Induction therapy

To be successful, antineoplastic therapy often has to be applied for considerable periods of time. The initial therapy period is being termed induction therapy which is then followed by a maintenance therapy and possibly a reinduction therapy. ... 

Villa et al. 1996). Recent reports from Japan suggest that daily IFN-p administration is highly effective in patients with low or moderate HCV RNA levels (Horiike and Onji 2003 Shiratori et al. 2000). Twice-daily administration of IFN-P as induction therapy has also been reported to be effective (Kim et al. 2005 Naka-jima et al. 2003). It is unlikely, however, that IFN-p will be used in routine clinical practice unless it is pegylated or otherwise modified, and until specific clinical trials are done. 

The goal of induction therapy is to provide a high level of immunosuppression in the critical early posttransplant period when the risk of acute rejection is highest. 

The improved short-term outcomes gained from induction therapy come with a degree of risk. By using these highly immunosuppressive agents, particularly the antilymphocyte antibodies (ALAs), muronomab-CD3 (OKT-3), and the antithymocyte antibodies, the body loses much of its innate ability to mount a cell-mediated immune response, which increases the risk of opportunistic infections and cancer.7,10... 

Basiliximab and daclizumab are considered monoclonal antibodies. Daclizumab is a humanized antibody that is approximately 10% murine and 90% human, whereas basiliximab is a chimeric antibody that is approximately 30% murine and 70% human.9,11 These agents bind with high affinity to the IL-2 receptor, where they act as CD25 receptor antagonists. These receptors are present on almost all activated T cells. Their role in induction therapy involves inhibiting IL-2-mediated activation of lymphocytes, which is an important step for the clonal expansion of T cells. 

Induction Therapy Agents Lymphocyte immune 1 S mg/kg IV x 3-14 days Flu-like symptoms, chills, 21,797- 101,720... 

Create a plan for induction therapy (i.e., would you recommend induction therapy If so, why Which agent ). 

FIGURE 52-2. Center-specific protocols may use RATG, an IL-2RA, or no induction therapy. In any situation, patients receive IV methylprednisolone prior to, during, or immediately following the transplant operation. The patient then will begin the maintenance immunosuppressive regimen. The center-specific protocol will specify which calcineurin inhibitor (cyclosporine or tacrolimus) is used in combination with mycophenolate mofetil or sirolimus with or without steroids. Patients then are monitored for signs and symptoms of rejection. 

The current induction therapy for acute lymphocytic leukemia (ALL) typically consists of vincristine, asparaginase, and a steroid (prednisone or dexamethasone). An anthracycline is added for higher-risk patients. 

The current induction therapy for acute myelogenous leukemia (AML) usually consists of a combination of cytara-bine and daunorubicin, with the frequent addition of a steroid and/or an antimetabolite such as 6-thioguanine. The risk of infection is so high during this period that patients receive antibiotic and fungal prophylaxis. 

In adults, there is a steady decline in the rate of complete remission (CR) following initial induction therapy with increasing age. While induction treatment produces 95% CR in children, it decreases to 40% to 60% in patients older than 60 years of age. The prognostic implication is due in part to decreased tolerance of stringent induction/consolidation... 

RH had a bone marrow aspiration performed on days 15 and 29 that showed morphologic remission. The MRD on day 29 was less than 0.1%. RH completed her induction therapy and started intensification therapy. 

In children, the intensity of the consolidation treatment is now determined not only by the child s risk classification but also by the rate of cytoreduction during induction.5 Patients who respond slowly to induction therapy (as determined by bone marrow examination early in induction) are at higher risk of relapse and are treated on more aggressive regimens. 

The Berlin-Frankfurt-Munster (BFM) Study Group introduced a treatment element called delayed intensification (or reinduction) therapy. This therapy consisted of repetition of the initial remission induction therapy administered approximately 3 months after remission. Most institutions have adopted this regimen.12... 

Once an initial remission is achieved, further intensive therapy is imperative to prevent relapse. Induction therapy fails to provide adequate cell kill, and leukemia cells survive the initial... 

The therapy far AML is extremely myelosuppressive. Children with AML have a 10% to 20% induction mortality rate secondary to infection and bleeding complications. Therefore, patients receiving induction therapy usually are hospitalized for the first 4 to 6 weeks of therapy. The induction therapy for ALL is less myelosuppressive therefore, these patients recover their counts quicker and usually do not require prolonged hospitalizations.6... 

Ronghe, M., Burke, G.A., Lowis, S.R, and Estlin, E.J. 2001. Remission induction therapy for childhood acute lymphoblastic leukaemia clinical and cellular pharmacology of vincristine, corticosteroids, L-asparaginase and anthracyclines. Cancer Treatment Reviews 27(6), 327-337. 

HIV-infected patients should receive induction therapy with amphotericin B and chronic suppressive therapy with an oral azole antifungal. Itraconazole is the drug of choice for non-life-threatening histoplasmosis. 

CNS disease Lipid formulation of amphotericin BIV 3-6 mg/kg/day x 6-10 weeks (Note Induction therapy with azoles alone is discouraged.) Amphotericin Brf IV 0.7-1 mg/kg/day + flucytosine 100 mg/kg/ day orally x 2 wk, followed by fluconazole 400 mg orally daily for a minimum of 10 weeks (in patients intolerant to fluconazole, substitute itraconazole 200-400 mg orally daily) or Amphotericin B IV 0.7-1 mg/kg/day + 5-flucytosine 100 mg/kj day orally x 6-10 weeks or Amphotericin Brf IV 0.7-1 mg/kg/day x 10 weeks Refractory disease Intrathecal or intraventricular amphotericin B (continued)... 

Efficacy of induction therapy for SCLC should be determined after two to three cycles of chemotherapy. If there is no response or progressive disease, therapy can be discontinued or changed to a non-cross-resistant regimen. If responsive to chemotherapy, the induction regimen should be administered for four to six cycles. 

Feng, W. H., Hong, G., Delecluse, H. J., and Kenney, S. C. (2004) Lytic induction therapy for Epstein-Barr virus-positive B-ceU lymphomas. J Virol. 78, 1893-1902. 

Walsh M, James M, Jayne D, Tonelli M, Manns BJ, Hemmelgam BR. (2007) Mycophenolate mofetil for induction therapy of lupus nephritis A systematic review and meta-analysis. Clin J Am Soc Nephrol 2 968-975. 

Chapman TM, Keating GM. Basihximab. A review of its use as induction therapy in renal transplantation. Drugs 20(B 63 2803-35. 

Monitoring The majority of patients will experience some decrease in renal function due to foscarnet administration. Therefore, it is recommended that Ccr be determined at baseline, 2 to 3 times/week during induction therapy, and at least... 

Wright CD, Wain JC, Lynch TJ, et al. Induction therapy for esophageal cancer with paclitaxel and hyperfractionatedradiotherapy aphaselandllstudy. JThorac CardiovascSurg 1997 114(5) 811—815. 

Eagan RT, Ruud C, Lee RE, et al. Pilot study of induction therapy with cyclophosphamide, doxirubicin, and cisplatin (CAP) and chest irradiation prior to thoracotomy in initially inoperable stage III non-small lung cancer. Cancer Treat Rep 1987 71 895-900. 

Gregor A, Cull A, Stephens RJ, et al. Prophylactic cranial irradiation as indicated following complete response to induction therapy in small-cell lung cancer Results of a multicentre randomized trial. Eur J Cancer 1997 33(Suppl 1) 1752-1758. 

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