Bendamustine, etoposide, and dexamethasone to mobilize peripheral blood hematopoietic stem cells for autologous transplantation in non-Hodgkin lymphoma

BACKGROUND: Bendamustine is a chemotherapeutic agent that has shown broad activity in patients with lymphoid malignancies. It contains both alkylating and nucleoside analog moieties, and thus, is not commonly used for stem cell mobilization due to concerns that it may adversely affect stem cell collection. Here we describe the lymphoma subset of a prospective, non-randomized phase II study of bendamustine, etoposide, and dexamethasone (BED) as a mobilization agent for lymphoid malignancies. METHODS: This subset analysis includes diffuse large B-cell lymphoma (N=3), follicular lymphoma (N=1), primary mediastinal B-cell lymphoma (N=1), and NK/T-cell lymphoma (N=1). Patients received bendamustine (120 mg/m² IV d 1, 2), etoposide (200 mg/m² IV d 1–3), and dexamethasone (40 mg PO d 1–4) followed by filgrastim (10 mcg/kg/d sc. through collection). RESULTS: We successfully collected stem cells from all patients, with a median of 7.9×10⁶/kg of body weight (range, 4.4 to 17.3×10⁶/kg) over a median of 1.5 days (range, 1 to 3) of apheresis. All patients who received transplants were engrafted using kinetics that were comparable to those of other mobilization regimens. Three non-hematologic significant adverse events were observed in one patient, and included bacterial sepsis (grade 3), tumor lysis syndrome (grade 3), and disease progression (grade 5). CONCLUSION: For non-Hodgkin lymphoma, mobilization with bendamustine is safe and effective.

Putting surveillance data into context: the role of health care utilization surveys in understanding population burden of pneumonia in developing countries

Background: Surveillance is essential to estimating the global burden of pneumonia, yet differences in surveillance methodology and health care-seeking behaviors limit inter-country comparisons Methods: Results were compared from community surveys measuring health care-seeking for pneumonia defined as: [1] cough and difficulty breathing for P2 days; or, [2] provider-diagnosed pneumonia. Surveys were conducted in six sites in Guatemala, Kenya and Thailand; these sites also conduct, active, hospital- and population-based disease surveillance for pneumonia

Results: Frequency of self-reported pneumonia during the preceding year ranged from 1.1% [Thailand] to 6.3% [Guatemala] and was highest in children aged <5 years and in urban sites. The proportion of persons with pneumonia who sought hospitalbased medical services ranged from 12% [Guatemala, Kenya] to 80% [Thailand] and was highest in children <5 years of age. Hospitals and private provider offices were the most common places where persons with pneumonia sought health care. The most commonly cited reasons for not seeking health care were: [a] mild illness; [b] already recovering; and [3] cost of treatment

Conclusions: Health care-seeking patterns varied widely across countries. Using results from standardized health care utilization surveys to adjust facility-based surveillance estimates of pneumonia allows for more accurate and comparable estimates

Monoclonal antibodies and immunoconjugates / Anticorpos monoclonais e imunoconjugados

Chimeric and radiolabeled antibodies produce high objective remission rates in patients with B cell lymphomas. Response rates using chimeric anti-CD20 antibodies are highest in patients with indolent lymphomas, intermediate in patients with mantle cell and diffuse large cell lymphomas, and lowest in patients with small lymphocytic lymphomas. Patients with newly diagnosed lymphomas have the highest response rates to antibodies and radioimmunoconjugates, whereas relapsed and refractory patients have lower but still substantial response rates. Further studies will be necessary to determine the optimal setting for antibody therapies and to define potential interactions with chemotherapy and other antibody conjugates.

No relato é apresentado o histórico do emprego clínico dos anticorpos monoclonais no tratamento dos linfomas não-Hodgkin. Descreve-se o uso do anti-CD20, os resultados e perspectivas futuras com imunotoxinas, Iodo e o Ytrium. Na sequência, é descrita a perspectiva do emprego em Seattle, EUA, da radioimunoterapia mieloblativa seguida do suporte de células progenitoras.

High dose chemotherapy with stem cell rescue for non-Hodgkin's lymphomas / Altas doses de quimioterapia seguida de resgate celular em linfomas não-Hodgkin

No relato é apresentada uma revisão sobre quimioterapia de altas doses seguida de resgate com células progenitoras em portadores delinfomas não-Hodgkin. Altas doses de quimioterapia seguidas de transplante autólogo de medula óssea ou de sangue periférico é o tratamento indicado nos pacientes recidivados após a quimioterapia. É necessária a realização de estudos para definir o papel da purgação, do transplante alogênico e da irnunoterapia pós-transplante, assim como do transplante nos linfomas de baixo grau.

A revision about high dose chemotherapy followed by rescue usingprogenitor cells in non-Hodgkin's lymphoma carriers is related in thisstudy. High levels of chemotherapy followed by autologous bone marrowor peripheral blood stem cell transplantation is the treatmentrecommended in relapsed patients after chemotherapy. Further studies to define the roles of purging, allogeneic transplantation, and post-transplant immunotherapy as well as the benefits of transplant for low-grade lymphomas are necessary.

Despitaje masivo del cancer gastrico en el Edo. Tachira. / Massive screening of gastric cancer in the State of Tachira

Con el fin de diagnosticar cancer gastrico en su fase precoz, se realiza en el Estado Tachira un programa de despistaje masivo, el cual se lleva a cabo con unidades moviles dotadas de aparato de rayos X apropiado y donde se practican estudios radiologicos con tecnica de doble contraste a la poblacion rural comprendida por encima de los 35 anos que previamente ha sido motivada y educada por los Trabajadores Sociales. Las personas con lesiones o con sospecha de ello son sometidos a endoscopia y biopsiados. Los que resultan con cancer son sometidos a tratamiento quirurgico.Desde octubre 80 a julio 81 se han examinado 4.407 personas, diagnosticandose 58 casos de cancer gastrico de los cuales 7 han sido precoces. Tambien ha permitido diagnosticar otra patologia gastrica como: polipos, ulceras, hernias hiatales etc.suceptibles de tratamiento. Concluimos que con este metodo, el pronostico de esta enfermedad cambiara en forma muy favorable para estos pacientes y se lograra en porcentaje de sobrevida muy altos