Background: The biology of some hematological diseases varies among different populations. No previous studies have evaluated the clinical behavior of mantle cell lymphoma (MCL) in México. Objective and Methods: This is a retrospective review of MCL cases seen in Mexico from January 2003 to June 2020. A total of 12 cases were identified. Results: There were nine males and three females; median age was 56 years. Eight patients had a high MCL international prognostic index score, one was intermediate, and three were low. Five patients had circulating malignant monoclonal cells. Initial treatment included rituximab, cyclophosphamide, daunorubicin, vincristine, and prednisone (R-CHOP) and CHOP. Subsequent treatment included hematopoietic stem cell transplantation in five patients; two were given maintenance therapy. Splenectomy was done in four patients. Median overall survival (OS) for all the patients has not been reached and exceeds 162 mos: OS at 162 mos was 56%. Achieving a complete remission (CR) after the first treatment was a significant prognostic factor, with a median OS exceeding 141 mos in patients achieving CR, and 16 mos among those not achieving CR (p = 0.0006). Conclusion: Some of MCL patients in Mexico have an indolent clinical course, particularly patients who achieve a CR to initial treatment and who undergo splenectomy. (REV INVEST CLIN. [AHEAD OF PRINT]
Introduction: Hematopoietic stem cell transplantation (HSCT) has been widely employed for autoimmune disorders under myeloablative and non-myeloablative regimens. The main indication for HSCT in this setting is multiple sclerosis (MS) in its relapsing-remitting form and related disorders such as neuromyelitis optica or clinical isolated syndrome. Results have varied, but response rates and prognostic features are still unkown along the spectrum of disease and conditioning regimens. Methods: People with MS (PwMS) autografted from March 2015 to March 2020 with a reduced intensity regimen (Cy/G-CSF + Rituximab) (NCT 02674217), were followed longitudinally every 3 months to assess the Expandable Disease Status Scale (EDSS). All patients with complete follow-up data were included in this study and two different cohorts were made according to PwMS that were followed by 12 or 24 months. The primary outcome was improvement or stabilization of EDSS at 12 months and 24 months. All potential prognostic factors were collected from electronic medical record of patients with complete sociodemographic, clinical and laboratory data. In order to identify prognostic factors related to responses, univariate analyses were carried out with logistic regression; variables that showed a p value <0.15 were included in the multivariate analyses (using age, sex, type of MS, previous history of EDSS as covariates) with logistic regression. All patients signed a consent to authorize intervention and contact for follow-up and the protocol study was approved by the Institutional Ethics Committee. Results: Two cohorts were formed according to follow-up periods. Cohort 1 (12 months follow-up) comprised of 200 pwMS, 133 (66.5%) being female and 47 (33.5%) male. Their features are shown in Figure 1A. Cohort 2 (24 months follow-up) was formed by 93 pwMS, 60 (64.5%) being female and 33 (35.5%) male. Their features are shown in Figure 1B. In cohort 1, 149 pwMS (74.5%) had a response while 51 (25.5%) did not. Mean change of EDSS between baseline and 12 months post-HSCT was -0.42 (range -7 to 4). In cohort 2, 54 patients (58%) had a response while 39 (42%) did not. Mean change of EDSS between baseline and 24 months post-HSCT was -0.02 (range -4 to 7). In cohort 1, baseline EDSS ≥4 was identified as a predictor of 12 months response in multivariate analysis (OR 0.02, p 0.02, 95% CI 0.1- 0.8). Also, early response at 3 months post-HSCT in the univariate (OR 8.5, p <0.0001, 95% CI 3.9 - 18.4) and multivariate (OR 10.3, p <0.0001, 95% CI 4.6 - 23.2) analyses presented as a predictor of 12 months response. In cohort 2, early response at 6 months predicted response at 24 months post-HSCT in the univariate (OR 16.1, p <0.0001, 95% CI 4.8 - 53.6) and multivariate analysis (OR 28, p <0.0001, 95% CI 5.8 - 133.8). Furthermore, duration of disease >10 years showed an association with a negative response at 24 months as well in the univariate (OR 0.3, p 0.008, 95% CI 0.1 - 0.7) and multivariate analyses (OR 0.1, p 0.002, 95% CI 0.04 - 0.5). These results are shown in Figure 1C and 1D. Conclusions: Early response at 3 or 6 months may be robust measures that could translate in long term improvement or stabilization of disease. Although the effects showed in this study are profound and were replicated on two cohorts, these results should be interpreted with caution and a longer follow-up could confirm these findings. Disclosures No relevant conflicts of interest to declare.
2020) Up to half of patients diagnosed with chronic lymphocytic leukemia in México may not require treatment, Hematology, 25:1, 156-159, ABSTRACT Introduction: Although therapeutic choices for patients with chronic lymphocytic leukemia (CLL) were once limited, treatment of this disease has vastly improved in the last decades. Patients and methods: Consecutive CLL patients diagnosed in a single institution were analyzed. Treatment was withheld in persons with CLL Rai stage 0 or 1, until progression and in persons with stages 2-4, with a negative expression of ZAP-70 until progression. Between 1983 and 1991, patients were give chlorambucil and prednisone (CP); after 1991 fludarabine and cyclophosphamide (FC) and after 1998, rituximab and FC (FCR). Results: 98 patients with CLL were identified; 49 were followed for >3 months. 21 persons (43%) did not require treatment nor progressed; 14 received CP, 6 FC, 7 FCR and one rituximab. Median overall survival (OS) has not been reached, being above 247 months; median OS for patients given CP was 115 months, for FC above 132 months and for FCR above 136 months (p > 0.5). Conclusion: CLL seems to be less aggressive in Mexican mestizos than in Caucasians; 43% of patients do not need treatment at all.
Background: Hodgkin's lymphoma (HL) is the model of curative care with radiation therapy, combination chemotherapy, staging approaches, peripheral blood stem cell transplantation, and immunotherapy. However, the value of the novel anti cancer drugs has been recently analyzed and questioned in view of the results in the real improvement of overall survival (OS). Material and methods: All consecutive patients seeking medical care after 1986 in our institution as a result of HL and followed for at least 3 months were entered in the study. A diagnosis of HL was based on the histological study of a pathology specimen, mainly a lymph node; the same pathologist analyzed all the specimens and defined the histological subtype. Clinical stage was defined according to the Ann Arbor classification. Bone marrow biopsies were done only in patients with clinical stages III or IV. Computed tomography (CT) scans were done in all cases, prior to starting the treatment. Fluorodeoxyglucose positron emission tomography (FDG-PET) scans were performed since 2002. Between 1986 and 1997, patients were treated with MOPP, and after 1997 with ABVD as frontline therapy. For stages I and II, four cycles of chemotherapy were delivered and a computerized tomography (CT) scan was performed; if lymph node enlargement were present at this point in time, four additional cycles were given, whereas two additional cycles were given if the CT scan was negative. For stages III and IV, the CT scans were performed at the end of six cycles and two or four more cycles. Mediastinal radiotherapy was delivered only to persons with a positive FDG-PET scan at the end of the treatment. Patients showing activity after these treatments were considered as refractory and treated with four courses of ICE (ifosfamide, carboplatin and etoposide). Autologous or allogeneic peripheral blood hematopoietic stem cell transplants (HSCT) were given to refractory patients after achieving a complete remission (CR): High-dose melphalan (200mg/m2) was employed in autologous transplants, whereas cyclophosphamide, fludarabine and busulfan were employed in allogeneic transplants, all of them from HLA-identical siblings. After the completion of the treatment, patients were every two months for one year and every four months later on. No FDG-PET scans were done during the follow up, unless clinically indicated. Results: Among 91 patients with HL identified between 1986 and 2020, 88 were followed three months or more and were included in the analysis. There were 37 females and 51 males. The median age was 29years (range5-73years). There were 62 patients with nodular sclerosing HL (70%), 19 mixed cellularity (HL), 2 lymphocyte depleted HL, and one lymphocyte predominant HL; in 4 cases the histologic variant could not be defined. According to Ann Arbor classification, 5 patients were found in stage I, 48 in stage II, 19 in stage III and 16 in stage IV. Ten patients presented with a mediastinal mass larger than 10 cm. in the chest X-ray film. Three cases presented with relapsed disease. Patients have been followed for a median of 114 months (range4-402). 44 patients are alive, 10 have died and 34 were lost to follow-up. Median OS for all the patients has not been reached, being above 402 months, the OS at 310 months is 88% and at 402 months 77%. Median OS has not been reached and is above 94, 109, 90 and 98 months for stages I, II, III and IV, respectively (p=0.2). The 310-month OS was 83% for patients treated with MOPP and 88% for those treated with ABVD (HR:0.76, 95% CI 0.2-2.8; p=0.6).Sixteen patients (18%) were refractory to the treatment and 9 (10%) relapsed; they were treated with ICE followed by HSCT (autologous 15 patients and allogeneic 10 patients). Patients who underwent auto-HSCT had a median survival of 329.1 months and an OS of 92.3%, whereas those given allo-HSCT had a median survival of 59.3 months and an OS of 45.7% (HR0.2, 95%CI 0.04-1.3, p=0.057). The OS of patients given or not HSCT was 73.5% and 92.9% at 266 and 404 months, respectively (HR4.09, 95%CI 1.0-16.6, p=0.01). The OS was similar. The causes of death were breast carcinoma in 2 cases, liver carcinoma in one and uncontrolled lymphoma activity in the remaining. Conclusion: HL may be less aggressive in Mexican population than in Caucasians. Combined chemotherapy renders acceptable results, irrespective of clinical stage. Disclosures No relevant conflicts of interest to declare.
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