Subject(s)
Antimetabolites, Antineoplastic/therapeutic use , Azacitidine/analogs & derivatives , Azacitidine/therapeutic use , Leukemia, Myelomonocytic, Chronic/drug therapy , Adult , Aged , DNA Methylation/drug effects , Decitabine , Female , Humans , Leukemia, Myelomonocytic, Chronic/mortality , Male , Middle Aged , Myelodysplastic Syndromes/drug therapy , Myelodysplastic-Myeloproliferative Diseases/drug therapy , Survival Analysis , Treatment OutcomeABSTRACT
INTRODUCTION: Limited data is available on the feasibility of high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (AHSCT) in elderly patients over 70 years of age with non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: In the setting of the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC) group, we retrospectively analyzed 81 consecutive patients with NHL over 70 years of age who received AHSCT. RESULTS: The median age at AHSCT was 72.3 years [70-80]. Patients' were diagnosed with diffuse large B-cell lymphoma (n=40), follicular lymphoma (n=16), mantle cell lymphoma (n=15), T-cell lymphoma (n=5), and other (n=5). Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) was 0 in 73% of patients. Main conditionings were BEAM (Carmustine-Etoposide-Cytarabine-Melphalan, n=61) and melphalan alone (n=14). Median delays to reach 0.5×109/L neutrophils and 20 × 10(9)/L platelets were of 12 [9-76] days and 12 [0-143] days, respectively. One hundred day and one year cumulative incidence of NRM was 5.4% and 8.5%, respectively. The main cause of death remains relapse. CONCLUSION: In conclusion, this study revealed that AHSCT seemed to be acceptable in patients over 70 years of age with NHL. Patient age is not a limiting factor if clinical condition is adequate.
Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Lymphoma, Non-Hodgkin/therapy , Societies, Medical , Aged , Aged, 80 and over , Bone Marrow Transplantation , Cell- and Tissue-Based Therapy , Disease-Free Survival , Female , Follow-Up Studies , France/epidemiology , Humans , Incidence , Lymphoma, Non-Hodgkin/epidemiology , Male , Prevalence , Retrospective Studies , Survival Rate/trendsABSTRACT
Posttransplantation lymphoproliferative disorders (PTLDs) are life-threatening complications after solid organ and hematopoietic stem cell transplantation. Only half of CD20-positive PTLDs respond to rituximab monotherapy, and outcomes remain poor for patients with relapsed/refractory disease, especially those who do not qualify for an anthracycline containing regimen due to frailty or comorbidities. Radioimmunotherapy (RIT) might be an option in this particular setting. We report a panel of eight patients with rituximab refractory/relapsed CD20-positive PTLDs including three ineligible for subsequent CHOP-like chemotherapy who received (90) Y-Ibritumomab tiuxetan as a single agent (n = 7) or combined to chemotherapy (n = 1). Five out of eight patients were kidney transplant recipients, while 2/8 had a liver transplant and 1/8 had a heart transplant. Patients received a median of two previous therapies. Overall response rate was 62.5%. Importantly, all responders achieved complete response. At a median follow-up of 37 months [5; 84], complete response was ongoing in four patients. Toxicity was predominantly hematological and easily manageable. No graft rejection was noticed concomitantly or following RIT administration despite immunosuppression reduction after diagnosis of PTLDs. This report emphasizes the potential efficiency of salvage RIT for early rituximab refractory PTLDs without any unexpected toxicity.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Graft Rejection/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Lymphoproliferative Disorders/therapy , Organ Transplantation/adverse effects , Radioimmunotherapy , Rituximab/pharmacology , Adult , Aged , Drug Resistance , Female , Follow-Up Studies , Graft Rejection/etiology , Graft Rejection/pathology , Graft Survival , Humans , Immunosuppressive Agents/therapeutic use , Lymphoproliferative Disorders/etiology , Lymphoproliferative Disorders/pathology , Male , Middle Aged , Postoperative Complications , Prognosis , Retrospective Studies , Risk Factors , Salvage Therapy , Transplant RecipientsSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Leukemia, Myeloid, Acute/drug therapy , Adolescent , Adult , Age Factors , Daunorubicin/administration & dosage , Follow-Up Studies , Hematopoietic Stem Cell Transplantation , Humans , Idarubicin/administration & dosage , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/therapy , Middle Aged , Remission Induction , Transplantation, Homologous , Treatment Outcome , Young AdultSubject(s)
Biomarkers, Tumor/genetics , Chromosomal Instability , Leukemia, Lymphocytic, Chronic, B-Cell/genetics , Telomere/genetics , Aged , DNA, Neoplasm/genetics , Female , Humans , In Situ Hybridization, Fluorescence , Leukemia, Lymphocytic, Chronic, B-Cell/classification , Male , Neoplasm Staging , Prognosis , Prospective Studies , Real-Time Polymerase Chain Reaction , Shelterin Complex , Telomerase/genetics , Telomere-Binding Proteins/genetics , Telomeric Repeat Binding Protein 1/genetics , Telomeric Repeat Binding Protein 2/geneticsABSTRACT
In haematology units, acute abdominal symptoms are common and often challenging for the clinician in charge. Two haematological conditions that may induce specific diagnoses are of particular concern: neutropenia and haematopoietic stem cell transplantation. Clinical and biological manifestations, including abdominal pain, fever, diarrhoea, hepatic cytolysis, or cholestasis are often non-specific. Computed tomography is often the primary imaging screening technique performed in such patients, as it is widely available, performs well for this indication, and may demonstrate evocative findings. The aim of this review is to provide the spectrum of specific diagnoses encountered and the corresponding key CT features in patients presenting with acute abdominal disorders following neutropenia and/or haematopoietic stem cell transplantation.
Subject(s)
Abdomen, Acute/diagnostic imaging , Hematopoietic Stem Cell Transplantation/adverse effects , Neutropenia/complications , Tomography, X-Ray Computed , Abdomen, Acute/etiology , Humans , Radiography, AbdominalSubject(s)
Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/genetics , Neoplasm, Residual/diagnosis , Neoplasm, Residual/genetics , Oncogene Proteins, Fusion/genetics , Adolescent , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Child , Child, Preschool , Chromosomes, Human, Pair 16/genetics , Female , France , Gene Rearrangement , Humans , Leukemia, Myeloid, Acute/drug therapy , Male , Middle Aged , Neoplasm, Residual/drug therapy , Retrospective Studies , Survival Rate , Treatment Outcome , Young AdultABSTRACT
Purpose. - Thalidomide, a major teratogen drug, was rehabilitated mainly in malignant hemopathy. Current knowledge and key points. - Thalidomide-mechanisms of action are well known, multiple, they combine immunomodulatory, antiangiogenic properties, and the modulation of cytokines, particularly tumour necrosis factor-alpha. Multiple trials are ongoing, however, the main indication remain multiple myeloma with a response rate of 30% in relapsed patients. Future prospects and projects. - New structural analogues of the thalidomide which priviligiate some of the thalidomide-specific mechanisms of action, the selected cytokine inhibitory drugs (SelCIDS) and the immunomodulatory drugs (IMiDs) family are under evaluation. The IMiDs, which mechanism is based on stimulation of T lymphopoiesis rather than inhibition of tumour necrosis factor-alpha, are under clinical trials in multiple myeloma with interesting results.