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Ramos F, Hermosín ML, Fuertes-Núñez M, Martínez P, Rodriguez-Medina C, Barrios M, Ibáñez F, Bernal T, Olave MT, Álvarez MÁ, Vahí M, Caballero-Velázquez T, González B, Altés A, García L, Fernández P, Durán MA, López R, Rafel M, Serrano J. Survival Outcomes and Health-Related Quality of Life in Older Adults Diagnosed with Acute Myeloid Leukemia Receiving Frontline Therapy in Daily Practice. J Pers Med 2023; 13:1667. [PMID: 38138894 PMCID: PMC10744855 DOI: 10.3390/jpm13121667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023] Open
Abstract
Acute myeloid leukemia has a poor prognosis in older adults, and its management is often unclear due to its underrepresentation in clinical trials. Both overall survival (OS) and health-related quality-of-life (HRQoL) are key outcomes in this population, and patient-reported outcomes may contribute to patient stratification and treatment assignment. This prospective study included 138 consecutive patients treated in daily practice with the currently available non-targeted therapies (intensive chemotherapy [IC], attenuated chemotherapy [AC], hypomethylating agents [HMA], or palliative care [PC]). We evaluated patients' condition at diagnosis (Life expectancy [Lee Index for Older Adults], Geriatric Assessment in Hematology [GAH scale], HRQoL [EQ-5D-5L questionnaire], and fatigue [fatigue items of the QLQ-C30 scale]), OS, early death (ED), treatment tolerability (TT) and change in HRQoL over 12 months follow-up. The median OS was 7.1 months (IC not reached, AC 5.9, HMA 8.8, and PC 1.0). Poor risk AML category and receiving just palliative care, as well as a higher Lee index score in the patients receiving active therapy, independently predicted a shorter OS. The Lee Index and GAH scale were not useful for predicting TT. The white blood cell count was a valid predictor for ED. Patients' HRQoL remained stable during follow-up.
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Affiliation(s)
- Fernando Ramos
- Department of Hematology, Hospital Universitario de León, 24008 Leon, Spain
| | - María Lourdes Hermosín
- Department of Hematology, Hospital Universitario de Jerez de la Frontera, 11407 Jerez de la Frontera, Spain
| | | | - Pilar Martínez
- Department of Hematology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Carlos Rodriguez-Medina
- Department of Hematology, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - Manuel Barrios
- Department of Hematology, Hospital Regional Universitario de Málaga, 29010 Malaga, Spain
| | - Francisco Ibáñez
- Department of Hematology, Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Teresa Bernal
- Department of Hematology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Maria Teresa Olave
- Department of Hematology, Hospital Clinico Lozano Blesa, 50009 Zaragoza, Spain
| | | | - María Vahí
- Department of Hematology, Hospital Universitario Virgen de Valme, 41014 Sevilla, Spain
| | - Teresa Caballero-Velázquez
- Department of Hematology, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Bernardo González
- Department of Hematology, Hospital Universitario de Canarias, 38320 La Laguna, Spain
| | - Albert Altés
- Department of Hematology, Hospital Sant Joan de Deu de Manresa—Fundació Althaia, 08243 Manresa, Spain
| | - Lorena García
- Department of Hematology, Complejo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
| | - Pascual Fernández
- Department of Hematology, Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - María Antonia Durán
- Department of Hematology, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Rocío López
- Medical Department, Hematology Area, Bristol Myers Squibb Company, Celgene, 28050 Madrid, Spain
| | - Montserrat Rafel
- Medical Department, Hematology Area, Bristol Myers Squibb Company, Celgene, 28050 Madrid, Spain
| | - Josefina Serrano
- Department of Hematology, Hospital Universitario Reina Sofía, IMIBIC UCO, 14004 Cordoba, Spain
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Montoro MJ, Pomares H, Coll R, Bernal Del Castillo T, Tormo M, Jiménez A, Brunet S, Casaño J, Oiartzabal I, Díez-Campelo M, Ramos F, Romero R, Salido-Fiérrez E, Pedro C, Bargay J, Muñoz-Novas C, López R, Rafel M, Valcárcel D. Evaluation of the outcomes of newly diagnosed patients with high-risk myelodysplastic syndrome according to the initial therapeutical strategies chosen in usual clinical practice. Leuk Lymphoma 2023; 64:679-690. [PMID: 36577016 DOI: 10.1080/10428194.2022.2154604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases without a care standard and show variability in treatment outcomes. This Spanish, observational, prospective study ERASME (CEL-SMD-2012-01) assessed the evolution of newly diagnosed and treatment-naïve high-risk MDS patients (according to IPPS-R). 204 patients were included: median age 73.0 years, 54.4% males, 69.6% 0-1 ECOG, and 94.6% with comorbidities. Active treatment was the most common strategy (52.0%) vs. stem cell transplantation (25.5%) and supportive care/watchful-waiting (22.5%). Overall (median) event-free survival was 7.9 months (9.1, 8.3, and 5.3); progression-free survival: 10.1 months (12.9, 12.8, and 4.3); and overall survival: 13.8 months (15.4, 14.9; 8.4), respectively, with significant differences among groups. Adverse events (AEs) of ≥3 grade were reported in 72.6% of patients; serious AEs reported in 60.6%. 33.1% of patients died due to AEs. Three patients developed second primary malignant neoplasms (median: 8.2 months). Our study showed better outcomes in patients receiving active therapy early after diagnosis.
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Affiliation(s)
- Maria Julia Montoro
- Department of Hematology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Helena Pomares
- ICO-Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Rosa Coll
- ICO-Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | | | - Mar Tormo
- Hospital Clínico Universitario de Valencia e Instituto de Investigación INCLIVA, Valencia, Spain
| | - Ana Jiménez
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Salut Brunet
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Casaño
- Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | | | | | - Rafael Romero
- Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | - Joan Bargay
- Hospital Son Llàtzer, Palma de Mallorca, Spain
| | | | - Rocío López
- Celgene S.L.U., a Bristol-Myers Squibb Company, Madrid, Spain
| | | | - David Valcárcel
- Department of Hematology, Hospital Universitari Vall d´Hebron, Barcelona, Spain
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Rovira M, Jimenéz M, De La Bellacasa JP, Mensa J, Rafel M, Ortega M, Almela M, Martínez C, Fernández-Avilés F, Martínez JA, Urbano-Ispizua A, Carreras E, Montserrat E. Detection of Aspergillus galactomannan by enzyme immunoabsorbent assay in recipients of allogeneic hematopoietic stem cell transplantation: a prospective study. Transplantation 2004; 77:1260-4. [PMID: 15114095 DOI: 10.1097/01.tp.0000120536.20045.aa] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasive aspergillosis (IA) has become the leading infectious cause of death after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This is partially because of the lack of a sensitive, specific, and noninvasive diagnostic test. New diagnostic tests for IA, such as the detection of Aspergillus galactomannan antigen (AGA) by sandwich enzyme-linked immunoabsorbent assay (ELISA), have recently been described. This study validates the usefulness of this diagnostic tool in the allo-HSCT setting. METHODS From January 1999 to January 2001, all consecutive adult patients undergoing allo-HSCT were prospectively studied with a galactomannan antigenemia assay (ELISA test) twice weekly from admission until death or discharge, and weekly afterward if the patient received immunosuppressive therapy. Proven, probable, and possible IA were defined according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. RESULTS During the 2 years of study, 74 patients underwent an allo-HSCT. A total of 832 serum samples were collected. According to the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria, it was ascertained that 66 patients did not fulfill any criteria of IA, 2 patients were classified with possible IA, 5 patients were classified with probable IA, and 1 patient was classified with proven IA. Fourteen samples were positive for AGA, all from patients with IA. The sensitivity and specificity of the test were 75% and 100%, respectively. The positive predictive and negative predictive values were 100% and 97%, respectively. CONCLUSIONS In this study, AGA detection was clearly related to IA. Although the ELISA test did not have any role in the anticipation of the diagnosis, it clarifies the diagnosis of IA in allo-HSCT.
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Affiliation(s)
- Montserrat Rovira
- Bone Marrow Transplant Unit, Department of Hematology, Postgraduate School of Hematology Farreras-Valentí, Hospital Clinic, University of Barcelona, Spain.
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Bladé J, Perales M, Rosiñol L, Tuset M, Montoto S, Esteve J, Cobo F, Villela L, Rafel M, Nomdedeu B, Montserrat E. Thalidomide in multiple myeloma: lack of response of soft-tissue plasmacytomas. Br J Haematol 2001; 113:422-4. [PMID: 11380408 DOI: 10.1046/j.1365-2141.2001.02765.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [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
Thalidomide is active in patients with refractory myeloma. Seventeen patients (nine men/eight women, median age 73 years) with multiple myeloma (MM) were treated with thalidomide. Fifteen patients had refractory disease and two untested relapse. The median dose of thalidomide was 500 mg (range, 200-800 mg). Nine of the 17 patients (53%) responded. The response rate was significantly higher in patients with no extramedullary disease than in those with soft tissue masses (75% CI: 43-95% versus 0%; P = 0.01)). Of note, no decrease in the size of soft tissue plasmacytomas was observed in all the five patients who had extramedullary involvement. This data suggests that the mechanism of action and effectiveness of thalidomide might depend on the site of the tumour cells.
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Affiliation(s)
- J Bladé
- Institute of Haematology and Oncology, Department of Haematology, Postgraduate School of Haematology Farreras-Valentí, Barcelona, Spain.
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5
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Rafel M, Cervantes F, Beltrán JM, Zuazu F, Hernández Nieto L, Rayón C, García Talavera J, Montserrat E. Deoxycoformycin in the treatment of patients with hairy cell leukemia: results of a Spanish collaborative study of 80 patients. Cancer 2000; 88:352-7. [PMID: 10640967 DOI: 10.1002/(sici)1097-0142(20000115)88:2<352::aid-cncr15>3.0.co;2-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [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: 11/09/2022]
Abstract
BACKGROUND Deoxycoformycin (DCF) has been reported to produce high response rates in patients with hairy cell leukemia (HCL), but to the authors' knowledge data regarding experience with such therapy in a large HCL series are scarce. METHODS Between 1988-1997, DCF (4 mg/m(2)/day, every 2 weeks) was administered to 80 HCL patients in 32 Spanish institutions. In 35 of 78 evaluable patients DCF was the first-line therapy; the remaining 43 patients had received other therapies. Pretreatment variables influencing the achievement of complete remission (CR) and event free survival were identified by multivariate analyses. RESULTS The median number of cycles administered was 7 (range, 1-22 cycles). A CR was obtained in 56 patients (72%) and a partial remission was obtained in 13 patients, for an overall response rate of 88%. In the multivariate analysis previous splenectomy and an Eastern Cooperative Oncology Group (ECOG) performance status > or = 2 were the parameters adversely influencing CR achievement. With a median follow-up of 31.2 months (range, 0.4-126.5 months), disease recurrence was observed in 11 of the CR patients, 5 of whom showed a further response to DCF. An ECOG performance status > or = 2 was the only pretreatment variable associated with a shorter event free survival. Seven patients died, four during the treatment period. The actuarial median event free survival was 46 months (95% confidence interval, 22.5-69.5 months), and 48.7% of the 56 patients who achieved a CR were expected to be alive and disease free at 5 years. Hematologic toxicity (marked neutropenia [22 cases], anemia [6 cases], and thrombocytopenia [1 case]) was the main side effect, followed by nausea and emesis (5 cases); 14 patients required hospitalization. CONCLUSIONS The results of the current study confirm the effectiveness and acceptable toxicity of DCF in the treatment of patients with HCL.
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Affiliation(s)
- M Rafel
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
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6
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Hernández-Boluda JC, Cervantes F, Camós M, Costa D, Rafel M, Montserrat E. [Philadelphia chromosome-positive chronic myeloid leukemia in the elderly: presenting features, natural history and survival]. Med Clin (Barc) 1999; 112:565-7. [PMID: 10365381] [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: 02/12/2023]
Abstract
BACKGROUND Among patients with chronic myeloid leukaemia (CML) old people represent a minority whose disease characteristics are not well known. The aim of the study was to analyze the presenting features, the evolutive course, and the survival of older persons with Ph-positive CML. PATIENTS AND METHODS Forty-four individuals > 65 years diagnosed with Ph-positive CML in a single centre were compared with 292 younger patients. RESULTS Comparison of the presenting features of chronic phase Ph-positive CML patients yielded the following significant differences: predominance of female sex (15 males/29 females versus 155/137; p = 0.02), higher proportion of patients with anaemic syndrome (12% versus 2%; p = 0.001), lower frequency of splenomegaly (41% versus 68%; p = 0.001), and higher serum levels of uric acid (p = 0.0006) in the older group. Although the latter patients survived significantly less (median survival 36.6 months, 95% CI: 27-46.2, versus 57.6 months, 95%: 51.2-64.1; p = 0.004), 9 of the 33 deaths registered in this group (27%) occurred in the chronic phase of CML, versus 15 (9%) of the 166 deaths in the younger group (p = 0.003). When chronic phase deaths were excluded and leukaemia-related deaths only considered (i.e., those occurring in the BC or the accelerated phase of CML), old patients still had a shorter survival but the difference was no longer significant. CONCLUSIONS Ph-positive CML features are essentially the same in older and young individuals, since most of the differences observed are attributable rather to the patients' advanced age than to the leukaemia itself.
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MESH Headings
- Aged
- Catchment Area, Health
- Chromosome Aberrations/genetics
- Chromosome Disorders
- Chromosomes, Human, Pair 22/genetics
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Male
- Philadelphia Chromosome
- Retrospective Studies
- Spain/epidemiology
- Survival Rate
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7
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Rafel M, Cobo F, Cervantes F, Bosch F, Campo E, Montserrat E. Transient pancytopenia after non-A non-B non-C acute hepatitis preceding acute lymphoblastic leukemia. Haematologica 1998; 83:564-6. [PMID: 9676030] [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: 02/08/2023] Open
Abstract
Transient pancytopenia preceding childhood acute lymphoblastic leukemia (ALL) is an unfrequent but well-known event. The association of this preleukemic syndrome with hepatitis is extremely rare, with only two such cases having been published in the literature. We report the case of a 16-year-old boy who was diagnosed with B-cell type ALL that was preceded by transient pancytopenia with absent hemopoietic cells in the bone marrow following a seronegative hepatitis episode. The clinical, morphologic and immunophenotypic features of this patient are described and the literature on this preleukemic syndrome reviewed, with special emphasis being made on its differential diagnosis with hepatitis-associated aplastic anemia.
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Affiliation(s)
- M Rafel
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
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8
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Rafel M, Esteve J, Cervantes F, Velasco M, Serra A, Campo E, Montserrat E. [Primary MALT-type lymphoma of the breast]. Sangre (Barc) 1998; 43:244-7. [PMID: 9741235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 47 year old woman with a MALT lymphoma affecting the breast exclusively is reported. Complete response was achieved after CHOP chemotherapy but three years later a relapse was observed. Second-line chemotherapy (CNOP) and local radiotherapy were administered, and a second remission was obtained lasting for 1 year at last follow-up. A bibliographic search of MALT lymphomas of the breast showed that most such cases correspond to localized forms (stage I-II) and that from the radiologic point of view nodular lesions are almost the rule, although in the present case diffuse involvement was observed. MALT lymphomas of the breast tend to remain localized, and to relapse locally, and these facts appear as independent of the treatment applied (surgery, radiotherapy, chemotherapy or any combination).
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Female
- Humans
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/radiotherapy
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/radiotherapy
- Middle Aged
- Mitoxantrone/administration & dosage
- Neoplasm Recurrence, Local
- Prednisolone/administration & dosage
- Prednisone/administration & dosage
- Vincristine/administration & dosage
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Affiliation(s)
- M Rafel
- Servicio de Hematología, Hospital Clínic de Barcelona, Universidad de Barcelona
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9
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Serra A, Estrach MT, Martí R, Villamor N, Rafel M, Montserrat E. Cutaneous involvement as the first manifestation in a case of T-cell prolymphocytic leukaemia. Acta Derm Venereol 1998; 78:198-200. [PMID: 9602226 DOI: 10.1080/000155598441521] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mature T-cell malignancies of extracutaneous origin are rare disorders. T-cell prolymphocytic leukaemia (T-PLL) is the most common form of all mature T-cell leukaemias in adults. Secondary skill involvement by T-PLL has been reported in 25% of patients. A case of T-PLL which presented with cutaneous infiltration mimicking a cellulitis-like lesion resistant to antibiotic therapy is described. The diagnosis of T-PLL was subsequently fully supported by the clinical, laboratory and cytological findings, as well as by the immunophenotypic study of the skin biopsy. The present case stresses the importance of accurate evaluation of skin lesions in the diagnosis of some haematological conditions and gives additional information about T-PLL such as a previously non-reported cytogenetic abnormality [t(6;6)] and lack of cutaneous lymphocytic-associated antigen expression.
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Affiliation(s)
- A Serra
- Department of Hematology, Hospital Clínic de Barcelona, Universitat de Lleida, Spain
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10
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Cervantes F, Pereira A, Esteve J, Rafel M, Cobo F, Rozman C, Montserrat E. Identification of 'short-lived' and 'long-lived' patients at presentation of idiopathic myelofibrosis. Br J Haematol 1997; 97:635-40. [PMID: 9207412 DOI: 10.1046/j.1365-2141.1997.782714.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.7] [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: 02/04/2023]
Abstract
To contribute to a better knowledge of the prognosis of idiopathic myelofibrosis (IM), the prognostic value of the presenting features in 106 patients diagnosed with IM at a single institution during a 21-year period was retrospectively analysed. Median survival was 59.4 months (95% CI 40.7-75.4). Using univariate analysis, age > 64 years, constitutional symptoms (fever, night sweats, weight loss), Hb < 10 g/dl, circulating blasts (> or= 1%), and serum LDH > 3 times upper normal level were associated with a significantly shorter survival; male sex, platelet count < 100 x 10(9)/l, blood percentage of immature granulocytes (excluding blasts), low cholesterol levels and advanced marrow histological stage had borderline significance. Using multivariate study, only age > 64 years, constitutional symptoms, Hb < 10 g/dl, and circulating blasts retained their prognostic relevance. The latter three variables confirmed their predictive value in patients above and below the series median age, and were able to identify two groups of patients: a low-risk group of 67 patients with none or one bad prognostic factor, in whom IM had an indolent course (median survival 98.8 months, 95% CI 68.7-127.6), and a high-risk group, including 39 patients with two or three factors, with a more aggressive disease (median survival 20.6 months, 95% CI 10-28.2). Finally, the application of two recently proposed scoring systems (in which three prognostic groups are considered) was unable to separate intermediate- from high-risk patients.
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Affiliation(s)
- F Cervantes
- Department of Haematology, Postgraduate School of Haematology Farreras-Valentí, Hospital Clínic, University of Barcelona, Spain
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Balasch J, Reverter JC, Fábregues F, Tàssies D, Rafel M, Creus M, Vanrell JA. First-trimester repeated abortion is not associated with activated protein C resistance. Hum Reprod 1997; 12:1094-7. [PMID: 9194672 DOI: 10.1093/humrep/12.5.1094] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The present study was undertaken to investigate the possible association between activated protein C resistance and first-trimester repeated abortion. Fifty-five consecutive patients with unexplained first-trimester repeated abortion and 50 healthy control women having at least one child but no previous abortion were included. Activated protein C resistance was measured in all subjects and factor V Leiden genotype testing was performed in those individuals with phenotypic activated protein C resistance. One patient with first-trimester repeated abortion and one control subject had phenotypic activated protein C resistance. Genotype analysis confirmed that both subjects were heterozygous for factor V Leiden. Our results indicate that first-trimester repeated abortion is not associated with activated protein C resistance. Factor V Leiden screening in first-trimester repeated abortion is not warranted.
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Affiliation(s)
- J Balasch
- Department of Obstetrics and Gynaecology, Faculty of Medicine-University of Barcelona, Hospital Clínic i Provincial, Spain
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12
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Sans M, Gatell JM, Rafel M, Mallolas J, Soriano E. [Varicella pneumonia in adults infected by HIV-1. Presentation of 2 cases]. Enferm Infecc Microbiol Clin 1994; 12:26-30. [PMID: 8155751] [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: 01/29/2023]
Abstract
BACKGROUND Infection by the varicella-zoster virus (VZV) is frequent in patients infected by the HIV-1. Nonetheless, visceral involvement in addition to that of pneumonia is rare, despite the important immune dysfunction found among these patients. METHODS Varicella pneumonia was diagnosed in 2 patients with HIV-1 infection who presented cough with high fever and a characteristic rash in addition to respiratory failure and a micronodular pattern on chest radiography. The medical literature is reviewed (MEDLINE). RESULTS An excellent clinical response was achieved with endovenous acyclovir treatment. CONCLUSIONS The authors underline how rare is varicella pneumonia in patients with HIV-1 infection. The appearance of a pustulous vesicular rash in the context of a febrile episode leads to suspicion of this diagnosis. The treatment of choice is endovenous acyclovir (5 mg/kg/8 h). Varicella pneumonia has also been described in children with HIV-1 infection. The possible increase in patients with varicella pneumonia with be assessed, due to the immunosuppressive state of these patients. Patients not having been in contact with the varicella-zoster virus are particularly susceptible to presenting primoinfection by this virus.
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Affiliation(s)
- M Sans
- Servicio de Enfermedades Infecciosas, Hospital Clínic i Provincial, Barcelona
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