Assuntos
Carcinoma de Células Escamosas/genética , Neoplasias do Mediastino/genética , Proteínas Nucleares/genética , Proteínas Oncogênicas/genética , Translocação Genética , Cariótipo Anormal , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/patologia , Cromossomos Humanos Par 15 , Cromossomos Humanos Par 19 , Cromossomos Humanos Par 4 , Evolução Fatal , Feminino , Humanos , Imuno-Histoquímica , Neoplasias do Mediastino/patologia , Proteínas de Neoplasias , Adulto JovemRESUMO
Asymptomatic (smoldering) multiple myeloma is a heterogeneous plasma cell proliferative disorder with a variable rate of progression to active multiple myeloma or related disorders. Hypercalcemia, renal insufficiency, anemia, bone lesions or recurrent bacterial infections characterize active multiple myeloma. Some patients with asymptomatic myeloma develop active disease rapidly, and others can stay asymptomatic for many years. Those who are likely to progress within the first 2 years of diagnosis have been categorized as having high-risk disease. The availability of novel agents in the treatment of active multiple myeloma and our better understanding of the heterogeneity of asymptomatic multiple myeloma have spurred interest in the early treatment of these patients. We have reviewed the current proposed definitions of high-risk asymptomatic multiple myeloma, the concerns about future therapy in view of the transient nature, remissions and toxicities of the therapies, and the eventual relapses that characterize this incurable disease.
Assuntos
Antineoplásicos/uso terapêutico , Doenças Assintomáticas/terapia , Mieloma Múltiplo/tratamento farmacológico , Ensaios Clínicos como Assunto , Evolução Clonal , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos , Humanos , Mieloma Múltiplo/diagnóstico , Resultado do TratamentoRESUMO
The new oral anticoagulants dabigatran etexilate (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) have predictable pharmacokinetic and pharmacodynamic profiles and are alternatives to warfarin. However, many physicians are wary of these drugs, since there is limited evidence on how to manage bleeding in patients taking them, and since no specific antidote is known to reverse their anticoagulant effect. Management requires careful adherence to first principles of bleeding care. Unapproved and untested reversal strategies may be required in patients with life-threatening bleeding.
Assuntos
Anticoagulantes/efeitos adversos , Benzimidazóis/efeitos adversos , Hemorragia/terapia , Morfolinas/efeitos adversos , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Tiofenos/efeitos adversos , beta-Alanina/análogos & derivados , Anticoagulantes/farmacocinética , Benzimidazóis/farmacocinética , Testes de Coagulação Sanguínea , Dabigatrana , Monitoramento de Medicamentos , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Técnicas Hemostáticas , Humanos , Morfolinas/farmacocinética , Assistência Perioperatória , Pirazóis/farmacocinética , Piridonas/farmacocinética , Rivaroxabana , Tiofenos/farmacocinética , beta-Alanina/efeitos adversos , beta-Alanina/farmacocinéticaRESUMO
Immunoglobulin A nephropathy (IgAN) has been identified in patients with various malignancies. Although membranous glomerulonephritis and minimal change disease have been described in patients with mesothelioma, to our knowledge IgAN associated with mesothelioma has not been reported. We present a case of IgAN, characterized by progressive deterioration of renal function from normal and confirmed by kidney biopsy. Despite improvement of renal function following treatment with cyclophosphamide and prednisone, the patient succumbed to acute respiratory failure 8 months later. We conclude that IgAN may be a potential complication of mesothelioma.
