ABSTRACT
Several studies have focused on investigation of the optimal salvage regimen to induce maximum response before autologous stem cell transplantation (ASCT) in patients with relapsed or refractory Hodgkin's disease (HD). However, in most of these studies, the follow-up is relatively short. In the present study, we report on long-term results of 55 consecutive patients with HD who received Mini-BEAM [BCNU (carmustine), etoposide, cytarabine, melphalan] as salvage therapy before ASCT. Eleven patients were refractory to front-line therapy, 17 were partial responders, and 27 patients had relapsed from HD. Twenty-eight patients achieved complete response, and 18 achieved partial response with a median of two cycles of Mini-BEAM, giving a total response rate of 84%. Significant factors predicting poor response (P < 0.05) were: initial treatment with MOPP (mechloroethamine, oncovin, procarbazine, prednisolone), > or = two previous chemotherapy regimens and three disease characteristics at Mini-BEAM treatment: presence of B symptoms, extranodal involvement or low serum albumin. However, only the last two factors retained independent influence on multivariate analysis. In total, 45/55 patients have been transplanted. Median follow-up after Mini-BEAM administration for living patients is 68 months. At the time of reporting, 31 out of 55 patients (56.4%) are still alive, 21 patients (38%) have relapsed, three (5.4%) have developed secondary neoplasias, and five have died of other complications not related to disease progression. The actuarial 7-year overall survival (OS) was 52%, the progression-free survival (PFS) 54% and the event-free survival (EFS) 36%. The response to Mini-BEAM was the most important prognostic factor for predicting the long-term probability of surviving the disease: none of the eight patients who did not respond to Mini-BEAM were alive at 3 years. On multivariate analysis, response to Mini-BEAM and extranodal involvement before Mini-BEAM had a significant influence on OS. Our results show the safety and efficacy of Mini-BEAM before ASCT for refractory or relapsed HD patients.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Carmustine/administration & dosage , Cytarabine/administration & dosage , Hematopoietic Stem Cell Transplantation , Hodgkin Disease/drug therapy , Melphalan/administration & dosage , Podophyllotoxin/administration & dosage , Salvage Therapy , Adolescent , Adult , Age Factors , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Blood Sedimentation , Carmustine/adverse effects , Cytarabine/adverse effects , Female , Follow-Up Studies , Hodgkin Disease/surgery , Humans , Male , Melphalan/adverse effects , Middle Aged , Podophyllotoxin/adverse effects , Prognosis , Recurrence , Sex Factors , Survival Analysis , Transplantation, AutologousSubject(s)
Bone Marrow/pathology , Leukemia, Monocytic, Acute/diagnosis , Muramidase/urine , Nephrotic Syndrome/diagnosis , Proteinuria , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Diagnosis, Differential , Fatal Outcome , Humans , Leukemia, Monocytic, Acute/drug therapy , Leukemia, Monocytic, Acute/pathology , Leukemia, Monocytic, Acute/urine , Male , Muramidase/blood , Nephrotic Syndrome/urine , Remission InductionABSTRACT
No disponible
Subject(s)
Adult , Female , Humans , Gaucher Disease/complications , Gaucher Disease/diagnosis , Lipid Metabolism, Inborn Errors/diagnosis , Hepatomegaly/complications , Splenomegaly/complications , Pregnancy Complications, Hematologic/diagnosis , Pregnancy Complications, Hematologic/physiopathology , Diagnosis, Differential , Gaucher Disease/epidemiology , Gaucher Disease/physiopathology , Gaucher Disease , Pregnancy Complications/diagnosisABSTRACT
Clinical findings and response to treatment in four cases with plasma cell leukemia (PCL) out of 152 patients of multiple myeloma diagnosed at the Hospital La Paz from 1969 to 1988 are studied. Three of the four plasma cell leukemia cases presented a primary form, and one a secondary form. Our cases had a lower incidence of lymphadenopathy and splenomegaly than reported in previous series. The incidence of serum M band in PCL was similar to that found in multiple myeloma. The four patients received combination chemotherapy; one of them attained PR lasting for 2 months, and the remaining three failed to respond to similar therapy. The mean duration of survival was less than 8 months. Current treatments are reviewed.
