4 research outputs found
Implicación pronóstica del inmunofenotipo en el mieloma múltiple: revisión de casos diagnosticados en el HUNSC de 2017 a 2020.
El mieloma múltiple (MM) es una neoplasia hematológica caracterizada por la expansión
de células plasmáticas clonales con inmunofenotipo aberrante. A día de hoy, existe evidencia
de asociación entre dicho inmunofenotipo y el pronóstico del paciente que sufre la
enfermedad. No obstante, con los avances en el tratamiento y los nuevos fármacos empleados
(inhibidores del proteosoma e inmunomoduladores), dicha asociación podría verse
modificada.
El objetivo de este proyecto fue describir si dicha asociación sigue siendo válida en la
actualidad. Para ello, realizamos un estudio observacional descriptivo con una muestra
compuesta por 77 pacientes diagnosticados de MM en el HUNSC, desde febrero de 2017
hasta febrero de 2020. Se clasificó a los pacientes según el inmunofenotipo presentado y se
valoró la progresión de la enfermedad tras el tratamiento.
Finalmente, se concluyó que, aún incluyendo los nuevos fármacos en el tratamiento del
MM, la asociación entre el inmunofenotipo y la evolución del paciente parece seguir
guardando correlación. Sin embargo, sería necesario un tamaño muestral mayor para afirmar
dicha asociaciónMultiple myeloma (MM) is a hematologic neoplasm characterized by the expansion of
clonal plasma cells with aberrant immunophenotype. To date, there is evidence of an
association between immunophenotype and the prognosis of the patient suffering from the
disease. However, with advances in treatment and new drugs used (proteasome inhibitors
and immunomodulators), this association could be modified.
The objective of this project was to describe whether this association is still valid today.
To do this, we carried out a descriptive observational study with a sample made up of 77
patients diagnosed with MM at the HUNSC, from February 2017 to February 2020. The patients were classified according to the immunophenotype presented and the progression of
the disease after the treatment.
Finally, it was concluded that, even including the new drugs in the treatment of MM, the
association between the immunophenotype and the evolution of the patient seems to continue
to be correlated. However, a larger sample size would be necessary to affirm this association
Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)
Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters.
Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs).
Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001).
Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio