Síndrome de lisis tumoral en paciente hematológico / Tumor lysis syndrome in hematologic patient

El síndrome de lisis tumoral (SLT) es una complicación potencialmente mortal caracterizada por una lisis masiva de células tumorales. A continuación, se presenta el caso de un varón de 28 años, diagnosticado de linfoma no Hodking de células B de alto grado. Este presentó un SLT tras la administración de la quimioterapia, de especial interés debido a las recomendaciones farmacológicas propuestas desde el Servicio de Farmacia en cuanto a la dosis de rasburicasa y las interacciones a nivel electrolítico con la medicación concomitante prescrita durante el ingreso. (AU)

Tumor lysis syndrome (TLS) is a life-threatening complication characterized by a massive lysis of tumor cells. The following is the case of a 28-year-old man diagnosed with high-grade B-cell non-Hodking lymphoma. The patient presented a TLS after the administration of chemotherapy. This case is of special interest due to the pharmaco logical recommendations proposed by the Pharmacy Service regarding the rasburicasa dose and the interactions at the electrolyte level with the concomitant medication prescribed during admission. (AU)

First-line mFOLFOX plus cetuximab followed by mFOLFOX plus cetuximab or single-agent cetuximab as maintenance therapy in patients with metastatic colorectal cancer: Phase II randomised MACRO2 TTD study.

BACKGROUND: This multicentre, randomised, and phase II study evaluated mFOLFOX+cetuximab followed by maintenance mFOLFOX+cetuximab or single-agent cetuximab in metastatic colorectal cancer (mCRC) patients (NCT01161316). PATIENTS AND METHODS: Previously, untreated mCRC patients (wild-type KRAS) were randomised to receive cetuximab+mFOLFOX-6 (8 cycles for 2 weeks) followed by maintenance therapy: single-agent cetuximab (Arm-A) or mFOLFOX-6 + cetuximab (Arm-B) until progression. Primary endpoint was progression-free survival (PFS) at 9 months. RESULTS: One hundred ninety-three patients (median [range] age 60 [33-74] years) were randomised (2:1): 129 Arm-A versus 64 Arm-B. PFS at 9 months (95% confidence interval) showed non-inferiority between arms (Arm-A/Arm-B: 60 [52, 69]%/72 [61, 83]%, p [non-inferiority]<0.1). There were no statistically significant differences in the PFS (Arm-A/Arm-B: 9 [95% CI 7, 10] months/10 [7,13] months, hazard ratio [HR] = 1.19 [0.80, 1.79]) or overall survival (23 [19, 28] months/27 [18, 36] months, HR = 1.24 [0.85, 1.79]) between arms. The objective response rate was also similar (48 [39, 57]%/39 [27, 52]%). The safety profile was similar between arms, and all patients experienced at least one adverse event (AE) (Arm-A/Arm-B grade ≥III AEs: 70%/68%). The most common grade ≥III AEs were as follows: neutropenia (Arm-A/Arm-B: 28%/26%), rash acneiform (15%/24%) and sensory neuropathy (2%/15%) in any group. Arm-A was associated with less grade ≥III rash and sensory neuropathy and a lower rate of serious AEs (20%/27%). CONCLUSION(S): This phase II exploratory trial with a non-inferiority design suggests that maintenance therapy with single-agent cetuximab following mFOLFOX+cetuximab induction could be a valuable option compared with mFOLFOX+cetuximab treatment continuation. We await phase III trials to confirm single-agent cetuximab as maintenance therapy in mCRC patients.

Ocular relapse of primary brain lymphoma in immunocompetent patient, treated with intrathecal rituximab

Primary brain lymphoma is a rare variant of extranodal non-Hodgkin's B-cell lymphoma. In >90% of cases, this is diffuse large B-cell lymphoma with CD20 expression and is confined to the brain, meninges, spinal cord, and eyes. It accounts for fewer than 7% of primary brain tumors. Its incidence has been rising in recent years in immunocompetent patients in their fifth and sixth decades. The rate of relapse after initial therapy based on high-dose methotrexate and/or total brain irradiation is high. There is no consensus for treating relapse, which ranges from retreatment with high doses of methotrexate, polychemotherapy, high doses of chemotherapy backed up by autologous stem-cell transplant to intrathecal chemotherapy, with widely differing results. Given the lack of consensus and poor results, new therapy options have appeared, including immunotherapy with rituximab. At a systemic level, alongside chemotherapy, its results are very modest and limited due to the low concentration it reaches in cerebrospinal fluid (CSF). However, its intrathecal and intraventricular use, though only isolated cases have been reported, has provided promising results (AU)

[Current state of adjuvant treatment to surgery in the initial stages of nonsmall cell lung cancer]. / Estado actual del tratamiento adyuvante a la cirugía en los estadios iniciales del cáncer de pulmón no microcítico.

The results of the recently performed randomised trials support the conclusion that adjuvant chemotherapy confers survival advantage in early stage in non-small cell lung cancer, and now has become the standard of care for patients with resected stage II and IIIA. The role of adjuvant chemotherapy for stage I disease remains controversial. Only some patients benefit from systemic adjuvant therapy and we need to identify factors of patients most likely to respond to chemotherapy. The purpose of this article is to provide a general overview of adjuvant chemotherapy for early stage in non-small cell lung cancer.

Estado actual del tratamiento adyuvante a la cirugía en los estadios iniciales del cáncer de pulmón no microcítico / Current state of adjuvant treatment to surgery in the initial stages of nonsmall cell lung cancer

Los resultados de los recientes estudios demuestran el beneficio de la quimioterapia adyuvante en la supervivencia de los pacientes con estadios iniciales de cáncer de pulmón no microcítico, por lo que en la actualidad se considera como tratamiento estándar en los estadios II y IIIA. El papel de la quimioterapia adyuvante en el estadio I es controvertido. Sólo algunos pacientes se benefician del tratamiento con quimioterapia adyuvante, por lo que es preciso la identificación de factores que nos indiquen la probabilidad de respuesta. El objetivo de este artículo es proporcionar una visión general del papel de la quimioterapia adyuvante en los estadios iniciales del cáncer de pulmón no microcítico

The results of the recently performed randomised trials support the conclusion that adjuvant chemotherapy confers survival advantage in early stage in non-small cell lung cancer, and now has become the standard of care for patients with resected stage II and IIIA. The role of adjuvant chemotherapy for stage I disease remains controversial. Only some patients benefit from systemic adjuvant therapy and we need to identify factors of patients most likely to respond to chemotherapy. The purpose of this article is to provide a general overview of adjuvant chemotherapy for early stage in non-small cell lung cancer (AU)

Tumor intraabdominal desmoplásico de células pequeñas y redondas. Revisión de la literatura a propósito de un caso con estudio citológico, histopatológico, inmunohistoquímico y molecular / No disponible

Propósito: Revisar los hallazgos citohistopatológicos,inmunohistoquímicos y moleculares del tumorde células pequeñas redondas (DSRCT).Material y métodos: Varón de 18 años conmasa intraabdominal epigástrica.Resultados: Tumoración constituida por unaproliferación en nidos y difusa de células pequeñasindiferenciadas sobre estroma desmoplásico, conformación de rosetas, inmunorreactivas para citoqueratinas,vimentina, desmina y enolasa y la fracciónWT1 de la proteína EWS/WT1. El estudio moleculardemostró la traslocación t(11;22)(p13;q12).Conclusiones: La formación de rosetas y lasáreas sólidas han sido descritas en otros casos deDSRCT. El producto quimérico puede detectarse medianteRT-PCR, Southern-blot, Western-blot e inmunohistoquímica.El estudio citológico está especialmenteindicado en el diagnóstico de recidivas. Eldiagnóstico diferencial debe incluir el grupo de tumoresindiferenciados de células pequeñas y redondas

Purpose: To review the cyto-histopathological, immunohistochemical and molecular characteristicsof small round cell desmoplastic tumor (DSRCT).Material and methods: A 18 year old malewith an intraabdominal epigastric mass.Results: The tumor consisted of nests andmasses of undifferentiated small round cellsembedded in a desmoplastic stroma, with areas ofrosette formation immuno-reactive to cytokeratins,vimentin, desmin, enolase, and WT1 fraction of theEWS/WT1 fusion protein transcript. The molecularstudy demonstrated the existence of the translocationt(11;22)(p13;q12).Conclusions: The solid areas and rosetteformation have been described in other cases ofDSRCT. The chimeric transcription product can bedetected by RT-PCR, Southern-blot, Western-blot,and immunohistochemistry. Cytology is especiallyuseful in recurrences. The differential diagnosisshould be made with the small round undifferented cell tumors group (AU)

Carcinoma de origen desconocido: diagnóstico y manejo terapéutico / Carcinoma of unknown origin: diagnosis and therapeutic management

El carcinoma de origen desconocido se define como la existencia de enfermedad metastásica sinprimario detectable al diagnóstico. Supone hasta el 3% de las neoplasias malignas y es uno de los 10diagnósticos de cáncer más frecuente. La definición requiere la realización de una serie de exploracionesbásicas para determinar que no existe tumor primario conocido. Dentro de este heterogéneo grupoexisten una serie de entidades clinicopatológicas que presentan un mejor pronóstico, ya que tienen untratamiento específico. El esfuerzo en la búsqueda del primario irá encaminado a definir estas entidadesy a saber reconocerlas. Actualmente existen diversas técnicas de inmunohistoquímica, biologíamolecular y radiodiagnóstico que parecen facilitar la labor al clínico a la hora de detectar el origen delos tumores, aunque ninguna de ellas es concluyente. Intentaremos analizar las distintos métodos diagnósticos,así como definir aquellas entidades que se beneficiarán de un tratamiento concreto

Carcinoma of unknown primary origin is defined as the appearance of a metastatic disease where noprimary tumor is detectable. It represents up to 3% of the malignant neoplasms and is among the tenmost frequent cancer diagnosis. The consideration of cancer of unknown primary localization requiresthe performance of several basic explorations resulting insufficient to diagnose a primary tumor.Within the heterogeneous group of cancer of unknown origin, there are some clinicopathologic entitieshaving specific treatment whose diagnosis would represent a better prognosis. It is then necessary tostrive for making the diagnosis of the primary tumor, having in mind such entities. There arenowadays several techniques that may help this purpose, related with immunochemistry, molecularbiology and radiodiagnosis, although even with them the results may be inconclusive. We attempt inthis work to analyze the different diagnostic methods, and to define those entities which may benefitwith a particular treatment

[Prevalence of hepatitis C virus infection in patients with non-Hodgkin's lymphoma]. / Prevalencia de infección por el virus de la hepatitis C en pacientes con linfomas no hodgkinianos.

BACKGROUND: To know the prevalence of HCV infection in patients diagnosed with B-NHL in our area. PATIENTS AND METHOD: A group of patients diagnosed with B-NHL between 1998-99 were carefully reviewed (serological tests, HCV RNA, laboratory studies, toxicity, response to treatment and evolution) in a transversal study. RESULTS: Overall 9/77 (11.68%) of patients tested positive for HCV. Of the 9 patients HCV(+) showed abnormal elevated trans aminases in opposition with 10.3% of patients that tested seronegative. CONCLUSION: Compared with normal individuals, we have seen a higher prevalence of HCV in our B-NHL patients. It may be possible that HCV play a role in that lymphoma's pathogenesis.

Immunoregulation with methisoprinol in Sjögren's syndrome.

In this work, we studied the therapeutic clinical efficacy and the immunoregulating effect of methisoprinol in 4 cases of primary SS and one case of secondary SS. After 12 weeks of treatment, no significant clinical improvement was detected in the glandular histology, in Schirmer's test and sialography. On the other hand, we have observed the following alterations: immunological changes characterized by an increase in the total population of T-lymphocytes (OKT3), a normalization and thereby a diminution in IgM, an increase in T-helper subpopulation (OKT4) in four cases and in T-suppressor subpopulation in one case. A noticeable fact was the best immunological response of the patient showing a negative histology, a functional alteration of the parotid and a short evolution of the syndrome. These findings support the hypothesis that methisoprinol can be an efficient coadjuvant in the treatment of primary Sjögren's syndrome in early stages when there is only functional alteration but no glandular atrophy.