Subject(s)
Liver Failure, Acute/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Adolescent , Adult , Clinical Deterioration , Fatal Outcome , Female , Flow Cytometry , Humans , Liver Failure, Acute/diagnosis , Male , Pancytopenia/blood , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Young AdultABSTRACT
Hematological diseases may cause acute hepatic failure and are seldom sought. We report two cases illustrating this situation. A 16-year-old male presented with an acute liver failure: a bone marrow biopsy showed complete infiltration with lymphoid type blasts. A flow cytometry confirmed the presence of an acute lymphoblastic leukemia. The patient died days later. A 20-year-old female presented with acute liver failure: due to a pancytopenia, a bone marrow biopsy was performed, which confirmed the presence of an acute lymphoblastic leukemia. Chemotherapy was started immediately. The patient had a favorable evolution.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Liver Failure, Acute/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Pancytopenia/blood , Liver Failure, Acute/diagnosis , Fatal Outcome , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Flow Cytometry , Clinical DeteriorationABSTRACT
Background: The intensity of conditioning chemotherapy and radiotherapy in hematopoietic stem cell transplantation (HSCT) varies according to several factors including the patients age, pre-existing conditions and performance status. Myeloablative conditioning (MA) increases transplant related mortality and reduces survival in older patients. Reduced intensity conditioning (RIC) is a good option for these patients. Aim: To report our experience with HSCT in patients of different ages with acute leukemia. Material and Methods: Retrospective analysis of 115 allogeneic HSCT performed in patients with acute myeloid or lymphoblastic leukemia. Results: We analyzed the cohort of patients in groups according to age at transplantation: younger than 40 years (n = 74), 41 to 50 years (n = 25) and older than 51 years of age (n = 16). Overall survival (OS), Disease free survival (DFS) and relapse at five years were similar in both groups of patients younger than 50 years (OS 40 and 44% respectively, DFS 38 and 42% respectively and relapse 40% and 34% respectively, p = NS). Patients over 51 years had a five years OS of 12%. However when we analyzed those patients by date and conditioning we found that patients who were treated with MA regimens in the first decade of the transplant program (before 2000) had lower OS compared to those treated after 2000 with RIC (five years OS 49% and 12% respectively, p < 0.01). No significant differences in terms of OS, recurrence or incidence of graft-versus-host disease were found when comparing groups under 40 years, between 41 and 50 years and older than 51 years treated only with RIC. Conclusions: RIC provides the possibility of HSCT in older patients with rates comparable to those obtained in younger patients successfully treated with MA conditioning.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Leukemia, Myelomonocytic, Acute/surgery , Hematopoietic Stem Cell Transplantation/methods , Transplantation Conditioning/methods , Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery , Recurrence , Transplantation, Homologous/methods , Transplantation, Homologous/mortality , Survival Analysis , Retrospective Studies , Age Factors , Hematopoietic Stem Cell Transplantation/mortality , Disease-Free Survival , Transplantation Conditioning/mortalityABSTRACT
BACKGROUND: The intensity of conditioning chemotherapy and radiotherapy in hematopoietic stem cell transplantation (HSCT) varies according to several factors including the patients age, pre-existing conditions and performance status. Myeloablative conditioning (MA) increases transplant related mortality and reduces survival in older patients. Reduced intensity conditioning (RIC) is a good option for these patients. AIM: To report our experience with HSCT in patients of different ages with acute leukemia. MATERIAL AND METHODS: Retrospective analysis of 115 allogeneic HSCT performed in patients with acute myeloid or lymphoblastic leukemia. RESULTS: We analyzed the cohort of patients in groups according to age at transplantation: younger than 40 years (n = 74), 41 to 50 years (n = 25) and older than 51 years of age (n = 16). Overall survival (OS), Disease free survival (DFS) and relapse at five years were similar in both groups of patients younger than 50 years (OS 40 and 44% respectively, DFS 38 and 42% respectively and relapse 40% and 34% respectively, p = NS). Patients over 51 years had a five years OS of 12%. However when we analyzed those patients by date and conditioning we found that patients who were treated with MA regimens in the first decade of the transplant program (before 2000) had lower OS compared to those treated after 2000 with RIC (five years OS 49% and 12% respectively, p < 0.01). No significant differences in terms of OS, recurrence or incidence of graft-versus-host disease were found when comparing groups under 40 years, between 41 and 50 years and older than 51 years treated only with RIC. CONCLUSIONS: RIC provides the possibility of HSCT in older patients with rates comparable to those obtained in younger patients successfully treated with MA conditioning.
Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Leukemia, Myeloid, Acute/surgery , Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery , Transplantation Conditioning/methods , Adolescent , Adult , Age Factors , Disease-Free Survival , Female , Hematopoietic Stem Cell Transplantation/mortality , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Survival Analysis , Transplantation Conditioning/mortality , Transplantation, Homologous/methods , Transplantation, Homologous/mortality , Young AdultABSTRACT
Hemophagocytic syndrome is a severe condition of excessive immune activation that has a high mortality in the absence of treatment. The syndrome is classified as primary if associated with congenital or hereditary problems, or secondary/acquired if associated with infectious, autoimmune or oncology diseases. We report four adult cases of the syndrome, one with viral, two with autoimmune and one with idiopathic causes who were successfully treated with HLH 94-04 chemotherapy protocol. Our experience shows that a high index of suspicion, early diagnosis and an opportune therapy are essential in the treatment of this disease.
Subject(s)
Cyclosporine/therapeutic use , Dexamethasone/therapeutic use , Etoposide/therapeutic use , Immunosuppressive Agents/therapeutic use , Lymphohistiocytosis, Hemophagocytic/drug therapy , Methotrexate/therapeutic use , Adult , Drug Therapy, Combination/methods , Early Diagnosis , Female , Ferritins/blood , Humans , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/physiopathology , Male , Young AdultABSTRACT
Hemophagocytic syndrome is a severe condition of excessive immune activation that has a high mortality in the absence of treatment. The syndrome is classified as primary if associated with congenital or hereditary problems, or secondary/acquired if associated with infectious, autoimmune or oncology diseases. We report four adult cases of the syndrome, one with viral, two with autoimmune and one with idiopathic causes who were successfully treated with HLH 94-04 chemotherapy protocol. Our experience shows that a high index of suspicion, early diagnosis and an opportune therapy are essential in the treatment of this disease.
Subject(s)
Adult , Female , Humans , Male , Young Adult , Cyclosporine/therapeutic use , Dexamethasone/therapeutic use , Etoposide/therapeutic use , Immunosuppressive Agents/therapeutic use , Lymphohistiocytosis, Hemophagocytic/drug therapy , Methotrexate/therapeutic use , Drug Therapy, Combination/methods , Early Diagnosis , Ferritins/blood , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/physiopathologyABSTRACT
Hematopoietic precursors transplantation is a therapeutic alternative for leukemia, some metabolic diseases and some immune deficiency syndromes. In its allogeneic variety leukemia eradication is based in the conditioning prior to transplantation and the allograñ effect against leukemia. Umbilical cord blood is an alternative source of hematopoietic precursors when there are no HLA compatible relatives available. Between 2003 and 2007 we have performed five umbilical cord blood transplant in adult patients in a University hospital. All patients had malignant diseases. Conditioning protocols were ablative in all except in one patient and in all, more than one unit of umbilical cord blood was used. Hematopoietic engraftment was confirmed in all patients and the main complications registered were infectious and associated to immunosuppression.
Subject(s)
Cord Blood Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/adverse effects , Leukemia, Myeloid/surgery , Adolescent , Adult , Chile , Fatal Outcome , Female , Humans , Male , Middle Aged , Remission Induction , Transplantation Conditioning , Young AdultABSTRACT
Hematopoietic precursors transplantation is a therapeutic alternative for leukemia, some metabolic diseases and some immune deficiency syndromes. In its allogeneic variety leukemia eradication is based in the conditioning prior to transplantation and the allograñ effect against leukemia. Umbilical cord blood is an alternative source of hematopoietic precursors when there are no HLA compatible relatives available. Between 2003 and 2007 we have performed five umbilical cord blood transplant in adult patients in a University hospital. All patients had malignant diseases. Conditioning protocols were ablative in all except in one patient and in all, more than one unit of umbilical cord blood was used. Hematopoietic engraftment was confirmed in all patients and the main complications registered were infectious and associated to immunosuppression.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Cord Blood Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/adverse effects , Leukemia, Myeloid/surgery , Chile , Fatal Outcome , Remission Induction , Transplantation Conditioning , Young AdultABSTRACT
Background: Severe acquired aplastic anemia (SAA) is an uncommon disease of childhood. Patients with SAA receive supportive care with transfusions and timely treatment of opportunistic infections, along with specific therapies, which may be allogenic stem cell transplantation (SCT) from a matched sibling or immunosupressive therapy (IT). Aim: To report the experience in the management of SAA. Patients and methods: Twenty five children with acquired SAA were treated from July 1992 to September 2005. Patients with full matched sibling donors received allogenic SCT after conditioning with a cyclophosphamide containing regimen. The other patients received immune suppression with cyclosporine plus methylprednisolone (n= 18) plus ATG (n=17). All received supportive care until recovery of hematopoietic function. Those who had severe opportunistic infections at diagnosis or did not respond to two cycles of ATG were evaluated for unrelated donor SCT. Results: Seven patients received sibling donor SCT and 18 IT, which was repeated in six. Three patients received mismatched related (1) or unrelated (2) SCT. Nineteen patients survived with a median follow up time of 4 years, 14 with full hematologic recovery. Six patients died: four due to infections after IT or SCT, one due to intracranial hemorrhage and one with secondary myelodysplasia 12 years after IT. Conclusions: Most children with SAA can be treated successfully with sibling donor SCT or IT. Patients without a histocompatible sibling who fail to respond to IS have a worse prognosis.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Anemia, Aplastic/therapy , Hematopoietic Stem Cell Transplantation , Immunosuppressive Agents/therapeutic use , Anemia, Aplastic/mortality , Combined Modality Therapy , Cyclophosphamide/therapeutic use , Cyclosporine/therapeutic use , Follow-Up Studies , Immunosuppressive Agents/adverse effects , Methylprednisolone/therapeutic use , Prognosis , Risk Factors , Severity of Illness Index , Transplantation, Homologous , Treatment OutcomeABSTRACT
BACKGROUND: Severe acquired aplastic anemia (SAA) is an uncommon disease of childhood. Patients with SAA receive supportive care with transfusions and timely treatment of opportunistic infections, along with specific therapies, which may be allogenic stem cell transplantation (SCT) from a matched sibling or immunosuppressive therapy (IT). AIM: To report the experience in the management of SAA. PATIENTS AND METHODS: Twenty five children with acquired SAA were treated from July 1992 to September 2005. Patients with full matched sibling donors received allogenic SCT after conditioning with a cyclophosphamide containing regimen. The other patients received immune suppression with cyclosporine plus methylprednisolone (n= 18) plus ATG (n=17). All received supportive care until recovery of hematopoietic function. Those who had severe opportunistic infections at diagnosis or did not respond to two cycles of ATG were evaluated for unrelated donor SCT. RESULTS: Seven patients received sibling donor SCT and 18 IT, which was repeated in six. Three patients received mismatched related (1) or unrelated (2) SCT. Nineteen patients survived with a median follow up time of 4 years, 14 with full hematologic recovery. Six patients died: four due to infections after IT or SCT, one due to intracranial hemorrhage and one with secondary myelodysplasia 12 years after IT. CONCLUSIONS: Most children with SAA can be treated successfully with sibling donor SCT or IT. Patients without a histocompatible sibling who fail to respond to IS have a worse prognosis.
Subject(s)
Anemia, Aplastic/therapy , Hematopoietic Stem Cell Transplantation , Immunosuppressive Agents/therapeutic use , Adolescent , Anemia, Aplastic/mortality , Child , Child, Preschool , Combined Modality Therapy , Cyclophosphamide/therapeutic use , Cyclosporine/therapeutic use , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/adverse effects , Male , Methylprednisolone/therapeutic use , Prognosis , Risk Factors , Severity of Illness Index , Transplantation, Homologous , Treatment OutcomeABSTRACT
Background: Treatment of intermediate and high grade non-Hodgkin lymphoma (NHL) includes chemotherapy with or without radiotherapy, depending on the clinical stage. The standard treatment for advanced NHL is 8 cycles of combined chemotherapy, cyclophosphamide, adriamicin, vincristine and prednisone (CHOP). Patients presenting with localized disease are treated with fewer chemotherapy cycles and involved field radiotherapy, with good results. Aim: To evaluate the treatment results including overall survival (OS) and event-free survival (EFS) in localized aggressive NHL patients treated at the Pontificia Universidad Católica de Chile, Clinical Hospital. Patients and Methods: Retrospective analysis of all patients with Ann Arbor stages I and II referred to the hematology and radiotherapy clinic between 1998 and 2003. OS and EFS analysis was made according to the Kaplan and Meier method. Log-rank and Cox methods were used for univariate and multivariate analyses, respectively. Chemotherapy and radiotherapy toxicities were scored according to World Health Organization (WHO) and Radiation Therapy Oncology Group (RTOG) scales, respectively. Results: 39 patients (20 men), aged between 20 to 85 years, were the source for this study. The average follow-up was 51 months (range 6-115). The 5 years OS and EFS were 72,4 percent and 63,3 percent, respectively. On univariate analysis, age over 60 was the only variable that affected negatively OS and EFS. Acute toxicity caused by chemotherapy and radiotherapy was uncommon. Conclusions: Age over 60 was the only independent variable associated with poor prognosis. The number of chemotherapy cycles and the drug combination did not influence the results. These results support the usefullness of a shortened chemotherapy regimen plus involved field radiotherapy.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/radiotherapy , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Combined Modality Therapy/methods , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Disease-Free Survival , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Etoposide/administration & dosage , Etoposide/adverse effects , Follow-Up Studies , Lymphoma, Non-Hodgkin/mortality , Neoplasm Staging , Prednisone/administration & dosage , Prednisone/adverse effects , Prognosis , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Survival Analysis , Treatment Outcome , Vincristine/administration & dosage , Vincristine/adverse effectsABSTRACT
BACKGROUND: Treatment of intermediate and high grade non-Hodgkin lymphoma (NHL) includes chemotherapy with or without radiotherapy, depending on the clinical stage. The standard treatment for advanced NHL is 8 cycles of combined chemotherapy, cyclophosphamide, adriamycin, vincristine and prednisone (CHOP). Patients presenting with localized disease are treated with fewer chemotherapy cycles and involved field radiotherapy, with good results. AIM: To evaluate the treatment results including overall survival (OS) and event-free survival (EFS) in localized aggressive NHL patients treated at the Pontificia Universidad Católica de Chile, Clinical Hospital. PATIENTS AND METHODS: Retrospective analysis of all patients with Ann Arbor stages I and II referred to the hematology and radiotherapy clinic between 1998 and 2003. OS and EFS analysis was made according to the Kaplan and Meier method. Log-rank and Cox methods were used for univariate and multivariate analyses, respectively. Chemotherapy and radiotherapy toxicities were scored according to World Health Organization (WHO) and Radiation Therapy Oncology Group (RTOG) scales, respectively. RESULTS: 39 patients (20 men), aged between 20 to 85 years, were the source for this study. The average follow-up was 51 months (range 6-115). The 5 years OS and EFS were 72,4% and 63,3%, respectively. On univariate analysis, age over 60 was the only variable that affected negatively OS and EFS. Acute toxicity caused by chemotherapy and radiotherapy was uncommon. CONCLUSIONS: Age over 60 was the only independent variable associated with poor prognosis. The number of chemotherapy cycles and the drug combination did not influence the results. These results support the usefulness of a shortened chemotherapy regimen plus involved field radiotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/radiotherapy , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Combined Modality Therapy/methods , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Disease-Free Survival , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Etoposide/administration & dosage , Etoposide/adverse effects , Female , Follow-Up Studies , Humans , Lymphoma, Non-Hodgkin/mortality , Male , Middle Aged , Neoplasm Staging , Prednisone/administration & dosage , Prednisone/adverse effects , Prognosis , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Survival Analysis , Treatment Outcome , Vincristine/administration & dosage , Vincristine/adverse effectsABSTRACT
Natural killer leukemia is a rare and highly aggressive neoplasm, is more common in young male patients and has a very poor prognosis, with a median survival of few weeks. We report a 17 years old male patient who developed, after an acute upper respiratory disease, a rapidly multiorganic failure with pancytopenia. Bone marrow aspiration and trephine biopsy showed an acute lymphoblastic leukemia. The immunophenotype and immunohistochemistry revealed a natural killer acute leukemia. The disease progressed rapidly and the patient died shortly after the diagnosis.
Subject(s)
Killer Cells, Natural , Leukemia/pathology , Adolescent , Antigens, CD/immunology , Biopsy , Bone Marrow/pathology , Fatal Outcome , Humans , Immunophenotyping , Leukemia/immunology , Leukemia/therapy , MaleABSTRACT
Natural killer leukemia is a rare and highly aggressive neoplasm, is more common in young male patients and has a very poor prognosis, with a median survival of few weeks. We report a 17 years old male patient who developed, after an acute upper respiratory disease, a rapidly multiorganic failure with pancytopenia. Bone marrow aspiration and trephine biopsy showed an acute lymphoblastic leukemia. The immunophenotype and immunohistochemistry revealed a natural killer acute leukemia. The disease progressed rapidly and the patient died shortly after the diagnosis.
Subject(s)
Adolescent , Killer Cells, Natural , Leukemia/immunology , Leukemia/pathology , Leukemia/therapy , Antigens, CD/immunology , BiopsyABSTRACT
We have treated 28 patients (pts) with malignant hematological diseases with allogenic bone marrow transplantation (BMT). 18 pts had acute lymphoblastic (ALL) and non lymphoblastic leukemia (ANLL), 5 chronic myeloid leukemia (CML), 2 severe aplastic anemia (SAA), 1 myelodisplasia, 1 Fanconi's anemia and 1 advanced Non Hodgkin's lymphoma. All but three received the graft from HLA identical sibling donors. We used conditioning with total body irradiation and chemotherapy (cyclophosphamide, cytarabine and etoposide) in 17 pts and chemotherapy alone in 11.24 pts had a full hematological recovery 18 to 25 days post BMT. 15 pts died after BMT as a consequence of toxicity or early infection (4), graft failure (2), graft vesus host disease (4) or relapse (5). Actuarial event free survival for the group with favorable prognosis (SAA, ALL and ANLL in first or second remission and CML in chronic phase) is 57 percent at 36 months. Allogeneic BMT is an effective and feasing therapeutic procedure for selected patients with hematological malignancies
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Bone Marrow Transplantation , Hematologic Diseases/surgery , Patient Isolation , Postoperative Complications/drug therapy , Transplantation, Homologous , Transplantation, Homologous/mortality , Leukemia/therapy , Neural Tube Defects/therapy , Anemia, Aplastic/therapy , Premedication/methods , Host vs Graft Reaction/immunology , Hematopoietic System/physiopathology , Blood Transfusion/methodsABSTRACT
Aim: To compare the efficacy of imipenem - cilastatine and ceftazidime - amikacin in the treatment of febril neutropenic patients. Design: Open prospective and randomized clinical study. Patients: 52 patients (26 females) aged 16 to 80 years old with 60 episodes of neutropenia were studied. They were randomly assigned to receive Imipenem - cilastatine in doses of 500 mg iv qid or the combination of ceftazidime 1 to 1.5 g iv tid and amikacin 7.5 mg/kg iv bid. Results: Global response to initial therapy was 53 percent in patients receiving imipenem - cilastatine and 37 percent in those receiving ceftazidime - amikacin (p=ns). When other antimicrobial were added, a 90 and 85 percent infection eradication success was achieved respectively. Six febrile episodes in the group receiving imipenem - cilastatine and 12 episodes in tha group receiving ceftazidime - amikacin had Gram positive cocci as the sole treatment outcome. Three patients receiving imipenem - cilastatine (10 percent) and 4 receiving ceftazidime - amikacin (13 percent) died. Superinfections and toxicity related to antibiotics were minimal in both groups. Conclusions: imipenem - cilastatine and the combination of ceftazidime with amikacin were equally effective in the treatment of febril episodes in neutropenic patients
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Amikacin/administration & dosage , Cilastatin/administration & dosage , Ceftazidime/administration & dosage , Imipenem/administration & dosage , Neutropenia/drug therapy , Communicable Diseases/drug therapy , Drug Therapy, Combination/administration & dosage , Fever/etiology , Fever/microbiology , Fever/drug therapy , Fever of Unknown Origin/drug therapy , Gram-Negative Aerobic Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Neutropenia/microbiology , Neutrophils , Clinical ProtocolsABSTRACT
Adhesions are the most common cause of intestinal obstruction. Medical treatment for those patients with no signs of vascular involvement has been successful in many cases. We reveiwed the clinical records of 87 patients with intestinal obstruction due to adhesions, having a total of 122 episodes Satisfactory follow up was obtained in 76% of patients for a mean of 29.6 months 47% of episodes resolved without need for surgical intervention. Volumen entrapment during the first hours was correlated with need for surgical treatment (p < 0.01). Recurrences were not different between medical and surgical patients (p = 0.28). Thus, medical treatment of this type of intestinal obstruction may be attempted in most patients, not only those who are poor surgical risks
