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1.
Transpl Infect Dis ; 15(3): 259-67, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23405972

RESUMEN

AIMS AND METHODS: This study assessed incidence, predictive factors, and outcome of Epstein-Barr virus (EBV) DNAemia in 100 recipients of allogeneic hematopoietic stem cell transplant. A total of 68 patients received anti-thymocyte globulin before unrelated grafts. RESULTS: Cumulative incidence of high-load EBV DNAemia defined by levels >10,000 copies/mL was 14% at 12 months. In multivariate analysis, a CD4+ T-lymphocyte count >50 µL at day +30 was the only factor significantly associated with a reduced risk of high-load EBV DNAemia. Thirteen of 16 patients with high viral loads were preemptively treated with rituximab and achieved EBV DNA negativity. Three patients had already developed post-transplant lymphoproliferative disorder (PTLD) at the time of detection of high EBV DNA loads, and they obtained complete response after rituximab infusions and chemotherapy. Patients with high EBV DNA load had a significantly higher transplant-related mortality (TRM) compared with patients with negative or low viral load (54% vs. 16%, P = 0.009) and a trend to lower overall survival (55% vs. 29%, P = 0.060). CONCLUSION: We conclude that CD4+ cell count at day +30 is a predictive factor for EBV DNAemia and may help identify patients requiring closer monitoring. Although only 3% of patients progressed to PTLD and were all successfully managed, EBV reactivation was associated with higher TRM, mainly because of infections.


Asunto(s)
Infecciones por Virus de Epstein-Barr , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Herpesvirus Humano 4/efectos de los fármacos , Viremia , Adulto , Anciano , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Suero Antilinfocítico/administración & dosificación , Recuento de Linfocito CD4 , ADN Viral/sangre , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Infecciones por Virus de Epstein-Barr/epidemiología , Infecciones por Virus de Epstein-Barr/mortalidad , Infecciones por Virus de Epstein-Barr/virología , Femenino , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Incidencia , Trastornos Linfoproliferativos/tratamiento farmacológico , Trastornos Linfoproliferativos/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Riesgo , Rituximab , Tasa de Supervivencia , Trasplante Homólogo/efectos adversos , Viremia/tratamiento farmacológico , Viremia/epidemiología , Viremia/mortalidad , Viremia/virología , Adulto Joven
2.
Bone Marrow Transplant ; 40(3): 273-7, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17549053

RESUMEN

The anti-CD20 chimaeric monoclonal antibody Rituximab has recently been shown to induce significant clinical response in a proportion of patients with refractory chronic graft-versus-host disease (cGVHD). We now report 38 patients, median age 48 years (22-61), receiving Rituximab for refractory cGVHD, assessed for clinical response and survival. Median duration of cGVHD before Rituximab was 23 months (range 2-116), the median number of failed treatment lines was 3 (range 1 to > or =6) and the median follow-up after Rituximab was 11 months (1-88). Overall response rate was 65%: skin 17/20 (63%), mouth 10/21 (48%), eyes 6/14 (43%), liver 3/12 (25%), lung 3/8 (37.5%), joints 4/5, gut 3/4, thrombocytopaenia 2/3, vagina 0/2, pure red cell aplasia 0/1 and, myasthenia gravis 1/1. During the study period 8/38 died: causes of death were cGVHD progression (n=3), disease relapse (n=1), infection (n=3), sudden death (n=1). The actuarial 2 year survival is currently 76%. We confirm that Rituximab is effective in over 50% of patients with refractory cGVHD and may have a beneficial impact on survival.


Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Enfermedad Injerto contra Huésped/mortalidad , Factores Inmunológicos/administración & dosificación , Adulto , Anticuerpos Monoclonales de Origen Murino , Enfermedad Crónica , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Enfermedad Injerto contra Huésped/etiología , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/mortalidad , Neoplasias Hematológicas/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rituximab , Trasplante de Células Madre , Tasa de Supervivencia
3.
Sci Total Environ ; 562: 1031-1043, 2016 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-27161907

RESUMEN

Global climate change is likely to pose increasing threats in nearly all sectors and across all sub-regions worldwide (IPCC, 2014). Particularly, extreme weather events (e.g. heavy precipitations), together with changing exposure and vulnerability patterns, are expected to increase the damaging effect of storms, pluvial floods and coastal flooding. Developing climate and adaptation services for local planners and decision makers is becoming essential to transfer and communicate sound scientific knowledge about climate related risks and foster the development of national, regional and local adaptation strategies. In order to analyze the effect of climate change on pluvial flood risk and advice adaptation planning, a Regional Risk Assessment (RRA) methodology was developed and applied to the urban territory of the municipality of Venice. Based on the integrated analysis of hazard, exposure, vulnerability and risk, RRA allows identifying and prioritizing targets and sub-areas that are more likely to be affected by pluvial flood risk due to heavy precipitation events in the future scenario 2041-2050. From the early stages of its development and application, the RRA followed a bottom-up approach taking into account the requests, knowledge and perspectives of local stakeholders of the North Adriatic region by means of interactive workshops, surveys and discussions. Results of the analysis showed that all targets (i.e. residential, commercial-industrial areas and infrastructures) are vulnerable to pluvial floods due to the high impermeability and low slope of the topography. The spatial pattern of risk mostly reflects the distribution of the hazard and the districts with the higher percentage of receptors' surface in the higher risk classes (i.e. very high, high and medium) are Lido-Pellestrina and Marghera. The paper discusses how risk-based maps and statistics integrate scientific and local knowledge with the final aim to mainstream climate adaptation in the development of risk mitigation and urban plans.


Asunto(s)
Cambio Climático , Inundaciones/estadística & datos numéricos , Medición de Riesgo/métodos , Ciudades , Monitoreo del Ambiente/métodos , Italia , Ríos , Tiempo (Meteorología)
4.
Bone Marrow Transplant ; 23(5): 437-42, 1999 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-10100556

RESUMEN

Anaplastic large cell lymphoma (ALCL) is a heterogeneous family of lymphoid tumours, among which the T and null cell types were recently listed in the REAL classification as a distinct entity. Reports on autologous stem cell transplantation (ASCT) in this group are only occasional. Sixty-four patients with T and null cell ALCL from 25 European centres had been registered with the European Group for Blood and Marrow Transplantation (EBMT) at the onset of this study. The median age was 25 years (range 3.2-53.0). Thirty of the 64 patients (47%) were in complete remission (CR), 18 (28%) in partial remission (PR), and the remaining 16 (25%) had a more advanced or chemotherapy-refractory disease at transplant. Eighty-one percent of the patients were conditioned with chemotherapy alone and 75% received marrow stem cells. All the patients transplanted in first CR (15), except one, maintained the CR over time; six of 15 transplanted in CR subsequent to first, six of 18 transplanted in PR and 14 of 16 transplanted in refractory or relapsed disease progressed. Actuarial overall survival (OS) at 10 years is 70%. Multivariate analysis showed that good status at transplant, younger age, absence of B symptoms and absence of extranodal disease indicated a better prognosis. These data suggest that ASCT should be considered as a possible treatment for chemosensitive patients in CR or PR. However, definitive conclusions cannot be drawn from this study and a prospective randomised trial between ASCT and conventional chemotherapy may be indicated.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trasplante de Células Madre Hematopoyéticas , Linfoma de Células B Grandes Difuso/terapia , Adolescente , Adulto , Niño , Preescolar , Terapia Combinada , Femenino , Humanos , Antígeno Ki-1 , Linfoma de Células B Grandes Difuso/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Recurrencia , Análisis de Supervivencia , Linfocitos T/patología , Trasplante Autólogo
5.
Bone Marrow Transplant ; 24(4): 433-5, 1999 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-10467336

RESUMEN

AL amyloidosis was diagnosed in a 56-year-old woman with spontaneous purpura, macroglossia and hepatomegaly, a serum IgGk monoclonal gammopathy and a 25% plasma cell bone marrow infiltration. She was started on high-dose treatment consisting of four monthly cycles of VID chemotherapy, then underwent a stem cell collection after priming with cyclophosphamide + G-CSF. Myeloablative therapy was with melphalan and busulfan. Hematologic recovery was fast and uncomplicated. At follow-up 22 months from ASCT, the patient shows a complete remission of the clonal plasma cell disorder, normalization of liver size and alkaline phosphatase level and a significant improvement in the signs of vascular and soft tissue amyloid infiltration.


Asunto(s)
Amiloidosis/complicaciones , Amiloidosis/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trasplante de Células Madre Hematopoyéticas , Hepatomegalia , Macroglosia , Púrpura , Busulfano/uso terapéutico , Ciclofosfamida/administración & dosificación , Dexametasona/administración & dosificación , Quimioterapia Combinada , Femenino , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Humanos , Idarrubicina/administración & dosificación , Melfalán/uso terapéutico , Persona de Mediana Edad , Trasplante Autólogo , Resultado del Tratamiento , Vincristina/administración & dosificación
6.
Bone Marrow Transplant ; 33(7): 751-8, 2004 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-14755316

RESUMEN

We evaluated the incidence, the risk factors, and the outcome of late-onset noninfectious pulmonary complications (LONIPCs) among 50 patients who underwent allogeneic stem cell transplantation from unrelated donors. Of the 39 patients surviving at least 3 months, 10 (26%) fulfilled the diagnostic criteria of LONIPCs and were further subclassified as having bronchiolitis obliterans (four patients), bronchiolitis obliterans with organizing pneumonia (four patients), and interstitial pneumonia (two patients). Two patients had a durable partial remission after treatment with prednisone and cyclosporine; the remaining eight patients did not respond to treatment and five of them died of respiratory failure. Advanced stage of disease at transplant and chronic extensive graft-versus-host disease (GVHD) were significantly associated with the development of LONIPCs. Pulmonary function test (PFT) results before transplantation were similar in all patients, but patients with LONIPCs had a significant decrease in PFT indexes at the third month after BMT compared with controls. Moreover, the rate of cyclosporine taper during the fourth and fifth months after BMT was significantly more rapid in patients with LONIPCs than in controls, suggesting that the risk of LONIPCs may be influenced by a faster reduction of GVHD prophylaxis.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedades Pulmonares Intersticiales/etiología , Adolescente , Adulto , Bronquiolitis Obliterante/tratamiento farmacológico , Bronquiolitis Obliterante/etiología , Estudios de Casos y Controles , Neumonía en Organización Criptogénica/tratamiento farmacológico , Neumonía en Organización Criptogénica/etiología , Ciclosporina/administración & dosificación , Femenino , Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Incidencia , Enfermedades Pulmonares Intersticiales/clasificación , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Pruebas de Función Respiratoria , Estudios Retrospectivos , Factores de Riesgo , Donantes de Tejidos , Trasplante Homólogo , Resultado del Tratamiento
7.
Bone Marrow Transplant ; 31(9): 789-94, 2003 May.
Artículo en Inglés | MEDLINE | ID: mdl-12732886

RESUMEN

The purpose of this study was to evaluate the incidence and extent of tumour cell contamination in bone marrow specimens and stem cell collections from 34 breast cancer patients undergoing high-dose therapy as adjuvant treatment, and to determine the prognostic significance for the clinical outcome. Tumour cell contamination was evaluated by flow cytometry using a double-colour test and an anti- Pan cytokeratin (CK) antibody. Two out of 34 (6%) baseline bone marrow specimens, none of seven marrow harvests and nine out of 32 aphereses (28%) mobilised from seven out of 27 patients (26%) contained CK+ cells. Tumour contamination was more frequent in patients with 10 or more involved lymph nodes and in those who received a shorter course of adjuvant chemotherapy before mobilisation. At a median follow-up of 43 months, 24 patients are in complete remission, whereas 10 patients experienced recurrence. Out of the 10 patients who relapsed, five (50%) had CK+ peripheral blood stem cell (PBSC) collections, whereas disease recurrence was seen in only two out of 24 (8%) patients who received CK- products (P=0.02). Moreover, CK+ PBSC collections were associated with a significantly shorter event-free survival and overall survival. CK+ collection is an unfavourable prognostic factor for patients treated with high-dose therapy. Whether the negative impact on clinical outcome depends on reinfusion of tumour cells or whether it simply indicates a larger disease extension is still unclear.


Asunto(s)
Eliminación de Componentes Sanguíneos/normas , Neoplasias de la Mama/patología , Células Neoplásicas Circulantes , Adulto , Antineoplásicos/uso terapéutico , Médula Ósea/patología , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/terapia , Femenino , Citometría de Flujo , Movilización de Célula Madre Hematopoyética , Humanos , Queratinas/análisis , Persona de Mediana Edad , Proteínas de Neoplasias/análisis , Trasplante de Células Madre de Sangre Periférica/mortalidad , Trasplante de Células Madre de Sangre Periférica/normas , Pronóstico , Estudios Prospectivos , Recurrencia , Análisis de Supervivencia
8.
Bone Marrow Transplant ; 30(5): 261-6, 2002 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12209346

RESUMEN

There is persistent immunosuppression not only in allogeneic but also in autologous stem cell transplantation because humoral and cellular immunity may take a year or more to return to normal, with increased risk of infectious complications. This immune defect may also involve antigen presentation, in particular dendritic cell (DC) function. We evaluated DC subset reconstitution in 58 patients who underwent bone marrow (BM) or peripheral blood (PB) autologous haematopoietic stem cell transplantation (HSCT). In all patients DC type 1 (DC1) and DC type 2 (DC2) were already significantly lower than in normal individuals before conditioning therapy (DC1/microl 3.1 +/- 1.0, DC2/microl 3.0 +/- 1.1). On day 0 and day +7 the mean DC1 and DC2 numbers were very low in both groups. Patients who received unmanipulated marrow or peripheral blood stem cells reached pre-conditioning levels of DC1 and DC2 cells on day +20. In patients receiving selected CD34 cells, DC increased slowly and pre-transplant counts were observed only on day +60. Nearly 'normal' levels of DC1 and DC2 could be observed in the first group from day +180, and were maintained thereafter; in CD34(+) selected patients DC1 and DC2 counts remained lower than normal. Our data emphasise that circulating antigen presenting cells (APC) recover quickly. It remains to be determined if DC frequency in PB reflects their tissue function. The relatively low incidence of infections in patients undergoing autologous transplantation, despite defective lymphocyte reconstitution, could be related to functionally efficient DC.


Asunto(s)
Células Dendríticas/citología , Trasplante de Células Madre Hematopoyéticas , Trasplante de Células Madre Hematopoyéticas/normas , Adolescente , Adulto , Antígenos CD34 , Células Sanguíneas , Trasplante de Médula Ósea/métodos , Trasplante de Médula Ósea/normas , Recuento de Células , Células Dendríticas/clasificación , Femenino , Supervivencia de Injerto , Neoplasias Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Sistema Inmunológico/citología , Cinética , Linfocitos/citología , Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Trasplante de Células Madre de Sangre Periférica/métodos , Trasplante de Células Madre de Sangre Periférica/normas , Trasplante Autólogo/métodos , Trasplante Autólogo/normas
9.
Bone Marrow Transplant ; 21(3): 263-71, 1998 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-9489649

RESUMEN

The aim of the study was to retrospectively evaluate the outcome of patients with aggressive non-Hodgkin's lymphoma (NHL), undergoing autologous stem cell transplantation (ASCT) in first complete (CR) or partial (PR) remission, according to the age-adjusted International Prognostic Index (IPI). Fifty-two consecutive patients, aged less than 60 years, with intermediate- or high-grade NHL, and at least one of the following adverse risk factors: bulky disease, B symptoms or Ann Arbor stage III-IV, and at least a PR after CHT (and radiotherapy (RT) on residual mediastinal mass when required), underwent ASCT conditioned with BAVC. Sixty-five percent (33/52) of the patients achieved CR after CHT; 69% (36/52) after CHT + RT; 90% (47/52) after CHT +/- RT + ASCT. One death during conditioning and three major toxic events after ASCT were recorded. Overall survival (OS) is 98% at 37 months (16-88); disease-free survival (DFS) is 100% at 27 months (7-82). Comparing the observed results with those expected if patients were treated only with CHT, the sequential treatment including ASCT conferred an advantage in terms of CR rate of 14, 23 and 54%, respectively, in the low-intermediate (LI), high-intermediate (HI) and high (H)-risk groups, respectively. The 2-year OS advantage is 10, 21, 31 and 63%, respectively, and the 2-year DFS advantage is 12, 26, 38 and 39%, respectively. Even more striking is the 5-year projected advantage in the number of patients alive without disease, even when considering only the low (L) (P < 0.0001) and the LI (P < 0.0001) risk groups. For patients in the higher (HI + H) risk groups, ASCT should be included in the initial plan of treatment as consolidation of first CR or PR, but the differences seen in this study suggest a formal comparison in a randomized study also for patients in the LI risk group.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Linfoma no Hodgkin/terapia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Ciclofosfamida/uso terapéutico , Citarabina/uso terapéutico , Doxorrubicina/uso terapéutico , Femenino , Fluorouracilo/uso terapéutico , Humanos , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Prednisona/uso terapéutico , Pronóstico , Inducción de Remisión , Estudios Retrospectivos , Trasplante Autólogo , Resultado del Tratamiento , Vincristina/uso terapéutico
10.
Bone Marrow Transplant ; 24(7): 757-61, 1999 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-10516679

RESUMEN

This study compares harvest and hematological recovery data of 100 lymphoma patients who underwent BM harvest either after a short course of G-CSF (16 microg/kg for 3 days) (n = 57) or in steady-state conditions (n = 43). G-CSF allowed the attainment of a significantly higher median number of total nucleated cells x 10(8)/kg (4.4, range 1.4-17, vs 2.1, range 0.6-4.2; P < 0.0001), mononuclear cells x 10(8)/kg (0.55, range 0.20-1.4, vs 0.41, range 0.15-0.76, P < 0.0001) and CFU-GM/ml (310, range 10-5500, vs 80, range 10-3800, P = 0.008), with lower volumes of blood collected (17.5 ml/kg, range 8-31 vs 21.0, range 15-30, P = 0.0001). Hematological recovery was faster in patients who received pre-treated BM (median time to PMN >0.5 x 10(9)/l and to platelets >20 x 10(9)/l was 12, range 10-14, and 13, range 10-18, days, respectively) than in those autotransplanted with steady-state BM (median time to PMN >0.5 x 10(9)/l and to platelets >20 x 10(9)/l 13, range 10-18 and 14, range 10-20 days, respectively, P = 0.004 and P = 0.01). Transfusional requirement was significantly different and patients of the G-CSF group needed shorter hospitalization (17 days, range 12-24, vs 20 days, range 14-32; P = 0.02). These data suggest that treating patients with G-CSF before BM harvest improves the quality of the harvest and accelerates engraftment and hematological recovery.


Asunto(s)
Trasplante de Médula Ósea/métodos , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Movilización de Célula Madre Hematopoyética/métodos , Linfoma no Hodgkin/terapia , Adulto , Amsacrina/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carmustina/administración & dosificación , Citarabina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Acondicionamiento Pretrasplante/métodos , Trasplante Autólogo
11.
Leuk Lymphoma ; 34(5-6): 591-6, 1999 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-10492084

RESUMEN

Patients with a monoclonal gammapathy of undetermined significance (MGUS) are usually submitted to a periodical clinical follow-up, but it is not known if this surveillance can ameliorate the prognosis of a plasma cell malignancy that will be eventually detected. We compared the clinical and laboratory characteristics at onset, the response to chemotherapy and the survival, of 21 cases of newly diagnosed multiple myeloma (MM) arising from the malignant transformation of MGUS and 41 cases without a previous history of MGUS, recruited to the same first-line treatments over a 3-years period. The former group showed a significant lower frequency of advanced stages as well as other several prognostic factors of high risk including anemia, renal failure, bone lesions and increase of beta2 microglobulin and C-reactive protein levels. Despite a similar response to treatment of the two groups, MM arising from MGUS showed a significantly longer median survival than MM without prior MGUS. This was particularly true for stage I, while stages II and III behaved similarly. We conclude that the regular clinical monitoring of MGUS patients allowed the identification of earlier malignant transformation, when tumor burden is lower, as indicated by lower beta2 microglobulin levels and marrow plasmacytosis of stage I MM arising from MGUS. Moreover, a slower proliferation rate of myeloma cells, as suggested by lower C-reactive protein levels, may be considered so as to explain the longer survival of these patients.


Asunto(s)
Mieloma Múltiple/diagnóstico , Mieloma Múltiple/mortalidad , Paraproteinemias/diagnóstico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Examen de la Médula Ósea , Proteína C-Reactiva/metabolismo , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/sangre , Mieloma Múltiple/complicaciones , Mieloma Múltiple/tratamiento farmacológico , Paraproteinemias/complicaciones , Pronóstico , Tasa de Supervivencia , Microglobulina beta-2/metabolismo
12.
Leuk Lymphoma ; 36(3-4): 323-30, 2000 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-10674904

RESUMEN

There are several reports describing acute liver decompensation in chronic carriers of HBsAg after withdrawal of chemotherapy or immunosuppressive therapy; recently the same was also reported for chronic HCV-RNA carriers. We retrospectively evaluated hepatic toxicity in eleven patients (6 carriers of HCV-RNA and 5 of HBsAg) autotransplanted at our Institution between March '92 and June '98. Male/female ratio was 7/4, median age 41 years (26-56). Nine patients (4 HBsAg) were affected by non-Hodgkin's lymphoma, 1 (HCV-RNA) by chronic myelogenous leukaemia and 1 (HBsAg) by breast cancer. In the immediate post-transplant period in only 1 patient (HBsAg carrier and affected by breast cancer) was hepatitis documented (at about 1 month from transplant) with an elevation of transaminase levels (x20-40 n.v.). Neither other complications, nor toxic deaths were observed. During the post-transplant follow-up (median 31 months, range 9-83) no hepatic abnormalities were observed. All patients are alive at 56 months (20-122) from diagnosis. Currently 10/11 patients are in complete remission, while 1 patient, affected by follicular centre lymphoma, is alive with disease 52 months from autologous stem cell transplantation. Our study shows that both conventional therapy and high-dose chemotherapy can be performed safely in chronic hepatitis B and C virus carriers.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Hepatitis B Crónica/complicaciones , Hepatitis C Crónica/complicaciones , Linfoma/complicaciones , Linfoma/terapia , Adulto , Antineoplásicos Alquilantes/uso terapéutico , Busulfano/uso terapéutico , Portador Sano , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Hígado/efectos de los fármacos , Hígado/metabolismo , Linfoma/tratamiento farmacológico , Linfoma/virología , Masculino , Melfalán/uso terapéutico , Persona de Mediana Edad , Acondicionamiento Pretrasplante , Trasplante Autólogo
13.
Leuk Lymphoma ; 35(1-2): 159-69, 1999 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-10512173

RESUMEN

The outcome of a series of adult patients, affected by primary systemic CD30-positive anaplastic large cell lymphoma (ALCL), treated with a sequential intensive therapeutic program, has been analyzed and all data available in the literature have been reviewed. Forty consecutive, unselected patients with ALCL were treated with the F-MACHOP regimen, followed by radiotherapy (RT) for residual mediastinal disease (15 cases) and by autologous stem cell transplantation (ASCT) conditioned with BAVC (29 cases). Eighty-nine percent (32/36) of the patients younger than 60 years were eligible for completing the sequential treatment. Since then, 3 patients in CR refused ASCT, 1 was excluded for cardiac toxicity and 3 progressed and died of disease. Thus, 29 have been so far submitted to the transplant procedure. CR and PR rates were 40% and 45% respectively after CHT; 52.5% and 35% after RT; 80% and 5% after ASCT, with 78% of patients transplanted in PR convertin to a CR. Actuarial overall survival is 85% at 48.5 months (93% at 66 months for the 29 transplanted patients) and disease free survival is 100% at 54 and 64 months respectively, with no relapses observed among patients who reached a CR. Considering our data and those of the literature, it can be concluded that although the role of ASCT in the therapy of ALCL must not be considered as definitive, its efficacy in converting PR into CR and in preventing relapses, suggests that a randomized trial comparing CHT alone vs CHT+ASCT should be undertaken.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma Anaplásico de Células Grandes/terapia , Adolescente , Adulto , Ciclofosfamida/administración & dosificación , Citarabina/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Metotrexato/administración & dosificación , Persona de Mediana Edad , Prednisona/administración & dosificación , Radioterapia Adyuvante , Estudios Retrospectivos , Resultado del Tratamiento , Vincristina/administración & dosificación
14.
Food Chem Toxicol ; 57: 57-68, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23523831

RESUMEN

Piper gaudichaudianum Kunth is used in popular medicine as anti-inflamatory and against liver disorders. One of the most studied components of the plant is the essential oil for which chemical analysis revealed (E)-nerolidol as major compound. Recently, we have shown that P. gaudichaudianum essential oil possesses strong cytotoxic effects in mammalian V79 cells. The aim of this study was to analyze the cytotoxicity and mutagenicity of P. gaudichaudianum essential oil and nerolidol using Saccharomyces cerevisiae as model study. Treatment of the XV185-14c and N123 strains with essential oil and nerolidol led to cytotoxicity but did not induce mutagenicity. Our results revealed an important role of base excision repair (BER) as the ntg1, ntg2, apn1 and apn2 mutants showed pronounced sensitivity to essential oil and nerolidol. In the absence of superoxide dismutase (in sod1Δ mutant strain) sensitivity to the essential oil and nerolidol increased indicating that this oil and nerolidol are generating reactive oxygen species (ROS). The ROS production was confirmed by DCF-DA probing assay in Sod-deficient strains. From this, we conclude that the observed cytotoxicity to P. gaudichaudianum essential oil and nerolidol is mainly related to ROS and DNA single strand breaks generated by the presence of oxidative lesions.


Asunto(s)
Aceites Volátiles/farmacología , Piper/química , Aceites de Plantas/farmacología , Saccharomyces cerevisiae/efectos de los fármacos , Sesquiterpenos/farmacología , Catalasa/genética , Citotoxinas/farmacología , Reparación del ADN/efectos de los fármacos , Reparación del ADN/genética , Pruebas de Mutagenicidad , Mutación , Aceites Volátiles/análisis , Aceites Volátiles/toxicidad , Aceites de Plantas/análisis , Aceites de Plantas/toxicidad , Especies Reactivas de Oxígeno/metabolismo , Saccharomyces cerevisiae/genética , Proteínas de Saccharomyces cerevisiae/genética , Sesquiterpenos/toxicidad , Superóxido Dismutasa/genética
16.
Food Chem Toxicol ; 47(9): 2389-95, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19563855

RESUMEN

We have investigated the chemical composition of Piper gaudichaudianum essential oil, as well as its cytotoxic, mutagenic and genotoxic effects in V79 cells. The chemical analyses showed that the major compounds are (E)-nerolidol (22.4%), alpha-humulene (16.5%), (E)-caryophyllene (8.9%) and bicyclogermacrene (7.4%). Dose-dependent cytotoxic effects were observed in V79 cells treated with essential oil by using clonal survival, 3-(4,5-dimethylthiazole-2-yl)-2,5-biphenyl tetrazolium bromide reduction assay (MTT) and trypan blue exclusion assay (TB), and a significant decrease in survival was observed at concentrations of 0.5 microg/mL and higher. The P. gaudichaudianum essential oil treatment caused DNA strand breaks in V79 cells at concentrations up to 2 microg/mL, as detected by the alkaline comet assay, but did not induce double-strand breaks, as verified by neutral comet assay. It induced a significant increase in the frequency of micronucleated cells at 4, 6 and 10 microg/mL. Moreover, P. gaudichaudianum essential oil significantly increased lipid peroxidation at doses of 0.5 microg/mL and higher, suggesting that the observed oxidant potential can be responsible, at least in part, for its cytotoxic and genotoxic effects.


Asunto(s)
Fibroblastos/efectos de los fármacos , Pulmón/efectos de los fármacos , Mutágenos/toxicidad , Aceites Volátiles/toxicidad , Piperaceae/química , Aceites de Plantas/toxicidad , Animales , Línea Celular , Supervivencia Celular/efectos de los fármacos , Ensayo Cometa , Cricetinae , Cricetulus , Daño del ADN , Relación Dosis-Respuesta a Droga , Fibroblastos/metabolismo , Fibroblastos/patología , Cromatografía de Gases y Espectrometría de Masas , Peroxidación de Lípido/efectos de los fármacos , Pulmón/patología , Malondialdehído/metabolismo , Micronúcleos con Defecto Cromosómico/inducido químicamente , Pruebas de Micronúcleos , Mutágenos/análisis , Aceites Volátiles/análisis , Hojas de la Planta/química , Aceites de Plantas/análisis , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismo
17.
Curr Oncol Rep ; 2(2): 172-5, 2000 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11122840

RESUMEN

Epidemiologic data presented in this review suggest the involvement of hepatitis C virus (HCV) in the patho- genesis of some histotypes of B-cell non-Hodgkin's lymphoma, in particular immunocytoma and lymphomas growing primarily in the liver and major salivary glands. Experimental data further support this hypothesis. Recent findings include demonstration that patients with hematologic malignancies can be treated safely with standard and high-dose chemotherapy even in the presence of HCV infection.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Hepatitis C/tratamiento farmacológico , Hepatitis C/epidemiología , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/epidemiología , Animales , Comorbilidad , Femenino , Hepatitis C/diagnóstico , Humanos , Linfoma de Células B/diagnóstico , Masculino , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento
18.
Br J Haematol ; 112(2): 370-2, 2001 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-11167831

RESUMEN

Several epidemiological data suggest the involvement of hepatitis C virus (HCV) in the pathogenesis of some histotypes of B-cell non-Hodgkin's lymphomas, in particular immunocytoma. We report a patient with HCV-associated immunocytoma, first treated with six courses of fludarabine. A partial response was achieved and subsequent therapy with alpha-interferon resulted in the clearance of the virus and a long-lasting complete clinical and histological remission of the lymphoproliferative disease.


Asunto(s)
Hepatitis C/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Vidarabina/análogos & derivados , Adulto , Hepatitis C/complicaciones , Humanos , Inmunosupresores/uso terapéutico , Interferón alfa-2 , Linfoma no Hodgkin/virología , Masculino , Proteínas Recombinantes , Inducción de Remisión , Factores de Tiempo , Vidarabina/uso terapéutico
19.
Ann Hematol ; 80(12): 758-62, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11797120

RESUMEN

Cerebral involvement is an unusual complication in multiple myeloma: herein four patients who presented myelomatous meningitis with multiple intraparenchymal lesions or a localized cerebral plasmacytoma are described. Two of these patients relapsed with meningeal involvement and a very limited disease outside the central nervous system after an initial complete remission obtained with induction chemotherapy. In the other two cases, the cerebral tumor appeared during first-line treatment. Cytological examination of the cerebrospinal fluid and magnetic resonance were essential for diagnosis. Different modalities of treatment were used, including intrathecal chemotherapy, cranial irradiation, and systemic chemotherapy with high-dose methotrexate and cytarabine, achieving improvement of neurological symptoms in three of four patients.


Asunto(s)
Neoplasias Encefálicas/complicaciones , Meningitis/etiología , Mieloma Múltiple/complicaciones , Plasmacitoma/complicaciones , Anciano , Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/líquido cefalorraquídeo , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/terapia , Líquido Cefalorraquídeo/citología , Proteínas del Líquido Cefalorraquídeo/análisis , Terapia Combinada , Resultado Fatal , Femenino , Glucocorticoides/uso terapéutico , Humanos , Cadenas Ligeras de Inmunoglobulina/análisis , Cadenas kappa de Inmunoglobulina/análisis , Imagen por Resonancia Magnética , Meningitis/líquido cefalorraquídeo , Meningitis/diagnóstico , Meningitis/terapia , Persona de Mediana Edad , Mieloma Múltiple/líquido cefalorraquídeo , Mieloma Múltiple/terapia , Plasmacitoma/líquido cefalorraquídeo , Plasmacitoma/diagnóstico , Plasmacitoma/terapia , Prednisona/uso terapéutico , Radioterapia , Recurrencia , Inducción de Remisión
20.
Haematologica ; 82(6): 703-4, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9499671

RESUMEN

A 25-year-old female with achondroplastic dwarfism, diagnosed when she was six months old, was diagnosed with chronic myeloid leukemia (CML) in chronic phase with 9;22 translocation, A2B3 gene rearrangement and a Sokal index of 0.5. A recombinant interferon-alpha 2A treatment was started in October '94, which obtained a hematological, but not a karyotypic, response at the 6th and 12th month. In August '94, the patient was submitted to allogeneic bone marrow transplantation (alloBMT) from a 36-year-old matched sibling. The procedure was well tolerated. Disease-free survival (DFS) and overall survival (OS) were 21 and 39 months, respectively. We have not found any reported cases of achondroplastic patients submitted to alloBMT in the literature or in the IBMT Registry.


Asunto(s)
Acondroplasia/genética , Trasplante de Médula Ósea , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Adulto , Femenino , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/genética
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