Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Azacitidina/uso terapêutico , Leucemia Mielomonocítica Crônica/terapia , Antimetabólitos Antineoplásicos/administração & dosagem , Azacitidina/administração & dosagem , Terapia Combinada , Humanos , Leucemia Mielomonocítica Crônica/tratamento farmacológico , Leucemia Mielomonocítica Crônica/radioterapia , Masculino , Pessoa de Meia-Idade , Sarcoma Mieloide/tratamento farmacológico , Sarcoma Mieloide/radioterapia , Resultado do TratamentoAssuntos
Leucemia Mielomonocítica Crônica/patologia , Infiltração Leucêmica/diagnóstico , Pele/patologia , Toxoide Tetânico/efeitos adversos , Antígenos CD/análise , Antígenos de Diferenciação Mielomonocítica/análise , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Medula Óssea/patologia , Citarabina/administração & dosagem , Etoposídeo/administração & dosagem , Evolução Fatal , Humanos , Idarubicina/administração & dosagem , Imunização Secundária , Leucemia Mielomonocítica Crônica/diagnóstico , Leucemia Mielomonocítica Crônica/tratamento farmacológico , Leucemia Mielomonocítica Crônica/radioterapia , Infiltração Leucêmica/tratamento farmacológico , Infiltração Leucêmica/etiologia , Infiltração Leucêmica/patologia , Infiltração Leucêmica/radioterapia , Leucossialina/análise , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante , Choque Séptico/etiologia , Toxoide Tetânico/administração & dosagemRESUMO
Clinical indications of splenic irradiation in haematological disorders include the irradiation in lymphoproliferative disorders with spleen infiltration, palliative treatment of splenomegaly in malignant diseases like chronic lymphocytic leukaemia or myeloproliferative disorders, with the purpose of relief from abdominal pain associated with capsular enlargement size and decrease cytopenias secundaries to hypersplenism.This paper reports our experience with spleen irradiation in the Hospital General Universitario Gregorio Marañón in the last five years, and analyzes indications, results and toxicity, and an actual review of the literature.
Assuntos
Leucemia Linfocítica Crônica de Células B/radioterapia , Leucemia Mielomonocítica Crônica/radioterapia , Linfoma/radioterapia , Neoplasias Esplênicas/radioterapia , Esplenomegalia/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Dosagem Radioterapêutica , Esplenomegalia/diagnóstico , Fatores de TempoRESUMO
Unlike beta particle-emitting isotopes, alpha emitters can selectively kill individual cancer cells with a single atomic decay. HuM195, a humanized anti-CD33 monoclonal antibody, specifically targets myeloid leukemia cells and has activity against minimal disease. When labeled with the beta-emitters (131)I and (90)Y, HuM195 can eliminate large leukemic burdens in patients, but it produces prolonged myelosuppression requiring hematopoietic stem cell transplantation at high doses. To enhance the potency of native HuM195 yet avoid the nonspecific cytotoxicity of beta-emitting constructs, the alpha-emitting isotope (213)Bi was conjugated to HuM195. Eighteen patients with relapsed and refractory acute myelogenous leukemia or chronic myelomonocytic leukemia were treated with 10.36 to 37.0 MBq/kg (213)Bi-HuM195. No significant extramedullary toxicity was seen. All 17 evaluable patients developed myelosuppression, with a median time to recovery of 22 days. Nearly all the (213)Bi-HuM195 rapidly localized to and was retained in areas of leukemic involvement, including the bone marrow, liver, and spleen. Absorbed dose ratios between these sites and the whole body were 1000-fold greater than those seen with beta-emitting constructs in this antigen system and patient population. Fourteen (93%) of 15 evaluable patients had reductions in circulating blasts, and 14 (78%) of 18 patients had reductions in the percentage of bone marrow blasts. This study demonstrates the safety, feasibility, and antileukemic effects of (213)Bi-HuM195, and it is the first proof-of-concept for systemic targeted alpha particle immunotherapy in humans.