Leucemias agudas secundarias a tratamiento con quimioterapia y/o radioterapia: estudio de 23 pacientes / Therapy-related acute leukemia: study of 23 pacients

Fundamento y objetivo: El uso creciente de tratamientos antineoplásicos ha provocado un aumento de la incidencia de leucemias agudas secundarias (LAS). El objetivo de este trabajo fue describir las características de las LAS en un solo centro.Pacientes y método: Se registraron 23 casos de LAS. Se analizaron los agentes citotóxicos utilizados, tiempo hasta el diagnóstico, características clínico-biológicas, tratamiento y pronóstico.Resultados: La edad mediana fue de 61 años. Los agentes administrados en la neoplasia previa fueron: alquilantes (17 pacientes), inhibidores de la DNA topoisomerasa II (14), antitubulina (12), radioterapia (9, en 6 con quimioterapia) y antimetabolitos (6). La mediana de tiempo hasta la aparición de la LAS fue 3 años (extremos 1,2-15,8). Trece pacientes recibieron quimioterapia intensiva (3 se consolidaron con un trasplante de progenitores hematopoyéticos [TPH]) mientras que los 10 restantes recibieron tratamiento de soporte (mediana de supervivencia de 3 años frente a 0,079 años, p=0,004). Conclusiones:En este estudio, la LAS se asoció con la exposición de agentes alquilantes, inhibidores de la topoisomerasa II y agentes antitubulina. La respuesta al tratamiento y el pronóstico fueron malos, aunque la quimioterapia y el TPH podrían proporcionar una supervivencia más prolongada (AU)

Background and objective: The growing use of antineoplastic treatments has led to an increase in the incidence of therapy-related leukemias (TRL). The objective was to describe the characteristics of TRL. Patients and methods: Twenty-three cases of TRL were registered. Chemotherapeutic agents used for the first tumor, time interval, clinical and biological characteristics, treatment and prognosis of the TRL were analyzed.Results: Median age was 61 years. Cytotoxic agents used in previous neoplasm consisted of alkylating agents (17 patients), inhibitors of DNA topoisomerase II (14), antitubulin agents (12), radiotherapy (9, in 6 with radiotherapy) and antimetabolites (6). Median time from diagnosis of the first neoplasm to TRL was 3 years (range 1.2-15.8). Thirteen patients received intensive chemotherapy [with stem cell transplantation (SCT) in 3] and the other 10 received symptomatic treatment (median survival 3 years versus 0.079 years, P=0.004).Conclusions: In this study, TRL were associated with exposure to alkylating agents, antitubulin agents and topoisomerase II inhibitors. Response to treatment and prognosis were poor, although chemotherapy and SCT may prolong survival (AU)

Identification of leptomeningeal disease in aggressive B-cell non-Hodgkin's lymphoma: improved sensitivity of flow cytometry.

PURPOSE: Here, we evaluate the sensitivity and specificity of a new 11-parameter flow cytometry (FCM) approach versus conventional cytology (CC) for detecting neoplastic cells in stabilized CSF samples from newly diagnosed aggressive B-cell non-Hodgkin's lymphoma (B-NHL) at high risk of CNS relapse, using a prospective, multicentric study design. PATIENTS AND METHODS: Moreover, we compared the distribution of different subpopulations of CSF leukocytes and the clinico-biologic characteristics of CSF+ versus CSF-, patients, in an attempt to define new algorithms useful for predicting CNS disease. RESULTS: Overall, 27 (22%) of 123 patients showed infiltration by FCM, while CC was positive in only seven patients (6%), with three other cases being suspicious (2%). CC+/FCM+ samples typically had more than 20% neoplastic B cells and/or >or= one neoplastic B cell/microL, while FCM+/CC- samples showed lower levels (P < .0001) of infiltration. Interestingly, in Burkitt lymphoma, presence of CNS disease by FCM could be predicted with a high specificity when increased serum beta2-microglobulin and neurological symptoms coexisted, while peripheral blood involvement was the only independent parameter associated with CNS disease in diffuse large B-cell lymphoma, with low predictive value. CONCLUSION: FCM significantly improves the sensitivity of CC for the identification of leptomeningeal disease in aggressive B-NHL at higher risk of CNS disease, particularly in paucicellular samples.