Sequelae and survivorship in patients treated with (131)I-MIBG therapy.

BACKGROUND: (131)I-meta-iodobenzylguanidine ((131)I-MIBG) has been in therapeutic use since 1980s. Newer treatment modalities are emerging for neuroendocrine tumours (NETs) and chromaffin cell tumours (CCTs), but many of these do not yet have adequate long-term follow-up to determine their longer term efficacy and sequelae. METHODS: Fifty-eight patients with metastatic NETs and CCTs who had received (131)I-MIBG therapy between 2000 and 2011 were analysed. Survival and any long-term haematological or renal sequelae were investigated. RESULTS: In the NET group, the overall median survival and median survival following the diagnosis of metastatic disease was 124 months. The median survival following the commencement of (131)I-MIBG was 66 months. For the CCT group, median survival had not been reached. The 5-year survival from diagnosis and following the diagnosis of metastatic disease was 67% and 67.5% for NETs and CCTs, respectively. The 5-year survival following the commencement of (131)I-MIBG therapy was 68%. Thirty-two patients had long-term haematological sequelae: 5 of these 32 patients developed haematological malignancies. Two patients developed a mild deterioration in renal function. CONCLUSION: Long follow up of (131)I-MIBG therapy reveals a noteable rate of bone marrow toxicities and malignancy and long term review of all patients receiving radionuclide therapies is recommended.

Cyclosporine or tacrolimus: which is the better partner for myfortic or cellcept?

BACKGROUND: Mycophenolic acid (MPA) pharmacokinetics using the mycophenolate mofetil (CellCept) formulation are known to differ between patients receiving tacrolimus (FK) or cyclosporine (CyA), but only limited data exist concerning concomitant use of FK or CyA with enteric-coated mycophenolate sodium (EC-MPS; Myfortic). This retrospective study compared the drug interactions with the mycophenolic acid blood levels using different immunosuppressants and their relation to graft survival. PATIENTS AND METHODS: We studied MPA levels in posttransplant sera from 298 renal transplant recipients. RESULTS: Patients receiving immunosuppression with CyA + Myfortic showed 94% at 5- and 10-year graft survivals, which were better than CyA + CellCept (75%, 63%). This combination suppressed posttransplant human leukocyte antigen (HLA) antibody development significantly (P = .03) with higher MPA levels. CONCLUSION: Patients immunosuppressed with CyA + Myfortic showed higher MPA levels and lower posttransplant HLA antibody development as well as the best graft survival. CyA + Myfortic or FK + Cellcept may be better combinations.

Growth inhibition of human endothelial cells by the phyto-oestrogen biochanin A, a metabolite of genistein.

This study examined the growth regulatory effects of a phyto-oestrogen, biochanin A, on a transformed human endothelial cell line ECV304 in vitro. Biochanin A was found to inhibit cell proliferation in a dose-dependent fashion and this effect was influenced by the concentration of serum present in the culture medium. In the absence of serum, the calculated IC50 of biochanin A was 0.18 +/- 0.1 microm compared to an IC50 of m at 10% serum. At low cell density, the growth inhibitory effects of biochanin A were more evident than at high cell density. Co-administration of a synthetic oestrogen diethylstilboestrol with biochanin A did not suppress the growth regulatory effects of biochanin A treatment. We conclude that biochanin A inhibits the cell proliferation of human endothelial cells at concentrations that are physiologically achievable in vivo and that this effect may play an important role in the cancer-preventing activity of the phyto-oestrogens.