RESUMEN
Rituximab is increasingly used in the treatment of CD20-positive B-cell-mediated disease. Prolonged use may cause B-cell dysfunction, dose-dependent T-cell dysfunction, and hypogammaglobulinaemia and result in severe non-neutropenic infections. We present two cases of viral encephalitis in patients treated with rituximab maintenance therapy: one patient presented with deafness; the other patient with paroxysmal light flashes, apraxia, and weakness.
Asunto(s)
Antineoplásicos Inmunológicos/efectos adversos , Encefalitis Viral/inducido químicamente , Rituximab/efectos adversos , Anciano , Antígenos CD , Antineoplásicos Inmunológicos/uso terapéutico , Resultado Fatal , Femenino , Humanos , Linfoma de Células del Manto/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Masculino , Rituximab/uso terapéutico , Resultado del TratamientoRESUMEN
We present a rare case of grade II lymphomatoid granulomatosis (LYG) with pulmonary and gastrointestinal involvement. LYG is considered an Epstein-Barr virus-driven lymphoproliferative disorder that often presents with multiple nodular lesions in the lungs and sometimes involvement of skin and the central nervous system. Although the aetiology is unknown, it is associated with the use of immunosuppressives. Involvement of other organ systems is very rare. We successfully treated our patients with 6 cycles of R-CHOP and autologous stem cell transplantation with a major response at 20â months follow-up.
Asunto(s)
Neoplasias Pulmonares/patología , Granulomatosis Linfomatoide/diagnóstico , Neoplasias Gástricas/diagnóstico , Anciano , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Femenino , Fiebre/etiología , Hematemesis/etiología , Trasplante de Células Madre Hematopoyéticas/métodos , Herpesvirus Humano 4 , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Granulomatosis Linfomatoide/tratamiento farmacológico , Granulomatosis Linfomatoide/patología , Prednisona/uso terapéutico , Rituximab/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Vincristina/uso terapéutico , Pérdida de PesoAsunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/diagnóstico , Neoplasias Pulmonares/secundario , Dolor de Hombro/etiología , Adulto , Enfermedad de Hodgkin/patología , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Ganglios Linfáticos/patología , Masculino , RadiografíaAsunto(s)
Adenocarcinoma Folicular/secundario , Neoplasias Óseas/secundario , Bocio Nodular/patología , Neoplasias de la Tiroides/patología , Adenocarcinoma Folicular/diagnóstico por imagen , Anciano , Biopsia con Aguja Fina , Femenino , Bocio Nodular/diagnóstico por imagen , Humanos , Radiografía , Neoplasias de la Tiroides/diagnóstico por imagenRESUMEN
Postprandial hyperlipidemia is considered to be a substantial risk factor for atherosclerosis. Interestingly, this concept has never been supported by randomized clinical trials. The difficulty lies in the fact that most interventions aimed to reduce postprandial lipemia, will also affect LDL-C levels. The atherogenic mechanisms of postprandial lipids and lipoproteins can be divided into direct lipoprotein-mediated and indirect effects; the latter, in part, by inducing an inflammatory state. Elevations in postprandial triglycerides (TG) have been related to the increased expression of postprandial leukocyte activation markers, up-regulation of pro-inflammatory genes in endothelial cells and involvement of the complement system. This set of events is part of the postprandial inflammatory response, which is one of the recently identified potential pro-atherogenic mechanisms of postprandial lipemia. Especially, complement component 3 levels show a close correlation with postprandial lipemia and are also important determinants of the metabolic syndrome. In clinical practice, fasting TG are frequently used as reflections of postprandial lipemia due to the close correlation between the two. The use of serial capillary measurements in an out-of-hospital situation is an alternative for oral fat loading tests. Daylong TG profiles reflect postprandial lipemia and are increased in conditions like the metabolic syndrome, type 2 diabetes and atherosclerosis. Studies are needed to elucidate the role of postprandial inflammation in atherogenesis and to find new methods in order to reduce selectively the postprandial inflammatory response. Future studies are needed to find new methods in order to reduce selectively the postprandial inflammatory response.
Asunto(s)
Aterosclerosis/etiología , Hiperlipidemias/metabolismo , Lipoproteínas/metabolismo , Periodo Posprandial/fisiología , Aterosclerosis/metabolismo , Humanos , Hiperlipidemias/complicaciones , Leucocitos/metabolismoRESUMEN
We report a case of an adult, immunocompetent male with lymphadenopathy of both groins, para-aortal lymph nodes and multiple lesions in the spleen. A neoplasm was excluded by histology of the largest lymph node from the left groin. The diagnosis of cat-scratch disease (CSD ) became apparent when serological testing for Bartonella henselae showed to be positive. A review of literature shows that disseminated (visceral) infection is a rare presentation of CSD.
Asunto(s)
Bartonella henselae , Enfermedad por Rasguño de Gato/diagnóstico , Inmunocompetencia , Ganglios Linfáticos/microbiología , Enfermedades del Bazo/microbiología , Animales , Bartonella henselae/aislamiento & purificación , Enfermedad por Rasguño de Gato/etiología , Enfermedad por Rasguño de Gato/fisiopatología , Humanos , Ganglios Linfáticos/patología , Enfermedades Linfáticas , Masculino , Persona de Mediana Edad , Enfermedades del Bazo/diagnóstico , Enfermedades del Bazo/patologíaRESUMEN
Cushing's syndrome results from lengthy and inappropriate exposure to excessive concentrations of either endogenous or exogenous glucocorticoids. This case report describes a patient with a novel type of Cushing's syndrome due to the use of party drugs. A 35-year-old woman had gained 8 kg body weight in 5 months and complained of anxiety. She showed a Cushing-like appearance and mild hypertension (blood pressure, BP 150/95 mmHg). She reported daily use of increasing doses of gamma-hydroxybutyric acid (GHB), a popular party drug. ACTH plasma levels were in the upper normal range (41 ng/l), with normal plasma cortisol (0.36 micromol/l). She showed an abnormal overnight 1 mg dexamethasone suppression test (cortisol 0.38 micromol/l). The urinary excretion of free cortisol in 24 h was also increased (0.47 micromol/24 h). CT scanning of the abdomen showed normal adrenals. After stopping GHB intake she lost 7 kg body weight and her BP normalized (BP 135/80 mmHg). GHB is a popular party drug in the Netherlands, but it is also used as a narcotic and for the treatment of narcolepsy. We hypothesize that GHB may bind to the pituitary gland gamma-aminobutyric acid-B receptors leading to ACTH overproduction.
Asunto(s)
Síndrome de Cushing/inducido químicamente , Oxibato de Sodio/efectos adversos , Adulto , Femenino , Humanos , Hidrocortisona/orina , Hipertensión/inducido químicamente , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
Postprandial hyperlipidaemia is a common metabolic disturbance in atherosclerosis. During the postprandial phase, chylomicrons and their remnants can penetrate the intact endothelium and cause foam cell formation. These particles are highly atherogenic after modification. People in the Western world are non-fasting for most of the day, which consequently leads to a continuous challenge of the endothelium by atherogenic lipoproteins and their remnants. Furthermore, atherosclerosis is considered a low-grade chronic inflammatory disease. Many studies have shown that the process of atherogenesis in part starts with the interaction between the activated leucocytes and activated endothelium. Postprandial lipoproteins can activate leucocytes in the blood and up-regulate the expression of leucocyte adhesion molecules on the endothelium, facilitating adhesion and migration of inflammatory cells into the subendothelial space. Another inflammatory process associated with postprandial lipaemia is the activation of the complement system. Its central component C3 has been associated with obesity, coronary sclerosis, the metabolic syndrome and fasting and postprandial TAGs (triacylglycerols). Moreover, chylomicrons are the strongest stimulators of adipocyte C3 production via activation of the alternative complement cascade. A postprandial C3 increment has been shown in healthy subjects and in patients with CAD (coronary artery disease) and with FCHL (familial combined hyperlipidaemia). Postprandial lipaemia has been related to TAG and free fatty acid metabolism. All of these mechanisms provide an alternative explanation for the atherogenicity of the postprandial period.
Asunto(s)
Aterosclerosis/etiología , Endotelio Vascular/patología , Inflamación/etiología , Animales , Aterosclerosis/patología , Aterosclerosis/fisiopatología , Quilomicrones/metabolismo , Complemento C3/metabolismo , Endotelio Vascular/fisiopatología , Humanos , Hiperlipidemias/fisiopatología , Inflamación/patología , Inflamación/fisiopatología , Modelos Cardiovasculares , Periodo PosprandialRESUMEN
Human T-cell lymphotropic virus type 1 (HTLV-1) can cause adult T-cell leukaemia/lymphoma (ATLL). Two patients originating from the Caribbean area with ATLL are described. The first patient developed respiratory insufficiency due to acute T-cell leukaemia. The diagnosis was suspected because of characteristics of abnormal lymphocytes in the blood smear. The second patient had lymphadenopathy and developed severe hypercalcaemia. Both patients were typical cases of ATLL. The pathogenesis, clinical manifestations, pitfalls and treatment of this intriguing disease are discussed.
Asunto(s)
Leucemia-Linfoma de Células T del Adulto/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Humanos , Leucemia-Linfoma de Células T del Adulto/tratamiento farmacológico , Leucemia-Linfoma de Células T del Adulto/epidemiología , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
In 3 female patients, aged 65, 83 and 76 years, with severe renal failure, light chain multiple myeloma was diagnosed, following a substantial delay on the part of the doctors concerned. Either the diagnosis had not suspected or the serum proteins had been misinterpreted. After a while, the first two patients declined further treatment with chemotherapy and haemodialysis, and subsequently died. The third patient attained a creatinine clearance of 20 ml/min and was subsequently treated for the multiple myeloma in the outpatients department. The absence of a paraprotein peak in the serum does not exclude the possibility of a multiple myeloma. In the case of light chain disease, the gammaglobulin region is, in fact, often empty. Treatment of multiple myeloma consists of a rapid rehydration and forced diuresis; the usefulness of plasmapheresis has not been demonstrated.
Asunto(s)
Lesión Renal Aguda/etiología , Proteína de Bence Jones/orina , Riñón/patología , Mieloma Múltiple/complicaciones , Mieloma Múltiple/diagnóstico , Proteínas de Mieloma/metabolismo , gammaglobulinas/metabolismo , Lesión Renal Aguda/fisiopatología , Anciano , Anciano de 80 o más Años , Algoritmos , Biopsia , Creatinina/orina , Diagnóstico Diferencial , Resultado Fatal , Fatiga/etiología , Femenino , Humanos , Mieloma Múltiple/fisiopatología , Mieloma Múltiple/terapia , Mieloma Múltiple/orina , Oliguria/etiología , Pronóstico , Proteinuria/etiología , Resultado del TratamientoRESUMEN
A 83-year-old woman known with a stable disease multiple myeloma was hospitalized frequently with dyspnoea caused by copious bilateral pleural effusions. Thoracentesis was performed repeatedly but pleural effusions returned. Extensive laboratory and radiological examinations failed to reveal the cause of the pleural effusions. Finally, after pleural biopsy the diagnosis of amyloidosis of the pleura could be made. The patient died in hospital from a stroke. Pleural amyloidosis is rarely reported and is accompanied by large uni- or bilateral pleural effusions even without amyloidosis of the heart.
Asunto(s)
Amiloidosis/complicaciones , Amiloidosis/diagnóstico , Mieloma Múltiple/complicaciones , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Anciano , Anciano de 80 o más Años , Biopsia , Trastornos Cerebrovasculares/complicaciones , Electrocardiografía , Resultado Fatal , Femenino , Humanos , Pleura/patología , Derrame Pleural/terapiaRESUMEN
Interleukin 6 plays a key role in the pathogenesis of multiple myeloma (MM). Therefore we conducted a phase I dose-escalating study with chimaeric monoclonal anti-IL6 antibodies (cMab) in MM patients resistant to second-line chemotherapy. The cMab (CLB IL6/8; Kd 6.25 x 10(-12)M) was given in two cycles of 14 daily infusions, starting on day 1 and day 28, repectively, with a daily dose of 5 mg in patients 1-3, 10 mg in patients 4-6, 20 mg in patients 7-9 and 40mg in patients 10-12 (total dose 140 mg, 280mg, 560 mg and 1120 mg of anti-IL6, respectively). 11/12 patients had elevated pretreatment IL6 levels. Except for transient thrombocytopenia in two patients there was no toxicity. There were no changes in haemoglobin levels, granulocyte count, liver enzymes or renal function. No human anti-chimaeric antibodies were induced. This was also reflected in a long half-life time of the cMab (median 17.8 d), resulting in accumulation of the anti-IL6 cMab and high levels of circulating IL6. However, this was in the form of biologically inactive IL6/cMab complexes and did not result in acceleration of the disease. Although C-reactive protein (CRP) levels were decreased to below detection level in 11/12 patients, indicating effective IL6 blocking, none of the patients achieved a response according to the standard criteria. We conclude that this chimaeric anti-IL6 Mab has a low toxicity, low immunogenicity and a long T1/2. A dose of 40 mg/d for 14 d can safely be used in future phase II studies.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Interleucina-6/administración & dosificación , Mieloma Múltiple/terapia , Proteínas Musculares , Anciano , Agranulocitosis/etiología , Anticuerpos Monoclonales/análisis , Anticuerpos Monoclonales/farmacocinética , Proteína C-Reactiva/análisis , Conectina , Relación Dosis-Respuesta Inmunológica , Femenino , Semivida , Humanos , Interleucina-6/inmunología , Interleucina-6/farmacocinética , Masculino , Persona de Mediana Edad , Mieloma Múltiple/sangre , Proteínas de Mieloma/análisis , Proteínas Recombinantes de Fusión , Análisis de Supervivencia , Trombocitopenia/etiología , Resultado del Tratamiento , Microglobulina beta-2/análisisRESUMEN
Interleukin-6 (IL6) plays a major role in the pathogenesis of multiple myeloma. In patients with monoclonal gammopathy serum levels of sIL6R have been found to be increased. The role of IL6 in the regulation of soluble receptors is still unclear. In a phase I/II study we treated 12 myeloma patients with high-affinity chimeric anti-IL6 monoclonal antibodies. This treatment resulted in a total in vivo blockage of IL6 activity and as a result we had an unique opportunity to gain insight into the possible regulation effects of IL6 on these soluble IL6 receptors. Pre-treatment sIL6R levels were elevated in 9 of the 12 patients; pre-treatment sgp130 levels were significantly increased in all patients. Total blockage of IL6 activity by the high-affinity cMab did not influence sIL6R in 10 of these 12 patients and sgp130 levels remained stable in all patients. Of the 2 patients whose sIL6R levels increased during therapy, one had progressive disease and the other developed an acute infection. We conclude that in most end-stage myeloma patients sIL6R and sgp130 serum levels are elevated, but that there is no relation between IL6 activity and sIL6R or sgp130 levels.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antígenos CD/sangre , Inmunización Pasiva , Interleucina-6/antagonistas & inhibidores , Glicoproteínas de Membrana/sangre , Mieloma Múltiple/terapia , Proteínas de Neoplasias/antagonistas & inhibidores , Receptores de Interleucina-6/sangre , Animales , Anticuerpos Monoclonales/farmacología , Receptor gp130 de Citocinas , Progresión de la Enfermedad , Femenino , Humanos , Interleucina-6/inmunología , Interleucina-6/fisiología , Masculino , Persona de Mediana Edad , Mieloma Múltiple/sangre , Mieloma Múltiple/inmunología , Mieloma Múltiple/patología , Proteínas de Neoplasias/análisis , Proteínas de Neoplasias/inmunología , Proteínas de Neoplasias/fisiología , Proteínas Recombinantes de Fusión/farmacología , Proteínas Recombinantes de Fusión/uso terapéutico , Solubilidad , Resultado del TratamientoRESUMEN
Interleukin-6 (IL6) is believed to be involved in alterations of thyroid hormone metabolism in acute nonthyroidal illness. To evaluate the effects of IL6 on thyroid hormone metabolism in a chronic IL6-mediated disease, we measured thyroid hormone concentrations in multiple myeloma patients treated with intravenous anti-IL6 chimeric monoclonal antibodies ([cMabs] Kd = 6.25 x 10(-12) mol/L). Twelve patients were studied, receiving at least one complete treatment cycle of 14 days (daily dose: 5 mg, n = 3; 10 mg, n = 3; 20 mg, n = 3; and 40 mg, n = 3). Eight of them also completed a second treatment cycle of 14 days. Thyroid hormone concentrations were measured before, during, and after treatment with the anti-IL6 cMab. Even in the group with the lowest dosage, IL6 activity measured by the B9 bioassay was blocked completely. Compared with the reference ranges, 10 of 12 patients had one or more abnormal pretreatment values for thyroid hormone concentrations. Thyroid autoantibodies were negative in all patients. There was no correlation between thyroid hormone concentrations and IL6 levels, although plasma IL6 levels were increased in all but one subject. Moreover, neutralization of free IL6 by the anti-IL6 cMab did not affect thyroid hormone concentrations, although IL6-dependent C-reactive protein (CRP) levels decreased to undetectable levels in 11 of 12 patients. Two patients developed infectious complications resulting in increased free IL6 and CRP levels and in profound alterations of thyroid hormone levels consistent with an acute euthyroid sick syndrome. We conclude that IL6 is not a major determinant of thyroid hormone abnormalities in a chronic disease like multiple myeloma, but IL6 may be involved in thyroid hormone metabolism in acute diseases (probably in combination with other factors).
Asunto(s)
Anticuerpos Monoclonales/inmunología , Interleucina-6/inmunología , Mieloma Múltiple/sangre , Hormonas Tiroideas/sangre , Tirotropina/sangre , Anciano , Animales , Anticuerpos Monoclonales/administración & dosificación , Bioensayo , Femenino , Humanos , Inmunoglobulina G/administración & dosificación , Inmunoglobulina G/inmunología , Infusiones Intravenosas , Interleucina-6/administración & dosificación , Interleucina-6/sangre , Masculino , Ratones , Persona de Mediana Edad , Mieloma Múltiple/inmunología , Mieloma Múltiple/fisiopatología , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/inmunología , Hormonas Tiroideas/inmunología , Hormonas Tiroideas/metabolismo , Tirotropina/inmunología , Tirotropina/metabolismo , Tiroxina/sangre , Tiroxina/inmunología , Tiroxina/metabolismo , Factores de Tiempo , Triyodotironina/sangre , Triyodotironina/inmunología , Triyodotironina/metabolismoRESUMEN
In vitro as well as in vivo observations have shown that IL6 plays a key role in the pathogenesis of multiple myeloma. Therefore we started a phase I/II dose escalating study with chimeric monoclonal anti-IL6 antibodies (cMab) in multiple myeloma (MM) patients resistant to second-line chemotherapy. Here we describe the pharmacological data as well as a new method for calculating the endogenous IL6 production. The cMab (CLB IL6/8; Kd: 6.25 x 10(-12) M) was given in two cycles of 14 daily infusions, starting on day 1 and day 28. Daily dose: 5 mg in patients 1-3, 10 mg in patients 4-6, and 20 mg in patients 7-9 (total dose 140, 280, and 560 mg of anti-IL6, respectively). Using the pharmacokinetic data of free IL6 and the binding characteristics of the cMab, the endogenous IL6 production could be calculated from day to day using a one-compartment open model. The median half-life time of this antibody was 17.6 d. No human antichimeric antibodies were induced. Pre-treatment median endogenous IL6 production in the MM patients was 60 micrograms/d (range 13.8-230; normal controls < 7 micrograms/d). During treatment with anti-IL6 cMabs, the endogenous IL6 production immediately decreased in all patients to below 3 micrograms/d and never reached the pre-treatment value during the treatment period, except in two patients who developed an active infection, resulting in an IL6 production of 128 and 1,208 micrograms/d, respectively. We concluded that in MM patients endogenous IL6 production is 2-30 times higher than in healthy individuals. The anti-IL6 cMab strongly suppress this endogenous IL6 production, probably by blocking a positive feed-back loop, but this cMab does not prevent infection-induced IL6 production. The chimeric anti-IL6 Mabs have a long half-life time, a low immunogenicity, and are able to block IL6-dependent processes in vivo.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Interleucina-6/biosíntesis , Interleucina-6/inmunología , Mieloma Múltiple/metabolismo , Mieloma Múltiple/terapia , Anciano , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/farmacocinética , Resistencia a Antineoplásicos , Femenino , Humanos , Interleucina-6/farmacocinética , Masculino , Persona de Mediana Edad , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/farmacocinética , Proteínas Recombinantes de Fusión/uso terapéuticoRESUMEN
In this paper we describe a new, rapid and sensitive method to determine plasma cell isotype and clonality in bone marrow using flowcytometry. With the use of a new fixation and permeabilization reagent (Permeafix), which preserves cell structure and morphology, and a monoclonal antibody (Mab) specific for plasma cells (B-B4), it has become possible to specifically select plasma cells and to determine the cytoplasmatic immunoglobulins by flowcytometry. Thirty successive bone marrow aspirates from multiple myeloma patients and patients with MGUS were studied as well as 10 bone marrow samples from patients with reactive plasmacytosis. Each sample was analysed both by immunofluorescence on cytospin smears and FACS analysis. There were no discrepancies between plasma cell isotype as determined by FACS and cytospin. Moreover, FACS analysis was shown to allow detection of very low numbers of plasma cells and to determine whether these plasma cells are mono- or polyclonal. Possible applications are discussed.
Asunto(s)
Médula Ósea/inmunología , Isotipos de Inmunoglobulinas/análisis , Inmunofenotipificación/métodos , Células Plasmáticas/inmunología , Anticuerpos , Recuento de Células , Células Clonales/inmunología , Citoplasma/inmunología , Fijadores , Citometría de Flujo , Humanos , Mieloma Múltiple/patologíaRESUMEN
We describe 3 patients with Corynebacterium jeikeium sepsis in neutropenic phase during treatment for acute myeloid leukaemia. Fever was the first symptom. All had a central venous catheter which was removed. Two patients developed subcutaneous nodules containing pus when the neutrophil count recovered; 1 had intracutaneous and pulmonary lesions. They were treated with vancomycin and recovered when the neutrophil count started to rise. A review of 80 neutropenic patients with C. jeikeium sepsis reported in the literature, together with our 3 cases indicates that risk factors for infection are the presence of a central venous catheter, being an adult male or postmenopausal female, profound and prolonged neutropenia and exposure to multiple antibiotics. Skin lesions are reported in 48% and pulmonary lesions in 36% of the patients. The overall mortality is 34% but in patients with recovery of the bone marrow only 5%. Therefore haematopoietic growth factors should be considered in neutropenic patients with C. jeikeium infection.
Asunto(s)
Bacteriemia/etiología , Infecciones por Corynebacterium/etiología , Corynebacterium/clasificación , Huésped Inmunocomprometido , Leucemia Mieloide Aguda/complicaciones , Adulto , Anciano , Antibacterianos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/fisiopatología , Corynebacterium/aislamiento & purificación , Infecciones por Corynebacterium/tratamiento farmacológico , Infecciones por Corynebacterium/fisiopatología , Quimioterapia Combinada/uso terapéutico , Femenino , Humanos , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/inmunología , Masculino , Persona de Mediana Edad , Neutropenia/complicaciones , PronósticoRESUMEN
BACKGROUND: Glutamine-supplemented total parenteral nutrition (TPN) improved the nitrogen balance in catabolic situations. In animal studies, parenteral glutamine supplementation appeared to maintain gut integrity. This study was performed to evaluate the possible positive effects of glutamine supplementation in catabolic hematologic patients. METHODS: This was a prospective double-blind placebo-controlled pilot study, in which 20 treatment cycles in unselected hematologic patients with intensive chemotherapy were studied. Glutamine was given as a dipeptide. Patients were randomized per treatment cycle to receive isonitrogenous TPN (0.272 g nitrogen/kg of body weight) and isoenergetic TPN (2200 kcal NPE/day) without or with 40 g L-alanyl-L-glutamine (26 g glutamine) until the neutrophil count was greater than 0.5 x 10(9)/L. The daily oral food intake was recorded and analyzed carefully. Toxicity grades for performance status, mucositis, and diarrhea were scored according to the World Health Organization classification. RESULTS: No differences in neutropenic period, fever, extra antibiotics, and toxicity scores were observed, except for a gain in body weight per treatment cycle in favor of the glutamine-supplemented TPN. No side effects or allergic reactions were noted after the dipeptide administration. CONCLUSION: Supplementation of glutamine dipeptide was safe but had no significant positive clinical effect.
Asunto(s)
Antineoplásicos/efectos adversos , Dipéptidos/administración & dosificación , Alimentos Fortificados , Glutamina/administración & dosificación , Enfermedades Hematológicas/terapia , Nutrición Parenteral Total , Adulto , Anciano , Método Doble Ciego , Femenino , Enfermedades Hematológicas/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios ProspectivosRESUMEN
During the past few years much insight has been gained into the immunobiology of multiple myeloma. It has become evident that the growth of myeloma cells is regulated by cytokines, notably interleukin-6. In this paper a brief review is given of the evidence derived from in vitro as well as in vivo observations that interleukin-6 is involved in the pathogenesis of multiple myeloma, and the implications of these findings for the development of new therapeutic strategies are discussed.