ABSTRACT
BACKGROUND: In the past decades, long-term survival outcomes for younger patients with acute myeloid leukemia (AML) have improved. Nonetheless, developing nations might be lagging behind, highlighting the need to assess real-world outcomes in such regions. METHODS: We performed a multicenter retrospective study, which included patients with AML diagnosed between January 2013 and December 2017 from 13 centers in Mexico. RESULTS: A total of 525 patients with AML met the inclusion criteria and were included in the study. Median age for the entire cohort was 47 years. The patients were classified according to cytogenetic risk: favorable 16.0%, intermediate 55.6%, and unfavorable 28.4%. Most patients received intensive chemotherapy (80.2%), and among these 74.1% underwent a 7 + 3 induction regimen. A complete remission was achieved in 71.3% of patients. Induction-related mortality occurred in 17.8% and we identify the following as independent risk factors: >60 years (odds ratio [OR] 2.09 [1.09-4.02]), Eastern Cooperative Oncology Group >2 (OR 4.82 [2.46-9.43]), prior solid tumor (OR 3.8 [1.24-11.59]) and active infection (OR 1.82 [1.06-3.12]). Further, allogeneic hematopoietic stem-cell transplantation (AlloHSCT) was performed in 8.2% in CR1. The 3-year overall survival (OS) was 34.8%. In a multivariate analysis, several factors were independently associated with a worse OS, including secondary AML (hazard ratio [HR] 2.14 [1.15-4.01]) and unfavorable cytogenetic risk (HR 1.81 [1.16-2.82]), whereas maintenance therapy (HR 0.53 [0.32-0.86]) and AlloHSCT (HR 0.40 [0.17-0.94]) were associated with better OS. CONCLUSIONS: This is the first multicenter report analyzing AML survival in Mexico. Challenges in this setting include a high induction-related mortality and low AlloHSCT rate, which should be addressed to improve outcomes.
Subject(s)
Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute , Registries , Adolescent , Adult , Aged , Aged, 80 and over , Developing Countries , Disease-Free Survival , Female , Humans , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/therapy , Male , Mexico/epidemiology , Middle Aged , Remission Induction , Survival Rate , Transplantation, HomologousABSTRACT
BACKGROUND: Novel therapies for multiple myeloma are not affordable for all healthcare systems. OBJECTIVES: The objectives of this study were to evaluate the response rates, overall survival, event-free survival, and toxicity of thalidomide and dexamethasone administered until best response in recently diagnosed patients with multiple myeloma. METHODS: All recently diagnosed multiple myeloma patients meeting the inclusion criteria received the same treatment with thalidomide and dexamethasone. RESULTS: We studied 28 patients. Overall response rate was 75%. Complete response, partial response, and very good partial response were 25.0, 32.1, and 17.9%, respectively. The most frequent adverse event related to therapy was neuropathy. Median overall survival was 66 months, and median event-free survival was 39 months (range, 27.6-50.4). Variables that negatively affected overall survival on multivariate analysis included the presence of extramedullary disease, t(14;16), and chromosome 13 deletion. CONCLUSIONS: Induction therapy with thalidomide and dexamethasone until obtaining the best response in patients with recently diagnosed multiple myeloma was a useful and safe strategy. It represents an alternative for patients with limited access to costly drugs.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Multiple Myeloma/drug therapy , Neoadjuvant Therapy/methods , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Dexamethasone/administration & dosage , Disease-Free Survival , Female , Humans , Male , Middle Aged , Multiple Myeloma/pathology , Pilot Projects , Survival Rate , Thalidomide/administration & dosage , Treatment OutcomeABSTRACT
Anemia is almost unavoidable in the last stages of chronic kidney disease. It is defined as a condition where hemoglobin concentration is below 2 standard deviations from the mean hemoglobin level of the general population, corrected for age and sex (typically, hemoglobin < 13 g/dL in adults and 12 g/dL in women). Although the cause is multi-factorial, the most known is inadequate erythropoietin production. Anemia has been associated with poor prognosis in patients with several conditions such as cancer, chronic kidney disease and congestive heart failure. Treatment with erythropoiesis-stimulating agents, such as erythropoietin, is a logical strategy that has enabled clinical improvement and reduced transfusion requirements for the patients; however, total correction of anemia with erythropoiesis-stimulating agents has demonstrated an increase in the risk of mortality or cardiovascular complications associated with these agents. In randomized trials, the achievement of normal or nearly normal hemoglobin levels is not associated with improved survival and reduced cardiovascular risk; however the ideal hemoglobin level with the use of erythropoiesis-stimulating agents seems to be problematic. More information is needed in order to obtain definite conclusions; in the meantime, using the lowest possible dose of erythropoietin seems to be the most prudent approach.
La anemia es casi inevitable en los últimos estadios de la insuficiencia renal crónica. Se define como la condición en la que la concentración de hemoglobina está por debajo de 2 desviaciones estándar del nivel medio de hemoglobina de la población general, corregida para edad y sexo (generalmente hemoglobina < 13 g/dL en hombres y < 12 g/dL en mujeres). Aunque la causa es multifactorial, la más conocida es la inadecuada producción de eritropoyetina. La anemia ha sido relacionada con pobre pronóstico en los pacientes con cáncer, enfermedad renal crónica o falla cardiaca congestiva. El tratamiento con agentes estimulantes de la eritropoyesis, como la eritropoyetina, es una estrategia lógica con la que se ha conseguido mejoría clínica de los pacientes y menos necesidades transfusionales, sin embargo, la corrección total de la anemia con agentes estimulantes de la eritropoyesis ha demostrado incremento en el riesgo de mortalidad y de complicaciones cardiovasculares. En estudios aleatorizados se ha demostrado que conseguir un nivel de hemoglobina normal o cerca del normal no se relaciona con mejoría en la supervivencia ni reducción del riesgo cardiovascular; además, el nivel de hemoglobina ideal con el uso de agentes estimulantes de eritropoyesis parece ser un problema. Se necesita más información para obtener conclusiones definitivas, mientras tanto, al parecer, lo más sensato es usar la dosis de eritropoyetina más baja posible.
Subject(s)
Anemia/etiology , Renal Insufficiency, Chronic/complications , Anemia/diagnosis , Anemia/drug therapy , Hematinics/therapeutic use , Humans , Risk Factors , Treatment OutcomeABSTRACT
Hemophilia is a genetic disease in which the clinical manifestation is mainly the presence of hemorrhage. There are two known types of hemophilia: hemophilia A and B, which have a deficiency of factor VIII or IX clotting, respectively. The intensity of bleeding in hemophilia depends on the plasma levels of factor VIII or IX and has traditionally been classified as mild (> 5 % activity), moderate (1-5 % activity) and severe (< 1 % activity). In laboratory tests, isolated prolongation of activated partial thromboplastin time (aPTT) can be found, but it is necessary to determine the plasma levels of factor VIII or IX to establish the diagnosis of hemophilia A or B. The treating of this disease involves replacing exogenous factor VIII or IX concentrates. Gene therapy could be an option in the future to achieve the cure of the disease. Complications of hemophilia are the risk of transfusion-associated infections, pseudotumor hemophilic, hemophilic arthropathy and the presence of serum inhibitors.
La hemofilia es una enfermedad genética en la que las manifestaciones clínicas consisten básicamente en la presencia de hemorragias. Se conocen dos tipos de hemofilia: A y B, las cuales se originan por la deficiencia de los factores VIII y IX de la coagulación, respectivamente. La intensidad de la hemorragia en la hemofilia depende de los niveles plasmáticos del factor VIII o IX y tradicionalmente se ha clasificado como leve (> 5 % de actividad), moderada (de 1 a 5 % de actividad) y severa (< 1 % de actividad). En las pruebas se identifica prolongación aislada del tiempo de tromboplastina parcial activada (TTPa), pero es necesario determinar los niveles plasmáticos del factor VIII o IX para establecer el diagnóstico de hemofilia A o B. El tratamiento de esta enfermedad consiste en la reposición exógena con concentrados del factor VIII o IX. En el futuro, la terapia genética podría ser una opción para lograr la curación de la enfermedad. Las complicaciones de la hemofilia son el riesgo de infecciones relacionadas con las transfusiones, el pseudotumor hemofílico, la artropatía hemofílica y la presencia de inhibidores.
