RESUMO
BACKGROUND: Chemotherapy is associated with significant toxicity in elderly patients treated for hematological malignancies. Adequate tools to identify the best tailored treatment are essential. PATIENTS AND METHODS: Medical charts of patients treated with adjusted chemotherapy for diffuse large B-cell lymphoma according to frailty status between August 1, 2013 and June 30, 2016 were included. Three groups were identified: fit, unfit, and frail patients. RESULTS: Fifty-six patients with a median age of 70.5 years were analyzed. Adverse prognostic characteristics were more frequent than expected in the frail group, contributing to a worse outcome. The complete response (CR) rate for all patients was 61.2% (66.6%, 78.3%, and 40.0% for fit, unfit, and frail patients, respectively; P = .121). The 2-year overall survival (OS) for all patients was 78% (87%, 82%, and 59% for fit, unfit, and frail patients, respectively; P = .159) and the mean 2-year disease-free survival was 96% (87% for frail patients and 100% for unfit and fit patients; P = .287). Grade 3/4 hematologic toxicity was present in 83.3%, 65.2%, and 45% of fit, unfit, and frail patients, respectively. CR after therapy had a positive effect on OS, whereas ≥ 2 extranodal sites and febrile neutropenia had a negative effect. CONCLUSION: Frailty status assessment resulted in the identification of a group of unfit patients who had adequate tolerance to adjusted chemotherapy (R-choP; rituximab with cyclophosphamide, doxorubicin, and vincristine adjusted to 80% of the corresponding total doses in R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone]) with good results.
Assuntos
Linfoma Difuso de Grandes Células B/tratamento farmacológico , Idoso , Feminino , Fragilidade , Humanos , Masculino , MéxicoRESUMO
BACKGROUND: Extranodal NK/T-cell lymphoma, nasal type (ENKTCL) has a high prevalence in Asia and Latin American countries, such as Mexico, where it encompasses 40% of all T-cell non-Hodgkin lymphomas. Historically, responses to anthracycline-based therapies have been disappointing. Since data about the effectiveness of L-asparaginase-based regimens in Mexico are limited, we compared both therapies in our center. METHODS: We performed a retrospective cohort of patients with newly diagnosed ENKTCL, who were divided into two groups for treatment and analysis (group 1: L-asparaginase-based regimen and group 2: anthracycline-based regimen) between 2001 and 2016. RESULTS: Of 36 patients with newly-diagnosed ENKTCL, 33 received at least one cycle of chemotherapy (22 in group 1 and 11 in group 2). Over a median follow-up interval of 17 months (range, 0-167), a complete response (CR) was observed in 45.5% of patients in group 1, compared to 27% of group 2 (P=0.45). Progression was more frequently observed in group 2 than in group 1 (54.5% vs. 18.4%, P=0.04). The median overall survival (OS) was 44 months in group 1, compared to 5 months in group 2 (P=0.012). The multivariate analysis showed that failure to achieve a CR after first-line therapy was the only significant factor for OS (HR, 3.04; 95% CI, 1.4-6.5; P=0.005). CONCLUSION: L-asparaginase-based regimens for patients with newly-diagnosed ENKTCL confer a survival advantage over anthracycline-based regimens.
RESUMO
Non-Hodgkin lymphoma comprises a heterogeneous group of haematological malignancies, classified according to their clinic, anatomic-pathological features and, lately, to their molecular biomarkers. Despite the therapeutic advances, nearly half of the patients will die because of this disease. The new diagnostic tools have been the cornerstone to design recent therapy targets, which must be included in the current treatment guidelines of this sort of neoplasms by means of clinical trials and evidence-based medicine. In the face of poor diagnoses devices in most of the Mexican hospitals, we recommend the present diagnose stratification, and treatment guidelines for non-Hodgkin lymphoma, based on evidence. They include the latest and most innovative therapeutic approaches, as well as specific recommendations for hospitals with limited framework and therapy resources.
Assuntos
Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/terapia , Humanos , MéxicoRESUMO
UNLABELLED: Therapeutic plasma exchange (TPE) is an effective treatment in Myasthenia gravis (MG) and Guillain-Barré syndrome (GBS) and 5% human albumin is the replacement fluid of choice; however, it is expensive. More recently, it has been suggested that starch is a safe and cheaper choice to human albumin. OBJECTIVE: To evaluate our 5-year experience using 3% hydroxyethyl starch (HES) and 5% human albumin mixture, as replacement fluid in TPE for these diseases. MATERIALS AND METHODS: Retrospective study carried out from January 2001 through September 2006. We included those patients with MG and GBS undergoing TPE. We analyzed clinical outcome (CO) and adverse events (AE) and our results were compared with a previous study which included similar patients undergoing TPE using just 5% human albumin. RESULTS: Thirty-one procedures were carried out in 26 patients, a total of 147 TPE sessions. In the group of MG we had 57% complete responses (CR) and 86% overall response (OR) while in the group of GBS we had 40% CR and 60% OR. When we analyzed our CO with the previous study no statistical differences were found. Mean processed plasma volume (PPV) was 4.2 in MG and 5.5 in GBS. Twenty patients had AE, being hypotension and catheter dysfunction the most frequent ones, while tachycardia, hypertension and paresthesias were statistically more frequent in the HES/albumin group. CONCLUSIONS: TPE with a mixture of 3% HES and 5% human albumin is as effective and safe as 5% human albumin alone for patients with these diseases.
