RESUMEN
We report a patient with Philadelphia chromosome positive (Ph +ve) chronic myelogenous leukemia (CML), treated with hydroxyurea alone, who upon disease progression developed an additional Ph - ve clone containing chromosomal abnormalities typical of myelodysplastic syndrome (MDS). Retrospective analysis of a cryopreserved stem cell specimen from diagnosis confirmed that this second clone developed during the course of treatment. The development of a clone with additional cytogenetic abnormalities in CML has only been reported after leukemogenic treatment, stem cell transplantation or interferon. We report a case of secondary Ph - ve MDS/AML during blast crisis in a patient treated with hydroxyurea for CML.
Asunto(s)
Antineoplásicos/uso terapéutico , Crisis Blástica/genética , Hidroxiurea/uso terapéutico , Leucemia Mielógena Crónica BCR-ABL Positiva , Síndromes Mielodisplásicos/genética , Síndromes Mielodisplásicos/patología , Neoplasias Primarias Secundarias , Anciano , Crisis Blástica/patología , Diferenciación Celular , Enfermedad Crónica , Femenino , Humanos , Cariotipificación , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Leucemia Mielógena Crónica BCR-ABL Positiva/patología , Cromosoma FiladelfiaRESUMEN
As both fludarabine and rituximab are active against indolent lymphoproliferative disorders, we have studied the combination of fludarabine and rituximab in patients with low-grade lymphoma and chronic lymphocytic leukemia (CLL) in phase I/II fashion. Of 33 patients enrolled, 21(63.6%) had low-grade lymphoma and 12 (36.4%) had CLL. They received fludarabine 30 mg/m2 on days 1-4 and rituximab 125, 250 or 375 mg/m2 on day 5 at intervals of 28 days to a maximum of 8 cycles. Three patients were removed from the study because of rituximab-associated anaphylaxis and four because of prolonged hematopoietic toxicity. Toxicity and responsiveness did not differ at the different dose levels of rituximab. For 29 evaluable patients, responses were seen in 82.8% and complete responses in 34.5%. Of 7 responding patients not referred for stem cell transplantation, 6 remain in complete remission at a median follow-up of 16 months (range 4-30 months). Of 13 previously untreated patients, all responded and 46.2% had a complete response. Of 16 previously treated patients, 68.5% responded and 25% had a complete response. The combination of fludarabine and rituximab has major activity and acceptable toxicity in patients with low-grade lymphoma and CLL.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antimetabolitos Antineoplásicos/uso terapéutico , Leucemia Linfocítica Crónica de Células B/terapia , Linfoma no Hodgkin/terapia , Vidarabina/análogos & derivados , Vidarabina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Anafilaxia/etiología , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales de Origen Murino , Antimetabolitos Antineoplásicos/efectos adversos , Terapia Combinada , Femenino , Estudios de Seguimiento , Enfermedades Hematológicas/inducido químicamente , Humanos , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Trasplante de Células Madre de Sangre Periférica , Inducción de Remisión , Rituximab , Resultado del Tratamiento , Vidarabina/administración & dosificación , Vidarabina/efectos adversosRESUMEN
The incidence of non-HIV-associated hematologic malignancies, including chronic myeloproliferative disorders, is increasing in HIV-infected (HIV+) patients. This is thought to be due to prolonged survival in the era of highly active antiretroviral therapy (HAART). Previously, only six cases of chronic myeloid leukemia (CML) have been described in HIV+ individuals and limited information is available regarding the management of patients with concurrent CML and HIV-infection. We report three cases of CML in HIV+ patients who were treated with imatinib and HAART. Treatment was generally well tolerated, and cytogenetic response (complete in two patients) was achieved with follow-up ranging from 3 to 69 months. HIV viral load remained undetectable and CD4 cell counts were stable in all three patients. Concurrent treatment with imatinib and HAART can result in appropriate control of CML and HIV-infection as well as long-term survival.