Résumé
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...
Sujets)
Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Protocoles de polychimiothérapie antinéoplasique/usage thérapeutique , Maladie de Hodgkin/traitement médicamenteux , Programmes nationaux de santé , Protocoles de polychimiothérapie antinéoplasique/administration et posologie , Bléomycine/administration et posologie , Loi du khi-deux , Chili , Cyclophosphamide/administration et posologie , Dacarbazine/administration et posologie , Survie sans rechute , Doxorubicine/administration et posologie , Études de suivi , Maladie de Hodgkin/radiothérapie , Mitoxantrone/administration et posologie , Prednisolone/administration et posologie , Prednisone/administration et posologie , Procarbazine/administration et posologie , Études prospectives , Résultat thérapeutique , Vinblastine/administration et posologie , Vincristine/administration et posologieRésumé
We have treated 28 patients (pts) with malignant hematological diseases with allogenic bone marrow transplantation (BMT). 18 pts had acute lymphoblastic (ALL) and non lymphoblastic leukemia (ANLL), 5 chronic myeloid leukemia (CML), 2 severe aplastic anemia (SAA), 1 myelodisplasia, 1 Fanconi's anemia and 1 advanced Non Hodgkin's lymphoma. All but three received the graft from HLA identical sibling donors. We used conditioning with total body irradiation and chemotherapy (cyclophosphamide, cytarabine and etoposide) in 17 pts and chemotherapy alone in 11.24 pts had a full hematological recovery 18 to 25 days post BMT. 15 pts died after BMT as a consequence of toxicity or early infection (4), graft failure (2), graft vesus host disease (4) or relapse (5). Actuarial event free survival for the group with favorable prognosis (SAA, ALL and ANLL in first or second remission and CML in chronic phase) is 57 percent at 36 months. Allogeneic BMT is an effective and feasing therapeutic procedure for selected patients with hematological malignancies
Sujets)
Humains , Mâle , Femelle , Enfant d'âge préscolaire , Adolescent , Adulte , Transplantation de moelle osseuse , Hémopathies/chirurgie , Isolement du patient , Complications postopératoires/traitement médicamenteux , Transplantation homologue , Transplantation homologue/mortalité , Leucémies/thérapie , Anomalies du tube neural/thérapie , Anémie aplasique/thérapie , Prémédication/méthodes , Réaction de l'hôte contre le greffon/immunologie , Système hématopoïétique/physiopathologie , Transfusion sanguine/méthodesRésumé
Aim: To compare the efficacy of imipenem - cilastatine and ceftazidime - amikacin in the treatment of febril neutropenic patients. Design: Open prospective and randomized clinical study. Patients: 52 patients (26 females) aged 16 to 80 years old with 60 episodes of neutropenia were studied. They were randomly assigned to receive Imipenem - cilastatine in doses of 500 mg iv qid or the combination of ceftazidime 1 to 1.5 g iv tid and amikacin 7.5 mg/kg iv bid. Results: Global response to initial therapy was 53 percent in patients receiving imipenem - cilastatine and 37 percent in those receiving ceftazidime - amikacin (p=ns). When other antimicrobial were added, a 90 and 85 percent infection eradication success was achieved respectively. Six febrile episodes in the group receiving imipenem - cilastatine and 12 episodes in tha group receiving ceftazidime - amikacin had Gram positive cocci as the sole treatment outcome. Three patients receiving imipenem - cilastatine (10 percent) and 4 receiving ceftazidime - amikacin (13 percent) died. Superinfections and toxicity related to antibiotics were minimal in both groups. Conclusions: imipenem - cilastatine and the combination of ceftazidime with amikacin were equally effective in the treatment of febril episodes in neutropenic patients