RESUMEN
BACKGROUND: Although rare, cytomegalovirus (CMV) reactivation can be lethal in patients with cancer. However, the criteria for the prevention of cytomegalovirus reactivation during cancer treatment are unclear. This study aimed to identify factors associated with CMV reactivation in patients with esophageal cancer who were receiving chemoradiotherapy. METHODS: This retrospective study included esophageal cancer patients receiving definitive or palliative chemoradiotherapy during April 2013-March 2020. Patients with fever during chemoradiotherapy underwent a systemic work-up to detect the primary focus of infection, and CMV antigenemia was assessed in cases of unidentifiable infection. RESULTS: Among 132 patients (80.3% male, median age 69 years [range, 39-86 years]), 124 received 5-fluorouracil plus cisplatin and 8 received oxaliplatin-5-fluorouracil-levofolinate chemotherapy. Overall, 19 patients had CMV reactivation, 37 had other infections, and 76 had no identified infection (groups 1, 2, and 3, respectively). Median minimum lymphocyte counts were 81.0/µl (interquartile range: 52.0-144.0/µl), 120.0/µl (81.0-162.5/µl), and 185.5/µl (120.5-328.0/µl) in groups 1, 2, and 3, respectively, with counts being significantly lower in groups 1 and 2 than in group 3 (p < 0.001). In multiple logistic regression analysis, the minimum lymphocyte count was associated with CMV reactivation (odds ratio 0.983, 95% confidence interval: 0.973-0.994, p = 0.002). CONCLUSION: CMV reactivation is not rare in patients with esophageal cancer who were receiving chemoradiotherapy and is associated with the minimum lymphocyte counts. CMV reactivation should be considered during differential diagnosis for patients with a severe decline in lymphocyte counts when receiving chemoradiotherapy.
Asunto(s)
Quimioradioterapia , Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/fisiología , Neoplasias Esofágicas/terapia , Neoplasias Esofágicas/virología , Activación Viral , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia/efectos adversos , Neoplasias Esofágicas/inmunología , Femenino , Humanos , Recuento de Linfocitos , Linfopenia/etiología , Masculino , Persona de Mediana Edad , Análisis MultivarianteRESUMEN
BACKGROUND: Human herpesvirus 6 (HHV-6) encephalitis is a known life-threatening complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, few studies have focused on the occurrence of HHV-6 encephalitis in patients receiving mycophenolate mofetil (MMF) combined with a calcineurin inhibitor as prophylaxis for graft-versus-host disease (GVHD). This study aimed to investigate the impact of MMF administered for GVHD prophylaxis in the occurrence of HHV-6 encephalitis after allo-HSCT and the characteristics of this condition. METHODS AND RESULTS: We retrospectively analyzed 73 patients who underwent allo-HSCT (83 transplants) at our hospital between April 2010 and December 2015. MMF (2-3 g/d) was administered along with a calcineurin inhibitor. Seven patients (8.0%) developed encephalitis due to HHV-6. The median period from allo-HSCT to the onset of HHV-6 encephalitis was 23 days (range, 17-98 days). The cumulative incidence of HHV-6 encephalitis on day 100 after treatment was 12% and 6% in patients who underwent cord blood transplantation (CBT) and non-CBT (ie, bone marrow transplantation and peripheral blood stem cell transplantation), respectively (P = 0.344). Neurological symptoms of encephalitis were more severe in non-CBT cases than those in CBT cases. All patients diagnosed with HHV-6 encephalitis were treated with ganciclovir or foscarnet. None of the enrolled patients died from HHV-6 encephalitis. CONCLUSIONS: Mycophenolate mofetil may have the potential to increase the frequency of severe HHV-6 encephalitis in patients undergoing CBT and non-CBT. Thus, MMF should be administered with caution, and patients should be monitored closely for HHV-6 encephalitis even those who did not undergo CBT.
Asunto(s)
Encefalitis Viral/epidemiología , Enfermedad Injerto contra Huésped/prevención & control , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Inmunosupresores/efectos adversos , Ácido Micofenólico/efectos adversos , Infecciones por Roseolovirus/epidemiología , Adulto , Anciano , Antivirales/uso terapéutico , Inhibidores de la Calcineurina/efectos adversos , Trasplante de Células Madre de Sangre del Cordón Umbilical/efectos adversos , Encefalitis Viral/diagnóstico , Encefalitis Viral/tratamiento farmacológico , Encefalitis Viral/virología , Femenino , Enfermedad Injerto contra Huésped/inmunología , Neoplasias Hematológicas/cirugía , Herpesvirus Humano 6/aislamiento & purificación , Humanos , Terapia de Inmunosupresión/efectos adversos , Terapia de Inmunosupresión/métodos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones por Roseolovirus/diagnóstico , Infecciones por Roseolovirus/tratamiento farmacológico , Infecciones por Roseolovirus/virología , Índice de Severidad de la Enfermedad , Trasplante Homólogo/efectos adversos , Adulto JovenRESUMEN
Immune reconstitution affects clinical outcomes after allogeneic hematopoietic stem cell transplantation (HSCT), and it has been suggested that lymphocyte recovery affects survival after HSCT. However, few studies have examined lymphocyte recovery in Asian patients who received mycophenolate mofetil (MMF) prophylaxis for graft-versus-host disease. We retrospectively evaluated early lymphocyte recovery after HSCT among Japanese adults who received MMF prophylaxis. Patients were divided into two groups according to their median absolute lymphocyte count (ALC) on day 28 after HSCT as follows: the "low ALC group" (≤ 0.22 × 109 cells/L) and the "high ALC group" (> 0.22 × 109 cells/L). With a median follow-up of 317 days, the high ALC group showed significantly better overall survival than the low ALC group (at 1 year: 62 vs. 46%, P = 0.02). The high ALC group also tended to have better non-relapse mortality than the low ALC group (at 1 year: 13 vs. 23%, P = 0.08). There was no significant difference in relapse rate between the high and low ALC groups (at 1 year: 29 vs. 35%, P = 0.2). We conclude that among Japanese patients who received MMF prophylaxis, ALC on day 28 after HSCT was effective in predicting overall survival and non-relapse mortality.
Asunto(s)
Enfermedad Injerto contra Huésped/prevención & control , Neoplasias Hematológicas/inmunología , Neoplasias Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas , Recuento de Linfocitos , Ácido Micofenólico/administración & dosificación , Adulto , Anciano , Aloinjertos , Pueblo Asiatico , Femenino , Estudios de Seguimiento , Predicción , Neoplasias Hematológicas/mortalidad , Trasplante de Células Madre Hematopoyéticas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
To identify strategies for reducing emesis induced by the CHOP regimen, which includes high-dose steroids, we prospectively evaluated the efficacy of palonosetron in Japanese patients. Palonosetron was administered at a dose of 0.75 mg via intravenous injection over 30 min before chemotherapy on day 1. Patients kept diaries of chemotherapy-induced nausea and vomiting (CINV) incidence from the start of chemotherapy until 168 h afterwards, in which they documented the occurrence and severity of nausea, vomiting, anorexia, and the use of rescue medication. The primary endpoint was the overall occurrence rate of nausea, vomiting, and anorexia; these rates were 56, 12, and 62 %, respectively, including all grades. The rates and severity of symptoms tended to worsen 120-168 h after completing oral prednisolone. We defined complete response (CR) as no vomiting and no use of rescue therapy. The CR rates of post palonosetron 0.75 mg treatment in the acute (0-24 h), delayed (24-168 h), and overall phases (0-168 h) were 86, 66, and 62 %, respectively. Antiemetic strategies of CHOP regimen for day 6 and, thereafter, should be investigated.
Asunto(s)
Antieméticos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Isoquinolinas/uso terapéutico , Linfoma/tratamiento farmacológico , Náusea/tratamiento farmacológico , Quinuclidinas/uso terapéutico , Antagonistas de la Serotonina/uso terapéutico , Vómitos/tratamiento farmacológico , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/efectos adversos , Ciclofosfamida/uso terapéutico , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Femenino , Humanos , Japón/epidemiología , Linfoma/epidemiología , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Palonosetrón , Prednisolona/efectos adversos , Prednisolona/uso terapéutico , Estudios Prospectivos , Vincristina/efectos adversos , Vincristina/uso terapéutico , Vómitos/inducido químicamente , Adulto JovenRESUMEN
OBJECTIVE: Cancer patients receiving chemotherapy are at risk of acquiring influenza infections. Two-dose vaccination is a proposed strategy for increasing vaccination efficacy; however, this has yet to be confirmed in this population. The purpose of this study was to clarify the efficacy and safety of this strategy. METHODS: We conducted a multicentre prospective study on a two-dose vaccination regimen in cancer patients receiving chemotherapy. Second vaccinations were performed in patients who did not respond to all three viral strains after the first vaccination. Serum haemagglutination inhibition titres were measured to determine the patients' immunological response, 2 weeks prior to the first vaccination, 3-5 weeks after each vaccination, and at the end of the influenza season. RESULTS: We enrolled 109 patients, including 70 with solid tumours, 36 with haematological malignancies, and 3 with both cancer types. Among the total patients, the proportion of patients with protective titres against the three viral strains increased significantly from 3 to 27% (P < 0.01) following vaccination. Among the 79 patients who received a second vaccination, the proportion of those with protective titres against the individual strains increased by 10% (H1N1), 8% (H3N2), and 3% (B) compared with after the first vaccination. Serious adverse events were not observed. CONCLUSIONS: We recommend influenza vaccinations for cancer patients, including those receiving chemotherapy. Also, the additional benefit of the second vaccination may be limited.
Asunto(s)
Antineoplásicos/uso terapéutico , Vacunas contra la Influenza/inmunología , Gripe Humana/prevención & control , Neoplasias/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Femenino , Humanos , Inmunosupresores/uso terapéutico , Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H3N2 del Virus de la Influenza A/inmunología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inhibidores de Proteínas Quinasas/uso terapéutico , Rituximab/uso terapéutico , Vacunación , Adulto JovenRESUMEN
The t(8;21)(q22;q22) translocation is specifically observed in acute myeloid leukemia (AML) M2 subtype, whereas del(5q) is one of the most common cytogenetic aberrations in myelodysplastic syndromes (MDS). Thus, t(8;21)(q22;q22) and del(5q) appear to be mutually exclusive, and the association between them has not been characterized yet. Here, we report an 81-year-old woman with coexistent t(8;21)(q22;q22) and del(5q) at initial diagnosis. The bone marrow was infiltrated with 18.4% myeloblasts, and showed marked myeloid and erythroid dysplasia. Myeloblasts were positive for CD19 and CD56 as well as CD13, CD33, CD34 and HLA-DR. G-banding and spectral karyotyping showed 46,XX,del(5)(q?),t(8;21)(q22;q22)[18]/46,XX[2]. Both del(5)(q?) and t(8;21)(q22;q22) were present in a single clone. Fluorescence in situ hybridization (FISH) on metaphase spreads detected a RUNX1/RUNX1T1 fusion signal on the der(8)t(8;21)(q22;q22), and confirmed deletion of CSF1R signaling at 5q33-q34 on the del(5)(q?). Furthermore, FISH on interphase nuclei revealed that the RUNX1/RUNX1T1 fusion signal and deletion of CSF1R signaling were found in 66.0% and 58.0% of interphase cells, respectively, suggesting that del(5)(q?) occurred in cells with RUNX1/RUNX1T1. These results indicated a diagnosis of AML with t(8;21)(q22;q22)/RUNX1/RUNX1T1 rather than MDS, even though the percentage of bone marrow myeloblasts was less than 20%. Based on these findings, together with those of other reported cases, del(5q) seems to be an extremely rare but recurrent secondary aberration in AML with t(8;21)(q22;q22).
Asunto(s)
Deleción Cromosómica , Cromosomas Humanos Par 21 , Cromosomas Humanos Par 5 , Cromosomas Humanos Par 8 , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/genética , Translocación Genética , Médula Ósea/metabolismo , Médula Ósea/patología , Bandeo Cromosómico , HumanosAsunto(s)
Antígenos CD34 , Núcleo Celular , Proteínas de Fusión bcr-abl/genética , Antígenos HLA-DR , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/genética , Anciano , Antígenos CD34/biosíntesis , Núcleo Celular/genética , Núcleo Celular/patología , Regulación de la Expresión Génica , Antígenos HLA-DR/biosíntesis , Humanos , MasculinoAsunto(s)
Cromosomas Humanos Par 11 , Cromosomas Humanos Par 21 , Cromosomas Humanos Par 8 , Subunidad alfa 2 del Factor de Unión al Sitio Principal/genética , Leucemia Mieloide Aguda/genética , Proteínas Proto-Oncogénicas/genética , Factores de Transcripción/genética , Translocación Genética , Médula Ósea/patología , Bandeo Cromosómico , Humanos , Hibridación Fluorescente in Situ , Leucemia Mieloide Aguda/diagnóstico , Masculino , Persona de Mediana Edad , Proteína 1 Compañera de Translocación de RUNX1Asunto(s)
Crisis Blástica/genética , Cromosomas Humanos Par 12/ultraestructura , Cromosomas Humanos Par 14/ultraestructura , Cromosomas Humanos Par 7/ultraestructura , Cromosomas Humanos Par 9/ultraestructura , Trastornos Mieloproliferativos/genética , Proteínas de Fusión Oncogénica/genética , Proteínas Tirosina Quinasas/genética , Translocación Genética , Adulto , Médula Ósea/patología , Bandeo Cromosómico , Cromosomas Humanos Par 12/genética , Cromosomas Humanos Par 14/genética , Cromosomas Humanos Par 7/genética , Cromosomas Humanos Par 9/genética , Errores Diagnósticos , Humanos , Hibridación Fluorescente in Situ , Ganglios Linfáticos/patología , Masculino , Trastornos Mieloproliferativos/clasificación , Trastornos Mieloproliferativos/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnósticoAsunto(s)
Antineoplásicos/efectos adversos , Asparaginasa/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/fisiopatología , Hígado/efectos de los fármacos , Adulto , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Asparaginasa/administración & dosificación , Asparaginasa/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico por imagen , Enfermedad Hepática Inducida por Sustancias y Drogas/tratamiento farmacológico , Colagogos y Coleréticos/uso terapéutico , Monitoreo de Drogas , Femenino , Humanos , Quimioterapia de Inducción/efectos adversos , Leucemia de Células B/tratamiento farmacológico , Hígado/diagnóstico por imagen , Sustancias Protectoras/uso terapéutico , Radiografía , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Ácido Ursodesoxicólico/uso terapéuticoAsunto(s)
Proteínas de Unión al ADN/genética , Reordenamiento Génico/genética , Leucemia Mieloide Aguda/genética , Proto-Oncogenes/genética , Trombocitosis/genética , Trombopoyesis/genética , Factores de Transcripción/genética , Translocación Genética/genética , Humanos , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/diagnóstico , Proteína del Locus del Complejo MDS1 y EV11 , Masculino , Persona de Mediana Edad , Trombocitosis/complicaciones , Trombocitosis/diagnósticoAsunto(s)
Cromosomas Humanos , Amplificación de Genes , Células Precursoras de Granulocitos , Leucemia Mieloide Aguda , Micronúcleos con Defecto Cromosómico , Proteínas Proto-Oncogénicas c-myc , Adulto , Cromosomas Humanos/genética , Cromosomas Humanos/metabolismo , Células Precursoras de Granulocitos/metabolismo , Células Precursoras de Granulocitos/patología , Humanos , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patología , Masculino , Proteínas Proto-Oncogénicas c-myc/genética , Proteínas Proto-Oncogénicas c-myc/metabolismoAsunto(s)
Células Dendríticas/patología , Trasplante de Células Madre de Sangre Periférica , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Anciano , Humanos , Masculino , Trasplante de Células Madre de Sangre Periférica/métodos , Inducción de Remisión/métodos , Neoplasias Cutáneas/patología , Trasplante AutólogoRESUMEN
Tolvaptan is an oral vasopressin V2-receptor antagonist recognized as effective for fluid retention associated with congestive heart failure and liver cirrhosis. However, there have been no reports concerning clinical experience with tolvaptan for sinusoidal obstruction syndrome (SOS). A 42-year-old male with primarily refractory T-lymphoblastic lymphoma underwent allogeneic peripheral blood stem cell transplantation from an HLA-matched sibling donor. The myeloablative conditioning regimen consisted of busulfan and cyclophosphamide. On day 20, the total bilirubin level was elevated to 2.0 mg/dL, and body weight increased from 76 to 85 kg, allowing a diagnosis of SOS to be made. Treatments with thrombomodulin, furosemide, carperitide, and low-dose dopamine were ineffective. By day 27, the patient's body weight had increased to 90 kg, and he subsequently developed cardiopulmonary failure. Therefore, we administered low-dose tolvaptan for 2 days (3.75 mg on day 27 and 7.5 mg on day 28). Consequently, his ascites and edema were significantly reduced, and body weight returned to 77 kg by day 34. However, he died of lymphoma progression on day 55. Tolvaptan may be an alternative and promising treatment for refractory fluid retention associated with SOS, although it is unclear whether tolvaptan administration leads to improvement in clinical outcome.
Asunto(s)
Benzazepinas/uso terapéutico , Edema/tratamiento farmacológico , Edema/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedad Veno-Oclusiva Hepática/complicaciones , Adulto , Benzazepinas/administración & dosificación , Benzazepinas/efectos adversos , Enfermedad Veno-Oclusiva Hepática/diagnóstico , Enfermedad Veno-Oclusiva Hepática/terapia , Humanos , Masculino , Tolvaptán , Trasplante HomólogoAsunto(s)
Pulmón/patología , Linfoma de Células B Grandes Difuso/diagnóstico , Neoplasias Vasculares/diagnóstico , Anciano de 80 o más Años , Biopsia , Humanos , Pulmón/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/patología , Masculino , Tomografía de Emisión de Positrones , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias Vasculares/patologíaAsunto(s)
Antineoplásicos/uso terapéutico , Mieloma Múltiple/tratamiento farmacológico , Sarcoma Mieloide/tratamiento farmacológico , Talidomida/análogos & derivados , Anciano de 80 o más Años , Humanos , Lenalidomida , Masculino , Mieloma Múltiple/patología , Plasmacitoma/tratamiento farmacológico , Plasmacitoma/patología , Sarcoma Mieloide/patología , Talidomida/uso terapéuticoAsunto(s)
Bacteriemia/complicaciones , Quimioterapia de Inducción , Leucemia de Células B/complicaciones , Leucemia de Células B/tratamiento farmacológico , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa , Uraco/microbiología , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Trasplante de Médula Ósea , Femenino , Humanos , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/aislamiento & purificación , Trasplante Homólogo , Resultado del TratamientoAsunto(s)
Busulfano/administración & dosificación , Busulfano/efectos adversos , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Leucoencefalopatías/inducido químicamente , Adulto , Resultado Fatal , Humanos , Inyecciones Intravenosas , Leucoencefalopatías/patología , Imagen por Resonancia Magnética , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirugía , Trasplante de Células MadreRESUMEN
A 59-year-old man was diagnosed with IgA-kappa multiple myeloma in October 2005. He was treated with 4 courses of VAD and autologous peripheral blood stem cell transplantation (auto-PBSCT) after 200 mg/m(2) melphalan in September 2006, followed by a second auto-PBSCT after 200 mg/m(2) melphalan in February 2007. However, he did not achieve a very good partial response (VGPR). Laboratory examinations showed increased serum IgA level and renal dysfunction gradually progressed. Bortezomib was then started at a dose of 1.3 mg/m(2) in November 2008. After three cycles of bortezomib, the patient developed numbness, pain and weakness of his upper and lower extremities. The sensation of position and vibration was diminished in the fingers and toes. He developed left foot drop and gait disturbance due to left peroneal nerve palsy. Autonomic dysfunction such as orthostatic hypotension and urinary retention also occurred. Nerve conduction studies showed severe sensorimotor polyneuropathy particularly in the lower extremities. He developed grade 4 motor neuropathy and severe painful neuralgia. Six months after the cessation of bortezomib, these symptoms gradually improved and he was able to walk with support and discharged. Close monitoring of neurological symptoms and prompt dose-reduction or cessation of bortezomib are important to prevent the progression of irreversible peripheral neuropathy.