Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 18 de 18
Filtrar
1.
Leuk Res ; 144: 107562, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39178610

RESUMO

To investigate the safety of total body irradiation-based myeloablative conditioning (TBI-MAC) in adolescent and young adult (AYA) Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL) patients treated with pediatric protocols, treatment outcomes of 106 AYA patients aged 16-39 years old undergoing allogeneic stem cell transplant (allo-SCT) with TBI-MAC in the first remission were compared according to chemotherapy types before transplant. Pediatric and adult protocols were used in 56 and 50 of the patients, respectively. The cumulative incidence (CI) of non-relapse mortality (NRM) and the overall survival (OS) rates were not significantly different between the pediatric-protocol and adult-protocol group (NRM: 4 % vs. 14 % at five years post-transplant, respectively, p = 0.26; OS: 81 % vs. 66 %, respectively, p = 0.14). Multivariate analysis for NRM revealed that a performance status >0 (hazard ratio [HR] = 4.8) and transplant due to chemotherapy toxicities (HR = 3.5) were independent risk factors, but a pediatric protocol was not (HR = 0.48). The CI of NRM and the OS rates were also similar among patients aged over 24 years old. These findings suggested that conventional allo-SCT with TBI-MAC can be performed without increasing NRM in AYA patients with Ph-negative ALL even after pediatric protocols.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Cromossomo Filadélfia , Leucemia-Linfoma Linfoblástico de Células Precursoras , Condicionamento Pré-Transplante , Transplante Homólogo , Irradiação Corporal Total , Humanos , Adolescente , Condicionamento Pré-Transplante/métodos , Adulto , Masculino , Feminino , Adulto Jovem , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Irradiação Corporal Total/métodos , Transplante de Células-Tronco Hematopoéticas/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
2.
J Infect Chemother ; 29(12): 1103-1108, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37532223

RESUMO

INTRODUCTION: Late cytomegalovirus (CMV) disease, which was defined as CMV disease occurring >100 days post-transplant, remains an important complication among allogeneic stem cell transplant recipients, even now that the prophylactic strategy using ganciclovir preemptive therapy has been established. Due to the recent expansion of donor sources and conditioning regimens, it is therefore appropriate to reevaluate the incidence, risk factors, and clinical impacts of late CMV disease. METHODS: This study included the 1295 adult patients, who underwent transplant for the first time from 2008 to 2015, without underlying disease relapse or CMV disease within 100 days post-transplant. There were no restrictions on underlying diseases or transplant procedures. RESULTS: During the median follow-up period of 48.4 months, 21 patients developed late CMV disease and the 5-year cumulative incidence of late CMV disease was 1.6%. By multivariate analysis, haploidentical related donor, adult T-cell leukemia lymphoma, and preemptive therapy before 100 days post-transplant were extracted as independent risk factors. Late CMV disease negatively affected transplant outcomes, and was identified as an independent risk factor for the non-relapse mortality rate (hazard ratio 3.83, p < 0.001) and overall survival rate (hazard ratio 4.01, p < 0.001). Although 17 of 21 patients with late CMV disease died, the main causes of death were not related to CMV, except in three patients with CMV pneumonia. CONCLUSIONS: Although the incidence of late CMV disease is low in transplant recipients, this complication negatively affects clinical courses. Therefore, transplant recipients with these risk factors should be more carefully managed.

3.
Blood Adv ; 6(2): 624-636, 2022 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-34516628

RESUMO

The standard treatment for adults with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) in Japan is imatinib-based chemotherapy followed by allogeneic hematopoietic stem cell transplantation (HSCT). However, ∼40% of patients cannot undergo HSCT in their first complete remission (CR1) because of chemotherapy-related toxicities or relapse before HSCT or older age. In this study, we evaluated dasatinib-based 2-step induction with the primary end point of 3-year event-free survival (EFS). The first induction (IND1) was dasatinib plus prednisolone to achieve CR, and IND2 was dasatinib plus intensive chemotherapy to achieve minimal residual disease (MRD) negativity. For patients who achieved CR and had an appropriate donor, HSCT during a consolidation phase later than the first consolidation, which included high-dose methotrexate, was recommended. Patients with pretransplantation MRD positivity were assigned to receive prophylactic dasatinib after HSCT. All 78 eligible patients achieved CR or incomplete CR after IND1, and 52.6% achieved MRD negativity after IND2. Nonrelapse mortality (NRM) was not reported. T315I mutation was detected in all 4 hematological relapses before HSCT. Fifty-eight patients (74.4%) underwent HSCT in CR1, and 44 (75.9%) had negative pretransplantation MRD. At a median follow-up of 4.0 years, 3-year EFS and overall survival were 66.2% (95% confidence interval [CI], 54.4-75.5) and 80.5% (95% CI, 69.7-87.7), respectively. The cumulative incidence of relapse and NRM at 3 years from enrollment were 26.1% and 7.8%, respectively. Dasatinib-based 2-step induction was demonstrated to improve 3-year EFS in Ph+ ALL. This study was registered in the UMIN Clinical Trial Registry as #UMIN000012173.


Assuntos
Cromossomo Filadélfia , Leucemia-Linfoma Linfoblástico de Células Precursoras , Doença Aguda , Adulto , Dasatinibe/uso terapêutico , Humanos , Mesilato de Imatinib , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Recidiva
4.
Int J Hematol ; 114(6): 664-673, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34523110

RESUMO

The efficacy of pharmacokinetically (PK) guided, once-daily administration of busulfan (BU) was evaluated in elderly patients with acute myeloid leukemia/myelodysplastic syndrome (AML/MDS). Twenty-one patients (median age 61) received 30 mg/m2 fludarabine for 6 days and BU for 4 days, starting from 3.2 mg/m2 and subsequently adjusted to the target area under the curve (AUC) of 6000 µmol-min/L. The median AUC of day 1 (AUC1), AUC4, and their average were 4871.3, 6021.0, and 5368.1 µmol-min/L, respectively. Veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS) occurred in five patients (24%) but all recovered well. Four patients (20%) had non-infectious pulmonary complications (NIPCs). Patients with high AUC1 had frequent gastrointestinal adverse events, but similar incidence of VOD/SOS and NIPCs. Two-year overall survival (OS), non-relapse mortality (NRM), and relapse rates were 44.4%, 28.6%, and 29.1%, respectively. Patients with high AUC1 had significantly high NRM (57.1% vs. 14.3%, P = 0.04) and inferior OS (14.3% vs. 60.1%, P = 0.002), while patients with high AUC4 had a significantly low relapse rate (8.3% vs. 55.6%, P = 0.02). In conclusion, once-daily BU and a PK-guided dose intensification were beneficial for reducing relapse in elderly patients with AML/MDS. However, caution should be exercised as rapid BU dose elevation may contribute to NRM.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda/terapia , Síndromes Mielodisplásicas/terapia , Condicionamento Pré-Transplante , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Área Sob a Curva , Bussulfano/administração & dosagem , Bussulfano/farmacocinética , Terapia Combinada , Gerenciamento Clínico , Monitoramento de Medicamentos , Sobrevivência de Enxerto , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/mortalidade , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/diagnóstico , Síndromes Mielodisplásicas/mortalidade , Cuidados Paliativos , Prognóstico , Condicionamento Pré-Transplante/métodos , Transplante Homólogo , Resultado do Tratamento , Vidarabina/administração & dosagem , Vidarabina/análogos & derivados , Vidarabina/farmacocinética
5.
Int J Hematol ; 113(1): 128-133, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32886279

RESUMO

Busulfan (Bu) has been used in combination with fludarabine (Flu; BuFlu) or cyclophosphamide (Cy; BuCy) as conditioning for allogeneic hematopoietic stem cell transplantation (HSCT). This multi-institutional prospective study compared pharmacokinetic (PK) parameters of Bu between BuFlu and BuCy. Plasma Bu concentrations were measured by high-performance liquid chromatography at the first dose of the first and fourth days of intravenous Bu administrations (total of 16 doses of 0.8 mg/kg). Thirty-seven patients were evaluable (BuFlu, N = 18; BuCy, N = 19). The median age was significantly higher in BuFlu. In BuFlu, the median area under the blood concentration-time curve of Bu on the fourth day was 1183 µmol min/L (range 808-1509), which was significantly higher than that on the first day [1095 µmol min/L (range 822-1453), P < 0.01]. In contrast, such differences were not observed in BuCy. Consistently, there was a significant decrease in the clearance of Bu on the fourth day as compared with the first day in BuFlu. These results suggest that the PK of Bu was altered during the co-administration of Flu, which was not the case with Cy. A large-scale study is required to evaluate the significance of the differences in the PK of Bu between the conditionings on HSCT outcomes.


Assuntos
Bussulfano/administração & dosagem , Bussulfano/farmacocinética , Ciclofosfamida/administração & dosagem , Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Vidarabina/análogos & derivados , Adulto , Fatores Etários , Idoso , Ciclofosfamida/farmacocinética , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante Homólogo , Resultado do Tratamento , Vidarabina/administração & dosagem , Vidarabina/farmacocinética , Adulto Jovem
6.
Bone Marrow Transplant ; 54(12): 2020-2026, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31186516

RESUMO

Although cytogenetic abnormalities at diagnosis are recognized as an important prognostic factor in patients with Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL), the prognostic impact has not been evaluated in allogeneic stem cell transplant (allo-SCT) recipients. Thus, we assessed 373 Ph-negative ALL patients who underwent allo-SCT. The high-risk (HR) group included those with t(4;11), t(8;14), low hypodiploidy, and complex karyotype, and the standard risk (SR) group included all other karyotypes. Among the 204 patients who underwent a transplant during the first remission (167 in the SR group and 37 in the HR group), the overall survival (OS) rates were similar between these groups (64.1% vs. 80.0% at 5 years, respectively; p = 0.12). Conversely, among the 106 patients who underwent a transplant while not in remission (84 in the SR group and 22 in the HR group), patients in the SR group showed a significantly superior OS rate compared to the HR group (15.4% vs. 4.5% at 5 years, respectively; p = 0.022). These results suggested that treatment outcomes of Ph-negative ALL patients with HR cytogenetic abnormalities may improve following allo-SCT, especially in the first remission. Innovative transplant approaches are warranted in patients who are not in remission.


Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Transplante Homólogo/métodos , Adolescente , Adulto , Idoso , Aberrações Cromossômicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cromossomo Filadélfia , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Prognóstico , Adulto Jovem
8.
Hematology ; 24(1): 52-59, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30101679

RESUMO

OBJECTIVES: Chemoimmunotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone combined with rituximab (R-CHOP) is currently the first-line therapy for diffuse large B-cell lymphoma (DLBCL). However, management of elderly patients is challenging and often requires dose reductions or prolonged treatment intervals. We investigated the proper dose of R-CHOP for them. METHODS: At our institute, for DLBCL patients aged 65-79 and ≥80 years, we had reduced CHOP dose to 5/6 and 7/12, respectively, and retrospectively evaluated the reduced-dose R-CHOP. RESULTS: Although the median age in the standard, 5/6, and 7/12-dose groups was 57, 73, and 84 years, respectively (p < 0.001), the 3-year event-free survival (EFS) rate did not differ between the standard and 5/6-dose groups (60.2 and 56.7%); however, 7/12-dose group had significantly inferior survival (25.9%). When patients aged 60-80 were evaluated, no difference in EFS was observed between the standard and 5/6-dose groups using the same international prognostic index. The neutrophil nadir and the frequency of infection were comparable among the three dose groups. DISCUSSION AND CONCLUSIONS: Reduced-dose R-CHOP chemotherapy is a promising treatment for elderly patients with DLBCL in terms of efficacy and toxicity.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Rituximab/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Murinos/administração & dosagem , Anticorpos Monoclonais Murinos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Humanos , Linfoma Difuso de Grandes Células B/sangue , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Estudos Retrospectivos , Rituximab/efeitos adversos , Vincristina/administração & dosagem , Vincristina/efeitos adversos
9.
Leuk Lymphoma ; 59(6): 1332-1337, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29032731

RESUMO

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative treatment for chronic myelomonocytic leukemia (CMML); however, factors predicting allo-HSCT outcomes for CMML have not been well defined. This study assessed whether the existing five scoring systems for CMML prognosis could be applied for predicting allo-HSCT outcomes. We retrospectively evaluated 38 patients who underwent allo-HSCT for CMML from 2000 to 2014. At 3 years, overall survival (OS) and disease-free survival were 34.6 and 24.7%, respectively. According to the risk stratification at the time of transplantation, only the CMML-specific cytogenetic risk scoring system could successfully predict transplantation outcomes. At 3 years, OS was 56.7, 12.5, and 0% (p = .01) in the low, intermediate, and high-risk groups. Our data suggest that the CMML-specific cytogenetic risk stratification at transplant may be useful for identifying patients with CMML who may benefit from HSCT. However, further studies are warranted to confirm this observation.


Assuntos
Aberrações Cromossômicas , Leucemia Mielomonocítica Crônica/genética , Leucemia Mielomonocítica Crônica/mortalidade , Adulto , Biomarcadores , Medula Óssea/patologia , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Leucemia Mielomonocítica Crônica/diagnóstico , Leucemia Mielomonocítica Crônica/terapia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Transplante Homólogo , Resultado do Tratamento , Adulto Jovem
10.
Jpn J Clin Oncol ; 47(11): 1047-1054, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28973362

RESUMO

BACKGROUND: The efficacy of conventional chemotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been controversial as post-remission therapies for adult Philadelphia chromosome-negative acute lymphoblastic leukemia patients. METHODS: We retrospectively analyzed 96 adolescent and adult cases of Philadelphia chromosome-negative acute lymphoblastic leukemia to evaluate whether allo-HSCT should be performed after first complete remission (1CR). RESULTS: In total, 34 patients received chemotherapy followed by allo-HSCT (HSCT group) and 62 received chemotherapy alone (chemotherapy group). No significant differences in the event-free survival (EFS) or overall survival were observed between the two groups. In the chemotherapy group, use of pediatric regimens was significantly associated with favorable EFS, while high white blood cell (WBC) count and CD20 positivity were associated with poor outcome. In patients who received pediatric regimens, subsequent allo-HSCT did not influence EFS. In patients who received conventional chemotherapy (adult regimen), subsequent allo-HSCT did not improve EFS. High WBC count and CD20 positivity were also significantly associated with poor EFS in patients who received adult regimens. Patients with low WBC count and absence of CD20 who received adult regimens did not benefit from allo-HSCT. CONCLUSIONS: Allo-HSCT may not be required in the pediatric regimen-eligible patients; however, pediatric regimen-ineligible patients with either CD20 positivity or high WBC count should receive allo-HSCT after achieving 1CR. This study was registered at http://www.umin.ac.jp/ctr/ as #C000016287.


Assuntos
Antígenos CD20/análise , Contagem de Leucócitos , Cromossomo Filadélfia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Adulto , Idoso , Feminino , Transplante de Células-Tronco Hematopoéticas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Intern Med ; 55(16): 2271-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27523007

RESUMO

Several reports have suggested an increased risk of malignant lymphoma in patients with rheumatoid arthritis treated with methotrexate (MTX). We herein describe the case of a 71-year-old woman with rheumatoid arthritis who developed MYC/BCL2 double-hit lymphoma associated with MTX therapy. She developed a fever and lymphadenopathies over a 2-week period and had elevated levels of soluble IL-2 receptor. Inguinal lymph node and bone marrow biopsies showed diffuse large B cell lymphoma. Fluorescent in situ hybridization revealed MYC and BCL2 gene rearrangements in her lymphoma cells. Accordingly, a diagnosis of MYC/BCL2 double-hit lymphoma was made. This is the first reported case of a double-hit lymphoma associated with MTX therapy.


Assuntos
Antirreumáticos/efeitos adversos , Linfoma Difuso de Grandes Células B/induzido quimicamente , Linfoma Difuso de Grandes Células B/diagnóstico , Metotrexato/efeitos adversos , Idoso , Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Hibridização in Situ Fluorescente , Linfoma Difuso de Grandes Células B/patologia , Metotrexato/administração & dosagem , Receptores de Interleucina-2
15.
Hematology ; 14(4): 213-9, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19635184

RESUMO

Adhesive interactions between hematopoietic progenitor cells and extracellular matrix can improve progenitor cell survival. These mechanisms involve a number of different molecules. CD44 is one such molecule, although its molecular basis has not been elucidated. In this study, we investigated the effect of CD44 monoclonal antibodies and hyaluronan, which is a ligand of CD44, on drug-induced apoptosis in human myeloid cell line KG1. Preincubation with anti-CD44 monoclonal antibody J173 or a lower-molecular-weight form of hyaluronan (LMW-HA) could reduce drug-induced apoptosis in a dose-dependent manner from 23.0 +/- 1.4% to 5.9 +/- 5.0% (p<0.01) or 9.7 +/- 1.8% (p<0.01) respectively. On the other hand, another anti-CD44 monoclonal antibody L178 and the native high-molecular-weight polymer of hyaluronan had no effect on drug-induced apoptosis. Furthermore, J173 and LMW-HA induced a rapid increase in tyrosine phosphorylation of intracellular proteins. Genistein, a protein tyrosine kinase inhibitor, abrogated the inhibition of drug-induced apoptosis promoted by J173 and LMW-HA. These results suggest that the anti-apoptotic effect by ligation of CD44 was mediated by tyrosine phosphorylation of intracellular proteins. These data indicate that tyrosine phosphorylation via CD44 is involved in the survival of primitive myeloid cells.


Assuntos
Anticorpos Monoclonais/farmacologia , Apoptose/efeitos dos fármacos , Células-Tronco Hematopoéticas/efeitos dos fármacos , Receptores de Hialuronatos/imunologia , Ácido Hialurônico/farmacologia , Células Mieloides/efeitos dos fármacos , Anticorpos Monoclonais/imunologia , Linhagem Celular Tumoral , Genisteína/farmacologia , Células-Tronco Hematopoéticas/citologia , Células-Tronco Hematopoéticas/imunologia , Células-Tronco Hematopoéticas/metabolismo , Humanos , Receptores de Hialuronatos/biossíntese , Ácido Hialurônico/imunologia , Leucemia Mieloide Aguda , Ligantes , Peso Molecular , Células Mieloides/citologia , Células Mieloides/imunologia , Fosforilação , Tirosina/metabolismo
16.
Rinsho Ketsueki ; 49(11): 1548-51, 2008 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-19047786

RESUMO

A 58-year-old man was admitted to a general hospital to undergo total hip replacement arthroplasty for idiopathic osteonecrosis of the right femoral head. Pre-operative screening examination demonstrated isolated prolonged aPTT. Factor VIII (FVIII) activity was mildly decreased but there was no detectable FVIII inhibitor, so he was diagnosed as having congenital hemophilia. Surgery was performed safely with administration of FVIII preparation but 33 days postoperatively bleeding from the right hip joint appeared. It was not controllable with FVIII preparation and he was therefore admitted to our hospital.Laboratory examination at admission demonstrated prolonged aPTT (111.1 sec), reduced FVIII activity (3.0%), and the presence of FVIII inhibitor (17.0 B.U./ml). He was diagnosed with acquired hemophilia and administered Factor IX complex concentrates, prednisolone and cyclophosphamide. However, these treatments had only a temporary effect. Rituximab was administered every week and his condition soon improved. This case suggests that acquired hemophilia, in which there was no detectable FVIII inhibitor, may change to refractory disease after surgery. As a result, surgeons should pay careful attention to the preoperative presence of any mild coagulation abnormalities.


Assuntos
Artroplastia de Quadril , Hemofilia A/diagnóstico , Hemofilia A/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Murinos , Autoanticorpos/sangue , Biomarcadores/sangue , Fator VIII/análise , Fator VIII/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Rituximab , Resultado do Tratamento
17.
Clin Lymphoma Myeloma ; 8(3): 184-7, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18650184

RESUMO

The adrenal glands are often an affected extranodal site in advanced non-Hodgkin lymphoma, but primary adrenal lymphoma (PAL) is extremely rare. Histologic examination of adrenal glands from patients with PAL reveals predominantly diffuse large B-cell lymphoma. Adrenal insufficiency is observed in about two thirds of patients. The prognosis of patients with PAL is poor: > 90% of patients die within 1 year of diagnosis, and long-term survivors are few. Effective therapeutic management of the condition has not been established. Herein, we report a 57-year-old man with PAL of diffuse large B-cell type that was later accompanied by hemophagocytic syndrome. He was initially treated with combination chemotherapy (1 cycle of CHOP [cyclophosphamide/doxorubicin/vincristine/prednisone] and 4 cycles of rituximab plus CHOP) and subsequently underwent autologous peripheral blood stem cell transplantation (auto-PBSCT) in his first complete remission. He has been well and disease free for 39 months since undergoing auto-PBSCT. The successful outcome of using auto-PBSCT in the treatment of a patient with PAL suggests that this therapeutic approach has value in treating this poor-prognostic disease.


Assuntos
Neoplasias das Glândulas Suprarrenais/terapia , Anticorpos Monoclonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Linfo-Histiocitose Hemofagocítica/terapia , Linfoma Difuso de Grandes Células B/terapia , Transplante de Células-Tronco de Sangue Periférico , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/patologia , Anticorpos Monoclonais Murinos , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/patologia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Indução de Remissão , Rituximab , Transplante Autólogo , Vincristina/administração & dosagem
18.
Am J Hematol ; 81(11): 838-44, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16888784

RESUMO

We retrospectively evaluated the effect of the blood cyclosporine (CsA) concentration on the outcome of allogeneic hematopoietic stem cell transplantation from an HLA-matched sibling donor in 171 patients who received a continuous infusion of CsA and short-course methotrexate to prevent graft-versus-host disease (GVHD). CsA was started at 3.0 mg/kg/day and the dose was adjusted to maintain the blood CsA concentration between 250 and 350 ng/ml. The actual dose of CsA averaged 1.9 mg/kg/day at the 3rd week after transplantation. The incidence of grade II-IV acute GVHD was 29.9%. Patient age and sex were identified as independent significant risk factors for acute GVHD. The CsA concentration during the 3rd week after transplantation most strongly affected the incidence of grade II-IV acute GVHD (RR 0.995 for an increase in CsA concentration by 1 ng/ml, P = 0.037) adjusted for other risk factors. The incidence of acute GVHD was significantly lower in patients with a 3rd-week CsA concentration higher than 300 ng/ml than in those with values between 200 and 300 ng/ml (20% vs. 35%, P = 0.036). We concluded that the blood CsA concentration at peri-engraftment period may be important in preventing acute GVHD.


Assuntos
Ciclosporina/sangue , Transplante de Células-Tronco Hematopoéticas , Teste de Histocompatibilidade , Leucemia/terapia , Ciclosporina/administração & dosagem , Feminino , Doença Enxerto-Hospedeiro/epidemiologia , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/sangue , Infusões Intravenosas , Rim/patologia , Masculino , Síndromes Mielodisplásicas/terapia , Estudos Retrospectivos , Irmãos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA