| 1. |
- Gimsing, Peter, et al.
(författare)
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Effect of pamidronate 30 mg versus 90 mg on physical function in patients with newly diagnosed multiple myeloma (Nordic Myeloma Study Group): a double-blind, randomised controlled trial
- 2010
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Ingår i: LANCET ONCOLOGY. - : Elsevier Science B.V., Amsterdam.. - 1470-2045 .- 1474-5488. ; 11:10, s. 973-982
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Tidskriftsartikel (refereegranskat)abstract
- Background Compared with placebo, prophylactic treatment with bisphosphonates reduces risk of skeletal events in patients with multiple myeloma. However, because of toxicity associated with long-term bisphosphonate treatment, establishing the lowest effective dose is important. This study compared the effect of two doses of pamidronate on health-related quality of life and skeletal morbidity in patients with newly diagnosed multiple myeloma. Methods This double-blind, randomised, phase 3 trial was undertaken at 37 clinics in Denmark, Norway, and Sweden. Patients with multiple myeloma who were starting antimyeloma treatment were randomly assigned in a 1:1 ratio to receive one of two doses of pamidronate (30 mg or 90 mg) given by intravenous infusion once a month for at least 3 years. Randomisation was done by use of a central, computerised minimisation system. Primary outcome was physical function after 12 months estimated by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire (scale 0-100). All patients who returned questionnaires at 12 months and were still on study treatment were included in the analysis of the primary endpoint. This study is registered with ClinicalTrials. gov, number NCT00376883. Findings From January, 2001, until August, 2005, 504 patients were randomly assigned to pamidronate 30 mg or 90 mg (252 in each group). 157 patients in the 90 mg group and 156 in the 30 mg group were included in the primary analysis. Mean physical function at 12 months was 66 points (95% CI 62.9-70.0) in the 90 mg group and 68 points (64.6-71.4) in the 30 mg group (95% CI of difference -6.6 to 3.3; p=0.52). Median time to first skeletal-related event in patients who had such an event was 9.2 months (8.1-10.7) in the 90 mg group and 10-2 months (7.3-14.0) in the 30 mg group (p=0.63). In a retrospective analysis, eight patients in the pamidronate 90 mg group developed osteonecrosis of the jaw compared with two patients in the 30 mg group. Interpretation Monthly infusion of pamidronate 30 mg should be the recommended dose for prevention of bone disease in patients with multiple myeloma.
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| 2. |
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| 3. |
- Blimark, Cecilie, et al.
(författare)
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Melphalan 100mg/m(2) with stem cell support as first relapse treatment is safe and effective for myeloma patients with long remission after autologous stem cell transplantation.
- 2011
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Ingår i: European journal of haematology. - : Wiley. - 1600-0609 .- 0902-4441. ; 87:2, s. 117-22
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Today, a number of therapeutic options are available as the patient with myeloma relapses from initial treatment with high-dose melphalan and autologous stem cell transplantation (ASCT). For patients who experience a durable response to primary ASCT, retreatment with high-dose melphalan is recommended by many current guidelines. Yet, toxicity is an important aspect in the choice of relapse treatment, and a second ASCT in this setting could be associated with enhanced toxicity. As the goal for the treatment for relapsed myeloma should be disease control while maintaining quality of life, lower doses of melphalan might be preferable. Methods and Objectives: In this retrospective study, we account for the outcome of 66 patients with myeloma in first systemic relapse after ASCT, who were treated with intermediate-dose melphalan, 100mg/m(2) , and stem cell support (MEL 100). The aim was to evaluate this treatment in relation to prior response duration after initial ASCT and with respect to response rate, toxicity and survival. Results: The overall response rate was 62%. There was limited, mostly haematological, toxicity, and no treatment-related mortality was observed. The median progression-free survival (PFS) was 8.5months, and the median overall survival was 24months. Patients with time to progression of 34months or more (n=17; ≥75th percentile) after initial ASCT had a median PFS of 12.5months after MEL 100. Conclusion: For patients with a long-lasting response after ASCT, MEL 100 could be a therapeutic option with low toxicity and with efficacy comparable to newer immunomodulatory drugs.
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| 4. |
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| 5. |
- Hjorth, Martin, et al.
(författare)
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Thalidomide and dexamethasone vs. bortezomib and dexamethasone for melphalan refractory myeloma: a randomized study.
- 2012
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Ingår i: European journal of haematology. - : Wiley. - 0902-4441 .- 1600-0609. ; 88:6, s. 485-496
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Thalidomide and bortezomib have been frequently used for second-line therapy in patients with myeloma relapsing after or refractory to initial melphalan-based treatment, but no randomized trials have been published comparing these two treatment alternatives. Methods: Thalidomide- and bortezomib-naïve patients with melphalan refractory myeloma were randomly assigned to low-dose thalidomide + dexamethasone (Thal-Dex) or bortezomib + dexamethasone (Bort-Dex). At progression on either therapy, the patients were offered crossover to the alternative drug combination. An estimated 300 patients would be needed for the trial to detect a 50% difference in median PFS between the treatment arms. Results: After inclusion of 131 patients, the trial was prematurely closed because of low accrual. Sixty-seven patients were randomized to Thal-Dex and 64 to Bort-Dex. Progression-free survival was similar (median, 9.0 months for Thal-Dex and 7.2 for Bort-Dex). Response rate was similar (55% for Thal-Dex and 63% for Bort-Dex), but time to response was shorter (P < 0.05) and the VGPR rate higher (P < 0.01) for Bort-Dex. Time-to-other treatment after crossover was similar (median, 13.2 months for Thal-Dex and 11.2 months for Bort-Dex), as was overall survival (22.8 months for Thal-Dex and 19.0 for Bort-Dex). Venous thromboembolism was seen in seven patients and cerebrovascular events in four patients in the Thal-Dex group. Severe neuropathy, reactivation of herpes virus infections, and mental depression were more frequently observed in the Bort-Dex group. In the quality-of-life analysis, no difference was noted for physical function, pain, and global quality of life. Fatigue and sleep disturbances were significantly more prevalent in the Bort-Dex group. Conclusions: Thalidomide (50–100 mg daily) in combination with dexamethasone seems to have an efficacy comparable with that of bortezomib and dexamethasone in melphalan refractory myeloma. However, the statistical strength of the results in this study is limited by the low number of included patients.
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| 6. |
- Hjorth Simonsen, Martin, 1988, et al.
(författare)
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State-of-the-art within ship weather routing
- 2015
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Ingår i: Proceedings of The ASME 2015 34th International Conference on Ocean, Offshore and Arctic Engineering (OMAE 2015). - 9780791856499 ; 3, s. 1-11
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Konferensbidrag (refereegranskat)abstract
- Increased fuel prices and public awareness of environment impacts from shipping have attracted large efforts in maritime sector to increase its energy efficiency as a factor of competitiveness. Weather routing has become a recognized measure, which can partly help to achieve the targets as well as enhancing safety. A routing system requires a reliable optimization algorithm to consider a ship’s operational costs, expected time of arrival, and cargo safety etc. simultaneously. Hence, the service provided by a weather routing system is highly dependent on a properly selected optimization algorithm and associated input parameters. In this paper the concept of weather routing is broken down into many elements for further analysis. Focus is given to algorithms, constraints and weather forecasts used in the optimized routing plan. Two different aspects of state-of-the-art have been considered. The first is a study of software already in use and the second is a study of methods investigated in the research community. Furthermore, this paper also provides examples of development trends, for example the fatigue based routing, and the risk based routing, as well as its integration with onboard monitoring systems for more reliable weather and ship specific response information.
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| 7. |
- Hugosson, Anna, et al.
(författare)
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A community outbreak of Legionnaires' disease from an industrial cooling tower: assessment of clinical features and diagnostic procedures.
- 2007
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 39:3, s. 217-24
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Tidskriftsartikel (refereegranskat)abstract
- An outbreak of Legionnaires' disease (LD) occurred in Lidköping, Sweden, in August 2004. A cooling tower was identified as the probable source of infection. During the outbreak period an unexpected 3-6-fold increase in pneumonia patients was noted at the local hospital. During 7 weeks LD was diagnosed in 15 patients by urinary antigen and/or sputum culture. Additionally, 15 LD patients were diagnosed later by serology. Patients with LD were generally younger, more healthy, and more often smokers compared to other pneumonia patients. On admittance they had more severe symptoms with high fever and raised CRP levels, and more often hyponatraemia, gastrointestinal and CNS symptoms. A causative agent besides Legionella was found in 2 patients only. A significant titre rise for Mycoplasma and/or Chlamydophila pneumoniae was found in 13 of 29 tested patients with confirmed LD. We conclude that the clinical diagnosis of LD is difficult and that available diagnostic methods detect only a minority of patients in the acute phase. Therefore in severe pneumonia, empirically targeted therapy should be instituted on clinical grounds irrespective of the results of diagnostic tests. The observation of increased antibody levels for M. and C. pneumoniae suggests an unspecific immune reaction and merits further study.
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| 8. |
- Larsson, Erik, 1988, et al.
(författare)
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DIRECT Optimization Algorithm for Ship Routing Plan
- 2015
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Ingår i: Proceedings of the International Offshore and Polar Engineering Conference. 25th International Offshore and Polar Engineering Conference, ISOPE-2015, Hawaii, 21-26 June 2015.. - 1098-6189.
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Konferensbidrag (refereegranskat)abstract
- Weather routing represents one increasingly recognized method for reducing fuel consumption, hereby lowering emissions and costs. This paper provides a short outline of the general concept of weather routing of ships, while focus is on the implementation of the DIRECT (DIviding RECTangles) algorithm in the construction of a novel weather routing tool made in cooperation with Maersk Maritime Technology. The developed routing tool is demonstrated on several conceptual cases to determine capabilities of route profiles avoiding obstacles such as land, avoiding adverse storms by varying voyage speed and utilizing weather to schedule a route with minimized fuel consumption. Strengths and weaknesses of the utilization of the DIRECT algorithm are discussed.
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| 9. |
- Larsson, Erik, 1988, et al.
(författare)
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DIRECT optimization algorithm in weather routing of ships
- 2015
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Ingår i: Proceedings of the International Offshore and Polar Engineering Conference. - 1098-6189 .- 1555-1792. - 9781880653890 ; 2015-January, s. 1207-
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Konferensbidrag (refereegranskat)abstract
- Weather routing represents one increasingly recognized method for reducing fuel consumption, hereby lowering emissions and costs. This paper provides a short outline of weather routing of ships, while focus is on the implementation of the DIRECT (Dividing RECTangles) algorithm in the construction of a novel weather routing tool made under supervision from Maersk Maritime Technology. It is evaluated on several conceptual cases to determine capabilities of route profiles avoiding obstacles such as adverse storms by varying voyage speed and utilizing weather to schedule a route with rmnimized fuel consumption. This paper discusses the application of the developed routing tool for shortest route, land avoidance, storm avoidance and combinations. Strengths and weaknesses of the utilization of the DIRECT algorithm are discussed.
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| 10. |
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