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1.
Leukemia ; 26(12): 2455-61, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22555150

RESUMEN

To address the prognostic value of minimal residual disease (MRD) before unrelated cord blood transplantation (UCBT) in children with acute lymphoblastic leukemia (ALL), we analyzed 170 ALL children transplanted in complete remission (CR) after myeloablative conditioning regimen. In all, 72 (43%) were in first CR (CR1), 77 (45%) in second CR (CR2) and 21 (12%) in third CR (CR3). The median interval from MRD quantification to UCBT was 18 days. All patients received single-unit UCBT. Median follow-up was 4 years. Cumulative incidence (CI) of day-60 neutrophil engraftment was 85%. CI of 4 years relapse was 30%, incidence being lower in patients with negative MRD before UCBT (hazard ratio (HR)=0.4, P=0.01) and for those transplanted in CR1 and CR2 (HR=0.3, P=0.002). Probability of 4 years leukemia-free survival (LFS) was 44%, (56, 44 and 14% for patients transplanted in CR1, CR2 and CR3, respectively (P=0.0001)). Patients with negative MRD before UCBT had better LFS after UCBT compared with those with positive MRD (54% vs 29%; HR=2, P=0.003). MRD assessment before UCBT for children with ALL in remission allows identifying patients at higher risk of relapse after transplantation. Approaches that may decrease relapse incidence in children given UCBT with positive MRD should be investigated to improve final outcomes.


Asunto(s)
Trasplante de Células Madre de Sangre del Cordón Umbilical/efectos adversos , Enfermedad Injerto contra Huésped/diagnóstico , Recurrencia Local de Neoplasia/mortalidad , Neoplasia Residual/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/terapia , Humanos , Lactante , Masculino , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/terapia , Neoplasia Residual/etiología , Neoplasia Residual/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Pronóstico , Sistema de Registros , Inducción de Remisión , Estudios Retrospectivos , Tasa de Supervivencia , Acondicionamiento Pretrasplante , Trasplante Homólogo
2.
Bone Marrow Transplant ; 46(2): 250-6, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20400980

RESUMEN

We retrospectively studied a series of 23 patients (median age 50 years, range 29-59 years) with multiple myeloma (MM), treated in first relapse by a sequential autologous-allogeneic tandem approach. Tandem transplantation (TT) consisted in high dose melphalan (HDT) and auto-SCT followed by an (allo-SCT) preceded by two gray TBI non-myeloablative conditioning. All patients received a first HDT as frontline treatment. At day 100 post allo-SCT, complete donor chimerism was detected in 22 patients (95%). Acute GVHD was observed in 19 patients (15 grade I-II (65%) and 4 grade III-IV (17%)). Ten patients (43%) developed an extensive chronic GVHD. The non-relapse mortality at 1 year was 17%. After TT, the overall response rate was 91% (17% partial response, 35% very good partial remission and 39% complete remission). At 2 years, OS was 61%. Median event-free survival and OS were 36.8 and 60 months, respectively. Based on the propensity score matching method, a significant survival advantage could be seen in patients treated with TT as compared with non-allografted patients. Thus, allo-SCT, in TT approach, provides a high response rate with low toxicity and may improve survival of patients with relapsing MM.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas/métodos , Mieloma Múltiple/cirugía , Acondicionamiento Pretrasplante , Adulto , Supervivencia sin Enfermedad , Femenino , Enfermedad Injerto contra Huésped/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trasplante de Células Madre Hematopoyéticas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , Recurrencia , Estudios Retrospectivos , Quimera por Trasplante , Trasplante Autólogo , Trasplante Homólogo
3.
Bone Marrow Transplant ; 44(10): 653-9, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19802021

RESUMEN

The use of umbilical or placental donor cord blood transplantation (CBT) in children with malignant and non-malignant diseases has witnessed important progress, mainly because of better cord blood donor choice and patient selection translating into better patient outcome. Approximately 2000 children with malignant diseases (about 75 % with acute leukemias) have been transplanted with a related (n=199) or unrelated CBT (UCBT, n=1663) and reported to Eurocord registry from 1990-2008. Disease-specific studies have been carried out after UCBT for acute lymphoblastic and myeloid leukemia and myelodysplastic syndromes in others to identify the risk factors that may improve outcomes. Outcomes after CBT have been compared with other alternative allogeneic hematopoietic SCT (HSCT) donors. Briefly, after CBT, myeloid engraftment is delayed, acute and chronic GVHD decreased and disease-free survival was not statistically different when compared with HLA identical and other alternative HSCT donor. Therefore, any physician has to carefully evaluate, for each single pediatric patient in need of an allograft, all the possible alternatives in order to choose the best hematopoietic stem cell donor, taking into account type of disease, urgency of transplantation, donor characteristics and center experience. This review will analyze the current results of CBT for pediatric patients with malignant diseases and the advantages and limitations of using this stem cell source.


Asunto(s)
Trasplante de Células Madre de Sangre del Cordón Umbilical , Leucemia/terapia , Neoplasias/terapia , Adolescente , Niño , Preescolar , Trasplante de Células Madre de Sangre del Cordón Umbilical/estadística & datos numéricos , Trasplante de Células Madre de Sangre del Cordón Umbilical/tendencias , Humanos , Lactante , Resultado del Tratamiento
4.
Eur J Clin Microbiol Infect Dis ; 27(1): 53-63, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17938978

RESUMEN

A recent meta-analysis, which included non-placebo open-labeled trials, showed that fluoroquinolone prophylaxis reduces mortality in neutropenic patients, whereas two recent large trials failed to show a similar benefit. Therefore, we performed a meta-analysis of randomized, blinded, placebo-controlled trials of fluoroquinolone prophylaxis in neutropenic patients. We searched several databases for relevant trials in any language. We used random effects models for pooling dichotomous data and assessed the between-study inconsistency with I (2). Two investigators independently assessed the eligibility and quality of the included trials. A total of 2,721 patients were randomized in eight eligible trials. Compared to the placebo, there was a statistically non-significant but consistent decrease in mortality with fluoroquinolone prophylaxis (4.5% vs. 3.9%, relative risk (RR) 0.76, 95% confidence interval (CI) 0.54, 1.08, p = 0.13, I (2) = 0%). Significant inconsistency, however, accompanied the pooled analysis of febrile episode (39% vs. 31%, RR 0.76, 95% CI 0.55, 1.03, p = 0.08, I (2) = 96.5%). To an extent, this inconsistency was explained in the subgroup analyses by the type of patient population studied and the type of fluoroquinolone used (p for interaction

Asunto(s)
Profilaxis Antibiótica/métodos , Fluoroquinolonas/uso terapéutico , Neoplasias/complicaciones , Neutropenia/complicaciones , Infecciones Oportunistas/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Neoplasias/terapia , Neutropenia/microbiología , Infecciones Oportunistas/sangre , Infecciones Oportunistas/microbiología , Placebos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
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