Allogeneic Stem Cell Transplantation for Patients with Advanced Hematological Malignancies: Comparison of Fludarabine-based Reduced Intensity Conditioning versus Myeloablative Conditioning

We compared the outcomes of allogeneic hematopoietic stem cell transplantation using reduced intensity and myeloablative conditioning for the treatment of patients with advanced hematological malignancies. A total of 75 adult patients received transplants from human leukocyte antigen-matched donors, coupled with either reduced intensity (n=40; fludarabine/melphalan, 28; fludarabine/cyclophosphamide, 12) or myeloablative conditioning (n=35, busufan/cyclophosphamide). The patients receiving reduced intensity conditioning were elderly, or exhibited contraindications for myeloablative conditioning. Neutrophil and platelet engraftment occurred more rapidly in the reduced intensity group (median, 9 days vs. 18 days in the myeloablative group, p or =grade II) occurred at comparable frequencies in both groups, while the incidence of hepatic veno-occlusive disease was lower in the reduced intensity group (3% vs. 20% in the myeloablative group, p=0.02). The overall 1-yr survival rates of the reduced intensity and myeloablative group patients were 44% and 15%, respectively (p=0.16). The results of present study indicate that patients with advanced hematological malignancies, even the elderly and those with major organ dysfunctions, might benefit from reduced intensity transplantation.

High dose Chemotherapy and Autologous Stem Cell Transplantation for Poor Risk and Recurrent Non-Hodgkin's Lymphoma: A Single-Center Experience of 50 Patients

BACKGROUND: The long-term survival of patients with non-Hodgkin's lymphoma after conventional chemotherapy is about 35%, with the remaining 65% of patients tending to be refractory or experience relapse. As such, primary refractory patients responding to salvage chemotherapy, and sensitive relapsed patients and primary high- risk patients are recommended to receive high-dose chemotherapy (HDC) and autologous peripheral blood stem cell transplantation (PBSCT). We evaluated the role of HDC and autologous PBSCT in patients with primary refractory, primary high risk, and sensitive relapsed non-Hodgkin's lymphoma. METHODS: We performed a retrospective analysis of the data from 50 patients with non-Hodgkin's lymphoma who were treated with HDC and autologous PBSCT in the Catholic Hematopoietic Stem Cell Transplantation Center between 1997 and 2002. RESULTS: Of the 50 patients, the conditioning regimen was BEAM in 20, CMT (cyclophosphamide, melphalan and thiotepa) in 19, fludarabine- and total body irradiation (TBI) -based regimen in 8, and cyclophosphamide and TBI in 2. There were 3 (6%) deaths due to treatment-related toxicity within the first 50 days after transplantation. Twenty-five patients remain alive at a median follow-up duration of 40.5 months (range 9~61). Among the patients with partial response before transplantation, 76% showed further response after transplantation. In half of these responders, the disease state was changed into complete response (CR) after transplantation. 2-year overall survival was 52% and 2-year progression free survival was 36.8%. Median overall survival was 34 months (range 8~60), and median progression-free survival was 8 months (range 1~14). Median overall survival was 14 months (range 9~19) in the primary high-risk group (n=13), 7 months (range 4~10) in the resistance relapse group (n=5), and 6 months (range 0~14) in the primary refractory group (n=10). Overall survival in the sensitive relapse group (n=22) did not reach the median; the mean overall survival in this group was 33 months. The disease status before transplantation was the only significant prognostic factor in determining overall survival (p=0.032) and progression- free survival (p=0.001). CONCLUSION: HDC and autologous PBSCT appears to produce high response rate. Primary high-risk group and sensitive relapse group had good prognosis, while refractory and resistance relapse group had poor prognosis. And the pre-transplantation disease status was the only significant prognostic factor in multivariate analysis.

Quimioterapia intratecal en leucemia aguda linfoblástica: evaluación prospectiva de la toxicidad utilizando una combinación recomendable en México / Intrathecal chemotherapy in acute lymphobastic leukemia: prospective evaluation of the toxicity using a combination employed in México

Con el propósito de disminuir la toxicidad de la quimioterapia intratecal en pacientes con leucemia aguda linfoblástica, estudiamos el pH y la osmolaridad de las diversas presentaciones comerciales, tanto nacionales como de importación, de medicamentos y diluyentes usualmente utilizados, hasta encontrar la combinación de quimioterapia más compatible con las condiciones fisiológicas. La combinación elegida fue aquella que contiene methotrexate, dexametasona y arabinósido de citosina, utilizando como diluyente solución salina isotónica (productos nacionales). Con la combinación señalada se hicieron 100 aplicaciones intratecales de quimioterapia en 32 individuos. La toxicidad consistió en cefala y/o vómitos de poca gravedad y con duración menor a 72 horas en 19% de los casos. Se concluye que la frecuencia observada de reacciones tóxicas es aceptablemente baja, por lo que se recomienda dicha combinación de quimioterapia para su uso en México

Vasculopatia cerebral de la encefalitis por herpes / The cerebral vasculitis of herpes encephalitis

En la encefalitis por herpes simple se encuentran edema cerebral, diapedesis hemorragica y necrosis tisular. Se sugiere que estos cambios resultan de la respuesta citotoxica de inmunidad mediada por las celulas del huesped, la cual provoca una vasculopatia cerebral identica a aquellas vasculomielopatias asociadas con otras infecciones virales o inmunizaciones. La adicion de corticoides a la Vidarabina podria controlar esta vasculopatia y reducir en forma apreciable la morbilidad y las secuelas.