Assuntos
Proliferação de Células , Aberrações Cromossômicas , Leucemia Linfocítica Crônica de Células B/genética , Leucemia Linfocítica Crônica de Células B/patologia , Mieloma Múltiplo/genética , Mieloma Múltiplo/patologia , Idoso , Medula Óssea/metabolismo , Medula Óssea/patologia , Humanos , Cadeias Pesadas de Imunoglobulinas/genética , Hibridização in Situ Fluorescente , Leucemia Linfocítica Crônica de Células B/terapia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/terapia , Análise de Sequência com Séries de Oligonucleotídeos , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
There are limited data on the comparison of unrelated vs related peripheral blood-derived hematopoietic cell transplantation (HCT) in patients with AML and its implications in high-risk patients. In this single-center retrospective study, we report on a total of 92 consecutive patients with AML (n=87) or myelodysplastic syndrome (MDS; n=5), who were treated between 1996 and 2006 with a uniform preparative regimen of BU and CY and peripheral blood-derived HCT from related (n=46) or unrelated donors (n=46). At transplantation, 45 patients were in CR, 11 were untreated and 36 had relapsed or refractory disease. Median follow-up was 864 days after transplant (range 24-3798). At 5 years after HCT, cumulative incidences for relapse (32% of all patients) and nonrelapse mortality (NRM; 17%) were low. The 5-year relapse-free survival (RFS) and OS rates were 36 and 45% for related and 47 and 57% for unrelated patients, respectively (RFS P=0.43; OS P=0.28). High-risk patients with an unfavorable remission status before HCT benefited more from unrelated HCT than related HCT, showing a significantly better 5-year RFS of 46% (95% confidence interval (CI) 27-65) vs 22% (95% CI 4-40) (P=0.04). Unrelated HCT benefited high-risk AML patients with an unfavorable remission status better than related HCT.
Assuntos
Leucemia Mieloide Aguda/terapia , Síndromes Mielodisplásicas/terapia , Transplante de Células-Tronco de Sangue Periférico/métodos , Terapia de Salvação/métodos , Doadores de Tecidos , Adolescente , Adulto , Ciclofosfamida/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: In this single-center analysis, we assessed whether lower thalidomide doses are feasible and result in favourable treatment response in multiple myeloma (MM) patients. RESULTS: Between May 2001 and October 2006, 38 consecutive MM patients received thalidomide. Their median age was 62.4 yr, all had stage II/III MM and 31.6% had deletion 13q14 (del13q14). Prior to thalidomide, patients had received a median of two treatment lines. The median thalidomide dose was 100 mg/d (range 50-800) and the median treatment duration was 34 wk. The median cumulative thalidomide dose was 24 g. Sixteen patients received thalidomide as a single agent and 22 in combination (+dexamethasone n = 18; others n = 4). The median time-to-treatment failure (TTF) after thalidomide initiation was 30.4 wk. Analysis of prognostic factors showed a significantly prolonged TTF without del13q14 (38.1 vs. 8.9 wk with del13q14; P = 0.006). Our analysis of TTF between thalidomide given alone vs. in combinations showed a better TTF for the combination (23.6 vs. 30.6 wk), albeit not reaching significance (P = 0.20). Other parameters, such as age, stage, and prior SCT showed no difference in TTF. Peripheral polyneuropathy (PNP) frequencies were increased with longer (>28 wk) and increased cumulative thalidomide doses (>40 g), which emphasizes (a) the need to carefully escalate thalidomide from 50 to 200 mg/d, thereby reducing side effects and increasing patient compliance, and (b) that PNP occurs more frequently with longer and higher thalidomide doses. CONCLUSION: The strategy to lower thalidomide doses seems a feasible and attractive approach in MM patients, this being currently tested in prospective randomized trials.