Efficacy and safety of VRD regimen of autologous hematopoietic stem cell transplantation in patients with newly diagnosed multiple myeloma / 中华内科杂志

Objective: To explore the stem cell collection rate and efficacy and safety of patients aged 70 and below with newly diagnosed multiple myeloma (MM) treated with the VRD (bortezomib, lenalidomide and dexamethasone) regimen followed by autologous stem cell transplantation (ASCT). Methods: Retrospective case series study. The clinical data of 123 patients with newly diagnosed MM from August 1, 2018, to June 30, 2020, at the First Affiliated Hospital of Soochow University and Suzhou Hopes Hematology Hospital, who were eligible for VRD regimen sequential ASCT, were collected. The clinical characteristics, efficacy after induction therapy, mobilization regimen of autologous stem cells, autologous stem cell collection rate, and side effects and efficacy of ASCT were retrospectively analyzed. Results: Of the 123 patients, 67 were males. The median patient age was 56 (range: 31-70) years. Patients with IgG, IgA, IgD, and light-chain types accounted for 47.2% (58/123), 23.6% (29/123), 3.2% (4/123), and 26.0% (32/123) of patients, respectively. In addition, 25.2% (31/123) of patients had renal insufficiency (creatinine clearance rate<40 ml/min). Patients with Revised-International Staging System (R-ISS) Ⅲ accounted for 18.2% (22/121) of patients. After induction therapy, the rates of partial response and above, very-good partial response (VGPR) and above, and complete response (CR)+stringent CR were 82.1% (101/123), 75.6% (93/123), and 45.5% (56/123), respectively. Overall, 90.3% (84/93) of patients were mobilized with cyclophosphamide+granulocyte colony-stimulating factor (G-CSF) and 8 patients with G-CSF or G-CSF+plerixafor due to creatinine clearance rate<30 ml/min and one of them was mobilized with DECP (cisplatin, etoposide, cyclophosphamide and dexamethasone)+G-CSF for progressive disease. The rate of autologous stem cell collection (CD34+cells≥2×106/kg) after four courses of VRD regimen was 89.1% (82/92), and the rate of collection (CD34+cells≥5×106/kg) was 56.5% (52/92). Seventy-seven patients treated with the VRD regimen sequential ASCT. All patients had grade 4 neutropenia and thrombocytopenia. Among the nonhematologic adverse events during ASCT, the highest incidence was observed for gastrointestinal reactions (76.6%, 59/77), followed by oral mucositis (46.8%, 36/77), elevated aminotransferases (44.2%, 34/77), fever (37.7%, 29/77), infection (16.9%, 13/77) and heart-related adverse events (11.7%, 9/77). Among the adverse events, grade 3 adverse events included nausea (6.5%, 5/77), oral mucositis (5.2%, 4/77), vomiting (3.9%, 3/77), infection (2.6%, 2/77), elevated blood pressure after infusion (2.6%, 2/77), elevated alanine transaminase (1.3%, 1/77), and perianal mucositis (1.3%, 1/77); there were no grade 4 or above nonhematologic adverse events. The proportion of patients who achieved VGPR and above after VRD sequential ASCT was 100% (75/75), and the proportion of patients who were minimal residual disease-negative (<10-4 level) was 82.7% (62/75). Conclusion: In patients aged 70 and below with newly diagnosed MM treated with VRD induction therapy, the collection rate of autologous stem cells was good, and good efficacy and tolerability were noted after follow-up ASCT.

O destino dos rins transplantados tratados com OKT3 para rejeiçäo córtico-resistente / The fate of trenal allgrafts treated with OKT3 for steroid-resistan rejection

Objetivo: Avaliar o efeito do anticorpo monoclonal anti-CD3 (OKT3), utilizado para tratamento de rejeição aguda córtico-resistente em pacientes transplantados renais, em relação à função do rim transplantado e à sobrevida do enxerto e do paciente a longo prazo...

Toxocaríase visceral / Visceral toxocariasis

Larva migrans visceral é uma infecção universal que ocorre mais frequentemente em crianças menores de 10 anos de idade, caracterizada por febre, hepatomegalia, doença pulmonar e eosinofilia. O agente é o ascaris intestinal de cães e gatos. O benefício das drogas anti-helmínticas não está definido. O tratamento com tiabendazol, albendazol ou mebendazol está indicado nas complicações da doença. A transmissão da infecção pode ser prevenida estimulando as crianças a lavarem suas mãos após brincarem em áreas onde há cães

Emesis y citostáticos en el paciente pediátrico / Vomiting and cytostatic therapy in the pediatric patients

El objetivo de este estudio fue evaluar la seguridad y eficacia del ondansetron en niños con neoplasias malignas para prevenir la emesis inducida por agentes antineoplásicos con potentes efectos emetizantes. Se incluyeron 138 niños, 76 varones y 62 mujeres con tumores sólidos que cumplieron 415 ciclos de quimioterapia, desde octubre de 1993 a noviembre de 1994, en la Unidad de Administración de Citostáticos del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". Las edades oscilaron entre 1 y 17 años con una mediana de 8 para todos los grupos. Se analizaron tres tratamientos: Grupo A) 65 ciclos de quimioterapia con ifosfamida a dosis de 1.800 mg/m2/día (n=29); grupo B) 177 ciclos con ifosfamida a dosis de 3.000 mg/m2/día (n=54) y grupo C) 173 ciclos con cis-platino a dosis > 50 mg/m2/día (n=55). El antiemético utilizado fue el ondansetron a 5 mg/m2/dosis administrado por vía intravenosa cada 8 hs, durante todo el ciclo y hasta el egreso del paciente. Se obtuvo completo control de la emesis en el 69 por ciento de los ciclos en el grupo A; 54 por ciento en el grupo B y 70 por ciento en el grupo C. No se registraron reacciones adversas atribuibles al antiemético utilizado. Comparando los grupos A vs B (z: 2,225; P=0,026); B vs C (z: 3156; P=0,002), la diferencia fue significativa. En los grupos A vs C (z: 0,009; P=0,993), la diferencia no fue significativa. Conclusiones: Si bien el ondansetron resultó ser un antiemético seguro y eficaz en el control de las néuseas y vómitos agudos durante la quimioterapia, la respuesta fue menor en protocolos que incluyeron ifosfamida a 3.000 mg/m2/día, diferencia estadísticamente significativa con los otros dos grupos analizados. La dosis de este citostático influyó en la respuesta antiemética del ondansetron. Sugerimos, en función de los resultados del presente trabajo, modificar el esquema antiemético en protocolos con ifosfamida a 3.000 mg/m2/día o tal vez, prolongar la infusión de este citostático

Effect of five-membered heterocycles against Leishmania donovani infection.

Impact of change of heteroatom in pentavalent heterocycles, viz., pyrroles, isoxazoles, imidazoles and crotonates on the profile of antileishmanial activity against amastigotes of L. donovani using in vivo test system and macrophage-amastigote culture system has been studied. Sixty-three compounds were tested. Nine imidazoles showed marginal activity in vivo, whereas 3 out of 10 compounds of isoxazolone series and 2 out of 4 substituted aminocrotonates exhibited antileishmanial activity. Of the 30 substituted pyrroles, except 8 all showed antileishmanial activity in vivo on day 7 post treatment.