Trasplante autólogo de progenitores hematopoyéticos en el Linfoma de Hodgkin / Autologous hematopoietic stem cell transplantation in Hodgkin's Lymphoma

Introducción: El trasplante autólogo de progenitores hematopoyéticos es una terapéutica aplicable en determinadas situaciones a pacientes con Linfoma de Hodgkin. Objetivo: Evaluar la respuesta al trasplante autólogo de progenitores hematopoyéticos en los pacientes con Linfoma de Hodgkin. Métodos: Se realizó un estudio de 60 pacientes con Linfoma de Hodgkin trasplantados en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, entre 1991 y 2018. Se estimó el porcentaje de respuesta a los tres meses, la supervivencia global y la supervivencia libre de enfermedad a los cinco años. Resultados: La tasa de respuesta a los tres meses fue de 82,7 por ciento. La supervivencia global y libre de enfermedad a los cinco años fue de 94,7 por ciento y 51,7 por ciento, respectivamente. La mortalidad temprana relacionada con el trasplante fue de 5 por ciento. Conclusiones: La aplicación del trasplante autólogo de progenitores hematopoyéticos constituyó una alternativa terapéutica válida. La baja mortalidad temprana evidenció una realización del procedimiento con un perfil de seguridad satisfactorio(AU)

Introduction: Autologous hematopoietic stem cell transplantation is an applicable therapy in certain situations to patients with Hodgkin's Lymphoma. Objective: To evaluate the response to autologous hematopoietic stem cell transplantation in patients with Hodgkin's Lymphoma. Methods: A study of 60 patients with Hodgkin lymphoma transplanted at Hermanos Ameijeiras Clinical and Surgical Hospital was carried out from 1991 to 2018. The percentage of response at three months, overall survival and disease-free survival period were estimated at five years. Results: The response rate at three months was 82.7 percent. Overall and disease-free survival at five years was 94.7 percent and 51.7 percent, respectively. Early transplant-related mortality was 5 percent. Conclusions: The use of autologous hematopoietic stem cell transplantation was a valid therapeutic alternative. The low early mortality evidenced that the procedure was performed with a satisfactory safety profile(AU)

TAC y PET/TC con 18-FDG para evaluar la respuesta al tratamiento en linfoma de Hodgkin y no Hodgkin / CT and PET/CT with 18-FDG to evaluate the response to treatment in Hodgkin's and non-Hodgkin's lymphoma

Resumen Introducción: La evaluación de la respuesta al tratamiento de linfoma se basa en estudios de imagen. Objetivo: Correlacionar la evaluación de la respuesta al tratamiento de linfoma mediante tomografía axial computarizada (TAC) y tomografía por emisión de positrones/tomografía computarizada (PET/TC). Método: Estudio observacional transversal en el que se revisaron expedientes de pacientes con linfoma en vigilancia mediante TAC y PET/TC. Resultados: La población de estudio estuvo constituida por 43 pacientes con edad media de 32.7 ± 22.4 años; 26 (60.5 %) tenían diagnóstico de linfoma de Hodgkin y 17 (9.5 %), de linfoma no Hodgkin. Por TAC se diagnosticaron 34 (79.1 %) con enfermedad y nueve (20.9 %) sin enfermedad. El criterio para evaluar la respuesta fue la experiencia del médico imagenólogo en 39 (90.7 %) y RECIST 1.1 en cuatro (9.3 %). Por PET/TC con 18-FDG se diagnosticó falta de respuesta al tratamiento o respuesta parcial-recurrencia en 32 pacientes (74.4 %) y con respuesta al tratamiento en 11 (25.6 %); con los criterios PERCIST en 13 (30.2 %) y con los de Deuaville en 30 (69.8 %). Al comparar el diagnóstico por TAC contra PET/TC, de 11 pacientes con respuesta total, tres tuvieron diagnóstico tomográfico similar. De los 34 pacientes con datos de enfermedad diagnosticados por tomografía, 26 tuvieron resultados similares por PET/TC con 18-FDG (p = 0.54). Conclusión: El valor de la respuesta al tratamiento por TAC en linfoma no concuerda con el obtenido mediante PET/TC con 18-FDG.

Abstract Introduction: The assessment of lymphoma response to treatment is based on imaging studies. Objective: To correlate the assessment of lymphoma treatment response by computed tomography (CT) and by positron emission tomography/computed tomography (PET/CT). Method: Cross-sectional, observational study, where records of patients with lymphoma under surveillance by CT and PET/CT were reviewed. Results: The study population consisted of 43 patients with a mean age of 32.7 ± 22.4 years; 26 (60.5 %) had a diagnosis of Hodgkin’s lymphoma and 17 (9.5 %) had non-Hodgkin lymphoma. By CT, 34 (79.1 %) were diagnosed with disease and nine (20.9 %) without disease. The criteria used to assess the response was radiologist experience in 39 (90.7 %) and RECIST 1.1 criteria in four (9.3 %). The diagnosis by 18-FDG PET/CT was no response to treatment or partial response-recurrence in 32 (74.4 %) and response to treatment in 11 (25.6 %); with PERCIST criteria in 13 (30.2 %) and Deuaville criteria in 30 (69.8 %). When the diagnosis by CT versus 18-FDG PET/CT was compared, out of 11 patients with complete response on PET/CT, three had a similar CT diagnosis. Of the 34 patients with data consistent disease diagnosed by CT, 26 had similar results by 18-FDG PET/CT (p = 0.54). Conclusion: The value of lymphoma treatment response on CT does not agree with that obtained by 18-FDG PET/CT.

Everolimus as a single agent in refractory or relapsed Hodgkin's lymphoma: the Brazilian Named Patient Program Experience

Abstract Background Despite all the scientific progress that has been made on understanding the disease, prognosis for patients with relapsed and refractory Hodgkin's lymphoma remains poor and the treatment is palliative in the majority of the cases. Thus, the aim of this study was to present the results on the compassionate use of everolimus in a group of patients who were monitored at nine different centers in Brazil. Methods A 10-mg oral dose of everolimus was given to each patient daily. Response time was evaluated from the beginning of medication use until loss of response, toxicity or medical decision to cease treatment. Results Thirty-three patients were evaluated. The median age at the beginning of medication administration was 29 years. Patients had received a median of five prior therapies. Overall response rate was 45.4%, with 13 patients achieving partial response, two achieved clinical response, 14 remained with stable disease, two had disease progression, and two were not evaluated. Patients received a median of 14 cycles. Progression-free survival was nine months, and overall survival was estimated to be 36 months. Three patients used the medication for more than four years. The most frequently reported adverse events were thrombocytopenia and hypercholesterolemia. Three patients had pulmonary toxicity. Grade III and IV adverse events occurred in 39% of the patients. Conclusion Everolimus was found to provide a response in a group of patients with refractory or relapsed Hodgkin's lymphoma who had adequate tolerability to the drug.

Guía de Práctica Clínica para la detección, tratamiento y seguimiento de Linfomas Hodgkin y No Hodgkin en población mayor de 18 años / Clinical practice guideline for the detection, treatment and follow-up of Hodgkin and Non-Hodgkin lymphomas in a population over 18 years of age

Esta guía esta dirigida al personal de la salud involucrado directamente en la atención de pacientes adultos mayores de 18 años con sospecha o diagnóstico de linfoma no Hodgkin B difuso de célula grande (Linfoma B difuso de células grandes), linfoma folicular (LF), linfoma de células del manto (LCM) y linfoma Hodgkin (LH), y a las instancias administrativas, empresas aseguradoras y entes gubernamentales involucrados en la generación de políticas en salud. Esta GPC basada en la evidencia incluye los temas de diagnóstico y tratamiento del Linfoma B difuso de células grandes, LF, LM y LH, bajo la perspectiva del Sistema General de Seguridad Social en Salud colombiano. Objetivos: Determinar los métodos diagnósticos más apropiados en pacientes con LBDCG para garantizar un diagnóstico preciso que permita una adecuada selección del tratamiento; Establecer las líneas de tratamiento en pacientes con LF para disminuir la heterogeneidad en la atención y mejorar los resultados del tratamiento; Determinar los esquemas de tratamiento de primera línea para pacientes con LCM en diferentes grupos de edad para disminuir la heterogeneidad y mejorar los resultados del mismo; y Mejorar la supervivencia libre de enfermedad y la supervivencia global de los pacientes adultos con LH.

Evaluation correlates C-reactive protein with advanced stage Hodgkin's lymphoma and response to treatment in a tertiary university hospital in Brazil

To demonstrate a correlation of C-reactive protein levels with disease stage and response to treatment in Hodgkin's lymphoma patients of the Hematology Service of Santa Casa de São Paulo.METHODS: A retrospective study based on review of medical records was carried out of 38 patients diagnosed with Hodgkin's lymphoma between October 2010 and December 2012. Three patients met the exclusion criteria, giving a final sample of 35 patients for analysis. C-reactive protein levels >1 mg/dL were considered positive.RESULTS: Among the patients analyzed, median age was 29 years, 65% were male and 85% had the classical nodular sclerosis subtype. Twenty-nine (82%) were in the advanced stage and 28% had bulky mass at diagnosis. Seventeen percent had bone marrow invasion by lymphoma. Baseline C-reactive protein levels were associated with both stage (p-value = 0.0035) and presence or absence of B symptoms (p-value = 0.008). The highest C-reactive protein levels were detected in patients with advanced disease while no patients with localized disease had C-reactive protein >5 mg/dL (p-value = 0.02). After the first treatment cycle, C-reactive protein fell to near-normal levels and no direct association with response pattern was found. As the mean follow-up was only 14 months, it was not possible to determine whether relapse was accompanied by a further increase in C-reactive protein.CONCLUSION: Baseline C-reactive protein levels directly correlated with stage and presence or absence of B symptoms, but the degree of improvement with treatment did not correlate with response pattern. After a longer follow-up, it may be possible to assess whether relapse correlates with a further increase in C-reactive protein levels...

Sandfly species diversity in association with human activities in the Kani tribe settlements of the Western Ghats, Thiruvananthapuram, Kerala, India

Sandfly prevalence in the Kani tribe settlements of Western Ghats in India was investigated. A total of 1,279 sandflies comprising 17 species was obtained. Sandfly abundance showed a negative correlation (r = -0.97, p = 0.003) with increase in altitudinal ranges from 0-1,000 m. When sandfly samples were grouped according to landscape characteristics of the location, the estimated Shannon-Weiner index (H) and species richness index (S) were high and species evenness index (J) was low in settlements located at 0-300 m altitudinal range. On the contrary, the values of H and J were high, while S was low at 301-600 m altitudinal range. With further increase in altitude, species diversity, S and J were low. Though the relative abundance of sandflies decreased with increase in altitude, the influence of altitudinal variation could not be attributed to determine sandfly diversity, since the number of sampling units were not uniform at all the altitudinal gradients due to nonavailability of suitable resting shelters. Sandfly species showed great aggregation at 0-300 m altitude interval, where not only the number of settlements were maximum (n = 19), but also the environmental conditions favoured sandfly abundance due to the concentration of tribal settlements, human dwellings and his activities.

Leisure activities and attitude of institutionalized elderly people: a basis for nursing practice / Atividades de lazer e atitude de idosos institucionalizados: subsídios para a prática de enfermagem / Las actividades de ocio y la actitud de ancianos institucionalizados: informaciones para la práctica de enfermería

Aim: to identify the leisure activities performed in Long-Stay Institutions for the Elderly (LSIEs), registered in the city of Maringá-PR, Brazil, and to analyze the attitude of the elderly people toward leisure promoted by the institutions. METHOD: this was a descriptive and transversal study with a quantitative approach, carried out with 97 elderly people, through the establishment of the socio-demographic profile and the application of the Leisure Attitude Scale. The data was subjected to descriptive statistical analysis, association tests (chi-square or Fisher's) and Spearman's correlation. RESULTS: males, aged 80 or over, widowed, with one to eight years of study, who had a monthly income were predominant. Age group and income were significantly associated with the performance of leisure activities. The results reflected the positive attitude of the elderly people in relation to leisure activities, except in the behavioral component. CONCLUSION: the findings of this study indicate the need for further investigation into the difficulties linked to the attitude toward leisure in the behavioral component, considering aspects such as individual concepts of leisure and the health status of the elderly people. .

OBJETIVOS: identificar as atividades de lazer realizadas em Instituições de Longa Permanência para Idosos (ILPI), regularmente cadastradas no município de Maringá - PR, Brasil, e analisar a atitude dos idosos face ao lazer promovido pelas instituições. MÉTODO: trata-se de uma pesquisa de caráter descritivo e transversal, com abordagem quantitativa, realizada com 97 idosos, por meio de levantamento do perfil sociodemográfico e da aplicação da Escala de Atitudes Face ao Lazer. Os dados passaram por análise estatística descritiva, testes de associação (quiquadrado ou Fisher) e correlação de Spearman. RESULTADOS: predominaram homens, na faixa etária de 80 anos ou mais, viúvos, com um a oito anos de estudo e que possuíam renda mensal. Faixa etária e renda tiveram associação significativa com a realização de atividades de lazer. Os resultados refletiram atitude positiva dos idosos em relação às atividades de lazer, exceto no componente comportamental. CONCLUSÃO: os achados deste estudo indicam a necessidade de investigação das dificuldades atreladas à atitude face ao lazer no componente comportamental, considerando aspectos como concepções individuais de lazer e condição de saúde dos idosos. .

OBJETIVOS: identificar las actividades de ocio o tiempo libre realizadas en Instituciones de Larga Permanencia para Ancianos (ILPA) regularmente registradas en el municipio de Maringá-PR, Brasil, y analizar la actitud de los ancianos frente al tiempo libre promovido por las instituciones. MÉTODO: se trata de una investigación de carácter descriptivo y transversal, con abordaje cuantitativo, realizada con 97 ancianos, por medio del levantamiento del perfil sociodemográfico y de la aplicación de la Escala de Actitudes Frente al Ocio. Los datos pasaron por análisis estadístico descriptivo, test de asociación (chi-cuadrado o Fisher) y correlación de Spearman. RESULTADOS: predominaron hombres, en el intervalo etario de 80 años o más, viudos, de uno a ocho años de estudio y que poseían renta mensual. El intervalo etario y la renta tuvieron asociación significativa con la realización de actividades de tiempo libre. Los resultados reflejaron una actitud positiva de los ancianos en relación a las actividades de tiempo libre, excepto en el componente comportamental. CONCLUSIÓN: los hallazgos de este estudio indican la necesidad de investigar las dificultades vinculadas a la actitud frente al tiempo libre en el componente comportamental, considerando aspectos como las concepciones individuales de tiempo libre y la condición de salud de los ancianos. .

Primeros diez trasplantes autólogos de progenitores hematopoyéticos en adultos, en el servicio público de salud en Chile / First ten hematopoietic stem cell transplants performed in the adult public health service in Chile

Background: Hematopoietic stem cell transplantation (HSCT) is an effective therapy for hematological diseases such as lymphoma and multiple myeloma. In 2004, the Cancer Unit of the Ministry of Health incorporated the HSCT to the National Cancer Program in Adults. Until 2008 we purchased services to private institutions while implementing the national center for HSCT of adults in the Hospital del Salvador. Aim: To report the first ten HSCT conducted in this center. Material and Methods: All cases were approved by a national commission for adult HSCT. The entire process was carried out based on evidence-based protocols. Results: Six patients with Hodgkin lymphoma, three with multiple myeloma and one with a diffuse large B cell lymphoma were transplanted. Age range was 19 to 48 years and five patients were male. An average of 2.2 aphereses per patient was required. The CD 34 stem cell collection was 5.06 x 10(6) x Kg. The conditioning regimes were BEAM (carmus-tine, etoposide, cytosine arabinoside, melphalan) and melphalan 200 according to the underlying disease. Seventy percent of the patients developed mild to moderate mucositis and 50% had febrile neutropenia, with good response to treatment. In two cases there was an association with influenza. The engraftment of neutrophils and platelets was achieved on day +10 and +11 respectively. At follow-up until day +100, there was no morbidity or mortality. Conclusions: These results confirm the quality standard that this intervention has achieved in our institution. The Chilean National Center for HSCT on Adults should be established as a public core care, teaching and research facility.

Linfoma de Hodgkin clássico na infância. Experiência de tratamento e fatores prognósticos / Classical Hodgkin?s lymphoma in childhood. Therapeutic experience and prognostic factors

Objetivos: Estimar as taxas de sobrevida global e livre de eventos em portadores de linfoma de Hodgkin (LH), bem como identificar fatores prognósticos. Métodos: Estudo de coorte retrospectivo, incluindo variáveis demográficas, laboratoriais, tipo histológico, estadiamento e tratamento de 107 pacientes menores de 18 anos de idade admitidos no Departamento de Pediatria do Centro de Tratamento e Pesquisa Hospital do Câncer, no período entre 1985 e 1995. Resultados: Dos pacientes, 81 (76%) eram do sexo masculino e 80% da raça branca. A média de idade foi 10 anos (2 a 18 anos). Adenomegalia cervical foi a principal queixa referida (68% dos pacientes) e 55% apresentavam tempo de queixa menor que seis meses. Os subtipos EN e CM foram encontrados em 43% e 41% dos casos, respectivamente. Os estádios clínicos II e III foram os mais frequentes (33% cada um). Os sítios metastáticos mais frequentes nos EC IV foram fígado (42%) e pulmão (38%). As taxas de SG e SLE em 10 anos foram de 82,4% e 82,5%, respectivamente. O estádio clínico se mostrou como fator prognóstico significativo para as SG e SLE. A análise univariada revelou a presença de sintomas B, nível de Hb £ 9,3 g/dl, leucócitos £ 6.100 mm3, plaquetas £ 274.000/mm3 e ocorrência de recaída como fatores de mau prognóstico, enquanto a análise múltipla mostrou como fatores prognósticos independentes a presença de sintomas B e contagem de plaquetas. Conclusões: A identificação de fatores prognósticos é valiosa para a adequada estratificação dos pacientes em grupos de risco, adequando-os a esquemas de tratamento que maximizem as taxas de cura e minimizem os efeitos colaterais tardios.

Brazilian experience using high dose sequential chemotherapy followed by autologous hematopoietic stem cell transplantation for malignant lymphomas

OBJECTIVE: To evaluate the use of high-dose sequential chemotherapy in a Brazilian population. METHODS: High-dose cyclophosphamide followed by autologous hematopoietic stem cell transplantation is an effective and feasible therapy for refractory/relapsed lymphomas; this regimen has never before been evaluated in a Brazilian population. All patients (106 with high-grade non-Hodgkin lymphoma and 77 with Hodgkin's lymphoma) submitted to this treatment between 1998 and 2006 were analyzed. Chemotherapy consisted of the sequential administration of high-dose cyclophosphamide (4 or 7 g/m²) and granulocyte-colony stimulating factor (300 µg/day), followed by peripheral blood progenitor cell harvesting, administration of etoposide (2g/m²) and methotrexate (8 g/m² only for Hodgkin's lymphoma) and autologous hematopoietic stem cell transplantation. RESULTS: At diagnosis, non-Hodgkin lymphoma patients had a median age of 45 (range: 8-65) years old, 78 percent had diffuse large B-cell lymphoma and 83 percent had stage III/IV disease. The Hodgkin's lymphoma patients had a median age of 23 (range: 7-68) years old, 64.9 percent had the nodular sclerosis subtype and 65 percent had stage III/IV disease. Nine Hodgkin's lymphoma patients (13 percent) and 10 (9 percent) non-Hodgkin lymphoma patients had some kind of cardiac toxicity. The overall survival, disease-free survival and progression-free survival in Hodgkin's lymphoma were 29 percent, 59 percent and 26 percent, respectively. In non-Hodgkin lymphoma, these values were 40 percent, 49 percent and 31 percent, respectively. High-dose cyclophosphamide-related mortality was 10 percent for Hodgkin's lymphoma and 5 percent for non-Hodgkin lymphoma patients. High-dose cyclophosphamide dosing had no impact on toxicity or survival for both groups. CONCLUSIONS: Despite a greater prevalence of poor prognostic factors, our results are comparable to the literature. The incidence of secondary neoplasias is noteworthy. ...

Epidemiología del linfoma con compromiso de cabeza y cuello en el Centro Asistencial Sótero del Río / Epidemiology of lymphoma of the head and neck in the Centro Asistencial Sótero del Río

Introducción: Los linfomas son la neoplasia hematológica más frecuente del adulto, ocupando el tercer lugar de las neoplasias de cabeza y cuello (CyC). Se distinguen dos tipos, el linfoma de Hodgkin (LH) y el linfoma no Hodgkin (LNH), constituyendo dos entidades clínicas separadas. Objetivo: Evaluar las manifestaciones de los linfomas en la región de CyC, analizando las diferencias de presentación y comportamiento entre en LH y el LNH. Material y método: Estudio retrospectivo de todos los casos de linfomas de CyC en el Centro Asistencial Dr. Sótero del Roo (CASR) entre los años 2005 y 2009, documentando específicamente presentación clínica, factores de riesgo, el tipo de linfoma, diagnóstico histológico, localización anatómica, etapificación al momento del diagnóstico, tratamiento administrado, sobrevida. Resultados: Se incluyeron 80 casos de pacientes con linfoma de CyC en el estudio, 16 (20 por ciento) con LH y 64 (80 por ciento) con LNH. Se encontraron diferencias estadísticamente significativas entre ambos para la edad de diagnóstico, el compromiso extranodal, compromiso de mediastino, presencia de síntomas B y sobrevida. Conclusión: En el CASR la presentación de los linfomas es similar a la reportada mundialmente con diferencias similares entre LH y LNH.

Introduction: Lymphomas are the most common hematologic neoplasia in the adult and the third most common neoplasias of the head and neck (CyC). There are two types of lymphoma: Hodgkin and non-Hodgkin lymphomas, which constitute two unique clinical entities. Aim: To evaluate the clinical manifestations of lymphomas in the CyC region, analizing the diferences between the clinical presentation and behavior of LH and LNH. Material and method: This is an retrospective study of all the cases of lymphoma of CyC in the Centro Asistencial Dr. Sótero del Río (CASR) between the years 2005 and 2009, describing specifically the clinical presentation, risk factors, type of lymphoma, histologic diagnosis, anatomical localization, etapification at diagnosis, treatment received and survival. Results: Eighty cases of lymphoma of the CyC were included, 16 patients (20 percent) with LH and 64 patients (80 percent) with LNH. We found statistically significant differences between both groups for their age at diagnosis, extranodal disease, mediastinal compromise, presence of "B" symptoms and survival. Conclusion: in the CASR the clinical presentation of lymphomas is similar to that reported in the international literature, maintaining the unique characteristics for LH and LNH.

Linfomas asociados a infección por Virus de Inmunodeficiencia Humana: Experiencia de un centro hospitalario de la V región, Chile / Lymphomas associated with human immunodeficiency virus infection: Retrospective review of medical records

Background: The incidence oflymphoma increases enormously inpatients infecten with the human immunodeficiency virus (HIV). Aim: To describe the incidence, clinical and histológica! characteristics, treatments and survival of lymphomas associated with HTV infection. Material and Methods: Retrospective review of medical records ofpatients with HIV and lymphoma, treated in a public hospital, between January 2001 and June 2009. Results: Twenty-two mole patients were included but 14 had immunohistochemical confirmation ofthe lymphoma. The accumulated incidence for thisperiod was 2.8 percent. The median age at lymphoma diagnosis was 39.5 years. Twelvepatients (86 percent) had non-Hodgkin lymphoma (NHI) and two (14 percent) Hodgkin lymphoma. The main pathological type of non-Hodgkin lymphomas was diffuse large B cell in seven cases (50 percent). The mean CD4 cell count and viral load were 83 cell/mm³ (33.5-113.5) and 26.000 RNA copies/ml (1210-196500), respectively Twelve patients (86 percent) had B type symptoms of lymphoma at the moment of diagnosis. Eleven patients (29 percent) received chemotherapy with or without radiotherapy, onepatient (7 percent) received radiotherapy alone and two patients (14 percent) received palliative symptomatic treatment. Six cases (43 percent) received highly active antiretroviral therapy simultaneously with chemotherapy. Global mortality in this series was 57 percent (8patients) with a median survival time of 5.8 months (2.6-26.2). Conclusions: In this series ofpatients infected with HIV, a predominance of aggressive histológica! subtypes of lymphomas and low complete remission rates, were observed.

Autologous blood stem cell transplantation for Hodgkin and non-Hodgkin lymphoma: Complications and outcome.

Background. We analysed data on patients of Hodgkin and non-Hodgkin lymphoma treated with high dose chemotherapy followed by autologous stem cell transplantation to determine the toxicity, pattern of infections and long term outcome. Methods. There were 34 male and 10 female patients (median age 35 years, range 15–67 years). Before transplantation, 31 patients (70.5%) had chemosensitive disease and 13 (29.5%) had chemoresistant disease. Granulocyte-colony stimulating factor mobilized peripheral blood stem cells were used as the source of stem cells. The patients received high dose chemotherapy using CBV (cyclophosphamide, BCNU and VP- 16 [etoposide] n=38), BEAM (BCNU, etoposide, cytosine arabinoside and melphalan, n=3), cytosine arabinoside, etoposide and melphalan (n=2) and melphalan alone (n=1). Prophylaxis with antifungal drugs (fluconazole/itraconazole) and acyclovir was used. Results. Following transplant, 32 patients (72.7%) responded; complete response was achieved in 25 patients (56.8%) and partial response in 7 (15.9%). The rate of complete response was higher for patients with pre-transplant chemosensitive disease (23/31 [74.2%] v. 2/13 [15.4%], p<0.001). Gastrointestinal toxicity, and renal and liver dysfunctions were major non-haematological toxicities; 3 patients (7%) died of regimen-related toxicity. Infections (predominantly Gram-negative) accounted for 2 deaths (4.5%) seen before day 30. At a median follow up of 79 months (range 14–168 months), median overall and event-free survival were 78 months and 28 months, respectively. Estimated mean (SE) overall and event-free survival at 60 months were 54.34% (0.07) and 34.3% (9.88), respectively. Conclusion. Patients with pre-transplant chemosensitive disease and those who achieved complete response following transplant had a significantly better chance of survival.

Evaluación clínica, pronóstico y terapéutica del linfoma de Hodgkin del adulto / Clinical assessment, prognosis and treatment of Hodgkin's lymphoma in adults

El linfoma de Hodgkin es una neoplasia de linfocitos B de etiología desconocida. La nueva clasificación de la OMS muestra dos subtipos; el linfoma nodular con predominio linfocítico CD20 positivo, que representa el 5%, y la variedad clásica CD 15 y CD 30 positivo, con cuatro subvariedades. Ambos grupos se diferencian en su presentación clínica, inmunofenotipo, pronóstico y terapéutica. La nueva modalidad de evaluación por imágenes que fusiona un estudio metabólico, la tomografía por emisión de positrones (PET) con una tomografía anatómica convencional (PET-TC), logra predecir tempranamente en el curso del tratamiento el pronóstico de la enfermedad. Los pacientes con resultado negativo en la PET-TC luego de 1-4 ciclos tienen pronóstico más favorable. El objetivo actual del tratamiento inicial del linfoma de Hodgkin es lograr mantener los excelentes niveles de remisión completa, supervivencia libre de progresión y supervivencia global, reduciendo al máximo la toxicidad, especialmente gonadal, pulmonar y cardíaca, así como la aparición de segundas neoplasias. La quimioterapia óptima es la combinación ABVD con evaluación temprana por PET-TC; si el resultado es negativo se puede reducir el número de ciclos a 3 o 4 y evitar la radioterapia. En pacientes con persistencia de PET-TC positiva (<20%) es necesario intensificar el tratamiento para intentar mejorar su mal pronóstico. Con esta estrategia se logra una supervivencia a 5 y 10 años del 85% al 90%, con mínimos efectos tóxicos tardíos.

Osseous involvement in pediatric hodgkin’s lymphoma.

Presented here is a report of 3 children, out of 66 total pediatric Hodgkin’s lymphoma (HL) patients (4.5%) with bone involvement over a 3 and a half year period. Two patients presented with osseous lesions at the time of relapse and one had concurrent evidence of non-osseous disease. The clinical presentation, radiographic findings, histology, treatment and outcome of these patients are discussed. Boys and girls are nearly equally affected, local bone pain is the commonest symptom and B-symptoms are common. Vertebrae and pelvis are most frequently involved, commonly with an osteolytic picture. Nodular sclerosis is the predominant histological subtype. Most children received combined modality treatment and the overall response and survival are good.

Recaída sistémica con compromiso de SNC de linfoma Hodgkin y respuesta al esquema Gemcitabina/Vinorelbina / Systemic Relapse with involvement of the CNS by Hodgkin's Lymphoma: response to gemcitabine/Vinorelbine Scheme

El compromiso del sistema nervioso central (SNC) por Linfoma de Hodgkin es infrecuente. El tratamiento con Gemcitabina/Vinorelbina es efectivo y bien tolerado en pacientes con Linforma de Hodkgin recaídos/refractarios.

Central nervous system involvement by Hodgkin is rare. Gemcitabine/Vinorelbine is an effective and well tolerated regimen for patients with relapsed and refractory Hodgkin's lymphoma.

Proliferating cell nuclear antigen (PCNA), p53 and MDM2 expression in Hodgkins disease

CONTEXT AND OBJECTIVE: Tumor cells in Hodgkins disease (HD) express cell proliferation markers that are evaluated according to the oncogenes involved or the expression of their proteins. Correlations between the protein expression grade and clinical data are now important for disease prognosis. DESIGN AND SETTING: This was a retrospective analysis on proliferating cell nuclear antigen (PCNA), p53 and MDM2 (murine double minute-2) expression using immunohistochemistry, on formalin-fixed, paraffin-embedded tissues from diagnostic biopsies on 51 patients with HD. The study was conducted at the Division of Hematology and Transfusion Medicine, Hospital São Paulo, Universidade Federal de São Paulo. METHODS: Antigen expression was evaluated as the proportions of positive Hodgkin and Reed-Sternberg (HRS) cells and reactive lymphocytes (L), which were compared using Spearman correlation coefficients. The Friedman test was used for comparisons between the markers. The Pearson test was used to investigate associations between marker expression and clinical and laboratory parameters, marrow involvement, complete remission (CR) and overall survival (OS) rates. RESULTS: There was overexpression of antigen proteins in HRS, in relation to L (p < 0.001). In HRS, MDM2 was higher than p53 and PCNA (p < 0.003), while the latter two were equivalent. In L, p53 was lower than MDM2 and PCNA (p < 0.001), while the latter two were equivalent. There was no relationship between protein expression and clinical and laboratory variables or outcome. CONCLUSIONS: PCNA, p53 and MDM2 are tumor markers for HD, but showed no clinical or prognostic significance in our analysis.

CONTEXTO E OBJETIVO: As células tumorais da doença de Hodgkin (HD) são positivas para marcadores de proliferação celular que são analisados por seus genes e respectivas proteínas. A correlação entre a expressão destas proteínas e os parâmetros clínico-laboratoriais são, no momento, de importância para o prognóstico da doença. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo da expressão do antígeno de proliferação celular (PCNA) e da p53 e MDM2 em tecidos obtidos ao diagnóstico, fixados por formol, embebidos em parafina de 51 pacientes com HD. O trabalho foi realizado na Divisão de Hematologia e Transfusão, Hospital São Paulo, Universidade Federal de São Paulo. MÉTODOS: As expressões antigênicas foram analisadas através da proporção de células de Hodgkin e células de Reed Sternberg (HRS) e linfócitos reacionais (L) positivos. A intensidade de expressão de cada proteína foi comparada entre L e HRS através do coeficiente de Spearman. A comparação da PCNA, p53 e MDM2 em L e HRS se fez pelo teste de Fiedman. As correlações entre variáveis clínico-laboratoriais, comprometimento da medula óssea, taxas de sobrevida geral e remissão clínica com as proteínas em HRS se fizeram pelo coeficiente de Pearson. RESULTADOS: Houve superexpressão das três proteínas em células HRS comparadas aos L (p < 0,001). Nas células HRS, a MDM2 foi maior que a p53 e a PCNA (p < 0,003), que foram equivalentes. Nos L, a p53 foi menor que a MDM2 e a PCNA (p < 0,001), que foram equivalentes Não houve relação entre as expressões das proteínas com as variáveis clínico-laboratoriais e sobrevida. CONCLUSÕES: PCNA, p53 e MDM2 são marcadores tumorais na HD, porém não mostraram significado clínico-prognóstico em nossa análise.