Introduction. Autologous stem cell transplant is considered the standard of care in young (<70) fit patients with Multiple Myeloma. We know that intensive chemotherapy or stem cell transplant do not produce a cure, but it does prolong event free survival and overall survival. The aim of this study is to report 15 years of experience in stem cell transplant at the Multiple Myeloma (MM) clinic at Instituto Nacional de Cancerologia (INCan). This is a retrospective, observational trial, we reviewed clinical and electronic files of patients that received an autologous stem cell transplant between January 1st of 2005 and March 1 2015. We assessed clinical status, demographic variables, disease status and clinical outcome of the patients that were included in the study. 48 patients were included into the study, 25 males and 23 females, we grouped the patients according to age, <35 years (2 patients), <50 years (14 patients), 50-65 years (31 patients), >65 years (1 patient). 34 patients had a normal karyotype, 4 had 13q14, 2 had MLL deletion and 8 did not had a karyotype performed. According to the M component we had 6 IgA patients, 32 IgG, 1 IgM, 1 Kappa, 5 lambda, 2 non secretory and 1 combined. According to ISS, 34 patients were assigned a ISS of 1, 10 a SS of 2, and 4 a ISS of 3. The majority of our patients were transplanted within the first line of treatment, 2 within the second line and none with more than 2 lines of treatment. 20 patients that received thalidomide plus dexamethasone achieved complete remission prior to transplant. 14 patients received thalidomide plus dexamethasone achieved very good partial response. 4 patients that received bortezomib plus thalidomide or dexamethasone achieved complete remission prior to transplant. 4 patients received bortezomib plus thalidomide or dexamethasone achieved very good partial response prior to transplant. 3 patients that received two lines of treatment achieved complete remission prior to transplant. 3 patients achieved very good partial response prior to transplant and received more than two lines of treatment. Time from diagnosis to transplant had a mean time of 17.4 months, with 6-12 months as the most prevalent group with 20 patients, followed with 13 patients in the 12-24 months window. 17 tandem transplants were performed. From the 25 patients that received a ASCT and were in CR, 19 maintained that response, from the 23 patients that achieved VGPR 20 maintained that response, 1 achieved partial response (PR), 4 had stable disease, and 4 had progression of the disease. We are looking forward to presenting the full data of our analysis. Since our casuistry does not differ from the international reports. Disclosures No relevant conflicts of interest to declare.
Infectious complications are a major cause of morbidity and mortality in hematologic patients with acute leukemia. In this paper we address the mayor infectious complications, at the Leukemia Clinic (LC) in the Instituto Nacional de Cancerologia (INCan) Material and Methods. This is a retrospective, observational study, carried on at INCan. We included all patients that attended the LC and died of an infectious complication between January 2012 and December 2014, regardless of status (new case/relapsed) at diagnosis, we included patients with Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Acute Biphenotypic Leukemia (ABL) and Acute Promyelocytic Leukemia (APML). The main objective of the study was to determine the most frequent causes of infectious complications in the treatment of acute leukemias. Results. We included 240 patients that were admitted to the LC between the study dates. 12 patients were excluded since they were later diagnosed with another hematologic malignancy rather than leukemia. 228 patients were analyzed. 132 males, 96 females, 36 years was the median age (14-85 years). 126 patients were new cases and 102 patients were treated for relapse. AML 69 patients, ALL 140 patients, ABL 9 patients, and APML 10 patients. We revised the data of all the deaths that occurred in the period of time. 100 cases were included in the study, of those, 30 that were not infectious related and were excluded. Of the 40 patients included, 41 were males and 29 females, with a mean age of 36.8 years (16-72). 44 ALL patients, 18 AML patients, 7 ABL patients and 1 APML patient. 32 patients were new cases and 38 were relapses. The media number of relapses was 1 (1-3). Septic Shock was stated as the cause of death on all electronic files, with Pneumonia as the most common cause of infection origin with 47 patients. As for determining the causal agent of the infection, we used the last positive culture 5 days prior to the death, we found a causal agent in only 47 patients; the most frequent agents involved were: Escherichia coli BLEE with 13 patients, Enterococus faecium with 6 patients, we also report 1 H1N1 and 1 H3N2 influenza infections. 14 patients did not received intensive chemotherapy prior to death, 11 were on supportive care, and 3 of them did not consent treatment. HyperCVAD was the most frequent regimen administered prior to death, with 13 patients, 7+3 followed with 11 patients. POMP in the setting of palliative regimen was also prevalent with 12 patients. 52% of the patients were in nadir of chemotherapy, with a mean of days of 19 (3-64). All patients that received intensive chemotherapy received GSFC and meropenem/vancomycin regimen once septic shock was diagnosed according to the data in the electronic file. All patients received treatment in the beginning, of the 70 patients only 19 were treated in the intensive care unit (ICU). Conclusions. We addressed the most frequent causes of infectious complications at the Acute Leukemia Clinic, as we thought, E. coli BLEE was the most frequent agent involved, perhaps diverting from reports in the literature, we have a low prevalence of gram positive cocci. Pneumonia is the most frequent site of infection, all our patients are admitted to for chemotherapy, hence all the pneumonia cases are hospital acquired. POMP is a prevalent regimen reported, since we use this regimen for palliative care we could relate mortality to relapse/refractory disease more than to toxicity itself. No maintenance regimens were reported in the results. Our study has certain limitations, no mycotic infections could be reported as the electronic file lacks reliable information. Disclosures No relevant conflicts of interest to declare.
Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that combines hydralazine / valproate(Transkrip) in cancer patients with cutaneous T-cell lymphoma Determine toxicity, duration of response and time to progression of epigenetic therapy with hydralazine / valproate in patients with T-cell lymphomas Material and methods an open-label, phase II, prospective and longitudinal in the National Cancer Institute of Mexico was carried out, recruiting patients diagnosed with Cutaneous T based on WHO classification 2008, newly diagnosed untreated, demographic data were analyzed and vital and somatometry signs, assessment of efficacy was established according to the therapeutic response in lymphomas measured at each visit at the affected sites for each patient, using the m-SWAT system sorted in complete response (CR), partial response (PR ), stable disease (SD) and progression (PE) and is considered response to patients with complete or partial response, these data were collected in the form of case report at baseline in the first consultation, during treatment and at the end the study at each visit to the doctor. Statistical analysis was performed with SPSS version 13.0 software. results 16 patients were selected with diagnosis of cutaneous T-cell lymphoma, one patients discontinued the study at baseline and 4 patients had disease progression during the first months of the study, a total of 10 patients who completed 18 months of study continuing the compassionate use treatment. The median age of patients was 45.8 years analyzed (18-83 years) of which 8 are women (53%) and 7 men (47%) with an ECOG 1 in 93.3% of patients, with an average weight of 72.5 ± 15.99 kg, height 1.6 ± 0.1 m, body mass index 28.3 ± 5.7 kg / m2, 46.7% of overweight patients, systolic blood pressure an average of 116.2 ± 14.3 mmHg and diastolic 75.1 ± 11.04 mmHg with respiratory rate 19.43 ± 1.74 resp / min and 77.8 ± 12.3 cardiac beats / min. Of the 10 patients who completed the study, 100% had complete or partial response itching to 6 month continuing unchanged at month 18, the dream as an adverse event occurred in 33% of patients, this being more frequent, adverse events attributed to the drug were known, expected and mild. From 6 months of treatment, the percentage of partial response and complete response of m-SWAT and pruritus were greater than 90% of patients. conclusions: Hydralazine/Valproate (Transkrip) is a medication that offers patients with cutaneous T-cell lymphoma, both first-line and refractory, a therapeutic alternative with high efficiency and good safety profile. Disclosures No relevant conflicts of interest to declare.
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