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Biomedical subjects

A Marín-López

Publications and source records attributed to A Marín-López.

At least 19 recordsLinked to original sources
PubMed1998

Non-cryopreserved peripheral blood stem cells autotransplants for hematological malignancies can be performed entirely on an outpatient basis.

We have prospectively performed peripheral blood stem cell autotransplants in six patients with hematological malignancies on an entirely outpatient basis. Patients were conditioned with high-dose melphalan and received a median of 4.2 x 10(8)/kg non-cryopreserved, non-purged mononuclear cells, containing a median of 3.9 x 10(6)/kg CD34 + cells. The median time to achieve > 500 granulocytes/microl was 21 days, with a range of 16 to 40, whereas the median time to achieve > 20,000 platelets/microl was 38 days, with a range of 21 to 48. Only three patients were transfused with platelets whereas packed red blood cells were transfused in two. All patients survived 60 days after the autograft and three are alive at 450, 690, and 1,950 days after the autotransplant. One patient was given an allogeneic bone marrow transplant when relapsing after the autotransplant. One patient had to be admitted to the hospital on day +10 because of fever. A median of 6,500.00 USD per patient was calculated as the total cost of each outpatient autotransplant. Since outpatient autologous transplants with non-frozen PBSC are feasible, restrictions to PBSC autotransplant programs may be overcome and costs may be diminished.

Adult↗
PubMed1995

Filgrastim-mobilized peripheral-blood stem cells can be stored at 4 degrees and used in autografts to rescue high-dose chemotherapy.

We studied 21 filgrastim (G-CSF)-mobilized peripheral blood stem cells (PBSC) apheresis products obtained from seven patients, and stored at 4 degrees C for periods of up to 96 hr prior to their reinfusion, to rescue high-dose chemotherapy. The apheresis products contained a median of 106 x 10(8)/L mononuclear cells (MNC), 14.6% of them displaying the CD34 antigen; the viability was over 90% in all samples studied at 24, 48, and 72 hr after harvesting. These PBSC were successfully used to rescue high-dose chemotherapy; patients received a median of 4.8 x 10(8)/Kg MNC; the median time to achieve > 500 granulocytes was 14 days (range 11-26) and the median time to achieve > 20,000 platelets was 20 days (range 11-40). Since autologous transplants with nonfrozen PBSC are feasible and less costly than those using frozen PBSC, restrictions to PBSC autotransplant programs may be overcome and costs may be diminished.

Adult↗
PubMed1995

Outpatient supportive therapy after induction to remission therapy in adult acute myelogenous leukaemia (AML) is feasible: a multicentre study.

Twenty-four adult patients with AML were treated with standard "7 + 3" chemotherapy. After administering the myeloablative drugs in the hospital, patients were instructed to continue their supportive treatment on an outpatient basis; they received ciprofloxacin, cotrimoxasole and itraconazole vo until the absolute granulocyte count rose above 1 x 10(9)/l. Platelet concentrates were given every other day until the platelet count rose above 20 x 10(9)/l. Complete remission (CR) was obtained in 87%. Fever developed in 29% and 2 cases were complicated by indwelling-catheter-related Pseudomona aeruginosa septicaemia, 1 Entamoeba hystolytica enteritis and 1 Pneumocystis carinii pneumonia; these patients were hospitalized to treat these infections specifically. In no case was the infection fatal. The median disease free-survival (DFS) was 17 months, 12-month DFS was 66%, and 30-month DFS was 17%. Our calculations have shown that 1700 USD/patient were saved by avoiding prolonged hospitalization; this may provide not only economical, but also psychological advantages to patients.

Adolescent↗
PubMed1993

[Autotransfusion and pregnancy].

PURPOSE: To analyse the results of a pre-deposit autologous transfusion programme in pregnant women on their third period of pregnancy. MATERIAL AND METHODS: Fifty donor/pregnant women were included in the study. They were in the third trimester of their pregnancy and had risk of requiring transfusion during or after surgery. Haemoglobin above 11 g/dL and haematocrit above 34% were required in each case. Phlebotomy was performed at one-week intervals, iron and folate being supplied. Constants such as foetal heart frequency were evaluated, the programme being interrupted in case of foetal bradycardia. Apart from weight, Apgar and Silverman scores were applied to each newborn. RESULTS: Cephalopelvic disproportion was the commonest obstetric indication, 26 cases (52%). For autologous blood transfusion, rare blood groups, 12 cases (24%), followed by intra- or post-operative bleeding risk, 10 cases (20%) and being Jehovah's Witnesses, 9 cases (18%), were the major indications. Ninety-four blood units were drawn, 34 of them being used. The remaining 60 units were used for homologous transfusion. No complications developed during phlebotomy and the neonatal determinations showed no significant anomalies. CONCLUSIONS: (1) Autologous blood transfusion with pre-deposit in the third trimester of pregnancy is a safe and effective way of collecting blood. (2) Its indication is not reduced to rare blood groups. (3) The procedure seems to be safe for both the mother and the newborn.

Adolescent↗
PubMed1989

Leukaemia and nutrition. I: Malnutrition is an adverse prognostic factor in the outcome of treatment of patients with standard-risk acute lymphoblastic leukaemia.

A group of 43 pediatric patients with standard-risk ALL were studied. Thirty-seven per cent of them presented with malnutrition at diagnosis. Malnourished children had a significantly worse outcome than well-nourished children. Five-year DFS was 83% for well-nourished children (WNC) and 26% for under-nourished children (UNC) (p less than 0.001). Relapses presented more frequently in the bone marrow in UNC than in WNC (56% vs 7%, p less than 0.0001). The doses of maintenance chemotherapy had to be reduced in 68% of UNC and 11% of WNC (p less than 0.005); the doses of maintenance myelosuppressive chemotherapy (6-MP, oral MTX and hydroxyldaunorubicin) received by UNC were approximately 50% of those received by WNC (p less than 0.01). The correlation between malnutrition and compromised treatment was 0.92. Malnutrition might be included as an adverse prognostic factor in acute lymphoblastic leukaemia (ALL).

Adolescent↗
PubMed1989

The pretreatment DNA labelling index of the blast cells of patients with acute lymphoblastic leukaemia as a prognostic factor in the outcome of treatment: the concept of 'G-0 acute leukaemia'.

A group of 15 patients with acute lymphoblastic leukaemia was studied prospectively to analyse the impact of the pretreatment DNA labelling indices of the blast cells. Patients with labelling indices less than 5% did significantly worse than those with labelling indices greater than 5%: the 60-week disease-free survival of patients with acute lymphoblastic leukaemia and labelling indices greater than 5% was 80%, whereas that for patients with labelling indices less than 5% was 24%, P less than 0.05. In addition, three patients with acute leukaemia and DNA labelling indices of 0%, so-called G-0 acute leukaemias, are described: all of them had refractory forms of acute lymphoblastic leukaemia with a very poor outcome to treatment.

Adolescent↗
PubMed1989

Low doses of high-potency antithymocyte globulin (ATG) in severe aplastic anemia: experience with the Mexican ATG.

Twenty patients with severe aplastic anemia (SAA) were treated with low doses (1-5 mg/kg/day) of a high-potency antithymocyte globulin (ATG) produced in Mexico, shown to have at least a 10-fold potency as compared with other globulins of commercial sources. Patients received ATG within a 10-day period, every other day (5 doses) at a dose of 1 mg/kg/day (4 courses), 2 mg/kg/day (12 courses) or 5 mg/kg/day (8 courses). Four patients received 2 consecutive courses of different doses of ATG. A response rate of 42% was recorded in the group, assessed by means of increases in reticulocytes, granulocytes or platelets. One patient showed a complete remission. The 570-day survival of the group was 51%. It is concluded that the domestically produced ATG is useful in the treatment of some patients with SAA in Mexico.

Adolescent↗
PubMed1988

The incidence of hybrid acute leukaemias.

During a 4-yr period, 292 patients with acute leukaemia were studied using morphology, cytochemistry and immunologic reagents to determine the cell lineage of the leukaemia. One hundred and sixty-three cases were shown to be acute lymphoblastic leukaemia (ALL), 127 acute myeloblastic leukaemia (AML) and two cases (0.6%) were classified as hybrid acute leukaemias. One was biphenotypic in which the blast cells displayed both T-lymphoid (60% E-rosettes) and megakaryocytic markers (47% CDw41/glycoprotein IIb/IIIa antigen, 50% myeloperoxidase). The second was a bilineal acute leukaemia in which some blast cells displayed B-lymphoid (47% CD10/CALLA, 40% acid phosphatase) features and other megakaryocytic (33% coagulation factor VIII:WVf antigen)/myeloid (30% Sudan Black) features. This study suggests that hybrid acute leukaemia are rare.

Adult↗
PubMed1988

A prospective trial of the treatment of acute megakaryoblastic leukaemia.

Acute megakaryoblastic leukaemia, the M-7 variant of acute leukaemia according to the French-American-British (FAB) co-operative group, comprises 8.4% of all cases of acute leukaemia in the city of Puebla, Mexico. The malignancy can be identified by means of monoclonal antibodies or electron microscopy. Using two monoclonal antibodies, Hp1-1d that binds the glycoprotein IIb/IIIa complex (CDw 41) and W1-23 that recognizes the factor VIII:von Willebrand fraction, we have found 19 cases of M-7 leukaemia. Fourteen of these were entered in a prospective therapeutic trial, seven were treated with low-dose (LD) Ara-C (10 mg/m2, delivered subcutaneously every 12 h in 21-day courses). The median age was 14 years, four were female and three male. The remaining seven patients were treated with HOP (adriamycin 25 mg/m2 + vincristine 1.4 mg/m2 orally, daily, for the same period. The median age was 20 years, three were females and four males. Patients were followed for periods of 1-24 months. Six of seven patients in each group achieved remission; however, 18-month disease-free survival was 14% for the LD Ara-C group and 42% for the HOP-treated group. All patients in the LD Ara-C group were dead at 24 months; three patients in the HOP group survived at 12, 14 and 18 months. Differences between these two groups are probably not significant due to the small number of patients involved.

Adolescent↗
PubMed1984

Lymphocyte subsets in patients with aplastic anemia.

Lymphocyte subsets were enumerated in a group of 31 patients with aplastic anemia. Abnormal numbers of immunoregulatory T-cells were found in some patients: 26% of them showed a reversed helper/suppressor ratio. Seven of 18 patients showed significantly decreased proliferation in response to PWM; this hyporesponsiveness was present in 75% of patients with a reversed helper/suppressor ratio and in 10% of those with a normal helper/suppressor ratio (R = 0.66, P = 0.008). Eight of 18 patients showed suppressor activity over PWM-induced allogeneic cell proliferation. This suppressive activity did not correlate with T-cell phenotype. Of the patients with a low number of T-cells, 73% had responded to treatment, whereas of those patients with a normal number of T-cells, 26% had responded (P = 0.016). The results are consistent with abnormal immune response in selected patients with aplastic anemia, and suggest a possible influence of T-cells on disease process.

Adolescent↗
PubMedDate not supplied

Non-cryopreserved unmanipulated hematopoietic peripheral blood stem cell autotransplant program: long-term results.

BACKGROUND: Methods to simplify bone marrow transplantation procedures are needed mainly in developing countries. METHODS: Between May 1993 and February 1999 in a private-practice setting, we performed 29 autotransplants in 28 patients using non-cryopreserved and unmanipulated peripheral blood stem cells mobilized from the bone marrow to the peripheral blood by means of hematopoietic growth factors. The autografting procedure was performed entirely on an outpatient basis in 19 cases (65%). The median age of the patients was 30 years, with a range of 9-67. There were 15 patients with acute leukemia (9 with acute myelogenous leukemia), 3 with chronic myelogenous leukemia, 2 with multiple myeloma, 3 with Hodgkin's disease, 2 with non-Hodgkin's lymphoma, and 4 with metastatic breast carcinoma. RESULTS: The median time to achieve > 0.5 x 10(9)/L granulocytes was 14 days (range 7-42), whereas the median time to achieve > 20 x 10(9)/L platelets was 20 days (range 5-49). The 64-month post-transplant survival was 38%, whereas the median post-transplant survival was 18 months. The transplant-related mortality was 3.4%. The approximate cost of this simplified procedure was 10.8% for in-hospital procedures and for outpatient autografts, substantially lower than figures reported from the U.S. for autotransplants. CONCLUSIONS: This simplified method for autografting patients, avoiding in-hospital stays, purging procedures and cryopreservation of the cells is feasible and results in a substantial decrease of the cost of autologous hematopoietic stem cell transplantation methods.

Adolescent↗
PubMedDate not supplied

[Malnutrition is an adverse prognostic factor in the response to treatment and survival of patients with acute lymphoblastic leukemia at the usual risk].

A group of 43 pediatric patients with standard risk acute lymphoblastic leukemia (ALL) was studied prospectively and treated with a protocol that included adriamycin, vincristine and prednisone (HOP) to induce remission; cranial irradiation and intrathecal methotrexate (MTX) as CNS prophylaxis and mercaptopurine and MTX together with pulses of HOP every three months to maintain remission. Complete remission (CR) was achieved in 95.3% of the group; 5-year survival was 67%. The following variables were analyzed in the outcome to treatment: Age, sex, WBC at diagnosis, FAB morphology, CALLA/CD10 reactivity of the blast cells, lymph node, liver or spleen enlargement, site of treatment (private practice versus city hospital) and malnutrition. None of these variables had a significant impact in survival, but malnutrition. Under-nourished children (UNC) n = 16, had a significant worse outcome than well-nourished children (WNC) n = 27. Although CR was achieved in 98% of WNC versus 94% of UNC, five-year survival was 83% for WNC and 26% for UNC (p less than .001); relapses were observed in 18% of WNC and 75% of UNC (p less than .0005). Relapses presented more frequently in the bone marrow in UNC than in WNC (56% versus 7% p less than .0001). The doses of maintenance chemotherapy had to be reduced in 68% of UNC and 10% of WNC (p less than .005). The poor outcome to treatment observed in UNC was due to systemic relapses, apparently related to a poor tolerance to maintenance chemotherapy. Malnutrition might be included as an adverse prognostic factor in the outcome to treatment of children with ALL, in developing countries.

Adolescent↗
PubMedDate not supplied

[Preliminary report on the effect of low doses of azidothymidine (AZT) in the treatment of patients with stage III infection by human immunodeficiency virus (HIV)].

Ten patients with CDC stage III of infection by HIV were treated with AZT at doses of 300 mg/day (100 mg tid). There were 5 males and 5 females, the median age being 40.5 yr' (range 26-46). Seventy percent of them had transfusion-associated HIV infection and the rest had been infected by the sexual route. A positive clinical response was observed in 100% of the group after 16-24 weeks of treatment: the Karnofsky performance status increased from 64% to 94% (p less than 0.01), the white blood cell count raised from 3.7 to 6.0 K/microL (p less than 0.01), the number of helper lymphocytes (CD4+) also raised significantly from 248.2 to 470.7/uL (p less than .01). Only two patients required red blood cells transfusions. The life expectancy at 82 weeks was 90%. Toxicity was both moderate and transitory. It is concluded that low doses of AZT (300 mg/day) produce similar clinical results as doses of 1200-1500 mg/day. A larger study is needed to support our preliminary findings.

AIDS-Related Complex↗
PubMedDate not supplied

[Paid blood donors: a new risk group for the development of AIDS in Mexico].

We analyzed the clinical and epidemiological characteristics of seven patients with AIDS who were infected through contaminated needles or blood letting equipment; no other risk factor was identified in these patients. In the Dirección de Epidemiología de los Servicios Coordinados de la Salud in the state of Puebla, 37 cases of AIDS were registered up to June 15, 1988. Nineteen percent of these were paid donors between the ages of 26 and 45. There were five males and two females. All of them had weight loss, fever, chronic diarrhea and adenomegaly. Six had respiratory complaints, four candidiasis and two pulmonary tuberculosis. In the state of Puebla, there are 517 paid donors registered as carriers of Human Immune Deficiency Virus (HIV). We do not know the number of blood donations and therefore the number of receptors. In this state, 52 percent of AIDS cases are post-transfusional and we fear an increase. We propose that all paid blood donors should be considered as a high risk group.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[High doses of cytosine arabinoside in the treatment of patients with acute relapsing or refractory leukemia].

Ten patients either in relapse (n = 7) or refractory (n = 3) acute leukemia were treated with high-dose Ara-C (3000 mg/m2) every 12 hours to a total of eight 2 doses (24,000 mg/m2). Myeloblastic (n = 5), lymphoblastic (n = 4) and hybrid (n = 1) acute leukemias were included. In the total group, complete remission was achieved in 6 of 10 cases (60%); the remission rate was higher in the relapsed than in the refractory acute leukemia group (71 versus 33%;) the duration of the complete remission ranged between 1 and 13 months, with a median of 2 months; the remission duration was also higher in the relapsed than in the refractory acute leukemia group (4 versus 1 month). Refractoriness to the high-doses of Ara-C was observed in two cases, and fatal iatrogenic myelosuppression was produced in two patients. The rate of complete remission was 80% in myelogenous leukemia and 50% in lymphoblastic leukemia. It is concluded that high-dose Ara-C is another therapeutic choice in the treatment of relapsed and perhaps refractory acute leukemia.

Adolescent↗
PubMedDate not supplied

[Blood transfusion from cadavers].

Most of the transplant programs in our days are based on cadaveric donation; blood has been not recovered from dead bodies, except by some Soviet groups. We selected 16 subjects, eight with brain death and eight with "biological" death (heart arrest) that were considered as ideal donors. From them we obtained 23 units of whole blood, either by surgical dissection of the internal jugular vein, by puncture of the femoral artery or by puncture of a peripheral arm vein. Twelve were not used due to bacterial growth, HBsAg positivity or hemolysis. Of the remaining, we obtained 10 packed red cells and 10 units of plasma, one unit was transfused as whole blood. Three plasma units were discharged due to "turbidity". Sixteen patients for whom it was difficult to get a voluntary donor were transfused with some of the products and followed for as long as they remained in hospital. None showed adverse reactions due to the procedure. We conclude that the organization of any program related to the transplantation of organs is not a simple matter, but that blood is easily recovered and that this should be done always as part of the "total use" of a donating body; cadaveric blood transfusion is harmless provided donors are carefully selected and that the sterility of the product is confirmed by culture.

Adolescent↗