Safety and efficacy of ibrutinib in combination with rituximab and lenalidomide in previously untreated follicular and marginal zone lymphoma: An open label, phase 2 study.

BACKGROUND: Follicular lymphoma (FL) and marginal zone lymphoma (MZL) are indolent non-Hodgkin lymphomas (iNHL). Median survival for iNHL is approximately 20 years. Because standard treatments are not curative, patients often receive multiple lines of therapy with associated toxicity-rationally designed, combination therapies with curative potential are needed. The immunomodulatory drug lenalidomide was evaluated in combination with rituximab for the frontline treatment of FL in the phase 3 RELEVANCE study. Ibrutinib, an oral Bruton tyrosine kinase inhibitor, is active in NHL and was evaluated in combination with lenalidomide, rituximab, and ibrutinib (IRR) in a phase 1 study. METHODS: The authors conducted an open-label, phase 2 clinical trial of IRR for previously untreated FL and MZL. The primary end point was progression-free survival (PFS) at 24 months. RESULTS: This study included 48 participants with previously untreated FL grade 1-3a (N = 38), or MZL (N = 10). Participants received 12, 28-day cycles of lenalidomide (15 mg, days 1-21 cycle 1; 20 mg, cycles 2-12), rituximab (375 mg/m2 weekly in cycle 1; day 1 cycles 2-12), and ibrutinib 560 mg daily. With a median follow-up of 65.3 months, the estimated PFS at 24 months was 78.8% (95% confidence interval [CI], 68.0%-91.4%) and 60-month PFS was 59.7% (95% CI, 46.6%-76.4%). One death occurred unrelated to disease progression. Grade 3-4 adverse events were observed in 64.6%, including 50% with grade 3-4 rash. CONCLUSIONS: IRR is highly active as frontline therapy for FL and MZL. Compared to historical results with lenalidomide and rituximab, PFS is similar with higher grade 3-4 toxicity, particularly rash. The study was registered with ClinicalTrials.gov (NCT02532257).

Epidemia de peste en 1649. Enfermería en el Hospital de las Cinco Llagas / Epidemia de peste 1649. Enfermagem no Hospital de Cinco Llagas / Plague epidemic in 1682. Nursing in the Hospital Five Wounds

Este artículo es un estudio sobre los cuidados aplicados en Sevilla de 1649, en el hospital de las Cinco Llagas. Su objetivo es dar a conocer una etapa de la historia, cultura, sociedad, política y de la Enfermería en la Sevilla del siglo XVII y promover la reflexión, en relación a las concepciones de cuidados de esta época, tomando como ejemplo el Hospital de las Cinco Llagas. Constituye un estudio descriptivo, histórico y enfoque crítico-reflexivo, cuya interpretación de los datos siguió los principios de análisis de contenido. Se llegó a la conclusión que a diferencia del resto del equipo sanitario, al equipo cuidador, no se le exigía requisitos profesionales académicos, también se descubrió que el fin del Hospital de las Cinco Llagas era atender a mujeres infectadas por enfermedades que se consideraban curables y no contagiosas. La mortalidad, debido a esta epidemia de peste, fue muy alta, destacando las actuaciones, en materia de salud pública. Destacamos la importancia de la Enfermera Mayor en la formación enfermera, siendo el origen de una docencia mas organizada, que posteriormente se reflejaría en la Constitución de 1734 (AU)

This article is a study of care applied in Seville in 1649, the hospital of the Five Wounds. Its aim is to present a stage of history, culture, society, politics and nursing in the seventeenth century Seville and promote reflection in relation to the conceptions of care this time, as exemplified by the Hospital of the Five Wounds. It is a descriptive, historical and critical reflexive approach, the interpretation of the data followed the principles of content analysis. They concluded that unlike the rest of the healthcare team, the care team, you are not required academic professional requirements, also found that the end of the Hospital of the Five Wounds was to attend to women infected with diseases that are considered curable not contagious. Mortality due to this epidemic of plague, was very high, highlighting the actions in public health. We stress the importance of nursing staff in nursing education, the origin of a more organized teaching, later reflected in the Constitution of 1734 (AU)

Este artigo é um estudo dos cuidados aplicados em Sevilha em 1649, o hospital das Cinco Chagas. Seu objetivo é apresentar um cenário da história, cultura, sociedade, política e de enfermagem no século XVII Sevilha e promover a reflexão em relação às concepções de cuidado neste momento, como exemplificado pelo Hospital do Cinco Chagas. É uma abordagem descritiva, histórica e crítico-reflexiva, a interpretação dos dados seguiu os princípios de análise de conteúdo. Eles concluíram que, ao contrário do resto da equipe de saúde, a equipe de cuidados, você não é obrigado acadêmica exigências profissionais, também descobriu que o fim do Hospital das Cinco Chagas foi para atender a mulheres infectadas com doenças consideradas incuráveis não é contagiosa. Mortalidade por esta epidemia de peste, foi muito alta, com destaque para as ações em saúde pública. Ressaltamos a importância da equipe de enfermagem no ensino de enfermagem, a origem de um ensino mais organizados, mais tarde consagrado na Constituição de 1734 (AU)

Activating FLT3 mutations are detectable in chronic and blast phase of chronic myeloproliferative disorders other than chronic myeloid leukemia.

FLT3 gene mutations, either internal tandem duplication (ITD) or D835 point mutations, have been studied extensively in acute myeloid leukemia and myelodysplastic syndrome (MDS). Little is known about FLT3 mutations in chronic myeloproliferative diseases (CMPDs) or their relationship with V617F JAK2 mutations. We analyzed bone marrow samples from 142 patients with Philadelphia (Ph) chromosome- CMPD or CMPD/MDS and from 119 patients with Ph+ chronic myeloid leukemia (CML) using a multiplex polymerase chain reaction assay. FLT3 mutations, 11 ITD and 2 D835, were detected in 13 (9.2%) patients with CMPD or CMPD/MDS, 7 in blast phase and 6 in chronic phase. Analyses for JAK2 mutations in 11 of 13 cases were all negative. By contrast, no FLT3 mutations were detected in CML, including 108 chronic and 11 blast phase cases. FLT3 mutations occur in approximately 10% of CMPD and CMPD/MDS but are not observed in JAK2+ CMPD or in CML.

Tumor de Wilms del adulto / Adults Wilms' tumor

OBJETIVO: Presentar un nuevo caso de tumor de Wilms (TW) en un adulto. MÉTODO: Se revisa el caso clínico de una tumoración renal en un adulto, cuya anatomía patológica reveló la existencia de un nefroblastoma. RESULTADOS: Se trata de un varón de 23 años que consulta por hematuria. La exploración física y las pruebas complementarias (Eco y TAC) objetivaron la presencia de una tumoración sólida en riñón derecho. El paciente fue sometido a cirugía radical, siendo el diagnóstico definitivo de nefroblastoma bifásico (TW), con infiltración de la grasa del hilio renal (estadío II). Posteriormente a la cirugía, recibió Quimioterapia adyuvante con VincristinaActinomicina D, durante 60 semanas. CONCLUSIONES: A pesar de su rareza en adultos, el tumor de Wilms debe considerarse en el diagnóstico diferencial de toda tumoración renal. El tratamiento habitual incluirá cirugía y quimioterapia con o sin radioterapia según el estadío (AU)