23 research outputs found

    High dose chemotherapy and autologous stem cell transplantation in patients with peripheral T-cell lymphoma not achieving complete response after induction chemotherapy. The GEL-TAMO experience

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    Background and objectives: patients with aggressive non-Hodgkin's lymphomas (NHL) who do not obtain a complete response (CR) after induction chemotherapy have a poor prognosis. However, provided they are sensitive to the first regimen of chemotherapy, 25-40% of them with a B-cell phenotype may achieve long-term survival when treated with high dose chemotherapy and autologous stem cell transplantation (HDC/ASCT). The aim of this study was to analyze the efficacy of this therapy in the corresponding patients with peripheral T-cell lymphoma (PTCL). Design and methods: we retrospectively evaluated the efficacy of ASCT in 35 patients with PTCL from the GEL-TAMO registry, who did not achieve a CR to standard induction chemotherapy regimens for aggressive NHL. Thirty-one patients underwent transplantation after achieving a partial response (PR) and 4 patients were non-responders. Results: following HDC/ASCT, 23 (66%) of the patients achieved a CR, 4 (11%) a PR and in 7 (20%) cases the transplant failed. One patient was not evaluated because of early toxic death. With a median follow-up of the survivors of 37.5 months, 18 patients (51%) are alive and 15 patients (43%) are free of disease. Transplant-related mortality rate at 100 days was 11% and at 5 years the probabilities of survival, freedom from progression and disease-free survival for complete responders were 37%, 36% and 55% respectively. Pre-transplant lactate-dehydrogenase level, age-adjusted International Prognostic Index (aa-IPI) and tumor score correlated with survival. Interpretation and conclusions: one third of the patients with PTCL who fail to achieve CR to the first chemotherapeutic regimen can be rescued with HDC/ASCT. Pre-transplant values of IPI and tumor score risk systems for aggressive lymphomas were useful to predict subsequent survival

    Mannose-binding lectin gene variants and infections in patients receiving autologous stem cell transplantation

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    BACKGROUND: Serious infections are common in patients undergoing autologous stem cell transplantation (ASCT) mainly because of the effects of immunosuppression. The innate immune system plays an important role in the defense against different infections. Mannose binding lectin (MBL) is a central molecule of the innate immune system. There are several promoter polymorphisms and structural variants of the MBL2 gene that encodes for this protein. These variants produce low levels of MBL and have been associated with an increased risk for infections. METHODS: Prospective cohort study. The incidence, severity of infections and mortality in 72 consecutive patients with hematologic diseases who underwent ASCT between February 2006 and June 2008 in a tertiary referral center were analyzed according to their MBL2 genotype. INNO-LiPA MBL2 was used for MBL2 gene amplification and genotyping. Relative risks (RR) (IC95%) as measure of association were calculated. Multivariate analysis was performed using logistic regression. RESULTS: A statistically significant higher number of fungal infections was found in patients with MBL2 variants causing low MBL levels (21.1%versus1.9%, p=0.016). In this MBL2 variant group infection was more frequently the cause of mortality than in the MBL2 wild-type group (p=0.05). Although not statistically significant, there was a higher incidence of major infections in the MBL2 variant group as well as a higher number of infections caused by gram-positive bacteria. CONCLUSIONS: Low-producer MBL2 genotypes were associated with an increased number of fungal infections in ASCT patients, which would suggest that MBL has a protective role against such infections. ASCT patients with MBL2 variant genotypes are more likely to die as a result of an infection

    Stratifying diffuse large B-cell lymphoma patients treated with chemoimmunotherapy: GCB/non-GCB by immunohistochemistry is still a robust and feasible marker

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    Diffuse large B cell lymphoma (DLBCL) is a heterogeneous group of aggressive lymphomas that can be classified into three molecular subtypes by gene expression profiling (GEP): GCB, ABC and unclassified. Immunohistochemistry-based cell of origin (COO) classification, as a surrogate for GEP, using three available immunohistochemical algorithms was evaluated in TMA-arranged tissue samples from 297 patients with de novo DLBCL treated by chemoimmunotherapy (R-CHOP and R-CHOP-like regimens). Additionally, the prognostic impacts of MYC, BCL2, IRF4 and BCL6 abnormalities detected by FISH, the relationship between the immunohistochemical COO classification and the immunohistochemical expression of MYC, BCL2 and pSTAT3 proteins and clinical data were evaluated. In our series, non-GCB DLBCL patients had significantly worse progression-free survival (PFS) and overall survival (OS), as calculated using the Choi, Visco-Young and Hans algorithms, indicating that any of these algorithms would be appropriate for identifying patients who require alternative therapies to R-CHOP. Whilst MYC abnormalities had no impact on clinical outcome in the non-GCB subtype, those patients with isolated MYC rearrangements and a GCB-DLBCL phenotype had worse PFS and therefore might benefit from novel treatment approaches

    Innovación educativa

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    Se analiza el uso de la prensa en el aula desde parámetros constructivistas, promoviendo una utilización amplia y eficaz de este medio de comunicación. Ofrece una visión general del mismo, en el ámbito de las nuevas reformas educativas del año 1992. A continuación, estudia el marco institucional, al amparo del convenio MEC-AEDE de otoño de 1985 y la perspectiva internacional sobre el uso educativo de la prensa en el aula. Por último, aborda los objetivos generales propuestos, incluyendo actividades agrupadas bajo temáticas comunes como, conocer qué es un periódico, el periódico como instrumento de aprendizaje o el periódico en trabajos monográficos.GaliciaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

    Phase II Study of Yttrium-90-Ibritumomab Tiuxetan as Part of Reduced-Intensity Conditioning (with Melphalan, Fludarabine ± Thiotepa) for Allogeneic Transplantation in Relapsed or Refractory Aggressive B Cell Lymphoma : A GELTAMO Trial

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    We designed a phase II clinical trial including Y-90 ibritumomab-tiuxetan as part of a reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (AlloSCT) in high-risk non-Hodgkin lymphoma (Clinical Trials Identifier: NCT00644371). Eligible patients had high-risk relapsed/refractory aggressive lymphoma. The conditioning regimen consisted of rituximab 250 mg (days −21 and −14), Y-90 ibritumomab IV (.4 m Ci/kg, day −14), fludarabine 30 mg/m i.v. (days −3 and −2) plus melphalan 70 mg/m i.v. (days −3 and −2) or 1 dose of melphalan and thiotepa 5 mg/kg (day −8). Donors were related. Eighteen patients were evaluable. At the time of transplantation, responses were complete remission (CR) (n = 7, 39%), partial remission (n = 6, 33%) or refractory disease (n = 4, 28%). Y-90-ibritumomab infusions were well tolerated, with no adverse reactions. Nonrelapse mortality at 1 year was 28%. Median follow-up was 46 (range, 39 to 55) months. Estimated 1-year progression-free survival (PFS) was 50%, and 4-year overall survival (OS) and PFS were both 44.4%. CR at the moment of AlloSCT had significant impact on PFS (71% versus 27%, P = .046) and OS (71% versus 27%, P = .047). Our results show that Y-90-ibritumomab-tiuxetan as a component of RIC for AlloSCT is feasible in patients with high-risk B cell lymphoma. Development of phase III clinical trials is needed to clarify the contribution of radioimmunotherapy to RIC AlloSCT

    Paleolimnological Indicators of Global Change

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    Anthropogenic climate change and the recent increase of Saharan dust deposition are potentially affecting Sierra Nevada alpine lakes. In this chapter, we summarize the results of paleolimnological research conducted to track recent environmental and ecological changes in the lakes and their catchments during the last two centuries. We analyzed several independent paleolimnological indicators preserved in highly resolved dated lake sediment cores including spectrally inferred chlorophyll- a concentration, leaf waxes (n-alkanes), and the subfossil remains of diatoms, cladocerans, and chironomids. Our results are indicative of significant changes in the lakes and their catchments with subtly starting over a century ago that accelerated in the 1960s-1970s, concurrent with trends in rising regional air temperature, declining precipitation, and increased Saharan dust deposition in the region. Our biological indicators registered pronounced changes in the composition of aquatic communities and a recent increase in algal biomass (inferred from chlorophyll- a ). Temperature was identified as the main predictor of the observed changes, whereas Saharan dust deposition drivers were secondary explanatory variables. The synchronous change among the paleolimnological proxies and climatic variables analyzed in the Sierra Nevada study lakes indicated that this is a regional shift. The nature of the change in these independent proxies is interpreted as a response to a lengthening of the lake ice-free period, an increase in lake water temperature, as well as a reduction in water availability in the catchments, which affected the volumes and water residence times. All these processes reflect the intensification of summer drought in the Sierra Nevada summit area over the last 50-60 years. In addition, distinct changes in species composition indicate an alkalinization of lake waters. Projected increases in global temperature, decreasing precipitation, and possible increases in Saharan dust inputs will further exacerbate the changes observed so far in these valuable aquatic ecosystems
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