BACKGROUNDThe efficacy and safety of immunosuppression for idiopathic membranous nephropathy (IMN) are still controversial. Recent studies showed tacrolimus is effective in the treatment of IMN. To evaluate the efficacy and safety of tacrolimus (TAC) for IMN, we conducted a meta-analysis of published medical literatures.

METHODSStudies addressing the effect of tacrolimus in IMN were searched on PUBMED, EMBASE, The Cochrane Library, and ClinicalTrials.gov (March 2013). Trials comparing tacrolimus with corticosteroid versus control group (cyclophosphamide with corticosteroid) were included. The quality of the studies was assessed using Jadad method. Statistical analyses were performed using Review Manager 5.2 and the results were summarized by calculating the risk ratio (RR) for dichotomous data or the mean difference (MD) for continuous data with 95% confident interval (CI).

RESULTSA total of four studies (259 patients) were included. It was shown that therapy with tacrolimus plus corticosteroid had a higher complete remission rate compared to therapy with cyclophosplamide plus corticosteroid (RR = 1.53, 95% CI: 1.05-2.24, P < 0.05), but not significant on total remission, partial remission and adverse effects. Also, no significant alterations were observed in proteinuria and serum albumin level between the two groups. During the entire follow-up period, serum creatinine level remained stable in both groups without = 50% increase in its level.

CONCLUSIONSTAC is more effective than cyclophosphamide (CTX) by achieving complete remission in patients with IMN. Multi-ethnic RCTs are needed to evaluate its long-term efficacy and safety.

Adrenal Cortex Hormones ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Glomerulonephritis, Membranous ; drug therapy ; Humans ; Immunosuppressive Agents ; therapeutic use ; Tacrolimus ; therapeutic use

Behcet's disease is characterized with multifactorial etiopathogenesis and multiclinical pictures. The treatment of patients with Behcet's disease is based on the severity of illness, and the most appropriate management of Behcet's disease requires a multidisciplinary approach. Although various therapeutic modalities have been employed for Behcet's disease, treatment is far from satisfactory. Treatment of Behcet's disease includes local, systemic, or surgical therapies. Limited success has been found with colchicine, azathioprine, indomethacin, cyclophosphamide, chlorambucil, levamisole, transfer factor, fibrinolytic therapy, and systemic corticosteroid. New therapeutic approaches have been introduced for Behcet's disease using cyclosporine, thalidomide, interferon, acyclovir, high-dose corticosteroids or cyclophosphamide pulse therapy, and FK 506. We suggest that therapeutic agents should be selected after thorough evaluation of the immune state of each patient by using various tests and by determining any aggravating or provoking factors involved. In general, a combination-agent regimen is more effective than a single-agent regimen. Early diagnosis and proper treatment can inhibit or at lease slow the progress of the disease remarkably.
Adrenal Cortex Hormones/therapeutic use ; Behcet's Syndrome/therapy* ; Cyclophosphamide/therapeutic use ; Human ; Immunosuppressive Agents/therapeutic use ; Tetracycline/therapeutic use ; Thalidomide/therapeutic use ; Zinc Sulfate/therapeutic use

OBJECTIVE: To analyze the efficacy of cyclophosphamideplus, epirubicin, vincristine, prednisone plus etoposide and/or bleomycin, with or without rituximab (R±BEACOP) regimen in patient with poor-prognosis lymphoma.
 METHODS: A total of 89 patients, who had poor-prognosis lymphoma and received at least 1 cycle of R±BEACOP regimen during 2002 to 2012, were enrolled and analyzed by a retrospective study.
 RESULTS: The rate of complete response was 62.9% (56 patients). The efficacy of Hodgkin lymphoma (HL) and T/NK NHL was better than that of other types of lymphoma. There was no significant difference in efficacy among the patients with different age, stage or international prognosis index (IPI) (all P>0.05).
 CONCLUSION R±BEACOP regimen is effective in some patients with poor prognosis, especially in HL patients. Thus, multicenter prospective study regarding the R±BEACOP regimen needs to be done to further test its efficacy.
Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Etoposide ; therapeutic use ; Humans ; Lymphoma ; classification ; diagnosis ; drug therapy ; Prednisone ; therapeutic use ; Procarbazine ; therapeutic use ; Prognosis ; Retrospective Studies ; Rituximab ; therapeutic use ; Vincristine ; therapeutic use

Adult ; Cyclophosphamide ; therapeutic use ; Female ; Humans ; Prednisone ; therapeutic use ; Takayasu Arteritis ; drug therapy ; surgery

Child ; Cyclophosphamide ; therapeutic use ; Humans ; Immunosuppressive Agents ; therapeutic use ; Nephrotic Syndrome ; drug therapy ; Treatment Outcome

Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Anticoagulants ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Cyclosporine ; therapeutic use ; Fish Oils ; therapeutic use ; Glomerulonephritis, IGA ; therapy ; Glucocorticoids ; therapeutic use ; Humans ; Mycophenolic Acid ; analogs & derivatives ; therapeutic use

BACKGROUNDIn recent years, increasing numbers of patients are accepting neoadjuvant chemotherapy before their operation in order to get a better prognosis. But chemotherapy has many side-effects. We have observed that patients who accepted neoadjuvant chemotherapy are more sensitive to anesthetics. The aim of this study was to determine the median effective dose (EC(50)) of intravenous anesthetics for neoadjuvant chemotherapy patients to lose consciousness during target-controlled infusion.

METHODSTwo hundred and forty breast cancer patients undergoing elective operations were assigned to six groups according to treatment received before their operation and the use of intravenous anesthetics during anesthesia; non-adjuvant chemotherapy + propofol group (group NP, n = 40), Taxol + propofol group (group TP, n = 40), adriamycin + cyclophosphamide + 5-Fu + propofol group (group CP, n = 40), non-adjuvant chemotherapy + etomidate group (group NE, n = 40), taxol + etomidate group (group TE, n = 40), adriamycin + cyclophosphamide + 5-Fu + etomidate group (group CE, n = 40). We set the beginning effect-site concentration (Ce) of propofol as 3.0 µg/ml and etomidate as 0.2 µg/ml. The concentration was increased by steps until the patient was asleep, (OAAS class I-II), then gave fentanyl 3 µg/kg and rocuronium 0.6 mg/kg and intubated three minutes later. The patients' age, height, and weight were recorded. BIS was recorded before induction, at the initial effect-site concentration and at loss of consciousness. The effect-site concentration was recorded when patient lost consciousness.

RESULTSThere were no significant differences between groups in general conditions before treatment; such as BIS of consciousness, age, sex and body mass index. The EC(50) of propofol in the NP, TP and CP groups was 4.11 µg/ml (95%CI: 3.96 - 4.26), 2.94 µg/ml (95%CI: 3.36 - 3.47) and 2.91 µg/ml (95%CI: 3.35 - 3.86), respectively. The EC50 of etomidate in the NE, TE and CE groups was 0.61 µg/ml (95%CI: 0.55 - 0.67), 0.38 µg/ml (95%CI: 0.33 - 0.44), and 0.35 µg/ml (95%CI: 0.34 - 0.36), respectively. There was no significant difference of BIS level before induction or in BIS50 level in any group when patients lost consciousness.

CONCLUSIONSThe EC(50) of intravenous anesthetics to cause loss of consciousness in neoadjuvant chemotherapy groups is lower than in the control group. There was no significant difference of BIS level at which patients lost consciousness.

Adult ; Anesthetics, Intravenous ; therapeutic use ; Breast Neoplasms ; drug therapy ; surgery ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Etomidate ; therapeutic use ; Female ; Fluorouracil ; therapeutic use ; Humans ; Middle Aged ; Neoadjuvant Therapy ; adverse effects ; Paclitaxel ; therapeutic use ; Propofol ; therapeutic use ; Unconsciousness ; chemically induced

BACKGROUND: To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution. METHODS: This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS). RESULTS: During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P  = 0.025 and P  = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11; 95% CI: 0.01-0.88) and 0.042 (HR: 0.19; 95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups. CONCLUSION Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.
Humans ; Rituximab/therapeutic use* ; Vincristine/therapeutic use* ; Retrospective Studies ; Prednisone/therapeutic use* ; Etoposide/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Lymphoma, Large B-Cell, Diffuse/drug therapy* ; Cyclophosphamide/therapeutic use* ; Doxorubicin/therapeutic use*

OBJECTIVETo investigate the efficacy and safety of Rituximab combined with second line regimen for treatment of relapsed and refractory Hodgkin lymphoma.

METHODSSeven patients with relapsed and refractory Hodgkin lymphoma were treated with Rituximab combined with second line regimen. Among them, two patients were treated with R-GDP (E) [rituximab, gemcitabine, cisplatin, dexamethasone (etoposide)] regimen, another two patients with R-IGVP (rituximab, ifosfamide, gemcitabine, vinorelbine, prednisone)regimen, and the left three patients with R-BEACOPP (rituximab, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone)regimen. The efficacy and safety were evaluated during and after chemotherapy.

RESULTSThere're three male and four female patients, whose median age was 21 years (range 12-36 years) old. One patient was diagnosed as nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), and the other six patients as classical HL (four nodular sclerosis HL, one lymphocyte-rich classical HL and one hmixed cellularity HL). The median cycles of salvage therapy were 4(1-4), and the median follow-up was 29 months (24-58 months). Among these 7 patients, the complete remission was observed in 4 patients, stable disease in 2 patients, but one patient died during salvage therapy. The two-year survival rates were 85.7% and the major toxic effects were bone marrow suppression.

CONCLUSIONThese results indicate that the Rituximab combined with second line regimen is an effective therapy for relapsed and refractory Hodgkin lymphoma.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; therapeutic use ; Child ; Cisplatin ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Dexamethasone ; therapeutic use ; Doxorubicin ; therapeutic use ; Etoposide ; therapeutic use ; Female ; Hodgkin Disease ; drug therapy ; Humans ; Male ; Neoplasm Recurrence, Local ; Prednisone ; therapeutic use ; Procarbazine ; therapeutic use ; Remission Induction ; Rituximab ; therapeutic use ; Salvage Therapy ; Vinblastine ; analogs & derivatives ; Vincristine ; therapeutic use ; Young Adult

OBJECTIVETo explore the clinical efficiency and safety of CHOP regimen containing pegylated liposomal doxorubicin (PLD) for the aged patients with advanced diffuse large B-cell lymphoma (DLBCL).

METHODSFifty aged patients with advanced DLBCL treated in our hospital from February 2010 to February 2014 were selected and divided into two groups. Out of 50 cases, 25 cases received standard CHOP regimen (sCHOP group), other 25 cases received CHOP regimen containing PLD at dose of 30 mg/m2 (PLD+CHOP). These patients were followed up for 18 months, and the total effective rate, the survival rate and the adverse reaction rate were compared between these two groups.

RESULTSAfter receiving different treatments, the survival rate of patients on 6, 12 and 18 months in PLD+CHOP group was 88.0%, 80.0% and 76.0%, respectively, and the survival rate of 18 month was significantly higher than that in the sCHOP group (P<0.05); The total effective rate in the PLD+CHOP group was statistically higher than that in the sCHOP group (P<0.05); and all the incidences of non-hematological toxicity, peripheral sensory neuropathy, lung infection, gastrointestinal reaction and hepatotoxicity were not statistically different between two groups (P>0.05), while the incidence of cardiac toxicity including acute myocardial infarction, congestive heart failure, atrioventricular block (AV block) and paroxysmal atrial tachycardia significantly decreased in the PLD+CHOP group (P<0.05).

CONCLUSIONThe efficiency of CHOP regimen containing PLD for the aged patients with advanced DLBCL has been confirmed to be significant, and its cardiac toxicity is low, thus being worth to be popularized and applied for the treatment of advanced diffuse large B-cell lymphoma.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; analogs & derivatives ; therapeutic use ; Humans ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; Polyethylene Glycols ; therapeutic use ; Prednisone ; therapeutic use ; Survival Rate ; Vincristine ; therapeutic use