RESUMO
Background: High-dose chemotherapy followed by Autologous SCT (stem cell transplantation) is a treatment of choice for relapsed and refractory lymphoma. Due to cost, toxicity, and shortage of Carmustine, we decided to conduct a phase 2 clinical trial to evaluate the safety and efficacy of Bendamustine instead of Carmustine in a previously used BEAM-like protocol. Materials and Methods:102 patients (median age,37) with Hodgkin(n=54) and non-Hodgkin lymphoma(n=48) were recruited and transplanted in two centers. After stem cell harvesting, a modified BeEAM regimen was administered to all the patients. Overall survival and disease-free survival (DFS) at two years were calculated as the study's primary endpoints. Results: Neutrophil and platelet recovery were observed after a median of 12 and 13 days, and all the patients were engrafted. Fever was observed in 25(24.5%) with only two documented infections. The only grade III toxicities were mucositis (20%) and nausea (15.6%). No transplant-related mortality (TRM) was observed after 100 days. After a median follow-up of 37(range 25-48) months, 68(66.6%) patients were in complete remission while 21 patients were in partial response, and 16 patients (15.6%) developed progressive disease, among which 13 (12.7%) had died. The OS at two years was (89 of 102, 87.3%), and the DFS rate was 68 of 102(66.7%). Conclusion: Our study showed that modified BeEAM is a safe, effective, and feasible conditioning regimen for ASCT in lymphoma instead of the BEAM regimen.
RESUMO
BACKGROUND: High blood pressure is a common condition in hemodialysis patients. Uric acid, which is high in these patients due to decreased clearance, had been shown to positively correlate with blood pressure in animal studies. OBJECTIVES: The goal of this investigation was to evaluate the impact of high uric acid level on blood pressure in these patients. PATIENTS AND METHODS: Ninety-one patients, on three times weekly hemodialysis, were studied. Uric acid levels were measured just before and after hemodialysis along with blood pressures before, during and after each session. Data were analyzed by SPSS 15. A P value less than 0.05 was considered significant. RESULTS: 40 (44%) of patients had serum uric acid ≥6 mg/dl. Before dialysis 51 (61%) and 19 (21%) had high systolic blood and diastolic blood pressures respectively. Also, 50 (55%) were with wide pulse pressure and 63 (69%) had high mean arterial pressure (MAP). Additionally 62 (68%) developed inter-dialysis hypotension. After measuring odds ratio for hyperuricemia in each group, we observed low risk of hypruricemia in the group with high systolic pressure (OR = 0.352; 95% CI: 0.147-0.844; P = 0.01), the high MAP group (OR = 0.382; 95% CI: 0.153-0.955; P = 0.03) and wide pulse pressure group (OR = 0.416; 95% CI: 0.177-0.975; P = 0.04). There was no association between high uric acid level and diastolic pressure (P = 0.11) and inter-dialysis hypotension (P = 0.33). No relationship was found between serum uric acid and KT/V (P = 0.2), normalized protein catabolic rate (nPCR) (P = 0.07) and body mass index (BMI) (P = 0.4). CONCLUSIONS: This study showed paradoxical association between high uric acid level and high systolic pressure, high MAP and wide pulse pressure and these effects were independent of dialysis duration, dialysis efficacy and nutrition, assuming that these relationships could be due to reverse epidemiology in dialysis patients.
