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1.
Br J Haematol ; 182(3): 330-343, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29741774

RESUMEN

The post-transplant lymphoproliferative disorders (PTLDs) are a heterogeneous group of neoplasms that are one of the most serious complications of bone marrow and solid organ transplants. Because these disorders are rare, there are no randomized trials from which to derive optimal treatment. Management can be challenging and must balance the goal of PTLD eradication with the risks of graft rejection, graft-versus-host disease, further delays in immune reconstitution and life-threatening infections, among others. This paper will provide a comprehensive review of PTLD following solid organ transplant and haematopoietic stem cell transplant with a focus on management. Included is a discussion of novel agents that are being studied in clinical trials and, when combined or sequenced with conventional therapy, have the potential to improve outcomes.


Asunto(s)
Trastornos Linfoproliferativos/etiología , Trasplante de Órganos/efectos adversos , Infecciones por Virus de Epstein-Barr/complicaciones , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/inmunología , Trastornos Linfoproliferativos/terapia , Pronóstico , Factores de Riesgo
2.
Eur J Haematol ; 99(3): 283-285, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28509395

RESUMEN

BACKGROUND: Post-transplant lymphoproliferative disorders (PTLD) are a potentially fatal group of neoplasms arising in an immunodeficient environment. Although the cornerstone of treatment is reduced immunosuppression (RI), advanced cases often warrant treatment with chemoimmunotherapy. The chemoimmunotherapy regimen of dose-adjusted (DA)-EPOCH-R is superior to R-CHOP in HIV associated aggressive lymphomas, suggesting that it might also be favorable in the setting of PTLD. METHODS: We performed a retrospective analysis of patients with advanced monomorphic PTLD treated with first line DA-EPOCH-R in addition to RI at our institution from 2003-2016. RESULTS: Seven patients were included. Mean age was 51 and mean time from transplant to diagnosis was 71 months. Six of the seven patients received a kidney transplant, six had stage III or IV disease, six had tumors that were EBV positive, and six completed therapy. All six patients who completed therapy achieved a complete response. Mean PFS and OS were 46.6 and 52.6 months, respectively. Treatment was well-tolerated with no significant treatment related morbidity or mortality. CONCLUSIONS: Our findings support several observations in the literature that DA-EPOCH-R is efficacious and well-tolerated for the treatment of advanced, monomorphic PTLD.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trastornos Linfoproliferativos/tratamiento farmacológico , Trastornos Linfoproliferativos/etiología , Trasplante de Órganos/efectos adversos , Adulto , Anciano , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Etopósido/uso terapéutico , Resultado Fatal , Femenino , Humanos , Terapia de Inmunosupresión , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/mortalidad , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Estudios Retrospectivos , Rituximab/administración & dosificación , Resultado del Tratamiento , Vincristina/uso terapéutico
4.
Invest New Drugs ; 29(1): 161-6, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19830389

RESUMEN

UNLABELLED: Melanoma continues to be a major health problem with no effective therapy. Melanocytes, both benign and malignant, express many anti-apoptotic factors. Survivin is a member of the family of inhibitors of apoptosis proteins (IAP) and is preferentially expressed in tumor cells, including melanoma. YM155 is a small molecule suppressant of survivin that has been shown in preclinical cell lines, xenograft models and phase I studies to have anti-tumor activity. METHODS: This was an open-label, multi-center, study of YM155 monotherapy in subjects with unresectable stage III or IV melanoma. Thirty-four chemotherapy naïve subjects were treated with YM155 at a dose of 4.8 mg/m(2)/day administered by continuous infusion for 168-hours (7 days) followed by a 14-day rest period, for up to 6 cycles or until disease progression. RESULTS: One subject had a partial response to treatment seen at cycle two and lasting through cycle eight. Median progression-free survival was 1.3 months (95% CI; 1.3-2.7). Median overall survival was 9.9 months (95% CI; 7.0-14.5). Overall, YM155 was well tolerated with the most common (>20%) adverse events reported as fatigue, nausea, pyrexia, headache, arthralgia and back pain. Only four subjects required dose reductions. CONCLUSIONS: YM155 was well tolerated in subjects with advanced melanoma; however, the pre-specified primary end-point for efficacy which required two responders in 29 evaluable subjects was not achieved.


Asunto(s)
Antineoplásicos/uso terapéutico , Imidazoles/uso terapéutico , Melanoma/tratamiento farmacológico , Melanoma/cirugía , Proteínas Asociadas a Microtúbulos/antagonistas & inhibidores , Naftoquinonas/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Supervivencia sin Enfermedad , Femenino , Humanos , Imidazoles/administración & dosificación , Imidazoles/efectos adversos , Proteínas Inhibidoras de la Apoptosis , Masculino , Melanoma/patología , Proteínas Asociadas a Microtúbulos/metabolismo , Persona de Mediana Edad , Naftoquinonas/administración & dosificación , Naftoquinonas/efectos adversos , Estadificación de Neoplasias , Neoplasias Cutáneas/patología , Survivin , Resultado del Tratamiento
5.
J Investig Med High Impact Case Rep ; 5(4): 2324709617746194, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29276712

RESUMEN

Pseudohyperkalemia is an uncommon finding in chronic lymphocytic leukemia. It is a misleading condition that could lead to iatrogenic hypokalemia when unwarranted treatment is administered. We describe an interesting case of pseudohyperkalemia in severe leukocytosis and how we identified it.

6.
Thromb J ; 2(1): 9, 2004 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-15530167

RESUMEN

BACKGROUND: Recently, there has been an increased use of recombinant activated factor VII (rFVIIa) to promote hemostasis in various hemorrhagic conditions. The objective of this study was to determine the outcome of patients treated with rFVIIa who had intractable bleeding associated with cardiac surgery (CSP) or as a result of other causes (OBP). METHODS: The medical records of 40 consecutive patients treated with rFVIIa were retrospectively reviewed for blood product use before and after treatment. In all patients, rFVIIa was given only after all other measures to stop bleeding had failed. The number of transfused units of red cells (R), platelets (P), fresh frozen plasma (F), and cryoprecipitate (C) were determined both before and after administration of rFVIIa, and the results compared. Mortality at 4 hours and 30 days was assessed. Patients dying within 4 hours of rFVIIa administration were not evaluable for response. Patient characteristics were also assessed as risk factors for mortality. RESULTS: Twelve of 24 CSP survived for more than 4 hours. These 12 patients required an average of 17 units (U) of R, 18 U of P, 18 U of F and 15 U of C pre-treatment compared to an average of 6 U, 10 U, 9 U and 4 U of R, P, F and C respectively, post-treatment. These differences were statistically significant. For the OBP, 11 of 16 survived more than four hours. These 11 patients required an average of 10 U of R, 11 U of P, 14 U of F and 10 U of C pretreatment compared to an average of 1 U, 2 U, 2 U and 0 U of R, P, F, and C respectively, post-treatment. With the exception of C, there was a statistically significant decrease in blood product use following treatment with rFVIIa. Of the survivors in each group, 6 of 12 CSP and 2 of 11 OBP died between 3 and 30 days post-treatment from causes other than bleeding. Mortality at 30 days for CSP and OBP survivors was 50% and 18% respectively, whereas overall 30 day mortality was 75% for CSP and 44% for OBP. CONCLUSIONS: rFVIIa is effective in decreasing blood product use and promoting hemostasis in patients with intractable bleeding associated with cardiac surgery and a variety of other causes.

7.
Leuk Lymphoma ; 53(4): 569-74, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21888618

RESUMEN

As a result of therapeutic advances, survivors of lymphoma are now living longer. However, their mortality is higher when compared to the general population, probably due to multiple factors. Survivors of childhood leukemia and lymphoma appear to have an increased prevalence of obesity. The objectives of this retrospective study were to analyze weight change after lymphoma treatment in an adult population and determine factors predictive of weight gain. Data were collected from 219 patients and analyzed sequentially at the initial visit and at 6, 12 and 18 months. There was a progressive increase in weight from the initial visit to 6 months (1.5% increase of initial body weight), 12 months (4.5%) and 18 months (6.4%). More than 9% of patients experienced weight gain greater than 20% during follow-up. There was a statistically significant association between the percentage of increase in weight and age, B symptoms and body mass index (BMI) at presentation. Younger patients, those with B symptoms or those with lower BMI manifested more weight gain (p = 0.0008, p = 0.0440 and p = 0.0009, respectively). Other assessed factors had no effect on weight gain including sex, race, lymphoma histology, disease outcome, radiation therapy, number of treatment regimens and use of steroids. Further studies are needed to explore long-term weight trends and their impact on the health of lymphoma survivors.


Asunto(s)
Linfoma/fisiopatología , Obesidad/fisiopatología , Sobrevivientes , Aumento de Peso/fisiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Peso Corporal/efectos de los fármacos , Peso Corporal/fisiología , Peso Corporal/efectos de la radiación , Quimioradioterapia , Femenino , Humanos , Modelos Logísticos , Linfoma/tratamiento farmacológico , Linfoma/radioterapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Aumento de Peso/efectos de los fármacos , Aumento de Peso/efectos de la radiación , Adulto Joven
8.
Ann Intern Med ; 136(2): 136-43, 2002 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-11790066
9.
Leuk Lymphoma ; 49(11): 2125-32, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19021055

RESUMEN

A retrospective analysis of factors influencing survival in patients with primary lymphoma of bone (PLB) treated at a single institution was performed. The records of 30 eligible patients were evaluated for overall survival (OS) as related to age, sex, stage, International Prognostic Index (IPI) score, number of sites involved and type of treatment. There was a significant difference in OS in patients with IPI scores of low (L) and low intermediate (LI) versus high intermediate (HI) (P = 0.0035), regardless of stage. Sex, age, stage and number of sites did not have a significant influence on OS. There was a statistically significant difference in OS favouring use of combined chemotherapy (with or without rituximab) and radiation compared with either modality alone (P = 0.02). The addition of rituximab resulted in a non-significant trend towards improved OS (P = 0.11). With a median follow up of 49 months, 73% of patients are alive 5 years from diagnosis.


Asunto(s)
Neoplasias Óseas/diagnóstico , Linfoma/diagnóstico , Factores de Edad , Neoplasias Óseas/mortalidad , Neoplasias Óseas/terapia , Terapia Combinada , Femenino , Humanos , Linfoma/mortalidad , Linfoma/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Sexuales , Análisis de Supervivencia
10.
South Med J ; 95(10): 1209-12, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12425512

RESUMEN

Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by antibody-mediated platelet destruction. Despite initial response to corticosteroids, most adults relapse during steroid taper, and splenectomy is the treatment of choice for these patients. Those whom splenectomy fails to cure present a therapeutic challenge. Subsequent management usually involves some form of chronic immune suppression, which has serious side effects and long-term morbidity. Rituximab, a recently-approved anti-CD20 chimeric monoclonal antibody, has shown efficacy in preliminary studies. We report the cases of 3 patients with refractory ITP who achieved acceptable platelet counts after treatment with rituximab.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antígenos CD20/inmunología , Púrpura Trombocitopénica Idiopática/terapia , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales de Origen Murino , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rituximab
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