelli2,*, Alessia Bari3,*, Franco Narni2,*, Roberto Marasca2 and Giuseppe Torelli2,* What's this? 1Hematology Home Care Service, A.I.L. (Italian Association against Leukemia-Lymphoma-Myeloma), Modena, Italy, 2 Division of Hematology, Modena University Hospital, Modena, Italy, 3 Division of Oncology, Modena University Hospital, Modena, Italy Abstract The majority of patients with multiple myeloma are not eligible for curative treatments because of advanced age at diagnosis or contraindications to high-dose chemotherapy. Several anti-myeloma agents and other supportive medications, generally provided on outpatient basis, have shown to improve overall survival and quality of life even in the setting of unfit and fragile patients. Frequent accesses to day-hospital or outpatient clinic may however cause discomfort and unease in myeloma patients presenting vertebral lesions, bone pain, severe immunodeficiency and comorbidities. In our department a hospital-based home care service supported by the fundraising organisation A.I.L. (Italian Association against Leukemia-Lymphoma-Myeloma) is active in order to assist hematology patients who have poor performance status and fulfil other inclusion criteria (appropriate home logistics, caregiver availability and trainability, distance from hospital within 20 km, cooperation with general practitioners, community nurses and on-call doctors). Through a 9-yrs period (July 1999 – June 2008) 53 patients (male=26, female=27) affected by multiple myeloma have been enrolled in a domiciliary program of supportive and palliative care agreed by the hospital Division of Hematology, the Community Health Trust and the local section of the Italian Association against Leukemia-Lymphoma- Myeloma (A.I.L.). All patients were stage II or III according to Salmon-Durie classification. ECOG performance status was 2.8 on average. Median age was 76 years (under 60 years=4 patients, between 60 and 70 yrs=11 pts, between 70 and 80 yrs=17 pts, over 80 yrs=21 pts). At the time they were referred to the service, 14 patients were in terminal phase of disease with a life expectancy of about 3 months; 35 patients presented progressive disease after at least one previous therapy; there were also 4 patients undergoing transplant-based therapeutic programs and discharged early from the ward. Patients were generally followed-up on weekly-basis for collection of blood samples, clinical assessment and intravenous therapies (bisphosphonates, blood and platelet transfusions, anti-myeloma agents, antimicrobials, immunoglobulins). Median duration of a home care cycle was 323 days, with significant differences among the three groups of patients (in terminal phase=84 days, in progressive disease=466 days, in causal treatment=55 days). Excluding 4 ongoing patients, the end of home care resulted in 15 patients deceased at home (37%) and 26 died as inpatients (63%) while 8 patients were referred back to day hospital or ward. Urgent hospital admissions were 66, corresponding to an average of 1.25 admissions per home care cycle: main reasons were infection and fever, cardiopulmonary complications, renal failure, major bleeding and caregiver burnout. Once-monthly bisphosphonate treatment regarded 31 patients for a total of 332 infusions (pamidronate=191, zoledronic acid=141). Blood transfusions were provided to 22 patients for a total of 202 erythrocyte units while 8 patients required platelet transfusions (82 bags). Although most patients were off- therapy or in treatment with oral drugs, several novel and conventional anti-myeloma agents were administered intravenously at home in monotherapy or in combination, such as bortezomib, dexamethazone, vincristine, cyclophosphamide, carmustine, doxorubicine. No serious adverse event was reported as direct consequence of home intravenous therapies. Home care has achieved a relevant role in the global management of patients with blood malignancies improving quality of life and reducing health care costs. Thanks to our operating model, characterized by the presence of a full-time specialist team and by a careful selection of patients, home care of unfit patients with multiple myeloma represents a valid integration to the standard in-hospital hematology services. Many issues remain open, such as cost analysis, quality-of-life assessment, legislation on domiciliary medications, role of fundraising organisations and recognition in public health system.