RESUMO
We investigated the roles of CD3McAb and rhIL-2 activated bone marrow in the killing and purging of leukemia cells. Cytotoxicity of activated bone marrow was detected with MTT assay. CFU-GM level in activated bone marrow and the destruction of leukemia cells were measured using the semi-solid cell culture. Immune activation markers in activated bone marrow were detected by indirect immunofluorescence assay. Bone marrow activated by CD3McAb and rhIL-2 displayed significantly upregulated the killing and purging abilities on the leukemia cell line K562 and HL-60. Such effects were superior to that of bone marrow activated by rhIL-2 or CD3McAb alone (P < 0.05, P < 0.01). Activation by rhIL-2 and (or) CD3McAb exerted no obvious influence on CFU-GM level in bone marrow. Compared with bone marrow activated by rhIL-2 or CD3McAb alone, the synergistic effect of both CD3McAb+ and hIL-2 caused significant increase of CD3(+), CD8(+), CD19(+), CD25(+), CD38(+), and CD56(+) levels. Our study indicates that CD3McAb enhanced the killing and purging effects of rhIL-2 activated bone marrow on leukemia cells.
Assuntos
Anticorpos Monoclonais/farmacologia , Células da Medula Óssea/efeitos dos fármacos , Purging da Medula Óssea , Interleucina-2/farmacologia , Adolescente , Adulto , Anticorpos Monoclonais/imunologia , Células da Medula Óssea/metabolismo , Células da Medula Óssea/patologia , Purging da Medula Óssea/métodos , Transplante de Medula Óssea , Complexo CD3/imunologia , Complexo CD3/metabolismo , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Ensaio de Unidades Formadoras de Colônias , Feminino , Células Progenitoras de Granulócitos e Macrófagos , Células HL-60 , Humanos , Imunofenotipagem , Células K562 , Leucemia/metabolismo , Leucemia/patologia , Leucemia/terapia , Masculino , Pessoa de Meia-Idade , Fenótipo , Adulto JovemRESUMO
Multiple myeloma (MM) is the second most common hematologic malignancy, affecting approximately 14,000 new patients per year in the United States. For over four decades, the standard treatment for MM has been a regimen of melphalan combined with prednisone. Using this treatment modality, complete responses are rare, and 50% of patients have had disease that was resistant to chemotherapy. Attempts have been made to improve the outcome of MM by administering combinations of I. V. polichemotherapy, but these treatments are equivalent in terms of overall survival. High-dose therapy with peripheral blood stem cell support can be applied safely in these patients and achieves significantly higher complete remission rates as well as better event-free survival and overall survival. However, neither tumor-cell purging, positive selection, intensification of conditioning with additional chemotherapeutic agents, nor total body irradiation have been shown to improve outcome. The role of tandem transplantation with high-dose melphalan seems to be a good selection of treatment in hospitals having all resources. Future research will include the combination of the best remission-induction regimen with tandem transplants and maintenance treatments (thalidomide, idiotype or dendritic cell vaccination) that will sustain complete remission. Development of non-myeloablative allogeneic transplantation in order to exploit the graft-versus myeloma effect provides an alternative for patients who have a compatible donor. Combining all of these modalities with the new drugs developed few years ago (thalidomide, bortezomib, revlimid), we hope that MM will become a manageable chronic disease and perhaps a curable disease at least for 30% to 40% of the patients.
El mieloma múltiple (MM) es la segunda patología oncohematológica más frecuente. En Estados Unidos son diagnosticados anualmente 14,000 casos nuevos. En las últimas cuatro décadas el tratamiento estándar ha sido la combinación de melfalán y prednisona. Con este régimen raramente se logran remisiones completas y 50% de los pacientes no responden a esta terapia. Se han hecho intentos de mejorar los resultados combinando poliquimioterapia, pero la sobrevida global ha sido la misma. Al aplicar quimioterapia a dosis altas y rescate con trasplante de células hematopoyéticas se logra un mayor porcentaje de remisiones completas, asimismo, una mayor sobrevida libre de enfermedad y sobrevida global. La purga de células hematopoyéticas, selección positiva, intensificación del régimen de acondicionamiento con otras drogas o irradiación corporal total, no han demostrado utilidad en términos de sobrevida global. El doble trasplante autólogo de células hematopoyéticas parece ser una opción útil para hospitales que cuentan con la infraestructura y los recursos necesarios para realizarlo. En un futuro, la investigación deberá incluir el uso del mejor régimen de inducción a la remisión más doble trasplante autólogo y terapia de mantenimiento (talidomida o vacunas con células dendríticas), con la finalidad de al menos prolongar la remisión completa. El uso del trasplante alogénico no mieloablativo para provocar el efecto injerto contra mieloma parece una buena alternativa para los pacientes que tengan donador. Al combinar todas estas modalidades de tratamiento con las nuevas drogas desarrolladas en los últimos años (talidomida, bortezomid, revlimid), se espera que en un futuro el MM se convierta en una enfermedad crónica y curable en al menos 30 a 40% de los enfermos.
Assuntos
Humanos , Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Purging da Medula Óssea , Terapia Combinada , Intervalo Livre de Doença , Mobilização de Células-Tronco Hematopoéticas/métodos , Hospitais Públicos/estatística & dados numéricos , Tábuas de Vida , Transfusão de Linfócitos , México/epidemiologia , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Transplante Autólogo , Transplante Homólogo , Resultado do Tratamento , Condicionamento Pré-Transplante/métodos , Estados Unidos/epidemiologiaRESUMO
Multiple myeloma (MM) is the second most common hematologic malignancy, affecting approximately 14,000 new patients per year in the United States. For over four decades, the standard treatment for MM has been a regimen of melphalan combined with prednisone. Using this treatment modality, complete responses are rare, and 50% of patients have had disease that was resistant to chemotherapy. Attempts have been made to improve the outcome of MM by administering combinations of i.v. poli-chemotherapy, but these treatments are equivalent in terms of overall survival. High-dose therapy with peripheral blood stem cell support can be applied safely in these patients and achieves significantly higher complete remission rates as well as better event-free survival and overall survival. However, neither tumor-cell purging, positive selection, intensification of conditioning with additional chemotherapeutic agents, nor total body irradiation have been shown to improve outcome. The role of tandem transplantation with high-dose melphalan seems to be a good selection of treatment in hospitals having all resources. Future research will include the combination of the best remission-induction regimen with tandem transplants and maintenance treatments (thalidomide, idiotype or dendritic cell vaccination) that will sustain complete remission. Development of non-myeloablative allogeneic transplantation in order to exploit the graft-versus myeloma effect provides an alternative for patients who have a compatible donor. Combining all of these modalities with the new drugs developed few years ago (thalidomide, bortezomib, revlimid), we hope that MM will become a manageable chronic disease and perhaps a curable disease at least for 30% to 40% of the patients.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Purging da Medula Óssea , Terapia Combinada , Intervalo Livre de Doença , Mobilização de Células-Tronco Hematopoéticas/métodos , Hospitais Públicos/estatística & dados numéricos , Humanos , Tábuas de Vida , Transfusão de Linfócitos , México/epidemiologia , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Condicionamento Pré-Transplante/métodos , Transplante Autólogo , Transplante Homólogo , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
Purging of neoplastic cells for autologous stem cell transplantation is usually done in vivo by administering chemotherapy and/or other agents before harvesting. It is also possible to decrease malignant cells counts directly in the cell harvest. In this study, we ascertained the effect of anti-CD20 monoclonal antibody and rituximab administration on peripheral blood hematopoietic stem cells. Five samples of stem cell harvests from different patients with B cell lymphoma were obtained. Each sample was divided in two tubes with calcium gluconate (20 mEq/50 microl). Rituximab (1 mg/600,000 mononuclear cells) was added to one of the tubes. Using flow cytometry, CD19, CD20 (B cell markers), and CD95 (apoptosis marker), expression was measured at baseline and 24 h after the addition of rituximab. A one-sided t-test with equal variances was used to analyze the results. Immediately after rituximab addition, CD20 expression became null. No significant difference in variation of CD19 expression was detected after the addition of rituximab (-3.64% control vs. 0.63% rituximab, p = 0.69). Mean variations of percentage of CD95 expression were 2.9% (controls) and 10.52% (rituximab tubes) (p = 0.06). We conclude that rituximab is capable of initiating apoptosis in vitro. We found no decrease in the CD19+ cell count, used as a surrogate marker for CD20+ cells, meaning that, at least in 24 h, apoptosis activation is not capable of decreasing CD20+ cell numbers. In vitro purging of peripheral blood stem cells harvests with rituximab could be part of a broader therapeutic strategy to be offered to lymphoproliferative disorder patients.
Assuntos
Anticorpos Monoclonais/farmacologia , Antígenos CD20/metabolismo , Apoptose/efeitos dos fármacos , Purging da Medula Óssea/métodos , Células-Tronco Hematopoéticas/efeitos dos fármacos , Células-Tronco Hematopoéticas/patologia , Linfoma de Células B/patologia , Anticorpos Monoclonais Murinos , Antígenos CD19/metabolismo , Antineoplásicos/farmacologia , Transfusão de Sangue Autóloga , Contagem de Células , Separação Celular , Células-Tronco Hematopoéticas/metabolismo , Humanos , Linfoma de Células B/metabolismo , Rituximab , Receptor fas/metabolismoRESUMO
Objetivo: Determinar la incidencia, características clínicas y complicaciones de la cistitis hemorrágica (CH). Material y Métodos: Estudio descriptivo sobre pacientes transplantados de médula ósea en la Unidad de Trasplante de Médula Ósea del Hospital Nacional Edgardo Rebagliati Martins, desde noviembre 1994 hasta octubre 2003, y que desarrollaron cistitis hemorrágica. Resultados: En 9 años fueron transplantados 170 pacientes, desarrollando cistitis hemorrágica 8 de ellos (incidencia acumulada 4,7 por ciento). El cuadro clínico se caracterizó por disuria más hematuria macroscópica o microscópica. La presentación tardía fue la más frecuente. En 4 pacientes, la cistitis hemorrágica fue severa. Dos de los tres pacientes que desarrollaron el cuadro de cistitis hemorrágica en dos oportunidades, fallecieron. Conclusiones: La mitad de los pocos pacientes que desarrollan CH en la Unidad, lo hacen bajo la forma severa y, si presentan la CH por segunda vez, su pronóstico se complica.
Objective: To determine the incidence, clinical features and complications of bone marrow transplant-related hemorrhagic cystitis (HC). Material and Methods: Retrospective study of bone marrow transplant patients attended at the Edgardo Rebagliati Martins National Hospital Bone Marrow Transplant Unit from November 1994 to October 2003 and who developed HC. Results: A total of 170 patients underwent hematopoietic cell transplantation. Eight patients developed HC with a cumulative incidence of 4,7 per cent, characterized by mainly late onset hematuria and dysuria. In 4 patients, the HC was severe. Two of the three patients who developed HC twice died. Conclusions: Half of the few patients with HC attended at the Unit developed serious disease and when they had HC for a second time the prognosis was fatal.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Cistite , Cistite/complicações , Incidência , Purging da Medula Óssea , Transplante de Medula Óssea , Epidemiologia Descritiva , PeruRESUMO
Chronic myeloid leukemia (CML) is a hematological neoplasia that results from the transformation of a hematopoietic stem cell. It is characterized by the expansion of the myeloid lineage, which results in the accumulation of mature and immature granulocytes in peripheral blood and bone marrow. However, when CML marrow cells are cultured in Dexter-type long-term cultures (LTMC) hematopoiesis is defective and can be sustained for only a few weeks. One possible explanation for the deficient growth of hematopoietic cells in CML LTMC is that some factors that act as key regulators of hematopoiesis are absent in this experimental system. Thus, we tested this hypothesis by adding recombinant cytokines to these cultures. As a first approach, we added recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF), rhGranulocyte-CSF (rhG-CSF) and rhErythropoietin (rhEPO); each factor was added individually once a week. Addition of rhGM-CSF and rhG-CSF resulted in a significant increase in the levels of nucleated cells and myeloid progenitors; the highest effects were seen in the presence of rhGM-CSF. Interestingly, such a cytokine also induced a significant decrease in the levels of erythroid progenitors. Recombinant hEPO had no significant effects on nucleated cells or myeloid progenitors, however, it induced a significant, although transient, increase in the levels of erythroid cells. The above results indicate that the hematopoietic regulators used here (rhGM-CSF, rhG-CSF and rhEPO) are capable of stimulating the growth of hematopoietic cells in LTMC from CML patients. Thus, this study demonstrates that it is, indeed, possible to manipulate CML LTMC by the addition of recombinant cytokines; this observation may be of particular relevance, since this in vitro experimental system has already been used as a method for purging of leukemic cells in autologous transplant settings. By using specific recombinant hematopoietic modulators it might be possible to make LTMC a more efficient system for such a clinical purpose.
Assuntos
Hematopoese/efeitos dos fármacos , Células-Tronco Hematopoéticas/efeitos dos fármacos , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Células-Tronco Neoplásicas/efeitos dos fármacos , Células Tumorais Cultivadas/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Purging da Medula Óssea , Linhagem da Célula , Eritropoetina/farmacologia , Feminino , Fator Estimulador de Colônias de Granulócitos/farmacologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/farmacologia , Células-Tronco Hematopoéticas/patologia , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Células-Tronco Neoplásicas/patologia , Proteínas Recombinantes/farmacologia , Células Tumorais Cultivadas/patologia , Ensaio Tumoral de Célula-TroncoRESUMO
Introducción. El síndrome hemofagocítico (SH) es una proliferación benigna de histiocitos, asociado con fagocitosis de elementos hemopoyéticos. El cuadro clínico se caracteriza por: fiebre, linfadenopatía, hepatoesplenomegalia, citopenias profundas y coagulopatías. Se ha asociado a: virus, bacterias, hongos, parásitos y neoplasias. Caso clínico. Se informa el caso de un SH después de trasplante de médula ósea autólogo y purga con mafosfamida en un paciente con leucemia aguda mieloblástica M-4 sin donador HLA compatible, en primera remisión completa con serología y reacción en cadena de la polimerasa (PCR) para citomegalovirus negativos (CMV) antes del trasplante, todas sus transfusiones se aplicaron con filtros leuco-reductores. La toma de injerto fue en el día +17. En el día +28 presentó neutropenia de 200 /mL, el aspirado de médula ósea mostró hemofagocitosis y PCR para CMV fue positiva, en leucocitos, plasma y orina; después de tratamiento con ganciclovir e inmunoglobulina intravenosa la PCR se negativizó y la médula ósea se observó sin evidencia de hemofagocitosis; no se documentaron otras infecciones o neoplasias.Conclusión. De acuerdo a las características clínicas y estudios de laboratorio, se consideró que la hemofagocitosis intramedular estuvo asociada a la infección por CMV.
Assuntos
Humanos , Masculino , Criança , Histiocitose de Células não Langerhans/diagnóstico , Purging da Medula Óssea/métodos , Transplante de Medula Óssea/efeitos adversos , Leucemia Mielomonocítica AgudaRESUMO
BACKGROUND: The aim of this study was to increase disease-free survival (DFS) in AML in CR1 using a high-dose cytarabine consolidation plus G-CSF as in vivo purging and mobilization of CD34+ cells before ablative therapy and peripheral blood autograft. PATIENTS AND METHODS: Fifty-six consecutive AML patients (pts) (including 11 children < 15 years), with a median age of 32 years, were analyzed. After achievement of CR with cytarabine-mitoxantrone (7 + 3) in adults and a BFM-like protocol in children, pts were intensified with cytarabine 2 g/m2 x six doses plus mitoxantrone for adults, or, 3 g/m2 x six doses plus etoposide for children, followed by G-CSF 5 micrograms/kg SC daily. The ablative regimens used were busulfan and cyclophosphamide (Bu/Cy) in standard-risk pts plus etoposide (2400 mg/m2) for high-risk pts. RESULTS: For the 54 pts who underwent autologous transplant, the median time to reach > 1.0 x 10(9)/l neutrophils was 13 days (8-48), and to reach platelets > 25 x 10(9)/l 32 days (8-364), and the median numbers of red blood cell and platelet units transfused were 3 and 5, respectively. Six pts had treatment-related deaths (11%). The disease-free survival and overall survival at 30 months (mos) for the 56 eligible pts were 61% and 62%, respectively. Only two relapses were observed after 21 mos, while there were 12 relapses within 12 mos. CONCLUSIONS: The above treatment results in a similar DFS rate as does rescue with bone marrow cells, with faster neutrophil and platelet recovery.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Citarabina/administração & dosagem , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda/terapia , Leucemia Mielomonocítica Aguda/terapia , Adolescente , Adulto , Antígenos CD34 , Purging da Medula Óssea , Bussulfano/administração & dosagem , Criança , Pré-Escolar , Terapia Combinada , Ciclofosfamida/administração & dosagem , Intervalo Livre de Doença , Feminino , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Leucemia Mieloide Aguda/imunologia , Leucemia Mielomonocítica Aguda/imunologia , Masculino , Pessoa de Meia-Idade , Mitoxantrona/administração & dosagem , Indução de Remissão , Transplante AutólogoAssuntos
Purging da Medula Óssea/efeitos adversos , Transplante de Medula Óssea/efeitos adversos , Puberdade/efeitos dos fármacos , Puberdade/efeitos da radiação , Adolescente , Terapia Combinada , Feminino , Humanos , Imunossupressores/efeitos adversos , Masculino , Irradiação Corporal Total/efeitos adversosRESUMO
FC-2.15 is an IgM monoclonal antibody (MAb) obtained by immunizing Balb/c mice with tumor epithelial cells from a human undifferentiated primary breast carcinoma. FC-2.15 reacts with 93.9% (31/33) of human breast primary tumors, independently of their histology and hormone receptor content. Moreover, FC-2.15 reacts with 79.6 +/- 13.8% (mean +/- SD) of total breast malignant tumor cells and with 88.7 +/- 9.9% of proliferating tumor cells. It recognizes other neoplasia such as colon cancer, squamous carcinoma and melanoma. Among the normal tissues examined, strong cross-reactivity was found with kidney proximal convolute tubules, bone marrow myeloid progeny, peripheral granulocytes and large bowel epithelium. Through Western blots, FC-2.15 recognizes three major bands of Mr 160 kDa, 130 kDa and 115 kDa in membrane extracts of MCF-7 cells grown in nude mice and of human breast carcinoma and three major bands of 250 kDa, 185 kDa and 105 kDa in membrane extracts of peripheral granulocytes. This MAb mediates complement- cytotoxicity against malignant cells, reducing the clonogenic capacity of breast primary tumor cells and MCF-7 cells to 35.6 +/- 41.2% and 11.7 +/- 4.8% of control values respectively, whereas that of normal bone marrow cells is not affected (104.7 +/- 17.4%).
Assuntos
Anticorpos Monoclonais/imunologia , Anticorpos Antineoplásicos/imunologia , Neoplasias da Mama/imunologia , Neoplasias/imunologia , Animais , Anticorpos Monoclonais/isolamento & purificação , Anticorpos Monoclonais/uso terapêutico , Anticorpos Antineoplásicos/isolamento & purificação , Especificidade de Anticorpos , Antígenos de Neoplasias/química , Antígenos de Neoplasias/imunologia , Biomarcadores Tumorais/imunologia , Purging da Medula Óssea , Neoplasias da Mama/terapia , Citotoxicidade Imunológica , Feminino , Humanos , Imunização , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Peso Molecular , Células Tumorais Cultivadas/imunologia , Ensaio Tumoral de Célula-TroncoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea , Linfoma não Hodgkin/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Transfusão de Componentes Sanguíneos , Transfusão de Sangue Autóloga , Purging da Medula Óssea , Transplante de Medula Óssea/métodos , Transplante de Medula Óssea/mortalidade , Ensaios Clínicos como Assunto , Terapia Combinada , Resistência a Medicamentos , Fatores de Crescimento de Células Hematopoéticas/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/cirurgia , Estudos Multicêntricos como Assunto , Recidiva Local de Neoplasia/terapia , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Transplante de Medula Óssea , Anemia Aplástica/cirurgia , Purging da Medula Óssea , Transplante de Medula Óssea/métodos , Transplante de Medula Óssea/estatística & dados numéricos , Histocompatibilidade , Humanos , Leucemia/cirurgia , Mieloma Múltiplo/cirurgia , Imunodeficiência Combinada Severa/cirurgia , Doadores de Tecidos , Talassemia beta/cirurgiaRESUMO
Fourteen S/S children with severe SCD were transplanted with marrow from HLA identical siblings. All developed frequent (> 4/y) vasoocclusive crises (VOC) and recurrent acute chest syndrome episodes (n:10), osteitis (n:3), osteonecrosis (n:3), strokes (n:3) or frequent massive deglobulisation (n:2). Two children undergone splenectomy, 2 were chelated and 2 had erythroid allo-immunization. Ethnic origins were from various countries in Africa (n:10), North-Africa (n:3) or West Indies (n:1). At BMT, they were 2y 3m to 14y 9m old (mean:8y 7m). Donors were AS (n:11) or AA (n:3). At first, various conditioning regimens were used consisting of busulfan (BU) plus Cyclophosphamide (CY) at different doses: CY:200 mg/kg (n:12) or 260 mg/kg (n:2); BU:14 mg/kg (n:1), 16 mg/kg (n:9), > 16 mg/kg (n:4); 1 patient received also TLI and one other antithymoglobulin (ATG): 20 mg/kg. GVHD prophylaxis was CSA alone (n:4) or CSA plus short-term MTX (n:10). Median follow-up was 23 months (8 m. to 48 m.). All patients had an engraftment (d13 to d32) with a stable total chimerism in 10/14 patients who are cured. In the 4 others, partial chimerism was observed: one patient had a early and progressive rejection of his graft but is doing very well (28 m. follow-up) without any manifestation of SCD, with a high stable 22% Hb F level. One patient developed an aplastic anaemia 15 m after BMT: a second BMT was achieved 21 m after the first one with engraftment and total chimerism. Two patients have a relatively stable partial chimerism with still undergoing CSA therapy (11 m. and 23 m. follow-up).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Anemia Falciforme/terapia , Transplante de Medula Óssea , Adolescente , África/etnologia , Anemia Falciforme/mortalidade , Purging da Medula Óssea/efeitos adversos , Purging da Medula Óssea/métodos , Transplante de Medula Óssea/efeitos adversos , Transplante de Medula Óssea/mortalidade , Bussulfano/efeitos adversos , Criança , Pré-Escolar , Ciclofosfamida/efeitos adversos , Cistite/induzido quimicamente , Feminino , França/epidemiologia , Sobrevivência de Enxerto , Doença Enxerto-Hospedeiro/epidemiologia , Doença Enxerto-Hospedeiro/etiologia , Hemorragia/induzido quimicamente , Humanos , Imunossupressores/efeitos adversos , Masculino , Resultado do Tratamento , Índias Ocidentais/etnologiaRESUMO
The first case of allogeneic bone marrow transplantation in acute myelogenous leukemia (AML) done in Mexico is reported. The patient was a 26 year old Mexican woman who in October 1987 was diagnosed of having AML of the M2 subtype. After three cycles of the TADOP regimen (6-thioguanine, cytosine-arabinoside, doxorubicin, vincristine & prednisone), the patient entered complete remission. Unfortunately, after a seven month period of remission she suffered a relapse which was refractory to a new chemotherapy cycle. On 9/14/88 an allogeneic BMT from her HLA identical brother was performed. The conditioning regimen consisted of busulfan and cyclophosphamide. Prophylaxis for GVHD consisted of cyclosporine and methylprednisolone. The posttransplantation course was satisfactory, reaching > 500 neutrophils x 10(9)/L on day 14 and > 50,000 platelets x 10(9)/L without support on day 23 posttransplant. The patient developed fever of unknown etiology, which was satisfactorily resolved with ceftazidime, vancomycin and metronidazole. She also presented a grade II oral and esophageal mucositis. As a late complication, on day 90 posttransplant, she developed a bilateral pneumonia which was resolved with sulfamethoxazole-trimethoprim administration. Up to the time of this report (40 months posttransplant) the patient is completely asymptomatic, is under no immunosuppression, and shows no evidence of graft versus host disease or recurrent leukemia.
Assuntos
Transplante de Medula Óssea , Leucemia Mieloide Aguda/terapia , Adulto , Antibacterianos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Purging da Medula Óssea/efeitos adversos , Citarabina/administração & dosagem , Doxorrubicina/administração & dosagem , Quimioterapia Combinada/uso terapêutico , Esofagite/etiologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/mortalidade , México , Prednisolona/administração & dosagem , Indução de Remissão , Terapia de Salvação , Taxa de Sobrevida , Tioguanina/administração & dosagem , Vincristina/administração & dosagemRESUMO
Autologous bone marrow transplantation (ABMT) is the treatment of choice for selected patients with acute myelogenous leukemia, non-Hodgkin's lymphoma, and poor prognosis breast cancer. A possible limitation of this approach is that clonogenic tumor cells could be collected and infused back into the patient along with the normal bone marrow. The major emphasis in our laboratory has been the development of marrow purging regimens for breast cancer patients. This paper describes two investigative approaches hematopoietic progenitor cell protection and selection. We describe how the use of G-CSF in the patients who receive positively selected marrow shortens the rate of engraftment.