RESUMO
The flow-cytometric DNA content in the plasma cells of patients with multiple myeloma has been studied as a prognostic factor and contrasting results have been found. In a group of 45 patients with myeloma from a single institution, the DNA content of the malignant plasma cells was studied by means of flow cytometry: no patients were found to have hypodiploid DNA content, 14 patients had hyperdiploid DNA, and 31 patients were found to have diploid DNA. The overall survival of patients with hyperdiploid DNA was better than that of patients with diploid DNA: 93% at 85 months and 79% at 89 months, respectively; in both groups, the median overall survival has not been reached. No correlation was found between the DNA content and the International Staging System and the discriminatory effect of the DNA content was apparent only in the patients who were not autografted. It is concluded that the flow-cytometric DNA content of the plasma cells of patients with multiple myeloma may be a prognostic factor independent of others already identified and that myeloma patients with hyperdiploid DNA content in the plasma cells may have a better prognosis than those with a normal DNA content.
Assuntos
DNA de Neoplasias/análise , Mieloma Múltiplo/genética , Plasmócitos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Citometria de Fluxo/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/patologia , Ploidias , Prognóstico , Taxa de SobrevidaRESUMO
In a single institution, in a group of 28 myeloma patients deemed eligible for autologous transplant, stem cell mobilization was attempted using filgrastim: 26 individuals were given 31 autografts employing 1-4 (median three) apheresis sessions, to obtain a target stem cell dose of 1 x 10(6) CD34 +ve viable cells / Kg of the recipient. The median number of grafted CD34 cells was 7.56 x 10(6) / Kg of the recipient; the range being 0.92 to 14.8. By defining as poor mobilizers individuals in which a cell collection of < 1 x 10(6) CD34 viable cells / Kg was obtained, a subset of eight poor mobilizers was identified; in two patients the autograft was aborted because of an extremely poor CD34 +ve cell yield (< 0.2 x 10(6) CD34 +ve viable cells / Kg of the recipient) after four apheresis sessions. The long-term overall survival of the patients grafted with > 1 x 10(6) CD34 +ve viable cells / Kg was better (80% at 80 months) than those grafted with < 1 x 10(6) CD34 +ve viable cells / Kg (67% at 76 months). Methods to improve stem cell mobilization are needed and may result in obtaining better results when autografting multiple myeloma patients.
RESUMO
Aplastic anemia (AA) is most frequently due to autoimmune attack on its own stem cells. Alemtuzumab is a monoclonal antibody which recognizes the CD52 antigen on the surface of T and B cells. It has proved useful in autoimmune diseases, lymphoproliferative conditions, and graft versus host disease. Based on its immunosuppressive properties, we treated 14 AA patients with alemtuzumab. Median age was 23 years. Ten milligrams of alemtuzumab were injected subcutaneously each day for five consecutive days. Cyclosporine A was also administered orally at a dose of 2 mg/kg every 12 h for 3 months, and then gradually tapered. Response to alemtuzumab was followed for a median of 20 months. There were eight responses (57.1%), two complete and six partial. Whereas six (42.8%) patients were non-responders. Median complete blood count values on alemtuzumab responders were Hb 13.1 mg/dL, absolute neutrophil count 2.4 x 10(9)/L, and platelets 97.5 x 10(9)/L. A good response was produced in 57% of AA patients with the administration of alemtuzumab, who lacked a stem cell donor.