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Biomedical subjects

R Arranz

Publications and source records attributed to R Arranz.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Imipenem combined with teicoplanin or vancomycin in the initial empirical treatment of febrile neutropenia. Analysis of the primary response and of a global sequential strategy in 126 episodes].

The results of empiric antibiotic therapy in 126 episodes of febrile neutropenia in patients with hematologic neoplasms postchemotherapy and bone marrow transplantation are presented. The main objective of this work was the study of the initial control of infection comparing two glycopeptidic antibiotics: vancomycin and teicoplanin combined with imipenem in first line of empiric therapy. The secondary objective was to analyze the overall control of infection during the complete episode of neutropenia using a sequential empiric antibiotic therapy course which included the addition of amikacin followed by intravenous amphotericin B when fever persisted or recurred without microbiological documentation. Both initial courses (no guidelines), imipenem + vancomycin (arm A) and imipenem + teicoplanin (arm B) resulted in a similar percentage of response at 72 hours, both in episodes of fever of unknown origin (FUO) (55% and 68%, respectively; p = NS) and in those microbiologically documented (54% and 34.5%, p = NS); 58% and 79% of these episodes, respectively, were caused by gram-positive organisms. About 60% of patients in both arm ultimately required the empiric addition of amikacin, with or without amphotericin B, because of persistence or recurrence of fever; the percentage of overall responses in both arm did not differ significantly, both in FUO (70% and 86%, p = NS) and in microbiologically documented episodes (71% and 45%, p = NS). The overall infectious mortality for the whole group was 1.58%. In conclusion, no significant differences were observed in the clinical response or in toxicity between the combination of imipenem with any of the two glycopeptides: vancomycin or teicoplanin, for the initial empiric therapy of febrile neutropenia. The sequential empiric use of amikacin followed by amphotericin B assured an adequate overall control of infection in a group of patients with prolonged severe neutropenia.

Adolescent↗
PubMed1995

[Allogeneic bone marrow transplantation in chronic myeloid leukemia. The clinical results and risk factors in 70 patients].

BACKGROUND: The 10 year experience of a single center performing allogeneic bone marrow transplantation in 70 patients with chronic myeloid leukemia (CML) is analyzed. METHODS: Seventy patients transplanted for CML between November 1982 and October 1992 were evaluated. Fifty-two patients were in the first chronic phase (FC), 10 in an accelerated phase, 4 in blast crisis and 4 in the second chronic phase. The combination of cyclosporin and methotrexate was the most commonly used prophylactic schedule for graft versus host disease (GVHD) (60 cases) and T depletion was not performed in any case. The combination of cyclophosphamide (120 mg/kg) and total body irradiation was used in 48 patients with the remaining patients received busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg). The estimation of survival was performed using the Kaplan-Meier limit product method. The prognostic factors influencing survival, disease free period and relapse were evaluated by Cox multivariate models of proportional risk. RESULTS: Actuarial survival at four years was 40% (95% Cl: 26-58%). Multivariate analysis selected variables associated with lower survival, the presence of acute GVHD (relative risk-RR-4.75), advanced disease phase (RR: 3.26) and age over 30 years (RR: 3.57). Eleven patients had relapsed. Multivariate analysis found the absence of chronic GVHD (RR: 5.3) and advanced phase (RR: 1.91) to be associated to a higher probability of relapse. In a separate analysis of the 48 patients transplanted in chronic phase who received cyclosporin and methotrexate, the disease free survival was longer for those under the age of 30 years (71.4% vs. 36%) without acute GVHD (68.8% vs. 39.6%) and those transplanted from a male donor (64.6% vs. 30%). CONCLUSIONS: Advanced phase of the disease, the presence of acute graft versus host disease and the age and female sex of the donor are the main factors associated to shorter survival in allogeneic bone marrow transplant for chronic myeloid leukemia. In contrast, the presence of chronic graft versus host disease decreases the possibilities of relapse.

Adolescent↗
PubMed1995

Hypertriglyceridemia may be severe in CML patients treated with interferon-alpha.

We analyzed serum triglyceride (TG) levels in 22 chronic myeloid leukemia (CML) patients treated with interferon-alpha (IFN-alpha). Hypertriglyceridemia was present in one-half of patients at diagnosis, and IFN-alpha treatment was associated with a further increase in 90% of the total group of patients. This increase was maximal during the first months of therapy. Four patients (18%) reached levels higher than 1,000 mg/dl. This is the first report describing this secondary effect in CML patients treated with IFN-alpha.

Adolescent↗
PubMed1995

Busulfan and melphalan as conditioning regimen for autologous peripheral blood stem cell transplantation in multiple myeloma.

Twenty-four patients with multiple myeloma (MM), three (12.5%) in complete remission (CR) and 21 (87.5%) in partial remission (PR) were treated with high-dose chemotherapy (HDCT) (busulfan 12 mg/kg+melphalan 140 mg/m2) as preparative regimen for autologous peripheral blood stem cell (PBSC) transplantation. These cells were previously collected by leukapheresis after mobilization by high-dose cyclophosphamide (HD Cy)+rhGM-CSF (18 patients) or rhG-CSF alone (six patients). Considering 23 evaluable patients following HDCT, the CR rate was 58% (14 patients) and the PR rate was 38% (nine patients). One transplant-related death occurred following this regimen (4%). With a median follow-up of 20 months (range 4-34) after transplantation, 21 patients are alive (87%). Disease progression after transplantation was observed in four patients. Overall and relapse-free actuarial survival at 24 months was 91% and 74%, respectively. 12 patients (50%) remain in CR 15 months (4-34) post transplant. The major toxicity was mucositis. Busulfan+melphalan is a safe and feasible conditioning regimen for APBSCT in MM with acceptable toxicity and a high objective response rate, which may result in prolonged survival.

Adult↗
PubMed1994

[Castleman's disease: description and comments on 3 cases].

Three representative cases of the clinical heterogeneity of Castleman's disease are presented: one localized form with hialine vascular histology (HV) and 2 multicentric forms corresponding to the plasmocellular variety (PC). The asymptomatic patient with HV was treated with surgical resection of one tumor. The 2 patients with the symptomatic PC variant were characterized by the different clinical presentation receiving polychemotherapy and steroids, respectively with good response. The literature is reviewed and the pathogenetic, clinical and therapeutic aspects of the disease, which remains difficult to define as a sole entity, are discussed.

Adult↗
PubMed1994

[Early bacterial infections in 103 patients treated with bone marrow transplantation].

PURPOSE: To analyse bacterial infections in the period immediately following bone-marrow transplantation. PATIENTS AND METHODS: A retrospective study of 174 febrile episodes appearing on 103 patients treated with bone-marrow transplantation in 1990 and 1991 was carried out, special attention being paid to the bacterial infections. RESULTS: Virtually all patients (100/103) had at least one febrile episode, and its infectious character was documented in 54% of the instances. Gram-positive germs were most commonly present, 85% of the bacteria isolated, and coagulase-negative staphylococci, especially St epidermidis, predominated (60%). Different species of streptococci, mostly of the viridans group, were isolated in 22% of the blood cultures attained in the first febrile episodes. The mortality due to infection in the series as a whole was 4.8%. CONCLUSIONS: Infections by gram-positive germs, especially coagulase-negative staphylococci, are commonly found among the patients subjected to bone-marrow transplantation. Increased streptococci infections, mostly of the viridans group, are also appreciated. These facts, along with decreased number of gram-negative infections, must be born in mind when designing initial antimicrobial coverage for these patients.

Adolescent↗
PubMed1994

Clinical results in 50 multiply transfused patients with severe aplastic anemia treated with bone marrow transplantation or immunosuppressive therapy.

Fifty patients with aplastic anemia (AA) were treated with BMT or immunosuppressive therapy (IST). Twenty-one patients underwent BMT using cyclophosphamide (CY) and 7 Gy total lymphoid irradiation (TLI) and cyclosporin A (CsA) plus methotrexate (MTX). Actuarial survival is 71% at 5.3 years with an incidence of graft failure of 0% and of acute GVHD of 38.9%. Univariate analysis of variables influencing survival showed a trend for a poorer outcome in patients who received > 30 transfusions prior to BMT and in male recipients from female donors. Twenty-nine patients > 40 years of age or without matched siblings received antithymocyte/antilymphocyte globulin (ATG/ALG). Response rate to the first course of treatment was 46.4%. Subsequent courses of IST rescued 33% of patients who relapsed or had not responded. Actuarial survival is 62% at 8.6 years. In our experience both treatment strategies have given encouraging results although overall morbidity is higher in the IST group because 25% of patients are therapy or transfusion-dependent. The role of irradiation in the conditioning regimen of BMT patients, recently challenged, is discussed.

Actuarial Analysis↗
PubMed1992

[Treatment with interferon alfa-2a in the chronic phase of Philadelphia-positive chronic myeloid leukemia].

PURPOSE: To evaluate the cytologic and cytogenetic response attained with interferon alpha-2a (IFN, Roferon*A) in patients with Ph '-positive chronic myelogenous leukaemia (CML) in the chronic phase. MATERIAL AND METHODS: A prospective study was carried out on 22 CML patients diagnosed in the Haematology Service at the Princesa Hospital in Madrid. The therapeutic regime consisted of two phases: A) Hydroxyurea was given until the white-cell count was reduced to 15-20 x 10(9)/L. B) Roferon*A was then given subcutaneously at a doses of 5 MU/m2 per day. The follow-up was performed weekly, and monthly once the leucocyte count had stabilized. The cytologic and cytogenetic response was assessed by bone marrow aspiration performed after 6, 9, 12 and 18 months. The toxicity was evaluated in accordance with the WHO recommendations. RESULTS: The median follow-up is 263 days (21-930). Thirteen patients (65%) had initial complete haematological response and 3 (15%) had partial response. The mean time to achieve response was 42 days (0-321). In the last evaluation, 69% of the patients were in sustained haematological remission (53% complete and 16% partial) with median follow-up of 232 days (21-930). The cytogenetic response was evaluable in 13 patients (follow up > or = 6 months): three attained complete response (23%) and three others partial response (23%). The commonest untoward effects were hypertriglyceridaemia (100%) and myelosuppression (86%). Grade-III thrombocytopenia was seen in 19% of the patients and grade-III anaemia or leucopenia in 5%. No infectious or haemorrhagic complications have appeared. Therapy was discontinued in 3 patients (14%), two due to severe flu-like syndrome and one for parkinsonism after 809 days of treatment. At the moment of evaluation two patients had died, one in lymphoid blastic crisis on day 217 and the other in the immediate post-BMT period. CONCLUSION: Treatment with interferon-alpha 2A is useful in the chronic phase of CML. An important number of responses can be attained, even in patients in the late chronic phase, and the toxicity seems acceptable.

Adolescent↗
PubMed1992

Allogeneic bone marrow transplantation for high risk acute lymphoblastic leukemia. Results from a single institution.

We present our experience with bone marrow transplantation (BMT) in 30 consecutive patients with high risk acute lymphoblastic leukemia. With a median follow-up of 4 years the disease-free survival (DFS) was 44% for the whole group, with a significant difference between patients in first or second complete remission (CR 1 and 2, as one group), compared with patients with more advanced disease (greater than CR2), 69.5% versus 15.4% (p less than 0.01). The main cause of BMT failure was leukemic relapse, with a relapse rate of 15% for patients in CR 1 and 2 and of 77% for patients with greater than CR2 (p less than 0.01). Among patients with active disease at BMT those who had 15% blast cells or less in the marrow fared better than those with more advanced disease or extramedullary relapse. Transplant-related death was 17%. Graft-versus-host disease (GVHD) was associated with an antileukemic effect; the DFS for patients with acute and/or chronic GVHD was better than for patients with no GVHD at all.

Adolescent↗
PubMed1991

Unexpectedly high toxicity of MACOP-B in young patients with low grade lymphoma.

We report the results of treatment with MACOP-B in 11 young patients with low grade lymphoma (LGL). Complete remission was obtained in 4 (57%) and partial remission in 3 (42.8%) of 7 evaluable patients. However, this aggressive chemotherapy has not offered any advantage because of an unacceptably high treatment-related morbidity and mortality (17%). Serious infection during neutropenia was the most common complication.

Adult↗
PubMed1989

[Treatment of severe aplastic anemia with bone marrow transplants or with antithymocyte globulin. Evaluation of 27 patients].

The therapeutic results obtained in 27 patients with severe aplastic anemia (SAA) have been studied retrospectively. Ten patients underwent allogenic bone marrow transplantation (BMT) and 17 received antithymocyte globulin (ATG). Five of the ten patients transplanted (50%) are living and show normal hemopoiesis. Although prophylaxis was used, the incidence of host-versus-graft disease (grade II-IV) was 40% and concomitant pneumonitis was the main cause of death. Twenty courses of ATG were given to the 17 patients. 12 responses were achieved (60%), of which two were complete and the remaining were partial. Two patients who did not respond initially and one who recurred responded to a second course. Eleven patients survived (64.7%) of which 10 were disease-free (58.8%). One of them had remission controlled with cyclosporine. The probability of long-term survival is 48% in the group transplanted and 61.6% in the group treated with ATG, showing no statistical differences.

Adolescent↗
PubMed1988

Donor bone marrow response to immunosuppressive treatment.

An 8-year-old male with idiopathic severe aplastic anemia was successfully treated with allogeneic bone marrow transplantation in June 1980. However, he had a severe aplastic recurrence on the donor marrow after 3 years of sustained and complete engraftment. An alternative immunosuppressive treatment was attempted as a second bone marrow transplantation could not be performed. Consecutive immunosuppressive courses with antithymocyte globulin, antithymocyte globulin plus ciclosporin A and ciclosporin A alone elicited good but transient responses. At present he needs uninterrupted ciclosporin A treatment to maintain normal donor hemopoiesis. An immune-related and persisting pathogeneic mechanism for the aplasia is suspected that responds to diverse and continuous immunosuppression.

Anemia, Aplastic↗
PubMed1988

Antithymocyte globulin in the treatment of gold induced severe aplastic anemia.

Severe aplastic anemia is the most serious complication of chrysotherapy. No treatment for this condition has been demonstrated effective. We report 3 patients with gold induced severe aplastic anemia treated with antithymocyte globulin. Complete marrow recovery was obtained in 1 case and a partial but satisfactory response in the other. All the patients remain alive without requiring blood transfusion after followup of longer than 16 months.

Adult↗