RESUMEN
Upper respiratory tract (URT) disorders are common in dogs but neither general nor breed-related epidemiological data are widely reported. This study´s aims were to describe the epidemiology of URT disorders in a Swedish population of dogs and to investigate whether brachycephalic breeds were overrepresented among high-risk breeds. A cohort of dogs insured by Agria Djurförsäkring in Sweden (2011-2014) was used to calculate overall and breed-specific incidence rate (IR), age at first URT diagnosis and relative risk (RR) for URT disorders. For breeds with high RR for URT disorders, co-morbidities throughout the dog's insurance period and age at death were investigated. The cohort included approximately 450,000 dogs. URT disorders had an overall IR of 50.56 (95% CI; 49.14-52.01) per 10,000 dog years at risk. Among 327 breeds, the English bulldog, Japanese chin, Pomeranian, Norwich terrier and pug had highest RR of URT disorders. Eight of 13 breeds with high RR for URT disorders were brachycephalic. The median age at first URT diagnosis was 6.00 years (interquartile range 2.59-9.78). French bulldogs with URT diagnoses had a significantly shorter life span (median = 3.61 years) than other breeds with URT diagnosis (median = 7.81 years). Dogs with high risk for URT disorders had more co-morbidities than average.
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Craneosinostosis , Enfermedades de los Perros , Seguro , Enfermedades Respiratorias , Perros , Animales , Suecia/epidemiología , Enfermedades de los Perros/epidemiología , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/veterinaria , Craneosinostosis/epidemiología , Craneosinostosis/veterinaria , Sistema RespiratorioAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Neoplasias del Mediastino/diagnóstico por imagen , Adolescente , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Humanos , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/mortalidad , Masculino , Neoplasias del Mediastino/tratamiento farmacológico , Neoplasias del Mediastino/mortalidad , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Prednisona/administración & dosificación , Pronóstico , Rituximab/administración & dosificación , Tomografía Computarizada por Rayos X , Vincristina/administración & dosificaciónRESUMEN
The present prospective study examined the follicular fluid oocyte/cumulus-free DNA concentrations (ff o/c-free DNA) during ovarian stimulation and the possible association between ff o/c-free DNA and embryological results such as embryo quality and pregnancy rate. Eighty-three women undergoing IV/ICSI-ET treatments were prospectively included in this study. ff o/c-free DNA was determined by conventional quantitative real time PCR-Sybr green detection approach. The 83 ff samples were categorized in two groups: group 1 (n = 62) with cumulus oocytes complexes (CoCs) ≥2 and group 2 (n = 21) with CoCs = 1. Group 1 revealed significant higher embryo quality in terms of mean score of embryo transfer (MSET), but lower ff o/c-free DNA concentrations compared to group 2. The two groups showed comparable pregnancy rates (positive hCG and clinical pregnancy). The higher the ff o/c-free DNA concentration, the lower the number of produced oocytes. ff o/c-free DNA did not seem to have any direct role in the IVF outcome. Further research is required to clarify whether ff o/c-free DNA is a biomolecular marker of embryo quality and IVF outcome.
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Biomarcadores/metabolismo , ADN/aislamiento & purificación , Fertilización In Vitro , Líquido Folicular/metabolismo , Adulto , Sistema Libre de Células , ADN/metabolismo , Transferencia de Embrión , Femenino , Humanos , Oocitos/crecimiento & desarrollo , Oocitos/metabolismo , Inducción de la Ovulación , EmbarazoRESUMEN
This is a report of a fracture of the medial trochlear ridge of the distal femur occurring as a major complication after surgery for medial patellar luxation. To address the complication, a non-vascularized iliac bone graft was collected and fixated with two positional screws to the trochlea. An external skeletal fixator was placed to prevent motion of the stifle joint during the healing period and to reduce the risk for fragment dislodgment. One year after the graft was placed the dog's function was satisfactory. This case report indicates that a non-vascularized iliac bone graft provides an alternative for management of fractures of the medial ridge of the distal femur.
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Trasplante Óseo/veterinaria , Perros/lesiones , Fémur/patología , Fracturas Óseas/veterinaria , Ilion/cirugía , Animales , Trasplante Óseo/métodos , Perros/cirugía , Fémur/cirugía , Fracturas Óseas/terapia , Masculino , Rodilla de Cuadrúpedos/patología , Rodilla de Cuadrúpedos/cirugíaRESUMEN
Osteoporosis is a severe complication of thalassemia. Sclerostin is a Wnt signaling inhibitor, which is produced by osteocytes and inhibits osteoblast function. Sclerostin is implicated in the pathogenesis of osteoporosis of different etiology. The aim of the study was to evaluate circulating sclerostin in 66 patients (median age 42 years) with thalassemia and osteoporosis who participated in a phase 2, randomized study (zoledronic acid vs. placebo) and the results were compared with those of 30 healthy controls (median age 44 years) without osteopenia/osteoporosis and 62 women with postmenopausal osteoporosis (median age 63 years). At baseline, thalassemic patients with osteoporosis had elevated circulating levels of sclerostin (median: 605 pg/ml, range: 22-1,227 pg/ml) compared to healthy controls without osteopenia/osteoporosis (250 pg/ml, 0-720 pg/ml, p<0.001) and reduced levels of sclerostin compared with postmenopausal women with osteoporosis (840 pg/ml, 181-1,704 pg/ml, p<0.001). Thalassemia patients had also increased serum dickkopf-1 (Dkk-1) and high bone turnover. Circulating sclerostin levels correlated with bone mineral density in lumbar spine (r=0.619, p<0.001), distal radius (r=0.401, p=0.001) and femoral neck (r=0.301, p=0.021). Zoledronic acid did not alter sclerostin levels after 12 months of therapy, although it reduced circulating Dkk-1. We conclude that circulating sclerostin is elevated in thalassemia patients with osteoporosis and correlated with their BMD, but it was not reduced post zoledronic acid administration. These findings suggest that high sclerostin may serve as a marker of increased osteocyte activity in thalassemia patients. Drugs targeting sclerostin may also be used in this difficult to treat disorder associated with bone loss.
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Densidad Ósea , Proteínas Morfogenéticas Óseas/sangre , Resorción Ósea/etiología , Osteoporosis/sangre , Osteoporosis/etiología , Talasemia/fisiopatología , Regulación hacia Arriba , Proteínas Adaptadoras Transductoras de Señales , Adulto , Anciano , Biomarcadores/sangre , Densidad Ósea/efectos de los fármacos , Conservadores de la Densidad Ósea/uso terapéutico , Resorción Ósea/prevención & control , Huesos/efectos de los fármacos , Huesos/metabolismo , Estudios de Cohortes , Femenino , Marcadores Genéticos , Humanos , Péptidos y Proteínas de Señalización Intercelular/sangre , Masculino , Persona de Mediana Edad , Osteoporosis/tratamiento farmacológico , Osteoporosis Posmenopáusica/sangre , Estudios Retrospectivos , Regulación hacia Arriba/efectos de los fármacos , Adulto JovenRESUMEN
BU combined with CY, the preferred preparatory regimen for thalassemic patients, is associated with a substantial incidence of graft rejection especially in patients with advanced disease stage. This study retrospectively analyzes the outcome of 75 consecutive pediatric patients with ß-thalassemia who underwent HLA-matched sibling transplantation after anti-thymocyte globulin (ATG)-containing myeloablative conditioning regimens. With a median follow-up of 9 years (range 1-15 years), the overall survival (OS) and thalassemia free survival (TFS) rates were 96% and 92%, respectively. Both the estimated TRM and the cumulative incidence of rejection/failure were 4%. The cumulative incidences of acute GVHD grade II-III and grade III were 20% and 5.3%, respectively. No patient developed acute GVHD grade IV. Only two patients developed extensive chronic GVHD. The estimated OS and TFS for patients with Class 1 and 2 disease according to Pesaro criteria were 96.3% and 94.4%, whereas for patients with Class 3 disease they were 94.1% and 88.2%, respectively. In our series, the use of myeloablative conditioning regimens, which include ATG for the transplantation of thalassemic children from matched sibling donors, resulted in excellent outcomes with very low incidences of TRM and rejection.
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Suero Antilinfocítico/administración & dosificación , Inmunosupresores/administración & dosificación , Donadores Vivos , Hermanos , Trasplante de Células Madre , Acondicionamiento Pretrasplante/métodos , Talasemia beta/mortalidad , Talasemia beta/terapia , Adolescente , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Rechazo de Injerto/etiología , Rechazo de Injerto/mortalidad , Rechazo de Injerto/terapia , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/mortalidad , Enfermedad Injerto contra Huésped/terapia , Grecia/epidemiología , Prueba de Histocompatibilidad , Humanos , Lactante , Masculino , Estudios Retrospectivos , Tasa de Supervivencia , Trasplante HomólogoRESUMEN
BACKGROUND AND AIMS: Hepatitis C virus (HCV) infection is an important health problem worldwide. The aim of the study is to describe the baseline characteristics and possible epidemiological changes of the patients with chronic HCV infection included in a nationwide Greek study. PATIENTS AND METHODS: two thousand eight hundred seventeen (2817) patients, followed-up at 20 hepatology centres throughout Greece between the years 1997 and 2006 were enrolled in the study. RESULTS: Intravenous drug use (IDU) and history of blood transfusion prior to 1992 was reported in 30.7% and 22.6% of our patients, respectively. In 1865 (66.2%) patients with known genotypes, the distribution for genotype 1, 2, 3 and 4 was 45.1%, 7%, 34% and 13.9% respectively. Genotype 1 was more common in older people, in women (55.9% p<0.001) and patients with transfusion-related hepatitis (61.6% p<0.001). Genotype 3 was more common in younger patients, in men (43% p<0.001) and in IDUs (63.3% p<0.001). A significant reduction of transfusion-related hepatitis C incidence (p<0.001) in conjunction with the proportion of genotype 1 (p<0.001) was observed during the last three decades while an increase in IDU infected patients and genotype 3 was detected. CONCLUSIONS: Our study showed a significant change in HCV genotype distribution and source of HCV infection during the last three decades and under that scope, urgent actions are needed in order to control the spread of HCV infection.
RESUMEN
Two three-month-old, intact female Abyssinian cats were presented with a history of lameness, constipation and ataxia. The cats had been fed a diet composed almost exclusively of meat. Both showed severe osteopenia and multiple pathological fractures on radiography. Following euthanasia of the more severely affected cat, postmortem examination revealed changes consistent with nutritional secondary hyperparathyroidism and fibrous osteodystrophy, such as cortical thinning, massive connective tissue invasion in the diaphysis of long bones, and hypertrophy of the chief cells in both parathyroid glands. After introducing a balanced commercial diet to the surviving cat, bone mineralisation improved from the baseline value, and at subsequent examinations at three, six and 22 weeks later, as indicated by bone mineral density measurements obtained by dual-energy X-ray absorptiometry and computed tomography.
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Hiperparatiroidismo/veterinaria , Absorciometría de Fotón/veterinaria , Animales , Antiinflamatorios no Esteroideos/uso terapéutico , Densidad Ósea , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Enfermedades Óseas Metabólicas/veterinaria , Gatos , Resultado Fatal , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/veterinaria , Femenino , Hiperparatiroidismo/diagnóstico por imagen , Hiperparatiroidismo/tratamiento farmacológico , Cojera Animal/diagnóstico por imagen , Cojera Animal/etiología , Meloxicam , Tiazinas/uso terapéutico , Tiazoles/uso terapéutico , Tomografía Computarizada por Rayos X/veterinaria , Resultado del TratamientoAsunto(s)
Trasplante de Células Madre Hematopoyéticas , Transfusión de Linfocitos , Trastornos Linfoproliferativos/terapia , Púrpura Trombocitopénica Idiopática/terapia , Acondicionamiento Pretrasplante/métodos , Adulto , Humanos , Trastornos Linfoproliferativos/inmunología , Masculino , Púrpura Trombocitopénica Idiopática/inmunologíaRESUMEN
Splenectomy has traditionally been considered as a standard first line treatment for splenic marginal zone lymphoma (SMZL) conferring a survival advantage over chemotherapy. However it carries significant complications, especially in elderly patients. The purpose of this retrospective study was to report our experience on the efficacy of Rituximab as first line treatment in 16 consecutive SMZL patients, diagnosed in our department. The diagnosis was established using standard criteria. Patients' median age was 57 years (range, 48-78). Prior to treatment initiation all patients had splenomegaly, nine had anemia, five lymphocytosis, five neutropenia and six thrombocytopenia. Rituximab was administered at a dose of 375 mg/m2/week for 6 consecutive weeks. The overall response rate was 100%. After treatment, all patients had a complete resolution of splenomegaly along with restoration of their blood counts. Eleven patients (69%) achieved a CR, three (19%) unconfirmed CR and two (12%) a PR. Among the complete responders seven patients had also a molecular remission. The median time to clinical response was 3 weeks (range, 2-6). Rituximab maintenance was given to 12 patients. Eleven of them had no evidence of disease progression after a median follow-up time of 28.5 months (range, 14-36), while two out of four patients who did not receive maintenance, relapsed 7 and 24 months after the completion of induction treatment. Median follow-up time for the entire series was 29.5 months (range, 15-81). No deaths were recorded during the follow-up period. Therapy was well tolerated. The present study demonstrates that rituximab is an effective treatment for SMZL and could be considered as a substitute or alternative to splenectomy.
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Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Linfoma de Células B/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Neoplasias del Bazo/tratamiento farmacológico , Anciano , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales de Origen Murino , Esquema de Medicación , Evaluación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inducción de Remisión , Estudios Retrospectivos , Rituximab , Resultado del TratamientoRESUMEN
BACKGROUND: Activating mutations of the FLT3 receptor tyrosine kinase are common in acute promyelocytic leukemia (APL) but have uncertain prognostic significance. Information regarding FLT3 expression levels in APL without FLT3 mutations is lacking. MATERIALS AND METHODS: Using RT-PCR, mutation analysis of the FLT3 gene, regarding internal tandem duplications (ITDs) and codon 835-836 point mutations, was performed and real-time PCR was carried out to determine the level of FLT3 expression in 11 APL patients at diagnosis and 5 in haematological remission with molecularly detectable disease. RESULTS: High levels of FLT3 transcript, at least a 10-fold increase compared to the normal controls, were found at diagnosis in all 3 mutated cases and in 2 patients without detectable FLT3 mutations. CONCLUSION: FLT3 overexpression can be documented in patients without FLT3 mutations. These patients might benefit from treatment using specific FLT3 tyrosine kinase inhibitors. Larger studies are needed to evaluate the clinical and biological significance of FLT3 overexpression in the absence of FLT3 mutations.
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Leucemia Promielocítica Aguda/genética , Mutación Puntual , Tirosina Quinasa 3 Similar a fms/genética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Médula Ósea/metabolismo , Codón , Humanos , Leucemia Promielocítica Aguda/tratamiento farmacológico , Leucemia Promielocítica Aguda/metabolismo , Proteínas de Neoplasias/biosíntesis , Proteínas de Neoplasias/genética , Proteínas de Fusión Oncogénica/biosíntesis , Proteínas de Fusión Oncogénica/genética , Proyectos Piloto , ARN Mensajero/biosíntesis , ARN Mensajero/genética , Secuencias Repetidas en Tándem , Tirosina Quinasa 3 Similar a fms/biosíntesisRESUMEN
PURPOSE: Serum beta-2 microglobulin (sbeta(2)m) is an established prognostic factor for several lymphoproliferative disorders. Because its significance in Hodgkin's lymphoma (HL) is controversial, we determined sbeta(2)m levels in pretreatment serum samples of patients with HL in order to elucidate its prognostic value in this condition. PATIENTS AND METHODS: Pretreatment sbeta(2)m levels were determined in 379 HL patients who were treated with ABVD or equivalent regimens with or without radiotherapy (RT), using a radioimmunoassay (upper normal limit 2.4 mg/l). Sbeta(2)m levels were correlated with several clinical and laboratory parameters. RESULTS: Elevated sbeta(2)m levels were detected in 138/379 (36%) patients and correlated with all clinical and laboratory baseline features except gender, lung involvement and mediastinal bulk. They also correlated with serum soluble CD30 and interleukin-10 levels. The 8-year failure-free survival (FFS) was 78 -/+ 4% for patients with normal versus 65 -/+ 7% for patients with elevated sbeta(2)m levels (p=0.003). The corresponding rates among early-stage patients were 83 -/+ 53% versus 71 -/+ 9% (p=0.003), while for advanced stages they were 70 -/+ 6% versus 64 -/+ 8% (p=0.54). In multivariate analysis of the whole patient population elevation of sbeta(2)m levels was not predictive of FFS, but it was strongly predictive among early-stage patients. The 8-year overall survival (OS) rates were 91 -/+ 3% for patients with normal versus 59 -/+ 11% (p <0,0001) for patients with elevated sbeta(2)m levels, while unrelated mortality at 8 years was 1 -/+ 1% versus 27 -/+ 12% (p<0.0001). CONCLUSION: Our data suggest that sbeta(2)m levels may be a potent prognostic factor for FFS in patients with early stage HL treated with ABVD and equivalent regimens. Their effect on OS is confounded by the higher unrelated mortality in patients with elevated baseline sbeta(2)m levels, probably due to the strong association between sbeta(2)m and older age.
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1. Effects of dietary conjugated linoleic acid (CLA) on various functional properties of macrophages and heterophils in the laying hen were determined. 2. Seventy two 28-week-old-ISA brown hens were randomly assigned to one of two experimental groups and were fed diets containing 0 or 1% CLA for a total period of 18 weeks. Blood samples were collected from 6 hens per diet group every 3 weeks and macrophages and heterophils were isolated. The following variables were determined in resting and phorbol myristate acetate-activated (65 microM) macrophages and heterophils: total cell-associated urokinase plasminogen activator (u-PA), membrane-bound u-PA, free u-PA binding sites and superoxide production. 3. There were no significant differences between diet groups throughout the whole experimental period in total cell-associated u-PA, membrane-bound u-PA, free u-PA binding sites and superoxide production by resting macrophages and heterophils. 4. Activated heterophils and macrophages isolated from hens fed the CLA-supplemented diet had higher membrane-bound u-PA activity compared with the corresponding values for activated heterophils and macrophages obtained from hens fed the basal diet. These differences were significant for heterophils during weeks 6, 12, 15 and 18 and for macrophages during weeks 6, 9 and 12 of the experiment. 5. Macrophages and heterophils from hens fed the CLA diet had lower superoxide production compared with the corresponding cells from the control hens on weeks 12, 15 and 18 of the experiment. 6. Dietary CLA modulated certain aspects of the immune system in the laying hen. The increased quantity of u-PA on the membrane of macrophages and heterophils isolated from hens fed the CLA diet may facilitate the ability of these cells to reach the point of a potential inflammation (pro-inflammatory effect). 7. In contrast to the effect on the u-PA system, dietary CLA reduced superoxide production by activated macrophages and heterophils during the second half (last 9 weeks) of the experimental period suggesting that CLA may exert an anti-inflammatory effect in the laying hen.
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Pollos/inmunología , Grasas Insaturadas en la Dieta/administración & dosificación , Granulocitos/fisiología , Ácido Linoleico/administración & dosificación , Macrófagos/fisiología , Animales , Grasas Insaturadas en la Dieta/metabolismo , Femenino , Isomerismo , Ácido Linoleico/metabolismo , Activación de Macrófagos/efectos de los fármacos , Distribución Aleatoria , Superóxidos/metabolismo , Activador de Plasminógeno de Tipo Uroquinasa/efectos de los fármacos , Activador de Plasminógeno de Tipo Uroquinasa/metabolismoRESUMEN
A tyrosine kinase inhibitor (STI571, Gleevec) has recently been applied in the treatment of chronic myeloid leukemia. We present the first reported case of pityriasis rosea occurring as a reaction to Gleevec in a woman with blast crisis of this disorder. It is suggested that although coincidental, this exanthem may be due to this agent.
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Antineoplásicos/efectos adversos , Erupciones por Medicamentos/etiología , Piperazinas/efectos adversos , Pitiriasis Rosada/inducido químicamente , Pirimidinas/efectos adversos , Adulto , Benzamidas , Femenino , Humanos , Mesilato de Imatinib , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológicoRESUMEN
Pulmonary involvement in Waldenström's macroglobulinaemia (WM) occurs in 3-5% of cases, but lung involvement without bone marrow infiltration is extremely rare. We report 2 patients who presented with bilateral consolidations on chest X-ray and non-specific symptoms and were treated for a long period of time for pulmonary infections until the diagnosis was made by open lung biopsy. Both patients presented high monoclonal IgM in the serum and one also had blood lymphoplasmacytosis. Trephine bone biopsy and bone marrow smears were normal and there was no other site of involvement. Along with the presentation of our patients, we review the literature, discuss some of the possible underlying mechanisms and raise the attention of clinicians to this rare manifestation of the disease.
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Neoplasias Pulmonares/diagnóstico por imagen , Macroglobulinemia de Waldenström/diagnóstico , Anciano , Humanos , Inmunoglobulina M/sangre , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamiento farmacológico , Linfoma/diagnóstico , Linfoma/diagnóstico por imagen , Linfoma/tratamiento farmacológico , Masculino , Radiografía , Macroglobulinemia de Waldenström/tratamiento farmacológico , Macroglobulinemia de Waldenström/patologíaRESUMEN
BACKGROUND AND OBJECTIVES: Interleukin-10 (IL-10) is a pleiotropic cytokine which increases bcl-2 levels and protects cells from steroid or doxorubicin-induced apoptosis. Hodgkin and Reed-Sternberg (HRS) cells bear functional IL-10 receptors. Thus serum IL-10 (sIL-10) might inhibit apoptosis in HRS cells, which could occur as a result of either chemotherapy or the crippled immunoglobulin genes. DESIGN AND METHODS: We determined sIL-10 levels in 122 patients with Hodgkin's lymphoma (HL), treated with ABVD or equivalent regimens with or without radiotherapy, and correlated them with presenting clinical and laboratory features, as well as failure-free survival (FFS) and overall survival. RESULTS: Elevated sIL-10 levels ( > or = 10 pg/mL) were detected in 55 patients (45%), and were correlated with advanced stage and elevated serum b2-microglobulin levels. At 7 years FFS was 85% vs. 63% for patients with normal vs. elevated sIL-10 levels, respectively (p=0.01); overall survival was 97% vs. 73% (p=0.005). Multivariate analysis with Cox's proportional hazards model demonstrated that elevated sIL-10 levels were the strongest independent predictor of FFS, and were also associated with inferior overall survival. INTERPRETATION AND CONCLUSIONS: We conclude that sIL-10 levels are elevated in 45% of patients with HL, and are associated with inferior FFS and overall survival, independently of other established prognostic factors.
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Enfermedad de Hodgkin/diagnóstico , Interleucina-10/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Enfermedad de Hodgkin/sangre , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de SupervivenciaRESUMEN
BACKGROUND: Advanced Hodgkin's lymphoma (HL) is curable by conventional chemotherapy in 60--70% of patients. The pretreatment identification of a sizeable subgroup of patients with sufficiently low failure-free survival (FFS) to be eligible for investigational treatment is necessary. OBJECTIVES: To determine the prognostic significance of the number of involved sites (NIS) in patients with advanced HL and its relationship to the International Prognostic Score (IPS). METHODS: A retrospective review of patients with advanced HL, defined as Ann Arbor stage (AAS) IB, IIB, III or IV, treated with anthracycline-based regimens. The end-point was FFS. RESULTS: We identified 277 patients with a median age of 32 yr (14--78), 57% of whom were males. AAS was I in 4% of patients, II in 29%, III in 38% and IV in 29%. B-symptoms were recorded in 81%. Most patients had nodular sclerosis (64%) and mixed cellularity (26%) histology. IPS was greater-than-or-equals 3 in 44% of 242 evaluable patients. The NIS was greater-than-or-equals 5 in 32% of the patients and 20% of all patients had both greater-than-or-equals 5 involved sites and IPS greater-than-or-equals 3. The 10-yr FFS was 67%, being 76% vs. 50% for patients with less-than-or-equals 4 vs. greater-than-or-equals 5 involved sites (P < 0.0001). The NIS (greater-than-or-equal 5), AAS IV and anemia were independent predictors of FFS in multivariate analysis. The NIS remained significant along with IPS, when the latter was included in the analysis. Patients with greater-than-or-equals 5 involved sites and IPS greater-than-or-equals 3 had 10-yr FFS overall, and relapse-free survival of 41%, 45% and 49%, respectively. CONCLUSIONS: The NIS was associated with FFS in advanced HL, was independent of IPS, and led to the identification of a sizeable subgroup of patients with 10-yr FFS of approximately 40%. This factor should be evaluated during the development of prognostic systems.
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Enfermedad de Hodgkin/patología , Adolescente , Adulto , Anciano , Antibióticos Antineoplásicos/uso terapéutico , Supervivencia sin Enfermedad , Femenino , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Pronóstico , Estudios RetrospectivosRESUMEN
Waldenström's macroglobulinemia (WM) is a lymphoplasmacytic lymphoma characterized by the presence in patients' serum of an IgM monoclonal component. We report on our experience with 60 WM patients, focusing on their clinical findings, response to treatment, and the possible identification of prognostic factors. Of these patients, 70% presented with fatigue, and lymphadenopathy was observed in 22%, splenomegaly in 18%, hepatomegaly in 13%, and extranodal site of involvement in 6%. Bleeding tendency was seen in 17%, infections in 17%, hyperviscosity syndrome in 12%, and cardiac failure in 25% of the patients. The median of IgM levels was 30 g/l with hypoalbuminemia in 20% of cases, hypogammaglobulinemia in 27%, polyclonal hypergammaglobulinemia in 15%, kappa light-chain restriction in 78%, and Bence-Jones proteinuria in 54%. Anemia was frequent (85%), followed by leukocytosis (18%), lymphocytosis (12%), leukopenia (10%), and thrombocytopenia (10%). Cryoglobulinemia and autoimmune hemolytic anemia were encountered in 5%. In all cases but two, bone marrow was involved. Of 50 patients initially treated with intermittent oral chlorambucil, 46 (92%) responded. Median overall survival was 108 months. Factors associated with adverse prognosis were age > or =65 years (p=0.06), presence of lymphadenopathy (p=0.06), bone marrow infiltration > or =50% (p=0.007), international prognostic index (IPI) > or =3 (p=0.0001), and Morel's scoring system (p=0.04). Concluding, we found in this series of WM patients that chlorambucil is an effective treatment and that the parameters of age, lymphadenopathy, percentage of bone marrow infiltration, IPI, and Morel's scoring system carry prognostic significance.
Asunto(s)
Macroglobulinemia de Waldenström/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Viscosidad Sanguínea , Gasto Cardíaco Bajo , Clorambucilo/uso terapéutico , Fatiga , Femenino , Hemorragia/complicaciones , Hepatomegalia , Humanos , Inmunoglobulina M/sangre , Infecciones/complicaciones , Enfermedades Linfáticas , Masculino , Persona de Mediana Edad , Pronóstico , Esplenomegalia , Tasa de Supervivencia , Macroglobulinemia de Waldenström/complicaciones , Macroglobulinemia de Waldenström/terapiaRESUMEN
Campath-1H is a humanized monoclonal antibody targeted against the CDw52 membrane antigen of lymphocytes, which causes complement and antibody-dependent cell-mediated cytotoxicity. Campath-1H has been used in B-chronic lymphocytic leukemia (B-CLL), T-prolymphocytic leukemia (T-PLL), and low-grade non-Hodgkin's lymphoma (LGNHL). Campath-1H is administered intravenously thrice weekly for up to 12 wk, at an initial dose of 3 mg, escalated to 10 and 30 mg. The responses (complete [CR] and partial [PR]) obtained in untreated B-CLL patients are of the order of 90%. In previously treated B-CLL patients, responses are of the order of approximately 40%, with 2-4% CRs. Responses are more prominent in the blood and bone marrow compared to the lymph nodes. The median duration of response is 9-12 mo. Because of the antibody's higher activity on circulating lymphocytes, it has been used for in vivo purging of residual disease in B-CLL, followed by autologous stem-cell transplantation. In heavily pretreated advanced stage LGNHL, response is achieved only in 14% of cases with B-phenotype; a 50% response rate is noted in mycosis fungoides. In T-PLL, the CR rate is approximately 60%. Promising results have been reported in a small number of patients with refractory autoimmune thrombocytopenia of lymphoproliferative disorders. The main complications of Campath-1H treatment are caused by tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 release, usually during the first intravenous infusion, and include fever, rigor, nausea, vomiting, and hypotension responsive to steroids. These side effects are usually less severe with subsequent infusions and can be prevented by paracetamol and antihistamines. Immunosupression resulting from normal B- and T-lymphocyte depletion is frequent, resulting in an increased risk for opportunistic infections. More clinical trials in a larger number of patients are necessary to determine the exact role and indications of Campath-1H in lymphoproliferative disorders.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Antineoplásicos/uso terapéutico , Antineoplásicos/uso terapéutico , Leucemia de Células B/tratamiento farmacológico , Leucemia Prolinfocítica/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Alemtuzumab , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales/farmacología , Anticuerpos Monoclonales Humanizados , Anticuerpos Antineoplásicos/efectos adversos , Anticuerpos Antineoplásicos/farmacología , Antineoplásicos/efectos adversos , Antineoplásicos/farmacología , Relación Dosis-Respuesta a Droga , Humanos , Terapia de Inmunosupresión , Infecciones , Infusiones Intravenosas , Interleucina-6/efectos adversos , Interleucina-6/metabolismo , Fenotipo , Factores de Riesgo , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/efectos adversos , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
In the present study samples of cannabis plants presented to us by the Drug Enforcement Units were characterised, based on the analysis of active substances. The fresh samples were dried in a dark room were they were kept until analysis. The samples included leaves, flowers roots and trunks. The analysis was performed by High Performance Liquid Chromatography (HPLC) and Gas Chromatography (GC) using standard solutions of cannabidiol, D-9 tetrahydrocannabinol, D-8 tetrahydrocannabinol and cannabinol. Chemical analysis of the flowers revealed that 80% of the plants were classified as resinous phenotype while the remaining 20% were found to be of the textile phenotype (low concentration of active cannabinoids). The concentration of D-9 tetrahydrocannabinol in the flowers and leaves ranged from 0.014 to 21.06 mg/g, of cannabinol from 0.0002 to 0.350 mg/g and of cannabidiol from 0.03 to 29.6 mg/g. Roots and trunks contained very small quantities of active substances and should not be used for phenotype identification. No delta-8 THC was detected in any sample. Leaves gave less resinous phenotypes than flowers. The use of either mathematical formula, A or B produced the same phenotype character for each separate part of the plant.