RESUMO
Imatinib mesylate (IM) is now first-line treatment for CML. To study the results of treatment with IM after IFN failure/intolerance versus allogeneic BMT (allo-BMT), we retrospectively analyzed 264 patients treated for CML in first chronic phase in three different institutions. Over a 6-year period (2001-2006), 174 patients received IM after failure of or intolerance to IFN. During the same period of time, 90 patients received an allo-BMT from an HLA-matched sibling (n=83) or an unrelated donor (n=7). The IM group was older (41 versus 33 years, P<0.001). Five-year EFS was 62% among patients receiving IM and 52% among patients undergoing allo-BMT (P=0.0002). OS at 5 years was 93% for IM-treated patients and 59% for patients undergoing allo-BMT (P<0.0001). Allo-BMT cannot be considered as first-line treatment for CML patients in first chronic phase.
Assuntos
Antineoplásicos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/métodos , Leucemia Mieloide de Fase Crônica/tratamento farmacológico , Leucemia Mieloide de Fase Crônica/terapia , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Adulto , Benzamidas , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Mesilato de Imatinib , Masculino , Estudos Retrospectivos , Condicionamento Pré-Transplante/métodos , Adulto JovemAssuntos
Efeito Enxerto vs Leucemia , Transplante de Células-Tronco Hematopoéticas , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Leucemia Mieloide de Fase Crônica/terapia , Ácido Micofenólico/análogos & derivados , Adulto , Alopurinol/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Benzamidas , Biomarcadores Tumorais/análise , Administração de Caso , Terapia Combinada , Quimioterapia Combinada , Proteínas de Fusão bcr-abl/análise , Proteínas de Fusão bcr-abl/antagonistas & inibidores , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/etiologia , Humanos , Hidroxiureia/administração & dosagem , Mesilato de Imatinib , Imunossupressores/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Leucemia Mieloide de Fase Crônica/tratamento farmacológico , Leucemia Mieloide de Fase Crônica/patologia , Masculino , Ácido Micofenólico/uso terapêutico , Piperazinas/farmacologia , Piperazinas/uso terapêutico , Prednisona/uso terapêutico , Pirimidinas/farmacologia , Pirimidinas/uso terapêutico , Indução de Remissão , Talidomida/uso terapêutico , Condicionamento Pré-TransplanteAssuntos
Humanos , Masculino , Adulto , Leucemia Mielogênica Crônica BCR-ABL Positiva , Efeito Enxerto vs Leucemia , Ácido Micofenólico/análogos & derivados , Leucemia Mieloide de Fase Crônica/terapia , Transplante de Células-Tronco Hematopoéticas , Piperazinas , Pirimidinas , Talidomida , Prednisona , Leucemia Mielogênica Crônica BCR-ABL Positiva , Alopurinol , Terapia Combinada , Quimioterapia Combinada , Hidroxiureia , Imunossupressores , Ácido Micofenólico/uso terapêutico , Administração de Caso , Condicionamento Pré-Transplante , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/etiologia , Indução de Remissão , Leucemia Mieloide de Fase Crônica/tratamento farmacológico , Leucemia Mieloide de Fase Crônica/patologia , Biomarcadores Tumorais/análise , Proteínas de Fusão bcr-abl/análise , Proteínas de Fusão bcr-abl/antagonistas & inibidores , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
Two cases of GVHD with severe dry eyes are reported where conventional therapy failed to control ocular signs and symptoms. Autologous serum tears, however, resulted in a beneficial clinical effect with marked attenuation of the symptoms. This therapy proved to be safe during 10 months of treatment. Bone Marrow Transplantation (2000).
Assuntos
Sangue , Doença Enxerto-Hospedeiro/complicações , Soluções Oftálmicas , Xeroftalmia/terapia , Adulto , Estudos de Avaliação como Assunto , Olho/patologia , Feminino , Humanos , Leucemia Mieloide de Fase Crônica/terapia , Síndrome de Sjogren/etiologia , Xeroftalmia/etiologia , Xeroftalmia/patologiaRESUMO
A 24-year-old woman with CML underwent allogeneic BMT in August 1995 from a one-antigen HLA mismatched brother. Conditioning included BuCy2 and CsA and MTX were used to prevent GVHD. In July 1997 she developed right leg pain, lytic bone lesions of distal femur and a solid mass of soft tissue. Histological diagnosis of malignant fibrous histiocytoma was made. Despite treatment with surgery and chemotherapy (doxorubicin and ifosfamide), the patient died 1 year later with local recurrence of the tumor and liver, lung and brain metastases. The CML was in CR.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Histiocitoma Fibroso Benigno/etiologia , Leucemia Mieloide de Fase Crônica/terapia , Segunda Neoplasia Primária/etiologia , Adulto , Feminino , Neoplasias Femorais/diagnóstico , Neoplasias Femorais/etiologia , Histiocitoma Fibroso Benigno/diagnóstico , Humanos , Masculino , Segunda Neoplasia Primária/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/etiologia , Transplante HomólogoRESUMO
PURPOSE: To evaluate the efficacy of the combination, alpha-interferon (IFN)-hydroxyurea (HU) in the treatment of patients with Philadelphia positive chronic myelogenous leukaemia (Ph'-CML). PATIENTS AND METHODS: A prospective study was started in 1988 in which 30 patients with chronic phase, low-risk Ph'-CML, according to Kantarjian's staging system, were included. They were treated with IFN at a dose of 5 MU/m2 subcutaneously twice a week plus HU in doses between 0.5 and 3 g/m2/day. The clinic and biologic controls performed twice a month included granulocyte alkaline phosphatase, and cytogenetic studies of bone-marrow and peripheral blood were carry out every third month. The quality and duration of haematologic and cytogenetic remissions were evaluated, along with the untoward effect of the treatment. Survival was estimated in accordance to the Kaplan Meier method. RESULTS: The mean age was 49 years (range: 17-70) and the M/F ratio was 18/12. The median follow-up was 51 months (range: 8-89). Twenty patients were in early- and four late-chronic phase. Complete haematological remission (CHR) was achieved in 26 patients (87%) with a median of 52 months and an estimated global median survival of 81 months. Cytogenetic response was seen in 11 patients (52%) of the 21 who were evaluable after 11 months of treatment. Disappearance of Ph' (complete cytogenetic response) was seen in 6 cases (28%). The incidence of early blast crisis in the first three years was, respectively, 0%, 3% and 6%. The treatment toxicity was negligible in most cases, having to suppress the treatment only in one patient due to persistent fever. CONCLUSIONS: The association of IFN and HU is effective and well tolerated in patients with low-risk CML, and it improves survival in CHR and overall survival.
Assuntos
Hidroxiureia/uso terapêutico , Fatores Imunológicos/uso terapêutico , Interferon-alfa/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Leucemia Mieloide de Fase Crônica/terapia , Adolescente , Adulto , Idoso , Terapia Combinada , Feminino , Febre/induzido quimicamente , Humanos , Hidroxiureia/efeitos adversos , Fatores Imunológicos/efeitos adversos , Interferon-alfa/efeitos adversos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Leucemia Mielogênica Crônica BCR-ABL Positiva/mortalidade , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Leucemia Mieloide de Fase Crônica/tratamento farmacológico , Leucemia Mieloide de Fase Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Indução de RemissãoRESUMO
The value of low-dose interferon (IFN) on the evolution of chronic myelogenous leukaemia was assessed in this study. Eleven patients previously treated with busulphan were analysed. Seven of them, in the chronic phase, received IFN 2 x 10(6) U/m2 subcutaneously three times a week; four patients in accelerated phase and two unresponsive to IFN were given a combination of IFN and hydroxyurea. Low-dose IFN proved capable of prolonging the remission period induced by busulphan. In the accelerated phase, the association of IFN and hydroxyurea protracted the evolution of the disease, although no conclusions can yet be drawn regarding the patients' survival. Ph1-chromosome negativity was attained in 28% of the cases. Minimal untoward effects were observed. It was concluded that low doses of IFN may induce scarce toxicity while preserving the therapeutic value.