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PubMedDate not supplied

[Analysis and protocolization of rasburicase use in patients with hematologic neoplasms].

OBJECTIVE: To describe the use of rasburicase in adult patients with hematological neoplasias and to present a protocol for its administration jointly prepared by the hematology and the pharmacy departments based on the scientific evidence available. METHOD: Retrospective study that reviews treatments with rasburicase administered in a tertiary 800-bed hospital from July 2002 to May 2004 to adult patients with hematological neoplasias. The following data were collected: demographic and clinical data, daily dose of rasburicase and length of treatment, plasma levels of creatinine, potassium, phosphate, calcium, LDH, uric acid and white blood cell count daily and until 48 hours after administering the last dose of rasburicase. RESULTS: Rasburicase was administered to a total of 18 adult patients (mean age of 57 years; range 27-84; 11 men and 7 women). Prior to treatment, 16 patient had high levels of LDH, 12 patients had a blood count over 50,000 white blood cells/mm3, and 11 had serum levels of uric acid above 7 mg/dl. The dose of rasburicase administered was 0.2 mg/kg/day and the median length of treatment was 5 days (range 1-10). The levels of uric acid returned to normal values in all patients. Furthermore, an statistically significant decrease of creatinine levels was observed. The other biochemical parameters studied were duly controlled throughout the treatment. CONCLUSIONS: A high variability is observed in the use of rasburicase in our patients. The hematology and pharmacy services have been working jointly to prepare a consensus-based protocol according to which, depending on the patient s risk of developing TLS (tumoral lysis syndrome), standard prophylaxis is administered to low-risk patients (intravenous hydration, alopurinol and urine alcalinization) and rasburicase is administered initially for 1-3 days to patients with high risk of developing TLS.

Adult↗
PubMed2002

[Tumor necrosis factor, interleukin-6, endotoxin and procalcitonin in septic shock in patients with hematologic neoplasms].

AIM: To study changes in proinflammatory markers and mediators in septic shock in patients with hematologic malignancy (HM). MATERIAL AND METHODS: The examination of 33 patients with HM and septic shock included measurement of plasma concentrations of tumor necrosis factor (TNF), interleukine-6 (IL-6), endotoxin, procalcitonin (PCT) 12-24 hours before and each 12 hours after shock; registration of central hemodynamics parameters, the condition severity by APACHE II. RESULTS: Out of 33 patients 18 died of refractory shock, 15 survived the shock. Within the first shock hour TNF fell from 571.2 +/- 195 to 115.8 +/- 71.1 pg/ml (p < 0.02), later being stable. In those who died and survived TNF was the same. IL-6 fall was seen 36 hours after shock and was observed in the survivors; in those who died IL-6 was unchanged. Endotoxin in the blood was detected in 21 of 33 patients. In the survivors endotoxinemia declined after 2 days of treatment. 72 hours after beginning of the shock the survivors had no endotoxin. In shock APACH II severity of the patient's condition was graver in patients with endotoxinemia than without it (31.6 +/- 1.6 and 28.1 +/- 1.6 scores, p < 0.05). Blood endotoxin levels and APACHE II scores correlated (r = 0.24, p < 0.05) positively and negatively with deficiency of buffer bases (r = -0.29, p < 0.05) and blood pH) r = -0.3, p < 0.05), left ventricular contractility index (r = -0.46, p < 0.01) and right ventricle (r = -0.52, p < 0.01), mean AP (r = -0.22, p < 0.03). PCT concentration was lower before shock than on its hour 1 (4.2 +/- 2.9 and 6.9 +/- 1.1 ng/ml, p < 0.05). No significant changes in PCT were found later. CONCLUSION: PCT is a specific marker of a severe infection. Rapid elimination from the blood of TNF and IL-6 makes them inadequate in sepsis diagnosis. Endotoxinemia aggravates the patients condition. Positive LAL-test results were obtained in gram-negative and fungal infections.

Adult↗
PubMed1989

[Autologous bone marrow transfusion in the treatment of adults with hematologic neoplasms. Experiences from Bern].

21 patients with hematological neoplasias (8 ALL, 4 AML, 4 NHL, 5 HD) were treated with high dose therapy and autologous bone marrow rescue (ABMT). At the time of ABMT 12 patients were in CR, 6 in PR and 3 in relapse. 66% of the patients were at high risk at the time of diagnosis. Before ABMT patients received an ablative regimen such as cyclophosphamide or ARA-C, VP-16, DNR and 12 Gy TBI in 6 fractions. In 9 patients the bone marrow was treated in vitro with monoclonal antibodies and complement. The hospital stay was a median 33 (24-57) days and isolation 19 (9-49) days. Complications were septicemia (7), herpes stomatitis (7), infections (6), fungal sepsis (1) and hemorrhagic cystitis (2). Late complications (up to 6 months after ABMT) were pneumococcal sepsis (1), cerebral toxoplasmosis (1) and herpes zoster (3). 10 of 19 evaluable patients are alive and relapse-free 1-33 months (median 10) after ABTM, and 3 of 10 more than 2 years later: 4 of 5 were transplanted in 1. CR, 4 of 6 in greater than or equal to 2. CR and 2 of 8 in PR. 4 patients are living in therapy sensitive relapse 2, 11, 11 and 39 months after ABMT in 2. CR or PR. 5 patients died 1-13 (median 3.5) months on relapse, 2 of 21 from septicemia. The morbidity of ABMT is comparable with conventional high dose chemotherapy. Relapse-free survival was significantly influenced by the remission status at ABMT. Long-term survivors can be expected even in patients with high risk hematological malignancies. However, only wider trials will serve to establish the efficacy of ABMT.

Adolescent↗
PubMedDate not supplied

[incidence of intestinal parasites in pediatric patients with hematologic neoplasms from 1 to 15 years of age].

INTRODUCTION: Reference is made to the most frequent intestinal parasites in the hematologic patients and the association with malnutrition. MATERIAL AND METHOD: In the Unit of Pediatrics of Hospital General de Mexico, it was studied in prospective, observational and descriptive form to a group of 85 patient hematoncologic, coming from the external consultation, with or without parasitic symptoms. The patients were assisted between June and December of 1994. To all they were carried out studies coproparasitoscopic in series of three, for the method of Faust. RESULTS: A total of 85 children was studied from 1 to 15 years of age; 59 were parasitaded (69.5%) and 26 (30.5%) free of parasites. CONCLUSIONS: The most frequent affections in the patients pediatric hematoncologic were: leukemia, tumors of the central nervous system and lymphomas. The most frequent parasites were: Giardia lamblia, 28.7%, Entamoeba histolytica 26%, Ascaris lumbricoides 12.3%. Of the 59 patients with some parasite, 54 (91.4%) they studied with some degree of malnutrition.

Adolescent↗
PubMed1984

Hematologic neoplasms with initial manifestations in lower urinary tract.

Hematologic tumors with initial clinical manifestations in the lower urinary tract are exceedingly rare. Six such cases are reported. Four of these were lymphomas, 2 involving the urinary bladder, 1 the urethra, and 1 the right ureter. The remaining 2 were an extramedullary plasmacytoma and a granulocytic sarcoma, both located in the urinary bladder. To our knowledge, this is the first case report of granulocytic sarcoma of the urinary bladder presenting with urologic symptoms.

Adult↗
PubMed2001

Hemogen is a novel nuclear factor specifically expressed in mouse hematopoietic development and its human homologue EDAG maps to chromosome 9q22, a region containing breakpoints of hematological neoplasms.

We cloned a novel murine gene, designated Hemogen (hemopoietic gene), which was sequentially expressed in active hematopoietic sites and downregulated in the process of blood cell differentiation. Hemogen transcripts were specifically detected in blood islands, primitive blood cells and fetal liver during embryogenesis, and then remained in bone marrow and spleen in adult mice. Immunostaining demonstrated that Hemogen was a nuclear protein. We also identified a human homologue of Hemogen, named EDAG, which was mapped to chromosome 9q22, a leukemia breakpoint. Like Hemogen, EDAG exhibited specific expression in hematopoietic tissues and cells. Taken together, these data are consistent with Hemogen and EDAG playing an important role in hematopoietic development and neoplasms.

Amino Acid Sequence↗
PubMed1997

[Contribution of phenotyping cells in metaphase and interphase (MAC and MACISH techniques) to the study of hematologic neoplasms].

BACKGROUND: Banding techniques are essential in the chromosomal analysis for the cytogenetic diagnosis. Even that, conventional cytogenetic techniques destroy the cytoplasmic membrane and the lineage involvement of the karyotyped cells is unknown. In this work the usefulness of a method that keeps the cell intact and allows the sequential application of immunological, cytochemical, morphological and cytogenetic techniques in the same cell is shown. This technique is called MAC for morphology, antibodies and chromosomes. The combination of MAC and in situ hybridization techniques (MACISH method) allows the detection of a chromosome abnormality in all the cells even when no mitosis are present. PATIENTS AND METHODS: The MAC method was applied in 51 patients and the MACISH method in 9 patients in order to identify the cells which karyotype is analyzed. We have studied 47 patients with normal karyotype (37 chronic lymphocytic leukaemia [CLL] and 10 essential trombocythaemias (ET) and 4 patients with different diseases and abnormal karyotype. RESULTS: Among 37 patients with CLL and normal karyotype, in 9 cases only normal T-cells were in mitoses and in 28 cases the normal karyotype belonged to neoplastic B cells. Trisomy 12 has been confined exclusively to the leukaemic B cells with the MACISH technique in 3 of these CLL cases. In 10 patients with ET and normal karyotype the MAC method showed that in any case the mitosis analyzed belonged to the megakaryocyte lineage. In 4 patients with different chromosomal abnormalities the haematological cell lines involved in the neoplasia were known with the MAC method. CONCLUSION: In this work is shown the usefulness of the combination of the MAC and MACISH techniques with conventional cytogenetics in order to complete the chromosomic study of the haematological neoplasms is confirmed. These methods are specially usefull when different cell lineages are involved in the neoplasia, reactive proliferations are suspected, or to discard false aneuploidies.

Hematologic Neoplasms↗
PubMed2000

[Donor lymphocyte infusions as adoptive immunotherapy in patients with relapsed hematologic neoplasms post-allogenic transplant of hematopoietic progenitor cells].

An increasing body of literature has documented the usefulness of donor lymphocyte infusions in inducing remissions in patients relapsing post allogeneic hematopoietic progenitor cell transplantation. Efficacy was shown to depend on the disease entity; the best results have been reported in chronic myeloid leukemia in chronic phase, where the remission rate varied between 60 and 80%. In acute myeloid leukemia and myelodysplastic syndromes the remission rate ranged between 20 and 40% and in multiple myeloma the response rate was approximately 40%. In contrast, results have been poor in acute lymphoid leukemia with only 10-20% and even lower reported responses. Considering the efficacy of donor lymphocyte infusions in inducing responses in several hematologic neoplasias post allogeneic transplantation, as will be described in detail in this review, it is justified to anticipate an increasing role for this modality of treatment in relapsed non transplanted patients and as maintenance of the responses achieved with chemotherapy at conventional or high doses.

Hematologic Neoplasms↗
PubMed1991

Total and HDL cholesterol in human hematologic neoplasms.

In this study serum cholesterol was measured in different types of human hematologic malignancies characterized by a wide range of cell proliferation. In all tumoral types a significant decrease of HDL cholesterol was observed, whereas total serum cholesterol generally remained unchanged. Another interesting observation of our study was the apparent inverse correlation between the extent of cell proliferation in these neoplastic disorders and the level of HDL cholesterol. Since a decrease of HDL cholesterol was previously observed, in our laboratory, in different experimental models of normal and neoplastic cell proliferation, we suggest that the decrease of HDL cholesterol may be a generalized phenomenon related to massive cellular growth in normal and malignant processes.

Adult↗
PubMed2005

Treatment of patients with hematologic neoplasm, fever, and neutropenia.

Choices of empirical antibiotic therapy for patients with febrile neutropenia must be made with very little information about the source and site of infection. The clinician is aided by recognition of the subtle signs and symptoms of infection in immunocompromised patients. National guidelines should be applied according to the microbiological patterns and trends in drug resistance at each institution. Case studies are provided to illustrate these challenges in daily practice.

Adult↗
PubMed2003

Neurologic complications of hematologic neoplasms.

The new WHO classification of hematopoietic and lymphatic neoplasms was devised to offer pathologists, oncologists, and geneticists a system of classification based on histopathologic, clinical, and genetic features. From the neurologic standpoint, it offers an opportunity to consolidate the complications produced by leukemias, lymphomas, and plasma cell dyscrasias. This article summarizes such complications that occur as a result of direct infiltration or compression of nervous tissue by tumor or as a result of indirect effects such as infection, vascular disorders, iatrogenesis, and paraneoplasia.

Central Nervous System Diseases↗