Paul M. Dainer

Multiple Myeloma Associated with Lactic Acidosis

Type B lactic acidosis is rare among patients with malignant diseases. To date only one case report has documented lactic acidosis occurring in a patient with multiple myeloma (MM). Our patient, a 55-year-old black man, was diagnosed with stage IIIA immunoglobulin G-kappa (IgG- κ ) MM in September 1995. He was found to have severe lactic acidosis at the time of second relapse. During the terminal phase of his disease, he required multiple hospitalizations for management of lactic acidosis and other complications of his MM. No other cause of his elevated lactate levels was identified. Although type B lactic acidosis may more commonly occur in patients with leukemia or lymphoma, it may rarely present in patients with rapidly progressive and refractory MM.

Infectious complications in patients receiving mobilization chemotherapy for autologous peripheral blood stem cell collection

The purpose of this retrospective study was to evaluate infectious complications in patients receiving mobilization chemotherapy for stem cell collection prior to autologous peripheral blood stem cell transplantation. An additional goal was to evaluate risk factors associated with the development of infectious complications. At the Medical College of Georgia BMT center, 54 patients were administered mobilization chemotherapy for the purpose of collecting stem cells between June, 1997, and May, 2002. All patients received Filgrastim in addition to chemotherapy, and 50 of 54 patients received prophylactic acyclovir, fluconazole, and ciprofloxacin until neutrophil recovery. The median duration to neutrophil recovery was 11 days. Fourteen of 54 (26%) patients developed fever/infections during the mobilization phase. One patient developed both a catheter-related infection and Clostridium difficile colitis, increasing the total number of infectious episodes to 15. Twelve patients had a documented site of infection whereas 2 patients had neutropenic fever with no identifiable source. Eight of the 15 (55%) infections were Gram-positive catheter infections. All the patients were treated successfully with antibiotics. No systemic fungal infections were identified and none of the patients died from complications related to mobilization chemotherapy. Logistic regression was applied for univariate and multivariate analysis and showed that age, sex, diagnosis, neutrophil recovery, disease status, use of salvage chemotherapy, and mobilization regimen used did not affect the infection rate. In our series of 54 patients, 14 patients developed fever/infections during mobilization. Although there is a substantial risk of infectious complications among patients who receive mobilization chemotherapy, it is not clear that prophylactic antibiotics decrease infectious complications. Because the vast majority of infections are Gram-positive catheter infections, it appears reasonable to employ Gram-positive prophylaxis. Controlled studies should be conducted to define the optimum mobilization regimens as well as the optimum combination of prophylactic antibiotics.

A phase II study of weekly paclitaxel and carboplatin in previously untreated patients with advanced non-small-cell lung cancer

AbstractPurpose: Both paclitaxel (P) and carboplatin (C) have a significant activity in non-small cell lung cancer (NSCLC). Weekly administration of P is active, is dose intense, and has a favorable toxicity profile. To evaluate the efficacy and toxicity of weekly P and C in advanced-stage NSCLC, we initiated this phase II study in patients with advanced NSCLC (III B with pleural effusion and stage IV). Patients and Methods: Eligible patients were treated with paclitaxel 100 mg/m2 intravenously (iv) over 1 h followed by carboplatin AUC 2 iv over 30 min. This treatment was administered weekly for 3 of every 4 wk until disease progression or intolerable toxicities. Results: Of the 30 patients enrolled in the study, one patient did not meet the eligibility criteria. Of the remaining 29 patients, 6 did not complete at least two cycles of treatment and hence were not assessable for response. The overall response rate was 43.5% (10/23) (all partial responses). An additional 43.5% had stable disease. The median time to progression was 162 d and the median duration of response was 169 d. Overall survival at 1 yr on intent-to-treat analyses was 44% and median survival was 10.8 mo. We observed the following grade 3/4 toxicities: hypersensitivity to paclitaxel (13%), hypersensitivity to carboplatin (3%), neutropenia (31%), thrombocytopenia (7%); 31% experienced grade 1 neuropathy and 17% experienced grade 2 neuropathy. Conclusions: We conclude that weekly paclitaxel and carboplatin is active and very well tolerated in patients with advanced NSCLC.

Azacitidine as salvage therapy for acute myeloid leukemia in a severely ill patient.

Acute myeloid leukemia (AML) is a hematological malignancy of myeloid progenitor cells that disrupt normal hematopoiesis. Current chemotherapy regimens result in complete remission in many cases; however, there exists no standard efficacious therapy for refractory acute myeloid leukemia. The hypomethylating agent, azacitidine, is effective in a limited number of such cases. We present a 57-year-old Filipino male with acute myeloid leukemia who was refractory to two induction chemotherapy regimens; however, he achieved complete remission after palliative therapy with azacitidine. We report this case to demonstrate the efficacy of azacitidine in refractory acute myeloid leukemia. Although the effectiveness of azacitidine in improving overall survival has been shown, this case demonstrates the effect on remission induction in high risk AML. Further studies are needed to delineate subsets of acute myeloid leukemia in which azacitidine will serve as effective therapy and to identify other targeted agents that may potentiate its effects.

Treatment of refractory anemia with ring sideroblasts associated with marked thrombocytosis with lenalidomide in a patient testing negative for 5q deletion and JAK2 V617F and MPL W515K/L mutations

Refractory anemia with ring sideroblasts associated with marked thrombocytosis (RARS-T) is a hematologic malignancy that often results in transfusion dependency and a hypercoagulable state. This rare disease currently lacks formal guidelines for treatment; however, various case reports have demonstrated efficacy in the use of lenalidomide. This immunomodulatory drug has shown promise in patients with 5q deletions, with reports of achieving transfusion independence and normalization of platelet counts. Herein we present the case of a 68-year-old African American woman with RARS-T who tested negative for 5q deletion and JAK2 V617F and MPL W515K/L mutations. Her treatment with lenalidomide therapy resulted in a five-year durable complete clinical response.

Abstract B62: Tailored parental cessation delivered concurrently with tobacco prevention in children enrolled in urban and rural southern elementary schools

Purpose: Socioeconomically disadvantaged populations have higher tobacco use rates resulting in more disparate cancer outcomes. The effectiveness of tailored cessation interventions in parent/caregiver smokers delivered within an elementary school setting while their child is concurrently enrolled in a smoking prevention program has been minimally explored. Procedures/Methods: During a randomized controlled trial (RCT) that included children and one parent/caregiver per child, parent/caregiver smokers were offered cessation in years 1 and 2 (if relapsed/refused in year 1) at their child9s respective school or local community setting. Parent/caregiver smokers in the intervention group received tailored cessation including eight individual face-to-face motivational interviewing sessions with a matched gender and/or racial/ethnically similar counselor and eight weeks of nicotine replacement therapy. The control parents/caregivers who smoked received information for contacting the state toll-free Tobacco Quit Line and tailored (based on race/ethnicity) written materials to assist with cessation. Children in the intervention arm received concurrently a tobacco prevention curriculum, Botvin9s LifeSkills Training, over the same time period in years 1 & 2. The control group children received the standard health education curriculum for public school systems. This study reports on the effectiveness of the parent/caregiver cessation intervention including outcomes of self-reported smoking status (percentages) and the biological measure, salivary cotinine (ng/ml), both obtained at baseline, end of treatment (EOT)/year 2, and in year 4 follow-up. Results/Summary: Parent/Caregiver smokers (n=110) comprised 24.6% of the enrolled (n=447) parent/caregiver sample. The parent/caregiver smokers were predominantly female (81%), mean age 37.2 yrs. (SD 11.1); 37% Black; 54% had Conclusions: This study provides beginning evidence that tailored cessation offered to parents/caregivers in their child9s school setting while their child is enrolled in tobacco prevention classes may be an avenue for more robust success in quitting smoking. Such a strategy may serve as an initial step for improving public health and for decreasing tobacco-related disparities and associated poor health outcomes among disadvantaged populations. By improving parent9s/caregiver9s success and maintenance of tobacco cessation, a joint program may reinforce the child9s resistance to the lure of tobacco products and may also potentially decrease his or her secondhand smoke exposure within the home. Citation Format: Martha S. Tingen, Jeannette O. Andrews, Janie Heath, Lovoria B. Williams, Carsten Schroeder, Paul Dainer, Samir N. Khleif, Jennifer L. Waller. Tailored parental cessation delivered concurrently with tobacco prevention in children enrolled in urban and rural southern elementary schools. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B62.