RESUMEN
The purpose of this trial was to study feasibility and tolerance of a dose-intensive multicyclic alternating induction chemotherapy with repeated stem cell support in a series of 43 metastatic breast cancer patients. Anthracycline-naive patients (n = 21) received cyclophosphamide 2.5 g/m(2) plus doxorubicin 80 mg/m(2) alternating every 14 days with paclitaxel 200-350 mg/m(2) plus cisplatin 120 mg/m(2). Patients who had previously received anthracyclines (n = 22) received cisplatin 120 mg/m(2) plus etoposide 600 mg/m(2) alternating with paclitaxel 200-350 mg/m(2) plus ifosfamide 8 g/m(2). Peripheral blood stem cells were infused after every course except the first, with a median CD34(+) dose of 2.1 x 10(6)/kg per cycle. Positive selection of CD34(+) cells was performed in good mobilizers. The median number of cycles administered was six (4-8), and the time interval between them was 17 days. Median summation dose intensities (SDI) actually administered for the CA-TP and PE-TI protocol were 4.95 and 4.69, respectively (87% of scheduled SDI). There were 15 complete (35%) and 21 partial responses (49%), for an overall response rate of 84% (95% CI, 73%-95%). Infection or neutropenic fever occurred in 50% of the cycles. There was one treatment-related death. After a median follow-up of 26 months, the median event-free-survival was 12 months (95% CI: 10-14) and overall survival was 31 months. These high dose-intensity induction treatments seem to be feasible with sequential stem cell support.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Mama/terapia , Trasplante de Células Madre Hematopoyéticas/métodos , Adulto , Antígenos CD34/análisis , Protocolos de Quimioterapia Combinada Antineoplásica/toxicidad , Neoplasias de la Mama/patología , Neoplasias de la Mama/secundario , Cisplatino/administración & dosificación , Ciclofosfamida/administración & dosificación , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Esquema de Medicación , Etopósido/administración & dosificación , Estudios de Factibilidad , Femenino , Humanos , Ifosfamida/administración & dosificación , Infecciones/inducido químicamente , Persona de Mediana Edad , Neutropenia/inducido químicamente , Paclitaxel/administración & dosificación , Inducción de Remisión/métodos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Dose intensity has been related to clinical outcome in several solid tumors. We studied the influence of clinical and cellular parameters on dose intensity received in a series of 53 patients with metastatic breast cancer or advanced ovarian cancer. They received courses of cisplatin 120 mg/m(2) plus etoposide 600 mg/m(2) alternating every 14 days with ifosfamide 8 g/m(2) plus paclitaxel 200--350 mg/m(2). Blood stem cell support was administered after every course except for the first one. Patients with excellent mobilization underwent immunomagnetic selection of CD34+ cells. We found a significant inverse correlation between the CD34+ cell dose infused and the delay for the administration of the next cycle. A CD34+ cell dose between 1.5 and 5 x 10(6)/kg per cycle was found to be feasible and was followed by a median delay of 1 day (not different from doses above 5 x 10(6)/kg). Three factors independently predicted the actually received dose intensity in a multiple regression model (R(2) = 0.4): previous autologous transplantation, eligibility for immunomagnetic selection (excellent response to mobilization) and median CD34+ cell dose received along the treatment.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/terapia , Trasplante de Células Madre Hematopoyéticas/normas , Neoplasias Ováricas/terapia , Células Madre/inmunología , Adulto , Antígenos CD34/análisis , Recuento de Células , Cisplatino/administración & dosificación , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Etopósido/administración & dosificación , Femenino , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Ifosfamida/administración & dosificación , Separación Inmunomagnética , Persona de Mediana Edad , Modelos Biológicos , Paclitaxel/administración & dosificación , Factores de Tiempo , Trasplante Autólogo , Resultado del TratamientoRESUMEN
INTRODUCTION: Primary central nervous system lymphomas (PCNSL) are infrequent, rapidly growing and generally limited to the central nervous system (CNS). In recent years there has been a threefold increase in cases occurring in immunocompetent individuals. Conventional treatment with corticosteroids and radiotherapy is effective, but over 80% relapse in less than a year. Chemotherapy has significantly improved the results of treatment. CLINICAL CASE: We present a case of PCNSL in an immunocompetent patient which was resistant to radiotherapy (RT). There was progression of the lymphoma three months after irradiation, and later multicentric progression one month after radiosurgery. The patient had complete radiological remission after systemic chemotherapy. The clinical improvement was obvious, since before chemotherapy was started the patient was in coma and had episodes of apnea. The therapeutic response obtained was consolidated by intensive chemotherapy and hemopoietic support. The condition is still in remission three years after completion of this treatment. CONCLUSIONS: There are no publications about the results of combined radiotherapy and chemotherapy in series of patients with PCNSL, since there are relatively few patients and many methods of treatment are tried.
Asunto(s)
Neoplasias Encefálicas/tratamiento farmacológico , Linfoma/tratamiento farmacológico , Adolescente , Neoplasias Encefálicas/patología , Quimioterapia Combinada , Humanos , Linfoma/patología , Imagen por Resonancia Magnética , Masculino , Neoplasias Primarias Múltiples , Resultado del TratamientoRESUMEN
A new case of spontaneous tumor regression (STR) occurring in a patient with multiple myeloma associated to an Staphylococcus Aureus infection. This case report fulfills the criteria of STR defined by Everson and Cole. The mechanisms of the STR remain unknown. This is the fifth case identified in our center.