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PURPOSE:To provide updated guidance regarding the therapy for multiple myeloma. METHODS:ASCO and Ontario Health (Cancer Care Ontario) convened a joint Expert Panel and conducted an updated systematic review of the literature. RESULTS:The updated review identified a total of 161 relevant randomized trials. UPDATED RECOMMENDATIONS:Daratumumab therapy may be offered to patients with high-risk smoldering myeloma. Quadruplet therapy with daratumumab or isatuximab, combined with bortezomib, lenalidomide, and dexamethasone, should be offered as initial therapy for transplant eligible patients. They should also be offered at least lenalidomide maintenance, with or without daratumumab, carfilzomib, and/or dexamethasone. Quadruplet therapy with daratumumab or isatuximab, combined with bortezomib, lenalidomide, and dexamethasone, should be offered as therapy for suitable transplant-ineligible patients. Patients with relapsed or refractory multiple myeloma should be offered triplet therapy or T-cell redirecting therapies according to a set of recommended principles.Additional information is available at www.asco.org/hematologic-malignancies-guidelines.
ObjectivesTo compare the treatments used for the first episode of lupus nephritis (LN) in two Latin American cohorts (historical and contemporary) over a 25-year period, and their associations with clinical outcomes.MethodsPatients with biopsy-confirmed first LN episode were classified as non-proliferative (class V) or proliferative (classes III/IV). Sociodemographic, clinical, and treatment variables were described. Propensity score matching was used to examine the associations with four outcomes: mortality, damage accrual (SDI), hospitalization, and end-stage renal disease (ESRD).ResultsA total of 532 SLE patients were included: 362 from GLADEL 1.0 (historical cohort) and 170 from GLADEL 2.0. (contemporary). Compared to GLADEL 1.0, patients in GLADEL 2.0 received lower doses of oral glucocorticoids (GC), more frequently GC pulses and antimalarials but less frequently cyclophosphamide. An increase in the use of mycophenolate mofetil and other immunosuppressants was also observed. In the logistic regression models, SDI was associated with baseline SDI and GC pulses, whereas belonging to the GLADEL 2.0 was a protective factor. Mortality was associated with Mestizo ethnicity and partial health coverage; antimalarial was identified as a protective factor. Hospitalizations were associated with baseline SLEDAI and SDI, follow-up time, and lower educational level. Belonging to the GLADEL 2.0 cohort was protective against the occurrence of ESRD.ConclusionsPatients in the contemporary cohort benefited from advances in treatment strategies, with less cumulative damage and progression to ESRD, although mortality remained unchanged. These improvements likely reflect the increased use of newer therapies, more targeted approaches, in line with current treatment guidelines, and better access to specialized care.
The objective of this study is to analyze five of the most common symptoms and treatment-related conditions in childhood cancer, along with their diagnosis and management within rehabilitation services. There is limited evidence on rehabilitation in pediatric cancer and the management of clinical problems in this population. Exercise is one of the non-pharmacological tools with the strongest supporting evidence; however, other approaches lack robust data. Therefore, it is essential to understand the current state of knowledge and define directions for future research. Despite strong evidence supporting rehabilitative interventions, these services remain underutilized in pediatric oncology. Interventions for symptoms and treatment-related conditions such as fatigue, pain, depression, peripheral neuropathy, and constipation are essential for early detection and optimal management. This review provides an in-depth analysis of the current evidence on non-pharmacological treatments and highlights the areas where further research is needed.
Ver el video en YouTube: https://www.youtube.com/watch?v=_VhU9mBzGdk&rco=1 La hernioplastia inguinal robótica ofrece beneficios frente a las técnicas convencionales y laparoscópicas. Comparadas con la cirugía abierta, las técnicas mínimamente invasivas reducen el dolor postoperatorio, el sangrado y el tiempo de recuperación. Frente a la laparoscopía, proporciona una visión tridimensional, mayor precisión y ergonomía, facilitando la disección en hernias recidivantes o bilaterales.
