18F-FDG PET/TC en el manejo clínico de los linfomas / 18F-FDG PET/CT in the clinical management of patients with lymphoma

El objetivo de la presente revisión es actualizar las recomendaciones sobre el papel de la tomografía por emisión de positrones (PET)/tomografía computarizada (TC) en la estadificación y valoración de la respuesta tras quimioterapia y/o trasplante de progenitores hematopoyéticos en pacientes con linfoma de Hodgkin (LH) y linfoma no-Hodgkin (LNH) en la práctica clínica habitual. En la primera reunión internacional sobre PET en linfoma, celebrada en 2009 en Deauville (Francia), se estableció una escala de 5 puntos para la valoración de la respuesta en pacientes con linfoma mediante la 18F-Fluordeoxiglucosa (FDG) PET/TC. Posteriormente, tras celebrarse la 11.a y 12.a Conferencia Internacional sobre Linfomas en Lugano (Suiza) en 2011 y 2013, respectivamente, se alcanzó un acuerdo en cuanto al uso de la PET/TC para la estadificación y se revisaron los criterios de respuesta en linfoma ávidos por la FDG en la práctica clínica y en ensayos clínicos; son los denominados criterios de valoración de respuesta de Lugano. Los principales consensos alcanzados fueron: I) la PET/TC con 18F-FDG fue formalmente incorporada en la estadificación de los linfomas con avidez por la FDG; II) la biopsia de médula ósea ya no está indicada en la estadificación rutinaria de pacientes con LH y en la mayoría de los pacientes con linfoma B difuso de células grandes (LBDCG), y III) la valoración de respuesta al tratamiento se hará mediante la PET/TC usando la escala de 5 puntos y la clasificación de Lugano. Actualmente, con la introducción de terapias basadas en agentes biológicos con mecanismos inmunes, los criterios de Lugano para valoración de la respuesta requieren una flexibilización y modificación, debido a que estos agentes pueden producir cambios en las técnicas de imagen que sugieren progresión de la enfermedad, a pesar de una respuesta clínica evidente (pseudoprogresión o tumor flare). Ello ha llevado a la adopción provisional de los criterios LYRIC (LYmphoma Response to Inmunomodulatory Therapy Criteria), con la introducción del término «respuesta indeterminada» para definir estos cambios hasta que sean confirmados o descartados como progresión de la enfermedad. El uso generalizado de todas estas recomendaciones mejorará la evaluación de pacientes con linfoma y hará posible la comparación de resultados procedentes de ensayos clínicos (AU)

The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using 18F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, 18F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term ‘Indeterminate Response’ in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials (AU)

18F-FDG PET/CT in the clinical management of patients with lymphoma. / 18F-FDG PET/TC en el manejo clínico de los linfomas.

The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using 18F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, 18F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term 'Indeterminate Response' in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials.

Toxicity and efficacy of busulfan and fludarabine myeloablative conditioning for HLA-identical sibling allogeneic hematopoietic cell transplantation in AML and MDS.

The safety and efficacy of a 4-day myeloablative conditioning (MAC) regimen consisting of Bu 3.2 mg/kg and fludarabine 40 mg/m(2)/day for HLA-identical sibling allogeneic hematopoietic cell transplantation (HCT) in myeloid malignancies was investigated in 133 patients (median age, 47 years; range 19-74 years) with de novo AML (60%), secondary AML (20%) or myelodysplastic syndrome (20%). All patients engrafted. Hepatic veno-occlusive disease occurred in five patients (4%), and severe toxicities, mostly mucositis, occurred in twenty-three (17%) patients. The non-relapse mortality (NRM) at 100 days was 1.5%. The incidences of acute GVHD grade 2-4 and grade 3-4 were 32 and 13%, respectively. At a median follow-up of 38 months, the cumulative incidence of chronic GVHD was 67%. The relapse incidence was 30% (27 and 31%, respectively, in patients with early- and late-stage disease), and the overall NRM was 15%. The actuarial 4-year disease-free survival (DFS) and overall survival (OS) were 54 and 62%, respectively. Patients aged <50 years had better outcomes compared with older patients (DFS 64 vs 42%, P=0.006; OS 73 vs 47%, P<0.001, respectively).

Influence of donor age in allogeneic stem cell transplant outcome in acute myeloid leukemia and myelodisplastic syndrome.

The impact of donor age in patients with acute myeloid leukemia and myelodysplastic syndrome who underwent allogeneic hematopoietic stem cell transplant (HSCT) remains unclear. In the current study, we evaluate 179 consecutive patients who received an HSCT, from January 2000 to January 2013, in our Institution. Most of the HSCT (91%) were HLA-matched. Patient and donor median age were 51 years (18-69) and 47 years (12-75) respectively, and 81 donors (45%) were older than 50 years. The median follow-up was 38 months (range 1-138), Kaplan-Meier estimated 3-year overall survival (OS) was 63% and disease free survival (DFS) was 56%. Interestingly, patients who received an HSCT from a donor older age (>50 y) showed a poorer OS (51% vs 73%; p=0.01), as well as a higher TRM (20% vs 8%; p=0.038) and higher relapse rate (28% vs 39%; p=0.03). In a stratified subanalysis, 3-year estimated OS was significantly lower among patients undergoing an HSCT from >50 years sibling donors compared to those receiving an HSCT from <50 years unrelated donor (54% vs 72%; p<0.001). In summary, we can conclude that receiving an HSCT from a donor over 50 years old is associated with poorer outcome in patients diagnosed with MDS and AML, and this information may be incorporated into the complex process of donor selection.

Actividad física y ocio y su relación con el Índice de Ruffier en adolescentes / Physical activity and leisure habits and relation with Ruffier Index in adolescents

El objetivo del estudio fue medir y correlacionar la práctica de actividad física y con el Índice de Ruffier (IR) en adolescentes. A un total de 884 alumnos (edad=16,4±0,8 años) se les midió la actividad física con la Versión modificada del Assessment of Physical Activity Level Questionnaire (APALQ) y se evaluó la capacidad de adaptación al esfuerzo mediante el Test Ruffier. La media del Índice de Ruffier fue 11,1±4,6 y el Índice de actividad física (IAF) 13,8±4,4. Las relaciones entre IAF y el IR, y entre horas de ocio sedentario e IR resultaron ser significativas aunque débiles (r=-0,31; p=0,000). En el IR los chicos presentaron valores superiores (t= -8,78; p= 0,000) a las chicas. También destinan más tiempo a la práctica de AF y estas diferencias fueron significativas en AF reglada y no reglada y en participación en competición (p=0,000), mientras que las chicas destinan más tiempo a actividades sedentarias como leer y estudiar (p=0,000). Es necesario promover la práctica de actividades físico-deportivas, especialmente entre las chicas (AU)

The aim of the study was to assess and correlate physical activity practice and fitness level in adolescents. A total of 884 students (age=16,4±0,8 years) answered the modified version of the 'Assessment of Physical Activity Level Questionnaire (APALQ)' and aerobic capacity was assessed through the Ruffier Test. The mean Ruffier Index (IR) was 11,1±4,6 and the mean Physical Activity Index (IAF) was 13,8±4,4. The relationship between IAF and IR, and between sedentary activities in leisure time and IR, was significant (r=-0,31; p=0,000). although weak. Boys showed higher physical fitness values (t= -8,78; p= 0,000) and spent more time practicing physical activity. These differences were significant for both regulated and not regulated physical activity and for participation in competition (p=0.000). Girls spent more time in sedentary activities like reading and studying (p=0.000). It is necessary to promote physical activity and sport practice, especially among girls (AU)

Diagnostic utility of bone marrow examination for the assessment of patients with fever of unknown origin: a 10-year single-centre experience.

Bone marrow (BM) examination is included in the diagnostic algorithm of fever of unknown origin (FUO), although its role is not clearly determined. The purpose of this study was to assess the role of BM studies in patients with FUO. We retrospectively reviewed 45 consecutive patients (25% human immunodeficiency virus-positive) with FUO who underwent a BM study in the University Hospital of Salamanca from 2000 to 2010. We analysed the diagnostic role of BM smears, multiparameter flow cytometry analysis, histology and microbiological cultures. Five patients (11%) were finally diagnosed by BM study (three had an infectious disease and two were found to have haematological malignancies), all of whom were immunocompetent patients. Histology was the most useful study (diagnosis was obtained in 4/5 patients), while BM cultures did not establish the final diagnosis in any patient. Flow cytometry established the diagnosis in one patient, although this patient was also diagnosed by histology. In conclusion, BM study is useful for establishing the aetiology of FUO. BM biopsy for histological examination should be always mandatory if a BM examination is performed.

Calidad de la dieta y su relación con el IMC y el sexo en adolescentes / Diet quality and its relation to sex and BMI in adolescents

El sobrepeso afecta de manera creciente a los adolescentes de los países occidentales. Analizar su incidencia y la relación con los hábitos nutricionales puede convertirse en el primer paso para diseñar estrategias de actuación. Se analizó la calidad de la dieta de 1057adolescentes de la ciudad de Leganés (Madrid, España) a través del índice KIDMED. Se calculó su IMC y se categorizó en normo peso, sobrepeso u obesidad. Existen diferencias significativas entre sexos en los hábitos nutricionales, donde los chicos presentan una nutrición más saludable, así como en la prevalencia de obesidad, siendo ésta mayor en el caso de los chicos. No se ha mostrado relación entre el índice de calidad de la dieta y la composición corporal. Deben diseñarse estrategias de actuación para mejorar la calidad de la dieta en los adolescentes, especialmente en las chicas (AU)

Overweight is an increasing affection among the adolescents in western countries. Analyzing its incidence and the relationship with nutritional habits can become the first step to design action strategies. The quality of the diet of 1057 adolescents from Leganés city (Madrid, Spain) was analyzed through index KIDMED. BMI was calculated and compared with the categorization according to normal weight, overweight or obesity. Significant differences exist between gender in the nutritional habits, where boys display a healthier nutrition, as well as in the obesity prevalence, being major in the case of boys. Relationship between diet quality index and body composition has not been found. Action strategies must be designed to improve the quality of the diet in adolescents, especially in girls (AU)

Biodescontaminación ambiental con peróxido de hidrógeno vaporizado en el ámbito quirúrgico / Environmental biodecontamination with vaporized hydrogen peroxide in the surgical field

Se estudió la viabilidad de la descontaminación ambiental en el ámbito hospitalario con vapor seco de peróxido de hidrógeno producido por sistema VHP® ARD de Steris. Se aplicó en un hospital general sobre un quirófano y una habitación de aislamiento con antesala, ambas de la Unidad de Quemados. Las exposiciones fueron respectivamente de más de 400 ppm durante 40 minutos y más de 250 ppm durante 89 minutos, siendo suficientes para el virado de los múltiples indicadores químicos y la esterilidad mostrada en indicadores biológicos de Geobacillus stearothermophilus. En resumen, el ensayo resultó satisfactorio de acuerdo con las previsiones hechas (AU)

We studied the feasibility of environmental decontamination in the hospital setting with dry steam of hydrogen peroxide produced by VHP-ARD Steris system. It was applied in a general hospital on an Operating Room and an Isolation Room with anteroom, both from the Burn Unit. Exposures were respectively more than 400 ppm for 40 minutes and more than 250 ppm for 89 minutes, being enough for the change of multiple chemical indicators and sterility shown in Geobacillus stearothermophilus biological indicators. In summary, the trial was satisfactory according to the forecasts made (AU)

[Complete nutritional status in school children. Opinions and attitudes]. / Estudio nutricional completo en escolares. Opiniones y actitudes.

OBJECTIVES: To discover the cooking habits of school students' families and the full nutritional picture of the school population of Huercal de Almería. To gather the views and attitudes of school students and mothers on the low amount of milk and vegetables consumed. DESIGN: Crossover, descriptive and technical study with focus group. SETTING: Rural area. METHODS: The study had three stages: 1. A questionnaire for all the school students on their food habits (675). 2. A sample of 101 students aged between 4 and 6 and between 10 and 14 was chosen for the nutritional study. Students at nutritional risk in 1996 (95% CI; p.q = 0.25). Intake was analysed through the "memory of 24 hours", measurement of physical details and biochemical determinations. 3. We gathered views and attitudes by the focus group technique in 1997, with 60 girls between 10 and 14 and mothers in 6 groups. MAIN RESULTS: Habits: the most commonly eaten meat was chicken, followed by pork, stewed if possible. Blue and fried fish, full-cream milk, white bread, fresh green vegetables and olive oil. Nutritional study: the students' weight and height were above average. Denutrition was rare: we found three students with a percentile less than three. There was tendency to overweight in both sexes, with cholesterol levels above 200 mgr in the 4-6 group. Hyper-protein and hyper-fatty diet. The Ca/P quotient was P < 1, especially in the 10-14 girls. Consumption of pulses, fibre, cereals and root vegetables was less than the recommended amounts. Micronutrients were sufficient except for less iron in 10 to 14 girls. Focal groups: the four groups of girls coincided in rejection of green vegetables, repeating to some extent habits acquired in their families. Usually vegetables are rejected without having been tried, due to smell, texture and look. Positive knowledge about milk and vegetables was not shown in practice. CONCLUSIONS: Hyper-protein and hyper-fat diet with high cholesterol levels, weight and height above the average and tendency to overweight. They all rejected green vegetables. They repeated family eating habits.

Estudio nutricional completo en escolares. Opiniones y actitudes / Full study of the nutrition of school students. Views and attitudes

Objetivos. 1. Conocer los hábitos culinarios del escolar y su familia y el estado nutricional completo de la población escolar de Huercal de Almería. 2. Opiniones y actitudes de escolares y madres referidas al escaso consumo de leche y verduras. Diseño. Estudio descriptivo transversal y técnica de grupo focal. Ámbito. Medio rural. Metodología. Realizamos un abordaje en tres etapas: 1. Para conocer los hábitos alimentarios realizamos una encuesta a todos los escolares (675). 2. Para el estudio nutricional elegimos una muestra de 101 escolares de 4-6 y 10-14 años. Escolares en riesgo nutricional en 1996 (nivel de confianza del 95 por ciento, error del 5 por ciento y p.q = 0,25). Hemos analizado la ingesta mediante el 'recuerdo de 24 horas', parámetros antropométricos y determinaciones bioquímicas. 3. La opinión y actitud las hemos recogido mediante la técnica de grupo focal a 60 personas, repartidos en 6 grupos focales, madres y niñas de 10-14 años en 1997.Resultados principales. Hábitos: las carnes más consumidas son la de pollo, seguida de la de cerdo, preferentemente guisado. El pescado azul y frito, la leche entera, el pan blanco, verduras frescas y aceite de oliva. Estudio nutricional: los escolares presentan peso y talla superiores a la media, la incidencia de desnutrición es escasa; hemos encontrado 3 escolares con un percentil menor de tres; tendencia al sobrepeso en ambos sexos; niveles de colesterol por encima de 200 mg en el grupo de 4-6 años. Dieta hiperproteica e hipergrasa. El cociente Ca/P < 1 sobre todo en el grupo de niñas de 10-14 años. Consumo de legumbres, fibras, cereales y hortalizas inferior a lo recomendado. Micronutrientes adecuados excepto el hierro, menor en niñas de 10-14 años. Grupos focales: coinciden en los 4 grupos de niñas el rechazo a las verduras; en cierta manera repiten los hábitos adquiridos en su familia. La mayoría de las veces el rechazo se origina sin haber probado el alimento, sólo por olor, textura y vista.Conocimientos positivos sobre la leche y verduras, que no se manifiesta en la práctica. Conclusiones. Dieta hiperproteica e hipergrasa con niveles de colesterol elevados, peso y talla superiores a la media y tendencia al sobrepeso. Coincidencia en el rechazo de la verdura. Repetición de hábitos alimentarios (AU)