Assuntos
Leucemia Mieloide Aguda , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea , Criança , Aberrações Cromossômicas , Humanos , Cariotipagem , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/terapia , Proto-Oncogenes/fisiologia , Resultado do TratamentoRESUMO
Our laboratory has been involved in the study of glutathione-sulfhydryl-transferase-pi (GST-pi) for several years. We have recently observed that during haematopoiesis in BMSC liquid cultures from CML patients who were candidates for transplant GST-pi was expressed in presumably malignant cells during different stages of cellular maturation. To confirm this finding, in the present work we are detecting GST-pi expression by immunofluorescence in BCR-ABL+ and BCR-ABL- cells done by FISH of PB from 30 CML patients during different clinical status: treatment (T), hematological relapse (R), blastic crisis (BC) or post-allotrasplant (PT). As well as in PB from 30 Blood-Bank donors. The results were %BCR-ABL+ GST-pi+ cells: T = 1-67, R = 33-69, BC = 90-100 and PT = 1-2; %BCR-ABL- GST-pi+ cells: T = 2-31, R = 5-18, BC = 0-10 and PT = 2-5; %BCR-ABL- GST-pi- cells: T = 2-97, R = 13-62, BC = 0 and PT = 93-96; %BCR-ABL+ GST-pi- cells: T = 0, R = 0, BC = 0 and PT = 0. GST-pi was not expressed in donor cells. The results obtained confirm our previous observations and suggest that GST-pi expression might be used for the evaluation of the minimal residual disease in CML patients.
Assuntos
Proteínas de Fusão bcr-abl/biossíntese , Proteínas de Fusão bcr-abl/genética , Glutationa Transferase/biossíntese , Glutationa Transferase/genética , Isoenzimas/biossíntese , Isoenzimas/genética , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Adolescente , Adulto , Idoso , Células Cultivadas , Feminino , Regulação Leucêmica da Expressão Gênica , Glutationa S-Transferase pi , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The use of single-cell polymerize chain reaction analysis has allowed for a better understanding of the origin of Hodgkin's disease, Burkitt. The study of the mechanisms regulating apoptosis and the survival of neoplastic clones have opened a whole area of research. The Revised European-American List of lymphoid neoplasms must be presented in a form that facilitates the understanding, learning, and teaching of these disorders. There is a great need for a better definition of the new category of lymphoplasmacytic lymphoma, the variants of mantle cell lymphoma and marginal zone B-cell lymphomas, and the coming of age of the NK-cell lymphomas. Based on current data, it is difficult to determine the site of transplantation in the management of follicular, low-grade non-Hodgkin's lymphoma. These patients remain at risk of relapse after transplantation, mirroring results with conventional therapy. The treatment of aggressive lymphomas remains an area of significant controversy. The Intergroup Study concluded that none of the more recent regimens was superior to CHOP. Recent data suggest that high-dose therapy with consolidative autologous or allogenic transplant may benefit patients with aggressive histology lymphoma who have poor prognostic features.
Assuntos
Linfoma/terapia , HumanosRESUMO
This descriptive study was undertaken to explore the perceptions and attitudes of 143 women (mean age+/-51) with advanced cancer. Outcome measures were the Perceptions and Attitudes Scale (PAS), a 65-item instrument validated as part of the study, and the Karnofsky Performance Status Scale. Internal consistency (Cronbach alpha) and factor analytic techniques (principal component and orthogonal rotation) were performed. The scale has an internal consistency of 0. 79. Factor analysis revealed six factors which explained 39.6% of the variance (1) loneliness; (2) family and social sphere; (3) limitations and dependence conditions; (4) perceptions about their lives; 5) perceptions about their health and pain; and (6) perceptions of pain and anguish. These results point out the necessity of a multivariate approach to women with advanced cancer.
Assuntos
Neoplasias dos Genitais Femininos/psicologia , Americanos Mexicanos/psicologia , Inventário de Personalidade/estatística & dados numéricos , Papel do Doente , Adaptação Psicológica , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Qualidade de VidaRESUMO
Cervical carcinoma is a common disease for which the prognosis has not been substantially improved with standard locoregional treatments. Three stage IB patients with untreated cervical carcinoma were treated with high-dose chemotherapy and refrigerated peripheral blood stem cell support using the ICE program (Ifosfamide 10 g/m2 plus mesna at 100% of the ifosfamide dose; Carboplatin at 1.5 g/m2 and Etoposide 2.1 g/m2). Patients received the treatment in an adjuvant setting after radical hysterectomy with pelvic lymph-node dissection and postoperative cisplatin-based standard-dose chemotherapy. All patients underwent postoperative radiotherapy. The treatment was well-tolerated, all patients had rapid hematologic recovery, and the most frequent complications were grade 3 mucositis and neutropenic fever. The three patients are disease-free at 58, 60, and 63 months of follow-up. Our results show that adjuvant high-dose chemotherapy could be effective to reduce the likelihood of relapse in high-risk patients. High-dose chemotherapy deserves a formal evaluation in high-risk cervical cancer.
Assuntos
Linfoma , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea , Ensaios Clínicos como Assunto , Terapia Combinada , Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Humanos , Linfoma/epidemiologia , Linfoma/etiologia , Linfoma/patologia , Linfoma/terapia , Prognóstico , Indução de Remissão , Terapia de Salvação , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Transplante de Medula Óssea , Transplante de Medula Óssea/efeitos adversos , Transplante de Medula Óssea/estatística & dados numéricos , Linhagem da Célula , Feminino , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/imunologia , Doença Enxerto-Hospedeiro/prevenção & controle , Neoplasias Hematológicas/epidemiologia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas/citologia , Histocompatibilidade , Humanos , Incidência , Masculino , México/epidemiologia , Neoplasias/mortalidade , Neoplasias/terapia , Resultado do TratamentoRESUMO
We describe our experience of the Instituto Nacional de Cancerología in Mexico City in the management of 22 healthy donors of the allogeneic bone marrow transplantation program. Twenty three bone marrow products were harvested from the 22 healthy donors (7 male, 15 female) with a median age of 26 (range 16 to 47). All were seronegative for HIV, HBV and HCV. The volume harvested ranged from 750 to 1500 mL. The postoperative hemoglobin dropped more than 3 g/dL in 14 donors but only seven required the transfusion of autologous blood collected before the procedure. All donors received a standard analgesic regimen with meperidene, dextropropoxiphene and ketoprofen for 24 hours after the harvest. Only two instances of procedure complications were recorded (9%) and were successfully resolved. Currently all donors are alive and in good health with a median follow up of two years. We conclude that bone marrow donation is a safe procedure with some predictable complications, the most common, anemia, easily corrected with autologous blood transfusion.
Assuntos
Anemia/etiologia , Transplante de Medula Óssea , Doadores Vivos , Doadores de Tecidos , Adolescente , Adulto , Anemia/terapia , Transfusão de Sangue Autóloga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Dor/etiologiaRESUMO
From April 1993 to September 1993, 15 patients with lymphoid or solid neoplasms underwent 16 non-cryopreserved peripheral stem cell transplantation courses using the ICE (ifosfamide, carboplatin, etoposide) program. They were randomized in a double-blind clinical trial to received oral misoprostol or placebo for mucositis prophylaxis. The active drug or placebo administration began jointly with chemotherapy at day -4 and was continued until day 16. The mucositis incidence and severity was significantly higher in patients who received misoprostol. We found no differences regarding myelosuppression, infections or other chemotherapy complications. Our results do not support the use of oral misoprostol as administered in this study, for high-dose chemotherapy-induced mucositis prophylaxis.
Assuntos
Antiulcerosos/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Transplante de Células-Tronco Hematopoéticas , Misoprostol/farmacologia , Estomatite/induzido quimicamente , Estomatite/prevenção & controle , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carboplatina/administração & dosagem , Carboplatina/efeitos adversos , Método Duplo-Cego , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Humanos , Ifosfamida/administração & dosagem , Ifosfamida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal , Neoplasias/tratamento farmacológico , Neoplasias/terapiaRESUMO
We report the first experience of the use of GM-CSF as prophylaxis of ganciclovir induced severe bone marrow suppression in a CMV seropositive patient with acute myeloid leukemia who underwent a complete remission after an allogeneic bone marrow transplantation from an identical HLA sibling who also was CMV seropositive. A successful bone marrow engraftment was documented by day 14. Once peripheral blood counts stabilized, the patient received ganciclovir 5 mg/kg TIW. By day 73 severe neutropenia was documented but a spontaneous improvement occurred with discontinuation of ganciclovir. From day 100 to day. 110 he received daily ganciclovir at a dose of 5 mg/kg and the same dose of GM-CSF without signs of toxicity. There was no evidence of either acute graft versus host disease or of CMV infection. One year after transplantation he relapsed and died of complications of acute leukemia.
Assuntos
Transplante de Medula Óssea , Infecções por Citomegalovirus/prevenção & controle , Ganciclovir/efeitos adversos , Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Leucemia Mieloide Aguda/terapia , Neutropenia/prevenção & controle , Adulto , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Evolução Fatal , Ganciclovir/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Masculino , Neutropenia/induzido quimicamente , Indução de RemissãoRESUMO
We studied the response to treatment and survival of 30 adults with acute lymphocytic leukemia (ALL) and 19 with acute non lymphoid leukemia (ANLL) classified on basis of immunophenotype (monoclonal antibodies) and cytochemistry. For the ALL cases 70% corresponded to common ALL (CALLA positive), 23% to B lymphocytes and 7% to T cells. We had 68% of the ANLL patients classified as myeloid, 21% as hybrid (positive both myeloid and lymphoid markers) and 11% as undifferentiated. We analyzed demographic data (gender and age), basic laboratory values (hemoglobin, leucocytes, platelets and cytomorphology in peripheral blood and bone marrow) using the French-American-British classification, and found no statistically significant differences between ALL and ANLL. Three of four patients (75%) with hybrid ANLL achieved complete remission (CR), while 46% of cases with myeloid ANLL and none of the subjects with undifferentiated ANLL reached CR; these differences were not statistically significant. Patients with common ALL had a median survival (SV) of 499 days, for B cell ALL it was of 212 days, and for T cell ALL of 285 days. Our data suggest that: a) expression of lymphoid markers in patients with ANLL is probably associated with a higher CR ratio, and b) SV in adults with common ALL seems to be longer than in those with B and T cell ALL.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Adulto , Feminino , Histocitoquímica , Humanos , Imunofenotipagem , Leucemia Mieloide Aguda/classificação , Leucemia Mieloide Aguda/mortalidade , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/classificação , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Taxa de SobrevidaRESUMO
This study describes the cytogenetic alterations in patients with chronic myelogenous leukemia (CML) seen at the Instituto Nacional de Cancerologia (INCAN), Mexico City, whether they have been treated previously or not. It correlates these findings with the prognosis. We studied 31 patients seen during June 1987 and June 1990. Philadelphia (Ph+) chromosome was present in 61% of all specimens. In 10 cases it was the only anomaly, resulting in a survival greater than 40 months. Aneuploidies were seen in 50% of patients with previous treatment and in 31.5% of those without treatment. Patients with numerous abnormalities and double Ph+ (with or without Ph+ chromosome) had a mean survival of 32 months. The worst prognosis was seen in the a cases with no growth, with a mean survival of 19 months. This study suggests that the prognosis of patients with CML correlates with the cytogenetic anomalies whether patients have been treated previously or not. It also seems that the group of patients whose cytogenetic study does not grow or cannot be evaluated upon direct exam have a worse prognosis which may be secondary to intrinsic defects of the neoplastic cells that do not grow in vitro, resulting in a more aggressive disease in vivo.