RESUMO
UNLABELLED: Burkitt lymphoma (BL) is highly FDG-avid even though its usefulness in the management of these patients is still controversial. AIM: We analyzed the role of positron emission tomography/computerized tomography (PET/CT) in staging newly diagnosed patients with BL and evaluating disease after first-line chemotherapy. METHODS: Fifty-two PET/CTs were performed in 32 patients (20 at diagnosis, 27 after treatment, five to monitor residual disease). Involved areas were retrospectively compared with those observed in contrast-enhanced CT. RESULTS: Discrepancies were found in 64.7% of patients for whom results of both tests at diagnosis were available (n = 17), most of them involving extranodal sites. Regarding response assessment, discrepancies were observed in 38% of patients with both tests (5/13): residual masses detected by CT with negative PET/CT. Of 27 patients with post-treatment PET/CT, 22 were in complete remission whereas one true-positive and four false-positive lesions (two nodal and two extranodal) were detected. With a median follow-up of 27 months, 22 patients with negative PET/CT did not relapse. Thus, negative predictive value (NPV) was 100%. With respect to positive predictive value (PPV), one of five patients with positive assays after treatment died due to progression while the remaining four had false-positive lesions. Nevertheless, for these four patients, mean SUVmax at nodal sites was 4.1 vs. 14.9 at diagnosis, while mean SUVmax at extranodal sites was 3.8 vs. 12.1. Thus, with a cutoff value for SUVmax < 66% of that observed at diagnosis, PPV was also 100%. CONCLUSION: More accurate staging can be achieved using PET/CT. NPV reaches 100%, and using a ΔSUV < 66%, a high PPV is also observed.
Assuntos
Linfoma de Burkitt/diagnóstico , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma de Burkitt/tratamento farmacológico , Linfoma de Burkitt/mortalidade , Criança , Pré-Escolar , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To analyze the simultaneous combination of all-trans retinoic acid (ATRA) and anthracycline monochemotherapy for children with acute promyelocytic leukemia (APL). PATIENTS AND METHODS: Since November 1996, 66 children (younger than 18 years) with genetically proven APL received induction therapy with ATRA and idarubicin. Consolidation therapy consisted of three courses of anthracycline monochemotherapy. After November 1999, patients with intermediate and high risk of relapse received consolidation therapy with ATRA and slightly reinforced doses of idarubicin. Maintenance therapy consisted of ATRA and low-dose mercaptopurine and methotrexate. RESULTS: Thirty-nine girls (59%) and 27 boys (41%) were included in this study. The WBC count at presentation was more than 10 x 10(9)/L in 26 patients (39%). Sixty-one children (92%) achieved complete remission (CR). Early deaths from hemorrhage and retinoic acid syndrome occurred in three patients and two patients, respectively. Toxicity was manageable during consolidation and maintenance therapy. No deaths in CR, clinical cardiomyotoxicity, or secondary malignancy occurred. Two patients had molecular persistence at the end of consolidation. Three clinical relapses and two molecular relapses were also observed. Apart from one molecular relapse, all these events occurred among children with hyperleukocytosis. The 5-year cumulative incidence of relapse was 17%, whereas disease-free and overall survival rates were 82% and 87%, respectively. CONCLUSION: A high incidence of hyperleukocytosis in children with APL was confirmed. Besides low toxicity and a high degree of compliance, a risk-adapted therapy combining ATRA and anthracycline monochemotherapy showed an antileukemic efficacy comparable to those previously reported with other chemotherapy combinations in children.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Promielocítica Aguda/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Adolescente , Antraciclinas/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Idarubicina/administração & dosagem , Incidência , Leucemia Promielocítica Aguda/epidemiologia , Masculino , Mercaptopurina/administração & dosagem , Metotrexato/administração & dosagem , Prognóstico , Indução de Remissão , Fatores de Risco , Taxa de Sobrevida , Tretinoína/administração & dosagemRESUMO
HTLV-I isolates exhibit peculiar geographic distributions, but are believed not to be associated with different pathogenic outcomes of these retroviral infections. We have analyzed two HTLV-I-infected Spanish native patients: one patient with a T-cell lymphoma had not travelled to HTLV endemic areas, and the other patient had a paraparesis and had travelled to many HTLV endemic areas such as South America, and Central and South Africa. LTR proviral sequences of these isolates were amplified and sequenced to generate phylogenetic trees with different reported HTLV-I strains in order to subtype them. Spanish isolates clustered into the cosmopolitan HTLV-Ia subtype. It is important to know which HTLV-I subtypes are circulating in Spain. It is possible that a subtype other than the cosmopolitan one is present in Spain, especially African subtypes due to the proximity of this continent and the rise of immigration from Central and South African countries.
Assuntos
Infecções por HTLV-I/virologia , Vírus Linfotrópico T Tipo 1 Humano/classificação , Adulto , Comorbidade , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Repetição Terminal Longa de HIV/genética , HIV-1/isolamento & purificação , Infecções por HTLV-I/epidemiologia , Vírus Linfotrópico T Tipo 1 Humano/genética , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Humanos , Leucemia-Linfoma de Células T do Adulto/virologia , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica Tropical/virologia , Filogenia , Provírus/genética , Homologia de Sequência do Ácido Nucleico , Espanha/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
We identified two patients with atypical PML-RAR(alpha) rearrangements, 53 and 13 base pairs longer than the typical bcr1 transcript. Sequence analysis revealed a new PML breakpoint at the end of exon 7a in patient 1, and a PML exon 6 breakpoint in patient 2, with an insertion of 35 nucleotides of RAR(alpha) intron 2. Patient 1 did not express RAR(alpha)-PML and patient 2 showed the RAR(alpha)-PML transcript, which corresponded to the typical bcr1. These results emphasize on the relevance of the correct identification of atypical PML-RAR(alpha) rearrangements because of the potential implications in leukemogenesis, in the response to treatment, and for the correct monitoring of minimal residual disease.
Assuntos
Leucemia Promielocítica Aguda/genética , Proteínas de Neoplasias/genética , Proteínas de Fusão Oncogênica/genética , RNA Mensageiro/análise , Adulto , Sequência de Bases , Rearranjo Gênico , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Only a few cases of AIDS-related primary lymphomas of the central nervous system (CNS) show a T-cell phenotype. We have recently studied two intravenous drug users with HIV infection who had primary CNS T-cell lymphomas. In both cases, the enzyme immunoassay (EIA) for HTLV gave a positive result. In the first case, study by western-blot (WB) and specific PCR confirmed the human T-cell lymphotropic virus type I (HTLV-I) infection and serological study by EIA for HTLV of his mother was negative. In the second case, analysis of ante-mortem serum samples by two different WBs showed an indeterminate pattern suggestive of HTLV-I infection, but adequate samples for PCR were not available. We speculate about the possibility that the horizontal transmission of HTLV-I infection could have facilitated the devepolment of a primary CNS T-cell lymphoma in these HIV patients, although they cannot be strictly considered as ATLL cases.
Assuntos
Neoplasias do Sistema Nervoso Central/etiologia , Infecções por HTLV-I/complicações , Linfoma de Células T/etiologia , Adulto , Infecções por HIV/complicações , Humanos , Masculino , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
Up to December 2002, a total of 56, 566 and 109 cases of human T-lymphotropic virus type 1 (HTLV-I), HTLV-II and human immunodeficiency virus type 2 (HIV-2) infection, respectively, were identified in Spain. Most HTLV-I- and HIV-2-infected subjects were immigrants from endemic areas or Spaniards who had traveled to, or had sexual contacts with natives from, these areas. In contrast, HTLV-II infection was mainly limited to Spanish intravenous drug users (IDU) who were frequently coinfected with HIV-1. Among HTLV-I-infected patients, 12 developed subacute myelopathy and 4 adult T-cell leukemia. As for the HIV-2-positive subjects, only 20 (18.3%) developed AIDS. There was no evidence of an increase in the incidence of HIV-2 and HTLV-I infections over time. In contrast, HTLV-II infection has spread in recent years among the HIV-1-positive IDU population in prisons, with a rate of 18% in some regions of Spain. Nevertheless, the prevalence of HTLV-II infection in HIV-1-positive IDU outpatients is still low (4.7%).
Assuntos
Infecções por HIV/epidemiologia , HIV-2/isolamento & purificação , Infecções por HTLV-I/epidemiologia , Infecções por HTLV-II/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Comorbidade , Emigração e Imigração , Feminino , Infecções por HIV/transmissão , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Infecções por HTLV-I/transmissão , Infecções por HTLV-II/transmissão , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/efeitos adversos , Prisioneiros , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Comportamento Sexual , Espanha/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Reação Transfusional , ViagemRESUMO
BACKGROUND: Standard therapy for suspected infections in patients with profound neutropenia is the combination of a beta-lactam antibiotic plus an aminoglycoside. Cefepime's broad-spectrum activity makes it an option for initial empirical therapy in neutropenic patients. The aim of this study is to evaluate the efficacy and safety of cefepime plus amikacin compared with piperacillin-tazobactam plus amikacin for initial empirical treatment of fever in adult haematology patients with severe neutropenia. METHODS: In this prospective multicentre trial, 969 patients with 984 febrile neutropenic episodes were randomized to receive iv amikacin (20 mg/kg every 24 h) combined with either cefepime (2 g every 8 h) or piperacillin-tazobactam (4 g/500 mg every 6 h). Clinical response was determined at 72 h and at completion of therapy. RESULTS: Eight hundred and sixty-seven episodes were assessable for efficacy (432 cefepime, 435 piperacillin-tazobactam). The frequency of success without modification of the empirical therapy was nearly identical for cefepime plus amikacin (49%) compared with piperacillin-tazobactam plus amikacin (51%). Similar rates of success were found for microbiologically documented infection: 40% versus 39%, respectively. Antibiotic modification was necessary in 49% of cefepime and 44% of piperacillin-tazobactam patients. The overall response rate, with or without modification of the assigned treatment, was 94% in both groups. Drug-related adverse events were reported in 10% of cefepime plus amikacin versus 11% of piperacillin-tazobactam plus amikacin patients. Mortality due to infection occurred in a total of 10 patients (two cefepime, eight piperacillin-tazobactam). CONCLUSION: The empirical regimen of cefepime plus amikacin is equivalent to piperacillin-tazobactam plus amikacin in febrile adult haematology patients with severe neutropenia. KEYWORDS: cefepime, piperacillin-tazobactam, amikacin, empirical antibiotic therapy, febrile neutropenia, haematological malignancy
Assuntos
Quimioterapia Combinada/administração & dosagem , Quimioterapia Combinada/uso terapêutico , Febre/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas , Neutropenia , Ácido Penicilânico/análogos & derivados , Adulto , Amicacina/administração & dosagem , Amicacina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Cefepima , Cefalosporinas/administração & dosagem , Cefalosporinas/uso terapêutico , Quimioterapia Combinada/efeitos adversos , Feminino , Febre/etiologia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Masculino , Neutropenia/complicações , Ácido Penicilânico/administração & dosagem , Ácido Penicilânico/uso terapêutico , Piperacilina/administração & dosagem , Piperacilina/uso terapêutico , Tazobactam , Resultado do TratamentoRESUMO
All-trans-retinoic acid (ATRA) increases the efficacy of chemotherapy when used for induction and maintenance treatment of acute promyelocytic leukemia (APL), but its role in consolidation is unknown. Since November 1996, 426 patients with newly diagnosed APL have received induction therapy with ATRA and idarubicin. Before November 1999 (LPA96 study), consolidation therapy consisted of 3 courses of anthracycline monochemotherapy. After November 1999 (LPA99 study), patients with intermediate and high risks of relapse received consolidation therapy with ATRA and increased doses of anthracyclines. Of the 384 patients who achieved complete remission (90%), 382 proceeded to consolidation therapy. Seven patients died in remission (1.8%). The 3-year cumulative incidence of relapse for patients in the LPA96 and LPA99 studies was 17.2% and 7.5%, respectively (P =.008). Patients treated with ATRA in consolidation therapy showed an overall reduction in the relapse rate from 20.1% to 8.7% (P =.004). In intermediate-risk patients the rate decreased from 14.0% to 2.5% (P =.006). This improved antileukemic efficacy also translated into significantly better disease-free and overall survival. A risk-adapted strategy combining anthracycline monochemotherapy and ATRA for induction and consolidation therapy of newly diagnosed APL results in improved antileukemic efficacy and a high degree of compliance.