1
|
Megías Vericat JE, Montesinos P, Herrero MJ, Bosó V, Moscardó F, Rojas L, Martínez-Cuadrón D, Aliño SF, Sanz MA, Poveda JL. PKP-020 Impact of nadph oxidase functional polymorphisms in acute myeloid leukaemia induction chemotherapy. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
2
|
Megías-Vericat JE, Rojas L, Herrero MJ, Bosó V, Montesinos P, Moscardó F, Poveda JL, Sanz MA, Aliño SF. Positive impact of ABCB1 polymorphisms in overall survival and complete remission in acute myeloid leukemia: a systematic review and meta-analysis. Pharmacogenomics J 2015; 16:1-2. [DOI: 10.1038/tpj.2015.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
3
|
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
|
4
|
Solves P, Carpio N, Gómez I, Hernani R, Sanz GF, Sanz MA. Risk of Rh (D) alloimmunisation after Rh (D) positive platelet transfusions in patients undergoing haematopoietic stem cell transplantation. Transfus Med 2015; 25:49-50. [PMID: 25737308 DOI: 10.1111/tme.12179] [Citation(s) in RCA: 2] [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] [Received: 09/30/2014] [Revised: 12/19/2014] [Accepted: 02/09/2015] [Indexed: 12/01/2022]
Affiliation(s)
- P Solves
- Transfusion Service, Hematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | | | | | | | | | | |
Collapse
|
5
|
Sanz MA, Sánchez J, Camarero JJ, Peguero-Pina JJ, Sancho-Knapik D, Gil-Pelegrín E. Change in the terpenoid profile and secondary growth in declining stands of Pinus sylvestris L. under mediterranean influence as a response to local factors. ACTA ACUST UNITED AC 2014. [DOI: 10.3989/pirineos.2014.169003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
6
|
Weitz I, Meyers G, Lamy T, Cahn JY, Uranga MT, García Vela JA, Sanz MA, Severino B, Kelly RJ, Hillmen P, Hill A. Cross-sectional validation study of patient-reported outcomes in patients with paroxysmal nocturnal haemoglobinuria. Intern Med J 2013; 43:298-307. [PMID: 22909078 DOI: 10.1111/j.1445-5994.2012.02924.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/23/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, acquired, clonal haemopoietic stem cell disorder that causes chronic intravascular haemolysis, increases the risk of thrombosis and results in significant patient morbidity and mortality. The symptoms of PNH may have a major impact on patient quality of life. AIMS To assess patient fatigue and health-related quality of life in 29 patients with PNH using the Functional Assessment of Chronic Illness Therapy Fatigue subscale version 4 (FACIT-Fatigue) and the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30, version 3 (EORTC QLQ-C30). METHODS Following completion of the questionnaires, patients were interviewed to assess the validity, clarity, relevance and comprehensiveness of the assessments. RESULTS Overall, patients considered both the FACIT-Fatigue and EORTC QLQ-C30 instruments to be relevant and adequate in assessing the level of PNH-associated fatigue and other quality-of-life measures. The FACIT-Fatigue questionnaire was considered to be clear and to comprehensively cover PNH-related fatigue. The EORTC QLQ-C30 instrument was considered to be easy to understand, but of an overall lower relevance, although some differences between countries were observed. Patients suggested additional questions that could be incorporated into future EORTC QLQ-C30 versions to make it more relevant to PNH. CONCLUSIONS This study confirms the validity of the FACIT-Fatigue and the EORTC QLQ-C30 questionnaires in this patient population and their routine use should be considered in the management of patients with PNH.
Collapse
Affiliation(s)
- I Weitz
- Keck-USC School of Medicine, Los Angeles, California, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
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
|
8
|
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
|
9
|
Spyridonidis A, Labopin M, Schmid C, Volin L, Yakoub-Agha I, Stadler M, Milpied N, Socie G, Browne P, Lenhoff S, Sanz MA, Aljurf M, Mohty M, Rocha V. Outcomes and prognostic factors of adults with acute lymphoblastic leukemia who relapse after allogeneic hematopoietic cell transplantation. An analysis on behalf of the Acute Leukemia Working Party of EBMT. Leukemia 2012; 26:1211-7. [PMID: 22290066 DOI: 10.1038/leu.2011.351] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To describe outcomes, treatment and prognostic factors that influence survival of adult patients with acute lymphoblastic leukemia (ALL), who relapsed after allogeneic hematopoietic cell transplantation (HCT), we retrospectively analyzed 465 ALL adult patients from European Group for Blood and Marrow Transplantation (EBMT) centers who relapsed after a first HCT performed in complete remission (CR1 65%, CR2/3 35%). Salvage treatments were: supportive care (13%), cytoreductive therapy (43%), donor lymphocyte infusion without or with prior chemotherapy (23%) and second HCT (20%). Median time from HCT to relapse was 6.9 months, median follow-up was 46 months and median survival after relapse was 5.5 months. Estimated 1-, 2- and 5-year post-relapse survival was 30 ± 2%, 16 ± 2% and 8 ± 1%, respectively. In a multivariate analysis, adverse factors for survival were: late CR (CR2/3) at transplant (P<0.012), early relapse after transplant (<6.9 months, P <0.0001) and peripheral blast percent at relapse (P <0.0001). On the basis of multivariate model for survival, three groups of patients were identified with estimated 2 year survival of 6 ± 2, 17 ± 3 and 30 ± 7%. Outcome of ALL patients relapsing after HCT is dismal and there is a need for new therapies. Our study provides the standard expectations in ALL relapse and may help in the decision of post-relapse therapy.
Collapse
Affiliation(s)
- A Spyridonidis
- Division of Hematology , BMT Unit, University of Patras, Patras, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Rodríguez-Sánchez JA, Sanz MA, Blanco M, Serrano MP, Joy M, Latorre MA. The influence of dietary lysine restriction during the finishing period on growth performance and carcass, meat, and fat characteristics of barrows and gilts intended for dry-cured ham production1. J Anim Sci 2011; 89:3651-62. [DOI: 10.2527/jas.2010-3791] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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
|
Hehlmann R, Simonsson B, Baccarani M, Grimwade D, Apperley J, Barbui T, Bene MC, Buchner T, de Witte TJ, Foà R, Haferlach C, Hallek M, Hasford J, Hochhaus A, Hoelzer D, Ljungman P, Niederwieser D, Sanz MA, Saussele S. LeukemiaNet: A transnational model for cooperative leukemia research. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6556] [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: 11/20/2022] Open
|
12
|
Hasan SK, Buttari F, Ottone T, Voso MT, Hohaus S, Marasco E, Mantovani V, Garagnani P, Sanz MA, Cicconi L, Bernardi G, Centonze D, Lo-Coco F. Risk of acute promyelocytic leukemia in multiple sclerosis: coding variants of DNA repair genes. Neurology 2011; 76:1059-65. [PMID: 21346221 DOI: 10.1212/wnl.0b013e318211c3c8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) in double-strand break repair genes may alter DNA repair capacity and, in turn, confer predisposition to leukemia. We analyzed polymorphic variants of DNA repair and detoxification genes in patients with multiple sclerosis (MS) who developed secondary acute promyelocytic leukemia (sAPL), in most cases after treatment with mitoxantrone (MTZ). METHODS Using MassARRAY high-throughput DNA analysis with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, we genotyped patients with sAPL (n=20) developed after treatment of MS (18 out 20 treated with MTZ) for the presence of 210 SNPs of 22 genes mostly involved in DNA repair and drug detoxification. Patients with MS who did not develop sAPL including 41 treated with MTZ (n=253 and 41, respectively) and healthy blood donors (n=310) were also genotyped as controls. RESULTS We observed risk allele frequency between MS and sAPL for BRCA2 (rs1801406): 6% and 26%, p=0.007; XRCC5 (rs207906): 2.5% and 15%, p=0.016; CYP3A4 (rs2740574): 4.5% and 25%, p=0.0035. The association of homozygous variants of BRCA2 and XRCC5 yielded higher risk of sAPL (MS vs sAPL: 0.4% and 18%, p=0.001). We also observed a significant association between a SNP in the promoter region (rs2740574) of CYP3A4, an enzyme involved in the metabolism of chemotherapeutic agents and development of sAPL. CONCLUSIONS Increased susceptibility to develop sAPL in patients with MS receiving MTZ may be linked to genetic variants in DNA repair and drug-metabolizing enzymes that result in impaired detoxification of chemotherapy or inefficient repair of drug-induced genetic damage.
Collapse
Affiliation(s)
- S K Hasan
- Department of Biopathology, University Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Held K, Fischer R, Baukloh V, Munne S, Xu J, Yeoman R, Lawson M, Zelinski M, Stouffer R, Lim JJ, Choi KH, Kim HJ, Song SH, Lee WS, Kim YS, Kwak IP, Lee DR, Cervello Alcaraz I, Gil-Sanchis C, Mas A, Santamaria X, Moscardo F, Sanz J, Higueras G, Sanz MA, Pellicer A, Simon C, Wyns C, Van Langendonckt A, Donnez J, Poels J. SELECTED ORAL COMMUNICATION SESSION, SESSION 22: FERTILITY PRESERVATION - BASIC, Monday 4 July 2011 15:15 - 16:30. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.22] [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: 11/12/2022] Open
|
14
|
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]
|
15
|
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]
|
16
|
Valencia A, Román-Gómez J, Cervera J, Such E, Barragán E, Bolufer P, Moscardó F, Sanz GF, Sanz MA. Wnt signaling pathway is epigenetically regulated by methylation of Wnt antagonists in acute myeloid leukemia. Leukemia 2009; 23:1658-66. [PMID: 19387464 DOI: 10.1038/leu.2009.86] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Activation of the Wnt signaling pathway has been implicated recently in the pathogenesis of leukemia. We studied the function of epigenetic regulation of the Wnt pathway and its prognostic relevance in acute myelogenous leukemia (AML). We used a methylation-specific polymerase chain reaction approach to analyze the promoter methylation status of a panel of Wnt antagonists including sFRP1, sFRP2, sFRP4, sFRP5, DKK1 and DKK3. Aberrant methylation of Wnt antagonists was detected in four AML cell lines and in up to 64% of AML marrow samples. Treatment of the cell lines with 5-aza-2'-deoxycytidine induced reexpression of methylated Wnt antagonists and inactivation of the Wnt pathway by downregulating the Wnt pathway genes cyclin D1, TCF1 and LEF1 and reducing nuclear localization of beta-catenin. In a subgroup of patients 60 years and younger with newly diagnosed AML and intermediate-risk cytogenetics, abnormal methylation of Wnt antagonists was associated with decreased 4-year relapse-free survival (28 vs 61%, respectively, P=0.03). Our results indicate a function of the epigenetic regulation of the Wnt pathway in predicting relapse in a subgroup of AML patients.
Collapse
Affiliation(s)
- A Valencia
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Bosca I, Pascual AM, Casanova B, Coret F, Sanz MA. FOUR NEW CASES OF THERAPY-RELATED ACUTE PROMYELOCYTIC LEUKEMIA AFTER MITOXANTRONE. Neurology 2008; 71:457-8. [DOI: 10.1212/01.wnl.0000324422.69067.e7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
18
|
de la Rubia J, de Arriba F, Arbona C, Pascual MJ, Zamora C, Insunza A, Martinez D, Paniagua C, Diaz MA, Sanz MA. Follow-up of healthy donors receiving granulocyte colony-stimulating factor for peripheral blood progenitor cell mobilization and collection. Results of the Spanish Donor Registry. Haematologica 2008; 93:735-40. [DOI: 10.3324/haematol.12285] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
19
|
Sanz J, Arriaga F, Montesinos P, Ortí G, Lorenzo I, Cantero S, Puig N, Moscardó F, de la Rubia J, Sanz G, Sanz MA. Autoimmune hemolytic anemia following allogeneic hematopoietic stem cell transplantation in adult patients. Bone Marrow Transplant 2007; 39:555-61. [PMID: 17351645 DOI: 10.1038/sj.bmt.1705641] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [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]
Abstract
Autoimmune hemolytic anemia (AIHA) after allogeneic hematopoietic stem cell transplantation (HSCT) is still not well characterized. The aim of this study was to analyze the incidence and risk factors for the development of AIHA, as well as its prognosis and response to treatment in a series of patients undergoing allogeneic HSCT at a single institution. Between 1996 and 2004, 272 adult patients with a variety of malignant hematopoietic disorders underwent allogeneic HSCT. Direct antiglobulin testing was performed in routine pretransfusion compatibility testing or after clinical suspicion of AIHA. Twelve patients developed AIHA after HSCT at a median time of 147 days (range, 41-170). The 3-year cumulative incidence of AIHA was 4.44%. Eight cold antibodies and four warm antibodies were detected. Multivariate analysis shows that HSCT from unrelated donors (P=0.02) and the development of chronic extensive graft-versus-host disease (GVHD) (P=0.0004) were the only independent factors associated with AIHA. Two patients are still alive. AIHA was never the primary cause of death but added morbidity in patients with other concomitant complications. Patients undergoing HSCT from unrelated donors and those who develop chronic extensive GVHD are especially predisposed for this complication.
Collapse
Affiliation(s)
- J Sanz
- Hematology Department, Hospital Universitario La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Sanz MA, Labopin M, Gorin NC, de la Rubia J, Arcese W, Meloni G, Bacigalupo A, Alessandrino P, Carreras E, Iriondo A, Novitzky N, Jacobs P, Bandini G, Lo-Coco F, Frassoni F, Rocha V. Hematopoietic stem cell transplantation for adults with acute promyelocytic leukemia in the ATRA era: a survey of the European Cooperative Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2007; 39:461-9. [PMID: 17322930 DOI: 10.1038/sj.bmt.1705620] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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: 11/10/2022]
Abstract
We performed a survey of the European Cooperative Group for Blood and Marrow Transplantation to analyze the outcome of 625 acute promyelocytic leukemia (APL) patients transplanted with auto- or allogeneic-hematopoietic stem cell transplantation (autoHSCT, alloHSCT) after 1993, in first (CR1) or in second complete remission (CR2). Leukemia-free survival (LFS) at 5 years in CR1 was 69% for 149 patients autografted and 68% for 144 patients allografted, whereas in CR2, LFS was 51% in 195 autoHSCT and 59% in 137 alloHSCT recipients, respectively. In the group of autoHSCT for CR1 (n=149), higher relapse incidence (RI) was associated with shorter time from diagnosis to transplant (<7.6 months); transplant-related mortality (TRM) was increased in older patients (>47 years), whereas for CR2, longer time from diagnosis to transplant (>18 months) was associated with increased LFS and decreased RI. In the alloHSCT group for CR1 (n=144), age (<33 years) was associated with increased LFS and decreased TRM and for CR2 (n=137), the use of mobilized peripheral blood stem cells was associated with decreased TRM. Female recipient, a female donor to male recipient and transplants performed before 1997 were associated with decreased RI. In conclusion, HSCT still appears to have a role in APL, especially for patients in CR2.
Collapse
Affiliation(s)
- M A Sanz
- Hematology Service, Hospital Universitario La Fe, Valencia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Esteve J, Escoda L, Martín G, Rubio V, Díaz-Mediavilla J, González M, Rivas C, Alvarez C, González San Miguel JD, Brunet S, Tomás JF, Tormo M, Sayas MJ, Sánchez Godoy P, Colomer D, Bolufer P, Sanz MA. Outcome of patients with acute promyelocytic leukemia failing to front-line treatment with all-trans retinoic acid and anthracycline-based chemotherapy (PETHEMA protocols LPA96 and LPA99): benefit of an early intervention. Leukemia 2007; 21:446-52. [PMID: 17205057 DOI: 10.1038/sj.leu.2404501] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [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
To determine prognosis of acute promyelocytic leukemia (APL) failing to front-line therapy with all-trans retinoic acid (ATRA) and anthracyclines, outcome of 52 patients (32 M/20 F; age: 37, 3-72) included in PETHEMA trials LPA96 and LPA99 who presented with either molecular failure (MOLrel, n=16) or hematological relapse (HEMrel, n=36) was analyzed. Salvage therapy consisted of ATRA and high-dose ara-C-based chemotherapy (HDAC) in most cases (83%), followed by stem-cell transplantation (autologous, 18; allogeneic, 10; syngeneic, 1). Fourteen patients with MOLrel (88%) achieved second molecular complete response (molCR), whereas 81% HEMrel patients responded to second-line treatment, with 58% molCR. After median follow-up of 45 months, four MOLrel and 18 HEMrel patients, respectively, experienced a second relapse. Outcome after MOLrel compared favorably to HEMrel, with longer survival (5-year survival: 64+/-14 vs 24+/-8%, P=0.01) and lower relapse risk (5-year relapse risk: 30+/-13 vs 64+/-9%; P=0.044). Additionally, age <or=40 and male gender were favorable variables for survival, whereas molecular response predicted longer leukemia-free survival. In conclusion, early institution of salvage therapy at molecular failure, before onset of hematological relapse, is beneficial in APL. Moreover, given the poor outcome of HEMrel managed with ATRA and HDAC, use of alternative therapeutic strategies in this setting is warranted.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/blood
- Child
- Child, Preschool
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Etoposide/administration & dosage
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Idarubicin/administration & dosage
- Kaplan-Meier Estimate
- Leukemia, Promyelocytic, Acute/blood
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/mortality
- Leukemia, Promyelocytic, Acute/pathology
- Leukemia, Promyelocytic, Acute/surgery
- Liposomes/administration & dosage
- Male
- Middle Aged
- Mitoxantrone/administration & dosage
- Neoplasm, Residual
- Oncogene Proteins, Fusion/blood
- Prognosis
- Recurrence
- Remission Induction
- Salvage Therapy
- Survival Analysis
- Time Factors
- Treatment Outcome
- Tretinoin/administration & dosage
Collapse
Affiliation(s)
- J Esteve
- Hospital Clínic, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
de Botton S, Sanz MA, Chevret S, Dombret H, Martin G, Thomas X, Mediavilla JD, Recher C, Ades L, Quesnel B, Brault P, Fey M, Wandt H, Machover D, Guerci A, Maloisel F, Stoppa AM, Rayon C, Ribera JM, Chomienne C, Degos L, Fenaux P. Extramedullary relapse in acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Leukemia 2006; 20:35-41. [PMID: 16307026 DOI: 10.1038/sj.leu.2404006] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [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: 12/13/2022]
Abstract
We analyzed the incidence, presenting features, risk factors of extramedullary (EM) relapse occurring in acute promyelocytic leukemia (APL) treated with all-trans retinoic acid (ATRA) and chemotherapy by using a competing-risk method. In total, 740/ 806 (92%) patients included in three multicenter trials (APL91, APL93 trials and PETHEMA 96) achieved CR, of whom 169 (23%) relapsed, including 10 EM relapses. Nine relapses involved the central nervous system (CNS) and one the skin, of which two were isolated EM relapse. In patients with EM disease, median WBC count was 26950/mm3 (7700-162000). The 3-year cumulative incidence of EM disease at first relapse was 5.0%. Univariate analysis identified age <45 years (P=0.05), bcr3 PML-RARalpha isoform (P= 0.0003) and high WBC counts (> or = 10,000/ mm3) (P<0.0001) as risk factors for EM relapse. In multivariate analysis, only high WBC count remained significant (P= 0.001). Patients with EM relapse had a poorer outcome since median survival from EM relapse was 6.7 months as compared to 26.3 months for isolated BM relapse (P=0.04). In conclusion, EM relapse in APL occurs more frequently in patients with increased WBC counts (> or = 10,000/mm3) and carries a poor prognosis. Whether CNS prophylaxis should be systematically performed in patients with WBC > or = 10,000/mm3 at diagnosis remains to be established.
Collapse
|
23
|
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
|
24
|
Heil G, Hoelzer D, Sanz MA, Lechner K, Noens L, Szer J, Ganser A, Matcham J, Renwick J. Long-term survival data from a phase 3 study of Filgrastim as an adjunct to chemotherapy in adults with de novo acute myeloid leukemia. Leukemia 2006; 20:404-9. [PMID: 16424872 DOI: 10.1038/sj.leu.2404090] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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
We previously reported the results of a double-blind, placebo-controlled study of Filgrastim in patients with de novo AML undergoing induction and consolidation chemotherapy. The study demonstrated that Filgrastim was effective and well tolerated and had no impact on complete remission or survival. We now report follow-up data on these patients, assessing long-term effects with emphasis on prognostic indicators. After a median follow-up of 7 years, 434 (83%) patients were dead, 73 (14%) were alive, and 14 (3%) were lost to follow-up. The proportions of deaths were similar in the Filgrastim (83%) and placebo (84%) groups. No differences in median time to death (1.04 years Filgrastim, 1.13 years placebo; P = 0.97) or median disease-free survival (0.86 years Filgrastim, 0.79 years placebo; P = 0.52) were evident. Proportional hazard modeling identified age, performance status, and French-American-British subtype as independent predictors for survival (P < 0.001, P = 0.005, and P = 0.036, respectively), whereas cytogenetic status was not (P = 0.118). Filgrastim had no effect on overall survival in any of these subgroup analyses as none of the treatment comparisons were statistically significant. These findings indicate that Filgrastim can be effectively used to support patients with AML undergoing induction and consolidation chemotherapy without worsening long-term disease outcome.
Collapse
Affiliation(s)
- G Heil
- Department of Internal Medicine, University of Ulm, Ulm, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
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
|
26
|
Sanz MA, Martin G, Vellenga E, Bolufer P, Gonzalez M, Rayon C, de la Serna J, Parody R, Bergua J, Negri S, Rivas C. Risk-adapted treatment of acute promyelocytic leukemia: Updated results of the Spanish PETHEMA LPA99 Trial using ATRA and anthracycline monochemotherapy. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6515] [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: 11/20/2022] Open
Affiliation(s)
- M. A. Sanz
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - G. Martin
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - E. Vellenga
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - P. Bolufer
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - M. Gonzalez
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - C. Rayon
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - J. de la Serna
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - R. Parody
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - J. Bergua
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - S. Negri
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| | - C. Rivas
- on behalf of the PETHEMA, HOVON and GATLA Groups, Valencia, Spain
| |
Collapse
|
27
|
Valcárcel D, Martino R, Sureda A, Canals C, Altés A, Briones J, Sanz MA, Parody R, Constans M, Villela SL, Brunet S, Sierra J. Conventional versus reduced-intensity conditioning regimen for allogeneic stem cell transplantation in patients with hematological malignancies. Eur J Haematol 2005; 74:144-51. [PMID: 15654906 DOI: 10.1111/j.1600-0609.2004.00360.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [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: 11/26/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (HSCT) from human leukocyte antigen (HLA)-compatible sibling donors is a potential curative treatment for hematological and non-hematological malignancies. Nevertheless, high mortality rates may be associated with this therapy, especially in older patients, those with other comorbidities or who receive a second HSCT. PATIENTS AND METHODS We analyzed the factors associated with transplant-related mortality (TRM) and overall survival in 157 consecutive adult patients (104 males and 53 females) who received a HSCT [29 bone marrow (BM) transplantation and 128 peripheral blood (PB) transplantation] from a HLA-identical sibling between January 1995 and March 2002 in our institution. One hundred patients received a standard conditioning prior to HSCT (STAND) and 57 patients received a reduced-intensity conditioning (RIC) HSCT. Fifty-eight patients were in an early phase at transplant and 99 in a non-early phase. Median age was 46 yr (16-66), and 90 patients (57%) were >45 yr of age. RESULTS Patients in the RIC group were older than those in the STAND group, and had a higher proportion of non-early disease phases including a prior autologous HSCT in 39%. Median follow-up for survivors was 28 and 15 months in the STAND and RIC groups (P < 0,001), respectively. Cumulative incidence of TRM at 2 yr was 30% [95% confidence interval (CI) 22-41%] for the STAND group and 22% (95% CI 13-37%) for the RIC group [non-significant (NS)]. Factors associated with a higher TRM in multivariate analysis were: STAND vs. RIC conditioning regimen [relative risk (RR) 5.4; 95% CI 2.3-12.8; P < 0.001]; age > or =45 yr vs. <45 yr (RR 5; 95% CI 2.4-10.8, P < 0.001); second vs. first HSCT (RR 2.8, 95% CI 1.3-6.3, P = 0.01) and non-T-cell-depleted vs. T-cell-depleted graft (RR 2.7, 95% CI 1.3-5.8, P = 0.009). Overall survival (OS) at 2 yr was 52.5 +/- 10.4% for STAND group and 59 +/- 16.8% in RIC group. Factors associated with poorer OS in multivariate analysis were: STAND vs. RIC conditioning regimen (RR 3.4, 95% CI 1.7-6.9, P = 0.001); age > or =45 vs <45 yr (RR 2.5, 95% CI 1.4-4.5, P = 0.002) and diagnosis [other than chronic myeloid leukemia (CML) vs. CML] (RR 2.6, 95% CI 1.2-5.7 P = 0.02). CONCLUSIONS Our results indicate that the introduction of RIC allogeneic HSCT for patients at high risk for TRM (advanced age, prior HSCT and non-T-cell depletion) leads to a reduction in the TRM and improvement in the OS.
Collapse
Affiliation(s)
- D Valcárcel
- Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
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
|
29
|
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
|
30
|
Sanz MA, Granizo N, Gradzielski M, Rodrigo MM, Valiente M. Mixed micellar systems of octyl ?,d-glucopyranoside with a nonionic surfactant and a water-soluble polymer. Colloid Polym Sci 2004. [DOI: 10.1007/s00396-004-1195-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Geissler K, Yin JAL, Ganser A, Sanz MA, Szer J, Raghavachar A, Hoelzer D, Martinez C, Taylor K, Kanz L, To LB, Archimbaud E. Prior and concurrent administration of recombinant human megakaryocyte growth and development factor in patients receiving consolidation chemotherapy for de novo acute myeloid leukemia?a randomized, placebo-controlled, double-blind safety and efficacy study. Ann Hematol 2003; 82:677-83. [PMID: 14530872 DOI: 10.1007/s00277-003-0737-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2003] [Accepted: 07/08/2003] [Indexed: 10/26/2022]
Abstract
Pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMGDF) administered after acute myeloid leukemia (AML) chemotherapy (CT) failed to shorten the time of transfusion-dependent thrombocytopenia in a previous study. In this multicenter, randomized, placebo-controlled, double-blind study we determined the effect of administration of PEG-rHuMGDF prior to CT and of administration prior, concurrent, and 1 day post CT on platelet recovery and transfusion requirements in patients receiving consolidation CT for de novo AML. Patients were randomized to receive either 30 microk/kg PEG-rHuMGDF as a single dose on day -6 ( n=37), placebo as a single dose on day -6 ( n=9), 30 microk/kg PEG-rHuMGDF administered on day -6 followed by 10 microg/kg on days -5 to day 6 (through CT and including the day after CT, n=35), or placebo administered on day -6 to day 6 ( n=9). The median times to transfusion-independent platelet recovery to >20x10(9)/l were 24.5 and 24.0 days in the PEG-rHuMGDF day -6 group and PEG-rHuMGDF day -6 to 6, respectively, compared to 21.0 days in the placebo group. There were no significant differences in the number of days of platelet transfusions between either PEG-rHuMGDF schedule or placebo. The PEG-rHuMGDF day -6 to 6 group had a delayed absolute neutrophil count (ANC) recovery compared to either placebo or PEG-rHuMGDF day -6 treated patients. Thus, alteration of the scheduling of PEG-rHuMGDF in terms of earlier dosing before and during chemotherapy did not improve platelet recovery but rather delayed hematopoietic reconstitution. Although unexpected, these observations may be of major relevance for the design of future clinical trials with recombinant thrombopoietins.
Collapse
|
32
|
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
|
33
|
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
|
34
|
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
|
35
|
Abstract
Umbilical cord blood (UCB) has emerged as an appealing alternative source of hematopoietic stem cells for unrelated donor transplantation. Shorter time to transplant and an improved chance of finding a suitable graft are evident advantages over bone marrow transplantation from unrelated donors. The majority of UCB transplants from unrelated donors have been performed in children, but the number in adults has been growing steadily in recent years. We review herein the reported experience with that source of hematopoietic stem cells in adults with hematological malignancies. The available data support the use of UCB transplantation from unrelated donors for young adults with hematological malignancies and no appropriate bone marrow donor, especially for those requiring urgent transplantation.
Collapse
Affiliation(s)
- M A Sanz
- Bone Marrow Transplantation Unit, Hematology Service, Hospital Universitario La Fe, Valencia, Spain
| | | |
Collapse
|
36
|
Valcárcel D, Sanz MA, Sureda A, Sala M, Muñoz L, Subirá M, Laborda R, Clopés A, Sierra J. Mouth-washings with recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) do not improve grade III-IV oropharyngeal mucositis (OM) in patients with hematological malignancies undergoing stem cell transplantation. Results of a randomized double-blind placebo-controlled study. Bone Marrow Transplant 2002; 29:783-7. [PMID: 12040477 DOI: 10.1038/sj.bmt.1703543] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2001] [Accepted: 02/19/2002] [Indexed: 11/08/2022]
Abstract
We investigated whether daily oral washings with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) solution improved grade III-IV oropharyngeal mucositis (OM) in patients with hematological malignancies undergoing stem cell transplantation. Forty-one consecutive patients (21 males and 20 females, median age (range) 44 (16-69) years) were prospectively randomized to perform daily mouth-washes with either a 400 microg rhGM- CSF (Molgramostin, Schering-Plough) solution (group A, n = 18) or with a saline solution (group B, n = 23). Primary end-points were the intensity of OM, night rest quality and characteristics of food intake. Secondary end-points were need for and duration of parenteral nutrition, oral and intravenous analgesic requirements, incidence of viral or fungal oral infections and development of neutropenic fever. No differences were found between the placebo and rhGM-CSF-treated groups regarding overall duration of OM, maximum grade, reduction in at least one grade of OM (nine patients (56%) in group A vs 13 patients (68%) in group B), reduction of spontaneous or swallowing-induced pain, improvement in oral food intake, use of parenteral nutrition or use of systemic analgesics. In conclusion, mouth-washings with a 400 microg of rhGM-CSF solution do not improve severe OM in hematological patients undergoing stem cell transplantation.
Collapse
Affiliation(s)
- D Valcárcel
- Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
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
|
38
|
Arranz R, Conde E, Rodriguez-Salvanés F, Pajuelo FJ, Cabrera R, Sanz MA, Petit J, Bueno J, Maldonado J, Odriozola J, Conde JG, Brunet S, Carreras E, Iriondo A, Fernández-Rañada JM, Marín P. CsA-based post-graft immunosuppression: the main factor for improving outcome of allografted patients with acquired aplastic anemia. A retrospective survey by the Spanish Group of Hematopoietic Transplantation. Bone Marrow Transplant 2002; 29:205-11. [PMID: 11859392 DOI: 10.1038/sj.bmt.1703349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 06/04/2001] [Accepted: 10/04/2001] [Indexed: 11/08/2022]
Abstract
A retrospective multicenter study was performed to assess the clinical results in patients with acquired aplastic anemia (AA) allografted over a 19 year period and to identify prognostic factors influencing survival. From April 1978 to December 1997, 176 patients were transplanted. Records from 160 receiving related matched bone marrow transplantation (BMT) were reviewed. Fifty-two percent of the patients were older than 20 years, 5% older than 40; 6.3% were untransfused at BMT and 56.2% had received prior treatments. Conditioning regimens were with chemotherapy in 43.7% of the procedures and with additional irradiation in 56.3%. Graft-versus-host disease (GVHD) prophylaxis was based on cyclosporin A (CsA) in 58.1% of the patients while methotrexate (MTX) was administered to 41.9%. Transplantation earlier on, a longer interval from diagnosis to BMT, GVHD prophylaxis with MTX, graft failure/rejection and acute severe GVHD were adverse factors for survival. The use of CsA emerged as the main factor for the improvement, inducing a significant decrease in graft failure/rejection rate and severe acute GVHD when compared with MTX alone. Radiation-containing regimens decreased the graft failure/rejection rate without improving survival due to the increased risk of acute GVHD. Age and number of transfusions pretransplant did not influence outcome. Survival achieved since 1991 is 79.79%, and graft failure and acute severe GVHD rates are 6.0% and 11.8%, respectively. In conclusion, CsA-based post-graft immunosuppression has been crucial in achieving improved survival in patients with acquired AA up to 40 years of age. Regardless of CsA use, further improvement in survival was apparent with time, probably due to better skills in patient care.
Collapse
Affiliation(s)
- R Arranz
- Hematology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Sanz MA, Martin G, Rayón C, Debén G, Tormo M, Díaz-Mediavilla J, Esteve J, González-San Miguel JD. Uncertain role of increased intensity chemotherapy with high-dose cytarabine in acute promyelocytic leukemia. Leukemia 2001; 15:1999-2002. [PMID: 11753627 DOI: 10.1038/sj.leu.2402297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2000] [Accepted: 06/13/2001] [Indexed: 11/08/2022]
|
40
|
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
|
41
|
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
|
42
|
Sanz MA, Valcárcel D, Sureda A, Muñoz L, Espinosa I, Nomdedeu J, Sierra J. Systemic mast cell disease associated with B-chronic lymphocytic leukemia. Haematologica 2001; 86:1106-7. [PMID: 11602421] [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: 02/21/2023] Open
|
43
|
de la Rubia J, Arriaga F, Linares D, Larrea L, Carpio N, Marty ML, Sanz MA. Role of methylene blue-treated or fresh-frozen plasma in the response to plasma exchange in patients with thrombotic thrombocytopenic purpura. Br J Haematol 2001; 114:721-3. [PMID: 11553005 DOI: 10.1046/j.1365-2141.2001.02991.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [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
Twenty patients with thrombotic thrombocytopenic purpura (TTP) underwent plasma exchange using either standard fresh-frozen plasma (Group A, n = 13) or methylene blue-treated plasma (Group B, n = 7). Both groups presented similar characteristics except that bilirubin values were higher in Group A (P < 0.05). The complete remission rate was higher in Group A than B (69% versus 57%). The mean number of procedures was higher in Group B (21 +/- 7 versus 11 +/- 3, P < 0.01) and the mean duration of hospitalization was also longer (37 +/- 12 d versus 22 +/- 11 d; P < 0.01). Our study shows that the use of methylene blue-treated fresh-frozen plasma to treat TTP is associated with a higher number of plasma exchanges and greater transfusion requirements without improving clinical results.
Collapse
Affiliation(s)
- J de la Rubia
- Haematology Service, University Hospital La Fe, Valencia, Spain
| | | | | | | | | | | | | |
Collapse
|
44
|
Hernández JM, Martín G, Gutiérrez NC, Cervera J, Ferro MT, Calasanz MJ, Martínez-Climent JA, Luño E, Tormo M, Rayón C, Díaz-Mediavilla J, González M, González-San Miguel JD, Pérez-Equiza K, Rivas C, Esteve J, Alvarez MDC, Odriozola J, Ribera JM, Sanz MA. Additional cytogenetic changes do not influence the outcome of patients with newly diagnosed acute promyelocytic leukemia treated with an ATRA plus anthracyclin based protocol. A report of the Spanish group PETHEMA. Haematologica 2001; 86:807-13. [PMID: 11522536] [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: 02/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To analyze in patients with de novo acute promyelocytic leukemia (APL) treated with an ATRA plus anthracyclin-based protocol if the presence of additional cytogenetic aberrations to the t(15;17) influences: 1. clinical and biological presenting features; 2. disease outcome. DESIGN AND METHODS One hundred and thirteen patients with newly diagnosed APL enrolled in the APL-96 protocol of the Spanish PETHEMA group were studied by conventional karyotyping, FISH and RT-PCR for the PML-RARa fusion. Treatment was homogeneous in all cases and consisted of anthracyclines and ATRA. RESULTS Additional chromosome aberrations were observed in 30% of cases. The most frequent secondary changes were +8 (14 cases), and abnormalities of chromosomes 9 or 3 (4 patients each), and of chromosomes 1 and 8 (3 cases each). No clinical, biological, morphological, immunophenotypic or molecular differences were observed between the group of APLs with t(15;17) alone and the group of patients with additional changes. Patients with additional changes had a higher rates of complete remission (CR) and 4-year disease-free survival (DFS) (97%, and 97%, respectively) than patients with t(15;17) alone (CR, 70% and DFS, 84%) but these differences were not statistically significant. INTERPRETATION AND CONCLUSIONS Patients with APL and additional cytogenetic abnormalities do not show different clinical, biological, morphological or molecular features as compared to patients with t(15;17) alone. The prognosis of patients with APL and t(15;17) alone and those with additional changes is similar in both groups. This study indicates that there is no rationale for administering more intensive treatment in APL patients with additional cytogenetic abnormalities receiving ATRA plus anthracycline-based chemotherapy.
Collapse
Affiliation(s)
- J M Hernández
- Servicio de Hematología, Hospital Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
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
|
46
|
Sanz MA, Carrasco L. Sindbis virus variant with a deletion in the 6K gene shows defects in glycoprotein processing and trafficking: lack of complementation by a wild-type 6K gene in trans. J Virol 2001; 75:7778-84. [PMID: 11462055 PMCID: PMC115018 DOI: 10.1128/jvi.75.16.7778-7784.2001] [Citation(s) in RCA: 41] [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: 11/20/2022] Open
Abstract
A Sindbis virus (SV) variant with a 6K gene partially deleted has been obtained. This SV Del6K virus is defective in the proteolytic processing of virus glycoprotein precursor, transport of glycoproteins to the plasma membrane, and plaque phenotype. A revertant virus (SV Del6K-revQ21L) containing a point mutation in the deleted 6K gene was isolated and characterized. SV Del6K-revQ21L has corrected the defects of proteolytic processing and transport of virus glycoproteins to the plasma membrane, but it still remains attenuated compared to wild-type (wt) SV, exhibiting defects in virus budding. Neither mutant nor revertant viruses are complemented by the coexpression in trans of a wt SV 6K gene.
Collapse
Affiliation(s)
- M A Sanz
- Centro de Biología Molecular, Universidad Autónoma de Madrid, Cantoblanco, 28049 Madrid, Spain.
| | | |
Collapse
|
47
|
Barragán E, Bolufer P, Moreno I, Martín G, Nomdedeu J, Brunet S, Fernández P, Rivas C, Sanz MA. Quantitative detection of AML1-ETO rearrangement by real-time RT-PCR using fluorescently labeled probes. Leuk Lymphoma 2001; 42:747-56. [PMID: 11697505 DOI: 10.3109/10428190109099337] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/13/2022]
Abstract
The persistence of the AML1-ETO rearrangement performed by reverse transcription polymerase chain reaction (RT-PCR) has been reported in acute myeloid leukemia (AML) patients in long-term complete remission (CR). This persistence, which is not associated with hematological relapse, limits the clinical use of qualitative RT-PCR. Here, we present a new quantitative real-time PCR method to detect AML1-ETO rearrangement using fluorescently labeled probes. Quantitative detection of AML1-ETO was performed in capillary tubes using two fluorescently labeled probes in the LightCycler equipment. The reliability of the method was checked in twenty-two bone marrow samples and one apheresis sample from eight patients with t(8;21) collected at diagnosis and during follow-up assessment. The regression coefficients obtained for standard curves of AML1-ETO and AML were all greater than 0.98. The sensitivity attained allowed the detection of rearrangements at a dilution of 10(-5) Kasumi-1 cDNA. The intra-assay coefficient of variation was 4% for AML1-ETO, and 7% for AML. The inter-assay coefficient of variation was 19% for AML1-ETO and 12% for AML. A log reduction from two to four in the AML1-ETO/AML ratio was evident after CR. The study of the method and first results obtained in patient samples support that quantitative real-time PCR with hybridization probes is a new reliable and sensitive method to monitor minimal residual disease in AML patients. Moreover, the fluorescent probes with the Light-Cycler technology offer the advantage of a rapid detection.
Collapse
Affiliation(s)
- E Barragán
- Department of Clinical Pathology, Hospital Universitario La Fe Valencia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Gomis F, Moscardó F, Mayordomo F, Martín G, Sempere A, Sanz MA. Bone marrow infiltrate by atypical histiocytic cells with cytoplasmatic Birbeck granules as initial presentation of an acute monoblastic leukemia. Haematologica 2001; 86:879-80. [PMID: 11524254] [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: 02/21/2023] Open
|
49
|
Moscardó F, Pérez F, de la Rubia J, Balerdi B, Lorenzo JI, Senent ML, Aznar I, Carceller S, Sanz MA. Successful treatment of severe intra-abdominal bleeding associated with disseminated intravascular coagulation using recombinant activated factor VII. Br J Haematol 2001; 114:174-6. [PMID: 11472364 DOI: 10.1046/j.1365-2141.2001.02878.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [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
Recombinant activated factor VII (rFVIIa) is indicated mainly for the treatment of patients with haemophilia and inhibitors. However, little information is available on the use of rFVIIa in the treatment of the severe bleeding associated with disseminated intravascular coagulation (DIC). We report a pregnant woman with DIC, who developed severe intra-abdominal bleeding after caesarean section. Despite treatment with fresh-frozen plasma, fibrinogen, platelet transfusions and surgery, the abdominal bleeding persisted and intravenous treatment with rFVIIa was initiated. The response to treatment was rapid, with control of the bleeding and resolution of the coagulopathy. No side-effects related to rFVIIa were noted. This case suggests a potential role for rFVIIa in the treatment of severe and refractory bleeding associated with DIC.
Collapse
Affiliation(s)
- F Moscardó
- Department of Haematology, Hospital Universitario La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
González M, Barragán E, Bolufer P, Chillón C, Colomer D, Borstein R, Calasanz MJ, Gómez-Casares MT, Villegas A, Marugán I, Román J, Martín G, Rayón C, Debén G, Tormo M, Díaz-Mediavilla J, Esteve J, González-San Miguel J, Rivas C, Pérez-Equiza K, García-Sanz R, Capote FJ, Ribera JM, Arias J, León A, Sanz MA. Pretreatment characteristics and clinical outcome of acute promyelocytic leukaemia patients according to the PML-RAR alpha isoforms: a study of the PETHEMA group. Br J Haematol 2001; 114:99-103. [PMID: 11472351 DOI: 10.1046/j.1365-2141.2001.02915.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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: 11/20/2022]
Abstract
Of 167 newly diagnosed acute promyelocytic leukaemia patients, 83 patients were long (L)-form (50%), eight variable (V)-form (5%) and 76 short (S)-form (45%). The V-form and S-form groups presented a significantly higher percentage of patients with white blood cell counts > 10 x 10(9)/l (P < 0.05). The S-form cases displayed a significantly higher number of cases with M3v microgranular features (P = 0.005) and CD34 expression (P < 0.0001). There were no differences between the three isoforms in complete remission (CR) rate (overall CR 90%), but the 3-year disease-free survival was lower for V-form cases than it was for L- and S-form cases (62% vs. 94% and 89%, P = 0.056). We conclude that the V-form and S-form types are associated with some negative prognostic features at diagnosis. However, our data were only able to demonstrate an association with adverse prognosis in the V-form type and, moreover, as the number of cases was limited, needs to be confirmed in large, uniformly treated series.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Antigens, CD34/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Disease-Free Survival
- Female
- Humans
- Infant
- Infant, Newborn
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/immunology
- Leukemia, Promyelocytic, Acute/metabolism
- Leukocyte Count
- Male
- Middle Aged
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Polymerase Chain Reaction/methods
- Prognosis
- Proportional Hazards Models
- Protein Isoforms/genetics
- Treatment Outcome
- Tretinoin/therapeutic use
Collapse
Affiliation(s)
- M González
- Department of Haematology, Hospital Universitario, Salamanca, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|