RESUMO
The AML16 trial evaluated the combination of the farnesyltransferase inhibitor, tipifarnib, and low dose cytarabine (LDAC) in older acute myeloid leukaemia (AML) patients in a 'Pick a Winner' design. The aim was to double remission rates compared to LDAC, with initial evaluation after 100 patients. Failure to improve remission would result in discontinuation. A total of 65 patients, median age 74 years (range 62-86), were randomized. After reviewing the first 45 patients, the Data Monitoring Committee concluded that the overall aspirations would not be met and recommended closure. The addition of tipifarnib had no effect on response, toxicity or survival.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Mieloide Aguda/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Citarabina/administração & dosagem , Inibidores Enzimáticos/administração & dosagem , Farnesiltranstransferase/antagonistas & inibidores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quinolonas/administração & dosagem , Análise de Sobrevida , Resultado do TratamentoAssuntos
Ácidos Borônicos/uso terapêutico , Leucemia Plasmocitária/tratamento farmacológico , Pirazinas/uso terapêutico , Exame de Medula Óssea , Bortezomib , Feminino , Humanos , Leucemia Plasmocitária/diagnóstico , Leucemia Plasmocitária/patologia , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Resultado do TratamentoRESUMO
POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) syndrome is a rare haematological condition with a constellation of clinical features that can present to the clinician in a variety of ways. This case highlights how a seemingly uncomplicated myocardial infarction can herald the development of this rare haematological disorder. While knowledge of the pathophysiological mechanisms that underpin POEMS syndrome is developing, so too are the diagnostic and treatment strategies available to the clinician.
RESUMO
The aim of the study was to evaluate whether adequate stem cells (CD34+) could be harvested at presentation in myeloma patients such that high dose melphalan (HDM) with autologous stem cell rescue can be offered as primary therapy. The regimes either involved no prior cytoreductive chemotherapy (steroids only, n = 31) or a single course of VAD (n = 22). The median number of CD34 cells collected with steroids was 1.3 x 10(6) (0.2-5.6) compared to 4.6 x 10(6) (0.3-19.2) cells/kg with VAD (P < 0.0001). We conclude that it is possible to collect stem cells from myeloma patients at presentation with minimal prior therapy. Using this strategy, of a single prior course of chemotherapy followed by immediate harvest, it is feasible to offer early high-dose therapy in clinical situations where this is important.