
The Patient Has Non-Hodgkin S Lymphoma . When Physicians During

When physicians during clinical trials see the drop in hemoglobin level 30% in less than 30 days after infusion of the drug, what should be his reaction?
Stop trial, continue for the next step in the trial and deeply investigate the problem or do nothing and continue for the next infusion approx in one month. If investigate how to investigate??
I got an answer from one physician already, I just would like to be sure, that I formulated m question correctly. My clinical trial was based on blood tests. I expected that exists a template or matrix from FDA with limiting values when a physician must do a deeper investigation of patient condition or stop the procedure. In my case, my doctor did nothing and my blood hemoglobin dropped to level 5.5 g/dl because I got pure red aplasia with serious consequences for me. I google to find the answer without success if exists something as clinical trial stopping rules templets or matrix form a blood test which would show clearly stopping points.
So my question is: stopping rules are statistical for trial or they are fixed values as matrix applying for each patient. This was a clinical trial, where anything was possible, the drug was known high risk attacking organs to stimulate immunity system. Or the safety of clinical trials is completely in the hand of physician without control. It does not have for me to much sense.

When physicians during clinical trials see the drop in hemoglobin level 30% in less than 30 days after infusion of the drug, what should be his reaction?
Stop trial, continue for the next step in the trial and deeply investigate the problem or do nothing and continue for the next infusion approx in one month. If investigate how to investigate??
I got an answer from one physician already, I just would like to be sure, that I formulated m question correctly. My clinical trial was based on blood tests. I expected that exists a template or matrix from FDA with limiting values when a physician must do a deeper investigation of patient condition or stop the procedure. In my case, my doctor did nothing and my blood hemoglobin dropped to level 5.5 g/dl because I got pure red aplasia with serious consequences for me. I google to find the answer without success if exists something as clinical trial stopping rules templets or matrix form a blood test which would show clearly stopping points.
So my question is: stopping rules are statistical for trial or they are fixed values as matrix applying for each patient. This was a clinical trial, where anything was possible, the drug was known high risk attacking organs to stimulate immunity system. Or the safety of clinical trials is completely in the hand of physician without control. It does not have for me to much sense.
NHL Leukemua
Detailed Answer:
Dear Gardnerabc
yes your point is pertinent.. I find that you have progressed from NHL To leukaemia.It is the normal process of the disease as it is a chronic progressive disorder. your parameters cannot tolerate any more chemotherapy. you are under bone marrow suppression and need bone marrow stimulants like colony stimulating agents and poetins to boost your bone marrow to improve your counts and anaemia. Withhold any form of chemotherapy. If need be one or two units of packed RBC's Have only symptomatic management. Take full care for aseptic precautions.
Truly,
Dr. Ticku.

NHL Leukemua
Detailed Answer:
Dear Gardnerabc
yes your point is pertinent.. I find that you have progressed from NHL To leukaemia.It is the normal process of the disease as it is a chronic progressive disorder. your parameters cannot tolerate any more chemotherapy. you are under bone marrow suppression and need bone marrow stimulants like colony stimulating agents and poetins to boost your bone marrow to improve your counts and anaemia. Withhold any form of chemotherapy. If need be one or two units of packed RBC's Have only symptomatic management. Take full care for aseptic precautions.
Truly,
Dr. Ticku.


But my second question is and was: Is somewhere published list by FDA, or sponsoring institution with clearly written stopping for clinical trials, as a response to the test procedure?

But my second question is and was: Is somewhere published list by FDA, or sponsoring institution with clearly written stopping for clinical trials, as a response to the test procedure?
WSMG/NHL
Detailed Answer:
Dare Gardenerabac
some drugs showing statistically meagre results are misused. Such type of drugs are known to cause immuno suppression and bone marrow depression. You need not have to have more chemo till your bone marrow is restored. Of course you have to continue conservative symptomatic management to prevent other organ damage.
Truly.

WSMG/NHL
Detailed Answer:
Dare Gardenerabac
some drugs showing statistically meagre results are misused. Such type of drugs are known to cause immuno suppression and bone marrow depression. You need not have to have more chemo till your bone marrow is restored. Of course you have to continue conservative symptomatic management to prevent other organ damage.
Truly.


after heavy chemotherapy of my Waldenstrom disease and restarting immunity system by heaviest recommended dosages of steroids, how many years need patients in my age group to recover bone marrow and if is full bone maroow recovery possible?

after heavy chemotherapy of my Waldenstrom disease and restarting immunity system by heaviest recommended dosages of steroids, how many years need patients in my age group to recover bone marrow and if is full bone maroow recovery possible?
WsMCg/NHL
Detailed Answer:
Dear Sir,
It is not time bound but response bound. Once the bone Marrow he recouped the drug will automatically be withdrawn. There are some side effects of corticosteroids for which you need supportive treatment. Normally after 50percent response tapering of steroids is done and finally completely withdrawn.
Truly

WsMCg/NHL
Detailed Answer:
Dear Sir,
It is not time bound but response bound. Once the bone Marrow he recouped the drug will automatically be withdrawn. There are some side effects of corticosteroids for which you need supportive treatment. Normally after 50percent response tapering of steroids is done and finally completely withdrawn.
Truly


In my case, they spoke about completely restarting my immunity system!, and for this reason, they used the highest possible dosage of steroids (this I was told). Also I got 4 liters of blood transfusion , platelets and white blood cells. After about 10 months I got new strong symptoms of Waldenstrom disease, stronger than anytime before. Then I was treated by Bendamusteen+Rituxan. Against my platelets and white cells were down and I received platelets that went below 10% and white blood cells from a donor. I never had such problems before, I had just a very mild case of Waldenstrom.
So my question is: "It is my understanding that possibly my bone marrow and immune system were not fully recovered"?? I read that to recover bone marrow and immune system could need time easily up to 3 years"
Thanks

In my case, they spoke about completely restarting my immunity system!, and for this reason, they used the highest possible dosage of steroids (this I was told). Also I got 4 liters of blood transfusion , platelets and white blood cells. After about 10 months I got new strong symptoms of Waldenstrom disease, stronger than anytime before. Then I was treated by Bendamusteen+Rituxan. Against my platelets and white cells were down and I received platelets that went below 10% and white blood cells from a donor. I never had such problems before, I had just a very mild case of Waldenstrom.
So my question is: "It is my understanding that possibly my bone marrow and immune system were not fully recovered"?? I read that to recover bone marrow and immune system could need time easily up to 3 years"
Thanks
Nhl/ WSMcg.
Detailed Answer:
sir,
It is true bone marrow recovery takes little time but not necessarily three years. bone marrow stimulants like granulocyte colony stimulating factors and platelet agents along with erythrhropoitin will help in maintaining your bone marrow. when there sort of chronic reduction of the bone marrow components possibly you will not need these agents regularly. That is what in the begining I said conservative symptomatic management. You have to remain protective about getting infection which can turn dangerous.
Truly.

Nhl/ WSMcg.
Detailed Answer:
sir,
It is true bone marrow recovery takes little time but not necessarily three years. bone marrow stimulants like granulocyte colony stimulating factors and platelet agents along with erythrhropoitin will help in maintaining your bone marrow. when there sort of chronic reduction of the bone marrow components possibly you will not need these agents regularly. That is what in the begining I said conservative symptomatic management. You have to remain protective about getting infection which can turn dangerous.
Truly.

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