Résumé
Background: Intensified treatment of Philadelphia chromosome negative acute lymphoblastic leukemia (Ph(-)ALL) in adolescents by pediatric teams, with fve years disease free survival (DFS) rate of 65%, encouraged the use of intensified protocols in patients between 15 and 30 years, improving the DFS from 45% to 60-80%. The protocol LLA 15-30 for patients between 15 and 30 years with Ph(-)ALL, based on the Children’s Oncology Group (COG) protocol AALL0232 resulting in a five years DFS of 78%, was started in 2007 by the PANDA national program. Aim: To report the results of the prospective cohort study evaluating the results of this protocol four years after its implementation. Patients and Methods: Between January 2007 and December 2010, 68 Ph(-) ALL patients, aged between 15-30 years (75% males) were incorporated. Survival was evaluated using Kaplan-Meier and log-rank tests. Results: Fifty percent of patients were of high risk. A complete response was achieved in 91%, early death occurred in 6% and induction failure in 3%. Median follow-up was 23 months. Overall survival, disease free survival and relapse rates at 35 months were 61.8, 67.5% and 31% respectively. Conclusions: LLA 15-30 protocol significantly improved three-year overall survival from 31 to 62%. The 20% difference observed with AALL0232 protocol is explained by the high rate of relapse. Improving provider and patient compliance with protocols may eliminate this gap.
Sujets)
Adolescent , Adulte , Femelle , Humains , Mâle , Jeune adulte , Protocoles de polychimiothérapie antinéoplasique/administration et posologie , Chromosome Philadelphie , Leucémie-lymphome lymphoblastique à précurseurs B et T/traitement médicamenteux , Leucémie-lymphome lymphoblastique à précurseurs B et T/génétique , Asparaginase/administration et posologie , Études de cohortes , Dexaméthasone/administration et posologie , Méthotrexate/administration et posologie , Pronostic , Études prospectives , Résultat thérapeutique , Vincristine/administration et posologieRésumé
Background: The current recommendations for treatment of patients with newly diagnosed acute promyelocytic leukemia (APL) include all-trans-retinoic acid (ATRA) and anthracycline based chemotherapy. Aim: To evaluate the results of the Chilean protocol following the LPA99 regimen of the Spanish PETHEMA group, except for the replacement of Idarubicin by Daunorubicin. Patients and Methods: Induction consisted of Daunorubicin 45 mg/m² on days 2, 4, 6 and 8 plus ATRA 45 mg/m² daily until complete remission. Patients in complete remission (CR) received three monthly chemotherapy courses: Daunorubicin 45 mg/m²/d/4days i.v. and ATRA 45 mg/m²/d/15 days p.o. (course no. 1); Mitoxantrone 10 mg/m²/d/5 days i.v. and ATRA 45 mg/m²/d/15 days p.o. (course no. 2); Daunorubicin 60 mg/m²/d/ day 1 i.v. in the low risk group, and 1 and 2 in the intermediate-high risk groups and ATRA 45 mg/m²/d/15 days p.o. (course no. 3). Maintenance therapy consisted of mercaptopurine 90 mg/m²/d p.o., methotrexate 15 mg/m²/wk p.o. and, ATRA intermittently, 45 mg/m²/d p.o. for 15 days every three months. Results: Between January 2000 and December 2005, 56 patients with newly diagnosed APL from 10 centers were enrolled. A total of 46 patients achieved CR (85%), 8 (15%) died of early complications, seven patients relapsed, with a 16% relapse risk at three years. The 5-year Kaplan-Meier estimates of overall survival and relapse-free survival were 64% and 84% respectively. Conclusions: These data indicate that this protocol has a good antileukemic effect but further reduction of early death and relapse, especially in the high risk group is needed.
Sujets)
Adolescent , Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Protocoles de polychimiothérapie antinéoplasique/administration et posologie , Daunorubicine/administration et posologie , Leucémie aiguë promyélocytaire/traitement médicamenteux , Trétinoïne/administration et posologie , Chili , Chimiothérapie d'induction , Estimation de Kaplan-Meier , Leucémie aiguë promyélocytaire/diagnostic , Leucémie aiguë promyélocytaire/mortalitéRésumé
Se analizan las características de laboratorio en 16 casos de Mieloma Múltiple, presentados en los últimos seis años. Se encontró que un 62,5% de los pacientes fueron mujeres. Un 56,3% de los casos tenían entre 51 y 70 años. Encontramos que un 75% de los casos presentó sólo anemia como alteración hematológica en sangre periférica. En un 83,3% de los pacientes, se encontró sobre un 30% de células plasmáticas en médula ósea. Un 57,1% de los Mielomas analizados, fueron IgG, y 28,6% IgA. El nivel promedio de Inmunoglobulinas, en los casos IgG, fue 8.574 mgr/dl y 5.135 mgr/dl en los IgA. Además, se presentan otras características hematológicas, inmunológicas y químicas observadas. La tasa de incidencia(1,1 al año, por cada 100 mil habts.), es baja en relación a lo descrito en la literatura. Se sugiere buscar más esta patología e implementar la técnica de Electroforesis de Proteínas en orina