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1.
Ann Hematol ; 94(5): 813-23, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25567231

RESUMO

Three sequential phase II trials were conducted with different immunotherapy approaches to enhance the outcome of autologous transplant (high-dose therapy and autologous stem cell transplantation (HDT/ASCT)) for recurrent follicular lymphoma. Seventy-three patients were enrolled from 1996 to 2009. Patients received HDT/ASCT combined with (1) interferon-α 3 MU/m(2) subcutaneously (SC) three times per week (TIW) for 2 years post-ASCT, (2) rituximab (R) 375 mg/m(2) for in vivo purging 3-5 days pre-stem cell collection and 2 × 4 weekly R at 2 and 6 months post-ASCT, respectively, or (3) three infusions of R pre-stem cell collection followed by 6× R weekly and interferon-α 3 MU/m(2) SC TIW. Although not statistically significant, progression-free survival (PFS) for patients who received rituximab was 56.4 and 49.1% at 5 and 10 years compared to 36 and 21% in those who did not receive rituximab. Molecular relapse post-HDT/ASCT was the strongest predictor of PFS in a multivariate analysis. Molecular relapse was coincident with or preceded clinical relapses in 84% of patients who relapsed­median of 12 months (range 0-129 months). Adverse events included secondary malignancy, transformation to diffuse large B cell lymphoma, prolonged mostly asymptomatic hypogammaglobulinemia, and pulmonary fibrosis. The long-term toxicity profile must be considered when selecting patients for this treatment.


Assuntos
Anticorpos Monoclonais Murinos/uso terapêutico , Antineoplásicos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Linfoma Folicular/tratamento farmacológico , Linfoma Folicular/terapia , Adulto , Intervalo Livre de Doença , Feminino , Humanos , Linfoma Folicular/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/mortalidade , Rituximab , Transplante Autólogo
2.
Eur Respir J ; 30(5): 1014-7, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17978158

RESUMO

Current guidelines support the use of corticosteroids and azathioprine as one possible treatment strategy for idiopathic pulmonary fibrosis (IPF). However, some patients with genetic polymorphisms of thiopurine methyltransferase (TPMT) are at risk of severe azathioprine myelotoxicity. The current authors present the case of an 85-yr-old Caucasian male with IPF who developed diffuse alveolar haemorrhage as a complication of azathioprine-induced myelosuppression. Leukocyte genetic TPMT testing revealed that the patient had homozygous polymorphisms associated with the absence of TPMT activity and severe azathioprine-induced myelotoxicity. Thiopurine methyltransferase deficiency should be considered in patients who develop leukopenia early in treatment with azathiopurine, or who present with severe marrow suppression at usual doses. For centres with equipped laboratories, a dosing suggestion is provided based on thiopurine methyltransferase testing. Even with screening strategies, frequent monitoring of complete blood count and liver biochemistry should remain the mainstay of surveillance for azathioprine toxicity.


Assuntos
Azatioprina/efeitos adversos , Hemorragia/induzido quimicamente , Imunossupressores/efeitos adversos , Pneumopatias/induzido quimicamente , Metiltransferases/genética , Feminino , Hemorragia/enzimologia , Humanos , Pneumopatias/enzimologia , Masculino , Metiltransferases/deficiência , Farmacogenética , Polimorfismo Genético , Fibrose Pulmonar/tratamento farmacológico , Fibrose Pulmonar/genética
3.
Leuk Lymphoma ; 43(10): 2051-4, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12481908

RESUMO

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative disorder characterized by a clonal proliferation of mainly mature neutrophils, which is often difficult to differentiate from reactive leukocytosis or other myeloproliferative disorders. Treatment to date has focused on disease control rather than cure. Once the disease has progressed to a more aggressive leukemia there is typically little chance of obtaining a long lasting remission due to the older age of most patients as well as the acquisition of multiple poor prognostic cytogenetic abnormalities. In this case report we describe a successful sibling allogeneic bone marrow transplant in a 60-year-old man with CNL performed while he was still in the stable phase of his disease. We propose that even in older patients this curative approach may be considered in selected patients at an early stage of their disease, similar to the approach taken with chronic myelogenous leukemia.


Assuntos
Transplante de Medula Óssea , Leucemia Neutrofílica Crônica/terapia , Gerenciamento Clínico , Intervalo Livre de Doença , Sobrevivência de Enxerto , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Leucemia Neutrofílica Crônica/complicações , Leucemia Neutrofílica Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Transplante Homólogo
4.
Can Respir J ; 7(2): 193-7, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10859406

RESUMO

Amiodarone is an iodinated benzofuran derivative class III antiarrhythmic that is highly effective in suppressing ventricular and supraventricular arrhythmias. It is also associated with an imposing side effect profile, which often limits its use. Numerous adverse effects have been documented including skin discolouration, photosensitivity, hepatitis, thyroid dysfunction, corneal deposits, pulmonary fibrosis, bone marrow suppression and drug interactions. These side effects are thought to be correlated with the total cumulative dose of amiodarone, but idiopathic reactions have been reported. The majority of adverse reactions resolve with discontinuation of the drug; however, rapid progression may occur, which may be fatal. The present report documents a patient who had a combination of serious amiodarone toxicities that, once recognized, were treated and eventually resulted in a good outcome.


Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Oftalmopatias/induzido quimicamente , Pneumopatias/induzido quimicamente , Doenças Neuromusculares/induzido quimicamente , Enterocolite Pseudomembranosa/etiologia , Humanos , Pulmão/patologia , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Doenças Neuromusculares/patologia , Tomografia Computadorizada por Raios X
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