Objetivo: describir los resultados clínicos obtenidos en los pacientes con artritis reumatoidea que recibieron infliximab durante el período enero de 2007 a octubre de 2008. Pacientes y métodos: se revisaron 240 historias clínicas de enfermos con AR atendidos en el lapso correspondiente, de las cuales 73 tenían información disponible que cumpliera los criterios de inclusión y exclusión. Se analizaron las características clínicas y sociodemográficas, el comportamiento de la respuesta terapéutica si la hubo y el tiempo de aparición, el uso de medicamentos coadyuvantes y el desarrollo de eventos adversos. Resultados: se describieron 73 pacientes, de los cuales el 89,04% fueron mujeres con edad promedio de 49.7 años y evolución de la AR de 12.0 (± 8.8) años, quienes recibieron 3 mg/k de infliximab con un número promedio de dosis de 9.1. Se obtuvo respuesta terapéutica en 52,05% a las 24.15 (±19.5) semanas de tratamiento. En contraste, los pacientes restantes que aun no tenían mejoría y continuaban con el tratamiento, llevaban con el medicamento un promedio de 26.65 (±22.5) semanas. La terapia fue suspendida en 29 pacientes: 11 (15,06%) de manera temporal y 18 (24,65%) permanente. Conclusiones: el infliximab redujo la actividad inflamatoria en más de la mitad de los enfermos del presente estudio con una baja frecuencia de efectos adversos. Dicha respuesta se documentó con el control en las articulaciones dolorosas e inflamadas. No hubo relación positiva con los marcadores inflamatorios, aclarando el bajo reporte de los mismos en las historias clínicas revisadas. Abreviaturas: AR, artritis reumatoidea; FNT-a, factor de necrosis tumoral; CAR, Colegio Americano de Reumatología.
4520 Between June 1995 and June 2011, we performed 133 Autologous Stem Cell Transplantation (ASCT) in patients with NHL. Long term results of treatment and outcome were analyzed. The data presented were obtained from the Statistical Center of the Center for International Blood and Marrow Transplant Research. Median age was 48 years (range 18–65), 9% ≥ 60 years, 77 males and 55 females. The histology was: 98 (74%) B NHL, Follicular Lymphoma (FL) 26 (20%), Diffuse large B Cell Lymphoma (DLBCL) 47 (35%), Primary Mediastinal Large B Cell Lymphoma 12 (9%), Mantle cell Lymphoma (MCL) 6(4.5%), Marginal Zone Lymphoma 4 (3%), Small Lymphoplasmocytic 2 (1.5%), precursor B Lymphoplasmoblastic 1 (1%), and 35 (26%) T NHL, Peripheral T Cell Lymphomas NOS 12 (9 %), Anaplastic LC, T/N Cell systemic 9 (6.5%), Anaplastic LC, T/N Cell cutaneous 1(1%) and T/NK Cell Lymphoma 7 (5%), Angioinmunoblastic T Cell Lymphoma 2 (1.5%), Mycosis Fungoides 2 (1.5%), other T Lymphoma 2 (1.5%). We emphasize that 59 % of the patients had advanced disease at the moment of the transplant: 41% CR1, 11% CR2, 5% REL1, 8% primary induction failure, other 33% (CR3+, PR, and REL2+), and 2% missing/unknown. Condition regimens were BEAC 88%, BEAM 10% and CBV 2%. Stem cells source: 74% peripheral blood stem cells (PBSC) and 26% received bone marrow (BM) and PBSC. Overall survival was 86% (95 CI, 80–92) at 1 year, 78% (95 CI, 70–85) at 3 years and 71% (95 CI, 62–79) at 5 years. Median follow up of survivors was 96 months (3–181). Primary cause of death was relapsed or progression. We concluded that high dose therapy and Autologous Stem Cell Transplantation is an effective and feasible therapy for patients with high risk NHL. However relapse continues to be the most common cause of treatment failure. Newer strategies such monoclonal antibodody, require further investigation but early reports appear promising in reducing relapses in ASCT. Disclosures: No relevant conflicts of interest to declare.
Between 1995 and 2005, we performed 329 hematopoietic stem cell transplantation (HSCT), 286 autoulogous and 43 allogeneic. Long term results of treatment and outcome of ASCT in 100 Non Hodgkin Lymphoma (NHL) were analyzed. Median age was 47 years (range18 – 64) and the histology was: Follicular Lymphoma 15%, diffuse large B cell lymphoma (DLBCL) 47%, T lymphoma 27% and 11% others. At diagnosis 66% had advanced stage (III/IV), 40% had B symptoms, and 34% had extranodal involvement. Disease status at HSCT was: 5 % primary induction failure, 41% CR1, 20% CR2 +, 7% CRU, 12% relapsed. Number of prior chemotherapy regimens was 47% 2 lines, 20% 3 lines and 3% 4 lines; 27% had received prior induction or consolidation radiotherapy. Condition regimens consisted of BEAC (81%), BEAM (15%), others (4%). Stem cell source: 39% received BM + PBSC and 61% PBSC. Sixty nine are alive with a median survival of 3448 days (9.5 years). Median overall survival was similar in DLBCL (59%) and peripheral T lymphoma (60%). The best overall survival was observed in CR1 (77%) versus 52% in CR2 and 66% in PR1. Primary cause of death was relapsed or progression (24/31). We concluded that high dose therapy and autologous HSCT is an effective therapy for patients with poor risk NHL however relapse continues to be the most common cause of treatment failure. Newer strategies such as monoclonal antibody, require further investigation but early reports appear promising in reducing relapses in autologous HSCT.
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