Evaluation of Bone Mineral Density in Patients with Type 1 Gaucher Disease in Argentina

The purpose of this study was to evaluate the frequency of osteoporosis (OP) in patients with Gaucher disease (GD) in Argentina. GD patients from 28 centers were consecutively included from April 2012 to 2014. Bone mineral density (BMD) was determined by dual X-ray absorptiometry in the lumbar spine and the femoral neck or the total proximal femur for patients ≥20 yr of age, and by whole-body scan in the lumbar spine in patients <20 yr of age. In children, mineral density was calculated using the chronological age and Z height. OP diagnosis was determined following adult and pediatric official position of the International Society for Clinical Densitometry. A total of 116 patients were included, of which 62 (53.5%) were women. The median age was 25.8 yr. All patients received enzyme replacement therapy, with a median time of 9.4 yr. Normal BMD was found in 89 patients (76.7%), whereas low bone mass (LBM) or osteopenia was found in 15 patients (13%) and OP in 12 patients (10.3%). The analysis of the pediatric population revealed that 4 patients (9.3%) had LBM and 3 (7%) had OP (Z-score ≤ -2 + fractures height-adjusted by Z), whereas in the adult population (n = 73), 11 patients (15%) had LBM or osteopenia and 9 (12.3%) had OP. Bone marrow infiltration and the presence of fractures were significantly correlated with the presence of OP (p = 0.04 and <0.001, respectively). This is the first study in Argentina and in the region describing the frequency of OP or LBM in GD patients treated with imiglucerase using the official position of the International Society for Clinical Densitometry.

Primary breast lymphomas: An Argentinian cooperative study

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Background: Primary Breast Lymphomas are rare tumors (less than 1% of all primary breast tumors). Because of that, the records of two institutions dedicated exclusively to the treatment of cancer (Hospital Municipal de Oncologia “Maria Curie” and Instituto Oncologico Henry Moore) have been working together in a single series. Objective: To make a retrospective study of the clinical onset, treatment and evolution of the patients with Primary Breast Lymphoma (PBL). Methods: Patients from hemato-oncological databases of both institutions, that presented PBL, were studied. A database containing characteristics of the population, clinical onset, treatments, evolution and survival Results: Gender F/M=2/15 pt. Mean age (range)=54.1 years (24–87). Pathology: Hodgkin's Lymphoma = 1 pt, NHL follicular = 8 pt, Large-Cell Diffuse NHL = 6 pt, lymphoplasmocytic NHL = 1 pt, Marginal Zone NHL = 1 pt. Stages: IA = 2 pt, IIA = 8 pt, IIIA = 1 pt, IVA = 6 pt. Radiotherapy: 11 pt. Polychemotherapy: CVP = 7 pt, COPP = 1 pt, CHOP = 2 pt, CNOP = 4 pt, CVP/CHOP = 1 pt, RCHOP = 1 pt, RESHAP = 1 pt. Response: CR16/16 evaluable pt. Evolution: Recurrence = 3 pt, Second tumors = 3 pt (breast cancer = 3 pt), Third tumors = 1 pt (melanoma = 1 pt). Survival. Dead = 4 pt. Alive with no illness = 12 pt, Alive under treatment = 1 pt. Conclusions: 1) Seventeen pt with PBL were identified. 2) Sixteen out of 17 were non-Hodgkin lymphomas. 3) Fifteen of 17 pt were women 4) Fourteen of the 17 cases affected only one breast. 5) Seven out of 17 cases were tumors of less than 5 cm. 6) Response reached 100% of the evaluable pt. 7) There was an important rate of second and third tumors (20%). 8) With a mean follow up time of 82 months, 75% of the population is alive and free of the illness.

No significant financial relationships to disclose.

Clinical findings in a large cohort of adult patients (pts) with Hodgkin’s disease (Hd) in Argentina: A report from two institutions

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Background: More than 20,000 new cases of HD are diagnosed each year all over Europe, Canada and the United States. Nevertheless, there are few reports in current literature showing data from large series in developing countries. Methods: The medical records of adult pts with an oncohaematologic diagnosis in two large oncological centers (HMC and IOHM) were reviewed. A period spanning the past 10 years was considered with the objective of measuring the incidence of HD. Oncologists in charge were asked to fill a form with the relevant clinical data. Results: Three hundred and fifty eight out of 1,884 medical records of pts with HD (19%) were retrieved (M: 55.2%/F: 44.8%). Seven pts were HIV positive. Bulky disease was present in 7,4%. The following table shows the main topics (See table ): Conclusions: Incidence of HD in our serie was similar to the published report. However, two important differences arose: it was not possible to notice neither the double curve described nor the usual histological subtype distribution (more MC than the expected frequency). According to previous reports, prevalence of NS was associated with mediastinal locations and younger pts. Actuarial survival must be presented.

[Table: see text]

No significant financial relationships to disclose.

[Single extramedullary plasmacytoma of the nose]

A new solitary extramedullary plasmacytoma of nasal localization meeting the conditions for definition is reported. The patient was treated with surgery and irradiation, which controlled the disease and produced excellent cosmetic results. The bibliography is reviewed and the pathologic, clinical, and evolutive characteristics are discussed.

Combination salvage chemotherapy with MIZE (ifosfamide-mesna, idarubicin and etoposide) for relapsing or refractory lymphoma

In this study, 54 patients with relapsed or refractory non-Hodgkin's lymphoma (NHL) were treated in a phase II, multicentric trial with ifosfamide-mesna 1500 mg/m2 IV days 1-3, idarubicin 12 mg/m2 IV day 1 and etoposide 100 mg/m2 IV day 1-3 (MIZE). Overall response was 72%; complete response (CR) and partial response (PR) were 46% and 26% respectively. In Stage I-II pts CR was 59% and in Stage III-IV pts CR was 40.5%. Patients who relapsed from an initial CR had a 64% CR rate when treated with MIZE, in contrast to refractory disease's patients who only had 19% CR (p = 0.004). The group of pts that had an objective response (CR + PR) to front line therapy had a 2 year survival rate of 55% compared with none for refractory disease (p = 0.029) after salvage therapy. Median survival for the entire group was 17.5 months. Better survival was seen in pts who were asymptomatic with low levels of LDH, previous CR, non high-grade histology, and limited disease stage at relapse. Toxicity was mainly hematologic: 91.5% had neutropenia, (56.5% grade III-IV), and 9.5% died from infectious complications. Other clinical toxicities including cardiac toxicity were negligible. MIZE chemotherapy was effective in patients with relapsed and refractory lymphoma and showed limited clinical and cardiac toxicity. Myelosupression was the most frequent single toxicity.

A randomized trial of melphalan and prednisone versus melphalan, prednisone, cyclophosphamide, MeCCNU, and vincristine in untreated multiple myeloma

In a randomized study with 234 previously untreated patients with multiple myeloma, 129 were treated with melphalan (8 mg/m2 perorally for four days) and prednisone (40 mg/m2 perorally for seven days, both every four weeks) and 105 with melphalan and prednisone at the same doses plus cyclophosphamide (600 mg/m2 intravenously every four weeks), MeCCNU (100 mg/m2 PO every eight weeks), and vincristine (MPCCV, 0.6 mg/m2 IV every four weeks). A total of 49 (38%) of the 129 patients treated with melphalan and prednisone (MP) and 48 (46%) of the 105 patients treated with MPCCV showed good response (GR) (P not significant); the overall response rates were 58% and 70%, respectively. Thirty-seven percent of the MP group and 39% of the MPCCV group remain alive at 48 months from first treatment (P not significant). The estimated 48-month survival from first treatment, according to different prognostic factors at diagnosis, in both groups was as follows: stage 1,56%; stage II, 46%, and stage III, 23% (I and II v III P less than .001). Survival at 48 months according to response was GR, 68%; partial response (PR), 33%; and null, 16% (GR v null, P less than .0005; GR v PR, P less than .0005). Survival according to renal function was 43% for a creatinine level less than 2 mg/100 mL and 27% for a creatine level greater than or equal to 2 mg/100 mL (P less than .0005). No significant difference has been found between the two treatment schedules in terms of response rate and survival time, in any stage of disease.