Plerixafor plus granulocyte CSF can mobilize hematopoietic stem cells from multiple myeloma and lymphoma patients failing previous mobilization attempts: EU compassionate use data.

Plerixafor was recently approved by the US Food and Drug Administration (FDA) and the European Medicines Evaluation Agency (EMEA) to enhance stem cell mobilization for autologous transplant in patients with lymphoma and multiple myeloma. In this study, we present the first European compassionate use experience in mobilization failures, patients who are hardest to remobilize but were not included in registration trials. A total of 56 consecutive patients from 15 centers in Spain and the United Kingdom were included: age 60 (33-69) years; 29 men (32 with myeloma and 24 with lymphoma); 2 lines of previous chemotherapy (1-10); 73 previously failed mobilization attempts with G-CSF (28), chemotherapy plus G-CSF (43) or G-CSF plus SCF(2). Overall, 71% of patients reached ≥ 10 CD34+ cells per µL with plerixafor on day 5 after a 7.6-fold expansion from day 4. A total of 42 patients (75%) collected ≥ 2 × 106, average 3.0 ± 1.7 (0.4-10.6) CD34+ cells per kg with plerixafor plus G-CSF. There were no severe drug-related adverse events. In all, 35 patients (63%) underwent transplant, receiving an average of 3.1±1.2 (1.9-7.7) × 106 CD34+ cells per kg. All patients engrafted neutrophils (day 12; 13.4 ± 0.8; 8-30) and platelets (day 15; 18.5 ± 2.4; 8-33). In our experience, plerixafor offers an effective alternative to collect sufficient CD34+ cells for autologous SCT from patients who fail conventional mobilization methods, with good tolerance and a high success rate.

[Characteristics of metastatic prostate cancer occurring in patients under 50 years of age]. / Patrón de presentación del cáncer de próstata avanzado en pacientes menores de cincuenta años.

OBJECTIVE: To identify the clinical features, diagnostic approach, and treatment of metastatic prostate cancer in young adult patients. METHODS: A retrospective review was made of the clinical histories of patients under 50 years of age diagnosed with prostate cancer at the urology department of the National Institute for Neoplastic Diseases from 1952 to 2005. Demographic characteristics and data on history, symptoms, diagnostic procedures, treatment, and disease course were collected. Data were statistically analyzed and compared to information obtained from a literature search. RESULTS: There were 69 patients aged less than 50 years who had been diagnosed with prostate cancer, 60% of whom had metastatic tumors. Mean patient age was 45.5 years, with a lower range of 29. All patients reported bone pain, associated to other signs and symptoms such as spinal cord compression (19.5%), lower limb edema (17%), peripheral adenopathies (36.5%), and abdominal tumor (2.4%). All patients had bone metastases, of which 14.6% were in solid organs (lung and liver), 48.7% in retroperitoneum, and 7.3% in mediastinum. Initially, three patients were diagnosed a lymphoproliferative syndrome, one patient a retroperitoneal tumor of unknown etiology, and four patients a metastasis from an unknown primary tumor. Mean prostate-specific antigen (PSA) level was 795 ng/mL (3-6500). All pathologies were reported as poorly differentiated or undifferentiated. Mean survival was 16.1 months (1-84), and all patients died due to disease progression. CONCLUSIONS: Advanced prostate cancer is an uncommon condition in young adults. Its clinical presentation is atypical, as metastases may mimic other diseases. The course of disease is indolent, and prognosis is poor. In patients with risk factors, PSA testing should be started before 50 years of age.

Patrón de presentación del cáncer de próstata avanzado en pacientes menores de cincuenta años / Characteristics of metastatic prostate cancer ocurring in patients under 50 years of age

Objetivo: Identificar las características clínico-patológicas de presentación del cáncer de próstata avanzado en pacientes menores de 50 años. Material y métodos: Se revisaron retrospectivamente historias clínicas de pacientes menores de 50 años con diagnóstico de cáncer de próstata avanzado del departamento de Urología del Instituto Nacional de Enfermedades Neoplasicas de 1952–2005. Se recopiló datos de filiación, antecedentes, sintomatología, métodos diagnósticos, tratamiento y evolución de la enfermedad. Se analizó estadísticamente y evaluó comparativamente con la información obtenida en la revisión de la literatura. Resultados: Se encontraron 69 pacientes menores de 50 años con diagnóstico de cáncer de próstata de los cuales 41 (60%) fueron metastásicos. El promedio de edad fue 45,5 años con un rango inferior de 29. Todos refirieron dolor óseo, asociado a otros signos y síntomas como compresión medular (19,5%), edema en miembros inferiores (17%), adenopatías periféricas (36,5%) y tumor abdominal (2,4%). El 100% presentaba metástasis ósea, 14,6% en vísceras sólidas (pulmón e hígado), 48,7% en retroperitoneo y 7,3% en mediastino. Inicialmente, 3 casos fueron catalogados como síndrome linfoproliferativo, uno como tumor retroperitoneal de etiología a determinar y 4 como metástasis de primario no conocido. El promedio del antígeno prostático especifico fue 795ng/ml (3–6.500). Todas las patologías fueron informadas como pobremente diferenciadas o indiferenciadas. La sobrevida promedio fue 16,1 meses (1–84), todos fallecieron por evolución de la enfermedad. Conclusiones: El cáncer de próstata avanzado en pacientes adultos jóvenes es una patología poco frecuente. La presentación clínica no es la típica, las metástasis pueden simular otras patologías. La evolución es torpida, con pronóstico pobre. En pacientes con factores de riesgo, se debe iniciar el estudio del antígeno prostático especifico antes de los 50 años (AU)

Objective: To identify the clinical features, diagnostic approach, and treatment of metastatic prostate cancer in young adult patients. Methods: A retrospective review was made of the clinical histories of patients under 50 years of age diagnosed with prostate cancer at the urology department of the National Institute for Neoplastic Diseases from 1952 to 2005. Demographic characteristics and data on history, symptoms, diagnostic procedures, treatment, and disease course were collected. Data were statistically analyzed and compared to information obtained from a literature search. Results: There were 69 patients aged less than 50 years who had been diagnosed with prostate cancer, 60% of whom had metastatic tumors. Mean patient age was 45.5 years, with a lower range of 29. All patients reported bone pain, associated to other signs and symptoms such as spinal cord compression (19.5%), lower limb edema (17%), peripheral adenopathies (36.5%), and abdominal tumor (2.4%). All patients had bone metastases, of which 14.6% were in solid organs (lung and liver), 48.7% in retroperitoneum, and 7.3% in mediastinum. Initially, three patients were diagnosed a lymphoproliferative syndrome, one patient a retroperitoneal tumor of unknown etiology, and four patients a metastasis from an unknown primary tumor. Mean prostate-specific antigen (PSA) level was 795ng/mL (3–6500). All pathologies were reported as poorly differentiated or undifferentiated. Mean survival was 16.1 months (1–84), and all patients died due to disease progression. Conclusions: Advanced prostate cancer is an uncommon condition in young adults. Its clinical presentation is atypical, as metastases may mimic other diseases. The course of disease is indolent, and prognosis is poor. In patients with risk factors, PSA testing should be started before 50 years of age (AU)

Disappearance of lupus anticoagulant after allogeneic bone marrow transplantation.

Lupus anticoagulant antibodies have never been reported to disappear after either allogeneic or autologous bone marrow transplantation in humans. We report the first case of disappearance of lupus anticoagulant antibodies in a patient without systemic lupus erythematosus or clinical evidence of other autoimmune disorders, who received an allogeneic bone marrow transplant as treatment for chronic myeloid leukemia. Although marrow transplantation is not a recognized therapy for antiphospholipid syndrome, our observation should be considered another example of the capability of intensive chemo-radiotherapy followed by stem cell transplantation to ablate a pathologic marrow clone resulting in an autoimmune disorder and improve, or even cure, some severe autoimmune diseases.

[Morbidity and mortality related to gastroenteroanastomosis in advanced gastric cancer]. / Morbilidad y mortalidad por gastroenteroanastomosis en cancer gástrico avanzado.

OBJECTIVE: Determination of the postoperative morbidity and mortality after gastroenterostomy in patients with unresectable gastric cancer. STUDY DESIGN: Retrospective review of clinical records of all patients with obstructive distal gastric cancer who underwent gastroenterostomy at the Instituto de Enfermedades Neoplásicas between 1980 and 1993. The following factors were analyzed: age, sex, hemoglobin, albumin, preoperative risk, ascites, extent of disease, operative time, hospital stay, morbidity and mortality. RESULTS: 198 gastroenterostomy were done with a morbidity and mortality rates of 20% and 10%, respectively. Pneumonia was the principal cause of postoperative morbidity and mortality. High operative risk, adjacent organ invasion by the tumor and peritoneal metastasis were factors associated with increased postoperative morbidity (p > 0.05). High operative risk was the only prognostic factor for postoperative mortality (p < 0.01). CONCLUSIONS: Because of high postoperative morbidity and mortality, gastroenterostomy should not be done in patients with unresectable gastric cancer and high preoperative risk.

[Epidemiological data on chronic myeloid leukemia in Asturias, 1972-1986]. / Datos epidemiológicos de la leucemia mieloide crónica en Asturias durante el periodo 1972-1986.

PURPOSE: To evaluate the incidence of CML in Asturias during the period 1972-1986, studying the variations in relation to age, sex and geographical zone. MATERIAL AND METHODS: Information relating to the date of diagnosis, name, age, sex and home address of the 108 cases (65 men and 43 women) diagnosed CML during the period 1972-1986 according to conventional criteria was collected from the hospital records of the region. For the calculations, SADEI demographic data were taken as a reference, comparing the incidence between sexes and geographical zones by means of the CHI2. RESULTS: A rate of incidence of 0.64/100,000 inhabitants/year was obtained, this being 0.8 in men and 0.5 in women (p < 0.05). The rate of incidence increased progressively with age until the 45-59 age group when it was maximum. There were no differences between the three main centres of population Gijón (0.53), Oviedo (0.55) and Avilés (0.69) nor the latter with the rest of the zones in Asturias; nor was three either any difference between coastal towns (0.56) and those of the interior (0.71) (p = NS). CONCLUSIONS: Limited incidence of CML in Asturias without significant differences in its geographical distribution within the region. The incidence, which was higher among males, increased progressively with age until reaching maximum importance in the 45-59 age group.

[Differentiated thyroid carcinoma in childhood]. / Carcinoma diferenciado de tiroides en la edad pediátrica.

We report the cases of 6 patients, all younger than 14 years of age, with differentiated thyroid carcinoma. None of the patients had a previous history of radiation exposure. All patients presented with an enlarged thyroid gland as a solitary nodule, with or without cervical nodes. The fine-needle aspiration cytological examination was found to be the most sensitive and specific, evidencing 5 pure papillary adenocarcinoma and 1 follicular. Our standard preoperative evaluation included thyroid scintiscan and ultrasound examination, laboratory studies of thyroid function and serum calcitonin, chest x-ray, fine needle aspiration and vocal cord examination. The treatment was total thyroidectomy and bilateral modified neck dissection. A whole body scan (WBS) with 131I was performed 6 weeks after surgery, followed by radioiodine therapy for ablation of thyroid remnants and treatment of metastases when present. Patients then began thyroid replacement treatment. The follow-up of the patients consisted of thyroglobulin and WBS. The microscopic carcinoma was found in the contralateral lobe in 100%. Lung metastases were detected in 2 patients. All of the patients have survived during a follow-up period ranging from 6 to 108 months.