RESUMO
BACKGROUND: Non-Hodgkin lymphoma (NHL) associated with HIV became an AIDS-defining condition early in the epidemic and remains the second most common malignancy in patients with AIDS. With the advent of highly active antiretroviral therapy (HAART), the incidence and mortality of AIDS-related opportunistic infections and Kaposi's sarcoma has fallen dramatically, this trend is not observed so clearly for NHL. Our objective was to review the clinical spectrum of patients with AIDS-associated NHL and to analyze the impact of HAART on survival at an oncological tertiary center. MATERIAL AND METHODS: We reviewed all medical records and histopathologic tissue of patients with HIV-associated NHL seen from January 1990 to September 2007 at the Instituto Nacional de Cancerologia in Mexico City. Survival or follow-up time was calculated from date of diagnosis to death, or to the date on which the patient was last seen. RESULTS: Eighty seven HIV-positive patients were diagnosed with NHL (diffuse large B-cell lymphoma n=69; Burkitt-like n=8; pleomorphic large cell n=7; low-grade n=2, and angiocentric n=1). Twenty eight patients never received HAART, and 59 received HAART. Overall, 38 patients (43.7%) achieved complete response to NHL therapy, including only 14.3% patients in the non-HAART compared with 57.6% in the HAART group (p < or = 0.0001). Two patients (7.1%) in the non-HAART were alive compared with 37 (63.8%) in the HAART group (p < or = 0.0001). Mean survival time for all patients was 11 +/- 16.8 months. Survival was significantly shorter in patients not receiving HAART (4.8 +/- 7.6 months) as compared with those who did (14 +/- 19.2) (p=0.01). CONCLUSIONS: Patients with NHL-HIV who were able to receive treatment with HAART and were sufficiently healthy to receive optimal chemotherapy treatment showed a significantly better prognosis.
Assuntos
Institutos de Câncer/estatística & dados numéricos , Linfoma Relacionado a AIDS/epidemiologia , Linfoma Difuso de Grandes Células B/epidemiologia , Linfoma não Hodgkin/epidemiologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Linfoma Relacionado a AIDS/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma não Hodgkin/tratamento farmacológico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: To compare the hematopoietic recovery and the clinical outcome after high dose chemotherapy and peripheral blood stem cell (PBSC) transplant between patients who received recombinant granulocyte colony-stimulating factor (G-CSF) starting on day 0 and those who received it starting on day +7. PATIENTS AND METHODS: Thirty-five consecutive patients received high dose chemotherapy with ifosfamide, etoposide and carboplatin (ICE) and autologous PBSC transplant. PBSC mobilization was achieved with G-CSF. In 19 transplants done in 1994, G-CSF was started on day 0 and in 16 procedures done in 1995, G-CSF was started on day +7. In both groups G-CSF was given until the absolute neutrophil count was 1 x 10(9)/L. RESULTS: The median number of days to reach an absolute neutrophil count > 0.1 x 10(9)/L, was 11 in the patients who started the G-CSF on day 0 and 11 days in the patients with delayed administration of G-CSF and to reach > 0.5 x 10(9)/L 14 days and 13 respectively. The median number of days to reach a platelet count > 20 x 10(9)/L was 14 and 13. Comparison of early vs. delayed administration of G-CSF did not show any significant differences regarding the time to achieve platelet independence, number of days with fever, median days of hospital stay, number of red cell or platelet transfusions. CONCLUSIONS: Starting G-CSF on day +7 after high dose ICE chemotherapy and autologous transplant of PBSC is as effective in restoring the hematopoietic function as is starting its administration on day 0.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Transplante de Células-Tronco Hematopoéticas , Neutrófilos/fisiologia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carboplatina/administração & dosagem , Esquema de Medicação , Etoposídeo/administração & dosagem , Feminino , Hematopoese , Humanos , Ifosfamida/administração & dosagem , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes , Estudos Retrospectivos , Transplante AutólogoRESUMO
Background. Oral etoposide administration is a suitable alternative to the intravenous route; therefore, commercial capsules have been developed. Before these capsules were available in Mexico, we studied drug bioavailability after oral administration of the intravenous etoposide solution (IVES). Methods. Eight adult cancer patients received a 50-mg oral etoposide dose as IVES and blood samples were collected over a period of 24 h. plasma etoposide concentration was determined by high-performance liquid chromatography, plasma concentration against time curves were constructed, and biovailability parameters were calculated. Results. Oral IVES yielded an adequate bioavailability profile because Cmax was 2.38 ñ 0.30 µg/mL, AUC was 12.87 ñ 2.02 µg/mL and half-life was 6.72 ñ 0.97 h. Conclusions. Considering that the pharmacokinetic aim is to maintain plasm concentrations between 0.5 and 1.0 µg/mL for several hours while avioding high concentrations, i.e., of 10 µg/mL or higher, oral administration of 50-mg etoposide as IVES appears to be a suitable dosing option. In addition, oral IVES is considerably less expensive than intravenous administration in terms of both drug presentation and administration