Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Intercambio Plasmático , Recuento de Plaquetas , Púrpura Trombocitopénica Trombótica/tratamiento farmacológico , Púrpura Trombocitopénica Trombótica/terapia , Púrpura/tratamiento farmacológico , Púrpura/terapia , Anticuerpos Monoclonales de Origen Murino , Terapia Combinada , Humanos , Factores Inmunológicos/uso terapéutico , RituximabRESUMEN
The number of CD34(+) cells in peripheral blood (PB) is a guide to the optimal timing to harvest peripheral blood progenitor cells (PBPC). The objective was to determine the number of CD34(+) cells in PB that allows achieving a final apheresis product containing > or =1.5 x 10(6) CD34(+) cells/kg, performing up to three aphereses. Between March 1999 and August 2003, patients with hematological and solid malignancies who underwent leukapheresis for autologous bone marrow transplantation were prospectively evaluated. Seventy-two aphereses in 48 patients were performed (mean 1.45 per patient; range 1-3). PBPC were mobilized with cyclophosphamide plus recombinant human granulocyte-colony stimulating factor (G-CSF) (n = 40), other chemotherapy drugs plus G-CSF (n = 7), or G-CSF alone (n = 1). We found a strong correlation between the CD34(+) cells count in peripheral blood and the CD34(+) cells yielded (r = 0.903; P < 0.0001). Using receiver-operating characteristic (ROC) curves, the minimum number of CD34(+) cells in PB to obtain > or =1.5 x 10(6)/kg in the first apheresis was 16.48 cells/microL (sensitivity 100%; specificity 95%). The best cut-off point necessary to obtain the same target in the final harvest was 15.48 cells/microL, performing up to three aphereses (sensitivity 89%; specificity 100%). In our experience, > or =15 CD34(+) cells/microL is the best predictor to begin the apheresis procedure. Based on this threshold level, it is possible to achieve at least 1.5 x 10(6)/kg CD34(+) cells in the graft with < or =3 collections.
Asunto(s)
Antígenos CD34 , Células Madre Hematopoyéticas/citología , Leucaféresis/normas , Trasplante de Células Madre de Sangre Periférica/normas , Valor Predictivo de las Pruebas , Adolescente , Adulto , Anciano , Células Sanguíneas/citología , Trasplante de Médula Ósea/métodos , Niño , Preescolar , Femenino , Movilización de Célula Madre Hematopoyética , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/terapia , Estudios Prospectivos , Curva ROC , Trasplante AutólogoRESUMEN
El reemplazo plasmático terapéutico (RPT) es el tratamiento de elección en Púrpura Trombótica Trombocitopénica - Síndrome Urémico Hemolítico (PTT-SUH) y debe ser instituído lo antes posible. Presentamos nuestra experiencia en el manejo de esta patología en los últimos diez años. Entre 1995 y 2004, tratamos 11 pacientes con diagnóstico de PTT-SUH con RPT. Hubo una preeminencia de mujeres (8:3); la edad media fue 40±17 años (16-75). En los pacientes tratados entre 1995 y 2000, la demora para iniciar las aféresis luego del diagnóstico fue de 9±9.3 días, mientras que en los pacientes tratados entre 2001 y 2004 la demora fue de 0.3±0.5 días (p=0.05). Efectuamos 114 aféresis en los 11 pacientes, recambiando 0.88±0.23 (0.58 a 1.19) veces la plasmemia teórica. El promedio de aféresis por paciente fue de 10.4±10.3 (2 a 37). Se presentaron 29 eventos adversos que motivaron la interrupción de los procedimientos en seis oportunidades. El 51.7 por ciento fueron reacciones alérgicas, de las cuales 4 fueron graves. De los 11 pacientes, 9 (81.8 por ciento) alcanzaron remisión completa luego de un promedio 12.4±9.9 aféresis (5 a 32). Un paciente tuvo una recaída y 2 pacientes fallecieron durante el tratamiento. En conclusión, nuestra serie muestra que el cuadro de PTT-SUH se beneficia ampliamente del recambio plásmatico terapéutico. Es indispensable reconcoer y tratar rápidamente las complicaciones para no interrumpir el tratamiento hasta lograr la normalización de los parámetros hematológicos.
Asunto(s)
Adolescente , Adulto , Masculino , Humanos , Femenino , Persona de Mediana Edad , Intercambio Plasmático/métodos , Púrpura Trombocitopénica Trombótica/terapia , Síndrome Hemolítico-Urémico/terapia , Eliminación de Componentes Sanguíneos/efectos adversos , Eliminación de Componentes Sanguíneos/estadística & datos numéricos , Recurrencia , Inducción de Remisión , Sobrevivientes , Resultado del TratamientoRESUMEN
El reemplazo plasmático terapéutico (RPT) es el tratamiento de elección en Púrpura Trombótica Trombocitopénica - Síndrome Urémico Hemolítico (PTT-SUH) y debe ser instituído lo antes posible. Presentamos nuestra experiencia en el manejo de esta patología en los últimos diez años. Entre 1995 y 2004, tratamos 11 pacientes con diagnóstico de PTT-SUH con RPT. Hubo una preeminencia de mujeres (8:3); la edad media fue 40±17 años (16-75). En los pacientes tratados entre 1995 y 2000, la demora para iniciar las aféresis luego del diagnóstico fue de 9±9.3 días, mientras que en los pacientes tratados entre 2001 y 2004 la demora fue de 0.3±0.5 días (p=0.05). Efectuamos 114 aféresis en los 11 pacientes, recambiando 0.88±0.23 (0.58 a 1.19) veces la plasmemia teórica. El promedio de aféresis por paciente fue de 10.4±10.3 (2 a 37). Se presentaron 29 eventos adversos que motivaron la interrupción de los procedimientos en seis oportunidades. El 51.7 por ciento fueron reacciones alérgicas, de las cuales 4 fueron graves. De los 11 pacientes, 9 (81.8 por ciento) alcanzaron remisión completa luego de un promedio 12.4±9.9 aféresis (5 a 32). Un paciente tuvo una recaída y 2 pacientes fallecieron durante el tratamiento. En conclusión, nuestra serie muestra que el cuadro de PTT-SUH se beneficia ampliamente del recambio plásmatico terapéutico. Es indispensable reconcoer y tratar rápidamente las complicaciones para no interrumpir el tratamiento hasta lograr la normalización de los parámetros hematológicos. (AU)
Asunto(s)
Adolescente , Adulto , Masculino , Humanos , Femenino , Persona de Mediana Edad , Anciano , Púrpura Trombocitopénica Trombótica/terapia , Síndrome Hemolítico-Urémico/terapia , Intercambio Plasmático/métodos , Resultado del Tratamiento , Inducción de Remisión , Recurrencia , Sobrevivientes , Eliminación de Componentes Sanguíneos/estadística & datos numéricos , Eliminación de Componentes Sanguíneos/efectos adversosRESUMEN
We assessed the efficacy and tolerability of VIM (etoposide/ifosfamide/methotrexate) combination therapy in 24 patients who were failing the treatment protocol of the Lymphomes Non Hodgkiniens (LNH) 84 study. Eight patients were refractory to the LNH 84 induction cycles, but ten achieved a partial response (PR). The six remaining patients attained complete response (CR) after LNH 84 induction, but relapsed either during consolidation therapy or after completing the whole program. Twenty-three patients are evaluable for response. The VIM regimen provided a CR rate of 43% and a PR rate of 17%. Treatment failed in nine cases (39%). The CR rate was particularly high (67%) in the group of patients who had PR with LNH 84 induction treatment. Of the ten who had attained CR, five relapsed after 4 to 42 months and five are still alive with no evidence of disease after 29 to 62 months. VIM therapy was well tolerated. A total of 101 VIM courses were given. Myelotoxicity was the most common side effect. Grade 3 or 4 cytopenia was recorded after 11% of the cycles. Among eight infectious episodes recorded, one was fatal. This study demonstrates that CR and long disease-free survival are obtainable with the VIM regimen in a small number of patients failing a high-dose doxorubicin-containing first-line treatment.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Terapia Recuperativa , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bleomicina/uso terapéutico , Médula Ósea/efectos de los fármacos , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Etopósido/administración & dosificación , Etopósido/efectos adversos , Humanos , Ifosfamida/administración & dosificación , Ifosfamida/efectos adversos , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Prednisolona/uso terapéutico , Inducción de Remisión , Vindesina/uso terapéuticoRESUMEN
We assessed the efficacy of an etoposide, ifosfamide and methotrexate combination therapy (VIM) in 24 patients failing the LNH 84 protocol. Eight of these patients were refractory to the LNH 84 induction regimen, 10 were partial responders and the six remaining attained complete response after LNH 84 induction but relapsed during consolidation therapy or after completing the whole programme. Twenty-three patients were evaluable for response. The VIM regimen provided a 43 per cent complete response rate and an additional 17 per cent partial response rate. The complete response rate was particularly high (67 per cent) in the group of patients who were partial responders to LNH 84 induction treatment. Of the 10 complete responders, five relapsed after 4 to 42 months and five are still alive with no evidence of disease after 27 to 60 months. Overall VIM was well tolerated. Myelotoxicity was the most common side-effect. Infections with fever were observed in 8 per cent of the VIM courses. This study demonstrates that a complete response and a long survival can be obtained in patients after failure of a high-dose doxorubicin containing front-line treatment.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Etopósido/uso terapéutico , Ifosfamida/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Metotrexato/uso terapéutico , Terapia Recuperativa , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Bleomicina/administración & dosificación , Bleomicina/efectos adversos , Bleomicina/normas , Bleomicina/uso terapéutico , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Ciclofosfamida/normas , Ciclofosfamida/uso terapéutico , Relación Dosis-Respuesta a Droga , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Doxorrubicina/normas , Doxorrubicina/uso terapéutico , Quimioterapia Combinada , Etopósido/administración & dosificación , Etopósido/efectos adversos , Etopósido/normas , Humanos , Ifosfamida/administración & dosificación , Ifosfamida/efectos adversos , Ifosfamida/normas , Linfoma no Hodgkin/mortalidad , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Metotrexato/normas , Persona de Mediana Edad , Prednisolona/administración & dosificación , Prednisolona/efectos adversos , Prednisolona/normas , Prednisolona/uso terapéutico , Tasa de Supervivencia , Factores de Tiempo , Vindesina/administración & dosificación , Vindesina/efectos adversos , Vindesina/normas , Vindesina/uso terapéuticoRESUMEN
The authors report a case of hypothyroid hypertrophic myopathy consecutive to mantle irradiation for Hodgkin's disease. A rise in TSH level is frequent after mantle irradiation and it justifies prolonged monitoring of these patients' thyroid function, in view of the risk of patent hypothyroidism and perhaps cancer. The patient's age, the pre-irradiation lymphography and the chemotherapy associated with radiotherapy are all factors that influence the incidence of thyroid dysfunction, but there is no agreement concerning their relative importance. Hypertrophic myopathies due to hypothyroidism are rare, and their dramatic clinical presentation contrasts with an almost normal muscle histology. Alterations of energy metabolism and changes in the properties of myosin induced by hormonal deficiency account for the muscular weakness of these patients. On the other hand, the mechanism of muscle hypertrophy remains controverted, the most probable theory being and increase in the number of myotubes. Following irradiation, notably for Hodgkin's disease, the frequency of hypothyroidism requires a regular and systematic laboratory follow-up. Replacement therapy must be instituted if the basal TSH level increases, even if the T4 level is normal.
Asunto(s)
Enfermedad de Hodgkin/radioterapia , Hipotiroidismo/etiología , Enfermedades Musculares/etiología , Adulto , Humanos , Hipertrofia , Masculino , CuelloRESUMEN
To evaluate the safety of on-line plasma perfusion over protein-A sepharose and the therapeutic advantage of combining plasma perfusion (PP) over protein-A sepharose with 5-fluorouracil (5-FU) chemotherapy in patients with metastatic colorectal carcinoma (MCRC), thirty patients were randomized after surgery of primary CRC to receive a combination of 5-FU and PP over protein-A sepharose (group A), or a combination of 5-FU and PP over sepharose (group B), or 5-FU alone (group C). Bi-weekly on-line PP over 200 ml protein-A sepharose gel (group A) or 200 ml sepharose gel (group B) were performed with a Cobe 2997 blood cell separator for a maximum of 19 treatments per patient. 5-FU was given at 1000 mg/m2/d on days 1-5 of a 4-weekly cycle until progression. PP was well tolerated and no severe or life-threatening toxicity was observed. Mild clinical side-effects consisted of fever and chills (36% in group A, 23% in group B). The most common biological effects of PP over protein-A sepharose were significant drops in IgG (66% of pre-PP values), CH50 and C3 (73% of pre-PP values) and a significant generation of C3a and C5a anaphylatoxins. Tumor response rates were 40% for group A, 0% for group B and 20% for group C. The median survival times tended to be longer in group A (17 months) than in group B (10 months) and in group C (9 months). This is the first randomized trial showing some therapeutic advantage in combining PP over protein-A sepharose with conventional chemotherapy in MCRC.
Asunto(s)
Neoplasias Colorrectales/terapia , Fluorouracilo/uso terapéutico , Técnicas de Inmunoadsorción , Neoplasias Hepáticas/secundario , Perfusión , Plasma , Proteína Estafilocócica A , Cromatografía en Gel , Terapia Combinada , Femenino , Humanos , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana Edad , SefarosaRESUMEN
We assessed the efficacy of a piperacillin (3 x 4 g/d) and netilmicin (5 mg/kg/d) combination therapy for infections in febrile neutropenic patients. The study was conducted over a 30-month period and 203 patients were included. Bone marrow transplant recipients were not included in this study. Origin of infection was documented in 101 (50%) episodes: 33 fungal, viral or parasitic infections and 68 bacterial infections mainly composed of septicemia. Of the 169 evaluable patients with proved bacterial infections or non-documented infections, 129 (76%) recovered with the piperacillin and netilmicin combination treatment. All gram-positive bacterial infections failing first line therapy were cured after the addition of vancomycin. Piperacillin and netilmicin appeared very effective in this large monocentric prospective study. It does not seem necessary to include vancomycin in first line therapy of infections of the neutropenic patients in our institution; however, vancomycin must be added early in the case of suspected or documented staphylococcal infection failing empiric treatment.
Asunto(s)
Infecciones/tratamiento farmacológico , Netilmicina/uso terapéutico , Neutropenia/complicaciones , Piperacilina/uso terapéutico , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/etiología , Quimioterapia Combinada , Humanos , Infecciones/etiología , Leucemia/complicaciones , Linfoma no Hodgkin/complicaciones , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
To evaluate the advantage with regard to toxicity, response rate, time to progression and survival of combination chemoimmunotherapy over single-agent chemotherapy in patients with metastatic colorectal carcinoma (CRC), 30 patients were randomized to receive a combination of 5-fluorouracil (5-FU) by continuous i.v. infusion and plasma perfusion (PP) over protein A-Sepharose (group A), or a combination of 5-FU and PP over sepharose (group B) or 5-FU alone (group C). 5-FU was given at 1,000 mg/m2/d on days 1-5 of a 4-weekly cycle until progression. Patients of groups A and B received bi-weekly on-line PPs until disease progression or for a maximum of 19 treatments. PP was well tolerated and no severe or life-threatening toxicity was observed. The response rates were 10% for the group A (1 PR), 0% for the group B and 20% for the group C (1 CR + 1 PR). The times to tumor progression for patients in groups A and C were 22 months, 12 and 11 months, respectively and the median survival times were 17 months, 10 months and 9 months. Although the time to progression and survival tended to be higher in patients treated with protein A. PP, these differences were not statistically significant. This is the first report of a randomized trial showing some therapeutic advantage in combining protein A. PP with 5-FU in CRC patients. Further randomized studies are required to demonstrate the real true value of this chemoimmunotherapeutic approach.