1
|
González-López TJ, Pascual C, Álvarez-Román MT, Fernández-Fuertes F, Sánchez-González B, Caparrós I, Jarque I, Mingot-Castellano ME, Hernández-Rivas JA, Martín-Salces M, Solán L, Beneit P, Jiménez R, Bernat S, Andrade MM, Cortés M, Cortti MJ, Pérez-Crespo S, Gómez-Núñez M, Olivera PE, Pérez-Rus G, Martínez-Robles V, Alonso R, Fernández-Rodríguez A, Arratibel MC, Perera M, Fernández-Miñano C, Fuertes-Palacio MA, Vázquez-Paganini JA, Gutierrez-Jomarrón I, Valcarce I, de Cabo E, Sainz A, Fisac R, Aguilar C, Paz Martínez-Badas M, Peñarrubia MJ, Calbacho M, de Cos C, González-Silva M, Coria E, Alonso A, Casaus A, Luaña A, Galán P, Fernández-Canal C, Garcia-Frade J, González-Porras JR. Successful discontinuation of eltrombopag after complete remission in patients with primary immune thrombocytopenia. Am J Hematol 2015; 90:E40-3. [PMID: 25400215 DOI: 10.1002/ajh.23900] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [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: 10/01/2014] [Revised: 11/04/2014] [Accepted: 11/10/2014] [Indexed: 01/05/2023]
Abstract
Eltrombopag is effective and safe in immune thrombocytopenia (ITP). Some patients may sustain their platelet response when treatment is withdrawn but the frequency of this phenomenon is unknown. We retrospectively evaluated 260 adult primary ITP patients (165 women and 95 men; median age, 62 years) treated with eltrombopag after a median time from diagnosis of 24 months. Among the 201 patients who achieved a complete remission (platelet count >100 × 10(9) /l), eltrombopag was discontinued in 80 patients. Reasons for eltrombopag discontinuation were: persistent response despite a reduction in dose over time (n = 33), platelet count >400 × 10(9) /l (n = 29), patient's request (n = 5), elevated aspartate aminotransferase (n = 3), diarrhea (n = 3), thrombosis (n = 3), and other reasons (n = 4). Of the 49 evaluable patients, 26 patients showed sustained response after discontinuing eltrombopag without additional ITP therapy, with a median follow-up of 9 (range, 6-25) months. These patients were characterized by a median time since ITP diagnosis of 46.5 months, with 4/26 having ITP < 1 year. Eleven patients were male and their median age was 59 years. They received a median of 4 previous treatment lines and 42% were splenectomized. No predictive factors of sustained response after eltrombopag withdrawal were identified. Platelet response following eltrombopag cessation may be sustained in an important percentage of adult primary ITP patients who achieved CR with eltrombopag. However, reliable markers for predicting which patients will have this response are needed.
Collapse
|
2
|
Ríos R, González-Silva M, Molina E, García-Fernández JR, Clavero ME, Durán JM, López-Berenguel F, Romero MM, Jiménez-Moleón JJ, Sánchez MJ, Sáinz J, Jurado M. The impact of the type of hospital on survival of multiple myeloma patients: the MICORE study. Rev Clin Esp 2013; 213:330-5. [PMID: 23562426 DOI: 10.1016/j.rce.2013.02.014] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/17/2013] [Accepted: 02/10/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To analyze the impact of the type of hospital in overall survival of multiple myeloma patients. PATIENTS AND METHOD A survival analysis was performed of all patients (n=431) diagnosed in 5 public hospitals (4 community hospitals and one university hospital) during the period 1993-2006. RESULTS Patients attended to in community hospitals differ significantly from those seen in the university hospital in the following variables: mean age (70 years [31-92] versus 67.9 (35-91), P=.038); percentage of stage iii patients (62.6% versus 69.1%, P=.033), and percentage of patients who had autologous stem cell transplant (8.2% versus 18.2%, P=.026). The variables associated with mortality in the multivariate analysis were age (P<.001), stage (iii versus i; P=.03) and renal failure (P=.04). The type of hospital did not reach statistical significance (hazard ratio of 0.72 (95% confidence interval 0.48-1.07), P=.1]. CONCLUSIONS The type of hospital is not significantly associated with mortality in multiple myeloma patients. These data support our current model of health care, in which the community hospitals are responsible for the primary care of these patients, in a coordinated work with the university hospital.
Collapse
Affiliation(s)
- R Ríos
- Servicio de Hematología-Hemoterapia, Hospital Universitario Virgen de las Nieves, Granada, España; Servicio de Hematología-Hemoterapia, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, España.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Matarraz S, Teodosio C, Fernandez C, Albors M, Jara-Acevedo M, López A, Gonzalez-Gonzalez M, Gutierrez ML, Flores-Montero J, Cerveró C, Pizarro-Perea M, Garrastazul MP, Caballero G, Gutierrez O, Mendez GD, González-Silva M, Laranjeira P, Orfao A. The proliferation index of specific bone marrow cell compartments from myelodysplastic syndromes is associated with the diagnostic and patient outcome. PLoS One 2012; 7:e44321. [PMID: 22952954 PMCID: PMC3432128 DOI: 10.1371/journal.pone.0044321] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/01/2012] [Indexed: 12/22/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are clonal stem cell disorders which frequently show a hypercellular dysplastic bone marrow (BM) associated with inefficient hematopoiesis and peripheral cytopenias due to increased apoptosis and maturation blockades. Currently, little is known about the role of cell proliferation in compensating for the BM failure syndrome and in determining patient outcome. Here, we analyzed the proliferation index (PI) of different compartments of BM hematopoietic cells in 106 MDS patients compared to both normal/reactive BM (n = 94) and acute myeloid leukemia (AML; n = 30 cases) using multiparameter flow cytometry. Our results show abnormally increased overall BM proliferation profiles in MDS which significantly differ between early/low-risk and advanced/high-risk cases. Early/low-risk patients showed increased proliferation of non-lymphoid CD34(+) precursors, maturing neutrophils and nucleated red blood cells (NRBC), while the PI of these compartments of BM precursors progressively fell below normal values towards AML levels in advanced/high-risk MDS. Decreased proliferation of non-lymphoid CD34(+) and NRBC precursors was significantly associated with adverse disease features, shorter overall survival (OS) and transformation to AML, both in the whole series and when low- and high-risk MDS patients were separately considered, the PI of NRBC emerging as the most powerful independent predictor for OS and progression to AML. In conclusion, assessment of the PI of NRBC, and potentially also of other compartments of BM precursors (e.g.: myeloid CD34(+) HPC), could significantly contribute to a better management of MDS.
Collapse
Affiliation(s)
- Sergio Matarraz
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Cristina Teodosio
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Carlos Fernandez
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Manuel Albors
- Servicio de Hematología, Hospital Juan Canalejo, La Coruña, Spain
| | - María Jara-Acevedo
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Antonio López
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - María Gonzalez-Gonzalez
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - María Laura Gutierrez
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Juan Flores-Montero
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Carlos Cerveró
- Servicio de Hematología, Hospital Virgen de la Luz, Cuenca, Spain
| | | | | | | | - Oliver Gutierrez
- Servicio de Hematología, Hospital Rio Hortega, Valladolid, Spain
| | - Guy Daniel Mendez
- Servicio de Hematología, Hospital de Jerez de la Frontera, Cádiz, Spain
| | | | - Paula Laranjeira
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Alberto Orfao
- Centro de Investigación del Cáncer (Instituto de Biología Celular y Molecular del Cáncer, CSIC-USAL), IBSAL, Servicio de Citometría and Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
- * E-mail:
| |
Collapse
|