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Jiménez-Antolinez V, Colunga-Pedraza J, Gómez-De León A, González-Lopez E, Gómez-Almaguer D, González-Llano O. Lesson learned in pediatric haploidentical transplantation in a low-resource environment: delivering melphalan IV and using low dose radiation reduce graft failure. Hematology 2024; 29:2335417. [PMID: 38568018 DOI: 10.1080/16078454.2024.2335417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Objectives: Primary graft failure (pGF) after hematopoietic stem-cell transplant is associated with considerable morbidity and mortality. The incidence in haplo-HSCT has been reported to be between 0% and 30%. In 2018, we identified a pGF incidence of 35% in our pediatric haplo-HSCT recipients with hematologic malignancies, which motivated us to enact changes to the conditioning regimen.Methods: We performed a single-center prospective, pre-post study of consecutive patients under 16 years with hematologic malignancies, from January 2015 to December 2022 who received a haplo-HSCT. Twenty-six pediatric patients received a haplo-HSCT before September 2018 (G1) and 36 patients after (G2). The main conditioning regimen for G1 was myeloablative with Flu/Cy/Bu, and for G2 the main regimen was reduced intensity Flu/Cy/Mel/TBI2.Results: Nine patients (35%) in G1 had primary graft failure, while in G2 there were no patients with pGF. The median follow-up for G1 was 15.9 months, and for G2 was 24.8 months, with an estimated overall survival at 12 months of 63% (95% CI 47-76) versus 85% (95% CI 73-93), and at 24 months of 47% (95% CI 31-64) versus 70% (95% CI 54-82) respectively (p = .007).Conclusion: After September 2018 conditioning regimen modifications were implemented with the objective of reducing primary failure, consisting mainly of switching from busulfan to melphalan as the alkylating agent of choice, and adding, when clinically possible TBI. Primary failure has been significantly reduced in our institution since then.
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Affiliation(s)
- Valentine Jiménez-Antolinez
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Julia Colunga-Pedraza
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - David Gómez-Almaguer
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Oscar González-Llano
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Chua CC, Gómez-De León A. Time to define and refine maintenance strategies in acute myeloid leukaemia. Lancet Haematol 2024; 11:e246-e247. [PMID: 38548403 DOI: 10.1016/s2352-3026(24)00068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Chong Chyn Chua
- Monash Health, Monash University, Melbourne, VIC, Australia; Northern Hospital Epping, Melbourne, VIC, Australia; Walter and Eliza Hall Institute of Medical Research, University of Melbourne, Melbourne, VIC, Australia
| | - Andrés Gómez-De León
- Haematology Service, Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Monterrey, 64460, Mexico; Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico; University Hospital Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
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Jaime-Pérez JC, Meléndez-Flores JD, Valdespino-Valdes J, Gómez-De León A, Colunga-Pedraza PR, Gutiérrez-Aguirre CH, Cantú-Rodríguez OG, Gómez-Almaguer D. Graft-versus-host disease after an outpatient peripheral blood hematopoietic cell transplant using reduced-intensity conditioning: a single-center LATAM experience. Expert Rev Hematol 2024; 17:77-86. [PMID: 38226642 DOI: 10.1080/17474086.2024.2305372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND HLA compatibility predicts allogeneic hematopoietic cell transplant (allo-HCT) and graft-versus-host disease (GvHD) outcomes. There is insufficient information regarding GvHD outcomes for outpatient HLA-identical and haploidentical-HCT employing reduced-intensity conditioning (RIC). RESEARCH DESIGN AND METHODS We compare GvHD outcomes between donor types and report risk factors associated with GvHD. Stem cell source was T-cell replete peripheral blood. GvHD prophylaxis was post-transplant cyclophosphamide (PT-CY), mycophenolic acid, and calcineurin inhibitors for haploidentical (n = 107) and oral cyclosporine (CsA) plus methotrexate i.v. for HLA-identical (n = 89) recipients. RESULTS One hundred and ninety-six HCT transplant patients were included. aGvHD and cGvHD frequency were similar between HCT types. aGvHD severity was comparable, but severe cGvHD was less frequent in the haploidentical group (p = .011). One-hundred-day cumulative incidence (CI) of aGvHD for haploidentical and HLA-identical was 31% and 33% (p = .84); 2-year CI of cGvHD was 32% and 38% (p = .6), respectively. Haploidentical recipients had less steroid-refractory cGvHD (p = .043). Patients with cGvHD had less 2-year relapse (p = .003); both aGvHD and cGvHD conferred higher OS (p = .010 and p = .001), respectively. Male sex was protective for steroid-refractory cGvHD (p = .028). CONCLUSIONS Acute and chronic GvHD rates were comparable between HLA-identical and haploidentical transplant groups. cGvHD severity was lower in the haploidentical group.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jesús Daniel Meléndez-Flores
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Valdespino-Valdes
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Gómez-De León
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Perla Rocío Colunga-Pedraza
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - César Homero Gutiérrez-Aguirre
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Olga Graciela Cantú-Rodríguez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
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Gómez-De León A, Demichelis-Gómez R, da Costa-Neto A, Gómez-Almaguer D, Rego EM. Acute myeloid leukemia: challenges for diagnosis and treatment in Latin America. Hematology 2023; 28:2158015. [PMID: 36607152 DOI: 10.1080/16078454.2022.2158015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE to review the current diagnostic and therapeutic landscape of AML in Latin America as a reflection of other low- and middle-income countries and regions of the world. Encompassing both acute promyelocytic and non-promyelocytic disease types. METHODS We reviewed the literature and study registries concerning epidemiological features of patients with AML/APL treated in Latin America, as well as evaluated diagnostic and genetic stratification and patient fitness assessment challenges, the importance of early mortality and supportive care capacity, intensive and non-intensive chemotherapy alternatives, consolidation, and maintenance strategies including novel agents and hematopoietic stem cell transplantation. RESULTS Although most of the current technologies and treatment options are available in the region, a significant fraction of patients have only limited access to them. In addition, mortality in the first weeks from diagnosis is higher in the region compared to developed countries. CONCLUSIONS Disparities in access to technologies, supportive care capacity, and availability of novel agents and HSCT hinder results in our region, reflecting barriers common to other LMICs. Recent developments in the diagnosis and treatment of this disease must be implemented through education, collaborative clinical research, and advocacy to improve outcomes.
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Affiliation(s)
- Andrés Gómez-De León
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universiadad Autónoma de Nuevo León, Monterrey, Mexico
| | - Roberta Demichelis-Gómez
- Department of Hematology, Instituto Nacional de Cinecias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Abel da Costa-Neto
- Department of Hematology, D'or Institute for Research and Education, São Paulo, Brazil
| | - David Gómez-Almaguer
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universiadad Autónoma de Nuevo León, Monterrey, Mexico
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Colunga-Pedraza PR, Irabien-Zuñiga M, Rodriguez-Roque CS, de la Cruz-de la Cruz C, Gómez-De León A, Santana-Hernández P, Jaime-Pérez JC, Mancías-Guerra C, Gómez-Almaguer D. Lactate dehydrogenase as a hematopoietic stem cell mobilization biomarker in autologous transplantation. Hematol Transfus Cell Ther 2023; 45:435-441. [PMID: 36163321 PMCID: PMC10627851 DOI: 10.1016/j.htct.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/17/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Pre-apheresis peripheral blood CD34+ cell count (PBCD34+) is the most important predictor of good cell mobilization before hematopoietic stem cell transplantation, albeit flow cytometry is not always immediately available. Identification of surrogate markers can be useful. The CD34+ cells proliferate after mobilization, resulting in elevated lactate dehydrogenase (LDH) activity and correlating with the PBCD34+ count. OBJECTIVE To determine the LDH cut-off value at which adequate CD34+ cell mobilization is achieved and its diagnostic yield. MATERIALS AND METHODS A total of 103 patients who received an autologous stem cell transplantation (ASCT) between January 2015 and January 2020 were included. Demographic and laboratory characteristics were obtained, including complete blood count, pre-apheresis PBCD34+ and LDH levels. Receiver operating characteristic (ROC) curves were performed to identify the optimal serum LDH activity cut-off points for ≥ 2 and ≥ 4 × 106 cells/kg post-mobilization CD34+ count and their diagnostic yield. RESULTS A post-mobilization serum LDH cut-off value of 462 U/L yielded a sensitivity (Se) = 86.8% (positive predictive value [PPV] = 72.7%), a pre- and post-mobilization serum LDH difference cut-off value of 387 U/L, an Se = 45.7% (PPV = 97%) and an LDH ratio of 2.46, with an Se = 47.1% (PPV = 97%) for an optimal mobilization count (CD34+ ≥ 4 × 106). CONCLUSION The LDH measurement represents a fast and affordable way to predict PBCD34+ mobilization in cases where flow cytometry is not immediately available. According to the LDH diagnostic yield, it could be used as a surrogate marker in transplant centers, supporting the CD34+ count, which remains the gold standard.
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Affiliation(s)
- Perla R Colunga-Pedraza
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Mariela Irabien-Zuñiga
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Carlos Saúl Rodriguez-Roque
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Carlos de la Cruz-de la Cruz
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Paola Santana-Hernández
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - José Carlos Jaime-Pérez
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Consuelo Mancías-Guerra
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México.
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De la Garza-Salazar F, Colunga-Pedraza PR, Gómez-Almaguer D, García-Zárate VA, Gómez-De León A. Low dose venetoclax plus itraconazole outpatient induction in newly diagnosed acute myeloid leukemia: A phase 2 study. Leuk Res 2023; 133:107373. [PMID: 37633156 DOI: 10.1016/j.leukres.2023.107373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
Data concerning venetoclax and azacitidine (Ven/Aza) as first-line therapy for newly diagnosed acute myeloid leukemia (ND-AML) in candidates for intensive chemotherapy are limited, and outpatient induction regimens in ND-AML have been poorly explored. The enzyme CYP3A4 metabolizes Venetoclax. Conversely, itraconazole is a strong CYP3A4 inhibitor; thus, it produces a 75 % reduction in the dose and cost of venetoclax. This phase 2 trial assessed the feasibility, safety, and efficacy of outpatient induction with venetoclax 100 mg daily from days 1-21, itraconazole 100 mg twice daily from days 1-21, and azacytidine 100 mg subcutaneously, once daily from days 1-7. Fifteen adults with ND-AML were enrolled. The median age was 53 (range 25-73) and twelve (80 %) were considered candidates for intensive chemotherapy. Nine (60 %) subjects started treatment as outpatients,. The first treatment cycle completion in the outpatient setting was achieved in 77.7 %. Early 14-day, 30-day, and 60-day mortality rates were 6.7 %, 13.3 %, and 13.3 %, respectively. Composite CR/CRi after the first and second treatment cycles were 53.9 % and 85.7 %, respectively. Common adverse events included hematological and gastrointestinal toxicities. Outpatient induction with low-dose venetoclax plus itraconazole is feasible, safe, and has acceptable preliminary efficacy in ND-AML patients. This trial was registered in www.clinicaltrials.gov as #NCT05048615.
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Affiliation(s)
- Fernando De la Garza-Salazar
- Univerisdad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Hematology service, Internal Medicine Department
| | - Perla Rocío Colunga-Pedraza
- Univerisdad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Hematology service, Internal Medicine Department
| | - David Gómez-Almaguer
- Univerisdad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Hematology service, Internal Medicine Department
| | - Valeria Abigail García-Zárate
- Univerisdad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Hematology service, Internal Medicine Department
| | - Andrés Gómez-De León
- Univerisdad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Hematology service, Internal Medicine Department.
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Jaime-Pérez JC, Ramos-Dávila EM, Picón-Galindo E, Jiménez-Castillo RA, León AGD, Gómez-Almaguer D. Outcomes and survival predictors of Latin American older adults with acute myeloid leukemia: Data from a single center. Hematol Transfus Cell Ther 2023; 45 Suppl 2:S43-S50. [PMID: 35115270 PMCID: PMC10433310 DOI: 10.1016/j.htct.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/04/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is most commonly presented in older adults; however, it appears 10 years earlier in Latin American countries. Clinical evolution in older adults from this populations has not been characterized. We analyzed outcomes and survival predictors. METHODS Patients ≥ 55 years old diagnosed with AML at a hematology referral center from 2005 to 2020 receiving intensive chemotherapy (IC), low-dose cytarabine (LDAC) and best supportive care (BSC) were included. Survival analysis included the Kaplan-Meier and Cox models and the cumulative incidence of relapse (CIR). RESULTS Seventy-five adults were included and the overall survival (OS) was 4.87, 1.67 and 1.16 months, using IC, LDAC and BSC, respectively. The IC led to a higher OS (p < 0.001) and was a protective factor for early death, at a cost of more days spent hospitalized and more non-fatal treatment complications; non-significant differences were found between the LDAC and BSC. Eight (10.7%) patients underwent hematopoietic cell transplantation, with a higher OS (p = 0.013). Twenty (26.7%) patients achieved complete remission; 12 (60%) relapsed with a 6-month CIR of 57.9% in those < 70 years old vs. 86.5% in those ≥ 70 years old, p = 0.034. Multivariate analysis showed the white blood cell count (WBC) and IC had a significant impact on the patient survival, whereas chronological age and the Charlson comorbidity index (CCI) did not. CONCLUSION AML in low-middle income countries demands a different approach; the IC improves survival, even with a high incidence of relapse, and should be offered as first-line treatment. Eligibility criteria should include WBC and a multidimensional evaluation. The age per se and the CCI should not be exclusion criteria to consider IC.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Eugenia M Ramos-Dávila
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ernesto Picón-Galindo
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Raúl A Jiménez-Castillo
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Coronado-Alejandro EU, Martínez-Hernández JP, Gómez-De León A, Colunga-Pedraza PR, Jaime-Pérez JC, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, Gómez-Almaguer D. Low-dose rituximab plus high-dose dexamethasone in newly diagnosed immune thrombocytopenia. Eur J Haematol 2023; 110:778-779. [PMID: 36919276 DOI: 10.1111/ejh.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Affiliation(s)
| | | | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - José Carlos Jaime-Pérez
- Hematology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | | | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Noyola-Pérez A, Gil-Flores L, Martínez-Espinosa HA, Ramos-Barrera E, Rodríguez-González V, Sung L, Guzman M, Hamad N, Colunga-Pedraza PR, Tarín-Arzaga L, Cantú-Rodríguez OG, Gutiérrez-Aguirre H, Jaime-Pérez JC, Gómez-Almaguer D, León AGD. Global representation among journal editors in haematology: are we diverse, equitable, and inclusive? The Lancet Haematology 2023; 10:e246-e247. [PMID: 36990621 DOI: 10.1016/s2352-3026(23)00069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Tokaz MC, Baldomero H, Cowan AJ, Saber W, Greinix H, Koh MBC, Kröger N, Mohty M, Galeano S, Okamoto S, Chaudhri N, Karduss AJ, Ciceri F, Colturato VAR, Corbacioglu S, Elhaddad A, Force LM, Frutos C, León AGD, Hamad N, Hamerschlak N, He N, Ho A, Huang XJ, Jacobs B, Kim HJ, Iida M, Lehmann L, de Latour RP, Percival MEM, Perdomo M, Rasheed W, Schultz KR, Seber A, Ko BS, Simione AJ, Srivastava A, Szer J, Wood WA, Kodera Y, Nagler A, Snowden JA, Weisdorf D, Passweg J, Pasquini MC, Sureda A, Atsuta Y, Aljurf M, Niederwieser D. An Analysis of the Worldwide Utilization of Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia. Transplant Cell Ther 2023; 29:279.e1-279.e10. [PMID: 36572384 DOI: 10.1016/j.jtct.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
Acute myeloid leukemia (AML) has an aggressive course and a historically dismal prognosis. For many patients, hematopoietic stem cell transplantation (HSCT) represents the best option for cure, but access, utilization, and health inequities on a global scale remain poorly elucidated. We wanted to describe patterns of global HSCT use in AML for a better understanding of global access, practices, and unmet needs internationally. Estimates of AML incident cases in 2016 were obtained from the Global Burden of Disease 2019 study. HSCT activities were collected from 2009 to 2016 by the Worldwide Network for Blood and Marrow Transplantation through its member organizations. The primary endpoint was global and regional use (number of HSCT) and utilization of HSCT (number of HSCT/number of incident cases) for AML. Secondary outcomes included trends from 2009 to 2016 in donor type, stem cell source, and remission status at time of HSCT. Global AML incidence has steadily increased, from 102,000 (95% uncertainty interval: 90,200-108,000) in 2009 to 118,000 (104,000-126,000) in 2016 (16.2%). Over the same period, a 54.9% increase from 9659 to 14,965 HSCT/yr was observed globally, driven by an increase in allogeneic (64.9%) with a reduction in autologous (-34.9%) HSCT. Although the highest numbers of HSCT continue to be performed in high-resource regions, the largest increases were seen in resource-constrained regions (94.6% in Africa/East Mediterranean Region [AFR/EMR]; 34.7% in America-Nord Region [AMR-N]). HSCT utilization was skewed toward high-resource regions (in 2016: AMR-N 18.4%, Europe [EUR] 17.9%, South-East Asia/Western Pacific Region [SEAR/WPR] 11.7%, America-South Region [AMR-S] 4.5%, and AFR/EMR 2.8%). For patients <70 years of age, this difference in utilization was widened; AMR-N had the highest allogeneic utilization rate, increasing from 2009 to 2016 (30.6% to 39.9%) with continued low utilization observed in AFR/EMR (1.7% to 2.9%) and AMR-S (3.5% to 5.4%). Across all regions, total HSCT for AML in first complete remission (CR1) increased (from 44.1% to 59.0%). Patterns of donor stem cell source from related versus unrelated donors varied widely by geographic region. SEAR/WPR had a 130.2% increase in related donors from 2009 to 2016, and >95% HSCT donors in AFR/EMR were related; in comparison, AMR-N and EUR have a predilection for unrelated HSCT. Globally, the allogeneic HSCT stem cell source was predominantly peripheral blood (69.7% of total HSCT in 2009 increased to 78.6% in 2016). Autologous HSCT decreased in all regions from 2009 to 2016 except in SEAR/WPR (18.9%). HSCT remains a central curative treatment modality in AML. Allogeneic HSCT for AML is rising globally, but there are marked variations in regional utilization and practices, including types of graft source. Resource-constrained regions have the largest growth in HSCT use, but utilization rates remain low, with a predilection for familial-related donor sources and are typically offered in CR1. Further studies are necessary to elucidate the reasons, including economic factors, to understand and address these health inequalities and improve discrepancies in use of HSCT as a potentially curative treatment globally.
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Affiliation(s)
- Molly C Tokaz
- Division of Medical Oncology, University of Washington, Seattle, Washington; Division of Hematology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Helen Baldomero
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, Washington; Division of Hematology, University of Washington, Seattle, Washington
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Mickey B C Koh
- Infection and Immunity Clinical Academic Group, St George's Hospital and Medical School, London, United Kingdom; Academic Cell Therapy Facility and Programme Health Sciences Authority, Singapore
| | | | - Mohamad Mohty
- Sorbonne University, Hospital Saint Antoine, Paris, France
| | - Sebastian Galeano
- Latin American Blood and Marrow Transplantation Group - LABMT Hospital Británico, Montevideo, Uruguay
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amado J Karduss
- Clínica Las Américas, Latin AmericanBlood and Marrow Transplantation Group- LABMT, Medellín, Colombia
| | - Fabio Ciceri
- University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Alaa Elhaddad
- African Blood and Marrow Transplantation Group - AfBMT; Department of Pediatric Oncology and Stem Cell Transplantation Unit, Cairo University, Cairo, Egypt
| | - Lisa M Force
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Department of Health Metrics Sciences, University of Washington, Seattle, Washington
| | | | | | - Nada Hamad
- Department of Haematology, St. Vincent's Hospital Sydney, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | | | - Naya He
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Aloysius Ho
- Department of Haematology, Singapore General Hospital, Singapore
| | - Xiao-Jun Huang
- Department of Hematology, Peking University Institute of Hematology, Beijing, China
| | - Ben Jacobs
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hee-Je Kim
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Leslie Lehmann
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | - Mary-Elizabeth M Percival
- Division of Hematology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Walid Rasheed
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Kirk R Schultz
- BC Children's Hospital/UBC, Vancouver, British Columbia, Canada
| | - Adriana Seber
- Latin American Blood and Marrow Transplantation Group-LABMT, Bern, Switzerland; Hospital Samaritano - Americas, Sao Paulo Brazil and Pediatric Oncology Institute-Graacc-Unifesp, São Paulo, Brazil
| | - Bor-Sheng Ko
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | | | | | - Jeff Szer
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), St. Vincent ́s Hospital Sydney, Sydney, New South Wales, Australia; Peter MacCallum Cancer Center and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - William A Wood
- CIBMTR, University of North Carolina, Chapel Hill, North Carolina
| | - Yoshihisa Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Arnon Nagler
- The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - John A Snowden
- Department of Hematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Daniel Weisdorf
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Jakob Passweg
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Dietger Niederwieser
- University Leipzig, Leipzig, Germany; Japanese Data Center for Hematopoietic Cell Transplantation, Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan; KaunoKlinikos University of Health Sciences, Kaunas, Lithuania
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De la Garza-Salazar F, Gómez-De León A, Gómez-Almaguer D, Colunga-Pedraza PR. Vinblastine as a bridge to 7 + 3 in acute myeloid leukaemia. Ann Hematol 2023; 102:487-489. [PMID: 36651981 DOI: 10.1007/s00277-022-05048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Fernando De la Garza-Salazar
- Hematology Service, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Perla R Colunga-Pedraza
- Hematology Service, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico.
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12
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León AGD, Faisal MS. A world, connected. Lancet Haematol 2023; 10:e10. [PMID: 36566043 DOI: 10.1016/s2352-3026(22)00382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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13
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León AGD, Gil-Flores L, Colunga-Pedraza P, Bourlon C, Vargas-Serafín C, del Campo-Martínez MDLÁ, Olaya-Vargas A, Pérez-García M, González-Leal XJ, Herrera Rojas MA, Lozano-Rodríguez S, Solano-Genesta M, Rodríguez-Zúñiga AC, Sánchez-Arteaga A, Ruiz-Argüelles GJ, Gómez-Almaguer D. Hematopoietic stem cell transplantation activity in Mexico during the COVID19 pandemic: on the way to recovery. Hematology 2022; 27:1294-1300. [DOI: 10.1080/16078454.2022.2156737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Lourdes Gil-Flores
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Perla Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Christianne Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - César Vargas-Serafín
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Xitlaly J. González-Leal
- Instituto Tecnológico de Estudios Superiores de Monterrey. Monterrey Nuevo León.S, Monterrey, Mexico
- Clínica Gómez-Almaguer, Monterrey
| | | | - Sergio Lozano-Rodríguez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | | | - Anna Cecilia Rodríguez-Zúñiga
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Alexia Sánchez-Arteaga
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | | | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
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14
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Colunga-Pedraza PR, Colunga-Pedraza JE, Peña-Lozano SP, Gómez-De León A, Ruiz-Delgado GJ, Ribeiro RC. Diagnosis and treatment of acute lymphoblastic leukemia in Latin America. Hematology 2022; 27:971-976. [PMID: 36040187 DOI: 10.1080/16078454.2022.2117119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE to discuss the status and challenges associated with the management of acute lymphoblastic leukemia (ALL) in Latin America. METHODS This review summarizes various insights gained from information regarding diagnostic approaches and treatment strategies in adult patients with ALL in Latin American Countries. RESULTS Information regarding ALL in Latin America is scarce; however, many efforts have been made to overcomes these barriers. Nevertheless, major obstacles to successful treatment in Latin America and LMIC remain poor adherence, abandonment of treatment, and lack of supportive therapy and new therapeutic agents. CONCLUSION Further improvements in survival should be pursued by developing more Latin American registries, forming cooperative groups, developing educational models to facilitate earlier diagnosis and prevention of complications, better support therapy and management of infections, and adapting treatment strategies.
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Affiliation(s)
- Perla R Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Julia E Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Samantha P Peña-Lozano
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Mexico.,Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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15
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León AGD. The underrepresented majority. Lancet Haematol 2022; 9:e720. [PMID: 36174637 DOI: 10.1016/s2352-3026(22)00287-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Andrés Gómez-De León
- Dr Andrés Gómez-De León Universidad Autónoma de Nuevo León and Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico.
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16
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Gómez-Almaguer D, Rojas-Guerrero EA, Gómez-De León A, Colunga-Pedraza PR, Jaime-Pérez JC. Alternatives for managing patients with newly diagnosed immune thrombocytopenia: a narrative review. Expert Rev Hematol 2022; 15:493-501. [PMID: 35615916 DOI: 10.1080/17474086.2022.2082936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Primary immune thrombocytopenia (ITP) is an acquired bleeding disorder. Conventionally, first-line ITP therapy aims to obtain a rapid response and stop or decrease the risk of bleeding by increasing the platelet count. At this point, the duration of the response, the tolerability, and the long-term safety of pharmacologic interventions are considered less of a priority. Combination treatments that simultaneously address multiple disease mechanisms are an attractive strategy to increase efficacy in acute ITP therapy. In this review, we discuss the treatment of newly diagnosed ITP patients, emphasizing the use of new combinations to benefit from their synergy. AREAS COVERED This article summarizes conventional treatment, recent and novel combinations, and COVID-19 management recommendations of newly diagnosed ITP patients. EXPERT OPINION The key areas for improvement consider the long-term effects of conventional first-line therapy, reducing relapse rates, and extending responses to achieve long-term remission. Although corticosteroids remain first-line therapy, restricting their use to avoid toxicity and the increasing use of rituximab and TPO-RAs in the first three months after diagnosis open the landscape for future interventions in frontline therapy for ITP. First-line therapy intensification or synergistic drug combination offers a potential and realistic shift in future treatment guidelines.
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Affiliation(s)
- David Gómez-Almaguer
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Edgar A Rojas-Guerrero
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Perla R Colunga-Pedraza
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - José C Jaime-Pérez
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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17
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Colunga-Pedraza PR, Peña-Lozano SP, Sánchez-Rendón E, De la Garza-Salazar F, Colunga-Pedraza JE, Gómez-De León A, Santana-Hernández P, Cantú-Rodríguez OG, Gómez-Almaguer D. Oseltamivir as rescue therapy for persistent, chronic, or refractory immune thrombocytopenia: a case series and review of the literature. J Thromb Thrombolysis 2022; 54:360-366. [PMID: 35471623 DOI: 10.1007/s11239-022-02651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease that results from antibody-mediated platelet destruction and impaired platelet production. Novel therapies have emerged in the last decade, but 15-20% of patients will relapse or fail and require further therapy. We performed a prospective, single-arm intervention study on seven patients with chronic, persistent, or refractory ITP from the Hospital Universitario "Dr. José E González", in Monterrey, Mexico between 2015 and 2019. Eligible patients received oral oseltamivir 75 mg twice daily for 5 days and were followed up for six months. Most patients received a median of three distinct therapies (range 2-6). Four patients (57.1%) received combined therapy. The median time for any response was 55.5 days (range = 14-150). All patients responded at some point in time (ORR = 100%, six had a proportion of loss of response [PR], and one achieved [CR]). Six months after oseltamivir administration, three patients (42.9%) maintained a response, and one patient had a CR (14.3%). Oseltamivir was well tolerated with a good overall response rate and was useful for treating chronic ITP. We observed an initial increase in the number of platelets; however, this response was not maintained.
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Affiliation(s)
- Perla R Colunga-Pedraza
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Samantha P Peña-Lozano
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Ernesto Sánchez-Rendón
- Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Monterrey, Mexico
| | - Fernando De la Garza-Salazar
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Julia E Colunga-Pedraza
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Paola Santana-Hernández
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Olga G Cantú-Rodríguez
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico.
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18
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Colunga-Pedraza PR, Varela-Constantino A, León AGD, De la Rosa-Flores GA, Cantu-Rodriguez OG, Gutierrez-Aguirre CH, Colunga-Pedraza JE, Peña-Lozano SP, Mancias-Guerra C, Jimenez-Antolinez YV, Gómez-Almaguer D. Early Cyclosporine As Cytokine Release Syndrome Prophylaxis after Peripheral Blood Haploidentical Transplantation in the Outpatient Setting. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gonzalez-Leal XJ, González-López EE, Soto-Lanza F, De la Rosa-Flores GA, Colunga-Pedraza PR, Rodríguez-Zuñiga AC, Gutierrez-Aguirre CH, Cantu-Rodriguez OG, Tarín-Arzaga L, Gómez-Almaguer D, León AGD. A Tale of Two Centers: Access to Private Care Improves Outcomes in Allogeneic Transplant Recipients. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gómez-Almaguer D, Gómez-De León A, Colunga-Pedraza PR, Cantú-Rodríguez OG, Gutierrez-Aguirre CH, Ruíz-Arguelles G. Outpatient allogeneic hematopoietic stem-cell transplantation: a review. Ther Adv Hematol 2022; 13:20406207221080739. [PMID: 35237396 PMCID: PMC8882949 DOI: 10.1177/20406207221080739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is usually performed in
well-equipped units inside a hospital. The cost of this in-hospital transplant
is usually very high; therefore, this procedure is more difficult to perform in
low- and middle-income countries. Autologous outpatient HSCT is now a common
procedure; however, outpatient allogeneic transplants are more complicated. Only
a few centers in the world have incorporated outpatient HSCT. This transplant
requires special adaptation, like a day hospital, careful selection of patients,
oral medications, and the patient must live relatively close to the hospital.
The results until now suggest that this outpatient transplant is factible and
similar to inpatient HSCT. The objective was to review and describe the
different methods and results following an outpatient allogeneic-HSCT
strategy.
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Affiliation(s)
- David Gómez-Almaguer
- Hematology Service, Facultad de Medicina y Hospital Universitario ‘Dr. Jose Eleuterio Gonzalez’, Universidad Autónoma de Nuevo León, Francisco I. Madero Ave., Mitras Centro, Monterrey 64460, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Perla R. Colunga-Pedraza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Olga G. Cantú-Rodríguez
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - César Homero Gutierrez-Aguirre
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Gómez-De León A, Demichelis-Gómez R, Pinedo-Rodríguez A, Enriquez-Vera D, Flores-Jiménez JA, Ceballos-López AA, Rodríguez-Mejorada M, Herrera Riojas MA, Ovilla-Martínez R, Báez-Islas P, Cota-Rangel X, Neme-Yunes Y, Inclán-Alarcón S, López-Flores NJ, Colunga-Pedraza PR, Rodríguez-Zúñiga AC, Gómez-Almaguer D. Venetoclax-based combinations for acute myeloid leukemia: optimizing their use in Latin-America. Hematology 2022; 27:249-257. [PMID: 35192778 DOI: 10.1080/16078454.2021.2024940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives: Venetoclax combinations are a new standard for patients with acute myeloid leukemia (AML). We aimed to evaluate the safety and efficacy of these combinations in a period of accelerated approval in Latin-America.Methods: This observational study evaluated adults with acute myeloid leukemia who received venetoclax-based therapy in 11 public or private centers in Mexico and Peru for both newly diagnosed or relapsed and refractory AML.Results: Fifty patients were included; 28 with newly diagnosed (ND) AML and 22 with relapsed/refractory (RR) disease. ND patients were older (64 vs. 40 years; p < 0.001) with a lower functional capacity (ECOG ≥2 64.3% vs 9%; p < 0.001). Venetoclax was frequently combined with azacytidine (60%) and prophylactic azoles (82%) with a median maximum dose of 200 mg (range, 100-600 mg). Hematologic toxicities were common. Complete response rates including patients with incomplete hematopoietic recovery were 78.6% in ND and 45.5% in RR patients, with a median overall survival of 9.6 (95% CI 3.7-15.5) and 8 months (95% CI 4.8-11.2).Discussion: Our study showed a preferred use of venetoclax plus azacytidine over cyatrabine. Patients in the first-line setting were similar to those in the landmark studies, while most patients with relapsed disease had received prior intensive therapies. Responses were favorable, with a median survival in agreement to other reports, albeit shorter than that observed in the randomized phase-3 trials.Conclusion: Venetoclax-based therapy in AML was effective despite dose reductions and prophylactic antifungals in two middle-income countries outside of a clinical trial setting.
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Affiliation(s)
- Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Roberta Demichelis-Gómez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, CDMX, Mexico
| | - Alfredo Pinedo-Rodríguez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, CDMX, Mexico
| | - Daniel Enriquez-Vera
- Universidad Privada San Juan Bautista, Lima, Perú.,Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | | | | | | | | | | | | | | | | | | | - Nelson J López-Flores
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Perla R Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Anna C Rodríguez-Zúñiga
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
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22
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Demichelis-Gómez R, Alvarado-Ibarra M, Vasquez-Chávez J, Delgado-López N, Gómez-Cortés C, Espinosa-Bautista K, Cooke-Tapia A, Milán-Salvatierra A, Gómez-De León A, Lee-Tsai YL, Rosales-López D, Cabrera-García Á, Amador-Medina F, Córdoba-Ramírez A, Murrieta-Álvarez I, Solís-Poblano JC, Apodaca-Chávez E, Rangel-Patiño J, Álvarez-Vera JL, Arana-Luna L, De la Peña-Celaya JA, Espitia-Ríos ME, Hernández-Ruiz E, Pérez-Zúñiga JM, Peña-López E, González-Rivera R, García-Leyva MF, Tejeda-Romero M, Cruz-Rico J, Balderas-Delgado C, Ruíz-Argüelles GJ, Gómez-Almaguer D. Treating Acute Leukemia During the COVID-19 Pandemic in an Environment With Limited Resources: A Multicenter Experience in Four Latin American Countries. JCO Glob Oncol 2021; 7:577-584. [PMID: 33891480 PMCID: PMC8162972 DOI: 10.1200/go.20.00620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The COVID-19 pandemic is a colossal challenge for global health; nonetheless, specific subgroups face considerably higher risks for infection and mortality. Among patients with malignant diseases, those with hematologic neoplasms are at a higher risk for poor outcomes. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and their short-term consequences in Latin America. METHODS Multicenter, prospective, observational, cohort study including patients older than 14 years from 14 centers in four countries (Mexico, Peru, Guatemala, and Panama) who had a confirmed diagnosis of acute leukemia, and who were undergoing active treatment since the first COVID-19 case in each country until the cutoff on July 15, 2020. RESULTS We recruited 635 patients. Treatment modifications because of the COVID-19 pandemic were reported in 40.8% of cases. The main reason for such modifications was logistic issues (55.0%) and the most frequent modification was chemotherapy delay (42.0%). A total of 13.1% patients developed COVID-19 disease, with a mortality of 37.7%. Several factors were identified as independently associated with mortality, including a diagnosis of acute myeloid leukemia (odds ratio 2.38 [95% CI, 1.47 to 3.84]; P < .001), while the use of telemedicine was identified as a protective factor (odds ratio 0.36 [95% CI, 0.18 to 0.82]; P = .014). CONCLUSION These results highlight the collateral damage of COVID-19 in oncology patients.
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Affiliation(s)
| | | | | | - Nancy Delgado-López
- Hospital de Especialidades, Centro Médico Nacional siglo XXI, Mexico City, Mexico
| | - Cynthia Gómez-Cortés
- Hospital de Especialidades, Centro Médico Nacional siglo XXI, Mexico City, Mexico
| | | | - Ana Cooke-Tapia
- Complejo Hospitalario Doctor Arnulfo Arias Madrid, Panama, Panama
| | | | - Andrés Gómez-De León
- Universidad Autónoma de Nuevo Léon, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | | | | | | | | | | | | | | | - Elia Apodaca-Chávez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Rangel-Patiño
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Luara Arana-Luna
- Centro Médico Nacional 20 de noviembre, ISSSTE, Mexico City, Mexico
| | | | | | | | | | | | - Rosa González-Rivera
- Hospital de Especialidades, Centro Médico Nacional siglo XXI, Mexico City, Mexico
| | | | | | | | | | | | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo Léon, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
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23
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Gómez-De León A, Colunga-Pedraza PR, Tarín-Arzaga L, Bugarín-Estrada E, Sung L, Cantú-Martínez O, Jaime-Pérez JC, Gómez-Almaguer D. Contributions to the American Society of Hematology Meeting From Low- and Middle-Income Countries: An In-Depth Analysis and Call to Action. JCO Glob Oncol 2021; 7:622-631. [PMID: 33909458 PMCID: PMC8162961 DOI: 10.1200/go.20.00600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Establishing research capacity in low- and middle-income countries (LMICs) is key for improving the outcomes of patients with hematologic diseases globally. Few studies have analyzed the contributions of LMICs to global hematology. The American Society of Hematology Meeting (ASH) is the largest international academic event where peer-reviewed contributions in our field are presented. METHODS In this cross-sectional analysis, all abstracts accepted to ASH 2018 selected for a poster or oral presentation were reviewed. Those that had a contributing author from an LMIC were identified. The proportion of LMIC abstracts across categories was analyzed. Country of origin, high-income country participation, the presence of a conflict of interest (COI), and sponsorship were determined. RESULTS From 4,871 abstracts reviewed, 506 had a contributing author from an LMIC (10.4%), with 277 (54.7%) contributions in partnership with a high-income country. LMIC-independent contributions corresponded to 19 of 1,026 oral abstracts (1.9%) and 209 of 3,845 posters (5.4%). Most abstracts from LMICs were clinical (n = 311; 61.5%) and multicentric in nature (n = 353; 69.8%). COI statements with the pharmaceutical industry were common (n = 214; 42.3%). Collaboration between LMICs was infrequent (n = 33; 6.5%). Upper-middle-income countries had 466 participations (81.5%), in comparison with 96 (16.8%) in low-middle-income and 10 (1.7%) in low-income countries. CONCLUSION LMICs were responsible for a small fraction of abstracts at ASH18; low-income countries were practically absent. Almost half of accepted works represented a form of international collaboration, with clinical, multicenter studies predominating and COI disclosures a frequent and unexpected feature, reflecting the instrumental nature of LMIC participation and a lack of independent, robust, locally developed hematology research.
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Affiliation(s)
- Andrés Gómez-De León
- Hematology Service, Facultad de Medicina y Hospital Universitario “Dr José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Perla R. Colunga-Pedraza
- Hematology Service, Facultad de Medicina y Hospital Universitario “Dr José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Luz Tarín-Arzaga
- Hematology Service, Facultad de Medicina y Hospital Universitario “Dr José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Emmanuel Bugarín-Estrada
- Hematology Service, Facultad de Medicina y Hospital Universitario “Dr José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Lilian Sung
- Child Health Evaluation Services, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Omar Cantú-Martínez
- Hematology Service, Facultad de Medicina y Hospital Universitario “Dr José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - José C. Jaime-Pérez
- Hematology Service, Facultad de Medicina y Hospital Universitario “Dr José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - David Gómez-Almaguer
- Hematology Service, Facultad de Medicina y Hospital Universitario “Dr José Eleuterio González,” Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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24
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Jaime-Pérez JC, Ramos-Dávila EM, Meléndez-Flores JD, Gómez-De León A, Gómez-Almaguer D. Insights on chronic immune thrombocytopenia pathogenesis: A bench to bedside update. Blood Rev 2021; 49:100827. [PMID: 33771403 DOI: 10.1016/j.blre.2021.100827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
Immune thrombocytopenia (ITP) is a heterogeneous disease with an unpredictable course. Chronicity can develop in up to two-thirds of adults and 20-25% of children, representing a significant burden on patients' quality of life. Despite acceptable responses to treatment, precise etiology and pathophysiology phenomena driving evolution to chronicity remain undefined. We analyzed reported risk factors for chronic ITP and associated them with proposed underlying mechanisms in its pathogenesis, including bone marrow (BM) microenvironment disturbances, clinical features, and immunological markers. Their understanding has diagnostic implications, such as screening for the presence of specific antibodies or BM examination employing molecular tools, which could help predict prognosis and recognize main pathogenic pathways in each patient. Identifying these underlying mechanisms could guide the use of personalized therapies such as all-trans retinoic acid, mTor inhibitors, FcRn inhibitors, oseltamivir, and others. Further research should lead to tailored treatments and chronic course prevention, improving patients' quality of life.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Eugenia M Ramos-Dávila
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jesús D Meléndez-Flores
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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25
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Galindo-Calvillo CD, Rodríguez-Roque CS, Gómez-De León A, Tarín-Arzaga L, Gómez-Almaguer D. Treating thrombotic thrombocytopenic purpura without plasma exchange during the COVID-19 pandemic. A case report and a brief literature review. Transfus Apher Sci 2021; 60:103107. [PMID: 33714651 PMCID: PMC7912363 DOI: 10.1016/j.transci.2021.103107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/19/2022]
Abstract
We report the case of a patient diagnosed with a clinical relapse of acquired immune-mediated thrombotic thrombocytopenic purpura (TTP) who was successfully treated with low-dose rituximab plus corticosteroids without the use of plasma exchange (PEx), which was unavailable at the time due to the COVID-19 pandemic. Rituximab 100 mg weekly for 4 weeks was administered, combined with 1 mg/kg of prednisone, obtaining a complete hematological response in 6 weeks. This case suggests that PEx may be unnecessary for a subset of patients with relapsed TTP who are clinically stable without significant end-organ damage. A brief literature review regarding TTP patients treated without plasma exchange is also included.
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Affiliation(s)
- César David Galindo-Calvillo
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Carlos Saúl Rodríguez-Roque
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Andrés Gómez-De León
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Luz Tarín-Arzaga
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - David Gómez-Almaguer
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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26
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Colunga-Pedraza PR, Gómez-De León A, Rodríguez-Roque CS, Morcos-Sandino M, Colunga-Pedraza JE, Cantú-Rodriguez OG, Gutiérrez-Aguirre CH, Gómez-Almaguer D. Outpatient Haploidentical Stem Cell Transplantation Using Post-Transplant Cyclophosphamide Is Safe and Feasible. Transplant Cell Ther 2020; 27:259.e1-259.e6. [PMID: 33781529 DOI: 10.1016/j.jtct.2020.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) feasibility has increased in the last decades because of haplo-HSCT, changes in chemotherapy schedules, and the possibility of an outpatient-based HSCT. The main barriers remain in low-middle income countries. There is a lack of information regarding haplo-HSCT with a myeloablative (MAC) regimen on an outpatient basis. OBJECTIVES Our primary objective was to determine if outpatient haplo-HSCT was feasible. STUDY DESIGN Single center, retrospective cohort, n=60 adult patients undergoing Haplo-HSCT. Descriptive statistical analysis, univariate and multivariate comparison. PATIENTS AND METHOD We analyzed 60 adult patients transplanted with an intended haplo-HSCT on an outpatient basis from 2015 to 2019 in our unit. A multivariate analysis was performed on risk factors for hospitalization. RESULTS Median age was 27 years (15-64). All patients underwent conditioning as outpatients, and none required hospitalization before day 0. Thirteen patients (21.6%) were followed completely in the outpatient clinic and 47 (78.3%) required hospitalization in a median of 3 days after infusion (range, 1-14). The median length of stay (LOS) was 8 days (IQR, 3-17). Fever secondary to cytokine release syndrome (CRS) was the most common reason for hospitalization occurring in 43/47 (91.5%), 4 were related to infection and 36 were related to CRS. In the univariate analysis, CRS, slower engraftment, and female sex were associated with the need for hospitalization. In the multivariate analysis, only CRS remained significant (OR 9.14 [95%CI, 1.58-56.46]). The 2-year overall survival (OS) was 41.7% for ambulatory transplant vs. 38% for those requiring hospitalization (P = 0.12). The 2-year event-free survival (EFS) was 33% for outpatient patients and 16.7% for those hospitalized (log-rank, P = 0.062). CONCLUSIONS We demonstrated the feasibility and safety of carrying out an outpatient haplo-HSCT, potentially resulting in cost savings and perhaps a higher quality of life.
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Affiliation(s)
- Perla R Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Carlos Saúl Rodríguez-Roque
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Michelle Morcos-Sandino
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Julia E Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Olga Graciela Cantú-Rodriguez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - César Homero Gutiérrez-Aguirre
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico.
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27
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Pezina-Cantú C, Gómez-De León A, Jaime-Perez JC, Colunga-Pedraza P, Tarín-Arzaga L, Leija-Walle R, Morcos-Sandino M, Gómez-Almaguer D. Pernicious anaemia can be treated effectively with a single high dose of cobalamin. Br J Haematol 2020; 191:e97-e100. [PMID: 32794581 DOI: 10.1111/bjh.17054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- César Pezina-Cantú
- Hematology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - José C Jaime-Perez
- Hematology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Perla Colunga-Pedraza
- Hematology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Luz Tarín-Arzaga
- Hematology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ramsés Leija-Walle
- Hematology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Michelle Morcos-Sandino
- Hematology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - David Gómez-Almaguer
- Hematology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Gómez-De León A, Villela-Martínez LM, Yáñez-Reyes JM, Gómez-Almaguer D. Advances in the treatment of thrombotic thrombocytopenic purpura: repurposed drugs and novel agents. Expert Rev Hematol 2020; 13:461-470. [DOI: 10.1080/17474086.2020.1750361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Andrés Gómez-De León
- Hematology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario ‘Dr. José Eleuterio González’, Monterrey, México
| | - Luis Mario Villela-Martínez
- Centro Médico “Dr. Ignacio Chavez”. ISSSTESON, Hermosillo, México
- Universidad del Valle de México. Campus Hermosillo, Hermosillo, México
| | - José Miguel Yáñez-Reyes
- Hematology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario ‘Dr. José Eleuterio González’, Monterrey, México
| | - David Gómez-Almaguer
- Hematology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario ‘Dr. José Eleuterio González’, Monterrey, México
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29
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Gómez-De León A, Alvarado-Navarro DM, Pezina-Cantú CO, Colunga-Pedraza PR, Gómez-Almaguer D, Salazar-Riojas R, Cantu-Rodriguez OG, Tarín-Arzaga L, Jaime-Pérez JC, Gutierrez-Aguirre CH. Incorporating Reduced-Dose Plerixafor to a Preemptive Mobilization Algorithm Increases Access to Autologous Transplantation in a Limited-Resource Setting. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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León AGD, Colunga-Pedraza PR, Garcia-Camarillo DE, Bustillos-Muñoz M, Salazar-Riojas R, López-Silva LJ, Cantu-Rodriguez OG, Gutierrez-Aguirre CH, Gómez-Almaguer D. The Road to Day 0: Barriers from HLA Typing to Infusion in the Era of Haploidentical Transplantation in Mexico. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Cantú-Rodríguez OG, Vázquez-Mellado A, González-Treviño JL, Martínez-Garza DM, Gómez-De León A, Hawing-Zarate JA, Jaime-Pérez JC, Gutierrez-Aguirre CH, Garza-Acosta AC, Mancías-Guerra C, González-Llano O, González-Cantú GA, Herrera-Rojas MA, Sada-Ovalle I, Gómez-Almaguer D. Cyclosporine A for the Prevention of Ocular Graft versus Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients Is Safe and Feasible. Acta Haematol 2019; 143:425-431. [PMID: 31505491 DOI: 10.1159/000502405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/27/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of ocular cyclosporine in the prevention of the development of ocular graft versus host disease (oGVHD) in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT) in comparison with historic data. DESIGN We developed a longitudinal, observational, prospective nonrandomized study. We evaluated the feasibility of prophylactic use of topical cyclosporine A (CsA) to prevent or decrease the incidence of oGVHD and compared this with historic data. METHODS Patients undergoing AHSCT were treated with prophylactic topical CsA for 12 months after engraftment, followed by serial ophthalmic evaluations, including the Schirmer test. RESULTS Twenty patients were included. No serious adverse effects were reported. Poor adherence was documented in 15% of patients. In spite of observing extra-ocular GVHD (acute and chronic GVHD incidence of 50 and 45%, respectively), only 1 in 20 patients developed oGVHD over the 20-month follow-up for the entire cohort. No statistically significant difference was observed in the incidence of oGVHD when compared to a historical cohort. CONCLUSIONS Topical CsA as a prophylactic measure for oGVHD, administered over a period of 1 year after grafting, is safe and feasible and may decrease the incidence of ophthalmic manifestations of GVHD. These findings must be confirmed in a randomized trial.
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Affiliation(s)
- Olga Graciela Cantú-Rodríguez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico,
| | - Alberto Vázquez-Mellado
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | | | - David Mauricio Martínez-Garza
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - José Angel Hawing-Zarate
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - José Carlos Jaime-Pérez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - César Homero Gutierrez-Aguirre
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Andrea Cecilia Garza-Acosta
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Consuelo Mancías-Guerra
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Oscar González-Llano
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | | | - Miguel Angel Herrera-Rojas
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Isabel Sada-Ovalle
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
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Gómez-Almaguer D, González-Llano O, Jiménez-Antolinez V, Gómez-De León A. Treatment of classical Hodgkin’s lymphoma in children and adolescents. Expert Opin Pharmacother 2019; 20:1227-1234. [DOI: 10.1080/14656566.2019.1606212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David Gómez-Almaguer
- Service of Hematology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Oscar González-Llano
- Service of Hematology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Valentine Jiménez-Antolinez
- Service of Hematology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Gómez-De León
- Service of Hematology, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
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Jaime-Pérez JC, Aguilar-Calderón P, Salazar-Cavazos L, Gómez-De León A, Gómez-Almaguer D. Treatment of autoimmune hemolytic anemia: real world data from a reference center in Mexico. Blood Res 2019; 54:131-136. [PMID: 31309092 PMCID: PMC6614091 DOI: 10.5045/br.2019.54.2.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/12/2019] [Accepted: 03/23/2019] [Indexed: 12/03/2022] Open
Abstract
Background Warm autoimmune hemolytic anemia (w-AIHA) is an uncommon disease with heterogeneous response to treatment. Steroids are the standard treatment at diagnosis, whereas rituximab has recently been recommended as the second-line therapy of choice. Our main objective was to document the response to treatment in patients with newly diagnosed w-AIHA, including the effectiveness of low-dose rituximab as frontline treatment and for refractory disease. Methods Patients with w-AIHA from 2002 to 2017 were included. Relapse-free survival (RFS), probability of maintained response (MR), and time-to-response were analyzed using the Kaplan–Meier method. Response was classified as complete, partial, and no response. Results We included 64 adults with w-AIHA (39 women and 25 men). The median age was 37 (16–77) years. Response rates to steroids alone were 76.7%, rituximab plus steroids, 100%; and cyclophosphamide, 80%. RFS with steroids at 6, 36, and 72 months was 86.3%, 65.1%, and 59.7%, respectively. Eighteen patients received rituximab at 100 mg/wk for 4 weeks plus high-dose dexamethasone as first-line therapy, with RFS at 6, 36, and 72 months of 92.3%, 58.7% and 44.1%, respectively. Eight patients refractory to several lines of therapy were treated with low-dose rituximab, and all achieved a response (three complete response and five partial response) at a median 16 days (95% confidence interval, 14.1–17.8), with a 75% probability of MR at 103 months; the mean MR was 81.93±18 months. Conclusion Outcomes of w-AIHA treatment were considerably heterogeneous. Low rituximab doses plus high dexamethasone doses were effective for refractory disease.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Patrizia Aguilar-Calderón
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Lorena Salazar-Cavazos
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Bugarin-Estrada E, Colunga-Pedraza PR, Gómez-De León A, Barrera-Salinas R, Santana-Hernández P, Gómez-Almaguer D. Does Outcomes of HSCT Differ According to Patients’ Socioeconomic Status? Real-World Data from an Outpatient-Based Center in Mexico. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Colunga-Pedraza PR, Gómez-De León A, Colunga-Pedraza JE, Santana-Hernández P, Bugarín-Estrada E, Gutierrez-Aguirre CH, Cantu-Rodriguez OG, Gómez-Almaguer D. Cytokine Release Syndrome after Peripheral Blood T-Cell Replete Haploidentical Transplantation Is Not Prevented By Dexamethasone and Limits Its Full-Outpatient Conduction. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bugarin-Estrada E, Gómez-De León A, López-García YK, Díaz-Chuc EA, Priesca-Marín JM, Ruiz-Argüelles GJ, Jaime-Pérez JC, Gómez-Almaguer D. Clinical presentation in thrombotic thrombocytopenic purpura: Real-world data from two Mexican institutions. J Clin Apher 2018; 33:645-653. [DOI: 10.1002/jca.21659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Emmanuel Bugarin-Estrada
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - Andrés Gómez-De León
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - Yadith Karina López-García
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - Erik Alejandro Díaz-Chuc
- Department of Clinical Pathology; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - José Manuel Priesca-Marín
- Department of Internal Medicine and Hematology, Centro de Medicina Interna y Hematología; Clínica Ruiz; Puebla Puebla Mexico
| | - Guillermo J. Ruiz-Argüelles
- Department of Internal Medicine and Hematology, Centro de Medicina Interna y Hematología; Clínica Ruiz; Puebla Puebla Mexico
| | - José Carlos Jaime-Pérez
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - David Gómez-Almaguer
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
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Mancias-Guerra C, Garza-Bedolla A, Gómez-De León A, González-Llano O, Gutierrez-Aguirre CH, Cantu-Rodriguez OG, Brochier MMA, Cepeda-Cepeda MG, Sanchez-Garcia SA, Carreño-Salcedo SA, Gómez-Almaguer D. Cryopreserved Hematopoietic Progenitor Units that are Eventually Discarded: Everything has a Price. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tarín-Arzaga L, Arredondo-Campos D, Martínez-Pacheco V, Martínez-González O, Ramírez-López A, Gómez-De León A, Gutiérrez-Aguirre CH, Cantú-Rodríguez O, Jaime-Pérez JC, Gómez-Almaguer D. Impact of the affordability of novel agents in patients with multiple myeloma: Real-world data of current clinical practice in Mexico. Cancer 2018; 124:1946-1953. [DOI: 10.1002/cncr.31305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Luz Tarín-Arzaga
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Daniela Arredondo-Campos
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Victor Martínez-Pacheco
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Odra Martínez-González
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Alba Ramírez-López
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Andrés Gómez-De León
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Cesar Homero Gutiérrez-Aguirre
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Olga Cantú-Rodríguez
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - José Carlos Jaime-Pérez
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - David Gómez-Almaguer
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
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Gómez-Almaguer D, Colunga-Pedraza PR, Gómez-De León A, Gutiérrez-Aguirre CH, Cantú-Rodríguez OG, Jaime-Pérez JC. Eltrombopag, low-dose rituximab, and dexamethasone combination as frontline treatment of newly diagnosed immune thrombocytopaenia. Br J Haematol 2017; 184:288-290. [PMID: 29270980 DOI: 10.1111/bjh.15070] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Gómez-Almaguer
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González". Haematology service, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Perla R Colunga-Pedraza
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González". Haematology service, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Andrés Gómez-De León
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González". Haematology service, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - César H Gutiérrez-Aguirre
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González". Haematology service, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Olga G Cantú-Rodríguez
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González". Haematology service, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - José C Jaime-Pérez
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González". Haematology service, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Jaime-Pérez JC, Fernández LT, Jiménez-Castillo RA, Gómez-De León A, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, Gómez-Almaguer D. Age Acts as an Adverse Independent Variable for Survival in Acute Lymphoblastic Leukemia: Data From a Cohort in Northeast Mexico. Clin Lymphoma Myeloma Leuk 2017; 17:590-594. [PMID: 28689002 DOI: 10.1016/j.clml.2017.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/10/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Survival for acute lymphoblastic leukemia (ALL) decreases with age. Patients across all age groups from a homogeneous ethnic and socioeconomic background were studied to document age effect. MATERIAL AND METHODS Patients diagnosed from 2005 to 2015 at a university hospital in Northeast Mexico were divided into 4 age groups: infants (< 1), children (≥ 1 to < 16), adolescents (≥ 16 to ≤ 20), and adults (> 20 years). Correlation between age at diagnosis and relapse-free (RFS) and overall survival (OS) was investigated. RESULTS A total of 377 patients were included. Five-year RFS and OS for children were 55.6% and 66.9%; for adolescents, 36.0% and 48.3%; for adults, 19.5% and 24.1%, respectively. Differences in RFS and OS between age groups were significant (P < .001, P < .001). In the Cox regression model, all age groups reached statistical significance in univariate analysis of mortality. CONCLUSION Age plays a decisive role in clinical evolution of ALL and strongly influences outcome. Age older than 20 represents a progressive high-risk factor for death.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Lucía Teresa Fernández
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Raúl Alberto Jiménez-Castillo
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Gómez-De León
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Olga Graciela Cantú-Rodríguez
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - César Homero Gutiérrez-Aguirre
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
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Gómez-Almaguer D, León AGD, Lozano-Morales RE, Colunga-Pedraza PR, Salazar-Riojas R, Valdes-Galvan MJ, Tarín-Arzaga L, González-Llano O. Filgrastim Biosimilars for Peripheral Blood Hematopoietic Stem Cell Mobilization in Healthy Donors: A Five-Year Experience From a University Hospital in Mexico. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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González-Llano O, Mancías-Guerra C, Gamboa-Alonso CM, Gómez-De León A, Jaime-Pérez JC, Gutiérrez-Aguirre CH, Cantú-Rodríguez O, Villarreal-Martínez L, García-Sepulveda R, Herrera-Rojas MA, Gómez-Almaguer D. Measurements of Catheter, Venous, and Capillary Cyclosporine A Blood Are Comparable and Useful in Pediatric Hematopoietic Stem Cell Transplant Recipients. Acta Haematol 2017; 137:113-116. [PMID: 28226327 DOI: 10.1159/000455817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/18/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Oscar González-Llano
- Hematology Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Gómez-Almaguer D, Marcos-Ramírez ER, Montaño-Figueroa EH, Ruiz-Argüelles GJ, Best-Aguilera CR, López-Sánchez MDC, Barrera-Chairez E, López-Arrollo JL, Ramos-Peñafiel CO, León-Peña A, González-López EE, Rivas-García PE, Tellez-Hinojosa CA, Gómez-De León A, Jaime-Pérez JC. Acute Leukemia Characteristics are Different Around the World: the Mexican Perspective. Clinical Lymphoma Myeloma and Leukemia 2017; 17:46-51. [DOI: 10.1016/j.clml.2016.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 01/19/2023]
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Jaime-Pérez JC, Gamboa-Alonso CM, Jiménez-Castillo RA, López-Silva LJ, Pinzón-Uresti MA, Gómez-De León A, Gómez-Almaguer D. TNF-α increases in the CSF of children with acute lymphoblastic leukemia before CNS relapse. Blood Cells Mol Dis 2016; 63:27-31. [PMID: 28061377 DOI: 10.1016/j.bcmd.2016.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/21/2016] [Indexed: 12/21/2022]
Abstract
There is scarce information regarding the concentration of cytokines in cerebrospinal fluid (CSF) of children with acute lymphoblastic leukemia (ALL) and their clinical association with CNS status. A prospective analysis of 40 patients <18years with newly diagnosed ALL was performed. Human cytokine magnetic bead panel assay values of IL-2, IL-4, IL-6, IL-8, IL-10, MCP-1, TNF-α in CSF at diagnosis, end of induction to remission, and 6months after diagnosis were determined. IL-6 and MCP-1 values showed a significant increment at the end of induction. From the whole group 4 (10.0%), patients relapsed to the CNS at a median of 11.48months. A significantly higher value of TNF-α at third determination in these CNS-relapsed patients was documented, 7.48 vs. 2.86pg/mL in 36 children without relapse (p=0.024). TNF-α concentration increased at a median 5.48months before CNS relapse. By receiver-operating characteristic curve (ROC) analysis, the best cut-off point of TNF-α concentration that better predicted CNS relapse was ≥1.79pg/mL. In conclusion an increase in TNF-α concentration on CSF preceded CNS relapse in children with ALL. An increase in MCP-1 and IL-6 was not associated to CNS relapse and appears to result from an inflammatory response after IT injection of chemotherapy.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Carmen Magdalena Gamboa-Alonso
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Raúl Alberto Jiménez-Castillo
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Leslie Jazmín López-Silva
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Mónica Andrea Pinzón-Uresti
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Gutierrez-Aguirre CH, García-Lozano JA, Treviño-Montemayor OR, Iglesias-Benavides JL, Cantú-Rodríguez OG, González-Llano O, Gómez-De León A, Salazar-Riojas R, Mancias-Guerra C, Jaime-Pérez JC, Guzman-López A, Gómez-Almaguer D. Comparative analysis of iron status and other hematological parameters in preeclampsia. ACTA ACUST UNITED AC 2016; 22:36-40. [PMID: 27558940 DOI: 10.1080/10245332.2016.1220120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare serum ferritin (SF) concentrations and other hematological parameters between patients with preeclampsia (PE) and normal pregnant women of the same gestational period who received supplemental iron during pregnancy. METHODS Prospective, comparative, observational pilot study that included 31 women with PE and 30 healthy pregnant women, at 20 weeks' of gestation. Ferritin, iron and complete blood cell count were compared between groups. RESULTS In comparison with controls, preeclamptic patients had a higher weight, body mass index, and arterial pressure. Serum ferritin and serum iron were higher in patients with PE (median: 36.5 μg/l vs. 20.9 μg/l and 103.9 μg/dl vs. 90.8 μg/dl) with a significant difference (P = 0.019 and P = 0.345). SF values >40 μg/l correlated with PE (r = 0.281; P = 0.032). A platelet count less than 100 × 109/l was higher in the PE group than in the control group (13% vs. 3%, P = 0.354). CONCLUSION Higher SF levels, despite being within normal range, were associated with PE. The incidence of thrombocytopenia was higher in preeclamptic women, however, the remaining hematological parameters were similar in both groups.
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Affiliation(s)
- César Homero Gutierrez-Aguirre
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - José Alberto García-Lozano
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Oscar Rubén Treviño-Montemayor
- b Obstetrics Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - José Luis Iglesias-Benavides
- b Obstetrics Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Olga Graciela Cantú-Rodríguez
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Oscar González-Llano
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Andrés Gómez-De León
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Rosario Salazar-Riojas
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Consuelo Mancias-Guerra
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - José Carlos Jaime-Pérez
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Abel Guzman-López
- b Obstetrics Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - David Gómez-Almaguer
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
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Jaime-Pérez JC, González-Leal XJ, Pinzón-Uresti MA, Gómez-De León A, Cantú-Rodríguez OG, Gutiérrez-Aguirre H, Gómez-Almaguer D. Is There Still a Role for Low-Dose All-Transretinoic Acid in the Treatment of Acute Promyelocytic Leukemia in the Arsenic Trioxide Era? Clin Lymphoma Myeloma Leuk 2015; 15:816-819. [PMID: 26500134 DOI: 10.1016/j.clml.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/03/2015] [Accepted: 09/11/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Low-dose all-transretinoic acid (LD-ATRA) has shown similar peak plasma concentrations and a mean area under the concentration time curve in comparison with standard doses of ATRA. We evaluated the efficacy of LD-ATRA plus anthracycline-based chemotherapy in patients with newly diagnosed acute promyelocytic leukemia (APL). PATIENTS AND METHODS Patients diagnosed with APL during the period of 2002 to 2014 were included. They received ATRA 25 mg/m(2) plus anthracycline (doxorubicin or mitoxantrone) as induction chemotherapy, followed by 3 consolidations with LD-ATRA and anthracycline and maintenance therapy with intermittent LD-ATRA and oral chemotherapy for 2 years. RESULTS Twenty-two patients with a median age of 28 years (range, 18-55 years) were included; 17 (77%) were in the low-risk group. Complete remission occurred in 86%, and the early death rate was 9%. At a median follow-up of 32 months (range, 4-126 months) disease-free survival (DFS) was 75% and overall survival (OS) was 86%, with a relapse rate of 27% for the entire follow-up period. CONCLUSION LD-ATRA plus anthracycline is safe and effective in achieving CR of APL. The early death rate is similar to that of treatment with standard doses, but it appears to be inferior in preventing relapses.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Hematology Department, Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Xitlaly Judith González-Leal
- Hematology Department, Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mónica Andrea Pinzón-Uresti
- Hematology Department, Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Gómez-De León
- Hematology Department, Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Olga G Cantú-Rodríguez
- Hematology Department, Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Homero Gutiérrez-Aguirre
- Hematology Department, Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Hematology Department, Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
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Salazar-Riojas R, García-Lozano JA, Valdés-Galván M, Martínez-González O, Cantú-Rodríguez OG, González-Llano O, Gómez-De León A, Jaime-Pérez JC, Gómez-Almaguer D, Gutiérrez-Aguirre CH. Effective collection of peripheral blood stem cells in children weighing 20 kilogram or less in a single large-volume apheresis procedure. J Clin Apher 2014; 30:281-7. [PMID: 25557252 DOI: 10.1002/jca.21375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/30/2014] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Peripheral blood stem cell (PBSC) transplantation has become a routine procedure in pediatric oncology. A special group of PBSC donors are children weighing 20 kg or less. Limited vascular access and low blood volume puts them at a higher risk. Central line placement and a priming apheresis machine are recommended to avoid these complications. PATIENTS AND METHODS PBSC collections performed from July 2006 to May 2013 in children weighing less than 20 kg were included. All donors had a central venous catheter (CVC). An apheresis machine was primed with packet red blood cells. RESULTS Twenty-seven PBSC collections were performed in 22 children weighing 20 kg or less, 14 for allogeneic and 8 for autologous transplantation, in order to collect at least 2 × 10(6) CD34+ cells/kg. In the allogeneic group, median age and weight were 3 years (0.8-7) and 15.5 kg (8-20). In the autologous group, median age and weight were 3 years (2-7) and 15.35 kg (12.5-19.5). A single large-volume apheresis was sufficient to obtain the CD34+ cells needed in 78.5% and 75% of the allogeneic and autologous groups, respectively, with a median 11.84 × 10(6) and 5.79 × 10(6) CD34+ cells collected per kilogram of weight of the recipient. No serious complications related to the apheresis procedure or CVC placement occurred. CONCLUSION PBSC collection in a single large-volume apheresis for allogeneic and autologous transplants in children weighing 20 kg or less is a safe and effective procedure when based on standardized protocols.
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Affiliation(s)
- Rosario Salazar-Riojas
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - José Alberto García-Lozano
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Mayra Valdés-Galván
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Odra Martínez-González
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Olga Graciela Cantú-Rodríguez
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Oscar González-Llano
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Andrés Gómez-De León
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - José Carlos Jaime-Pérez
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - David Gómez-Almaguer
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
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Mancías-Guerra C, Marroquín-Escamilla AR, González-Llano O, Villarreal-Martínez L, Jaime-Pérez JC, García-Rodríguez F, Valdés-Burnes SL, Rodríguez-Romo LN, Barrera-Morales DC, Sánchez-Hernández JJ, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, Gómez-De León A, Elizondo-Riojas G, Salazar-Riojas R, Gómez-Almaguer D. Safety and tolerability of intrathecal delivery of autologous bone marrow nucleated cells in children with cerebral palsy: an open-label phase I trial. Cytotherapy 2014; 16:810-20. [PMID: 24642016 DOI: 10.1016/j.jcyt.2014.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AIMS Cerebral palsy (CP) is related to severe perinatal hypoxia with permanent brain damage in nearly 50% of surviving preterm infants. Cell therapy is a potential therapeutic option for CP by several mechanisms, including immunomodulation through cytokine and growth factor secretion. METHODS In this phase I open-label clinical trial, 18 pediatric patients with CP were included to assess the safety of autologous bone marrow-derived total nucleated cell (TNC) intrathecal and intravenous injection after stimulation with granulocyte colony-stimulating factor. Motor, cognitive, communication, personal-social and adaptive areas were evaluated at baseline and 1 and 6 months after the procedure through the use of the Battelle Developmental Inventory. Magnetic resonance imaging was performed at baseline and 6 months after therapy. This study was registered in ClinicaTrials.gov (NCT01019733). RESULTS A median of 13.12 × 10(8) TNCs (range, 4.83-53.87) including 10.02 × 10(6) CD34+ cells (range, 1.02-29.9) in a volume of 7 mL (range, 4-10.5) was infused intrathecally. The remaining cells from the bone marrow aspirate were administered intravenously; 6.01 × 10(8) TNCs (range, 1.36-17.85), with 3.39 × 10(6) cells being CD34+. Early adverse effects included headache, vomiting, fever and stiff neck occurred in three patients. No serious complications were documented. An overall 4.7-month increase in developmental age according to the Battelle Developmental Inventory, including all areas of evaluation, was observed (±SD 2.63). No MRI changes at 6 months of follow-up were found. CONCLUSIONS Subarachnoid placement of autologous bone marrow-derived TNC in children with CP is a safe procedure. The results suggest a possible increase in neurological function.
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Affiliation(s)
- Consuelo Mancías-Guerra
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Alma Rosa Marroquín-Escamilla
- Neuropediatrics Department, Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Oscar González-Llano
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Laura Villarreal-Martínez
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - José Carlos Jaime-Pérez
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Fernando García-Rodríguez
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Sagrario Lisete Valdés-Burnes
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Laura Nely Rodríguez-Romo
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Dinorah Catalina Barrera-Morales
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Olga Graciela Cantú-Rodríguez
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - César Homero Gutiérrez-Aguirre
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Gómez-De León
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Guillermo Elizondo-Riojas
- Radiology and Imaging Department, Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rosario Salazar-Riojas
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Hematology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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