Publications by authors named "Amanda Janes"

4 Publications

  • Page 1 of 1

Ibrutinib treatment via alternative administration in a patient with chronic lymphocytic leukemia and dysphagia.

J Oncol Pharm Pract 2020 Oct 27:1078155220967440. Epub 2020 Oct 27.

Atrium Health, Levine Cancer Institute, Concord, NC, USA.

Introduction: Ibrutinib is a small molecule inhibitor of Bruton's tyrosine kinase indicated for the treatment of a variety of B-cell malignancies including chronic lymphocytic leukemia, mantle cell lymphoma, marginal zone lymphoma, and Waldenstrom's macroglobulinemia. These indolent hematologic malignancies are considered diseases of the elderly, a population that may have dysphagia leading to difficulty swallowing tablets and capsules. Ibrutinib is currently not available in a liquid oral dosage form. We report the utilization and clinical outcomes associated with alternative administration of ibrutinib capsules in a patient with chronic lymphocytic leukemia and significant dysphagia.

Case Report: An 86-year old female requiring chronic lymphocytic leukemia-directed therapy due to a rising absolute lymphocyte count and worsening, transfusion-dependent anemia with a past medical history of dementia and dysphagia, was initiated on ibrutinib.

Management & Outcome: Due to the patient's significant inability to swallow, ibrutinib capsules were administered via an alternative method by opening them and sprinkling onto soft food or applesauce. With ibrutinib therapy, the patient has had a significant clinical response in her chronic lymphocytic leukemia as evidenced by her decreased absolute lymphocyte count and achieving transfusion independence with improvements in hemoglobin.

Discussion: Ibrutinib administration via this alternative method resulted in an initial clinical response in the treatment of our patient's chronic lymphocytic leukemia as evidenced by a decreasing absolute lymphocyte count and improved anemia that achieved transfusion independence. The patient has maintained this response to therapy after approximately 1 year at the time of manuscript preparation.
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http://dx.doi.org/10.1177/1078155220967440DOI Listing
October 2020

Dialysis Independence Following Combination Daratumumab, Thalidomide, Bortezomib, Cyclophosphamide, and Dexamethasone in Multiple Myeloma With Severe Renal Failure.

Clin Lymphoma Myeloma Leuk 2020 07 7;20(7):e395-e398. Epub 2020 Apr 7.

Levine Cancer Institute, Concord, NC.

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http://dx.doi.org/10.1016/j.clml.2020.03.014DOI Listing
July 2020

Ibrutinib for the treatment of Bing-Neel syndrome, a complication of Waldenström macroglobulinemia: Patient case report.

J Oncol Pharm Pract 2019 Sep 13;25(6):1534-1539. Epub 2019 Feb 13.

2 Department of Oncology, Carolinas Healthcare System NorthEast, Levine Cancer Institute, Concord, NC, USA.

Bing-Neel syndrome is a rare complication of Waldenström macroglobulinemia, characterized by infiltration of lymphoplasmacytic cells to the central nervous system. Multiple treatment modalities exist including purine analogs, bendamustine, high-dose methotrexate, or high-dose cytarabine. Of interest, ibrutinib, a Bruton tyrosine kinase inhibitor has also displayed efficacy in Bing-Neel syndrome. Current literature is limited for the treatment of Bing-Neel syndrome considering its rarity, and while ibrutinib is indicated for the treatment of Waldenström macroglobulinemia, it is utilized off-label for treatment of Bing-Neel syndrome. Additionally, debate exists regarding the recommended dosing strategy for ibrutinib for this indication with disease remission demonstrated at 560 mg and 420 mg. We present a case report that provides additional evidence for this debate with a patient who received 560 mg of ibrutinib initially and maintained disease control despite a dose reduction to 420 mg for tolerability. Ultimately, more data are needed to develop standardized Bing-Neel syndrome treatment strategies with specific consideration to the use of ibrutinib in this condition.
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http://dx.doi.org/10.1177/1078155219830162DOI Listing
September 2019

A review of R-DHAP administration in the outpatient setting and a case of the alternative regimen R-DHAX given outpatient for refractory diffuse large B-cell lymphoma.

J Oncol Pharm Pract 2019 Dec 7;25(8):2041-2044. Epub 2019 Jan 7.

Levine Cancer Institute, Atrium Health, Concord, USA.

Introduction: Several regimens for treating hematologic malignancies are given inpatient due to multiple factors. Many clinicians are evaluating methods to deliver traditionally inpatient regimens in the outpatient setting to increase patient satisfaction, improve access to therapy, and reduce costs. A regimen traditionally administered inpatient, dexamethasone, cytarabine, and cisplatin (DHAP) is a common and effective salvage regimen for relapsed/refractory non-Hodgkin's lymphoma. DHAX, which substitutes oxaliplatin for cisplatin, has been identified as a reasonable alternative to DHAP and offers the potential for tolerable administration in the outpatient setting as well.

Case Description: A 74-year-old patient with double hit relapsed/refractory diffuse large B cell lymphoma was given rituximab, dexamethasone, high-dose cytarabine, and oxaliplatin (R-DHAX) in our outpatient clinic; however, this regimen is traditionally administered in the inpatient setting. Our main obstacle being cytarabine doses traditionally given 12 h apart. The outpatient regimen given to our patient was rituximab and oxaliplatin on day 1, cytarabine dose one late afternoon on day 2, cytarabine dose two early morning on day 3, and dexamethasone on days 1-4. Doses of oxaliplatin and cytarabine were reduced due to thrombocytopenia experienced with Cycle 1. He did not experience any increased toxicities or complications associated with the regimen moving forward.

Discussion: This illustrates a unique administration of R-DHAX in an infusion center that operates during typical outpatient clinic hours. Both DHAP and DHAX, with or without rituximab, administered in the outpatient setting may be options to consider in relapsed/refractory non-Hodgkin's lymphoma.
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http://dx.doi.org/10.1177/1078155218820108DOI Listing
December 2019