ABSTRACT
Durante los últimos años, se ha evidenciado una mejoría significativa en la supervivencia de los pacientes con cáncer en las unidades de cuidados intensivos (UCI). Tanto el avance en el tratamiento médico y quirúrgico, como una mejor selección de pacientes, han influido en la mejoría de las expectativas vitales de estos enfermos. En la UCI una resucitación adecuada y precoz, sin limitaciones iniciales a técnicas de soporte vital, ha demostrado disminuir también la mortalidad en los pacientes con cáncer. Actualmente, no debemos denegar el ingreso en UCI solo por la enfermedad neoplásica de base. Aun así, la mortalidad del paciente con cáncer en la UCI, especialmente el hematológico, sigue siendo alta y en algunos casos es necesario realizar una prueba de ingreso en UCI (test de UCI) de, al menos, 3 días para diferenciar a los pacientes que se estén beneficiando de un tratamiento intensivo. Proponemos un algoritmo de decisión al ingreso en la UCI que nos ayude en una situación, a veces, compleja (AU)
In recent years, there has been a significant improvement in the survival of patients with cancer in intensive care units (ICUs). Advances in medical and surgical treatments and better selection of patients has helped improve the life expectancy of this type of patient. An appropriate and early resuscitation in the ICU, without initial limitations on the life support techniques, has been shown to also decrease the mortality of patients with cancer. At present, we should not deny admission to the ICU based only on the underlying neoplastic disease. However, the mortality rate for patients with cancer in the ICU, especially those with hematologic disease, remains high. In some cases, an ICU admission test (ICU test) is required for at least 3 days to identify patients who can benefit from intensive treatment. We would like to propose a decision algorithm for ICU admission that will help in making decisions in an often complex situation (AU)
Subject(s)
Humans , Male , Female , Critical Care/methods , Critical Care/trends , Critical Care , Intensive Care Units/organization & administration , Intensive Care Units/trends , Neoplasms/epidemiology , Neoplasms/prevention & control , Respiration, Artificial/methods , Respiration, Artificial/trends , Respiration, Artificial , Heart Failure/complications , Multiple Organ Failure/complications , Neutropenia/complicationsABSTRACT
In recent years, there has been a significant improvement in the survival of patients with cancer in intensive care units (ICUs). Advances in medical and surgical treatments and better selection of patients has helped improve the life expectancy of this type of patient. An appropriate and early resuscitation in the ICU, without initial limitations on the life support techniques, has been shown to also decrease the mortality of patients with cancer. At present, we should not deny admission to the ICU based only on the underlying neoplastic disease. However, the mortality rate for patients with cancer in the ICU, especially those with hematologic disease, remains high. In some cases, an ICU admission test (ICU test) is required for at least 3 days to identify patients who can benefit from intensive treatment. We would like to propose a decision algorithm for ICU admission that will help in making decisions in an often complex situation.
ABSTRACT
We evaluate the efficacy of the oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) in 71 refractory/relapsed multiple myeloma patients, including a prognostic analysis to predict both response and survival. Patients received thalidomide at escalating doses (200-800 mg/day), daily cyclophosphamide (50 mg/day) and pulsed dexamethasone (40 mg/day, 4 days every 3 weeks). On an intention-to-treat basis and using the EBMT response criteria, 2% patients reached complete response (CR), 55% partial response (PR) and 26% minor response (MR) yielding a total response (CR+PR+MR) rate of 83% after 3 months of therapy. After 6 months of therapy, responses were maintained including a 10% CR. The 2-year progression free and overall survival were 57 and 66%, respectively. A favorable response was associated with beta2 microglobulin < or =4 mg/dl, platelets >80 x 10(9)/l and nonrefractory disease. Regarding survival, low beta2 microglobulin (< or =4 mg/dl), age (< or =65 years) and absence of extramedullary myelomatous lesion were associated with a longer survival. Major adverse effects included constipation (24%), somnolence (18%), fatigue (17%) and infection (13%). Only 7% of patients developed a thrombo-embolic event. ThaCyDex is an oral regimen that induces a high response rate and long remissions, particularly in relapsing patients with beta2 microglobulin < or =4 mg/dl and < or =65 years.
