RESUMO
PURPOSE: The present study aimed to investigate the efficacy and severity of adverse effects of HCAG and CAG re-induction chemotherapy in elderly low- and intermediate-risk group patients diagnosed with acute myeloid leukemia (AML) following induction failure. METHODS: A total of 94 AML patients were enrolled in the study, of whom 46 were treated with HCAG chemotherapy, while 48 were treated with CAG chemotherapy. RESULT: The complete remission (CR) was 39.6% in the patients with HCAG, while the CR was 33.3% in the CAG group. The overall remission (ORR) was 63.0% and 43.5% in patients of the HCAG and CAG groups, respectively (P = 0.038). The median survival time of progression free survival (PFS) was 8.0 (95% CI 3.843-10.157) months in the HCAG group and 7.0 (95% CI 2.682-13.318) months in the CAG group (P = 0.032). A total of 31 patients in the HCAG group suffered from grade 4 hematological toxicity, whereas 29 patients were treated with CAG (P = 0.622). A total of 27 (58.7%) cases indicated apparent pulmonary infection in the HCAG group, while 25 (52.1%) were noted with this complication in the CAG group (P = 0.519). Oral cavity toxicity was evident for 13 (28.3%) and 11 (23.0%) cases in the HCAG and CAG groups, respectively (P = 0.216). CONCLUSION: The HCAG regimen was more effective than the CAG regimen in elderly low- and intermediate-risk group patients diagnosed with acute myeloid leukemia although the HCAG regimen exhibited similar toxicity with that of the CAG group.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mepesuccinato de Omacetaxina/uso terapêutico , Quimioterapia de Indução/métodos , Leucemia Mieloide Aguda/tratamento farmacológico , Aclarubicina/efeitos adversos , Aclarubicina/uso terapêutico , Idoso , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Citarabina/efeitos adversos , Citarabina/uso terapêutico , Esquema de Medicação , Feminino , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Mepesuccinato de Omacetaxina/efeitos adversos , Humanos , Quimioterapia de Indução/efeitos adversos , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/mortalidade , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Indução de Remissão , Retratamento/métodos , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação , Método Simples-Cego , Fatores de Tempo , Falha de TratamentoRESUMO
PURPOSE: The aim of the present study was to investigate the efficacy and adverse effects of HCAG and FLAG re-induction chemotherapy in acute myeloid leukemia (AML) patients of low- and intermediate-risk groups following induction failure. METHODS: A total of 98 AML patients were enrolled. Among these subjects, 47 patients were treated with HCAG chemotherapy, while 51 patients were treated with FLAG chemotherapy. RESULT: The complete remission (CR) and overall remission (OFF) were 24% and 38%, respectively in patients with HCAG induction chemotherapy, while the corresponding percentages were 28% and 42% in subject receiving FLAG chemotherapy. The median survival time of progress-free survival (PFS) was 29.8 (95% CI 23.749-35.851) months in the HCAG group and 30.8 (95% CI 21.728-39.872) months in the FLAG group (P = 0.620). A total of 42 patients in the HCAG group suffered from grade 4 hematological toxicity, while this adverse reaction was noted for all patients who were treated with FLAG chemotherapy (P = 0.023). A total of 19 cases indicated apparent nonhematological toxicity in the HCAG group, while only 40 (78.4%) were noted with these adverse reactions in the FLAG group (P = 0.000). CONCLUSION: The HCAG regimen exhibited a similar effect compared with the FLAG regimen in low- and intermediate-risk groups, although the HCAG regimen significantly decreased the toxicity compared with that noted in the FLAG regimen group.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia de Indução/métodos , Leucemia Mieloide Aguda/tratamento farmacológico , Aclarubicina/administração & dosagem , Aclarubicina/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Citarabina/administração & dosagem , Citarabina/efeitos adversos , Esquema de Medicação , Feminino , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Mepesuccinato de Omacetaxina/administração & dosagem , Mepesuccinato de Omacetaxina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Prospectivos , Risco , Método Simples-Cego , Falha de Tratamento , Vidarabina/administração & dosagem , Vidarabina/efeitos adversos , Vidarabina/análogos & derivadosRESUMO
Introdução: o Adalimumabe (ADA) é um anticorpo monoclonal totalmente humano, utilizado no tratamento da doença de Crohn (DC). Nos casos com necessidade de interrupção desta terapia, o resgate da resposta é controverso, e o papel da reindução da remissão com dose total de ataque pode ser uma alternativa nos casos graves da DC. Não há relatos desta forma de tratamento na literatura. O objetivo deste estudo foi relatar a experiência de dois pacientes tratados com reindução da remissão com ADA, após sua interrupção. Método: análise retrospectiva de dois casos submetidos a reindução em meio a uma coorte de 24 pacientes em uso de ADA para DC. Resultados: são descritos dois casos de pacientes jovens, em tratamento com ADA subcutâneo, que tiveram necessidade de interrupção da terapia (um por abscesso perineal extenso e outro por dificuldade de acesso ao fornecimento da medicação). Ambos foram tratados pela reindução com dose total de ataque do ADA, com bons resultados, sem efeitos adversos. Conclusão: não há na literatura estudos controlados que comparem a reindução com outras formas de resgate da terapia após a parada de qualquer agente anti-TNF. Experiências isoladas mostram bons resultados com esta alternativa terapêutica em casos graves e selecionados.
Introduction: Adalimumab (ADA) is a fully-human anti-TNF-alpha antibody approved for the management of Crohnïs disease (CD). In situations in which interruption of the treatment is mandatory, rescue therapy is controversial. Reinduction of remission with full dose may be an alternative in severe CD cases. There are no descriptions of this alternative in the literature. The aim of this study was to describe the experience with two patients treated with reinduction of remission with ADA, after interruption of treatment. Method: retrospective analysis of two patients in a cohort of 24 CD patients treated with ADA, with case reports. Results: description of two young patients with fistulizing CD, with the need of interruption of ADA therapy due to different reasons (perianal abscess and difficulties in receiving the medication). Both were treated with reinduction of remission with full dose ADA regimen (160/80 mg), with good results and no adverse events. Conclusions: there are no studies in the literature comparing reinduction of remission with other possibilities of rescue therapy after interruption of treatment with any anti-TNF agent. Small case series like this, show good results with this alternative in selected and severe cases of CD.