RESUMEN
PURPOSE: This randomized phase III study compared bendamustine and prednisone (BP) to standard melphalan and prednisone (MP) treatment in previously untreated patients with multiple Myeloma (MM). PATIENTS AND METHODS: To be included, patients had to have histologically and cytologically proven stage II with progressive diseases or stage III MM. They were randomly assigned to receive BP (n=68) or MP (n=63). The primary endpoint was the time to treatment failure (TTF). Secondary endpoints included survival, remission rate, toxicity and quality of life. RESULTS: The overall response rate was 75% in the BP and 70% in the MP group. A significantly higher number of patients treated with BP achieved a complete remission than did patients receiving MP (32 vs. 13%; P=0.007), and the maximum response was achieved more rapidly in patients treated with BP compared to those receiving MP (6.8 vs. 8.7 cycles; P<0.02). TTF and remission duration were significantly longer in the BP group. Patients receiving BP had higher QoL scores and reported pain less frequently than patients receiving MP. CONCLUSION: BP is superior to MP with respect to complete remission rate, TTF, cycles needed to achieve maximum remission and quality of life and should be considered the new standard in first-line treatment of MM patients not eligible for transplantation.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Melfalán/administración & dosificación , Mieloma Múltiple/tratamiento farmacológico , Compuestos de Mostaza Nitrogenada/administración & dosificación , Prednisona/administración & dosificación , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Clorhidrato de Bendamustina , Supervivencia sin Enfermedad , Femenino , Alemania Oriental , Humanos , Masculino , Melfalán/efectos adversos , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , Mieloma Múltiple/patología , Compuestos de Mostaza Nitrogenada/efectos adversos , Prednisona/efectos adversos , Inducción de Remisión , Análisis de Supervivencia , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
Recently, the diagnosis of a variant form of chronic granulomatous disease (CGD) could be established in an 11-year-old girl who had been treated for atopic dermatitis for many years. In addition to severe superinfections of lesions of the skin, the following symptoms were found currently or in her history: an episode of chronic diarrhoea (suspected as lactose intolerance), an endomyocarditis, a paranephritic abscess and recurrent lymph node abscesses. This case is demonstrated to underline the importance of extensive immunologic diagnostics in situations of recurrent severe infections of the skin, especially if other organs are involved. Diagnosis and type of CGD were strongly indicated by flow cytometrical measurement of H2O2 and cytochrome b558-expression by neutrophils and confirmed by a Western blot test. No immunoreactive p47phox could be found in the patient's cells. In this autosomal recessive variant of CGD some retained ability of phagocytes to produce reactive oxygen intermediates was present. Special management of patients with CGD is necessary to prevent serious infectious complications. Genetic counselling is another important consequence of the correct diagnosis.
Asunto(s)
Dermatitis Atópica/etiología , Enfermedad Granulomatosa Crónica/complicaciones , Infecciones/etiología , Niño , Femenino , Enfermedad Granulomatosa Crónica/inmunología , Humanos , Inmunoglobulinas/análisis , Infecciones/inmunología , Mediciones Luminiscentes , Activación de Linfocitos , Fagocitos/inmunología , Recurrencia , Enfermedades Cutáneas Infecciosas/etiología , Enfermedades Cutáneas Infecciosas/inmunologíaRESUMEN
To determine the proportion of T-helper cell subsets in the peripheral blood we studied 16 patients with mild, moderate and severe atopic dermatitis. Lymphocytes were isolated from heparinized peripheral blood and analysed by two-colour flow cytometry. Patients with severe atopic dermatitis had a decreased CD4+CD29+: CD4+CD45RA+ ratio (p < 0.01). We found a decreased absolute number of CD4+CD29+ cells (p < 0.05) and an increased absolute number of CD4+CD45RA+ cells (p < 0.05) in the peripheral blood. No significant changes in the CD4+CD29+: CD4+CD45RA+ ratio were found in the peripheral blood of patients with clinically mild or moderate atopic dermatitis.
Asunto(s)
Antígenos CD/sangre , Antígenos CD4/sangre , Dermatitis Atópica/inmunología , Antígenos Comunes de Leucocito/sangre , Subgrupos de Linfocitos T/inmunología , Linfocitos T Colaboradores-Inductores/inmunología , Adolescente , Adulto , Niño , Humanos , Inmunoglobulina E/metabolismo , Integrina beta1 , Persona de Mediana EdadRESUMEN
After a car accident a 23-year-old man was found to have rotational luxation of the cervical spine at the level C7/T1. The diagnosis was suspected from indirect signs on the ap X-ray and subsequently confirmed by conventional lateral tomography. Neurological symptoms were not present. Magnetic resonance imaging demonstrated dorsal protrusion of the intervertebral disc.