Trasplante de médula ósea alogénico en un paciente con fusariosis diseminada y leucemia mieloide aguda / Allogeneic hematopoietic cell transplantation in a patient with disseminated fusariosis and acute myeloid leukemia

La infección diseminada por Fusarium se ha convertido en un problema creciente en las personas con neoplasias hematológicas malignas, principalmente en pacientes con leucemias agudas; se describen cada vez más casos en aquellos sometidos a un trasplante de médula ósea. No existe un tratamiento óptimo establecido para la fusariosis diseminada. La mortalidad global comunicada de esta infección oscila entre el 50 y el 80%. Se presenta a continuación el caso de un paciente de sexo masculino de 29 años, con diagnóstico de leucemia mieloide aguda, que presenta como complicación una fusariosis diseminada, y logra sobrellevar un trasplante alogénico de médula ósea en el Hospital Italiano de San Justo (Argentina) de forma exitosa. (AU)

Disseminated fusariosis has become an increasing problem in people with hematopoietic neoplasms, mainly in patients affected by acute leukemias, and even more in those who undergo hematopoietic cell transplantation. There is not an optimal treatment for disseminated fusariosis. The global mortality described in the literature is between 50% and 80%. We introduce a case of a 29 year old patient with diagnosis of acute myeloid leukemia complicated with disseminated fusariosis, who copes with an allogeneic hematopoietic cell transplantation with a successful outcome in the "Hospital Italiano de San Justo" (Argentina). (AU)

Successfully conservative treatment of large cervical choriocarcinoma with profuse vaginal bleeding.

Primary choriocarcinoma of the uterine cervix is a rare disease. The accurate diagnosis of such a disease is difficult to achieve because of its rarity. Furthermore, the majority of cases presented with abnormal vaginal bleeding that could be caused by other more common conditions including, threatened abortion, cervical polyp, cervical pregnancy, or cervical cancer. In the present report, the authors present a case of large cervical choriocarcinoma with life-threatening vaginal bleeding, which was initially misdiagnosed as a cervical cancer The active cervical bleeding was successfully controlled with selective uterine arterial embolization. Remission of cervical choriocarcinoma was accomplished with combination chemotherapy without the need of hysterectomy.

Linfoma de Hodkin en Chile: Experiencia de 15 años del Programa Nacional de Cáncer del Adulto / Hodgkin lymphoma in Chile: Experience of the national adult cancer program

Background: Hodgkin lymphoma is a highly curable disease. Aim: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. Patients and methods: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. Results: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61 percent of cases. Age over 40 was an adverse prognostic factor (p <0.001). The rate of PFS at 5 and 10 years for early stages was 73 percent and 66 percent with RT, 80 percent and 74 percent with C-MOPP+RT, 73 percent and 71 percent with C-MOPP/ABV, 59 percent and 59 percent with NOVP+RT, and 81 percent with ABVD+RT, at 5 years, being significantly lower for NOVP (p =0.02). The rate of OS at 5 and 10 years for advanced stages was 82 percent and 70 percent with RT, 82 percent and 76 percent with C-MOPP+RT, 82 percent and 80 percent with C-MOPP/ABV, 68 percent and 60 percent with NOVP, and 85 percent with ABVD at 5 years, also significantly lower for NOVP (p =0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49 percent and 43 percent with C-MOPP, 69 percent and 62 percent with C-MOPP/ABVD or C-MOPP/ABV, and 71 percent at 5 years with ABVD, significantly lower for C-MOPP (p =0.01). The rate of OS at 5 and 10 years was 52 percent and 46 percent with C-MOPP, 70 percent and 63 percent with C-MOPP/ABVD or C-MOPP/ABV and 76 percent with ABVD at 5 years, significantly lower for C-MOPP (p =0.0002). Conclusions: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early...

Mitoxantrone in secondarily progressive multiple sclerosis: a series of 18 patients

Hidrocloridrato de mitoxantrone (Novantrone®) é um antracenedione utilizado como o agente mais recente de uma longa linha de imunossupressivos gerais estudados em esclerose múltipla (EM). Realizamos revisão de dados clínicos, laboratoriais, de neuroimagem e ecocardiografia de 18 pacientes, no período de fevereiro de 2001 a março de 2004, a partir de um total de 100 pacientes com EM definida. Quatorze pacientes eram do sexo feminino (77,7%) e quatro eram do sexo masculino. A idade média dos pacientes foi 41,6±10 anos (intervalo de confiança 95%: 36,4-46,7 anos). A duração média da doença foi 10,5±6,3 anos. Quatorze pacientes apresentavam a forma secundária progressiva de EM e quatro a forma surto-remissão. O mitoxantrone é uma droga útil e clinicamente eficaz , sendo a principal limitação sua potencial cardiotoxicidade devido à dose cumulativa (140 mg).

Leucemia mieloide aguda del adulto: resultado del protocolo nacional de drogas antineoplásica: Hospital del Salvador 1990-1998 / Acute myeloid leukemia in the adult: results of the national antineoplastic drug protocol (Panda) at Hospital del Salvador, Chile

Background: The incidence of acute myeloid leukemia is 3 cases per 100.000 inhabitants/year and its five years event free survival is 15 to 20 percent. Since the incorporation of trans retinoic acid, event free survival of M3 acute myeloid leukemia is 80 percent. Aim: To report the results of acute myeloid leukemia treatment at the Hospital del Salvador, between 1990 and 1998. Patients and methods: The medical records of 117 patients (66 female, mean age 48.2 years), treated between 1990 and 1998 using PANDA protocol, were retrospectively reviewed. Immunophenotyping was done in 69 patients and cytogenetic studies were done in 65. Results: Sixteen percent of patients had M3 acute myeloid leukemia. The most frequent phenotype was the association of DR, CD34 plus a panmyeloid marker. DR and CD34 were negative in seven of nine patients with M3 acute myeloid leukemia. Cariotype was abnormal in 78 percent of patients. Complete remission was achieved in 65 percent of cases with a 13 percent of failures. Early mortality was 21.3 percent and decreased to 6.1 percent in the last three years. Infections and coagulation disorders were the main causes of death. Mean survival was 10.5 months. Five years event free survival was 11 percent. In M3 acute myeloid leukemia, the figure is 50 percent. Conclusions: Treatment results are less effective than protocols that consider more aggressive chemotherapeutic protocols or bone marrow transplantation. The reduction in early mortality is due to a better management of febrile neutropenia

Mitoxantrone, mitomycin-C, methotrexate combination chemotherapy with radiotherapy and/or surgery in stage III (T4B, NO-2, M0) breast cancer.

Results of primary surgery with or without locoregional radiotherapy (LRRT) are poor in stage III (T4b, NO-2, M0) breast cancer. Combination of mitoxantrone, mitomycin-c and methotrexate (MMM) has been reported to be as efficacious as doxorubicin based protocols with advantages of reduced nausea, vomiting, alopecia and cardiotoxicity. We tested MMM chemotherapy with LRRT and surgery in locally advanced breast cancer (LABC) with a view to assess response, survival, breast conservation, cost and toxicity. Fifty two previously untreated patients were given Mitoxantrone: 8 mg/m sq by infusion on days 1 and 21, Mitomycin-C: 8 mg/m sq by infusion on day 1 and Methotrexate: 35 mg/m sq i.v. on days 1 and 21. Cycles were repeated every 42 days. After 3 cycles LRRT was given if lump reduced to less than 2 cms. Otherwise patients were subjected to modified radical mastectomy (MRM) or radical mastectomy (RM). Following this 3 more cycles of chemotherapy were given. Patients with soft tissue, skin or heavy nodal involvement also received LRRT. Tamoxifen 20 mg daily was prescribed at the end of chemotherapy to postmenopausal patients. Complete/partial responses were seen in 5 and 26 patients, respectively after chemotherapy giving an overall response of 59.5%. Twenty four patients each had LRRT and MRM/RM. Responses could be significantly enhanced by LRRT/and or surgery. Nineteen out of 25 relapses were at distant sites. Breast conservation was achieved in 24/52 (46%) patients. Three year disease free and overall survival was 54% and 65%, respectively. There was 1 toxic death. Severe prolonged myelosuppresion was seen in those who also received LRRT. Mucositis, alopecia, nausea and vomiting were minor problems. Overall, combination was less expensive than doxorubicin based protocols.

Comparación de dos regímenes de poliquimioterapia en leucemia aguda refractaria o en recaída / Comparison of two polychemotherapies in refractory or relapsed acute leukemia

Objetivo. Comparar la efectividad de dos regímenes de poliquimioterapia para tratar pacientes con leucemias agudas refractarias o en recaida. Métodos. Fueron 24 pacientes asignados al azar a uno de dos grupos: el LARR1 de 13 pacientes recibió como inducción de la remisión VP16 a la misma dosis y durante los mismos días que el grupo LARR1 más motoxantrona por tres días. Ambas ramas recibieron consolidación con las mismas drogas a las mismas dosis. Todos recibieron ciclos de sostén con vincristina, metotrexante, ciclofosfamida, BCNU, L-asparaginasa, citarabina y busulfán. Cada tres y medio meses los pacientes recibieron una nueva consolidación de acuerdo a la rama asignada. Ambas ramas recibieron factor estimulador de colonias granulocíticas. Resultados. La mediana de supervivencia global fue 5 meses límites 1-17). A los 10 meses quedaban tres pacientes libres de enfermedad en el grupo LARR1 y dos en el LARR2. No encontramos diferencias estadísticamente significativas en el número de remisiones completas obtenidas (p= 0.62), fallas (p=0.58), recaídas (p=0.5), o duración de la remisión (p=0.9). La duración de la neutropenia postquimioterapia y el número de episodios de fiebre y neutropenia fueron semejantes en los dos grupos (0.08 y 0.41 respectivamente). Conclusión. La única ventaja que encontramos fue la posibilidad de administrar LARR1 en pacientes que ya han alcanzado dosis cardiotóxicas de antracíclicos

Esquemas de quimioterapia y bacteriemias en pacientes adultos con leucemia aguda / Chemotherapy schedules and bacteremias in adult patients with acute leukemia

En un estudio efectuado para evaluar la utilidad de la profilaxis con fluoroquinolonas en pacientes neutropénicos afebriles, se encontró una asociación inesperada entre el esquema de poliquimioterapia utilizado y la posterior documentación de bacteriemias durante los episodios de neutropenia y fiebre. Se analizaron 25 episodios de neutropenia febril secundaria a quimioterapia antileucémica. Los pacientes recibieron etoposide y mitoxantrona o bien citarabina - en dosis estándar, intermedia o alta - asociada a daunomicina o mitoxantrona. El análisis de los datos microbiológicos demostró una mayor incidência de bacteriemias con el uso combinado de antraciclinas y citarabina en dosis intermedia o alta en comparación con la administración de etoposide y mitoxantrona (p = 0,000387). Ambos grupos de pacientes desarrollaron una neutropenia igualmente veloz y severa con una mucositis digestiva equivalente. El esquema de poliquimioterapia fue el único dato que se asoció con la aparición o no de bacteriemias en el episodio de neutropenia febril subsiguiente. Se concluye en que otros efectos - además de la aplasia medular y la mucositis digestiva - podrían ser relevantes en la susceptibilidad a las infecciones que originan los citostáticos.

Tratamiento del cáncer avanzado de la glándula mamaria con mitoxantrona, s-fluorouracilo y ciclofosfamida / Advanced breast cancer treatment with a combination of mitoxantrona, s-fluorouracil and ciclophosfamide

La combinación de mitoxantrona (M), 5-fluorouracilo (F) y ciclofosfamida (C), se administró como tratamiento inicial a 180 pacintes con cáncer avanzado de la glándula mamaria. Este estudio no comparativo se llevó a cabo en 7 diferentes instituciones médicas de Argentina, Brasil y México. Las dosis utilizadas fueron: mitoxantrona 12 mg/m2 i.v. día 1-21; 5-fluorouracilo 500 mg'm2 i.v. días 1-8-21 y ciclofosfamida 500 mg/m2 i.v. día 1-21. Las dosis se modificaron de acuerdo a la toxicidad presentada. En el 37% de los 1026 ciclos se presentó leucopenia <2000/mm3 y trombocitopenia <100,000/mm3 en el 16%. Náusea y vómito se presentaron en 82%, diarrea en el 27% y alopecia en el 74%. Respuesta global se observó en 88 de 147 pacientes valorables (60%); respuesta completa en 32 (21.8%) y respuesta parcial en 56 (38%), nos e observaron cambios en 38 (25.9%) y progresión en 21 (14.3%). La sobrevida promedio en este grupo fue de 25 meses; actualmente continúan con vida y sin evidencia de actividad tumoral, a más de 6 años, 24 (16.3%) de las pacientes. Aparte de la mielosupesión, en su mayoría neutropenia, la combinación MFC generalmente fue efectiva y bien tolerada con una baja incidencia de efectos secundarios. Se concluye que mitoxantrona en combinación con 5-fluorouracilo y ciclofosfamida, contribuyen a prolongar la sobrevida de las enfermas con cáncer mamario avanzado, mejorando la calidad de vida en un número importante de ellas. Se recomienda la combinación de MFC como esquema de priemra línea.