RESUMEN
Background: The combination of intermediate-dose cytarabine plus mitoxantrone (IMA) can induce high complete remission rates with acceptable toxicity in elderly patients with acute myeloid leukemia (AML). We present the final results of a randomized-controlled trial comparing IMA with the standard 7 + 3 induction regimen consisting of continuous infusion cytarabine plus daunorubicin (DA). Patients and methods: Patients with newly diagnosed AML >60 years were randomized to receive either intermediate-dose cytarabine (1000 mg/m2 twice daily on days 1, 3, 5, 7) plus mitoxantrone (10 mg/m2 days 1-3) (IMA) or standard induction therapy with cytarabine (100 mg/m2 continuously days 1-7) plus daunorubicin (45 mg/m2 days 3-5) (DA). Patients in complete remission after DA received intermediate-dose cytarabine plus amsacrine as consolidation treatment, whereas patients after IMA were consolidated with standard-dose cytarabine plus mitoxantrone. Results: Between February 2005 and October 2009, 485 patients were randomized; 241 for treatment arm DA and 244 for IMA; 76% of patients were >65 years. The complete response rate after DA was 39% [95% confidence interval (95% CI): 33-45] versus 55% (95% CI: 49-61) after IMA (odds ratio 1.89, P = 0.001). The 6-week early-death rate was 14% in both arms. Relapse-free survival curves were superimposable in the first year, but separated afterwards, resulting in 3-year relapse-free survival rates of 29% versus 14% in the DA versus IMA arms, respectively (P = 0.042). The median overall survival was 10 months in both arms (P = 0.513). Conclusion: The dose escalation of cytarabine in induction therapy lead to improved remission rates in the elderly AML patients. This did not translate into a survival advantage, most likely due to differences in consolidation treatment. Thus, effective consolidation strategies need to be further explored. In combination with an effective consolidation strategy, the use of intermediate-dose cytarabine in induction may improve curative treatment for elderly AML patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Citarabina/administración & dosificación , Daunorrubicina/administración & dosificación , Leucemia Mieloide Aguda/tratamiento farmacológico , Mitoxantrona/administración & dosificación , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Citarabina/efectos adversos , Daunorrubicina/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mitoxantrona/efectos adversos , Inducción de Remisión , Análisis de SupervivenciaAsunto(s)
Tumores Neuroendocrinos/tratamiento farmacológico , Receptores de Somatostatina/efectos de los fármacos , Receptores de Somatostatina/metabolismo , Somatostatina/farmacología , Ensayos Clínicos Controlados como Asunto , Sistemas de Liberación de Medicamentos , Humanos , Técnicas In Vitro , Tumores Neuroendocrinos/fisiopatología , Medicina Nuclear , Radiofármacos , Receptores de Péptidos/efectos de los fármacos , Receptores de Péptidos/metabolismo , Somatostatina/análogos & derivadosRESUMEN
BACKGROUND: To evaluate the long-term benefit from high-dose chemotherapy (HDCT) with autologous stem-cell transplantation (ASCT), as part of the initial treatment for patients with chemosensitive, high-grade B non-Hodgkin's lymphoma (hg B-NHL), stratified according to the age-adjusted International Prognostic Index (aaIPI). PATIENTS AND METHODS: Eligible patients were 33 consecutive hg B-NHL patients responding to first-line chemotherapy and fulfilling at least one of the following criteria: stage III or IV, bulky disease, elevated lactate dehydrogenase or failure to achieve complete remission (CR). Twenty-two of 33 patients (67%) had two or three risk factors with respect to the aaIPI. All patients received HDCT with ASCT after a minimum of 6 weeks of VACOP-B standard therapy and VIP-E for mobilization. RESULTS: After ASCT, 31 patients (94%) achieved CR. No treatment-related death occurred. The cumulative incidence of relapse at a medium follow-up of 10 years is 16% for 31 of 33 patients achieving CR. Twenty-five of 33 patients are in sustained CR with a disease-free survival of 76% [95% confidence interval (CI) 67% to 86%]. The overall survival at a median follow-up of 122 months (range 86-148) is 79% (95% CI 68% to 89%). CONCLUSIONS: The results suggest that up-front HDCT with ASCT may improve long-term outcome in high-risk patients with chemotherapy-sensitive hg B-NHL when compared to historic populations treated solely with dose-intense chemotherapy. We observed that long-term survival of high-risk (two to three risk factors) patients is comparable to low-risk (zero to one risk factor) patients after HDCT and ASCT with a low incidence of late relapse.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/uso terapéutico , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Etopósido/uso terapéutico , Linfoma de Células B/terapia , Linfoma no Hodgkin/terapia , Prednisona/uso terapéutico , Trasplante de Células Madre , Vincristina/uso terapéutico , Adulto , Factores de Edad , Bleomicina/administración & dosificación , Ciclofosfamida/administración & dosificación , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Doxorrubicina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Linfoma de Células B/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Prednisona/administración & dosificación , Pronóstico , Recurrencia , Factores de Riesgo , Factores de Tiempo , Trasplante Autólogo , Resultado del Tratamiento , Vincristina/administración & dosificaciónRESUMEN
CA 19-9 is a tumor marker of pancreatic and gastrointestinal cancer. Elevation in nonmalignant disease is rare. The case of a patient with a partial staghorn calculus, giant hydronephrosis, and elevated CA 19-9 serum levels is presented. Open transperitoneal right-sided nephrectomy was performed. In immunohistochemical analysis, CA 19-9 was expressed in the renal tubular epithelium and the renal pelvis. During postoperative follow-up, the CA 19-9 levels returned to normal. Hydronephrosis might cause false-positive results when CA 19-9 measurement is used to screen for malignant disease. Posttreatment CA 19-9 levels of patients with hydronephrosis have to be monitored closely to safely exclude malignant disease.
Asunto(s)
Antígeno CA-19-9/sangre , Hidronefrosis/sangre , Cálculos Renales/complicaciones , Biomarcadores de Tumor/sangre , Neoplasias de la Mama/cirugía , Antígeno CA-19-9/análisis , Diagnóstico Diferencial , Reacciones Falso Positivas , Femenino , Humanos , Hidronefrosis/etiología , Riñón/anomalías , Neoplasias Renales/sangre , Pelvis Renal/química , Túbulos Renales/química , Persona de Mediana Edad , Nefrectomía , Periodo Posoperatorio , Valor Predictivo de las PruebasRESUMEN
This report describes the case of a 59-year-old woman with a history of non-Hodgkin's lymphoma who developed bacteremia with Vibrio vulnificus. The patient had been swimming in the unusually warm Baltic Sea in the summer of 2002. She presented with symptoms of septicemia and severe bullous necrotizing skin lesions of the extremities. Blood culture revealed Vibrio vulnificus as the pathogenic organism. Under treatment with cefotaxime and gentamicin, she recovered slowly without further complications. Vibrio vulnificus is a marine bacterium that is present in aquatic ecosystems worldwide, especially when water temperatures exceed 20 degrees C. Infections with Vibrio vulnificus are uncommon in Europe, and most cases are reported from subtropical or tropical regions.
Asunto(s)
Bacteriemia/diagnóstico , Infecciones Oportunistas/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/microbiología , Vibriosis/diagnóstico , Vibrio vulnificus/aislamiento & purificación , Antibacterianos , Bacteriemia/tratamiento farmacológico , Quimioterapia Combinada/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/inmunología , Persona de Mediana Edad , Infecciones Oportunistas/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Natación , Resultado del Tratamiento , Vibriosis/tratamiento farmacológico , Vibrio vulnificus/efectos de los fármacosRESUMEN
We describe a patient initially diagnosed with a chronic myeloproliferative disorder in the accelerated phase. Cytogenetic analysis showed the presence of two independent clones. One clone contained a typical Philadelphia (Ph) chromosome due to t(9;22)(q34;q11), as the sole abnormality which was proven molecularly to result in the b2a2-BCR/ABL fusion. The other clone displayed a complex karyotype with several structural and numerical aberrations including trisomy 11 and 22 but lacking a t(9;22) or any other structural abnormalities involving chromosomes 9 and 22. Fluorescence in situ hybridization demonstrated that the t(9;22) was present only in cells with two copies of chromosomes 11 and 22. In contrast, cells with trisomies 11 and 22 lacked evidence for a BCR/ABL fusion. Based on the genetic findings, simultaneous chronic and acute myelocytic leukemias were diagnosed rather than a blastic phase of a chronic myelocytic leukemia.
Asunto(s)
Aberraciones Cromosómicas , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Leucemia Mieloide Aguda/genética , Anciano , Médula Ósea/fisiología , Cromosomas Humanos , Análisis Citogenético , Diagnóstico Diferencial , Proteínas de Fusión bcr-abl/genética , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/diagnóstico , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Cromosoma Filadelfia , Translocación GenéticaRESUMEN
A patient presented with symptoms of cerebellar degeneration and nephrotic syndrome. A work-up at that time failed to reveal an underlying disease; however, 20 months later Hodgkin's disease was diagnosed. Hodgkin's lymphadenopathy developed 2 wk after prednisone therapy for the nephrotic syndrome had been discontinued. Systemic polychemotherapy resulted in complete remission of both Hodgkin's disease and nephrotic syndrome, while the neurological deficit persisted. Patients with unexplained cerebellar degeneration and/or nephrotic syndrome demand extensive evaluation for the presence of Hodgkin's disease, and steroid therapy may delay diagnosis.
Asunto(s)
Enfermedad de Hodgkin/diagnóstico , Síndrome Nefrótico/etiología , Degeneración Cerebelosa Paraneoplásica/etiología , Corticoesteroides/farmacología , Corticoesteroides/uso terapéutico , Adulto , Ataxia de la Marcha/etiología , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Masculino , Síndrome Nefrótico/diagnóstico , Síndrome Nefrótico/tratamiento farmacológico , Degeneración Cerebelosa Paraneoplásica/diagnóstico , Degeneración Cerebelosa Paraneoplásica/tratamiento farmacológico , Factores de TiempoRESUMEN
A patient with painful peripheral neuropathy is presented, whose symptoms were thought to result from an infection with Borrelia burgdorferi sensu lato. Investigations of the cerebrospinal fluid for signs of inflammation and borrelial antibodies were negative, and the patient did not benefit from repeated antibiotic treatment. Electrophysiologic studies and sural nerve biopsy showed axonal neuropathy consistent with a paraneoplastic syndrome. Further workup revealed mediastinal Hodgkin's disease (HD; nodular sclerosing subtype) Ann Arbor stage II and non-small cell cancer of the lung (stage T1N0M0). Surgical resection of the lung cancer and combined chemo- and radiotherapy for HD resulted in complete remission of both malignancies. While the preexisting neurologic symptoms persisted during treatment, neurography showed some improvement of the distal nerves. During radiation therapy the patient developed transient left-sided brachial plexopathy. This case illustrates that the diagnosis of borreliosis in patients with isolated painful peripheral neuritis cannot be based solely upon positive IgG titers and supports the requirement for a thorough workup for an underlying--potentially curable--disease. In addition, singular pulmonary lesions in the setting of HD should be suspected to have a separate cause.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Enfermedad de Hodgkin/diagnóstico , Neoplasias Pulmonares/diagnóstico , Enfermedad de Lyme/diagnóstico , Polineuropatía Paraneoplásica/complicaciones , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Ceftriaxona/uso terapéutico , Electrofisiología , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/terapia , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/cirugía , Enfermedad de Lyme/complicaciones , Enfermedad de Lyme/tratamiento farmacológico , Masculino , Polineuropatía Paraneoplásica/diagnóstico , Radioterapia , Inducción de Remisión , Nervio Sural/patología , Tomografía Computarizada por Rayos XRESUMEN
A number of recent developments in the supportive care of hematological malignancies have been selected for critical discussion. The first section focuses on the role of evidence-based guidelines in influencing the use of hematopoietic growth factors in medical practice. The next section updates the current clinical status of amifostine (Ethyol, Alza Corp., Palo Alto CA, USA, and US Bioscience, West Conshohocken, PA, USA) the first broad-spectrum cytoprotective agent available. The management of invasive fungal infections and the use of liposomal antifungal agents are reviewed next. Finally, the current status of transfusion support is presented.
Asunto(s)
Neoplasias Hematológicas/terapia , Adulto , Amifostina/farmacología , Amifostina/uso terapéutico , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Animales , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Aspergilosis/prevención & control , Transfusión Sanguínea/estadística & datos numéricos , Médula Ósea/efectos de los fármacos , Médula Ósea/patología , Ensayos Clínicos Fase I como Asunto , Neoplasias Hematológicas/complicaciones , Factores de Crecimiento de Célula Hematopoyética/farmacología , Factores de Crecimiento de Célula Hematopoyética/uso terapéutico , Células Madre Hematopoyéticas/efectos de los fármacos , Humanos , Control de Infecciones , Neutropenia/etiología , Neutropenia/terapia , Atención al Paciente , Guías de Práctica Clínica como Asunto , Protectores contra Radiación/farmacología , Protectores contra Radiación/uso terapéutico , Sociedades Médicas , Reacción a la TransfusiónRESUMEN
A 40-year old patient with small cell lung cancer (SCLC) was treated with combined modalities including high-dose chemotherapy with subsequent autologous peripheral blood progenitor cell transplantation plus adjuvant radiotherapy. He achieved complete remission with regards to the primary disease. After an interval of 28 months, he was diagnosed with chronic myelogenous leukemia (CML). Analysis of graft samples at time of primary treatment for SCLC using polymerase chain reaction (PCR) did not show the bcr-abl transcript characteristic for CML. This case supports the observation that CML can develop as a treatment-related malignancy and gives insight in the length of the preclinical phase of the disease.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Células Pequeñas , Leucemia Mielógena Crónica BCR-ABL Positiva/etiología , Neoplasias Pulmonares , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/etiología , Carcinoma de Células Pequeñas/radioterapia , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/fisiopatología , Leucemia Inducida por Radiación/etiología , Leucemia Inducida por Radiación/fisiopatología , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/etiología , Neoplasias Pulmonares/radioterapia , Masculino , Neoplasias Primarias Secundarias/etiología , Neoplasias Primarias Secundarias/fisiopatologíaRESUMEN
Treatment-related (Tr) AML and MDS after chemotherapy, radiotherapy, or the combination of both have been well characterized. However, tr-CML seems to differ from these better-known entities in frequency, clinical course, and prognosis. Tr-CML cannot be distinguished from de novo CML cytogenetically, and, in contrast to tr-AML and tr-MDS, typical chromosomal aberrations related to tr-CML have not been described. Treatment-related CML is a late effect of cytotoxic or immunosuppressive therapy which might be increasingly recognized due to a higher number of patients treated with intensive therapy regimens. We review here the available data on incidence of tr-CML as well as the affected individual's characteristics with regard to different treatment options in malignant and nonmalignant diseases.
Asunto(s)
Antineoplásicos/efectos adversos , Leucemia Mielógena Crónica BCR-ABL Positiva/etiología , Radioterapia/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This article focuses on a selected number of topics among recent developments in the supportive care of hematological malignancies. The first section focuses on the role of hematopoietic growth factors, such as granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, thrombopoietin, interleukin-11, and keratinocyte growth factor. The following sections discuss the management of fungal and viral infections as well as changes in the current policies of platelet transfusion. The focus of this review is on the clinical utility and economic feasibility of the published findings.
Asunto(s)
Neoplasias Hematológicas/terapia , Cuidados para Prolongación de la Vida , Antiinfecciosos/uso terapéutico , Enfermedades Transmisibles/complicaciones , Enfermedades Transmisibles/tratamiento farmacológico , Neoplasias Hematológicas/complicaciones , Factores de Crecimiento de Célula Hematopoyética/uso terapéutico , Humanos , Transfusión de PlaquetasRESUMEN
BACKGROUND: We conducted a phase I-II trial to assess the feasibility and activity of a combination chemotherapy regimen with etoposide, ifosfamide, cisplatin or carboplatin, and epirubicin in limited-disease (LD, stages I-IIIB) and extensive-stage (ED, stage IV) small-cell lung cancer (SCLC). PATIENTS AND METHODS: Standard-dose chemotherapy (SDC) consisting of etoposide (500 mg/m2), ifosfamide (4000 mg/m2), cisplatin (50 mg/m2) and epirubicin (50 mg/m2) (VIP-E), followed by granulocyte colony-stimulating factor (G-CSF), was given to 100 patients with SCLC. Thirty patients with qualifying responses to VIP-E proceeded to high-dose chemotherapy (HDC) with autologous peripheral blood stem-cell transplantation (PBSCT) after etoposide (1,500 mg/m2), ifosfamide (12,000 mg/m2), carboplatin (750 mg/m2) and epirubicin (150 mg/m2) (VIC-E) conditioning. RESULTS OF STANDARD-DOSE VIP-E: Ninety-seven patients were evaluable for response. The objective response rate was 81% in LD SCLC (33% CR, 48% PR; excluding patients in surgical CR) and 77% in ED SCLC (18% CR, 58% PR). The treatment-related mortality (TRM) of SDC was 2%. Two additional patients in CR from their SCLC developed secondary non-small-cell lung cancers (NSCLC), and both were cured by surgery. The median survival was 19 months in LD SCLC and 6 months in ED SCLC. The five-year survivals were 36% in LD and 0% in ED SCLC. RESULTS OF HIGH-DOSE VIC-E: HDC was feasible in 16% of ED-, and 58% of LD-patients. All HDC patients (n = 30) improved or maintained prior responses. Four patients died of early treatment-related complications (TRM 13%). Two additional patients in CR from their SCLC developed secondary malignancies (esophageal cancer, secondary chronic myelogenous leukemia). The median survivals were 26 months in LD SCLC, and 8 months in ED SCLC. The five-year survival was 50% in LD and 0% in ED SCLC. CONCLUSIONS: Despite high response rates, survival after VIP-E SDC and VIC-E HDC in patients with ED SCLC is not superior to that achieved with less toxic traditional regimens. The high five-year survival rates achieved with these protocols in LD SCLC probably reflect both patient selection (high proportion of patients with prior surgical resection) and the high activity of our chemotherapy regimen in combination with radiotherapy. A study comparing protocols using simultaneous radiation therapy and chemotherapy, and other dose-escalated forms of SDC with HDC is needed to further define the role of this treatment modality in SCLC. Given the high rate of secondary malignancies observed in patients in CR > 2 years in our study, close follow-up and early treatment of these neoplasms may contribute to maintaining overall survival in patients with SCLC.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carcinoma de Células Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Anciano , Carboplatino/administración & dosificación , Carcinoma de Células Pequeñas/mortalidad , Carcinoma de Células Pequeñas/cirugía , Cisplatino/administración & dosificación , Supervivencia sin Enfermedad , Epirrubicina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Ifosfamida/administración & dosificación , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Neoplasias Primarias Secundarias/etiologíaRESUMEN
BACKGROUND: We conducted a phase I-II trial to assess the activity of standard-dose (SDC) and high-dose chemotherapy (HDC) with etoposide, ifosfamide, cis/carboplatin, and epirubicin (VIP-E, VIC-E) in 107 patients with limited-stage (LS, stage I-IIIB) and extensive stage (ES, stage IV) non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Updated results of a previously published trial are presented. RESULTS: Response rates and survival after VIP-E were comparable to those of other standard-dose combination chemotherapies in NSCLC. Treatment-related mortality (TRM) in SDC was 3% in LS-NSCLC, and 8% in ES-NSCLC. TRM was 4% in patients selected for HDC by response rate and performance score. Five-year survival in LS-NSCLC was 12% after SDC, and 18% after HDC; it was 0% for both treatment protocols in ES-NSCLC. CONCLUSIONS: The activity of VIP-E SDC and VIC-E HDC is not superior to that of established protocols in the treatment of NSCLC. In view of the toxicity and TRM associated with this protocol, less aggressive regimens should be preferred for most patients. Whether selected patients with chemosensitive disease could benefit from VIP-E SDC and/or VIC-E HDC in an adjuvant or neo-adjuvant setting could not be determined within the scope of this study.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Carboplatino/administración & dosificación , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Cisplatino/administración & dosificación , Epirrubicina/administración & dosificación , Etopósido/administración & dosificación , Estudios de Seguimiento , Humanos , Ifosfamida/administración & dosificación , Neoplasias Pulmonares/mortalidad , Tasa de SupervivenciaRESUMEN
BACKGROUND: Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy. The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients. METHODS: A group of cancer patients receiving high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group; n = 27) followed an exercise program during hospitalization. The program was comprised of biking on an ergometer in the supine position following an interval training pattern for 30 minutes daily. Patients in the control group (n = 32) did not train. Psychologic distress was assessed at hospital admission and discharge with the Profile of Mood States and Symptom Check List 90. RESULTS: By the time of hospital discharge, fatigue and somatic complaints had increased significantly in the control group (P for both < 0.01) but not in the training group. Furthermore, by the time of hospital discharge, the training group had a significant improvement in several scores of psychologic distress (obsessive-compulsive traits, fear, interpersonal sensitivity, and phobic anxiety) (P value for all scores < 0.05); this outcome was not observed in the control group. CONCLUSIONS: The current study found that aerobic exercise can reduce fatigue and improve psychologic distress in cancer patients undergoing chemotherapy.
Asunto(s)
Afecto , Ejercicio Físico , Fatiga/terapia , Neoplasias/complicaciones , Calidad de Vida , Estrés Psicológico/prevención & control , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Fatiga/etiología , Fatiga/psicología , Femenino , Trasplante de Células Madre Hematopoyéticas , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Neoplasias/terapiaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Enfermedades del Sistema Digestivo/virología , Herpes Simple/complicaciones , Infecciones Oportunistas/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Adulto , Resultado Fatal , Femenino , HumanosRESUMEN
Growth factors have had an increasingly strong impact in breast cancer management in recent years. The main role of growth factors, particularly hematopoietic growth factors, in this setting has been to promote better tolerance of standard-doses, and for the implementation of high-dose chemotherapy in innovative protocols. After a brief overview of growth factor biology, the current clinical guidelines for their use in cancer management is reviewed. Finally, the role growth factors in palliative and curative chemotherapy of breast cancer and methods to reduce tumor cell contamination of peripheral stem cell harvests will be discussed.
Asunto(s)
Neoplasias de la Mama/terapia , Sustancias de Crecimiento/uso terapéutico , Factores de Crecimiento de Célula Hematopoyética/uso terapéutico , Femenino , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
The increasing use of high-dose chemotherapy with autologous hematopoietic transplantation for the treatment of solid malignancies has raised concern about the role of tumor cells contaminating the grafts. Minimal residual disease (MRD) in autologous grafts has became a dynamic and intensively studied field in oncology. This review discusses the current status of MRD in breast cancer autografts and presents existing data on detection methodology, clinical relevance, biologic characteristics and purging techniques.
Asunto(s)
Neoplasias de la Mama/terapia , Trasplante de Células Madre Hematopoyéticas , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/patología , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Neoplasia Residual , Resultado del TratamientoRESUMEN
Supportive care in hematologic malignancies includes a wide range of topics. We have selected the following issues for a review of recently published developments: new insights into the benefits and risks of established hematopoietic growth factors (HGF), such as granulocyte- or granulocyte-macrophage colony-stimulating factor (G-CSF, GM-CSF); the emerging role of newly introduced HGFs such as keratinocyte-growth factor (KGF) and thrombopoietin; the prophylactic and therapeutic use of amifostine, a cytoprotective agent; the role of hematopoietic growth factors and the demethylating agent decitabine in myelodysplastic syndromes (MDS); infectious complications of anticancer therapy; and, recent improvements in and complications of transfusional therapy, including the renewed interest in granulocyte transfusions.