RESUMEN
Patients with advanced-stage Hodgkin lymphoma treated with ABVD who have a positive interim FDG-PET (iPET) have a poor prognosis. Escalation to BEACOPP has been shown to improve progression-free survival (PFS). However, randomized trials are lacking to determine the best strategy for intensification. We report on A-AVD escalation treatment outcomes for 15 iPET-positive patients post-ABVD. Overall response and complete response rates were 80% and 60%, respectively. Four patients underwent salvage therapy followed by autologous stem cell transplantation. At a median 17-month follow-up, all patients are alive, 87% in complete remission, and 1-year PFS was 57.8%. For patients ineligible for BEACOPP due to age, comorbidities, or preference, A-AVD escalation may be a viable alternative.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Bleomicina , Brentuximab Vedotina , Dacarbazina , Doxorrubicina , Enfermedad de Hodgkin , Tomografía de Emisión de Positrones , Vinblastina , Humanos , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/diagnóstico por imagen , Enfermedad de Hodgkin/terapia , Enfermedad de Hodgkin/mortalidad , Enfermedad de Hodgkin/patología , Brentuximab Vedotina/uso terapéutico , Masculino , Femenino , Adulto , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Persona de Mediana Edad , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Vinblastina/uso terapéutico , Vinblastina/administración & dosificación , Dacarbazina/uso terapéutico , Dacarbazina/administración & dosificación , Adulto Joven , Estadificación de Neoplasias , Anciano , Resultado del Tratamiento , Estudios de SeguimientoRESUMEN
Hodgkin lymphoma (HL) occuring during pregnancy is a rare condition, and management relies on sparse literature. The specificity of pregnancy requires the clinician to take into account the clinical emergency, the stage of the lymphoma, the trimester of pregnancy, and the patient's choices. The main objective is twofold: to limit the risk of toxicity and adverse events for both mother and fetus, without reducing the chances of a successful outcome. Current literature data suggest that the use of ABVD-type polychemotherapy (adriamycin, bleomycin, vinblastine, dacarbazine) is associated with obstetrical events and long-term fetal toxicity. We report here the results of a homogeneous management considering wait-and-see, vinblastine monotherapy and ABVD polychemotherapy options. The outcomes in terms of obstetrical complications, response rate, and overall survival (100â¯%) reinforce the idea that strategies that do not involve the use of multidrug therapy are possible and are associated with very good results.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Enfermedad de Hodgkin , Complicaciones Neoplásicas del Embarazo , Humanos , Enfermedad de Hodgkin/tratamiento farmacológico , Embarazo , Femenino , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Vinblastina/uso terapéutico , Vinblastina/administración & dosificación , Vinblastina/efectos adversos , Dacarbazina/uso terapéutico , Dacarbazina/administración & dosificación , Dacarbazina/efectos adversos , Resultado del Tratamiento , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Bleomicina/efectos adversos , Adulto , Doxorrubicina/uso terapéutico , Doxorrubicina/efectos adversos , Doxorrubicina/administración & dosificación , Resultado del EmbarazoRESUMEN
INTRODUCTION: The current treatment regimens for Hodgkin's lymphoma (HL) are associated with high incidences of adverse events. PURPOSE: This study aimed to compare the efficacy and safety of doxorubicin + bleomycin + vincristine + dacarbazine (ABVD) and standard bleomycin + etoposide + doxorubicin + cyclophosphamide + vincristine + procarbazine + prednisone (BEACOPP) chemotherapy in the treatment of advanced stage HL. METHODS: This multicenter, randomized, parallel, open, positive control noninferiority trial was conducted from 2016 to 2019 and comprised 93 subjects who were randomized in a 1:1 ratio between the treatment (BEACOPP; n = 44) and control (ABVD; n = 49) groups. RESULTS: The primary efficacy endpoint of this trial was the objective response rate (ORR) after eight cycles of chemotherapy, which was 100.00% (36/36) in the treatment group and 95.74% (45/49) in the control group. The incidence of adverse reactions was 100% in both groups. Significant differences (P < 0.05) in the incidences of grade 3 (39/44 [88.64%] vs. 23/49 [46.94%]) and grade 4 (27/44 [61.36%] vs. 8/49 [16.94%]) adverse events were observed between the treatment and control groups, respectively. However, most of these reactions were manageable, with no serious consequences, and were reversible after discontinuation of the treatment. CONCLUSION: Both regimens had a similar ORR and were associated with a high number of adverse events. The ABVD regimen was better tolerated and safer than the standard BEACOPP regimen. This study indicates that the standard BEACOPP regimen may be considered as a treatment option for patients with advanced HL.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Bleomicina , Ciclofosfamida , Dacarbazina , Doxorrubicina , Etopósido , Enfermedad de Hodgkin , Prednisona , Procarbazina , Vincristina , Humanos , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/patología , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/administración & dosificación , Bleomicina/efectos adversos , Bleomicina/uso terapéutico , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Vincristina/efectos adversos , Vincristina/uso terapéutico , Vincristina/administración & dosificación , Masculino , Procarbazina/administración & dosificación , Procarbazina/efectos adversos , Procarbazina/uso terapéutico , Adulto , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Ciclofosfamida/uso terapéutico , Femenino , Etopósido/administración & dosificación , Etopósido/efectos adversos , Etopósido/uso terapéutico , Prednisona/administración & dosificación , Prednisona/efectos adversos , Prednisona/uso terapéutico , Dacarbazina/efectos adversos , Dacarbazina/administración & dosificación , Dacarbazina/uso terapéutico , Persona de Mediana Edad , Adulto Joven , Vinblastina/administración & dosificación , Vinblastina/efectos adversos , Vinblastina/uso terapéutico , Adolescente , Estadificación de Neoplasias , Resultado del TratamientoRESUMEN
Electrochemotherapy (ECT) with intravenous (IV) and/or intratumoral (IT) bleomycin has shown considerable efficacy in the treatment of non-resectable feline cutaneous squamous cell carcinoma (cSCC), boasting response rates of up to 95%, but other chemotherapy protocols have not yet been investigated. The objective of this prospective multicentre study was to compare the overall response rate (ORR) and progression-free interval (PFI) between cats with cSCC treated with ECT using IT and IV carboplatin (IV + IT), IV carboplatin (IV) or IV bleomycin (IV). A total of 44 cats with unresectable cSCC across three centres were enrolled and treated with ECT using carboplatin IV + IT (n = 10), carboplatin IV (n = 11) or bleomycin IV (n = 23). Treatment response according to RECIST criteria was recorded at 2 and 4 weeks post-treatment, and patients were followed until disease progression and/or death. All three groups were comparable regarding age, sex, weight, and lesion size. Adverse events were generally mild, localised and similar between groups. ORRs were 90.0% (carboplatin IV + IT), 90.9% (carboplatin IV) and 95.6% (bleomycin IV) and were not significantly different (p = 0.79). Median PFI was not reached for carboplatin IV + IT or carboplatin IV and was 566 days for bleomycin IV, with no significant difference between the three groups (p = 0.81). This study suggests that ECT using IV or IV + IT carboplatin is a reasonable alternative therapeutic option for managing cSCC, and further studies are warranted to compare outcomes between treatment protocols.
Asunto(s)
Antineoplásicos , Bleomicina , Carboplatino , Carcinoma de Células Escamosas , Enfermedades de los Gatos , Electroquimioterapia , Neoplasias Cutáneas , Animales , Gatos , Electroquimioterapia/veterinaria , Electroquimioterapia/métodos , Bleomicina/uso terapéutico , Bleomicina/administración & dosificación , Neoplasias Cutáneas/veterinaria , Neoplasias Cutáneas/tratamiento farmacológico , Enfermedades de los Gatos/tratamiento farmacológico , Carboplatino/uso terapéutico , Carboplatino/administración & dosificación , Femenino , Masculino , Carcinoma de Células Escamosas/veterinaria , Carcinoma de Células Escamosas/tratamiento farmacológico , Antineoplásicos/uso terapéutico , Antineoplásicos/administración & dosificación , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of this study was to assess the value of CO2 laser vaporization in treating huge adult laryngeal vascular anomalies (HALVAs) by combining it with bleomycin injection. MATERIALS AND METHODS: This study retrospectively reviewed the records of 13 adult patients who underwent 18 different procedures. Methods to treat HALVAs include traditional bleomycin injection and CO2 laser vaporization combined with bleomycin injection between September 2009 and January 2023. Treatment results were evaluated by the grade of lumen constriction. RESULTS: A total of five males and eight females, with an average age of 46.3 years (range, 22-66 years), were included in the study. The huge adult laryngeal vascular anomalies in our study were greater than 1633.71 mm3, and the long diameters of the bases were longer than 15 mm. Compared with the bleomycin injection-only group, the results with the CO2 laser vaporization and bleomycin injection combined were better. CONCLUSIONS: Both bleomycin injection and CO2 laser vaporization are safe treatment methods. Their combination may produce better results for huge adult laryngeal vascular anomalies.
Asunto(s)
Bleomicina , Láseres de Gas , Humanos , Masculino , Persona de Mediana Edad , Adulto , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Bleomicina/análogos & derivados , Femenino , Láseres de Gas/uso terapéutico , Estudios Retrospectivos , Anciano , Adulto Joven , Malformaciones Vasculares/cirugía , Malformaciones Vasculares/terapia , Terapia Combinada , Laringe/cirugía , Terapia por Láser/métodos , Resultado del TratamientoRESUMEN
Ranula is a mucous cyst that occurs in the sublingual gland (SLG) in the floor of the mouth. It can be classified into two types based on origins: One is the the lesser sublingual gland (LSLG) in the anterior segment and the Rivini duct, which is connected to it, and the other is the greater sublingual gland (GSLG) in the posterior segment. Because of the anatomical characteristics, surgical resection of the cysts carries the risk of damaging adjacent tissues and has a high recurrence rate. Intralesional injection of sclerotherapy may be a better alternative treatment. We summarized 65 cases of ranula treated with intralesional injections of bleomycin(BML). According to the origin of the ranula, 60 cases were from the LSLG and the Rivini duct, and 5 cases were from the GSLG. The results showed that 60 cases of ranula from LSLG and Rivini ducts were 100% cured during the follow-up period. The median number of injections for all patients was 1.16. All 5 cases of ranula from the GSLG did not wholly recover. This study confirmed that BLM intralesional injection is a safe and effective treatment modality for cysts from LSLG or the ducts of Rivini rather than GSLG. Therefore, before treatment, it is necessary to determine the type and origin of the cyst by characterizing its morphology to ensure the effectiveness of the treatment.
Asunto(s)
Bleomicina , Inyecciones Intralesiones , Ránula , Escleroterapia , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Humanos , Escleroterapia/métodos , Femenino , Adulto , Masculino , Persona de Mediana Edad , Adolescente , Soluciones Esclerosantes/uso terapéutico , Soluciones Esclerosantes/administración & dosificación , Adulto Joven , Resultado del Tratamiento , Anciano , Niño , Glándula SublingualRESUMEN
Hodgkin lymphoma (HL) is one of the most common lymphomas, with an incidence of 3 per 100,000 persons. Current treatment uses a cocktail of genotoxic agents, including adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), along with or without radiotherapy. This treatment regimen has proved to be efficient in killing cancer cells, resulting in HL patients having a survival rate of >90% cancer-free survival at five years. However, this therapy does not have a specific cell target, and it can induce damage in the genome of non-cancerous cells. Previous studies have shown that HL survivors often exhibit karyotypes characterized by complex chromosomal abnormalities that are difficult to analyze by conventional banding. Multicolor fluorescence in situ hybridization (M-FISH) is a powerful tool to analyze complex karyotypes; we used M-FISH to investigate the presence of chromosomal damage in peripheral blood lymphocytes from five healthy individuals and five HL patients before, during, and one year after anti-cancer treatment. Our results show that this anti-cancer treatment-induced genomic chaos that persists in the hematopoietic stem cells from HL patients one year after finishing therapy. This chromosomal instability may play a role in the occurrence of second primary cancers that are observed in 10% of HL survivors. This chapter will describe a protocol for utilizing M-FISH to study treatment-induced genome chaos in Hodgkin's lymphoma (HL) patients, following a brief discussion.
Asunto(s)
Enfermedad de Hodgkin , Hibridación Fluorescente in Situ , Enfermedad de Hodgkin/genética , Enfermedad de Hodgkin/terapia , Humanos , Hibridación Fluorescente in Situ/métodos , Aberraciones Cromosómicas/efectos de la radiación , Doxorrubicina/uso terapéutico , Genoma Humano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Inestabilidad Cromosómica , Linfocitos/efectos de la radiación , Linfocitos/efectos de los fármacos , Linfocitos/metabolismo , Bleomicina/uso terapéuticoAsunto(s)
Bleomicina , Macroglosia , Escleroterapia , Humanos , Macroglosia/cirugía , Macroglosia/etiología , Macroglosia/terapia , Bleomicina/uso terapéutico , Escleroterapia/métodos , Anomalías Linfáticas/terapia , Anomalías Linfáticas/diagnóstico por imagen , Anomalías Linfáticas/cirugía , Antibióticos Antineoplásicos/uso terapéutico , Terapia Combinada , Femenino , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Vanishing bile duct syndrome is an uncommon condition characterised by the progressive loss and disappearance of bile ducts. It is an acquired form of cholestatic liver disease presenting with hepatic ductopenia (loss of >50% bile ducts in the portal areas). We present a case of vanishing bile duct syndrome as a presentation of Hodgkin's lymphoma who was treated with standard-of-care chemotherapy-doxorubicin, bleomycin, vinblastine and dacarbazine (along with brief administration of rituximab), which led to complete response and normalisation of liver function.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Bleomicina , Enfermedad de Hodgkin , Adulto , Femenino , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedades de los Conductos Biliares/diagnóstico , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Dacarbazina/uso terapéutico , Dacarbazina/administración & dosificación , Doxorrubicina/uso terapéutico , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/diagnóstico , Rituximab/uso terapéutico , Rituximab/administración & dosificación , Síndrome , Vinblastina/uso terapéutico , Vinblastina/administración & dosificaciónRESUMEN
INTRODUCTION: Trophoblastic neoplasms are often associated with pregnancy, and nongestational trophoblastic neoplasms are extremely rare. Nongestational ovarian choriocarcinoma (NGCO) is a highly aggressive germ cell-derived tumor frequently presenting with early hematogenous metastasis. PATIENT CONCERNS: Herein, we report a case of a 28-year-old unmarried woman with regular menstruation who experienced vaginal bleeding 1 week after her last menstrual cycle. Doppler ultrasound revealed bilateral adnexal masses and elevated serum human chorionic gonadotropin (hCG) levels. The patient was initially misdiagnosed as presenting an ectopic pregnancy. DIAGNOSIS: The final pathology confirmed an International Federation of Gynecology and Obstetrics stage IA NGCO with bilateral mature teratoma of the ovary. This is an extraordinary instance of ovarian choriocarcinoma which emerged without any prior gestation, and the patient's lack of a history of pregnancy made the diagnosis ignored. INTERVENTIONS: After initial surgery and 1 cycle of bleomycin, etoposide, and cisplatin (BEP) chemotherapy, a laparoscopic fertility-preserving comprehensive staging surgery was performed. Two cycles of chemotherapy with BEP were administered as supplemental therapy postsurgery, and leuprorelin was administered to protect ovarian function. OUTCOMES: Menstruation resumed 4 months after chemotherapy completion, and tumor indicators were within the normal range. No signs of recurrence were observed at the 36-month follow-up. CONCLUSION: NGCO should be considered if a female patient exhibits irregular vaginal bleeding and masses in the adnexal area. The present case and our literature review also highlighted that fertility-sparing surgery and multidrug chemotherapy are effective methods for treating NGCO.
Asunto(s)
Coriocarcinoma no Gestacional , Neoplasias Ováricas , Teratoma , Humanos , Femenino , Adulto , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/patología , Teratoma/diagnóstico , Teratoma/patología , Coriocarcinoma no Gestacional/diagnóstico , Coriocarcinoma no Gestacional/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Etopósido/uso terapéutico , Etopósido/administración & dosificación , Embarazo , Bleomicina/administración & dosificación , Bleomicina/uso terapéuticoRESUMEN
A 26-year-old male with a history of orbital lymphangioma and compressive optic neuropathy presented with recurrent proptosis in the OS. After examination and imaging, a left orbital lymphatic malformation and a new subcutaneous temporal-parietal vasculo-lymphatic malformation were diagnosed. The patient underwent a bleomycin injection for the orbital malformation and an excisional biopsy for the temporal lesion, leading to symptom resolution. Recurrence of lymphatic malformations and hemorrhage typically occurs at the same site, here we report a patient with the appearance of a new site lesion with orbital recurrence.
Asunto(s)
Anomalías Linfáticas , Neoplasias Orbitales , Humanos , Masculino , Adulto , Anomalías Linfáticas/diagnóstico , Neoplasias Orbitales/diagnóstico , Linfangioma/diagnóstico , Imagen por Resonancia Magnética , Órbita/diagnóstico por imagen , Órbita/anomalías , Antibióticos Antineoplásicos/uso terapéutico , Exoftalmia/diagnóstico , Bleomicina/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: To evaluate the safety and clinical outcome of bleomycin electrosclerotherapy (BEST) for treating extracranial slow-flow malformations. METHODS: In this retrospective investigation of a multicenter cohort presenting symptomatic slow-flow malformations, patient records were analyzed with respect to procedural details and complications. A treatment-specific, patient-reported questionnaire was additionally evaluated, obtained 3-12 months after the last treatment, to assess the subjective outcomes, including mobility, aesthetic aspects, and pain, as well as the occurrence of postprocedural skin hyperpigmentation. All outcome parameters were compared according to patients' age. RESULTS: Overall, 325 BEST treatments were performed in 233 patients after intralesional and/or intravenous bleomycin injection. The total complication rate was 10.2% (33/325), including 29/352 (8.9%) major complications. Patient-reported mobility decreased in 10/133 (8.8%), was stable in 30/113 (26.5%), improved in 48/113 (42.5%), and was rated symptom-free in 25/113 (22.1%) patients. Aesthetic aspects were rated impaired compared to baseline in 19/113 (16.8%), stable in 21/133 (18.6%), improved in 62/113 (54.9%), and perfect in 11/133 (9.7%) patients. Postprocedural skin hyperpigmentation occurred in 78/113 (69%) patients, remaining unchanged in 24/78 (30.8%), reduced in 51/78 (65.5%), and completely resolved in 3/78 (3.8%) patients. The median VAS pain scale was 4.0 (0-10) preprocedural and 2.0 (0-9) postprocedural. Children/adolescents performed significantly better in all parameters compared to adults (≥ 16 years) (mobility, p = 0.011; aesthetic aspects, p < 0.001; pain, p < 0.001). CONCLUSIONS: BEST is effective for treating slow-flow vascular malformations, with few but potentially significant major complications. Regarding patient-reported outcomes, children seem to benefit better compared to older patients, suggesting that BEST should not be restricted to adults. CLINICAL RELEVANCE STATEMENT: Bleomycin electrosclerotherapy is a safe and effective approach and therapy should not be restricted to adults due to good clinical outcomes in children.
Asunto(s)
Bleomicina , Humanos , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Femenino , Masculino , Niño , Estudios Retrospectivos , Adulto , Adolescente , Resultado del Tratamiento , Preescolar , Persona de Mediana Edad , Adulto Joven , Escleroterapia/métodos , Lactante , Anciano , Antibióticos Antineoplásicos/uso terapéutico , Electroquimioterapia/métodosRESUMEN
Few data are known regarding the use of interim positron emission tomography (iPET) after the first two cycles (iPET2) of chemotherapy in treatment-naïve classical Hodgkin lymphoma (cHL) in routine clinical practice, and about the real-life adoption of intensification strategies for iPET positive patients. We conducted a multicenter retrospective study on cHL to investigate the use of iPET in the real-life setting, its prognostic role and outcomes of patients early shifted to intensification. Six hundreds and forty-one patients were enrolled (62% had advanced stage). iPET2 was positive in 89 patients (14%) including 8.7% and 17% early and advanced stage patients, respectively (p = 0.003). Among iPET 2 positive cases treatment was immediately modified in 19 cases; in 14 cases treatment was modified after an additional positive iPET4. Overall 56 iPET2 positive patients never received intensified therapies. Most frequently used intensified therapy was autologous stem cell transplantation followed by BEACOPP. After a median follow-up of 72 months, the 5-year progression-free survival (PFS) was 82% with iPET2 positive patients showing a worse PFS compared with iPET2 negative cases: 31% versus 85%. Focusing on advanced stage patients with a positive iPET2, the 5-year PFS was 59% for patients shifted to intensified therapy at any time point versus 61% for patients who never received intensified therapy. Our study confirmed the higher curability of naïve cHL patients in a real-world setting, and the prognostic role of iPET2 in this setting. A poor adherence to response-adapted strategy which however did not translate into a difference in patient outcomes.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Enfermedad de Hodgkin , Humanos , Enfermedad de Hodgkin/terapia , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/patología , Enfermedad de Hodgkin/mortalidad , Masculino , Femenino , Adulto , Persona de Mediana Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Estudios Retrospectivos , Adolescente , Adulto Joven , Anciano , Pronóstico , Tomografía de Emisión de Positrones , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Etopósido/administración & dosificación , Vincristina/administración & dosificación , Vincristina/uso terapéutico , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Procarbazina/administración & dosificación , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Tasa de Supervivencia , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Estudios de SeguimientoRESUMEN
Hemangiomas are most common benign liver tumor. Most patients have an excellent prognosis because of the small size and benign nature of tumor. On some occasions, giant liver hemangioma may cause symptoms and significant challenges due to its complication. We report a case of giant liver hemangioma treated with minimal invasive approach by transarterial embolization (TAE). Following three TAE sessions over a specific timeframe, the patient was successfully managed, addressing that TAE may be a useful alternative to hepatic surgery in such cases.
Asunto(s)
Bleomicina , Embolización Terapéutica , Aceite Etiodizado , Hemangioma , Neoplasias Hepáticas , Humanos , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/diagnóstico por imagen , Hemangioma/terapia , Hemangioma/diagnóstico por imagen , Aceite Etiodizado/administración & dosificación , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Embolización Terapéutica/métodos , Antibióticos Antineoplásicos/administración & dosificación , Antibióticos Antineoplásicos/uso terapéutico , Femenino , Masculino , Persona de Mediana Edad , Emulsiones , Quimioembolización Terapéutica/métodosRESUMEN
The article "The impact of bleomycin deficit on survival in Hodgkin's lymphoma patients: A retrospective study" have presented the experience of AVD chemotherapy regimen in newly diagnosed Hodgkin's lymphoma (HL) in a single center in Brazil. Though being a small retrospective study, results from this study have provided the medical community a real-world data on HL in Brazil. ABVD has remained the standard of care for patients of newly diagnosed HL both in early and advance stages. Newer targeted molecules have also come for use in novel combinations with existing drugs. However, in a situation of temporary scarcity of bleomycin due to lack of supply during 2017 in Brazil led to use of incomplete ABVD regimen without bleomycin, i.e. AVD for HL. However, Soldi et al. utilized the opportunity to retrospectively study if the omission of bleomycin leads to subnormal treatment or unwarranted effects.
Asunto(s)
Bleomicina , Enfermedad de Hodgkin , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/mortalidad , Bleomicina/uso terapéutico , Bleomicina/administración & dosificación , Humanos , Estudios Retrospectivos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Vinblastina/uso terapéutico , Brasil/epidemiología , Doxorrubicina/uso terapéutico , Dacarbazina/uso terapéuticoRESUMEN
PURPOSE: To evaluate the safety, efficacy and predictors of response of transcatheter arterial embolization (TAE) to treat hepatic hemangiomas (HHs). MATERIALS AND METHODS: A retrospective analysis was conducted of consecutive HH patients who received TAE with bleomycin-Lipiodol emulsion and gelatin sponge particles at three institutions from January 2014 to January 2021. TAE effectiveness was defined as more than 50% reduction of tumor volume. The effectiveness, safety, and CT changes of hemangiomas after TAE were assessed. Factors affecting TAE efficacy on tumor size were analyzed with logistic regression analysis. RESULTS: A total of 102 patients with 109 HHs were included. After treatment, both the tumor diameter and volume were significantly reduced from 8.5 ± 3.9 to 5.9 ± 3.8 cm (P < 0.001) and 412.6 ± 742.3 cm3 to 102.0 ± 232.7 cm3 (P < 0.001), respectively. TAE effectiveness was achieved in 80.7% (88/109) of hemangiomas, which was characterized by progressive reduction in tumor volume over time with Lipiodol retention. Atypical enhancement pattern (tiny enhancing dots in the hepatic arterial and portal venous phase) (p = 0.001) and central arterioportal shunt (APS) (p = 0.002) associated with the tumor were independent predictors of TAE ineffectiveness. Postembolization syndrome and transient increase in liver enzymes were common without severe complications and death. CONCLUSION: TAE was safe and effective in reducing HH size. Lesion enhancement pattern and APS type were associated with TAE efficacy on tumor shrinkage. LEVEL OF EVIDENCE: Level 3, non-controlled retrospective cohort study.
Asunto(s)
Bleomicina , Aceite Etiodizado , Hemangioma , Neoplasias Hepáticas , Humanos , Masculino , Estudios Retrospectivos , Femenino , Aceite Etiodizado/administración & dosificación , Aceite Etiodizado/uso terapéutico , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/diagnóstico por imagen , Persona de Mediana Edad , Bleomicina/uso terapéutico , Hemangioma/terapia , Hemangioma/diagnóstico por imagen , Adulto , Resultado del Tratamiento , Anciano , Embolización Terapéutica/métodos , Antibióticos Antineoplásicos/uso terapéutico , Antibióticos Antineoplásicos/administración & dosificación , Carga Tumoral , Quimioembolización Terapéutica/métodos , Esponja de Gelatina Absorbible/uso terapéuticoRESUMEN
BACKGROUND: Sclerotherapy is purportedly less effective in patients with hemorrhagic than with non-hemorrhagic lymphatic malformations (LMs). We aimed to compare the efficacy of bleomycin-lauromacrogol foam (BLF) sclerotherapy in the treatment of macrocystic LMs with and without intralesional hemorrhage. METHODS: Fifty-five children with macrocystic LMs admitted to the Pediatric Surgery Department were retrospectively included. The patients were allocated into a hemorrhage group (23 cases) or a non-hemorrhage group (32 cases) based on the occurrence of an intracapsular hemorrhage. The diagnosis was confirmed by physical examination, color ultrasound, magnetic resonance imaging, and puncture findings. BLF was injected into the capsule after draining the cystic fluid under color ultrasound guidance. Patients whose lesions were unchanged or showed minor change after 1 month were treated again using the same method. Changes in lesion size and the number of treatments were recorded. Effectiveness was classified as excellent (volume reduction ≥90%), good (50%≤volume reduction<90%), or poor (volume reduction <50%). RESULTS: In the hemorrhage group, 17, 6, and 0 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 100%. In the non-hemorrhage group, 23, 7, and 2 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 93.8%. There was no significant difference in efficacy rate between groups (P = 0.767). CONCLUSIONS: BLF is an effective and safe treatment for macrocystic LMs with bleeding. The results were similar in patients with and without bleeding. LEVEL OF EVIDENCE: Treatment, Level III.
Asunto(s)
Bleomicina , Hemorragia , Anomalías Linfáticas , Soluciones Esclerosantes , Escleroterapia , Humanos , Escleroterapia/métodos , Masculino , Femenino , Estudios Retrospectivos , Bleomicina/administración & dosificación , Bleomicina/uso terapéutico , Anomalías Linfáticas/tratamiento farmacológico , Anomalías Linfáticas/terapia , Preescolar , Hemorragia/etiología , Niño , Soluciones Esclerosantes/administración & dosificación , Soluciones Esclerosantes/uso terapéutico , Lactante , Resultado del Tratamiento , Polidocanol/administración & dosificación , Polidocanol/uso terapéutico , Adolescente , Polietilenglicoles/administración & dosificación , Polietilenglicoles/uso terapéuticoRESUMEN
The phenomenon of multiple external cervical root resorption (ECRR) lesions in a single patient is rare but may have a link with the chemotherapeutic agent bleomycin. This case details an adult male with multiple ECRR lesions that developed following chemotherapy. His treatment regimen for Hodgkin's lymphoma included the chemotherapeutic antibiotic bleomycin, which has previously been linked with development of multiple ECRR lesions. The patient developed graft versus host disease following an allogeneic stem cell transplant, which could have a significant role in the development and promotion of the ECRR lesions. In total, 8 teeth developed ECRR, and all the known causative factors were excluded when examined. To our knowledge, this is only the second reported case in the literature to link bleomycin to multiple ECRR lesions. This case report aims to bring the reader's attention to the fact that multiple cervical resorption lesions can develop simultaneously. These lesions can be difficult to diagnose and treat and are often misdiagnosed as caries. Finally, the reader should consider the possible role of bleomycin and graft versus host disease in development of multiple lesions of ECRR.