ABSTRACT
PURPOSE: We evaluate the effectiveness and toxicity of high-dose sequential chemotherapy (HDS) as salvage therapy in patients with advanced-stage Hodgkin lymphoma. PATIENTS AND METHODS: We performed a retrospective analysis on 77 patients receiving HDS between 1998 and 2006. Patients enrolled were in disease progression or relapsed disease, or did not achieve a complete remission after first-line treatment. HDS consisted of the sequential administration of cyclophosphamide and granulocyte colony-stimulating factor with stem cell harvesting, followed by methotrexate plus vincristine and etoposide. RESULTS: The majority of patients had stage III/IV (64%) and B symptoms (71.4%). Disease status improvement after HDS was observed in 24 of 57 patients (42%) previously in disease progression or relapse. HDS-related deaths occurred in 8 of 77 patients (10.4%). Four patients (5.2%) developed acute myeloid leukemia/myelodysplastic syndrome. Overall, disease-free and progression-free survival was 27%, 57%, and 25%, respectively. CONCLUSION: Despite the treatment-related mortality, HDS is feasible, with satisfactory response rates, even in patients with poor prognosis.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hematopoietic Stem Cell Transplantation , Hodgkin Disease/therapy , Adolescent , Adult , Aged , Child , Disease-Free Survival , Female , Hodgkin Disease/mortality , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Transplantation, AutologousABSTRACT
Analisamos a experiência do Hospital das Clínicas da Unicamp com plasmaferese: (PF) na miastania grave (MG). 17,8 % do total dos casos de MG submeteu-se a PF, 26 casos, 19 mulheres e sete homens. A idade média de início da MG foi 28 anos (extremos 11 e 69). O menor déficit clínico foi IIb (O & G) e IIIa (MGFA). A PF foi indicada no pré-operatório de timectomia em um caso e em sete devido a crise miastênica. Em 18 casos, com MG generalizada e sintomas bulbares ou com exacerbação de déficit prévio, a PF foi indicada como intervenção aguda. Em dois pacientes desse grupo ela foi indicada também em regime crônico de ciclos mensais. Os 26 pacientes submeteram-se a 44 ciclos e a 171 sessões de PF. O número médio de sessões em cada ciclo foi 3,9 (DP ± 1,4); mediana de 5, extremos 2 e 6. O tempo médio de cada sessão foi 106,5 minutos (DP ± 35,2); mediana de 100,5 (extremos 55 e 215).O volume médio de plasma trocado em cada sessão foi 2396 ml (DP ± 561); mediana 2225 (extremos 1512 e 4500). Efeitos colaterais foram reversíveis: hipotensão (sete casos), tremor ou parestesias leves (sete casos). Taxas de infecção e mortalidade devido a PF foram zero. A totalidade dos pacientes teve benefícios imediatos a cada ciclo de PF e usualmente receberam prednisona ou outro imunossupressor. Houve boa aceitação ao procedimento em 80,7% dos pacientes.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Myasthenia Gravis/therapy , Plasmapheresis , Plasmapheresis/adverse effects , Retrospective Studies , Treatment OutcomeABSTRACT
Flow cytometric characterization of platelet membrane glycoproteins expression and procoagulant surface is a sensitive technique to identify platelet activation in platelet concentrates. Platelet activation could contribute to platelet storage lesion reducing platelet viability and its hemostatic function. Detection of activation in platelet concentrates may help to determine the mechanism by which platelets activate during preparation and storage. It may also suggest interventions to prevent and reduce the platelet storage lesion. A monoclonal antibody panel that evaluate glycoproteins IIb-IIIa and Ib-IX migration, platelet degranulation and platelet procoagulant surface would provide more information about platelet activation than activation-dependent monoclonal antibodies alone
Flow cytometric characterization of platelet membraneglycoprotein expression and procoagulant surface is asensitive technique to identify platelet activation inplatelet concentrates. Platelet activation couldcontribute to platelet storage lesion reducing plateletviability and its hemostatic function. Detection ofactivation in platelet concentrates may help to determinethe mechanism by which platelets are activatedduring preparation and storage. It may also suggestmethods of intervention to prevent and reduce theplatelet storage lesion. A monoclonal antibody panelthat evaluates glycoproteins IIb-IIIa and Ib-IXmigration, platelet degranulation and plateletprocoagulant surface would provide more informationabout platelet activation than activation-dependentmonoclonal antibodies alone.
