RESUMEN
Therapeutic approaches against multiple myeloma (MM) have largely changed during the past decade. Hematopoietic stem cell transplantation (HSCT) and licensing of immunomodulators and proteasome inhibitors have resulted in better response and increased overall survival rates compared to previous conventional therapies. To assess the impact that these new strategies have had on outcome of patients with symptomatic MM in Spain, we conducted an epidemiological retrospective analysis of 338 newly diagnosed patients with stage II-III MM who started first-line treatment over a 2-yr period (2003-2005) by collecting data from their medical records. Most patients had been diagnosed with secretory MM (94.4%), 41.7% stage II and 58.3% stage III. The presence of bone lesions (72.2%), as well as anemia (79.8%) and elevated beta2-microglobulin levels (62.3%), was a common finding; in contrast, hypercalcemia and elevated serum creatinine were less frequent (25% each). First-line treatment had consisted of either conventional chemotherapy (62%) or induction treatment plus autologous HSCT (38%), as per standard clinical practice. HSCT not only resulted in greater objective response rates (93% vs. 50%), but also contributed to a significant increase in 3-yr survival (85% vs. 49.7%; 95% CI, range 77-91 vs. 41-58; P < 0.001). Overall, 55% of patients presented treatment-related adverse events, mainly hematological. Toxicity rates were higher among patients treated with alkylating-based regimens and in those undergoing transplantation. In conclusion, data analysis shows an adequate balance between increased response rates and safety that supports the use of up-front high-dose HSCT therapy in younger patients. Most importantly, this study provides further confirmation that the introduction of HSCT has significantly prolonged survival of patients with MM.
Asunto(s)
Anemia/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trasplante de Células Madre Hematopoyéticas , Hipercalcemia/terapia , Quimioterapia de Inducción/métodos , Mieloma Múltiple/terapia , Adulto , Anciano , Anciano de 80 o más Años , Anemia/complicaciones , Anemia/diagnóstico , Anemia/mortalidad , Creatinina/sangre , Femenino , Humanos , Hipercalcemia/complicaciones , Hipercalcemia/diagnóstico , Hipercalcemia/mortalidad , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/mortalidad , Estadificación de Neoplasias , Estudios Retrospectivos , Análisis de Supervivencia , Trasplante Autólogo , Microglobulina beta-2/sangreRESUMEN
Bendamustine is a bifunctional alkylating agent with proven activity in myeloma. In this study 60 newly diagnosed myeloma patients were given bendamustine plus bortezomib and prednisone in a regimen consisting of one cycle of bortezomib twice weekly for 6 weeks (1.3 mg/m(2) on days 1, 4, 8, 11, 22, 25, 29, and 32), plus bendamustine (90 mg/m(2) on days 1 and 4) and prednisone. The following cycles included bortezomib once weekly. Patients who were transplant candidates proceeded to stem cell collection after four cycles and the transplant was performed after six cycles. Patients who were not candidates for transplantation received up to nine cycles. Forty-two patients were transplant candidates and after six cycles, 50% achieved at least a very good partial response, with 24% having complete responses; 35 proceeded to a transplant, and the complete response rate was 54%. Seventeen patients continued up to nine cycles, and 57% achieved at least a very good partial response, including 26% with complete responses. The 2-year progression-free survival and overall survival rates were 62% and 86%, respectively. The safety profile was manageable, but stem cell mobilization was compromised in 35% of patients. In summary, this combination is effective in untreated patients, with an acceptable toxicity profile, but given the introduction of second-generation novel agents and monoclonal antibodies, the combination will probably be better reserved for relapsing patients, in whom stem cell collection is not needed, while cost-effective combinations with non-cross-resistant drugs continue to represent a medical need. This trial was registered with ClinicalTrials.gov, number NCT01376401.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Mieloma Múltiple/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bleomicina/efectos adversos , Bleomicina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/mortalidad , Estadificación de Neoplasias , Prednisona/efectos adversos , Prednisona/uso terapéutico , España , Análisis de Supervivencia , Resultado del Tratamiento , Vinblastina/efectos adversos , Vinblastina/uso terapéuticoRESUMEN
BACKGROUND: Preinfarction angina, a possible form of ischaemic preconditioning, improves the prognosis in patients who experience a major ischaemic event; though the associated pathophysiology is not yet fully understood. The aim of this study was to determine the possible involvement of endothelial progenitor cells (EPC), the vascular endothelial growth factor (VEGF) and the hepatocyte growth factor (HGF) in the development of preinfarction angina. METHODS AND RESULTS: We studied 41 patients (60·5 ± 12 years; 34% women) and 14 healthy controls; 43·9% of the patients had preinfarction angina. No differences were found in the baseline characteristics of the two groups. Although the EPC, VEGF and HGF were raised as compared with the control group, no significant differences were found according to the presence or absence of preinfarction angina in the levels of EPC (baseline, P = 0·25; day 3, P = 0·11; day 7, P = 0·32), VEGF (baseline, P = 0·96; day 3, P = 0·06; day 7, P = 0·57) or HGF (baseline, P = 0·18; day 3, P = 1; day 7, P = 0·86). An association was seen in the patients who had preinfarction angina between the EPC levels at baseline and on days 3 and 7 and the HGF on admission with the time from the angina to the STEMI (ß = -0·070; ß = -0·066; ß = -0·081; ß = -80·16; P < 0·05), showing a reduction in the level of EPC cells for each hour passed since the event. CONCLUSIONS: No differences were found in the release kinetics of EPC, VEGF or HGF after a first infarction according to whether the patients had angina during the week before the infarction.
Asunto(s)
Angina Inestable/fisiopatología , Endotelio Vascular/metabolismo , Factor de Crecimiento de Hepatocito/sangre , Infarto del Miocardio/fisiopatología , Células Madre/metabolismo , Factor A de Crecimiento Endotelial Vascular/sangre , Anciano , Estudios de Casos y Controles , Humanos , Inmunofenotipificación , Persona de Mediana Edad , Estadística como Asunto , Factores de TiempoRESUMEN
BACKGROUND AND OBJECTIVE: A retrospective analysis of a registration database was used to assess the efficacy and tolerability of anagrelide for treating essential thrombocythemia (ET). The study was conducted by analysing information on response to treatment, time to response and tolerability. PATIENTS AND METHOD: A total of 411 patients with ET from 54 centres in Spain were included in a retrospective chart review. Patients who had started treatment with anagrelide as a first- or second-line therapy before December 31, 2004 were included. RESULTS: Of 411 patients, anagrelide was given as a first-line therapy in 110 patients, following hydroxyurea in 280 patients, and following other drugs in 21 patients. Overall response (OR) with anagrelide was 81.2% (77,0-84,9; p=0,05). Complete response (platelets <400x10(9)/L) was observed in 53.6% (48,6-58,5; p=0,05) and partial response (<600x10(9)/L) in 27.6% (23,4-32,2; p=0,05) of patients. There was no significant correlation of previous treatment with OR rate (p=0.103) despite a higher OR for previously untreated patients (86.4%) than for previously treated patients (79.3%). The most frequent treatment-related adverse reactions were headache (13.1%), palpitations (10.2%) and tachycardia (7.5%). CONCLUSIONS: The observed response rates and tolerability profile are similar to those reported previously. Anagrelide is well tolerated and effective in reducing platelets to target levels in patients with ET.
Asunto(s)
Inhibidores de Agregación Plaquetaria/uso terapéutico , Quinazolinas/uso terapéutico , Trombocitemia Esencial/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND AND OBJECTIVE: There are few epidemiological studies on massive transfusion (MT), although they may be important to evaluate possible strategies to reduce the number of transfused units, as well as transfusion side-effects. We, therefore, retrospectively assessed the incidence of MT at our institution (a 700-bed university hospital) during a 5-year period. PATIENTS AND METHOD: Local blood bank records were searched for MT episodes occurred from January 2001 to December 2005. MT was defined as the transfusion of 8 or more packed red cell (PRC) units within 24 h. Patient's clinical data were exclusively gathered from the blood requesting form. RESULTS: Overall, 304 episodes of MT were identified in 288 patients (one episode per week), who received 4,845 PCR units (3,515 units within the first 24 h), because of ruptured aortic aneurism (n = 62), poly-trauma (n = 57), upper digestive bleeding (n = 51), cardiac surgery (n = 41), elective surgery (n = 36), emergency surgery (n = 30), and oncology surgery (n = 27). Mortality rate was 48%, and multivariate analysis identified age (odds ratio [OR] =1.023; 95% confidence interval [CI]. 1.006-1.040) and number of PRC transfused within the first 24 h (OR = 1.094; 95% CI, 1.0032-1.160) as weak but significant independent predictors of mortality, whereas poly-trauma diagnosis was a protective factor (OR = 0.325; 95% CI, 0.112 - 0,940). CONCLUSIONS: Overall, the mortality rate among patients receiving MT was very high, and was influenced by the number of transfused units, patient's age, and admitting diagnose. As the majority of the MT episodes occurred within the surgical or polytrauma context, possible strategies to reduce the volume of MT are discussed.
Asunto(s)
Transfusión de Eritrocitos/estadística & datos numéricos , Mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Transfusión de Eritrocitos/mortalidad , Femenino , Hospitales Universitarios , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , EspañaRESUMEN
INTRODUCTION AND OBJECTIVES: Multivessel coronary disease is still a postinfarction prognostic marker despite new forms of reperfusion, such as primary angioplasty. The aim of this study was to determine the time sequence of various sets of endothelial progenitor cells and angiogenic cytokines (vascular endothelial growth factor, hepatocyte growth factor) according to the degree of extension of the postinfarction coronary disease. METHODS: We studied the release kinetics in 32 patients admitted for a first myocardial infarction with ST elevation, grouped according to whether they had single or multivessel disease, and 26 controls. RESULTS: The patients had a higher number of endothelial progenitor cells and angiogenic cytokines than the controls at all 3 measurements (admission, day 3, and day 7) of the following subsets: CD34, CD34+CD133+, CD34+KDR+, and CD34+CD133+KDR+CD45+(weak); this latter was higher on day 7. The levels of these cell subsets were all higher in the patients with single-vessel disease and at all 3 measurements. The vascular endothelial growth factor levels were raised during the first week and the hepatocyte growth factor showed an early peak on admission for infarction. No significant differences were seen in the cytokines according to coronary disease extension. CONCLUSIONS: Although the release kinetics of different subsets of endothelial progenitor cells in patients with a first acute myocardial infarction with ST elevation was similar in those with single vessel disease to those with multivessel disease, the number of circulating endothelial progenitor cells was greater in the patients with single vessel disease. The vascular endothelial growth factor levels were raised during the first postinfarction week and the hepatocyte growth factor were higher on admission.
Asunto(s)
Enfermedad Coronaria/patología , Citocinas/metabolismo , Células Endoteliales/fisiología , Movilización de Célula Madre Hematopoyética , Células Madre Hematopoyéticas/fisiología , Infarto del Miocardio/patología , Adulto , Anciano , Antígenos CD34/metabolismo , Recuento de Células , Separación Celular , Dolor en el Pecho/etiología , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/terapia , Electrocardiografía , Femenino , Factor de Crecimiento de Hepatocito/metabolismo , Humanos , Cinética , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Monocitos/fisiología , Infarto del Miocardio/terapia , Fenotipo , Pronóstico , Factor A de Crecimiento Endotelial Vascular/metabolismoRESUMEN
Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results.
Asunto(s)
Antifúngicos/uso terapéutico , Enfermedades Hematológicas/complicaciones , Micosis/complicaciones , Micosis/tratamiento farmacológico , Humanos , Leucemia/complicaciones , Micosis/microbiología , Síndromes Mielodisplásicos/complicaciones , RiesgoAsunto(s)
Citostáticos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Trombocitemia Esencial/tratamiento farmacológico , Adulto , Anciano , Médula Ósea/patología , Citostáticos/efectos adversos , Manejo de la Enfermedad , Femenino , Predisposición Genética a la Enfermedad , Hemorragia/inducido químicamente , Humanos , Interferón-alfa/efectos adversos , Interferón-alfa/uso terapéutico , Janus Quinasa 2/genética , Lactancia , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/efectos adversos , Mutación Puntual , Embarazo , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Quinazolinas/uso terapéutico , Trombocitemia Esencial/clasificación , Trombocitemia Esencial/diagnóstico , Trombocitemia Esencial/epidemiología , Trombocitemia Esencial/patología , Trombofilia/tratamiento farmacológico , Trombofilia/etiologíaRESUMEN
The aim of this study was to compare the performance of the automatic TEST 1 ESR system, SIRE Analytical Systems (TEST 1), with that of the the Sedisystem 15, Becton Dickinson (SEDI), and the International Council for Standardization in Haematology reference method (Westergren) for measuring the length of sedimentation reaction in blood (LSRB). This reaction was measured in 418 paired blood samples drawn in K2-EDTA vacuum tubes and specific tubes from patients scheduled for routine LSRB measurement. The TEST 1 system uses micro-sedimentation and quantitative capillary photometry technology, whereas the SEDI uses a CCD camera. For Westergren, a 200 mm column with 3.0 mm internal diameter was used. Compared to Westergren, TEST 1 gives accurate values of LSRB in most of the samples (mean of differences: 0.99 +/- 10.4 mm; 95% CI, -0.807 to 2.78 mm; n =131). Similar results were obtained in the comparison with SEDI (mean of differences: -0.626 +/- 8 mm; 95% CI, -1.756 to 0.5 mm; n = 195). Compared to those of fresh blood samples, LSRB values were significantly lower in 24 h stored samples, either at 4 degrees C (21.5 +/- 2.3 vs. 19.4 +/- 2.2 mm; p (Spearman's coefficient of correlation): 0.981; n = 44) or at room temperature (19.1 +/- 2.5 vs. 16.2 +/- 2.1 mm; p: 0.903; n = 46). In conclusion, TEST 1 is a rapid, reliable system for automatic measurement of LSRB in standard K2-EDTA blood samples. It has a very low imprecision and maintains a good performance in 24 h stored samples. In addition, due to its operational characteristics (60 samples/20 min) it is a suitable tool for clinical laboratories with a high work load as well as for emergency laboratories.
Asunto(s)
Análisis Químico de la Sangre/métodos , Sedimentación Sanguínea , Química Clínica/métodos , Eritrocitos/fisiología , Pruebas Hematológicas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Automatización , Recolección de Muestras de Sangre , Ácido Edético/farmacología , Humanos , Microscopía por Video , Persona de Mediana Edad , Fotometría , Estándares de Referencia , Valores de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Manejo de Especímenes , Temperatura , Factores de TiempoRESUMEN
BACKGROUND: Although transfusion or return of salvaged shed blood has become popular in major orthopedic procedures, this blood-saving method is still controversial because shed blood may be contaminated with chemical and tissular debris, such as fat particles, which may increase the risk of fat embolism after bone surgery. STUDY DESIGN AND METHODS: In an effort to find an easy, reliable method for determination of both fat particle content and removal from shed blood, analyses of perioperative blood samples were performed with a cell counter (Technicon H3 [H3]) in orthopedic patients undergoing spinal fusion in which postoperative shed blood was collected and returned with a blood collection canister. A screen or surface filter was intercalated in the return line to eliminate microaggregates, fat particles, and/or WBCs. RESULTS: Fat particles in shed blood are clearly detected as a condensed, sigmoidal-shaped area at the right-hand side of the PMN zone in the channel in which the H3 measures particles according to their degree of lobularity. This signal can be reproduced by the addition of animal or vegetable fat to venous blood, but not by the addition of activated platelets or RBC membranes. Fat particles, together with WBCs and microaggregates, in shed blood were effectively removed by surface filters, whereas screen filters were not effective. CONCLUSION: The use of the TH3 seems to be an easy, reliable, and low-cost approach for monitoring fat particle content and removal from postoperative salvaged shed blood in orthopedic procedures.
Asunto(s)
Transfusión de Sangre Autóloga/métodos , Sangre , Embolia Grasa/prevención & control , Grasas , Procedimientos Ortopédicos , Recuento de Células Sanguíneas/instrumentación , Procedimientos Quirúrgicos Electivos , Filtración , Humanos , Tamaño de la Partícula , Periodo Posoperatorio , SeguridadRESUMEN
Introducción y objetivos. La enfermedad coronaria multivaso es un importante factor pronóstico postinfarto a pesar de nuevas formas de reperfusión como la angioplastia primaria. El objetivo del presente estudio es determinar la secuencia de variación de diferentes poblaciones de células progenitoras endoteliales y factores angiogénicos (factor de crecimiento endotelial vascular, factor de crecimiento hepatocitario) según el grado de extensión de la enfermedad coronaria. Métodos. Estudiamos la cinética de liberación en 32 pacientes ingresados por un primer infarto, agrupados según tuvieran enfermedad coronaria monovaso o multivaso y 26 sujetos que constituyen el grupo control. Resultados. Los pacientes presentaban un mayor número de células progenitoras endoteliales y citocinas angiogénicas que los controles en las tres determinaciones realizadas (al ingreso, día 3 y día 7) de las siguientes subpoblaciones: CD34, CD34+CD133+, CD34+KDR+ y CD34+CD133+KDR+CD45+ (débil); este último era mayor el día 7. Los valores de las tres poblaciones analizadas eran mayores en los pacientes con enfermedad coronaria monovaso en las tres determinaciones. Las cifras del factor de crecimiento endotelial vascular subían durante la primera semana y las del factor de crecimiento hepatocitario mostraron un pico precoz al ingreso. No apreciamos diferencias significativas en las variaciones de citocinas según el grado de extensión de la enfermedad coronaria. Conclusiones. Aunque las cinéticas de liberación de diferentes poblaciones de células progenitoras endoteliales en pacientes con un primer infarto agudo de miocardio con enfermedad monovaso con enfermedad multivaso fueron similares, su número fue mayor en los pacientes con enfermedad coronaria monovaso. Las cifras del factor de crecimiento endotelial vascular ascendieron durante la primera semana y las del factor de crecimiento hepatocitario muestran un pico precoz al ingreso (AU)
Introduction and objectives. Multivessel coronary disease is still a postinfarction prognostic marker despite new forms of reperfusion, such as primary angioplasty. The aim of this study was to determine the time sequence of various sets of endothelial progenitor cells and angiogenic cytokines (vascular endothelial growth factor, hepatocyte growth factor) according to the degree of extension of the postinfarction coronary disease. Methods. We studied the release kinetics in 32 patients admitted for a first myocardial infarction with ST elevation, grouped according to whether they had single or multivessel disease, and 26 controls. Results. The patients had a higher number of endothelial progenitor cells and angiogenic cytokines than the controls at all 3 measurements (admission, day 3, and day 7) of the following subsets: CD34, CD34+CD133+, CD34+KDR+, and CD34+CD133+KDR+CD45+(weak); this latter was higher on day 7. The levels of these cell subsets were all higher in the patients with single-vessel disease and at all 3 measurements. The vascular endothelial growth factor levels were raised during the first week and the hepatocyte growth factor showed an early peak on admission for infarction. No significant differences were seen in the cytokines according to coronary disease extension. Conclusions. Although the release kinetics of different subsets of endothelial progenitor cells in patients with a first acute myocardial infarction with ST elevation was similar in those with single vessel disease to those with multivessel disease, the number of circulating endothelial progenitor cells was greater in the patients with single vessel disease. The vascular endothelial growth factor levels were raised during the first postinfarction week and the hepatocyte growth factor were higher on admission (AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Vasos Coronarios/citología , Vasos Coronarios/fisiología , Células Endoteliales/fisiología , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatología , Dolor en el Pecho/complicaciones , Dolor en el Pecho/diagnóstico , Citocinas/análisis , Angiografía , Antígenos CD34 , Pronóstico , Angioplastia/métodos , Cinética , Factores de Riesgo , Consentimiento Informado/estadística & datos numéricos , Análisis de Varianza , Fibrinólisis/fisiologíaRESUMEN
El tratamiento antifúngico del paciente hematológico ha alcanzado una gran complejidad con la llegada de nuevos antifúngicos y pruebas diagnósticas que han dado lugar a diferentes estrategias terapéuticas. La utilización del tratamiento más adecuado en cada caso es fundamental en infecciones con tanta mortalidad. La disponibilidad de recomendaciones como éstas, realizadas con la mejor evidencia por un amplio panel de 48 expertos, en las que se intenta responder a cuándo está indicado tratar y con qué hacerlo considerando diferentes aspectos del paciente (riesgo de infección fúngica, manifestaciones clínicas, galactomanano, TC de tórax y profilaxis realizada), puede ayudar a los clínicos a mejorar los resultados(AU)
Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results(AU)
Asunto(s)
Humanos , Masculino , Femenino , Antifúngicos/metabolismo , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Factores de Riesgo , Farmacorresistencia Fúngica , Farmacorresistencia Fúngica/fisiología , Farmacorresistencia Fúngica Múltiple , /métodosRESUMEN
Fundamento y objetivo: Se efectuó un registro retrospectivo para valorar la eficacia y la tolerabilidad de la anagrelida en el tratamiento de la trombocitemia esencial (TE). Se analizó la información de la respuesta al tratamiento, el tiempo transcurrido hasta la respuesta y la tolerabilidad. Pacientes y método: Registro retrospectivo de 411 pacientes con TE de 54 centros españoles. Se incluyó a enfermos que habían empezado a recibir anagrelida como tratamiento de primera o segunda línea antes del 31 de diciembre de 2004. Resultados: De los 411 pacientes, a 110 se les administró anagrelida como tratamiento de primera línea, a 280 después de hidroxicarbamida y a 21 después de otros fármacos. La respuesta global (RG) con anagrelida fue del 81,2% (intervalo de confianza [IC] del 95%: 77,0 a 84,9). Se observó una respuesta completa (recuento de plaquetas<400×109/l) en el 53,6% de los pacientes (IC del 95%: 48,6 a 58,5) y una respuesta parcial (<600×109/l) en el 27,6% (IC del 95%: 23,4 a 32,2). No hubo una correlación significativa entre el tratamiento previo y la tasa de RG (p=0,103), a pesar de una RG mayor en los pacientes no tratados previamente (86,4%) que en los tratados previamente (79,3%). Los acontecimientos adversos más frecuentes relacionados con el tratamiento fueron cefalea (13,1%), palpitaciones (10,2%) y taquicardia (7,5%). Conclusiones: Las tasas de respuesta y el perfil de tolerabilidad son similares a los descritos con anterioridad. La anagrelida tiene buena tolerancia y es eficaz en la reducción de las plaquetas hasta los valores deseados en los pacientes con TE
Background and objective: A retrospective analysis of a registration database was used to assess the efficacy and tolerability of anagrelide for treating essential thrombocythemia (ET). The study was conducted by analysing information on response to treatment, time to response and tolerability. Patients and method: A total of 411 patients with ET from 54 centres in Spain were included in a retrospective chart review. Patients who had started treatment with anagrelide as a first- or second-line therapy before December 31, 2004 were included. Results: Of 411 patients, anagrelide was given as a first-line therapy in 110 patients, following hydroxyurea in 280 patients, and following other drugs in 21 patients. Overall response (OR) with anagrelide was 81.2% (77,0 84,9; p=0,05). Complete response (platelets <400×109/L) was observed in 53.6% (48,6 58,5; p=0,05) and partial response (<600×109/L) in 27.6% (23,4 32,2; p=0,05) of patients. There was no significant correlation of previous treatment with OR rate (p=0.103) despite a higher OR for previously untreated patients (86.4%) than for previously treated patients (79.3%). The most frequent treatment-related adverse reactions were headache (13.1%), palpitations (10.2%) and tachycardia (7.5%). Conclusions: The observed response rates and tolerability profile are similar to those reported previously. Anagrelide is well tolerated and effective in reducing platelets to target levels in patients with ET
Asunto(s)
Humanos , Trombocitemia Esencial/tratamiento farmacológico , Imidazolinas/farmacología , Estudios Retrospectivos , Trombocitemia Esencial/complicaciones , Tolerancia a Medicamentos , Trastornos Mieloproliferativos/diagnóstico , Resultado del TratamientoRESUMEN
Fundamento y objetivo: Existen pocos estudios epidemiológicos sobre la transfusión masiva (TM), a pesar de su importancia para evaluar posibles estrategias que reduzcan el número de concentrados de hematíes (CH) transfundidos y sus efectos adversos. Por ello evaluamos retrospectivamente la incidencia de TM en nuestra institución (un hospital universitario con 700 camas) durante un período de 5 años. Pacientes y método: Se revisaron los registros del depósito de hemoderivados para identificar los episodios de TM ocurridos entre enero de 2001 y diciembre de 2005. La TM se definió como la transfusión de como mínimo 8 unidades de CH en 24 h. Los datos clínicos se obtuvieron exclusivamente de las peticiones de transfusión. Resultados: Se identificaron 304 episodios de TM en 288 pacientes (un episodio por semana), que recibieron 4.845 CH (3.515 durante las primeras 24 h), debido a rotura de aneurisma aórtico (n = 62), politraumatismo (n = 57), hemorragia digestiva alta (n = 51) o cirugía cardíaca (n = 41), electiva (n = 36), urgente (n = 30) u oncológica (n = 27). La mortalidad fue del 48%, y el análisis multivariante identificó la edad (odds ratio [OR] = 1,023; intervalo de confianza [IC] del 95%, 1,006-1,040) y el número de CH en 24 h (OR = 1,094; IC del 95%, 1,0032-1,160) como predictores independientes de mortalidad, mientras que el politraumatismo aparecía como factor protector (OR = 0,325; IC del 95%, 0,112-0,940). Conclusiones: La mortalidad entre los pacientes con TM fue alta y en ella influyeron el número de CH, la edad y el diagnóstico. Dado que la mayoría de los episodios de TM ocurren en cirugía y politraumatismos, se discuten algunas estrategias para reducir el volumen de la TM
Background and objective: There are few epidemiological studies on massive transfusion (MT), although they may be important to evaluate possible strategies to reduce the number of transfused units, as well as transfusion side-effects. We, therefore, retrospectively assessed the incidence of MT at our institution (a 700-bed university hospital) during a 5-year period. Patients and method: Local blood bank records were searched for MT episodes occurred from January 2001 to December 2005. MT was defined as the transfusion of 8 or more packed red cell (PRC) units within 24 h. Patient's clinical data were exclusively gathered from the blood requesting form. Results: Overall, 304 episodes of MT were identified in 288 patients (one episode per week), who received 4,845 PCR units (3,515 uints within the first 24 h), because of ruptured aortic aneurism (n = 62), poly-trauma (n = 57), upper digestive bleeding (n = 51), cardiac surgery (n = 41), elective surgery (n = 36), emergency surgery (n = 30), and oncology surgery (n = 27). Mortality rate was 48%, and multivariate analysis identified age (odds ratio [OR] =1.023; 95% confidence interval [CI]. 1.006-1.040) and number of PRC transfused within the first 24 h (OR = 1.094; 95% CI, 1.0032-1.160) as weak but significant independent predictors of mortality, whereas poly-trauma diagnosis was a protective factor (OR = 0.325; 95% CI, 0.112 - 0,940). Conclusions: Overall, the mortality rate among patients receiving MT was very high, and was influenced by the number of transfused units, patient's age, and admitting diagnose. As the majority of the MT episodes occurred within the surgical or polytrauma context, possible strategies to reduce the volume of MT are discussed
Asunto(s)
Humanos , Transfusión Sanguínea/estadística & datos numéricos , Hemorragia/terapia , Estudios Retrospectivos , Hematínicos/farmacocinética , Hipovolemia/terapia , Anemia/terapiaRESUMEN
No disponible