metabolic response (CMR) was centrally assessed at End of Induction (EOI; fPET) using the 5-point Deauville scale (DS). In this study we included only patients for whom MR was also assessed during ICT between cycle 4 and 5 (iPET). iPET results were defined on the basis of the local report and were also centrally reviewed applying standard DS. The primary endpoint was 3-year Progression Free Survival (PFS).Results: iPET was performed in 211/807 patients enrolled in the FOLL12 trial and local report was available in 186 cases. Forty-eight percent of patients were older than 60 years, 37% had a high-risk FLIPI2, 44% received BR as induction ICT. Based on local report iPET was considered positive in 38/186 patients (20%). iPET and fPET were both available for comparison in 174 cases and showed a concordance rate of 82%: 131 out of 140 iPET-confirmed their CMR at fPET (94%). Regarding the 31 iPET+, a fPET-was achieved in 23 cases (68%). In univariable analysis, the 3-year PFS was lower for the iPET+ patients compared to the iPET-(52% vs 87%: HR of 2.73 95% CI 1.51 -4.95) (Fig 1A). Considering both iPET and fPET, a positive iPET was associated with an increased risk of progression also if a negative fPET was achieved (HR 2.09: 95% CI3.22 -19.5) (Fig 1B).iPET was also associated with a different 3-year OS rate (99% vs 89% for iPET -vs +; p = 0.035). In multivariable analysis the prognostic role of iPET for PFS was confirmed (HR 2.60 (1.41 -4.79) and was independent from FLIPI2 (0-2 vs 3-5 HR 1.88 (1.05 -3.35)), and for ICT (RB vs R-CHOP (HR 1.39 (0.77 -2.51)). The centralized review of iPET response according to DS is ongoing. Conclusions:Interim metabolic response is confirmed with a strong prognostic role for PFS in patients with advanced stage FL treated with standard ICT. Considering the higher rates of iPET+ cases compared to fPET, iPET may better contribute to anticipate the identification of FL patients at different risk of progression and might be used to define a novel generation of response adapted trials in FL.
INTRODUCCIÓNLas enfermedades mielodisplásicas/mieloproliferativas (SMD/SMP) constituyen neoplasias clonales hematopoyéticas que reúnen características clínicas, de laboratorio y morfológi-cas que apoyan un diagnóstico tanto de síndrome mielodisplási-co como de síndrome mieloproliferativo. Dentro de este grupo de hemopatías malignas, la clasificación OMS de los tumores hematopoyéticos y de los tejidos linfoides reconoce tres enfermedades con criterios definidos (leucemia mielomonocítica crónica, leucemia mieloide crónica atípica y leucemia mielomonocítica juvenil) y una cuarta, denominada enfermedad mielodisplásica/mieloproliferativa inclasificable, no encuadrable en las anteriores (1). Aunque no existen trabajos con una casuística amplia que describan las características clínicas y evolutivas de esta última entidad (2), es un hecho conocido la asociación de las enfermedades mielodisplásicas con complicaciones de tipo infeccioso (3). Sin embargo, la infección por Mycobacterium tuberculosis, local o diseminada, es muy infrecuente en pacientes con síndrome mielodisplásico, y las publicaciones que recogen esta asociación son ocasionales (4). Describimos a continuación el caso de un paciente diagnosticado de SMD/SMP inclasificable que presentó en su evolución un cuadro de tuberculosis diseminada que inicialmente simulaba una carcinomatosis peritoneal. CASO APORTADOVarón de 68 años de edad, con antecedentes personales de nefrectomía derecha por carcinoma renal de células claras, litiasis renal, hiperplasia prostática benigna y herpes zóster de repetición. En [0212-7199 (2008) RESUMENPresentamos el caso de un paciente de 68 años diagnosticado de sín-drome mieloproliferativo/mielodisplásico inclasificable (clasificación OMS), con tratamiento corticoesteroideo prolongado y mala respuesta a terapia citorreductora, que presenta en su evolución un cuadro clínico de astenia progresiva, dolor torácico, disnea a mínimos esfuerzos y distensión abdominal, que hace sospechar inicialmente una rotura esplénica. La laparotomía exploradora pone de manifiesto la existencia de implantes peritoneales múltiples, y la biopsia de éstos es diagnóstica de tuberculosis peritoneal. A ello se añade la positividad del cultivo y la PCR en orina, para Mycobacterium tuberculosis, y la posibilidad de probables afectaciones tuberculosas pleural y esplénica. La respuesta al tratamiento antituberculoso fue favorable. No hemos encontrado en la literatura revisada un caso de características similares.
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