1
|
Martín García-Sancho A, Baile M, Rodríguez G, Dlouhy I, Sancho JM, Jarque I, González-Barca E, Salar A, Espeso M, Grande C, Bergua J, Montes-Moreno S, Redondo A, Enjuanes A, Campo E, López-Guillermo A, Caballero D. Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: A phase 2 study from GELTAMO. Br J Haematol 2023; 203:202-211. [PMID: 37485564 DOI: 10.1111/bjh.18989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) patients with relapsed or refractory (RR) disease have poor outcomes with current salvage regimens. We conducted a phase 2 trial to analyse the safety and efficacy of adding lenalidomide to R-ESHAP (LR-ESHAP) in patients with RR DLBCL. Subjects received 3 cycles of lenalidomide 10 mg/day on days 1-14 of every 21-day cycle, in combination with R-ESHAP at standard doses. Responding patients underwent autologous stem-cell transplantation (ASCT). The primary endpoint was the overall response rate (ORR) after 3 cycles. Centralized cell-of-origin (COO) classification was performed. Forty-six patients were included. The ORR after LR-ESHAP was 67% (35% of patients achieved complete remission). Patients with primary refractory disease (n = 26) had significantly worse ORR than patients with non-refractory disease (54% vs. 85%, p = 0.031). No differences in response rates according to the COO were observed. Twenty-eight patients (61%) underwent ASCT. At a median follow-up of 41 months, the estimated 3-year PFS and OS were 42% and 48%, respectively. The most common grade ≥3 adverse events were thrombocytopenia (70% of patients), neutropenia (67%) and anaemia (35%). There were no treatment-related deaths during LR-ESHAP cycles. In conclusion, LR-ESHAP is a feasible salvage regimen with promising efficacy results for patients with RR DLBCL.
Collapse
Affiliation(s)
- A Martín García-Sancho
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| | - M Baile
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| | - G Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío/Virgen Macarena, Sevilla, Spain
| | - I Dlouhy
- Hematology Department, Hospital Clinic, Barcelona, Spain
| | - J M Sancho
- Hematology Department, Hospital Germans Trias i Pujol/ICO-IJC, Badalona, Spain
| | - I Jarque
- Hematology Department, Hospital Universitari i Plotècnic La Fe, CIBERONC, Valencia, Spain
| | - E González-Barca
- Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de-Barcelona, Barcelona, Spain
| | - A Salar
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | - M Espeso
- Hematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - C Grande
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Bergua
- Hematology Department, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - S Montes-Moreno
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Redondo
- Hematology Department, Hospital Virgen del Puerto, Plasencia, Spain
| | - A Enjuanes
- Unidad de Genómica del IDIBAPS, Barcelona, Spain
| | - E Campo
- Pathology Department, Hospital Clinic, Barcelona, Spain
| | | | - D Caballero
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
2
|
Pavía Pascual M, Jarque I, Morell Hita JL, Loarce-Martos J, Montaño Tapia LF, Rusinovich O, De la Torre Rubio N, Navarro Palomo P, Machattou M, Barbadillo Mateos C, Godoy H, Sanz J, Fernandez Castro M, De Villa LF, Merino Argumánez C, Garcia-Magallon B, Andréu Sánchez JL, Campos Esteban J. POS0903 ASSOCIATION STUDY BETWEEN ANTI-TIF 1γ ANTIBODY AND DEVELOPMENT OF NEOPLASIA IN THREE TERTIARY HOSPITALS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAnti-transcriptional intermediary factor 1γ (anti-TIF 1γ) antibody is robustly linked with cancer-associated dermatomyositis (DM) in adults, but its specificity varies widely between series. TIF 1γ can act either as a tumor promoter or suppressor and may behave as an autoantigen.ObjectivesInvestigate the association between anti-TIF 1γ antibody positivity and development of neoplasia.MethodsA retrospective chart review was conducted among patients with positive anti-TIF 1γ antibodies detected by immunoblot from March 2019 to December 2021 in three tertiary hospitals. Demographic variables, creatine kinase (CK) values, other autoantibodies, associated autoimmune diseases (AIDs) and existence or not of a cancer diagnosis were analyzed. To rule out malignancy, patients had to present a PET-CT scan without pathological findings or a chest CT scan, a gynecological study and a digestive study without alterations. A descriptive statistical analysis was performed.Results29 patients with anti-TIF 1γ antibodies were analyzed, 82.7% women, with a mean age of 61 years (31-96 years).The reason for requesting this antibody was: clinical features suggestive of DM in 10 patients (34.5%), muscle weakness in 9 (31%), interstitial lung disease (ILD) in 5 (17.2%), persistent CK elevation in 3 (10.3%), constitutional syndrome in 1 (3.5%) and antiphospholipid syndrome in 1 patient (3.5%). The mean time from symptoms onset to the detection of anti-TIF 1γ was 14 months (0-60 months).10 patients (34.5%) had a diagnosis of DM; 4 patients (13.8%) systemic lupus erythematosus (SLE); one (3.5%) had a SLE/DM overlap syndrome; one patient (3.5%) subacute cutaneous lupus; one (3.5%) was diagnosed with diffuse systemic sclerosis; one patient (3.5%) limited systemic sclerosis; one patient (3.5%) antiphospholipid syndrome; one patient (3.5%) HLA-B27+ spondyloarthritis and 9 patients (31%) had no associated AIS.5 patients (17.2%) showed ILD with different patterns: UIP (n=2), NSIP (n=2) and COP (n=1). Only 9 patients (31%) had elevated CK levels at the time of antibody determination.10 patients (34.5%) were diagnosed with cancer: lung adenocarcinoma (n=2), small cell lung carcinoma (n=2), breast carcinoma (n=2), hepatocarcinoma (n=1), cervical cancer (n=1), ovarian carcinoma (n=1) and gallbladder adenocarcinoma (n=1). Of those, 7 patients (70%) had elevated CK levels and 6 (60%) had a diagnosis of DM. None of the patients diagnosed with cancer had ILD.In 4 patients (40%), the diagnosis of cancer was simultaneous with the diagnosis of anti-TIF 1γ antibodies; in 4 (40%), the diagnosis of the tumor preceded the finding of the antibodies; in the other 2 (20%), the finding of the antibodies preceded that of the tumor. 30-month survival after cancer diagnosis was 10%.In 17 patients (58.6%) no malignancy has been found so far in the annual cancer screening. In two patients (6.9%) no cancer screening was performed.ConclusionIn our study, 60% of patients with DM and anti-TIF 1γ presented neoplasia, a prevalence similar to that established in other series (60-80%). Furthermore, 21% of patients with antibodies and without DM were diagnosed with cancer, suggesting that anti-TIF 1γ antibodies could also be associated with neoplasia in patients without DM. Patients with ILD did not present cancer, supporting the observation of previous studies in which the presence of ILD is a marker of low risk for neoplasia in patients with DM. HyperCKemia might predict the association with neoplasia in patients with anti-TIF 1γ antibodies.References[1]De Vooght J, Vulsteke JB, De Haes P, Bossuyt X, Lories R, De Langhe E. Anti-TIF1-γ autoantibodies: warning lights of a tumour autoantigen. Rheumatology. 2020 Mar 1;59(3):469-477[2]Shimizu K, Kobayashi T, Kano M, Hamaguchi Y, Takehara K, Matsushita T. Anti-transcriptional intermediary factor 1-γ antibody as a biomarker in patients with dermatomyositis. J Dermatol. 2020 Jan;47(1):64-68[3]Masiak A, Kulczycka J, Czuszyńska Z, Zdrojewski Z. Clinical characteristics of patients with anti-TIF1-γ antibodies. Reumatologia. 2016;54(1):14-8Disclosure of InterestsNone declared
Collapse
|
3
|
Lopez-Parra M, Bellei M, Rambaldi A, Novelli S, Panizo C, Martelli M, Dhouly I, Bastos M, Gutierrez A, Sancho J, Ramirez M, Moraleda J, Carrillo Cruz E, Jimenez Ubieto A, Jarque I, Vittolo U, de las Heras N, Arranz R, Lopez-Jimenez J, Montalbán C, Pascual M, Corradini P, Bobillo S, Estefania G, Spina M, Rossi G, Manni M, Federico M, Caballero D, Martín A. AUTOLOGOUS STEM CELL TRANSPLANTATION AS PART OF FIRST-LINE THERAPY IN PATIENTS WITH PERIPHERAL T-CELL LYMPHOMA: A MULTICENTER GELTAMO/FIL STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.63_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Lopez-Parra
- Hematology; University Hospital of Salamanca-IBSAL; Salamanca Spain
| | - M. Bellei
- Department of Diagnostic, Clinical and Public Health Medicine; University of Modena; Modena Italy
| | - A. Rambaldi
- Hematology and bone marrow transplant Unit; University of Milan; Milan Italy
| | - S. Novelli
- Hematology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - C. Panizo
- Hematology; Clínica Universidad de Navarra; Pamplona Spain
| | - M. Martelli
- Hematology; Sapienza, University of Rome; Rome Italy
| | - I. Dhouly
- Hematology; Hospital Clinic de Barcelona; Barcelona Spain
| | - M. Bastos
- Hematology; Hospital Gregorio Marañón; Madrid Spain
| | - A. Gutierrez
- Hematology; Hospital Son de Espases; Palma Spain
| | - J. Sancho
- Hematology; Hospital Germans Trias i Pujol/ ICO-IJC; Barcelona Spain
| | - M. Ramirez
- Hematology; Hospital de Jerez de la Frontera; Jerez de la Frontera Spain
| | - J. Moraleda
- Hematology; Hospital Vírgen de la Arrixaca; Murcia Spain
| | | | | | - I. Jarque
- Hematology; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - U. Vittolo
- Dipartimento di Oncologia e Ematologia; Città della Salute e della Scienza di Torino; Turin Italy
| | - N. de las Heras
- Hematology; Complejo Asistencial Universitario de León; León Spain
| | - R. Arranz
- Hematology; Hospital La Princesa; Madrid Spain
| | | | - C. Montalbán
- Hematology; MD Anderson Cancer Center; Madrid Spain
| | - M. Pascual
- Hematology; Hospital Carlos Haya; Málaga Spain
| | | | - S. Bobillo
- Hematology; University Hospital Vall d'Hebron; Barcelona Spain
| | | | - M. Spina
- Division of Medical Oncology; National Cancer Institute; Aviano Italy
| | - G. Rossi
- Hematology; Spedali Civili; Brescia Italy
| | - M. Manni
- Diagnostic; Clinic and Public Health Medicine, University of Modena and Reggio Emilia; Modena Italy
| | - M. Federico
- Hematology; Università degli Studi di Modena e Reggio Emilia; Modena Italy
| | - D. Caballero
- Hematology; University Hospital of Salamanca-IBSAL; Salamanca Spain
| | - A. Martín
- Hematology; University Hospital of Salamanca-IBSAL; Salamanca Spain
| |
Collapse
|
4
|
Gonzalez-Barca E, Carrillo E, Grande C, Martín A, Montes-Moreno S, Coronado M, Mercadal S, Roncero J, Perez De Oteyza J, Nicolas C, Rodriguez-Salazar M, Sancho J, Palomera L, Lopez J, Albo C, Peñalver F, Hernandez J, Lopez-Guillermo A, Ramirez M, Jarque I, Bargay J, Canales M, Conde E, Caballero D. PHASE 2 RANDOMIZED TRIAL COMPARING STANDARD RCHOP VERSUS BRCAP AS FIRST LINE TREATMENT IN YOUNG PATIENTS WITH HIGH-RISK DLBCL. A STUDY FROM SPANISH GROUP GELTAMO. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- E. Gonzalez-Barca
- Hematology; Instituto Catalan De Oncologia-L'Hospitalet; Barcelona Spain
| | - E. Carrillo
- Hematology; H. Virgen Del Rocio; Sevilla Spain
| | - C. Grande
- Hematology, H. 12 De Octubre; Madrid Spain
| | - A. Martín
- Hematology; Complejo Hospitalario De Salamanca; Salamanca Spain
| | | | - M. Coronado
- Nuclear Medicine, H. U. La Paz; Madrid Spain
| | - S. Mercadal
- Hematology; Instituto Catalan De Oncologia-L'Hospitalet; Barcelona Spain
| | - J.M. Roncero
- Hematology; ICO Girona (H.U. Dr. Josep Trueta); Girona Spain
| | | | - C. Nicolas
- Hematology; H. U. Central De Asturias; Oviedo Spain
| | | | - J.M. Sancho
- Hematology; Ico Badalona (H. Germans Trias I Pujol); Barcelona Spain
| | - L. Palomera
- Hematology, H. C. U. Lozano Blesa; Zaragoza Spain
| | - J. Lopez
- Hematology, H. U. Ramón Y Cajal; Madrid Spain
| | - C. Albo
- Hematology, C.H.U De Vigo; Pontevedra Spain
| | | | | | | | - M.J. Ramirez
- Hematology, H. De Jerez, Jerez De La Frontera; Spain
| | - I. Jarque
- Hematology, H. U. Politècnic La Fe; Valencia Spain
| | - J. Bargay
- Hematology, H. Son Llàtzer; Palma Spain
| | | | - E. Conde
- Hematology, H. U. Marqués De Valdecilla; Santander Spain
| | - D. Caballero
- Hematology, H. U. Marqués De Valdecilla; Santander Spain
| |
Collapse
|
5
|
Jiménez Ubieto A, Grande C, Caballero D, Yañez L, Novelli S, Hernández-Garcia M, Manzanares M, Arranz R, Ferreiro J, Bobillo S, Mercadal S, Galego A, López-Jiménez J, Moraleda J, Vallejo C, Albo C, Pérez-Ceballos E, Marrero C, Magnano L, Palomera L, Jarque I, Martín A, Coria E, López-Guillermo A, Salar A, Lahuerta J. AUTOLOGOUS STEM CELL TRANSPLANTATION MAY POTENTIALLY ABROGATE THE NEGATIVE PROGNOSTIC EFFECT OF EARLY RELAPSE AFTER CHEMO OR INMUNOCHEMOTHERAPY IN FOLLICULAR LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - C. Grande
- Hematology; Hospital 12 de Octubre; Madrid Spain
| | - D. Caballero
- Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - L. Yañez
- Hematology; Hospital Universitario Marqués de Valdecilla; Santander Spain
| | - S. Novelli
- Hematology; Hospital Universitario Sant Pau; Barcelona Spain
| | | | - M. Manzanares
- Hematology; Hospital Universitario de Jerez; Jerez Spain
| | - R. Arranz
- Hematology; Hospital Universitario La Princesa; Madrid Spain
| | - J. Ferreiro
- Hematology; Hospital Universitario Donostia-Aránzazu; San Sebastián Spain
| | - S. Bobillo
- Hematology; Hospital Universitario Vall de Hebrón; Barcelona Barcelona Spain
| | - S. Mercadal
- Hematology; Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat; Spain
| | - A. Galego
- Hematology; Hospital Universitario A Coruña, A Coruña; Spain
| | - J. López-Jiménez
- Hematology; Hospital Universitario Ramón y Cajal, Madrid; Madrid Spain
| | - J. Moraleda
- Hematology; Hospital Universitario Virgen de la Arriaxaca, El Palmar; Murcia Spain
| | - C. Vallejo
- Hematology; Hospital Central de Asturias, Asturias; Oviedo Spain
| | - C. Albo
- Hematology; Hospital Universitario de Vigo; Vigo Spain
| | - E. Pérez-Ceballos
- Hematology; Hospital Universitario Morales de Messeguer; Murcia Spain
| | - C. Marrero
- Hematology; Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Santa Cruz de Tenerife; Spain
| | - L. Magnano
- Hematology; Hospital Clinic de Barcelona; Barcelona Spain
| | - L. Palomera
- Hematology; Hospital Clínico Universitario Lozano Blesa; Zaragoza Spain
| | - I. Jarque
- Hematology; Hospital Universitario La Fe; València Spain
| | - A. Martín
- Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - E. Coria
- Hematology; Hospital Clínico San Carlos; Madrid Spain
| | | | - A. Salar
- Hematology; Hospital del Mar; Barcelona Spain
| | - J. Lahuerta
- Hematology; Hospital 12 de Octubre; Madrid Spain
| |
Collapse
|
6
|
Cabrero M, Lopez-Corral L, de la Cruz F, Jarque I, Valcarcel D, Perez-Lopez E, Martin A, Sanchez-Guijo F, Grande C, Martin-Calvo M, Martin A, Caballero D. Results of a prospective phase II trial with ofatumumab as part of reduced intensity conditioning regimen in high-risk non-Hodgkin B lymphoma patients: A GELTAMO trial. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Cabrero
- Hematology; Salamanca University Hospital; Salamanca Spain
| | | | - F. de la Cruz
- Hematology; Virgen del Rocio University Hospital; Sevilla Spain
| | - I. Jarque
- Hematology; La Fe University Hospital; Valencia Spain
| | - D. Valcarcel
- Hematology; Hospital Vall d'Hebron; Barcelona Spain
| | - E. Perez-Lopez
- Hematology; Salamanca University Hospital; Salamanca Spain
| | - A. Martin
- Hematology; Salamanca University Hospital; Salamanca Spain
| | | | - C. Grande
- Hematology; 12 de Octubre University Hospital; Madrid Spain
| | | | - A. Martin
- Hematology; Salamanca University Hospital; Salamanca Spain
| | - D. Caballero
- Hematology; Salamanca University Hospital; Salamanca Spain
| |
Collapse
|
7
|
Martín A, Baile M, Rodríguez G, Dlouhy I, Sancho J, Jarque I, González-Barca E, Salar A, Espeso M, Grande C, Bergua J, Montes-Moreno S, López-Guillermo A, Campo E, Caballero D. Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: A phase 2 study from the Spanish group GELTAMO. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- A. Martín
- Hematology; Hospital Universitario de Salamanca and IBSAL; Salamanca Spain
| | - M. Baile
- Hematology; Hospital Universitario de Salamanca and IBSAL; Salamanca Spain
| | - G. Rodríguez
- Hematology; UGC HH.UU. Virgen del Rocío / Virgen Macarena; Sevilla Spain
| | - I. Dlouhy
- Hematology; Hospital Clinic; Barcelona Spain
| | - J.M. Sancho
- Hematology; Hospital Germans Trias i Pujol / ICO-IJC, Barcelona; Badalona Spain
| | - I. Jarque
- Hematology; Hospital Universitario La Fe; Valencia Spain
| | - E. González-Barca
- Hematology; Hospital Duran i Reynals / ICO-IDIBELL, Hospitalet de Llobregat; Barcelona Spain
| | - A. Salar
- Hematology; Hospital del Mar; Barcelona Spain
| | - M. Espeso
- Hematology; Hospital Regional Universitario de Málaga; Málaga Spain
| | - C. Grande
- Hematology; Hospital Universitario 12 de Octubre; Madrid Spain
| | - J. Bergua
- Hematology; Hospital San Pedro de Alcántara; Cáceres Spain
| | - S. Montes-Moreno
- Pathology; Hospital Universitario Marqués de Valdecilla; Santander Spain
| | | | - E. Campo
- Pathology; Hospital Clinic; Barcelona Spain
| | - D. Caballero
- Hematology; Hospital Universitario de Salamanca and IBSAL; Salamanca Spain
| |
Collapse
|
8
|
Montesinos P, Rodríguez-Veiga R, Boluda B, Martínez-Cuadrón D, Cano I, Lancharro A, Sanz J, Arilla MJ, López-Chuliá F, Navarro I, Lorenzo I, Salavert M, Pemán J, Calvillo P, Martínez J, Carpio N, Jarque I, Sanz GF, Sanz MA. Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis. Bone Marrow Transplant 2015; 50:1465-72. [PMID: 26281032 DOI: 10.1038/bmt.2015.181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/01/2015] [Accepted: 07/03/2015] [Indexed: 01/24/2023]
Abstract
Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.
Collapse
Affiliation(s)
- P Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - R Rodríguez-Veiga
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - B Boluda
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - D Martínez-Cuadrón
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Cano
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - A Lancharro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M J Arilla
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - F López-Chuliá
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Navarro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Lorenzo
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Pemán
- Department of Microbiology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - P Calvillo
- Department of Radiology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Martínez
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - N Carpio
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Jarque
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - G F Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M A Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Departament de Medicina, Universitat de València, Valencia, Spain
| |
Collapse
|
9
|
Sanz J, Arango M, Senent L, Jarque I, Montesinos P, Sempere A, Lorenzo I, Martín G, Moscardó F, Mayordomo E, Salavert M, Cañigral C, Boluda B, Salazar C, López-Hontangas JL, Sanz MA, Sanz GF. EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases. Bone Marrow Transplant 2013; 49:397-402. [PMID: 24292521 DOI: 10.1038/bmt.2013.190] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/06/2013] [Accepted: 09/30/2013] [Indexed: 11/09/2022]
Abstract
We analyzed the incidence, clinicopathological features, risk factors and prognosis of patients with EBV-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in 288 adults undergoing umbilical cord blood transplantation (UCBT) at a single institution. Twelve patients developed proven EBV-PTLD at a median time of 73 days (range, 36-812). Three-year cumulative incidence (CI) of EBV-PTLD was 4.3% (95% CI: 1.9-6.7). All patients presented with extranodal involvement. Most frequently affected sites were the liver, spleen, central nervous system (CNS), Waldeyer's ring and BM in 7, 6, 4, 3 and 3 patients, respectively. One patient had polymorphic and 11 had monomorphic EBV-PTLD (7 diffuse large B-cell lymphomas not otherwise specified, 4 plasmablastic lymphomas). We confirmed donor origin and EBV infection in all histological samples. EBV-PTLD was the cause of death in 11 patients at a median time of 23 days (range, 1-84). The 3-year CI of EBV-PTLD was 12.9% (95% CI: 3.2-22.5) and 2.6% (95% CI: 0.5-4.7) for patients receiving reduced-intensity conditioning (RIC) and myeloablative conditioning, respectively (P<0.0001). In conclusion, adults with EBV-PTLD after UCBT showed frequent visceral and CNS involvement. The prognosis was poor despite routine viral monitoring and early intervention. An increased risk of EBV-PTLD was noted among recipients of RIC regimens.
Collapse
Affiliation(s)
- J Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Arango
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - L Senent
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Jarque
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - P Montesinos
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A Sempere
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Lorenzo
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - G Martín
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - F Moscardó
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - E Mayordomo
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Salavert
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Cañigral
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - B Boluda
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Salazar
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J L López-Hontangas
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M A Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - G F Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
10
|
Jarque I, Tormo M, Bello JL, Rovira M, Batlle M, Julià A, Tabares S, Rivas C, Fernández-Sevilla A, García-Boyero R, Debén G, González-Campos J, Capote FJ, Sanz MA. Caspofungin for the treatment of invasive fungal disease in hematological patients (ProCAS Study). Med Mycol 2013; 51:150-4. [DOI: 10.3109/13693786.2012.693213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
Jaramillo F, Sanz J, Montesinos P, Martinez-Cuadron D, Lorenzo I, Palau J, Martin G, Jarque I, De La Rubia J, Moscardó F, Martinez J, Sanz M, Sanz G. Cord Blood Transplantation from Unrelated Donors Versus Stem Cell Transplantation from HLA-Identical Sibling in Adults with Philadelphia-Positive Acute Lymphoblastic Leukemia. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
12
|
Sanz J, Jaramillo F, Montesinos P, Martinez-Cuadron D, Lorenzo I, Palau J, Martin G, Jarque I, De La Rubia J, Moscardo F, Martinez J, Sanz M, Sanz G. Epstein-Barr Virus-Related Complications (EBV-RC) After Umbilical Cord Blood Transplantation (UCBT) for Adult Patients with High-Risk Hematologic Malignancies. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
de la Cámara R, Jarque I, Sanz MA, Grau S, Casado MA, Sabater FJ, Carreras E. Erratum: Economic evaluation of posaconazole vs fluconazole in the prevention of invasive fungal infections in patients with GVHD following haematopoietic SCT. Bone Marrow Transplant 2010. [DOI: 10.1038/bmt.2009.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
14
|
Cámara RDL, Jarque I, Sanz MA, Grau S, Casado MA, Sabater FJ, Carreras E. Economic evaluation of posaconazole vs fluconazole in the prevention of invasive fungal infections in patients with GVHD following haematopoietic SCT. Bone Marrow Transplant 2009; 45:925-32. [DOI: 10.1038/bmt.2009.272] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
15
|
Solano C, Benet I, Clari MA, Nieto J, de la Camara R, Lopez J, Hernandez-Boluda JC, Remigia MJ, Jarque I, Calabuig ML, Garcia-Noblejas A, Alberola J, Tamarit A, Gimeno C, Navarro D. Enumeration of cytomegalovirus-specific interferon CD8+ and CD4+ T cells early after allogeneic stem cell transplantation may identify patients at risk of active cytomegalovirus infection. Haematologica 2008; 93:1434-6. [DOI: 10.3324/haematol.12880] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
16
|
Pemán J, Jarque I, Frasquet J, Alberola C, Salavert M, Sanz J, Gomila B, Esteban G. Unexpected postmortem diagnosis of Acanthamoeba meningoencephalitis following allogeneic peripheral blood stem cell transplantation. Am J Transplant 2008; 8:1562-6. [PMID: 18510635 DOI: 10.1111/j.1600-6143.2008.02270.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Meningoencephalitis caused by pathogenic free-living amebas is usually fatal. Only a few cases of Acanthamoeba meningoencephalitis, diagnosed at autopsy, have been reported following hematopoietic stem cell transplantation. We here report a case of Acanthamoeba meningoencephalitis following allogeneic peripheral blood stem cell transplantation with rapidly evolving neurologic symptoms that remained unexplained. Magnetic resonance imaging failed to show brain lesions and cerebrospinal fluid was negative for microbiological cultures. Definite diagnosis was an unexpected autopsy finding. As overall and teaching hospital autopsy rates are declining worldwide, we must emphasize the need of autopsy exams if we want to improve our knowledge as the best way to care for our patients.
Collapse
Affiliation(s)
- J Pemán
- Servicio de Microbiología, Hospital Universitario La Fe, Valencia, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Moreno A, Cervera C, Gavaldá J, Rovira M, de la Cámara R, Jarque I, Montejo M, de la Torre-Cisneros J, Miguel Cisneros J, Fortún J, López-Medrano F, Gurguí M, Muñoz P, Ramos A, Carratalá J. Bloodstream infections among transplant recipients: results of a nationwide surveillance in Spain. Am J Transplant 2007; 7:2579-86. [PMID: 17868067 DOI: 10.1111/j.1600-6143.2007.01964.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bloodstream infections (BSIs) are a major cause of morbidity and mortality in transplant recipients. The aim of this study is to describe the incidence, microbiology and outcomes of BSIs in transplant recipients in Spain. The Spanish Network for Research on Infection in Transplantation (RESITRA) is formed by 16 centers with transplant program in Spain. The incidence and characteristics of BSIs in transplant patients were obtained prospectively from the cohort. We included 3926 transplant recipients (2935 solid organ and 991 hematopoietic stem cell transplants). Overall, 730 episodes of BSIs were recorded with an incidence rate ranging from 3 episodes per 10 000 transplant days in kidney recipients to 44 episodes per 10 000 transplant days in allogeneic hematopoietic stem cell transplantation (HSCT). The most frequent sources were intravascular catheters and the most frequent microorganisms isolated were coagulase-negative staphylococci. Crude mortality of BSIs was 7.8%, being highest in liver recipients (16%). Multidrug resistant nonfermentative gram-negative BSIs had significantly worse prognosis than those caused by their susceptible counterparts (p = 0.015), but no differences were found between resistant and susceptible gram-negative enteric bacilli, S. aureus or Candida spp. BSIs are still a major concern in transplant recipients. The increasing isolations of multiresistant microorganisms represent a challenge for the next years.
Collapse
Affiliation(s)
- A Moreno
- Hospital Clínic-IDIBAPS-University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Díaz-Pedroche C, Salavert M, Aguado JM, Jarque I, Lizasoain M, Sanz MA. [Individualized evaluation of the risk of infections in the oncohematologic patient]. Rev Esp Quimioter 2006; 19:117-29. [PMID: 16964329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In order to take the best approach to infection in the oncohematologic patient with fever, it is important to know not only how profound the neutropenia is and how long the patient has had it, but also the characteristics of the underlying disease, the immunosuppressive therapy received and the type of hematopoietic stem/progenitor cell transplantation performed. Moreover, is important to consider if these patients have any personal or familial history of infectious diseases. All these aspects let us calculate the net state of immunosuppression and the risk of infection, and provide us with information about the most probable etiology in each case and the best prophylaxis and treatment. In this study we review the more important advances in chemotherapy in recent years that will make it necessary in the future to change our prophylactic guidelines for more effective prevention of infection in the oncohematologic patient.
Collapse
Affiliation(s)
- C Díaz-Pedroche
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
19
|
Salavert M, Jarque I. [Effect of new antifungals on the etiology of invasive fungal infections: emergence, resistance and breakthrough infection]. Rev Esp Quimioter 2006; 19:11-3. [PMID: 16688286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
|
20
|
de la Rubia J, Cantero S, Sanz GF, Remigia MJ, Monteagudo E, Moscardó F, Martín G, Lorenzo I, Jiménez C, Martínez J, Montesinos P, Jarque I, Sanz MA. Transplantation of CD34+ selected peripheral blood to HLA-identical sibling patients with aplastic anaemia: results from a single institution. Bone Marrow Transplant 2005; 36:325-9. [PMID: 15968276 DOI: 10.1038/sj.bmt.1705067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We evaluated the use of CD34+ selected allogeneic peripheral blood as a source of hematopoietic progenitors for allogeneic transplantation in 11 patients with aplastic anemia (AA). The median age was 17 years (range, 6--9), and the median time between diagnosis and transplant 1 month (range, 1--4). Conditioning consisted of cyclophosphamide (50 mg/kg per day) on days--7 to--4 and antithymocyte globulin (30 mg/kg per day) on days--4 to--2 in nine patients. Total lymphoid irradiation was added to the preparative regimen for two. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine A and prednisone. Median doses of CD34+ and CD3+ cells infused were 3.91 x 10(6) and 0.3 x 10(6)/kg, respectively. The median time taken to achieve a neutrophil count >0.5 x 10(9)/l was 12 days and to recover a platelet count >20 x 10(9)/l, 13 days. Two patients developed acute GVHD grade I--II and one developed limited chronic GVHD. There were two treatment-related deaths. At a median follow-up of 44 months (range, 4--3), nine patients were alive with sustained and complete engraftment. This is a promising procedure in patients with AA, resulting in a rapid hematopoietic recovery, a low transplant-related mortality, and a low incidence of GVHD.
Collapse
Affiliation(s)
- J de la Rubia
- Bone Marrow Transplant Unit, Hematology Service, University Hospital La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Sureda A, Constans M, Iriondo A, Arranz R, Caballero MD, Vidal MJ, Petit J, López A, Lahuerta JJ, Carreras E, García-Conde J, García-Laraña J, Cabrera R, Jarque I, Carrera D, García-Ruiz JC, Pascual MJ, Rifón J, Moraleda JM, Pérez-Equiza K, Albó C, Díaz-Mediavilla J, Torres A, Torres P, Besalduch J, Marín J, Mateos MV, Fernández-Rañada JM, Sierra J, Conde E. Prognostic factors affecting long-term outcome after stem cell transplantation in Hodgkin's lymphoma autografted after a first relapse. Ann Oncol 2005; 16:625-33. [PMID: 15737986 DOI: 10.1093/annonc/mdi119] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To analyse outcome and prognostic factors for overall survival (OS) and time to treatment failure (TTF) in 357 patients with Hodgkin's lymphoma (HL) undergoing an autologous stem cell transplantation (ASCT) after a first relapse and reported to the The Grupo Espanol de Linfomas/Trasplante Autologo de Medula Osea (GEL/TAMO) Cooperative Group. METHODS Two hundred and twenty males and 137 females with a median age of 29 years were autografted in second remission (n=181), first sensitive relapse (n=148) and first resistant relapse (n=28). RESULTS Five-year actuarial TTF and OS were of 49% +/- 3% and 57% +/- 3%. Advanced stage at diagnosis, complementary radiotherapy before ASCT, a short first complete response (CR) and detectable disease at ASCT adversely influenced TTF. Year of transplant < or =1995, bulky disease at diagnosis, a short first CR, detectable disease at ASCT and > or =1 extranodal areas involved at ASCT were adverse factors for OS. CONCLUSIONS ASCT constitutes a therapeutic option for HL patients after a first relapse. Promising results are observed in patients with low tumour burden at diagnosis, autografted after a long CR and without detectable disease at ASCT. Innovative approaches should be pursued for patients with risk factors at relapse.
Collapse
Affiliation(s)
- A Sureda
- Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Antoni Maria i Claret, 167, 08025 Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sanz J, Sanz G, Moscardoó F, Cupelli L, Montesinos P, Puig N, Lorenzo I, Benlloch L, Jarque I, de la Rubia J, Martı́nez J, Martı́n G, Sanz M. Regimen related toxicity after thiotepa, cyclophosphamide and intravenous busulfan as conditioning for allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
23
|
Jarque I, Salavert M, Romá E, Gobernado M, Chiveli MA, Ruano M, Solé A, Poveda JL, Ferrer E, García-Pellicer J, Sanz MA, Pemán J, Sánchez V. [Hospital Universitario La Fe Guide to the prophylaxis and treatment of fungal infections in immunodepressed patients or in patients requiring special care]. Rev Esp Quimioter 2004; 17:357-89. [PMID: 15696227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- I Jarque
- Servicio de Hematología Clínica, Hospital Universitario La Fe, Valencia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
de la Rubia J, Martín G, Martínez J, Lorenzo I, Sanz G, Jarque I, Moscardó F, Jiménez C, Lorente P, Camps A, Sanz MA. Peripheral blood stem cell collection after intermediate-dose cytarabine in adult patients with acute myeloblastic leukemia undergoing autologous blood stem cell transplantation in first complete remission. Int J Hematol 2004; 80:168-73. [PMID: 15481447 DOI: 10.1532/ijh97.e0321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Different strategies for collecting peripheral blood stem cells (PBSC) for autologous blood stem cell transplantation (ABSCT) have been reported for patients with acute myeloblastic leukemia (AML). We compared the clinical results of 2 consecutive protocols in 75 adult patients with AML in first complete remission who underwent ABSCT. In the first 56 patients (group A), PBSC were collected after induction and/or consolidation chemotherapy courses. In the subsequent 19 patients (group B), PBSC collection was done after a further intensification course with intermediate-dose cytarabine and mitoxantrone. Hematopoietic engraftment was similar in the 2 groups, with the median times to reach 0.5 x 10(9) neutrophils/L and 20 x 10(9) platelets/L being 13 days each in group A, and 12 days and 24 days, respectively, in group B. There were 3 graft failures (all in group A) and 5 transplantation-related deaths (6.6%, 4 in group A and 1 in group B). Although not statistically significant, the 3-year probabilities of both relapse (31% versus 66%; P = .12) and disease-free survival (60% versus 36%; P = .1) compared favorably for group B. Our study suggests that collection of PBSC after additional intensification can result in a better outcome for AML patients who undergo ABSCT.
Collapse
Affiliation(s)
- J de la Rubia
- Bone Marrow Transplant Unit, Hematology Service, University Hospital La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Rodriguez J, Caballero MD, Gutierrez A, Solano C, Arranz R, Lahuerta JJ, Sierra J, Gandarillas M, Perez-Simon JA, Zuazu J, Lopez-Guillermo A, Sureda A, Carreras E, Garcia-Laraña J, Marin J, Garcia JC, Fernandez De Sevilla A, Rifon J, Varela R, Jarque I, Albo C, Leon A, SanMiguel J, Conde E. Autologous stem-cell transplantation in diffuse large B-cell non-Hodgkin's lymphoma not achieving complete response after induction chemotherapy: the GEL/TAMO experience. Ann Oncol 2004; 15:1504-9. [PMID: 15367411 DOI: 10.1093/annonc/mdh391] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Here we evaluate the results of high-dose chemotherapy and autologous stem-cell transplantation (HDC/ASCT) in 114 patients included in the GEL/TAMO registry between January 1990 and December 1999 with diffuse large B-cell lymphoma who failed to achieve complete remission (CR) with front-line conventional chemotherapy. PATIENTS AND METHODS Sixty-eight per cent had a partial response (PR) and 32% failed to respond to front-line therapy. At transplant, 35% were chemoresistant and 29% had two to three adjusted International Prognostic Index (a-IPI) risk factors. RESULTS After HDC/ASCT, 57 (54%) of 105 patients evaluable for response achieved a CR, 16 (15%) a PR and 32 (30%) failed. Nine patients were not assessed for response because of early death due to toxicity. With a median follow-up of 29 months for alive patients, the survival at 5 years is 43%, with a disease-free survival for complete responders of 63%. The lethal toxicity was 8%. Multivariate analysis revealed a-IPI and chemoresistance to be predicting factors. CONCLUSIONS Our results show that one-third of patients who do not obtain a CR to front-line chemotherapy may be cured of their disease with HDC/ASCT. However, most chemoresistant patients pretransplant failed this therapy. For this population, as well as for those who presented with adverse factors of the a-IPI, pretransplant novel therapeutic modalities need to be tested.
Collapse
Affiliation(s)
- J Rodriguez
- Hospital Son Dureta, Palma de Mallorca, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Jarque I. [Azoles: Prophylactic or therapeutic?]. Rev Esp Quimioter 2004; 17:94-7. [PMID: 15201931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- I Jarque
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| |
Collapse
|
27
|
Constans M, Sureda A, Terol MJ, Arranz R, Caballero MD, Iriondo A, Jarque I, Carreras E, Moraleda JM, Carrera D, León A, López A, Albó C, Díaz-Mediavilla J, Fernández-Abellán P, García-Ruiz JC, Hernández-Navarro F, Mataix R, Petit J, Pascual MJ, Rifón J, García-Conde J, Fernández-Rañada JM, Mateos MV, Sierra J, Conde E. Autologous stem cell transplantation for primary refractory Hodgkin's disease: results and clinical variables affecting outcome. Ann Oncol 2003; 14:745-51. [PMID: 12702529 DOI: 10.1093/annonc/mdg206] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with primary refractory Hodgkin's disease (PR-HD) have a dismal prognosis when treated with conventional salvage chemotherapy. We analyzed time to treatment failure (TTF), overall survival (OS) and clinical variables influencing the outcome in patients undergoing autologous stem cell transplantation (ASCT) for PR-HD and reported to the Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GEL/TAMO). PATIENTS AND METHODS Sixty-two patients, 41 males and 21 females with a median age of 27 years (range 13-55) were analyzed. Forty-two patients (68%) had advanced stage at diagnosis, 47 (76%) presented with B symptoms and 29 (47%) with a bulky mediastinal mass. Seventy-five percent of the patients had received more than one line of therapy before ASCT. Thirty-three patients received bone marrow as a source of hematopoietic progenitors, and 29 peripheral blood. Six patients were conditioned with high-dose chemotherapy plus total-body irradiation and 56 received chemotherapy-based protocols. RESULTS One-year transplantation-related mortality was 14% [95% confidence interval (CI) 6% to 23%]. Response rate at 3 months after ASCT was 52% [complete remission in 21 patients (34%), partial remission in 11 patients (18%)]. Actuarial 5-year TTF and OS were 15% (95% CI 5% to 24%) and 26% (95% CI 13% to 39%), respectively. The presence of B symptoms at ASCT was the only adverse prognostic factor significantly influencing TTF [relative risk (RR) 1.75, 95% CI 0.92-3.35, P = 0.08]. The presence of B symptoms at diagnosis (RR 2.08, 95% CI 0.90-4.79, P = 0.08), MOPP-like regimens as first-line therapy (RR 3.84, 95% CI 1.69-9.09, P = 0.001), bulky disease at ASCT (RR 2.79, 95% CI 0.29-6.03, P = 0.009) and two or more lines of therapy before ASCT (RR 2.24, 95% CI 0.95-5.27, P = 0.06) adversely influenced OS. CONCLUSIONS In our experience, although overall results of ASCT in PR-HD patients are poor, one-quarter of the patients remain alive at 5 years. Despite this, other therapeutic strategies should be investigated in this group of patients to improve the outcome.
Collapse
Affiliation(s)
- M Constans
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Carral A, de la Rubia J, Martín G, Mollá S, Martínez J, Sanz GF, Soler MA, Jarque I, Jiménez C, Sanz MA. Factors influencing the collection of peripheral blood stem cells in patients with acute myeloblastic leukemia and non-myeloid malignancies. Leuk Res 2003; 27:5-12. [PMID: 12479846 DOI: 10.1016/s0145-2126(02)00068-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Factors influencing the collection of autologous peripheral blood stem cells (PBSCs) were studied in 182 mobilization procedures performed on 145 consecutive patients with acute myeloblastic leukemia (AML; n=67) and with various non-myeloid malignancies (NMM; n=78). PBSC were collected following mobilization with chemotherapy, treatment with granulocyte colony-stimulating factor (G-CSF) or chemotherapy plus G-CSF. Fewer colony-forming unit granulocyte-macrophages (CFU-GMs) were collected from patients with AML than from patients with NMM (P<0.0001), although there were no differences in the numbers of CD34+ cells collected between both groups. Multiple regression analysis showed that chemotherapy alone was predictive of a low CD34+ yield in patients with NMM (regression coefficient (RC)=-2.1; P=0.003). In addition, the interactions "diagnosis mutliple myeloma (MM)xmobilization with chemotherapy" (RC=2.9; P=0.004) and "diagnosis MMxmobilization with chemotherapy plus G-CSF" (RC=2.1; P=0.04) also remained in the model, both showing a favorable influence. In AML, mobilization with chemotherapy plus G-CSF was associated with higher CD34+ yields (P=0.003). In this subgroup of patients, multiple regression analysis identified the number of cycles of previous chemotherapy (< or =2 cycles; RC=1.3; P=0.03) and peripheral blood counts (WBC > or =1.5 x 10(9)/l and monocytes >20%; RC=0.8; P=0.02) as the factors most predictive of CD34+ cell yield. These findings emphasize the need to optimize harvesting technique to enhance safety and minimize morbidity and costs of this valuable procedure.
Collapse
Affiliation(s)
- A Carral
- Bone Marrow Transplant Unit, Hematology Service, University Hospital La Fe, 46009, Valencia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Saavedra S, Sanz GF, Jarque I, Moscardó F, Jiménez C, Lorenzo I, Martín G, Martínez J, De La Rubia J, Andreu R, Mollá S, Llopis I, Fernández MJ, Salavert M, Acosta B, Gobernado M, Sanz MA. Early infections in adult patients undergoing unrelated donor cord blood transplantation. Bone Marrow Transplant 2002; 30:937-43. [PMID: 12476288 DOI: 10.1038/sj.bmt.1703764] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2002] [Accepted: 07/25/2002] [Indexed: 11/10/2022]
Abstract
Early transplant-related mortality after cord blood transplantation from unrelated donors (UD-CBT) is close to 50%, mainly due to infectious complications. We have studied the incidence and characteristics of early infections (before day 100) in a series of 27 adult patients (median age 30 years, range 16-46) undergoing UD-CBT at a single institution. All 27 patients experienced at least one infectious episode and 18 (66%) suffered a severe infection. Bacteremia occurred in 55% of patients (13 with Gram-positive and 11 with Gram-negative microorganisms). Eleven of 19 CMV-seropositive patients (58%) developed CMV antigenemia and one patient had CMV disease. Fungal infections were documented in three patients (11%), comprising invasive fungal infections in two cases and a localized esophagitis in one. Ten patients (37%) died before day 100 after transplantation. Infection was considered the primary cause of death in four patients (sepsis by Acinetobacter spp. bacteremia in three cases) and contributed to death in another four. The most striking findings in this series were the high incidence of, and mortality due to multiresistant Acinetobacter spp. and the low incidence of and lack of mortality due to CMV disease. This report confirms that infection is a major complication in adults undergoing UD-CBT.
Collapse
Affiliation(s)
- S Saavedra
- Bone Marrow Transplant Unit, Department of Haematology, Hospital Universitario La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Saavedra S, Jarque I, Sanz GF, Moscardó F, Jiménez C, Martín G, Plumé G, Regadera A, Martínez J, De La Rubia J, Acosta B, Pemán J, Pérez-Bellés C, Gobernado M, Sanz MA. Infectious complications in patients undergoing unrelated donor bone marrow transplantation: experience from a single institution. Clin Microbiol Infect 2002; 8:725-33. [PMID: 12445010 DOI: 10.1046/j.1469-0691.2002.00458.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To analyze the incidence and characteristics of documented infections in patients with hematologic malignancies undergoing unrelated donor bone marrow transplantation (UD-BMT). METHODS We studied the occurrence of infections in 22 patients with hematologic malignancies or severe aplastic anemia who underwent UD-BMT from April 1990 to December 2000. The median age was 26 years (range 13-46). Acyclovir-ganciclovir, co-trimoxazole, fluconazole-nystatin and ciprofloxacin were administered for anti-infectious prophylaxis. RESULTS We registered 61 infectious episodes. During the early post-transplant period, there were eight clinically documented infections (CDIs), four cases of fever of unknown origin (FUO), seven cases of bacteremia, two cases of cytomegalovirus (CMV) antigenemia, and one case of CMV disease. In the intermediate period (days 30-100 after BMT), there were nine cases of CMV antigenemia, three bacterial infections, two fungal infections, one case of disseminated toxoplasmosis, and one case of FUO. In the late period (day 100 and later), we documented 13 viral infections, eight bacterial infections, one CDI, and one case of invasive aspergillosis. Infections contributed to death in 10 of 17 patients. Citrobacter bacteremia and sepsis of unknown origin were the main causes of infectious mortality in the early period. Infection was the main cause of death in six of seven patients in the late period. CONCLUSION A high incidence of life-threatening infections and infection-related mortality was observed. A high rate of CMV infection in the early period, and death caused by multiresistant Gram-negative microorganisms in the late period, were the main findings in this series.
Collapse
Affiliation(s)
- S Saavedra
- Servicio de Hematología, Hospital Universitario La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Carral A, de la Rubia J, Martín G, Martínez J, Sanz G, Jarque I, Sempere A, Soler MA, Marty ML, Sanz MA. Factors influencing hematopoietic recovery after autologous blood stem cell transplantation in patients with acute myeloblastic leukemia and with non-myeloid malignancies. Bone Marrow Transplant 2002; 29:825-32. [PMID: 12058232 DOI: 10.1038/sj.bmt.1703566] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2002] [Accepted: 03/02/2002] [Indexed: 11/08/2022]
Abstract
Factors influencing hematopoietic recovery (HR) after autologous blood stem cell transplantation (ABSCT) were analyzed in 73 patients with various non-myeloid malignancies (NMM), and in 58 patients with acute myeloblastic leukemia (AML). Peripheral blood stem cells were collected following mobilization with chemotherapy, granulocyte colony-stimulating factor (G-CSF), or chemotherapy plus G-CSF. The conditioning regimen used consisted of either chemotherapy alone (112 cases) or chemotherapy plus total body irradiation (19 cases). The median number of colony-forming units granulocyte-macrophage (CFU-GM) was similar in both groups of patients, with the median number of CD34(+) cells infused being higher in the AML group (5.4 vs 4 x 10(6)/kg; P = 0.03). Median time neutrophils >0.5 x 10(9)/l was 13 days in both groups, and median time to a platelet count >20 x 10(9)/l was longer in AML patients (14 vs 12 days; P = 0.01). In multivariate analysis, the only factors affecting neutrophil recovery in the NMM group were the CD34+ cell number (continuous model) and the CFU-GM dose (categorized model) infused, whereas for platelet recovery, previous chemotherapy also remained significant. In the AML group, the only factors significantly affecting the speed of neutrophil recovery were dose of CD34+ cells administered and the patient's age. As for platelet recovery, only the progenitor dose administered remained significant. In the NMM group, the most discriminating cut-off values for a rapid neutrophil and platelet recovery were 1.5 x 10(6) and 2.5 x 10(6) CD34+ cells/kg, respectively, and for AML patients these figures were 1.5 x 10(6) and 4 x 10(6) CD34+ cells/kg, respectively. Our results confirm the slower HR after ABSCT in AML, and highlight the importance of progenitor cell dose in accelerating HR after ABSCT.
Collapse
Affiliation(s)
- A Carral
- Hematology Service. University Hospital La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A, Rodríguez-García JA, Massó P, Pérez-Aliaga A, Monteagudo MD, Navarro I, Moreno G, Toledo C, Alonso A, Besses C, Besalduch J, Jarque I, Salama P, Rivas JA, Navarro B, Bladé J, Miguel JF. Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. Br J Haematol 2001; 115:575-82. [PMID: 11736938 DOI: 10.1046/j.1365-2141.2001.03144.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this report we analyse the presenting features of a series of patients diagnosed with Waldenström macroglobulinaemia (WM) in Spain over the last 10 years. Criteria for diagnosis required a serum monoclonal IgM protein > or = 30 g/l and > 20% bone marrow lymphocytes. Two hundred and seventeen patients were included in the study, with a median age of 69 years and male/female ratio of 2:1. The most common symptoms at diagnosis were anaemia (38%), hyperviscosity (31%), B symptoms (23%), bleeding (23%) and neurological symptoms (22%). Sixty-one patients (27%) were asymptomatic at diagnosis and, to date, 32 of them have not received chemotherapy. Variables predicting a shorter survival free of therapy were haemoglobin < 12.5 g/dl and high beta2microglobulin (beta2M). The 83% of patients who did receive treatment were distributed as follows: chlorambucil/prednisone (43%), intermittent chlorambucil (11%), continuous chlorambucil (26%), cyclophosphamide/vincristine/prednisone (COP, 13.5%) and other (6.5%). Response to therapy was complete in 2%, partial in 48% and minor in 10%. Finally, 28% and 13% of patients presented stable and progressive disease, respectively, which was more common among patients treated with COP. Progression-free survival was 43% at 5 years, with three independent predictors for shorter progression-free survival (PFS): COP treatment, age > 65 and B symptoms at diagnosis. The 10-year projected overall survival (OS) was 55%. The two most frequent causes of death were development of second malignancies (31%), or infections (19%). The two main variables predicting a poor OS were hyperviscosity and high beta2M. In summary, this study favours the use of chlorambucil-based therapy as the standard treatment for WM, and describes a subset of patients who should be considered as suffering a smouldering form and who therefore do not require treatment for a long period of time.
Collapse
Affiliation(s)
- R García-Sanz
- Department of Haematology, University Hospital of Salamanca, Paseo de San Vicente, Salamanca, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Jarque I, Andreu R, Llopis I, De la Rubia J, Gomis F, Senent L, Jiménez C, Martín G, Martínez JA, Sanz GF, Ponce J, Sanz MA. Absence of platelet response after eradication of Helicobacter pylori infection in patients with chronic idiopathic thrombocytopenic purpura. Br J Haematol 2001; 115:1002-3. [PMID: 11843840 DOI: 10.1046/j.1365-2141.2001.03194.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Eradication of Helicobacter pylori infection has been associated with the correction of thrombocytopenia in patients with idiopathic thrombocytopenic purpura (ITP). We have analysed the response to eradication of H. pylori in a series of 56 adult patients with chronic ITP. Forty patients had H. pylori infection (71%) that was eradicated in 23 of 32 evaluable patients (72%). Platelet counts did not significantly vary according to H. pylori treatment outcome. Three of 56 patients (5%) achieved a partial response attributable to H. pylori eradication. Therefore, detection of H. pylori infection should not be routinely included in the initial work-up of ITP.
Collapse
Affiliation(s)
- I Jarque
- Haematology Services, Hospital Universitario La Fe, Av. Campanar. 21, 46009 Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Sanz GF, Saavedra S, Planelles D, Senent L, Cervera J, Barragán E, Jiménez C, Larrea L, Martín G, Martínez J, Jarque I, Moscardó F, Plumé G, Andreu R, Regadera AI, García I, Mollá S, Solves P, de La Rubia J, Bolufer P, Benlloch L, Soler MA, Marty ML, Sanz MA. Standardized, unrelated donor cord blood transplantation in adults with hematologic malignancies. Blood 2001; 98:2332-8. [PMID: 11588027 DOI: 10.1182/blood.v98.8.2332] [Citation(s) in RCA: 197] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The potential role of unrelated donor cord blood transplantation (UD-CBT) in adults remains unclear. This study reports the results of UD-CBT in 22 adults with hematologic malignancies following conditioning with thiotepa, busulfan, cyclophosphamide, and antithymocyte globulin in 21, with thiotepa, fludarabine, and antithymocyte globulin in 1, and graft-versus-host disease (GVHD) prophylaxis with cyclosporine and prednisone. Median age was 29 years (range, 18-46 years), and median weight was 69.5 kg (range, 41-85 kg). HLA match was 6 of 6 in 1 case, 5 of 6 in 13 cases, and 4 of 6 in 8 cases. Median number of nucleated cells infused was 1.71 x 10(7)/kg (range, 1.01 x 10(7)/kg to 4.96 x 10(7)/kg). All 20 patients surviving more than 30 days had myeloid engraftment, and only 1, who received the lowest cell dose, developed secondary graft failure. Median time to reach an absolute neutrophil count of at least 0.5 x 10(9)/L was 22 days (range, 13-52 days). Median time to platelets numbered at least 20 x 10(9)/L was 69 days (range, 49-153 days). Seven patients (32%) developed acute GVHD above grade II, and 9 of 10 patients at risk developed chronic GVHD, which became extensive in 4 patients. Twelve patients remained alive and disease-free 3 to 45 months after transplantation. Disease-free survival (DFS) at 1 year was 53%. Age strongly influenced DFS (P =.01). For patients aged 30 years or younger, the DFS at 1 year was 73%. These preliminary results suggest that UD-CBT should be considered a reasonable alternative in young adults with hematologic malignancy and no appropriate bone marrow donor.
Collapse
Affiliation(s)
- G F Sanz
- Bone Marrow Transplantation Unit, Department of Hematology, and Laboratory of Molecular Biology, Department of Clinical Pathology, Hospital Universitario La Fe, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
López A, de la Rubia J, Martín G, Martínez J, Cervera J, Jarque I, Sempere A, Plumé G, Saavedra S, Regadera A, Sanz G, Gomis F, Pérez-Sirvent ML, Senent L, Jiménez C, Sanz MA. Recent improvements in outcome for elderly patients with de novo acute myeloblastic leukemia. Leuk Res 2001; 25:685-92. [PMID: 11397474 DOI: 10.1016/s0145-2126(01)00006-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A retrospective analysis was performed on 263 consecutive patients aged over 60 with de novo acute myeloid leukemia (AML) diagnosed in a single institution between 1979 and 1998. Eighty-nine patients (33%) received only palliative treatment, while 174 patients (67%) were treated with different intensive chemotherapy regimens. The 5- and 10-year overall survival (OS) for the whole series was 7.7+/-1.2 and 4.3+/-1.6%, respectively. For patients receiving chemotherapy, OS was 10.5+/-2.5 and 7+/-2.6%, while for those patients receiving supportive treatment it was 1.1+/-1.1 and 0%, respectively (P=0.002). Within the group of patients receiving chemotherapy, the complete remission (CR) rate was 46%; treatment failure rate was 54% (36% due to treatment-related mortality and 18% due to resistant disease). Variables influencing CR rate were FAB subtype, CD7 positivity, chemotherapy regimen, creatinine level, hepatomegaly, and period of diagnosis. Median disease-free survival (DFS) duration was 8.4 months with a probability of being disease-free at 10 years of 10+/-5%. There were no significant differences in DFS according to age. According to the period of diagnosis (1979-1986 vs. 1987-1998), improvements in the CR rate (27 vs. 56%, P=0.0002), and OS (10.9 vs. 15.7 months, P=0.0007) were observed. This large single-center study of unselected de novo AML elderly patients substantiates the progressive improvement achieved in the management of elderly patients with AML, probably due to an improvement in supportive care and the administration of conventional induction chemotherapy.
Collapse
Affiliation(s)
- A López
- Hematology Department, University Hospital La Fe, Avda. Campanar, 21, 46009, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Sanz GF, Saavedra S, Jiménez C, Senent L, Cervera J, Planelles D, Bolufer P, Larrea L, Martín G, Martínez J, Jarque I, Moscardó F, Plumé G, Andreu R, de la Rubia J, Barragán E, Solves P, Soler MA, Sanz MA. Unrelated donor cord blood transplantation in adults with chronic myelogenous leukemia: results in nine patients from a single institution. Bone Marrow Transplant 2001; 27:693-701. [PMID: 11360108 DOI: 10.1038/sj.bmt.1702878] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2000] [Accepted: 02/06/2001] [Indexed: 11/09/2022]
Abstract
The potential role of unrelated donor cord blood transplantation (UD-CBT) in adults is not well established. We report the results of UD-CBT in nine adult patients with chronic myeloid leukemia (CML). The median age was 27 years (range, 19-41 years), and the median weight was 62 kg (range, 45-78 kg). At transplant, six patients were in chronic phase (five in first, and one in second), two in blast crisis, and one in accelerated phase. Eight had received intensive chemotherapy, and three had undergone autologous peripheral blood hematopoietic stem cell transplantation. Four had received interferon with no cytogenetic response, and only three underwent UD-CBT within 1 year of diagnosis. After serological typing for class I antigens, and high-resolution DNA typing for DRB1, the degree of HLA match between patients and cord blood (CB) units was 4/6 in six cases and 5/6 in three cases. The median number of nucleated cells infused was 1.7 x 10(7)/kg (range, 1.2 to 4.9 x 10(7)/kg), and was above 2 x 10(7)/kg in only two cases. All patients received thiotepa, busulfan, cyclophosphamide and anti-thymocyte globulin as conditioning; cyclosporine and prednisone for graft-versus-host disease (GVHD) prophylaxis; and G-CSF from day +7 until engraftment. All seven evaluable cases engrafted. The median time to reach an absolute neutrophil count > or =0.5 x 10(9)/l and > or =1 x 10(9)/l was 22 days (range, 19-52 days) and 28 days (range, 23-64 days), respectively. In the four patients evaluable for platelet recovery time to levels of > or =20 x 10(9) platelets/l, > or =50 x 10(9) platelets/l, and > or =100 x 10(9) platelets/l, these ranged from 50 to 128 days, 60 to 139 days, and 105 to 167 days, respectively. Three patients developed acute GVHD above grade II, and three of the five patients at risk developed extensive chronic GVHD. Four patients, all transplanted in chronic phase, remain alive in molecular remission more than 18, 19, 24 and 42 months after transplantation. These preliminary results suggest that UD-CBT may be considered a reasonable alternative in adults with CML who lack an appropriate bone marrow donor.
Collapse
Affiliation(s)
- G F Sanz
- Bone Marrow Transplantation Unit, Department of Hematology, Hospital Universitario La Fe, Av. Campanar 21, 46009 Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Moscardó F, Sanz GF, de La Rubia J, Jiménez C, Saavedra S, Regadera A, Andreu R, García I, Plumé G, Martínez J, Martín G, Jarque I, Sanz MA. Marked reduction in the incidence of hepatic veno-occlusive disease after allogeneic hematopoietic stem cell transplantation with CD34(+) positive selection. Bone Marrow Transplant 2001; 27:983-8. [PMID: 11436110 DOI: 10.1038/sj.bmt.1703025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2000] [Accepted: 02/08/2001] [Indexed: 02/05/2023]
Abstract
Veno-occlusive disease of the liver (VOD) is a common and severe complication of allogeneic hematopoietic stem cell transplantation (HSCT). To determine the incidence of, and the risk factors for the development of VOD, we performed a retrospective analysis of a series of 178 patients, who underwent allogeneic HSCT at our institution between 1990 and 1999. Busulfan and cyclophosphamide constituted the conditioning regimen most frequently administered. Bone marrow was the source of stem cells in 129 patients (73%), and peripheral blood (PBSC) in 49 patients (27%). Thirty-one patients of the PBSC group received CD34(+) positively selected grafts. Most patients were given cyclosporin A and methotrexate (MTX) as graft-versus-host disease (GVHD) prophylaxis. Overall, 30 patients (17%) developed VOD. In univariate analyses, the incidence of VOD was significantly higher in recipients of unmanipulated grafts (20% vs 0%; P = 0.01), in patients with active malignant disease at transplantation (24% vs 9%; P = 0.03), in recipients of marrow from unrelated donors (33% vs 15%; P = 0.03), in patients grafted with bone marrow (21% vs 6%; P = 0.03), and in those receiving MTX as GVHD prophylaxis (21% vs 6%; P = 0.05). Under multivariate analysis, only CD34(+) positive selection (P = 0.0004) and the status of the disease at transplant (P = 0.03) were statistically significant variables for the development of VOD. We conclude that CD34(+) positively selected PBSC transplantation could result in a marked reduction in the incidence of VOD after allogeneic HSCT.
Collapse
Affiliation(s)
- F Moscardó
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Sureda A, Arranz R, Iriondo A, Carreras E, Lahuerta JJ, García-Conde J, Jarque I, Caballero MD, Ferrà C, López A, García-Laraña J, Cabrera R, Carrera D, Ruiz-Romero MD, León A, Rifón J, Díaz-Mediavilla J, Mataix R, Morey M, Moraleda JM, Altés A, López-Guillermo A, de la Serna J, Fernández-Rañada JM, Sierra J, Conde E. Autologous stem-cell transplantation for Hodgkin's disease: results and prognostic factors in 494 patients from the Grupo Español de Linfomas/Transplante Autólogo de Médula Osea Spanish Cooperative Group. J Clin Oncol 2001; 19:1395-404. [PMID: 11230484 DOI: 10.1200/jco.2001.19.5.1395] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To analyze clinical outcome and significant prognostic factors for overall (OS) and time to treatment failure (TTF) in a group of 494 patients with Hodgkin's disease (HD) undergoing autologous stem-cell transplantation (ASCT). PATIENTS AND METHODS Detailed records from the Grupo Español de Linfomas/Transplante Autólogo de Médula Osea Spanish Cooperative Group Database on 494 HD patients who received an ASCT between January 1984 and May 1998 were reviewed. Two hundred ninety-eight males and 196 females with a median age of 27 years (range, 1 to 63 years) received autografts while in complete remission (n = 203) or when they had sensitive disease (n = 206) or resistant disease (n = 75) at a median time of 26 months (range, 4 to 259 months) after diagnosis. Most patients received high-dose chemotherapy without radiation for conditioning (n = 443). The graft consisted of bone marrow (n = 244) or peripheral blood (n = 250). RESULTS The 100-day mortality rate was 9%. The 5-year actuarial TTF and OS rates were 45.0% (95% confidence interval [CI], 39.5% to 50.5%) and 54.5% (95% CI, 48.4% to 60.6%), respectively. In multivariate analysis, the presence of active disease at transplantation, transplantation before 1992, and two or more lines of therapy before transplantation were adverse prognostic factors for outcome. Sixteen patients developed a secondary malignancy (5-year cumulative incidence of 4.3%) after transplantation. Adjuvant radiotherapy before transplantation, the use of total-body irradiation (TBI) in the conditioning regimen, and age > or = 40 years were found to be predictive factors for the development of second cancers after ASCT. CONCLUSION ASCT achieves long-term disease-free survival in HD patients. Disease status before ASCT is the most important prognostic factor for final outcome; thus, transplantation should be considered in early stages of the disease. TBI must be avoided in the conditioning regimen because of a significantly higher rate of late complications, including secondary malignancies.
Collapse
Affiliation(s)
- A Sureda
- Clinical Hematolgy Division, Hospital de la Santa Creu i Sant Pau, St Antoni Maria Claret, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
de la Rubia J, Saavedra S, Sanz GF, Martín G, Moscardó F, Martínez J, Jarque I, Jiménez C, Sanz MA. Transplant-related mortality in patients older than 60 years undergoing autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2001; 27:21-5. [PMID: 11244434 DOI: 10.1038/sj.bmt.1702736] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although high-dose therapy with autologous hematopoietic stem cell transplantation (ASCT) is a widely used method of dose intensification in patients with hematological malignancies, patients aged over 60 are generally excluded. We evaluated high-dose therapy and ASCT in 29 cases involving 27 such patients (median age 63 years; range 61-68) with different malignancies. Patients were eligible if they had a good performance status, normal cardiac, respiratory, and hepatic function and a serum creatinine concentration of less than 2 mg/dl (<5 mg/dl in myeloma patients). Engraftment was assessable in 27 procedures. The median time to attain 0.5 and 1 x 10(9) PMN/l was 13 days (range 9-30) and 14 days (range 10-66), respectively. The median time taken to reach a platelet count greater than 50 x 10(9)/l was 14 days (range 8-223). Five patients (17%) died in the first 100 days after transplant, in two cases due to disease progression. The remaining three patients died as a consequence of transplant-related complications, with an overall transplant-related mortality of 10%. Five patients relapsed and died between 5 and 36 months after transplant. The remaining 17 patients are still alive without disease progression, with an actuarial overall survival of 47% at 42 months (95% CI 33-61). We consider that high-dose therapy with ASCT should be considered in those elderly patients with good performance status and without general organ impairment.
Collapse
Affiliation(s)
- J de la Rubia
- Bone Marrow Transplant Unit, Hematology Service, University Hospital La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Sanz MA, Larrea L, Sanz G, Martín G, Sempere A, Gomis F, Martínez J, Regadera A, Saavedra S, Jarque I, Jiménez C, Cervera J, de La Rubia J. Cutaneous promyelocytic sarcoma at sites of vascular access and marrow aspiration. A characteristic localization of chloromas in acute promyelocytic leukemia? Haematologica 2000; 85:758-62. [PMID: 10897129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Extramedullary disease (EMD) is a rare clinical event in acute promyelocytic leukemia (APL). Although the skin is involved in half of the reported EMD cases, the occurrence of cutaneous promyelocytic sarcoma (PS) has been described very rarely. We report here three cases of PS which have the peculiarity of appearing at sites of punctures for arterial and venous blood and marrow samples (sternal manubrium, antecubital fossa, wrist over the radial artery pulse, catheter insertion scar). At presentation, all patients had hyperleukocytosis and a morphologic diagnosis of microgranular acute promyelocytic leukemia variant confirmed at the genetic level by demonstration of the specific chromosomal translocation t(15;17). A BCR3 type PML/RARa transcript was documented in the two patients for whom diagnostic RT-PCR was available. Patients had morphologic bone marrow remission at the time the PS appeared. A predilection for the development of cutaneous PS at sites of previous vascular damage has been noted, but the pathogenesis remains largely unknown. A potential role for all-trans retinoic acid has been advocated, although one of the three patients in our series had received no ATRA. A review of the literature revealed six similar cases and hyperleukocytosis at diagnosis was a consistent finding in all of them. A careful physical examination of these particular sites in the follow-up of patients at risk, as well as cutaneous biopsy and laboratory examination of suspected lesions are strongly recommended.
Collapse
Affiliation(s)
- M A Sanz
- Servicio de Hematología, Hospital Universitario La Fe, Av. Campanar 21, 46009 Valencia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Jarque I, Saavedra S, Martin G, Pemán J, Pérez Bellés C, Sanz MA. Delay of onset of candidemia and emergence of Candida krusei fungemia in hematologic patients receiving prophylactic fluconazole. Haematologica 2000; 85:441-3. [PMID: 10757896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
|
42
|
de La Rubia J, García I, Jarque I, Arriaga F, Gomis F, Sanz MA. Splenectomy in patients with refractory or relapsing thrombotic thrombocytopenic purpura. Haematologica 2000; 85:440-1. [PMID: 10756380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
|
43
|
Jarque I, Sanz MA. [Application of the concepts of evidence-based medicine to the evidence on the treatment of febrile neutropenia]. Enferm Infecc Microbiol Clin 1999; 17 Suppl 2:95-102. [PMID: 10605194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Infectious complications are an important cause of morbidity and mortality in cancer patients, especially those receiving chemotherapy. Early empirical administration of broad-spectrum antibiotics at the onset of fever has become common practice, but the specific empirical regimen remains controversial. Over the last two decades, a marked shift in the spectrum of causative organisms towards a gram-positive predominance has been the main factor influencing therapeutic approaches. METHODS A MEDLINE search (January 1966-March 1999) for studies evaluating the treatment of adult patients with febrile neutropenia was carried out. Reference lists from identified articles also served as literature sources. All studies were critically evaluated for an evidence-based discussion. RESULTS Most clinical studies have advocated the use of combination therapy, including a beta-lactam plus an aminoglycoside. However, recent trials comparing combination therapy versus monotherapy with the newer extended-spectrum agents such as carbapenems and third-generation cephalosporins could not prove relevant differences in outcome. Empirical therapy has evolved towards a planned-progressive modification in patients with persistent fever, especially aiming at early antifungal coverage. Although overwhelming streptococcal sepsis has raised particular concern, the role of glycopeptide antibiotics remains another controversial issue especially because of increasing reports of infections caused by resistant grampositive cocci (enterococci and recently S. aureus). Likewise routine antibacterial and antifungal chemoprophylaxis is being questioned due to its association with emergence of resistant organisms (particularly fluoroquinolone-resistant Escherichia coli and fluconazole-resistant non-albicans Candida species). CONCLUSIONS Empirical therapy has dramatically reduced mortality rates in febrile neutropenic patients. Monotherapy with extended-spectrum antibiotics is a feasible alternative to combination therapy. The indiscriminate use of empirical glycopeptides should be discouraged. Early antifungal therapy with amphotericin B is essential in case of persistent fever. Prompt recognition of institutional resistance trends is of paramount importance for an optimal antibiotic selection. Further studies of larger size designed to confirm low-risk patient characteristics are necessary.
Collapse
Affiliation(s)
- I Jarque
- Servicio de Hematología, Hospital Universitario La Fe, Valencia
| | | |
Collapse
|
44
|
Abstract
We report a 27-year-old man who presented with fatigue, moderate weight loss and progressive abdominal distension as primary manifestations of a light-chain multiple myeloma (MM). Liver scan showed an enlarged liver with multiple low attenuation areas. Liver biopsy revealed sinusoidal infiltration by small size cells identified as Kappa light chain-producing primitive plasma cells by immunohistochemistry. The patient responded to three courses of EDAP. Subsequently he received intensive therapy with busulfan/melfalan and a peripheral blood stem cell transplantation enriched for CD34+ cells from his HLA-identical brother. No acute graft-versus-host disease was detected. Now, 12 months after transplant, the patient is asymptomatic.
Collapse
Affiliation(s)
- P Solves
- Servicio de Hematología, Hospital Universitario La Fe, Valencia, Spain
| | | | | | | | | | | | | |
Collapse
|
45
|
de la Rubia J, Sanz GF, Martín G, Martínez J, Cervera J, Solves P, Jiménez C, Arnao M, Vicente A, Jarque I, Sempere A, Sanz MA. Autologous blood stem cell transplantation for acute myeloblastic leukemia in first complete remission. Intensification therapy before transplantation does not prolong disease-free survival. Haematologica 1999; 84:125-32. [PMID: 10091410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To compare the clinical results of two consecutive therapeutic protocols including autologous blood stem cell transplantation (ABSCT) for patients with de novo acute myeloblastic leukemia (AML) in first complete remission (CR1). DESIGN AND METHODS Between November 1989 and January 1997, 50 patients with AML in CR1 underwent ABSCT using two consecutive protocols. In the first one (Group A, 25 patients) peripheral blood stem cells (PBSC) were collected after induction and consolidation chemotherapy courses, and ABSCT was performed immediately thereafter. In the subsequent 25 patients (Group B), PBSC were collected after consolidation alone, and a further chemotherapy course with intermediate dose cytarabine (Ara-C 1 g/m2/12 h x3 days) and mitoxantrone (12 mg/m2/d x3 days) was administered as early intensification. The conditioning regimen consisted of busulfan (16 mg/kg) and cyclophosphamide (200 mg/kg) in every case. RESULTS Hematopoietic engraftment was slightly quicker in Group B, with median times to reach 0.5 x 10(9) neutrophils/L and 20 x 10(9) platelets/L being 13 and 12 days in Group A and 12 and 11 days in Group B, respectively. There were three graft failures (8%) (2 in Group A and 1 in Group B) and three transplant-related deaths (8%) (2 in Group A and 1 in Group B). No significant differences were observed between the groups in terms of relapse (64% at 4-years in Group A and 81% in Group B). Likewise, the actuarial 4-year disease-free survival (DFS) was not significantly different between the two groups (32% v 18%). INTERPRETATION AND CONCLUSIONS Our study confirms that AML patients in CR1 receiving ABSCT have rapid engraftment with low mortality. However, autologous transplants with PBSC collected after consolidation chemotherapy were still associated with a high rate of relapse (RR). This RR was not apparently reduced by the administration of intermediate dose Ara-C before transplantation.
Collapse
Affiliation(s)
- J de la Rubia
- Hematology Department, University Hospital La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Larrea L, Martínez JA, Sanz GF, Martín G, de la Rubia J, Jiménez C, Jarque I, Cid A, López A, Sanz MA. Carboplatin plus cytarabine in the treatment of high-risk acute myeloblastic leukemia. Leukemia 1999; 13:161-5. [PMID: 10025888 DOI: 10.1038/sj.leu.2401278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thirty-one patients (20 male and 11 female; median age 51 years (16-79)) with high-risk acute myeloblastic leukemia (AML) (20 refractory AML and 11 secondary AML (s-AML) (four to myelodysplastic syndrome, five to chemo/radiotherapy, one to aplastic anemia and one blastic chronic myelogenous leukemia (B-CML)) were treated with CBDCA (300 mg/m2/day x 5 days in continuous i.v. infusion) plus intermediate-dose Ara-C (500 mg/m2/day x 3 days in rapid i.v. infusion). Nine patients (29%) achieved CR (five s-AML (three myelodysplastic syndromes, one CML and one ALL) and four refractory AML) and 11 patients had resistant disease. There were 11 early deaths (35%). Median disease-free survival of the nine responders was 4 months. The main toxicity was hematological, febrile episodes took place in nearly all the patients (96%). The CBDCA plus Ara-C regimen showed an evident antileukemic activity in high-risk leukemia. However, the lack of long-term disease-free survivors shows the need for innovative postremission strategies. The high initial response rate seen in AML secondary to myelodysplastic syndromes (MDS) warrants further investigation of CBDCA in combination regimens for MDS patients.
Collapse
Affiliation(s)
- L Larrea
- Hematology Service, University Hospital La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Senent L, Jarque I, Martín G, Sempere A, González-García Y, Gomis F, Pérez-Sirvent M, De La Rubia J, Sanz MA. P-glycoprotein expression and prognostic value in acute myeloid leukemia. Haematologica 1998; 83:783-7. [PMID: 9825574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Drug resistance has become a major cause of treatment failure in patients with acute leukemia. P-glycoprotein (Pgp), which is associated with the multidrug resistance (MDR) phenotype, has been reported to be an important predictor of treatment outcome. The aim of this study was to analyze the value of Pgp expression in bone marrow or peripheral blood as a predictor of the response to remission induction chemotherapy as well as the duration of remission in patients with de novo acute myeloid leukemia (AML). DESIGN AND METHODS We examined the expression of Pgp in 82 patients with de novo AML using an immunocytochemical assay with the C219 monoclonal antibody. RESULTS Twenty-seven of the 82 patients (33%) were C219-positive in from 1% to 100% of their cells. Thirteen cases (16%) showed a positive reaction in more than 50% of the leukemic cells. Only hyperleukocytosis was significantly associated with higher expression of Pgp. Although 8 of the 13 cases (62%) with more than 50% of cells having Pgp expression were CD34-positive, this association was not statistically significant. A univariate analysis of resistance to induction therapy showed a significantly higher resistance rate in patients with increased Pgp expression (P = 0.01) as well as in those patients with decreased reactivity to myeloperoxidase. The multivariate analysis revealed the independent prognostic value of Pgp expression. C219 reactivity did not have an influence on remission duration. INTERPRETATION AND CONCLUSIONS Our data indicate that P-glycoprotein expression is a reliable marker of resistance to induction treatment in patients with de novo AML.
Collapse
MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/biosynthesis
- ATP Binding Cassette Transporter, Subfamily B, Member 1/immunology
- Actuarial Analysis
- Acute Disease
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/immunology
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Cohort Studies
- Cytarabine/administration & dosage
- Cytarabine/pharmacology
- Daunorubicin/administration & dosage
- Daunorubicin/pharmacology
- Disease-Free Survival
- Drug Resistance, Multiple
- Drug Resistance, Neoplasm
- Etoposide/administration & dosage
- Etoposide/pharmacology
- Female
- Genes, MDR
- Humans
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukocyte Count
- Male
- Middle Aged
- Mitoxantrone/administration & dosage
- Mitoxantrone/pharmacology
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Neoplasm Proteins/immunology
- Neoplastic Stem Cells/chemistry
- Prognosis
- Remission Induction
Collapse
Affiliation(s)
- L Senent
- Hematology Service, La Fe University Hospital, Valencia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Ubeda P, Salavert M, Giner S, Jarque I, López-Aldeguer J, Pérez-Bellés C, Gobernado M. [Bacteremia caused by Stenotrophomonas maltophilia: a clinical-epidemiological study and resistance profile]. Rev Esp Quimioter 1998; 11:205-15. [PMID: 9795306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Over a 7-year period (1990-1996), the causal disease, predisposing factors, focus infection, clinical manifestations, complications and evolution of patients presenting bacteremia from Stenotrophomonas maltophilia were analyzed retrospectively in a university hospital. A microbiological study was carried out to determine the percentage of positive blood cultures per episode and the characteristics of bacteremia and to evaluate the antibiotic susceptibility of the isolated strains. Twenty-seven episodes of bacteremia from S. maltophilia were identified in 26 patients, half of whom were women, and the median age was 40 years. A total of 48% of the patients had blood malignancy (12 cases), with acute myeloid leukemia (5 cases) being the most frequent. Seven patients (27%) needed to be admitted to an intensive care unit for some type of vital support and/or intensive treatment. The previous administration of large spectrum antimicrobials (21/26) and the presence of a catheter or central catheter (19/26) were the most frequently found predisposing factors (81% and 73%, respectively). One-quarter of the patients had received treatment with carbapenems. Immunodepression caused by chemotherapy or corticosteroids occurred in 65% of the cases. Half of the patients had undergone a major surgical procedure or had been intubated and submitted to mechanical ventilation. One-third presented granulocytopenia on the detection of bacteremia and 6 of the 12 patients with blood malignancy showed severe neutropenia (<500 neutrophils/mm3). The bacteremia was acquired in hospital in 78% of the cases (21/27). In 26% of these cases, S. maltophilia was diagnosed as the probable cause of bacteremia; in 34% this was just a possibility. The origin of the bacteremia was unknown in 11 cases (40%). Infection from the vascular catheter was the most frequent focus infection (7 cases). An average of 3.6 blood cultures were performed per patient, out of a total of 92, and 54% showed positive. The average time of growth for S. maltophilia in the blood culture bottles was 30 hours. One-third of the bacteremia episodes from S. maltophilia were polymicrobial (9/27). Clinical evolution was favorable in 18 patients, while 8 died (31%), 5 cases (20%) from causes directly related to the bacteremia (4 from septic shock). The mortality associated with the polymicrobial bacteremia was not significantly different from that for single microbial bacteremia from S. maltophilia. Ninety percent of the isolated strains showed susceptibility to co-trimoxazole, 77% to ticarcillin-clavulanic acid, 60% to ciprofloxacin, 62% to ceftazidime, 20% to amikacin and just 18% to imipenem.
Collapse
Affiliation(s)
- P Ubeda
- Servicio de Microbiología, Servicio de Hematología Clínica, Unidad de Enfermedades Infecciosas (Serv. Medicina Interna),Hospital Universitario La Fe, Avda. Campanar 21, 46009 Valencia
| | | | | | | | | | | | | |
Collapse
|
49
|
López F, Jarque I, Martín G, Sanz GF, Palau J, Martínez J, de la Rubia J, Larrea L, Arnao M, Solves P, Cervera J, Martínez ML, Pemán J, Gobernado M, Sanz MA. [Invasive fungal infections in patients with blood disorders]. Med Clin (Barc) 1998; 110:401-5. [PMID: 9608494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Invasive fungal infections (IFI) are severe infectious complications frequently observed in patients with hematological disorders. The aims of this study were to analyse the characteristics of this particular type of infection in a large series of a single institution and to determine the factors associated with the outcome and therapeutic response. PATIENTS AND METHODS This study reviews the clinical and microbiological features of 155 IFI occurred among 144 patients with hematologic disorders throughout a period of 17 years in a single institution. RESULTS In 118 cases (82%) the diagnosis was acute leukemia. The main risk factors for developing IFI included a persistent and profound granulocytopenia, the use of broad-spectrum antibacterial agents, indwelling central venous catheters and the damage of normal host barriers following intensive cytotoxic chemotherapy. Candida (65 cases [44%]) and Aspergillus (38 cases [26%]) species were the most common fungal species isolated. An increasing number of IFI were caused by fungi previously considered as contaminants or harmless colonizers. The outcome of IFI was favourable in 78 cases (50%). The most important prognostic factors for the outcome of the IFI were the phase of cytotoxic chemotherapy (p = 0.005), the response of the underlying disease to the cytotoxic chemotherapy (p < 0.00001), and the recovery of neutropenia during the infection course (p < 0.00001). An earlier use of empirical antifungal therapy was also associated with a better outcome. CONCLUSIONS In spite of earlier treatment and regardless the development of new antifungal agents, the prognosis of IFI in patients with hematological malignancies remains poor. The use of hematopoietic growth factors, through their impact in the duration and severity of neutropenia, may prove valuable the management of IFI in this setting.
Collapse
Affiliation(s)
- F López
- Servicios de Hematología y Microbiología, Hospital Universitario La Fe, Valencia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Sanz MA, Jarque I, Larrea L. [Monotherapy with meropenem in febrile granulocytopenic patients]. Enferm Infecc Microbiol Clin 1997; 15 Suppl 1:69-72. [PMID: 9410073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Infection remains the major cause of morbidity and mortality for cancer patients who become granulocytopenic. Combinations of beta-lactams plus aminoglycosides have been the standard empiric therapy for febrile granulocytopenic patients, especially those with profound long-lasting granulocytopenia. The advent of new broad-spectrum cephalosporins and carbapenems has favoured the possibility of empiric monotherapy. Meropenem is a parenteral carbapenem antibiotic stable to renal dehydropeptidase-I which has excellent bactericidal activity against almost all clinically significant aerobic and anaerobic organisms. Meropenem hasta an antibacterial spectrum similar to that of imipenem but it is more active against Pseudomonas aeruginosa, all Enterobacteriaceae, Haemophilus influenzae, Proteus spp, Morganella spp and Providencia spp. Recently, the efficacy, safety, and tolerance of meropenem monotherapy for the empirical treatment of fever in granulocytopenic cancer patients have been compared in two large prospective randomized multicenter trials. The Meropenem Study Group compared monotherapy with meropenem versus ceftazidime and the EORTC conducted a comparative study of meropenem monotherapy versus the combination of ceftazidime plus amikacin. In both groups, success rates were similar by type of infection and infection-related mortality was low. Related adverse events were also similar in both groups. These studies confirm that monotherapy with meropenem is as effective as ceftazidime-containing regimens for the empiric treatment of fever in granulocytopenic patients.
Collapse
Affiliation(s)
- M A Sanz
- Servicio de Hematología, Hospital Universitario La Fe, Valencia.
| | | | | |
Collapse
|