Linfoma de Burkitt en pacientes HIV positivo tratados con quimioterapia intensiva en el Hospital del Salvador entre 2011 y 2014: Protocolo Nacional de Cáncer del Adulto, Chile / Intensive chemotherapy for Burkitt lymphoma in HIV positive patients

Background: Burkitt lymphoma has a low incidence, is highly aggressive, may be endemic, sporadic or associated with immunodeficiency and it has a high frequency of extranodal involvement. Overall and relapse free survival in HIV patients is 72 and 71% respectively. However, the current protocol in Chile considers a positive HIV serology as an exclusion criterion for intensive chemotherapy. Aim: To analyze the response to Burkitt lymphoma treatment among HIV positive patients. Material and Methods: All HIV positive patients with a Burkitt lymphoma treated using PANDA protocol in a public hospital were analyzed. Results: Eight male patients aged between 25 and 43 years, 63% in stage IV, were analyzed. All patients received an intensified chemotherapy regime, three of them without Rituximab. Complete remission was achieved in 87%. One patient was refractory to treatment and one patient relapsed at 5 months and died. Overall and relapse free survival were 58 and 60% respectively. All patients had episodes of high risk febrile neutropenia, but it did not cause deaths. Conclusions: In this group of HIV patients, intensive chemotherapy for Burkitt lymphoma had a high degree of effectiveness with a low relapse rate and high cure rate.

[Intensive chemotherapy for Burkitt lymphoma in HIV positive patients]. / Linfoma de Burkitt en pacientes HIV positivo tratados con quimioterapia intensiva en el Hospital del Salvador entre 2011 y 2014: Protocolo Nacional de Cáncer del Adulto, Chile.

BACKGROUND: Burkitt lymphoma has a low incidence, is highly aggressive, may be endemic, sporadic or associated with immunodeficiency and it has a high frequency of extranodal involvement. Overall and relapse free survival in HIV patients is 72 and 71% respectively. However, the current protocol in Chile considers a positive HIV serology as an exclusion criterion for intensive chemotherapy. AIM: To analyze the response to Burkitt lymphoma treatment among HIV positive patients. MATERIAL AND METHODS: All HIV positive patients with a Burkitt lymphoma treated using PANDA protocol in a public hospital were analyzed. RESULTS: Eight male patients aged between 25 and 43 years, 63% in stage IV, were analyzed. All patients received an intensified chemotherapy regime, three of them without Rituximab. Complete remission was achieved in 87%. One patient was refractory to treatment and one patient relapsed at 5 months and died. Overall and relapse free survival were 58 and 60% respectively. All patients had episodes of high risk febrile neutropenia, but it did not cause deaths. CONCLUSIONS: In this group of HIV patients, intensive chemotherapy for Burkitt lymphoma had a high degree of effectiveness with a low relapse rate and high cure rate.

Resultados de profilaxis con itraconazol 800 mg/día vía oral en adultos con leucemia aguda y neutropenia de alto riesgo: Hospital del Salvador 2006-2008 / Itraconazole 800 mg for the prophylaxis of fungal infections in patients with acute leukemia and severe neutropenia

Background: Systemic fungal infections and specifically invasive aspergillosis (IA) are associated with a high morbi-mortality rate in patients with hematologic malignancies. Itraconazole kinetic studies show that plasma levels are not satisfactory, even though there is a reduction of the severity in clinical cases. Aim: To evaluate the results of oral prophylaxis with high dose itraconazole, 400 mg bid, among patients with adult acute leukemia. Material and Methods: Prospective analysis of 93 high risk febrile episodes (with an absolute neutrophil count of less than 500 x mm3 for more 10 days), that occurred in 76 patients. Results: Seventy five percent of episodes occurred in patients with acute myeloid leukemia and 25 percent in patients with acute lymphoblastic leukemia. Fifty two percent occurred during the induction of chemotherapy. Median duration of severe neutropenia was 21 days (range 10-48). Median duration of itraconazole prophylaxis was 17 days (range 6-34). A low frequency of invasive fungal infections was observed (17 percent). According to diagnostic criteria, 5 percent of episodes corresponded to persistent fever , 1 percent and 11 percent of episodes, to probable or possible IA, respectively. No confirmed or proven IA was observed. Mortality of IA was 18 percent. No serious adverse events due to itraconazole were observed. Conclusions: The use of high dose itraconazole prophylaxis in adult patients with acute leukemia and severe neutropenia was associated to low incidence and mortality of invasive mycoses.

[Itraconazole 800 mg for the prophylaxis of fungal infections in patients with acute leukemia and severe neutropenia]. / Resultados de profilaxis con itraconazol 800 mg/día vía oral en adultos con leucemia aguda y neutropenia de alto riesgo: Hospital del Salvador 2006-2008.

BACKGROUND: Systemic fungal infections and specifically invasive aspergillosis (IA) are associated with a high morbi-mortality rate in patients with hematologic malignancies. Itraconazole kinetic studies show that plasma levels are not satisfactory, even though there is a reduction of the severity in clinical cases. AIM: To evaluate the results of oral prophylaxis with high dose itraconazole, 400 mg bid, among patients with adult acute leukemia. MATERIAL AND METHODS: Prospective analysis of 93 high risk febrile episodes (with an absolute neutrophil count of less than 500 x mm3 for more 10 days), that occurred in 76 patients. RESULTS: Seventy five percent of episodes occurred in patients with acute myeloid leukemia and 25% in patients with acute lymphoblastic leukemia. Fifty two percent occurred during the induction of chemotherapy. Median duration of severe neutropenia was 21 days (range 10-48). Median duration of itraconazole prophylaxis was 17 days (range 6-34). A low frequency of invasive fungal infections was observed (17%). According to diagnostic criteria, 5% of episodes corresponded to persistent fever , 1% and 11% of episodes, to probable or possible IA, respectively. No confirmed or proven IA was observed. Mortality of IA was 18%. No serious adverse events due to itraconazole were observed. CONCLUSIONS: The use of high dose itraconazole prophylaxis in adult patients with acute leukemia and severe neutropenia was associated to low incidence and mortality of invasive mycoses.