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1.
Hematol Oncol Stem Cell Ther ; 12(4): 194-203, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31319058

RESUMO

OBJECTIVE/BACKGROUND: Patients with follicular lymphoma (FL) with early therapy failure (ETF) within 2 years of frontline therapy have poor overall survival (OS). We recently reported the results of autologous stem cell transplantation (ASCT) in patients from the Grupo Español de Linfomas y Trasplantes de Médula Ósea (GELTAMO) registry treated with rituximab prior to ASCT and with ETF after first-line immunochemotherapy, leading to 81% 5-year OS since ASCT. We explored whether ASCT is also an effective option in the pre-rituximab era-that is, in patients treated in induction and rescued only with chemotherapy. METHODS: ETF was defined as relapse/progression within 2 years of starting first-line therapy. We identified two groups: the ETF cohort (n = 87) and the non-ETF cohort (n = 47 patients receiving ASCT but not experiencing ETF following first-line therapy). RESULTS: There was a significant difference in 5-year progression-free survival between the ETF and non-ETF cohorts (43% vs. 57%, respectively; p = .048). Nevertheless, in patients with ETF with an interval from first relapse after primary treatment to ASCT of <1 year, no differences were observed in 5-year progression-free survival (48% vs. 66%, respectively; p = .44) or in 5-year OS (69% vs. 77%, p = .4). Patients in the ETF cohort transplanted in complete remission showed a plateau in the OS curves, at 56%, beyond 13.7 years of follow-up. CONCLUSION: ASCT may be a curative option for ETF in patients who respond to rescue chemotherapy, without the need for immunotherapy or other therapies, and should be considered as an early consolidation, especially in patients with difficult access to rituximab.

4.
Cancer Med ; 6(12): 2766-2774, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29076254

RESUMO

Overall survival (OS) is the gold-standard end point for studies evaluating autologous stem cell transplantation (ASCT) in follicular lymphoma (FL), but assessment may be elusive due to the lengthy disease course. We analyzed the validity of two earlier end points, proposed in the setting of first-line chemo-/immunotherapy, as surrogates for OS-progression-free survival (PFS) status at 24 months (PFS24) and complete response at 30 months (CR30) post-ASCT. We also have investigated the clinical features of patients with early progression after ASCT. Data were available for 626 chemosensitive FL patients who received ASCT between 1989 and 2007. Median follow-up was 12.2 years from ASCT. In the PFS24 analysis, 153 (24%) patients progressed within 24 months and 447 were alive and progression-free at 24 months post-ASCT (26 who died without disease progressions within 24 months were excluded). Early progression was associated with shorter OS (hazard ratio [HR], 6.8; P = 0.00001). In the subgroup of patients who received an ASCT in the setting or relapse after being exposed to rituximab, the HR was 11.3 (95% CI, 3.9-30.2; P < 0.00001). In the CR30 analysis, 183 of 596 (31%) response-evaluable patients progressed/died with 30 months post-ASCT. The absence of CR30 was associated with shorter OS (HR, 7.8; P < 0.00001), including in patients with prior rituximab (HR, 8.2). PFS24 and CR30 post-ASCT are associated with poor outcomes and should be primary end points. Further research is needed to identify this population to be offered alternative treatments.


Assuntos
Linfoma Folicular/cirurgia , Transplante de Células-Tronco , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Bases de Dados Factuais , Progressão da Doença , Intervalo Livre de Doença , Determinação de Ponto Final , Feminino , Humanos , Imunoterapia/métodos , Estimativa de Kaplan-Meier , Linfoma Folicular/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Espanha , Transplante de Células-Tronco/efeitos adversos , Transplante de Células-Tronco/mortalidade , Fatores de Tempo , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
5.
Biol Blood Marrow Transplant ; 23(10): 1631-1640, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28533060

RESUMO

High-dose chemotherapy supported by autologous stem cell transplantation (HDT/ASCT) has contributed to modify the natural history of follicular lymphoma (FL); however, an overall survival (OS) benefit has been demonstrated at relapse only after a rituximab-free chemotherapy regimen. A total of 655 patients with FL were reported to the Spanish GELTAMO (Grupo Español de Linfomas y Trasplantes de Médula Ósea) registry and underwent first ASCT between 1989 and 2007. A total of 203 patients underwent ASCT in first complete response (CR1), 174 in second complete response (CR2), 28 in third complete response (CR3), 140 in first partial response (PR1), 81 in subsequent PR, and 29 with resistant/refractory disease; 184 patients received rituximab before ASCT. With a median follow-up of 12 years from ASCT, median progression-free survival (PFS) and overall survival (OS) were 9.7 and 21.3 years, respectively. Actuarial 12-year PFS and OS were 63% (95% confidence interval [CI], 58%-68%) and 73% (95% CI, 68%-78%), respectively, for patients in CR (with a plateau in the curve beyond 15.9 years), 25% (95% CI, 19%-28%) and 49% (95% CI 42%-56%), respectively, for patients in PR, and 23% (95% CI, 8%-48%) and 28% (95% CI, 9%-45%), respectively, for patients with resistant/refractory disease (P < .001). In patients who received rituximab before ASCT, the estimated 9-year PFS and OS from ASCT were 59.5% (95% CI, 51%-67%) and 75% (95% CI, 68%-83%), respectively. Interestingly, for patients who underwent transplantation in CR ≥2 or PR ≥2 who had received rituximab before ASCT (n = 90), 9-year PFS and OS were 61% (95% CI, 51%-73%) and 75% (95% CI, 65%-80%), respectively, with no relapses occurring beyond 5.1 years after ASCT. The cumulative incidence of second malignancies in the global series was 6.7% at 5 years and 12.8% at 10 years. This analysis strongly suggests that ASCT is a potentially curative option for eligible patients with FL. In the setting of relapse, it is of especial interest in pretransplantation rituximab-sensitive patients with FL.


Assuntos
Linfoma Folicular/terapia , Transplante de Células-Tronco/métodos , Adolescente , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Linfoma Folicular/mortalidade , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária , Recidiva , Sistema de Registros , Estudos Retrospectivos , Rituximab/uso terapêutico , Transplante Autólogo/métodos , Adulto Jovem
6.
Brain ; 133(Pt 4): 1128-42, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20356854

RESUMO

Phosphatase and tensin homolog-induced putative kinase 1 gene mutations have been associated with autosomal recessive early-onset Parkinson's disease. To date, no neuropathological reports have been published from patients with Parkinson's disease with both phosphatase and tensin homolog-induced putative kinase 1 gene copies mutated. We analysed the coding region of phosphatase and tensin homolog-induced putative kinase 1 gene in a large Spanish family with six members with parkinsonism. The phenotype was characterized by an early-onset (mean: 31.6, standard deviation: 9.6 years, range: 14-45 years), slowly progressive levodopa-responsive parkinsonism, initial gait impairment and psychiatric symptoms. We identified two segregating pathogenic phosphatase and tensin homolog-induced putative kinase 1 mutations that were either in homozygous or heterozygous compound state in all affected family members. We found an exon 7 deletion (g.16089_16383del293; c.1252_1488del) and a novel+1U1-dependent 5' splice-site mutation in exon 7 (g.16378G>A; c.1488+1G>A). Leukocyte-derived messenger RNA analysis showed that both mutations caused exon 7 skipping and c.1488+1G>A also lead to an in-frame transcript with a 33 base-pair deletion (p.L485_R497del) resulting from activation of a 5' cryptic exon 7 splice site. Single photon emission computed tomography quantification of striatal dopamine transporter binding (123I-Ioflupane) revealed a posterior-anterior gradient similar to that of idiopathic Parkinson's disease, but there was no correlation between striatal reduced uptake and disease duration. Post-mortem neuropathological examination of an early-onset Parkinson's disease carrier of two heterozygous compound phosphatase and tensin homolog-induced putative kinase 1 mutations showed neuronal loss in the substantia nigra pars compacta, Lewy bodies and aberrant neurites in the reticular nuclei of the brainstem, substantia nigra pars compacta and Meynert nucleus, but the locus ceruleus and the amygdala were spared. This is the first neuropathological report of the brain from an early-onset phosphatase and tensin homolog-induced putative kinase 1-linked parkinsonism showing that mutated phosphatase and tensin homolog-induced putative kinase 1 protein induces Lewy body pathology. Unbalanced preservation of the locus ceruleus may well play a role in the slow evolution of motor symptoms and, probably, in the psychiatric symptoms often encountered in Parkinson's disease associated with phosphatase and tensin homolog-induced putative kinase 1 mutation.


Assuntos
Corpos de Lewy/genética , Corpos de Lewy/patologia , Transtornos Parkinsonianos/genética , Transtornos Parkinsonianos/patologia , Proteínas Quinases/genética , Adolescente , Adulto , Idoso , Feminino , Ligação Genética , Humanos , Masculino , Mutação/genética , Linhagem
7.
J Urban Health ; 83(6): 1105-13, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17075726

RESUMO

Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.


Assuntos
Hepatite C/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Western Blotting , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Hepatite C/transmissão , Humanos , Masculino , Porto Rico/epidemiologia , Assunção de Riscos , Estudos Soroepidemiológicos , Fatores Socioeconômicos
8.
Health Policy ; 75(2): 159-69, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16338479

RESUMO

This paper reports findings on 334 out-of-treatment drug users in Puerto Rico and 617 in New York City, at the 6-month follow-up interview of a Longitudinal Survey. Main outcomes were health care and drug treatment utilization since baseline, assessed by asking participants if they had received physical or mental health services (including HIV medications), and if they had been in methadone maintenance, inpatient or outpatient drug treatment, or drug treatment while incarcerated. Chi-square tests were used to evaluate associations between gender and the various correlates. Logistic regression was used to calculate the contribution of each variable in predicting use of drug treatment. The analysis suggests that women in both sites were likely to suffer from disparities in both health care and drug treatment utilization when compared with men, albeit women in New York utilized more drug treatment resources and were more embedded in the immediate family than their female peers in Puerto Rico. Further research to specify the impact of contextual factors at the organizational and community levels, among members of the same ethnic group residing in different sites, may prove valuable in identifying the health needs and the factors that impede or facilitate drug-using women in obtaining the most appropriate treatment. Findings from these studies can help in developing appropriate public health policy and science-based drug treatment programs to eliminate disparities such as the ones detected in this study.


Assuntos
Acesso aos Serviços de Saúde , Hispano-Americanos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Cidade de Nova Iorque , Porto Rico/etnologia
9.
Actas dermo-sifiliogr. (Ed. impr.) ; 96(9): 607-611, nov. 2005. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-041782

RESUMO

Los linfomas primarios cutáneos son un grupo heterogéneo de procesos linfoproliferativos que se caracterizan por afectación cutánea sin evidencia de enfermedad sistémica en el momento del diagnóstico. Por lo general tienen un comportamiento clínico indolente, y sólo ocasionalmente suele observarse el desarrollo de enfermedad extracutánea. A partir de la década de 1980, se han considerado los linfomas primarios cutáneos de células B como un grupo específico de linfomas, diferenciándose tanto de los linfomas de células T como de los linfomas cutáneos secundarios de células B. Tanto la EORTC como la OMS han propuesto clasificaciones alternativas para estas entidades con discrepancias importantes que últimamente se han aclarado elaborando una nueva clasificación (clasificación de la OMS-EORTC de los linfomas cutáneos) que unifica criterios hasta ahora dispares. Se presentan dos nuevos casos de linfoma primario cutáneo B de célula grande difuso tipo piernas según esta nueva clasificación


Primary cutaneous lymphomas are a heterogeneous group of lymphoproliferative disorders characterized by skin involvement with no evidence of systemic disease at the time of diagnosis. Their clinical behavior is generally indolent, and only occasionally is the development of extracutaneous disease observed. Since the 1980s, primary cutaneous B-cell lymphomas have been considered a specific group of lymphomas, differentiated from both T-cell lymphomas and from secondary cutaneous B-cell lymphomas. Both the EORTC and the WHO have proposed alternative classifications for these entities, with significant discrepancies that were finally resolved through the development of a new classification (WHO-EORTC classification for cutaneous lymphomas), which standardizes criteria that had previously been different. We present two new cases of primary cutaneous diffuse large B-cell lymphoma of the leg according to the new classification


Assuntos
Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Humanos , Linfoma Cutâneo de Células T/complicações , Linfoma Cutâneo de Células T/diagnóstico , Linfoma Cutâneo de Células T/terapia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/classificação , Imuno-Histoquímica/métodos , Imunoglobulinas/uso terapêutico , Linfoma Difuso de Grandes Células B/terapia , Complexo I de Transporte de Elétrons/uso terapêutico , Recidiva Local de Neoplasia/complicações
10.
Actas Dermosifiliogr ; 96(9): 607-11, 2005 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-16476307

RESUMO

Primary cutaneous lymphomas are a heterogeneous group of lymphoproliferative disorders characterized by skin involvement with no evidence of systemic disease at the time of diagnosis. Their clinical behavior is generally indolent, and only occasionally is the development of extracutaneous disease observed. Since the 1980s, primary cutaneous B-cell lymphomas have been considered a specific group of lymphomas, differentiated from both T-cell lymphomas and from secondary cutaneous B-cell lymphomas. Both the EORTC and the WHO have proposed alternative classifications for these entities, with significant discrepancies that were finally resolved through the development of a new classification (WHO-EORTC classification for cutaneous lymphomas), which standardizes criteria that had previously been different. We present two new cases of primary cutaneous diffuse large B-cell lymphoma of the leg according to the new classification.


Assuntos
Perna (Membro) , Linfoma de Células B/classificação , Linfoma Difuso de Grandes Células B/classificação , Neoplasias Cutâneas/classificação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfoma de Células B/patologia , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia
11.
Support Care Cancer ; 12(10): 701-7, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15095074

RESUMO

Catheter-related infection in cancer patients remains an important health-care problem with major financial implications. During the last few years a better understanding of the pathogenesis of catheter-related infections and the interaction between microorganisms and catheter surfaces has emerged. Recently the influence of biofilm formation in catheter-related infections has been established. The development of biofilm by the colonizing microbes permits attachment of the organisms to the vascular access device and confers resistance to antibiotics and host defense mechanisms. Strategies to overcome the development of biofilm are being developed to prevent catheter- and other medical device-related infections.


Assuntos
Biofilmes/crescimento & desenvolvimento , Cateterismo Venoso Central/efeitos adversos , Aderência Bacteriana , Humanos , Neoplasias/tratamento farmacológico , Fatores de Risco
13.
Bol. Asoc. Méd. P. R ; 82(12): 523-7, dic. 1990. tab
Artigo em Inglês | LILACS | ID: lil-96452

RESUMO

En este análisis se entrevistaron y analizaron 385 usuários de droga intravenosas reclutados en varios vecindarios del área metropolitana de San Juan. Los usuarios de drogas intravenosas (UDI), independientemente de raza, grupo étnico o medio ambiente geográfico, continúan practicando conductas de riesgo para el contagio del virus de inmuodeficiencia humana (VIH). En general los UDI incluídos en este análisis son jóvenes. Sin embargo, se encontró que los grupos de puertorriqueños e hispanos tenían un nivel de escolaridad menor al de los blancos y negros de los Estados Unidos. El hecho de que casi la mitad de los UDI puertorriqueños reidiendo en los Estados Unidos Continentales reportaran actividades ilegales como fuente de ingreso, sorprendió a los investigadores. Tal y como fuera hipotetizado, casi la mitad de los UDI puertorriqueños en la isla informaron vivir con sus padres. Los UDI en la isla de Puerto Rico continúan practicando conductas de riesgo, se inyectan drogas y utilizan los "hospitalillos" con más frecuencia y son menos propensos a desinfectar las agujas y a utilizar condone que los UDI puertorriqueños, blancos y los negros que residen en los Estados Unidos. Los UDI son el grupo de mayor riesgo para el contagio del síndrome de inmunodeficiencia adquirida (SIDA) entre los puertorriqueños que residen en Puerto Rico y en Estados Unidos. Los UDI son también el grupo con mayor riesgo de contagio heterosexual y la mayor fuente de contagio perinatal de la enfermedad. Por lo tanto, los recursos para prevenir el SIDA en Puerto Rico son más necesarios entre los UDI, donde el 44.5% de los sujetos han obtenido resultados positivos en la prueba del VIH


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Comportamento , Hispano-Americanos , Síndrome de Imunodeficiência Adquirida/transmissão , Abuso de Substâncias por Via Intravenosa/epidemiologia , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Europeu , Fatores de Risco , Síndrome de Imunodeficiência Adquirida/prevenção & controle
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