Rituximab intralesional como tratamiento de linfoma folicular primario de conjuntiva recidivante / Intralesional rituximab in primary conjunctival follicular lymphoma relapsed

Caso clínico: Mujer de 49 años que presenta recidiva de un linfoma folicular (LF) primario de conjuntiva. Se realiza inyección subconjuntival de rituximab intralesional de 6mg/ml, semanalmente durante 4 semanas, seguido de una administración mensual durante 6 meses. Tras la primera inyección se observa disminución del tejido linfoide. A los 10 meses del seguimiento no se observa recidiva de linfoma ni se aprecian efectos adversos. Discusión: Rituximab intralesional como tratamiento del LF primario de conjuntiva resultó efectivo y seguro, por lo que podría ser una alternativa a otras opciones terapéuticas convencionales como la radioterapia o la quimioterapia (AU)

Clinical case: A 49-year-old woman experienced a local relapse of a primary follicular lymphoma (FL) of the conjunctiva. She received 4 weekly intra-lesional injections followed by 6 monthly injections of rituximab (6mg/ml). A clinical response was achieved after first injection. No adverse ocular event or signs of lymphoma relapse were seen after 10 months of follow-up. Discussion: Intralesional administration of rituximab for treating primary FL of the conjunctiva was an effective and safe therapeutic option; therefore it could be an alternative to other conventional treatments, such as radiotherapy or chemotherapy (AU)

Intralesional rituximab in primary conjunctival follicular lymphoma relapsed. / Rituximab intralesional como tratamiento de linfoma folicular primario de conjuntiva recidivante.

CLINICAL CASE: A 49-year-old woman experienced a local relapse of a primary follicular lymphoma (FL) of the conjunctiva. She received 4 weekly intra-lesional injections followed by 6 monthly injections of rituximab (6mg/ml). A clinical response was achieved after first injection. No adverse ocular event or signs of lymphoma relapse were seen after 10 months of follow-up. DISCUSSION: Intralesional administration of rituximab for treating primary FL of the conjunctiva was an effective and safe therapeutic option; therefore it could be an alternative to other conventional treatments, such as radiotherapy or chemotherapy.

The oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) is effective in relapsed/refractory multiple myeloma.

We evaluate the efficacy of the oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) in 71 refractory/relapsed multiple myeloma patients, including a prognostic analysis to predict both response and survival. Patients received thalidomide at escalating doses (200-800 mg/day), daily cyclophosphamide (50 mg/day) and pulsed dexamethasone (40 mg/day, 4 days every 3 weeks). On an intention-to-treat basis and using the EBMT response criteria, 2% patients reached complete response (CR), 55% partial response (PR) and 26% minor response (MR) yielding a total response (CR+PR+MR) rate of 83% after 3 months of therapy. After 6 months of therapy, responses were maintained including a 10% CR. The 2-year progression free and overall survival were 57 and 66%, respectively. A favorable response was associated with beta2 microglobulin < or =4 mg/dl, platelets >80 x 10(9)/l and nonrefractory disease. Regarding survival, low beta2 microglobulin (< or =4 mg/dl), age (< or =65 years) and absence of extramedullary myelomatous lesion were associated with a longer survival. Major adverse effects included constipation (24%), somnolence (18%), fatigue (17%) and infection (13%). Only 7% of patients developed a thrombo-embolic event. ThaCyDex is an oral regimen that induces a high response rate and long remissions, particularly in relapsing patients with beta2 microglobulin < or =4 mg/dl and < or =65 years.

[Impact of the protocol of ABO group and irregular antibodies on the transfusional index]. / Impacto de un protocolo de grupo ABO y anticuerpos irregulares sobre el índice transfusional.

OBJECTIVES: The ABO group/irregular red cell antibodies (G/A) protocol is a scheme for reducing the number of unnecessary crossmatch tests in selected patients scheduled for surgery. Reduction would lower expenses and risks related to the overuse of such tests. Studying transfusion rates allows us to predict which patients are candidates for application of the protocol. The present study evaluated the impact of the G/A protocol on transfusion rate. PATIENTS AND METHODS: A retrospective analysis of pre-transfusion testing of patients in our hospital in 1996, before application of the G/A protocol, and in 2001, after four years of experience with the scheme. RESULTS: The G/A protocol was followed with 194 patients in 2001. The surgical transfusion rate decreased by 27.8% over the rate for 1996 (1.84 vs. 2.55). The outdating of blood units in 2001 decreased by 42.4% (65 units outdated vs. 113). Only one patient subject to the protocol had to be transfused. CONCLUSION: The transfusion rate can be significantly reduced by applying the G/A protocol with selected patients, with no loss of transfusion safety.

Impacto de un protocolo de grupo AB0 y anticuerpos irregularessobre el índice transfusional / Impact on transfusion rate of an ABO group/ irregular antibodies testing protocol

OBJETIVOS: El protocolo de grupo AB0-anticuerpos irregulares (G/A) es un esquema que trata de reducir el número de pruebas cruzadas innecesarias en pacientes seleccionados, que van a ser sometidos a cirugía programada. De este modo se evitan el gasto y los riesgos asociados a la práctica excesiva de estas pruebas. A través del índice transfusional (IT) podemos evaluar sobre qué pacientes está más indicado aplicar el protocolo. En este estudio se evalúa el impacto de la aplicación de un protocolo de G/A sobre el IT en nuestro hospital. PACIENTES Y MÉTODOS: Se llevó a cabo un estudio retrospectivo en el que se analizaron las pruebas pretransfusionales de los pacientes de nuestro hospital en 1996, antes de la aplicación del G/A, y en 2001, tras cuatro años de experiencia con el esquema. RESULTADOS: En 2001 se incluyeron 194 pacientes en el protocolo de G/A. Se consiguió una reducción del 27,8 por ciento del IT en los servicios quirúrgicos, comparado con lo obtenido en 1996 (1,84 frente a 2,55), y una reducción del 42,4 por ciento en la tasa de caducidad de unidades de hematíes (65 frente a 113 unidades caducadas). Solamente un paciente de los incluidos en el protocolo fue transfundido. CONCLUSIÓN: El IT se puede reducir significativamente a través de la aplicación de un protocolo de G/A en pacientes seleccionados, sin que disminuya la seguridad transfusional (AU)

[Adequacy of blood component transfusion according to previously established criteria]. / Adecuación de la transfusión de hemoderivados a criterios previamente establecidos.

PURPOSE: Transfusion is not devoid of adverse effects; therefore every transfusional procedure must be indicated correctly. With this in mind in 1991 transfusion guidelines were published by our Hospital Transfusion Committee. Four years later, a retrospective audit was performed. MATERIAL AND METHODS: We have evaluated all blood component orders (order is a transfusion request) during one month, classifying them as appropriate or inappropriate according to the transfusion guidelines. The evaluation was performed 24 hours after transfusion. The results obtained were compared with the ones obtained before the published transfusion guidelines. RESULTS: 481 transfusion orders were studied. 87 percent (420/481) were considered appropriate according to the transfusion guidelines. These 481 orders referred to the transfusion of 1178 units to 293 patients. 12 percent of the transfused units was considered as inappropriate. 16 percent of the patients (48/239) had at least on inappropriate transfusion procedure. The comparison with the data obtained in 1991 showed a significant increase of the appropriate transfusion orders (74 versus 87 percent). The use of fresh frozen plasma showed the greatest incidence in inappropriate use, mainly in haemorrhagic disorders without factor deficit. The patients with haemoglobin levels between 70 and 100 g/L without signs of hypoxia were the most important cause of inappropriate use of red cell concentrates. And the patients with platelet levels > 20 x 10(9)/L were the major cause of inappropriate use of platelet concentrates. CONCLUSION: Transfusion guidelines knowledge improves the use of blood components.

[Alloimmunization in polytransfused patients. Usefulness of selecting erythrocytes compatible with antigens different from ABO and D]. / Aloinmunización en pacientes politransfundidos. Utilidad de seleccionar hematíes compatibles para antígenos differentes al ABO y D.

PURPOSE: Antibody formation against red blood cells' antigen is a very important complication due to transfusions, and it can make the following transfusions difficult. To avoid this, it has been proposed giving identical red blood cells for the antigens more frequently involved in sensitizations. To evaluate this fact, we have accomplished a study with the transfused patients in our Hospital since 1990. MATERIAL AND METHODS: 10,308 transfused patients in the Hospital Nitra. Sra. de Covadonga (Oviedo), between January 1990 and March 1994, were studied. The patients have been included in two groups: The first one was constituted by 4,226 patients from the Haematology and the Nephrology Departments, who received red blood cells units compatible with ABO and CcDEe antigens. The second group was formed by the remainding patients transfused with red blood cells compatible only with ABO and D antigens. RESULTS: All 165 antibodies were detected in 132 patients, which means an incidence of 1.3 percent. In 63 cases, antibodies were present before the first transfusion. In the remaining patients, an allosentitization of 0.2 percent in group 1 and 1 percent in group 2 (p < 0.0001) was shown. This difference cannot be explained only for transfusing red blood cells with the same Rh phenotype in the group 1, because a lower immune response had persisted when we analyzed the other antibodies. More than 70 percent of antibodies appeared before the 10th transfusion. DISCUSSION: A lower sensitization exist in the patients of group 1. This seems to be caused by a state of immunosuppression for their disease or their treatments. However, in some patients, the risk of allosensitization persists, so we think it is a good practice to transfuse red blood cells without the most immunogenic antigens in haematological and nephrological patients who already have one antibody.