ABSTRACT
El objetivo principal de la guía es proporcionar a los profesionales sanitarios, recomendaciones para la prevención, el diagnóstico y el manejo terapéutico de los pacientes con Linfoma B Difuso de célula grande (LBDCG), que presentan (o tienen riesgo de) afectación leptomeníngea o del parénquima cerebral por una recaída en el SNC del LBDG.
Subject(s)
Humans , Central Nervous System Diseases/etiology , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Large B-Cell, Diffuse/drug therapy , Rituximab/therapeutic use , Antineoplastic Agents/therapeutic use , Spinal Puncture/methods , Biopsy/methods , Magnetic Resonance Spectroscopy/methods , Central Nervous System Diseases/prevention & control , Methotrexate/therapeutic use , GRADE ApproachABSTRACT
BACKGROUND: We have evaluated the ex vivo pharmacology of single drugs and drug combinations in malignant cells of bone marrow samples from 125 patients with acute myeloid leukemia using a novel automated flow cytometry-based platform (ExviTech). We have improved previous ex vivo drug testing with 4 innovations: identifying individual leukemic cells, using intact whole blood during the incubation, using an automated platform that escalates reliably data, and performing analyses pharmacodynamic population models. PATIENTS AND METHODS: Samples were sent from 24 hospitals to a central laboratory and incubated for 48 hours in whole blood, after which drug activity was measured in terms of depletion of leukemic cells. RESULTS: The sensitivity of single drugs is assessed for standard efficacy (EMAX) and potency (EC50) variables, ranked as percentiles within the population. The sensitivity of drug-combination treatments is assessed for the synergism achieved in each patient sample. We found a large variability among patient samples in the dose-response curves to a single drug or combination treatment. CONCLUSION: We hypothesize that the use of the individual patient ex vivo pharmacological profiles may help to guide a personalized treatment selection.