RESUMEN
The role of Ann Arbor staging in determining treatment intensity after achieving a negative positron emission tomography (PET) has not been established in classical Hodgkin lymphoma (cHL). Patients with stage I-IV cHL, received three cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and an interim PET scan (PET3). PET3-negative patients received no further therapy. PET3-positive patients received three additional cycles of ABVD plus involved-field radiation therapy or salvage chemotherapy, if refractory to ABVD, and were re-evaluated by PET scan (PET6). Study endpoints were 3-year progression-free survival (PFS) and overall survival (OS) rates. Two hundred and thirty-nine patients with early-stage and 138 with advanced-stage were evaluable. Overall, 260 patients (70%) were PET3-negative and had higher 3-year PFS (90% vs. 65%; P < 0·0001) and OS (98% vs. 92%; P = 0·007) rates than PET3-positive patients. All PET3-negative patients, regardless of disease stage at diagnosis, achieved similarly good PFS (90-91%; P = 0·76) and OS (97-99%). The only independent prognostic factor for PFS was PET3-negativity (Hazard ratio 3·8; 95% confidence interval 2·4-6·3; P < 0·0001). This study suggests that cHL patients who achieve a negative PET3 following ABVD have an excellent outcome, regardless of stage at diagnosis. An appropriately powered, phase III trial will be necessary to confirm these findings.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedad de Hodgkin/diagnóstico por imagen , Enfermedad de Hodgkin/tratamiento farmacológico , Tomografía de Emisión de Positrones/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Bleomicina/farmacología , Bleomicina/uso terapéutico , Dacarbazina/farmacología , Dacarbazina/uso terapéutico , Doxorrubicina/farmacología , Doxorrubicina/uso terapéutico , Femenino , Enfermedad de Hodgkin/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Supervivencia , Vinblastina/farmacología , Vinblastina/uso terapéutico , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: Sinus cerebral venous thrombosis (SCVT) is an unfrequent disease, with variable clinical presentation and prognosis. The objective of this study was to analyze the relationship between factor V Leiden, prothrombin G20210A mutation (PT 20210A) and MTHR and SCVT. PATIENTS AND METHOD: Cases and control study including 15 patients with diagnosis of SCVT. We performed a genetic analysis of the mutation of factor V Leiden, the PT G20210A and the C677T of the MTHR. RESULTS: Factor V Leiden: 26.6% heterozygote in cases and only 8.3% in control group, thus showing odds ratio [OR] = 4,0. Mutation 20210A of the prothrombin: in patients, 13.3% of heterozygote, while a 6,6% in controls, finding an OR = 2.1 (95% confidence interval [CI], 1.67-10.04). Mutation of the MTHR: 40% heterozygote and 20% homozygote in patients group respect to 51.6% and 6,9%, respectively, in the control group, but no statistical differences were found. CONCLUSIONS: The presence of factor V Leiden and PT 20210A are risk factors for SCVT, but not the mutation of the MTHR.
Asunto(s)
Factor V/genética , Trombosis Intracraneal/genética , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Protrombina/genética , Trombofilia/genética , Adulto , Anciano , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Lactante , Trombosis Intracraneal/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trombofilia/complicacionesRESUMEN
Fundamento y objetivo: La trombosis del seno venoso cerebral (TVSC) es una enfermedad poco frecuente, con presentación clínica y pronóstico muy variables. El objetivo de este trabajo ha sido analizar la relación entre el factor V Leiden, la mutación 20210A de la protrombina (PT 20210A) y C677T de la metilentetrahidrofolato-reductasa (MTHR) y la TVSC. Pacientes y método: Se ha realizado un estudio de casos y controles que incluyó a 15 pacientes diagnosticados de TVSC, a quienes se efectuó un análisis genético de la mutación del factor V Leiden, la PT 20210A y la C677T de la MTHR. Resultados: El 26,6% de los casos y sólo el 8,3% del grupo control eran heterocigotos para la mutación factor V Leiden, por lo que mostraban un mayor riesgo de trombosis (odds ratio [OR] = 4,0). En cuanto a la PT 20210A, eran heterocigotos el 13,3% de los pacientes y un 6,6% de los controles (OR = 2,1; intervalo de confianza del 95%, 1,67-10,04). Por lo que se refiere a la mutación de la MTHR, en el grupo de pacientes el 40% eran heterocigotos y el 20% homocigotos, frente al 51,6 y el 6,9%, respectivamente, en el grupo control, pero sin encontrar diferencias significativas. Conclusiones: El factor V Leiden y la PT 20210A son factores de riesgo para TVSC, pero no la mutación de la MTHR
Background and objective: Sinus cerebral venous thrombosis (SCVT) is an unfrequent disease, with variable clinical presentation and prognosis. The objective of this study was to analyze the relationship between factor V Leiden, prothrombin G20210A mutation (PT 20210A) and MTHR and SCVT. Patients and method: Cases and control study including 15 patients with diagnosis of SCVT. We performed a genetic analysis of the mutation of factor V Leiden, the PT G20210A and the C677T of the MTHR. Results: Factor V Leiden: 26.6% heterozygote in cases and only 8.3% in control group, thus showing odds ratio [OR] = 4,0. Mutation 20210A of the prothrombin: in patients, 13.3% of heterozygote, while a 6,6% in controls, finding an OR = 2.1 (95% confidence interval [CI], 1.67-10.04). Mutation of the MTHR: 40% heterozygote and 20% homozygote in patients group respect to 51.6% and 6,9%, respectively, in the control group, but no statistical differences were found. Conclusions: The presence of factor V Leiden and PT 20210A are risk factors for SCVT, but not the mutation of the MTHR
