RESUMO
Coagulation management in the patient with cirrhosis has undergone a significant transformation since the beginning of this century, with the concept of a rebalancing between procoagulant and anticoagulant factors. The paradigm that patients with cirrhosis have a greater bleeding tendency has changed, as a result of this rebalancing. In addition, it has brought to light the presence of complications related to thrombotic events in this group of patients. These guidelines detail aspects related to pathophysiologic mechanisms that intervene in the maintenance of hemostasis in the patient with cirrhosis, the relevance of portal hypertension, mechanical factors for the development of bleeding, modifications in the hepatic synthesis of coagulation factors, and the changes in the reticuloendothelial system in acute hepatic decompensation and acute-on-chronic liver failure. They address new aspects related to the hemorrhagic complications in patients with cirrhosis, considering the risk for bleeding during diagnostic or therapeutic procedures, as well as the usefulness of different tools for diagnosing coagulation and recommendations on the pharmacologic treatment and blood-product transfusion in the context of hemorrhage. These guidelines also update the knowledge regarding hypercoagulability in the patient with cirrhosis, as well as the efficacy and safety of treatment with the different anticoagulation regimens. Lastly, they provide recommendations on coagulation management in the context of acute-on-chronic liver failure, acute liver decompensation, and specific aspects related to the patient undergoing liver transplantation.
Assuntos
Insuficiência Hepática Crônica Agudizada , Transtornos da Coagulação Sanguínea , Humanos , Insuficiência Hepática Crônica Agudizada/complicações , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/terapia , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Coagulação Sanguínea , HemostasiaRESUMO
OBJECTIVES: Blood component transfusion is a common procedure used during hospital admissions; however, it is not risk-free. The evaluation of correct use of blood products (BP) is of vast importance considering the risks and costs implied in their use. Our principal objective was to evaluate the adherence to national guidelines for blood transfusion in pediatric patients at a third level university hospital. MATERIAL AND METHODS: A prospective and retrospective descriptive analytical study was conducted to report the incidence of incorrect use of BP in pediatric patients (1 month to 16 years of age). In a timeline period of 4 years, 579 medical records were randomly selected from a total of 6575 transfusions realized to create a statistically significant sample. The variables studied were volume, infusion time, and transfusion criteria. Indications were evaluated in patient's medical records according to national guidelines. RESULTS: Of the transfusions analyzed, 54% were classified as incorrect mainly due to lack of transfusion criteria fulfillment. Blood transfusion indications in pediatric patients adhered poorly to national guidelines. CONCLUSION: The implementation of effective programs for education and information on the use of BP are needed to increase compliance with current guidelines.
Assuntos
Transfusão de Componentes Sanguíneos , Transfusão de Sangue , Criança , Hospitais Universitários , Humanos , Estudos Prospectivos , Estudos RetrospectivosRESUMO
A total of 72 patients with Ph-positive CML in first chronic phase were followed during a 6-year period in two different institutions in México. Among them, 22 were given a reduced-intensity allogeneic SCT, whereas 50 were given a tyrosine kinase inhibitor (TKI), mainly imatinib mesylate. The 6-year overall survival (OS) after the therapeutic intervention for patients allografted or given a TKI was 77 and 84%, respectively (P, NS); the median OS for both groups has not been reached, being above 90 and 71 months, respectively (P, NS). The freedom from progression to blast or accelerated phases was also similar for both groups, as well as the overall OS after diagnosis. Most patients allografted (91%) chose this treatment because they were unable to afford continuing treatment with the TKI, whereas most treated with the TKI (84%) were given the treatment without charge, through institutions able to pay for their treatment. The median cost of each nonmyeloablative allograft was US$18,000, an amount that is enough to cover 180 days of treatment with imatinib (400 mg per day) in México. Cost considerations favor allogeneic SCT as a 'once only' procedure whereas lifelong treatment with an expensive drug represents an excessive burden on resources.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Piperazinas/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/uso terapêutico , Adolescente , Adulto , Idoso , Benzamidas , Criança , Análise Custo-Benefício , Países em Desenvolvimento/economia , Feminino , Humanos , Mesilato de Imatinib , Leucemia Mielogênica Crônica BCR-ABL Positiva/economia , Masculino , México , Pessoa de Meia-Idade , Piperazinas/economia , Estudos Prospectivos , Inibidores de Proteínas Quinases/economia , Pirimidinas/economia , Análise de Sobrevida , Condicionamento Pré-Transplante , Transplante Homólogo/economiaRESUMO
BACKGROUND AND OBJECTIVE: Cytospin conventional cytomorphology (CCC) is the standard method for detecting lymphoblasts in cerebrospinal fluid (CSF) of patients with acute lymphoblastic leukemia (ALL) and for guiding treatment decisions. We evaluated flow cytometry immunophenotyping (FCI) performance for improving detection of central nervous system (CNS) involvement in ALL. METHODS: This prospective study included analysis of consecutive CSF samples of patients of all ages with ALL at 3 clinical stages: new diagnosis, relapse suspicion, and after relapse treatment. Manual, cytospin, automated, and FCI methods were compared and their performance statistically assessed. Using FCI as the reference method, optimal CSF cutoff cell count that better correlated with presence of lymphoblasts was established by receiver operating characteristic (ROC) curve analysis. RESULTS: Seventy-seven CSF samples were investigated, 35 (45.4%) from newly diagnosed cases, 30 (39%) suspicion of relapse, and 12 (15.6%) after treatment for relapse. Median manual WBC count in patients with CNS involvement detected by FCI was 3.75 cells/µL (0.0-1280), and this was also the count that best correlated with CNS infiltration (sensitivity, 50.0%; specificity, 82.2%). Compared with FCI, CCC sensitivity and specificity were 28.6% and 100%. Automated CSF WBC count in patients with CNS involvement detected by FCI was 5 (0.0-1578). For automated count, optimal WBC cutoff was 4.5 cells/µL (sensitivity, 62.5%; specificity, 70.5%). CONCLUSION: Flow cytometry immunophenotyping complements conventional cytospin analysis for detection of lymphoblasts in the CSF of ALL patients at any clinical stage.
Assuntos
Sistema Nervoso Central/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/líquido cefalorraquidiano , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Forma Celular , Citometria de Fluxo , Humanos , Imunofenotipagem , Contagem de Leucócitos , Linfócitos/patologia , Invasividade Neoplásica/diagnóstico , Recidiva , Sensibilidade e EspecificidadeRESUMO
Using non-myeloablative conditioning, allogeneic hematopoietic stem cell transplantation (HSCT) was conducted in 43 ALL patients in a CR2. The median age of the patients was 19 years. Patients received oral busulfan 4 mg/kg/day for 2 days; i.v. cyclophosphamide 350 mg/m(2)/day for 3 days; and i.v. fludarabine 30 mg/m(2)/day for 3 days. Oral cyclosporin A 4 mg/kg was started and methotrexate 5 mg/m(2) was delivered on days 1, 3, 5 and 11. The median CD34+ cell dose received was 5.0 x 10(6)/kg. The medium time to achieve a granulocyte count above 0.5 x 10(9)/l was 14 days. Thirteen patients were alive 30-1050 days after the HSCT. The 3-year overall survival rate was 30%. Ten patients (23%) developed acute GVHD, whereas eight patients (18.6%) developed chronic GVHD. Thirty patients died between days 47 and 1050 after the HSCT, most of them (70%) because of an ALL relapse. One hundred-day mortality was 15%, whereas transplant-related mortality was 21%. These results are inferior to those obtained using the same allografting method in other leukemias, probably as a consequence of poor susceptibility to the graft-versus-leukemia effect of the ALL cells beyond first remission as compared with other hematological malignancies.
Assuntos
Efeito Enxerto vs Leucemia , Transplante de Células-Tronco Hematopoéticas , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Condicionamento Pré-Transplante/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Granulócitos/citologia , Humanos , Lactente , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Indução de Remissão , Taxa de Sobrevida , Transplante HomólogoRESUMO
A group of 132 patients with both malignant and nonmalignant conditions was allografted using the 'Mexican' method of non-ablative conditioning. The conditioning was delivered on an outpatient basis and the procedure was planned to be conducted on outpatients in all cases. While 103 patients (78%) were able to complete the procedure totally as outpatients, 29 (22%) were hospitalized because of fever, mucositis or acute graft-versus-host disease. In a multivariate analysis, although differences were not statistically significant, it was found that the patients who were allografted as outpatients had higher levels of hemoglobin (12 versus 11.8 g/dl), higher platelet counts (248 versus 191 x 10(9)/l), lower white blood cell counts (11.7 versus 12.4 x 10(9)/l), higher Karnofsky scale scores (100 versus 90%) and lower creatinine levels (0.9 versus 0.93 mg/dl). A total of 86% of the patients with normal values for these variables could be allografted as outpatients, whereas only 67% of those with abnormal values completed the entire procedure as outpatients. It is concluded that allografting can be accomplished totally on an outpatient basis using the 'Mexican' reduced intensity-conditioning regimen.
Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Adolescente , Adulto , Assistência Ambulatorial , Criança , Feminino , Doenças Hematológicas/mortalidade , Doenças Hematológicas/terapia , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hospitalização , Humanos , Masculino , México , Pessoa de Meia-Idade , Segurança , Taxa de Sobrevida , Condicionamento Pré-Transplante/efeitos adversos , Transplante HomólogoRESUMO
Autologous peripheral blood stem cell transplantation is the therapy of choice for the treatment of multiple myeloma (MM) patients younger than 70 years old. Between August 1993 and November 2004, 54 patients with MM were autografted after conditioning with high-dose oral melphalan 140 mg/m(2) in combination with etoposide and carmustine (28 patients) or with high-dose melphalan 200 mg/m(2) I.V. (26 patients). The oral and IV melphalan groups were comparable. There were no significant differences in disease-free survival (DFS) and overall survival (OS) between the groups; however, in patients transplanted in remission, OS and DFS were better in the I.V. melphalan group. Four good-prognostic factors were identified: interval between diagnosis and transplant <18 months, number of prior chemotherapy lines < or =2, remission status (complete or partial), and the use of I.V. melphalan. In conclusion, I.V. melphalan is the therapy of choice for conditioning patients with MM who are in remission.
Assuntos
Melfalan/uso terapêutico , Mieloma Múltiplo/terapia , Transplante de Células-Tronco de Sangue Periférico/métodos , Administração Oral , Adulto , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Carmustina/administração & dosagem , Carmustina/uso terapêutico , Terapia Combinada , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Etoposídeo/administração & dosagem , Etoposídeo/uso terapêutico , Feminino , Humanos , Infusões Intravenosas , Masculino , Melfalan/administração & dosagem , México , Pessoa de Meia-Idade , Mieloma Múltiplo/patologia , Indução de Remissão , Transplante Autólogo , Resultado do TratamentoRESUMO
Haematopoietic cell transplant activity in the 28 countries comprising Latin America is poorly defined. We conducted a voluntary survey of members of the Latin American Bone Marrow Transplantation Group regarding transplant activity 2009-2012. Collated responses were compared with data of transplant rates from the Worldwide Network for Blood and Marrow Transplantation for other geographic regions. Several socio-economic variables were analysed to determine correlations with transplant rates. In total, 94 teams from 12 countries reported 11 519 transplants including 7033 autotransplants and 4486 allotransplants. Annual activity increased from 2517 transplants in 2009 to 3263 in 2012, a 30% increase. Median transplants rate (transplant per million inhabitants) in 2012 was 64 (autotransplants, median 40; allotransplants, median 24). This rate is substantially lower than that in North America and European regions (482 and 378) but higher than that in the Eastern Mediterranean and Asia Pacific regions (30 and 45). However, the Latin America transplant rate is 5-8-fold lower than that in America and Europe, suggesting a need to increase transplant availability. Transplant team density in Latin America (teams per million population; 1.8) is 3-4-fold lower than that in North America (6.2) or Europe (7.6). Within Latin America, there is substantial diversity in transplant rates by country partially explained by diverse socio-economic variables including per capita gross national income, health expenditure and physician density. These data should help inform future health-care policy in Latin America.
Assuntos
Transplante de Células-Tronco Hematopoéticas/tendências , Atenção à Saúde/estatística & dados numéricos , Atenção à Saúde/tendências , Previsões , Saúde Global/estatística & dados numéricos , Saúde Global/tendências , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Humanos , América Latina , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs (P=0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% (P=0.18), and for grades III-IV was 2.6% vs 11.6% (P=0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% (P=0.002) and extensive 5% vs 23.6% (P=0.01). OS was 74% vs 76% for BM vs PBSCs (P=0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P=0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P=0.005) respectively. In multivariate analysis, aGvHD II-IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1-5.6, P=0.02) and aGvHD III-IV (HR 8.3 CI 3.4-20.2, P<0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patients.
Assuntos
Anemia Aplástica/terapia , Soro Antilinfocitário/administração & dosagem , Antígenos HLA , Irmãos , Transplante de Células-Tronco , Doença Aguda , Adolescente , Adulto , Idoso , Aloenxertos , Anemia Aplástica/mortalidade , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Doença Enxerto-Hospedeiro/mortalidade , Doença Enxerto-Hospedeiro/prevenção & controle , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Taxa de SobrevidaRESUMO
Using a reduced-intensity stem cell transplantation (RIST) schedule, 24 patients with Philadelphia (Ph1) (+) chronic myelogenous leukemia (CML) in first chronic phase (CP) were prospectively allografted in four Latin American countries: México, Brazil, Colombia and Venezuela, using HLA-identical siblings as donors. The median age of the patients was 41 years (range 10-71 years); there were eight females. Patients received a median of 4.4 x 10(6)/kg CD34 cells. The median time to achieve above 0.5 x 10(9)/l granulocytes was 12 days, range 0-41 days, and the median time to achieve above 20 x 10(9)/l platelets was also 12 days, range 0-45 days. In all, 22 patients are alive 81-830 (median 497) days after RIST. The 830-day probability of survival is 92%, and the median survival has not been reached, being beyond 830 days. A total of 11 patients (46%) developed acute graft-versus-host disease (GVHD), and seven of 23 (30%) developed chronic GVHD. Two patients died 43 and 210 days after RIST, one as a result of sepsis and the other of chronic GVHD. The 100-day mortality was 4.4%, and transplant-related mortality was 8%. RIST for patients with CML in CP appears to be an adequate therapeutic option.
Assuntos
Antineoplásicos/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Transplante de Células-Tronco/métodos , Adolescente , Adulto , Idoso , Antígenos CD34/biossíntese , Benzamidas , Remoção de Componentes Sanguíneos , Criança , Feminino , Doença Enxerto-Hospedeiro/terapia , Humanos , Mesilato de Imatinib , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Condicionamento Pré-Transplante , Resultado do TratamentoRESUMO
Four multitransfused patients with severe aplastic anaemia (SAA) are described. Two received a BMT after conditioning with cyclophosphamide (Cy) plus antithymocyte globulin (ATG). Both suffered a graft failure (GF) and had a second transplant with PBSC from the original donor. Two other patients received a PBSCT as a first option, with Cy as the only conditioning drug. The four patients received methotrexate (MTX) and cyclosporine (CYA) as post-grafting immunosuppression. The two BMT patients with GF were successfully rescued with a PBSC second transplant. In the two cases where a PBSCT was done as a first option no GF was observed and a successful and complete haematological recovery was achieved. In conclusion, PBSCT rescued two SAA patients with GF after BMT. PBSCT without ATG as a first option produced a quick and complete haematological recovery in two additional patients, suggesting that PBSCT without ATG can be an alternative to BMT plus ATG in SAA as a first transplant option.
Assuntos
Anemia Aplástica/terapia , Transfusão de Sangue , Transplante de Células-Tronco Hematopoéticas , Doença Aguda , Adolescente , Adulto , Soro Antilinfocitário/administração & dosagem , Ciclofosfamida/administração & dosagem , Ciclosporina/administração & dosagem , Feminino , Humanos , Imunossupressores/administração & dosagem , Masculino , Metotrexato/administração & dosagemRESUMO
Using a non-myeloablative, immunosuppressive, fludarabine-based conditioning regimen, we performed allogeneic peripheral blood stem cell transplants totally on an outpatient basis in four patients (two with chronic myelogenous leukemia, one with acute myelogenous leukemia and one with thalassemia major). The median granulocyte recovery time to 0.5 x 109/l was 10 days and the lowest absolute neutrophil count was 0.064 x 109/l; only one patient developed thrombocytopenia below 20 x 109/l. No patient required red blood cell transfusions and one was given a single prophylactic platelet transfusion. All patients are alive at 210-390 (median 285) days and have definite evidence of chimerism; one developed biopsy-proven GVHD on day 50, with a limited cutaneous rash. The procedure is less costly than its counterpart using myeloablative conditioning regimens and may represent another approach in the management of patients requiring an allogeneic stem cell transplant. Bone Marrow Transplantation (2000) 25, 131-133.
Assuntos
Assistência Ambulatorial , Transplante de Células-Tronco Hematopoéticas/métodos , Leucemia Mieloide/terapia , Condicionamento Pré-Transplante/métodos , Talassemia beta/terapia , Adolescente , Adulto , Assistência Ambulatorial/economia , Transfusão de Componentes Sanguíneos , Feminino , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/economia , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Leucemia Mieloide/sangue , Leucemia Mieloide/complicações , Contagem de Leucócitos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Taxa de Sobrevida , Trombocitopenia/etiologia , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/economia , Resultado do Tratamento , Vidarabina/efeitos adversos , Vidarabina/análogos & derivados , Vidarabina/uso terapêutico , Talassemia beta/sangue , Talassemia beta/complicaçõesRESUMO
Because radiotherapy (RT) equipment technology in some developing countries is outdated, its side effects are more frequent and severe and its efficacy suboptimal, whereas chemotherapy (CT) meeting international standards is generally more consistent. With this in mind, we treated 29 patients with stages I and II Hodgkin's disease with the MOPP or the MOPP/ABV hybrid schedule without prior staging laparotomy. The complete remission rate was 96%: five patients relapsed and of these, two died and three were rescued with CT, in one case followed by an autologous stem cell autograft. The median follow-up is 54 months (range 9 to 126), the overall survival of the group 88% at 126 months, and the relapse-free survival 72% at 110 months. Conventional CT alone has been shown to be useful in achieving acceptable long-term results. This observation could be important in circumstances where RT is unavailable or of suboptimal quality.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Feminino , Doença de Hodgkin/mortalidade , Doença de Hodgkin/radioterapia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The features of the engraftment in 26 patients allografted using reduced-intensity conditioning regimen (8 with chronic myelogenous leukemia, 6 with acute myelogenous leukemia, 9 with acute lymphoblastic leukemia, 1 with hybrid acute leukemia, 1 with myelodysplasia and 1 with thalassemia major) were analyzed. Patients received a median of 10 x 10(8)/Kg mononuclear cells (range 1.6 to 22.9), and a median of 4.2 x 10(6)/Kg CD34 cells (range 0.3 to 14). There was a linear correlation between the number of infused mononuclear cells (MNC) and that of CD34 cells (r = 0.78, p = 0.002). Three patients (11%) failed to engraft; in those who engrafted, the median time to achieve > 500 granulocytes was 11 days (range 10 to 22), and the median time to achieve > 10,000 platelets was 12 days (range 10 to 41). The three patients who failed to engraft received less than 5 x 10(8)/Kg MNC (1.6, 4.6 and 4.9) and less than 0.5 x 10(6)/Kg CD34; however, five of eight patients who received less than 5 x 10(8)/Kg MNC still engrafted successfully. On the other hand, all the patients who received less than 0.5 x 10(6)/Kg CD34 cells failed to engraft. Within the group of patients who engrafted, it was found that those who received more than 7 x 10(6)/Kg CD34+ cells tended to earlier recover > 20 x 10(9)/L platelets (p = 0.02), and > 0.5 x 10(9)/L neutrophils (p = 0.06) before day 15, than those who received less than 7 x 10(6)/Kg CD34+ cells. No such association could be established between the number of MNC and the time for recovery. In these patients allografted using reduced-intensity conditioning regimens, the target doses of hematopoietic cell used were similar to those described for conventional allografts: The number of CD34 infused cells was significantly related to the possibility of failure to engraft and to the recovery rate of the hemopoiesis.
Assuntos
Sobrevivência de Enxerto , Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Adolescente , Adulto , Antígenos CD34 , Contagem de Células Sanguíneas , Criança , Pré-Escolar , Feminino , Neoplasias Hematológicas/terapia , Hematopoese , Humanos , Imunossupressores/administração & dosagem , Leucaférese/normas , Contagem de Leucócitos , Leucócitos Mononucleares , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Transplante Homólogo/métodos , Vidarabina/administração & dosagem , Vidarabina/análogos & derivadosRESUMO
BACKGROUND: Cytoskeleton-free microvesicles can be generated from normal red blood cells (RBCs). These RBC vesicles maintain a representative sampling of the lipid bilayer and several membrane proteins. We investigated RBC antigen segregation and persistence of immunoreactivity in RBC microvesicles. METHODS: Cytoskeleton-free RBC microvesicles were generated from erythrocytes expressing known RBC antigens. Antigen segregation into vesicles was documented by immunospecific antigen-antibody binding using IgG eluates and 125I Protein A. 125I Protein A counts per minute (cpm) ratios between antigen-positive vesicles sensitized with 11 eluates compared with those of vesicles incubated with normal human serum are reported. RESULTS: Cytoskeleton-free RBC microvesicles preserved the antigenic expression of the original RBC's. Differences in cpm between eluate-sensitized vesicles and those incubated with normal human serum ranged from 3:1 for the Fy(b) antigen to 65:1 for the D antigen. CONCLUSIONS: This study demonstrates that molecules bearing common RBC antigens segregate into microvesicles, fully preserving their epitope-bearing activity. The major proteins of the RBC cytoskeleton are not required for such antigen expression.
Assuntos
Antígenos de Grupos Sanguíneos/imunologia , Citoesqueleto/fisiologia , Membrana Eritrocítica/imunologia , Anticorpos Anti-Idiotípicos/imunologia , Humanos , Imunoglobulina G/imunologiaRESUMO
BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a rare non-neoplastic, frequently fatal disease of childhood. HLA-matched bone marrow transplantation (BMT) can bring about long-term remission and an eventual cure. METHODS: We report on the beneficial effect of BMT in a 2-month-old male using a less intensive conditioning regimen. The regimen included busulfan at 4 mg/kg/day (total dose 16 mg/kg), etoposide at 300 mg/m2/day (total dose 900 mg/m2), and cyclophosphamide at 50 mg/kg/day (total dose 150 mg/kg). Prophylaxis for graft-vs.-host disease included methotrexate and cyclosporine. RESULTS: An absolute neutrophil count of 500 microL was noticed on + day 12 (engraftment day). At present, i.e., 400 days after the procedure, the patient is asymptomatic, his physical examination is normal, and a slightly increased level of gamma-glutamyl-transpeptidase (GGT) and alkaline phosphatase are the only laboratory abnormalities. CONCLUSIONS: In this case, the conditioning regimen was adequate for the eradication of the disease and allowed persistent engraftment without significant toxicity. The results in our patient suggest that a less toxic regimen is feasible and permits rapid engraftment without compromising the effectiveness of chemotherapy.
Assuntos
Transplante de Medula Óssea , Histiocitose de Células não Langerhans/terapia , Histiocitose de Células não Langerhans/tratamento farmacológico , Histiocitose de Células não Langerhans/fisiopatologia , Humanos , Lactente , MasculinoRESUMO
OBJECTIVE: To evaluate if short and intermittent courses of human recombinant interferon alpha (IFN) are useful in the long term palliation of hairy cell leukemia. METHODS: Nine patients with hairy cell leukemia received 3 megaunits of IFN thrice a week for 12 weeks. They received 8 weeks of IFN upon relapse or after 10 months of followup every year. RESULTS: A hematological remission was obtained in all cases before 12 weeks. Only three patients, because of relapse, required therapy before 10 months. All the patients are alive and well after a median followup of 62 months. CONCLUSIONS: Short courses of IFN proved to be an alternative in the treatment of hairy cell leukemia. It is less expensive and was effective in the initial therapy and maintenance of selected patients with this kind of leukemia.
Assuntos
Antineoplásicos/uso terapêutico , Interferon-alfa/uso terapêutico , Leucemia de Células Pilosas/tratamento farmacológico , Adolescente , Adulto , Antineoplásicos/economia , Custos de Medicamentos , Feminino , Humanos , Interferon-alfa/economia , Masculino , Pessoa de Meia-IdadeRESUMO
The Witnesses of Jehovah is a religious community posing special problems because of their religions conviction which objects to transfusions of blood or blood products. Six patients with acute lymphoblastic leukemia (one adult and 5 children) are presented. We obtained permission for blood transfusion in four children without resorting to legal pressures which, on the hand, are non-existent in Mexico.
Assuntos
Transfusão de Sangue , Cristianismo , Aceitação pelo Paciente de Cuidados de Saúde , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Consentimento Livre e Esclarecido , Masculino , Educação de Pacientes como Assunto , Relações Médico-Paciente , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Indução de RemissãoRESUMO
Bone marrow necrosis (BMN) is mostly diagnosed at postmortem examination. It has been observed in association with acute leukemia and other malignant diseases. We report here BMN in two patients with acute myeloid leukemia (AML) and one with acute lymphocytic leukemia (ALL) in whom the diagnosis was made while alive. Two patients died because of intracranial bleeding. One with AML (M5) developed BMN one week after he was treated with a second course of chemotherapy: he had a complete recovery and remains in remission almost five years after the diagnosis. We conclude that antemortem diagnosis of BMN is technically difficult, but as it is not always associated to a fatal prognosis, an early diagnosis and vigorous supportive therapy should be attempted.
Assuntos
Medula Óssea/patologia , Leucemia Monocítica Aguda/patologia , Leucemia Promielocítica Aguda/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Exame de Medula Óssea , Hemorragia Cerebral/etiologia , Evolução Fatal , Feminino , Humanos , Leucemia Monocítica Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Necrose , Dor/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Indução de RemissãoRESUMO
The first two cases in Mexico of patients with hematological malignancies treated with heterologous peripheral blood stem cell transplantation are presented. The stem cells were mobilized in the siblings by means of filgrastim; in one case, the graft was obtained from an identical twin and in the other from an HLA-identical sibling. In both instances the post-transplant aplasia lasted less than 15 years and the engraftment was complete. In the allogeneic transplantation, the graft versus host disease was treated with immunosuppression. The approximate cost of each of these procedures was 20000 U.S. dollars. The advantages of grafting heterologous peripheral blood stem cells instead of bone marrow cells are briefly discussed, focusing on economic aspects.