Experiencia de uso de brentuximab vedotina en monoterapia o en combinación con bendamustina en linfoma de Hodgkin y linfoma anaplásico de células grandes / Experience of use of brentuximab vedotin in monotherapy or combination with bendamustin in Hodgkin lymphoma and anaplastic large cell lymphoma

Objetivo: Analizar el uso de brentuximab vedotina (BV) en monoterapia o en combinación con bendamustina en el tratamiento de linfoma Hodgkin (LH) y linfoma anaplásico de células grandes (LACG) en recaída o refractario.Métodos: Estudio retrospectivo y multicéntrico de los pacientes con LH o LACG en recaída o refractarios tratados con BV hasta febrero de 2019. Se analizaron variables demográficas, de la patología (clínicas y analíticas), respuesta y efectos adversos (EA).Resultados: Se incluyeron 16 pacientes en dos grupos.Grupo 1 (BV en monoterapia, 10 pacientes): 6 hombres, 57,5 años (rango: 44-72). 7 pacientes presentaban LH y 3 LACG. Tras 4 ciclos, se obtuvieron 6 respuestas parciales (RP), 3 respuestas completas (RC) y un paciente refractario. Tasa respuesta objetiva (TRO) 90%. 5 pacientes en RP progresaron siendo la supervivencia libre de progresión (SLP) 4 meses (IC 95% 2,55-4,27). Un paciente en RC fue sometido a trasplante autólogo de progenitores hematopoyéticos (TAPH) y recibió BV en mantenimiento.Grupo 2 (en combinación con bendamustina, 6 pacientes): 4 hombres, 42 años (rango: 18-74). Tras 4 ciclos se obtuvieron 2 RP, 3 RC y 1 paciente refractario. TRO 83,33%. 1 paciente en RP progresó (SLP 3 meses). Los pacientes en RC pudieron beneficiarse de TAPH y mantenimiento con BV.En ambos grupos los EA principales fueron neuropatía (grado 3 en 2 pacientes) y alteraciones digestivas.Conclusiones: BV presenta buena actividad en monoterapia, logrando TRO elevadas. La combinación con bendamustina ha permitido aumentar la eficacia logrando respuestas más duraderas y nos ha permitido ofertar TAPH a pacientes no candidatos previamente. (AU)

Objective: To analyze the use of brentuximab vedotin (BV) in monotherapy or in combination with bendamustine in the treatment of relapsed or refractory Hodgkin’s lymphoma (HL) and anaplastic large cell lymphoma (ALCL).Methods: Retrospective and multicenter study of patients with relapsed or refractory HL or ALCL treated with BV until February 2019. Demographic, pathological (clinical and analytical), response and toxicity variables were analyzed.Results: Sixteen patients were included in two groups.Group 1 (BV in monotherapy, 10 patients): 6 men, 57.5 years (range: 44-72). 7 patients presented HL and 3 ALCL. After 4 cycles, 6 partial responses (PR), 3 complete responses (CR) and one refractory patient were obtained. Objective response rate (ORR) 90%. 5 patients in PR progressed being progression-free survival (PFS) 4 months (95% CI 2.55-4.27). A patient in CR was submitted to autologous stem cell transplantation (ASCT) and received BV in maintenance.Group 2 (in combination with bendamustine, 6 patients): 4 men, 42 years (range: 18-74). After 4 cycles, 2 PR, 3 CR and 1 refractory patient were obtained. ORR 83.33%. 1 patient in PR progressed (PFS 3 months). The patients in CR could benefit from ASCT and maintenance with BV.In both groups, the main adverse effects (AE) were neuropathy (grade 3 in 2 patients) and digestive alterations.Conclusions: BV presents good activity in monotherapy, achieving high ORR. The combination with bendamustine has made it possible to increase efficiency by achieving more lasting responses and it has allowed us to offer ASCT to previously non-candidates. (AU)

Bortezomib como alternativa en el tratamiento de pacientes con gammapatías malignas / Bortezomib as an alternative in the treatment of patients with malignant gammopathy

Objetivo: Describir el uso de bortezomib en un hospital comarcal como alternativa en el tratamiento de gammapatías malignas. Métodos: Análisis retrospectivo de los pacientes tratados con bortezomib en nuestro hospital desde noviembre de 2005 hasta octubre de 2007. A partir de la revisión de las historias clínicas de los pacientes se recogieron los datos correspondientes al diagnóstico, tratamientos previos a bortezomib, fecha de la última progresión de la enfermedad, número de ciclos de bortezomib, respuesta a éste, super vivencia global y libre de progresión, complicaciones y efectos secundarios. Resultados: El 47% de los pacientes estudiados eran varones (5/12), con una mediana de edad de 67 años (rango, 40-81 años). El diagnóstico principal fue mieloma múltiple, solo o asociado a plasmocitoma. El inicio con bortezomib coincidió con la última progresión de la enfermedad en el 83% de los pacientes (10/12). El 50% completó 7-8 ciclos con bortezomib. Se obtuvo respuesta en el 58% de los pacientes (7/12), alcanzándose criterios de respuesta parcial en el 33% (4/12) y respuesta completa en el 25% (3/12). Las reacciones adversas más frecuentes fueron neuropatía y toxicidad gastrointestinal, y supuso la suspensión del tratamiento en el 50% de los casos. Conclusiones: Según los resultados obtenidos, bortezomib es una buena alternativa en el tratamiento de las gammapatías malignas, sobre todo en el caso de plasmocitomas (AU)

Objective: To describe the use of bortezomib in a district hospital as an alternative in the treatment of malignant gammopathy. Methods: A retrospective analysis was carried out on patients treated with bortezomib in our hospital between November 2005 and October 2007. The patients’ medical histories were used to obtain data regarding diagnosis, treatments prior to bortezomib, date of the last disease progression, number of bortezomib courses, response to bortezomib, overall and event free survival. Results: 47% of the patients studied were male (5/12). The medianage was 67, (age range between 40 and 81). The main diagnosis was multiple myeloma on its own or associated with plasmocytoma. Bortezomib initiation coincided with the last disease progression in 83%of patients (10/12). 50% of the patients completed 7-8 courses of bortezomib. Response was seen in 58% of the patients (7/12), partial response in 33% of them (4/12) and complete response in 25%(3/12). The most common adverse reactions were neuropathy and gastrointestinal toxicity which required treatment to be discontinued in 50% of cases. Conclusions: According to the results obtained, bortezomib is a good alternative in the treatment of malignant gammopathy, above all in the case of plasmocytomas (AU)

[Bortezomib as an alternative in the treatment of patients with malignant gammopathy]. / Bortezomib como alternativa en el tratamiento de pacientes con gammapatías malignas.

OBJECTIVE: To describe the use of bortezomib in a district hospital as an alternative in the treatment of malignant gammopathy. METHODS: A retrospective analysis was carried out on patients treated with bortezomib in our hospital between November 2005 and October 2007. The patients' medical histories were used to obtain data regarding diagnosis, treatments prior to bortezomib, date of the last disease progression, number of bortezomib courses, response to bortezomib, overall and event free survival. RESULTS: 47% of the patients studied were male (5/12). The median age was 67, (age range between 40 and 81). The main diagnosis was multiple myeloma on its own or associated with plasmocytoma. Bortezomib initiation coincided with the last disease progression in 83% of patients (10/12). 50% of the patients completed 7-8 courses of bortezomib. Response was seen in 58% of the patients (7/12), partial response in 33% of them (4/12) and complete response in 25% (3/12). The most common adverse reactions were neuropathy and gastrointestinal toxicity which required treatment to be discontinued in 50% of cases. CONCLUSIONS: According to the results obtained, bortezomib is a good alternative in the treatment of malignant gammopathy, above all in the case of plasmocytomas.

[Nutritional assessment at the time of hospital-admission: study initiation among different methodologies]. / Valoración nutricional al ingreso hospitalario: iniciación al estudio entre distintas metodologías.

BACKGROUND AND OBJECTIVES: The elevated prevalence figures of hyponutrition in hospitalized patients--near 40%--is an issue of concern. This allows deducing that early identification of malnourished, or at risk for hyponutrition, patients by means of effective nutritional assessment methods may represent an essential tool for nutritional planning. The aim of this study was applying to a same group of patients different nutritional assessment methods (objective and subjective) at the time of hospital admission in order to assess the degree of effectiveness for its clinical application. SETTING, PATIENTS AND INTERVENTIONS: A prospective randomized study is designed, in which 50 admitted patients of our hospital are included between October 1st and December 31st of 2004, 9 of them being rejected for laboratory errors. During the first 3 days of hospital staying, anthropometrics (weight, height, arm circumference, and tricipital fold measure), biochemistry (full blood count, albumin, pre-albumin, retinol-bound protein, transferrin, and cholesterol), two nutritional assessment questionnaires (Global Subjective Assessment (GSA) and Mini Nutritional Assessment (MNA). RESULTS: Thechi-squared2 test has been applied to compare the results obtained from the different objective methods, separately and globally, with the MNA and GSA questionnaires, establishing the following anthropometrical comparisons: anthropometrics/MNA, Biochemistry/MNA, Chang/MNA, anthropometrics/GSA, Biochemistry/GSA, Chang/GSA, and MNA/GSA. Statistical significance has been set at p < 0.05. Statistical analysis has been done with the SPSS v.11 software. We have not observed a statistical significance between any of the three objective parameters studied: biochemistry, anthropometrics and immunology separately considered in the two nutritional assessment questionnaires. However, the significance is positive when we relate the results obtained by the Chang method, which comprises the three types of objective parameters, with those from the MNA and GSA. A statistical significance was also reached when relating both subjective methods between each other: MNA and GSA. CONCLUSIONS: Both the GSA and MNA represent a good indicator to determine high-risk patients for developing complications attributable to hyponutrition. We can attribute them a predictive power similar to that of objective data considered as a whole.

[A descriptive analysis of the use of the parenteral nutrition protocol in an area hospital]. / Análisis descriptivo de la aplicación del protocolo de nutrición parenteral en un hospital de área.

A retrospective study was carried out of all the Parenteral Nutrient Units (PNUs) prepared in the Pharmacy Service (PS) of an Area Hospital with 378 beds, over a four-year term (1988-1991), with the aim of describing the use of Parenteral Nutrition (PN) and to find out to what level it is adjusted to the established methodology. PN start and finish records were used to compile a variety of data: number of patients, age, sex, diet, days PN treatment, indication and motive for cessation. The results obtained are grouped by years and services. PN patients numbered 272 in all: most were in the surgery service (47%) followed by ICU (32%) and internal medicine (17%). 2.651 PNUs were prepared during the four years studied: 97.5% were adult diet, days PN treatment, indication and motive for cessation. The results obtained are grouped by years and services. PN patients numbered 272 in all: most were in the surgical service (47%) followed by ICU (32%) and internal medicine (17%). 2.651 PNUs were prepared during the four years studied: 97.5% were adult 84.6% of PNUs prepared were in line with the established methodology. Of the 398 individually formulated diets prepared, 74.6% were not considered justified. A 140% raise was observed in the number of patients undergoing PN after 4 years. In the light of these results, we consider that the parenteral diet code should be updated.