Originales
Trasplante de células progenitoras hematopoyéticas como tratamiento de rescate en pacientes con linfomas no hodgkinianos agresivos
Hematopoietic stem cell transplantation as salvage treatment in patients with aggresive non-Hodgkin's lymphoma
Reyes Arranz
, César Sanz-Rodríguez, Francisco J. Pajuelo, Carmen Martínez Chamorro, José Ma Fernández Rañada.
Autor para correspondencia
rarranzs@aehh.org
Correspondencia: Servicio de Hematología. Hospital Universitario de la Princesa. Diego de León, 62. 28006 Madrid.
Correspondencia: Servicio de Hematología. Hospital Universitario de la Princesa. Diego de León, 62. 28006 Madrid.
Anatomía Patológica del Hospital Universitario de la Princesa. Leganés. Madrid
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"autores" => array:5 [ 0 => array:4 [ "nombre" => "Reyes" "apellidos" => "Arranz" "email" => array:1 [ 0 => "rarranzs@aehh.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "César" "apellidos" => "Sanz-Rodríguez" ] 2 => array:2 [ "nombre" => "Francisco J." "apellidos" => "Pajuelo" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Martínez Chamorro" ] 4 => array:2 [ "nombre" => "José M<span class="elsevierStyleSup">a</span>" "apellidos" => "Fernández Rañada." ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Anatomía Patológica del Hospital Universitario de la Princesa. Leganés. Madrid" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Servicio de Hematología. Hospital Universitario de la Princesa. Diego de León, 62. 28006 Madrid." ] ] ] 1 => array:3 [ "autoresLista" => "Agustín Acevedo, Guillermo Pérez" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Agustín" "apellidos" => "Acevedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff00005" ] ] ] 1 => array:3 [ "nombre" => "Guillermo" "apellidos" => "Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff00010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicios de Hematología Leganés. Madrid" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff00005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología del Hospital Severo Ochoa. Leganés. Madrid" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff00010" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Hematopoietic stem cell transplantation as salvage treatment in patients with aggresive non-Hodgkin's lymphoma" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1999-09-27" "fechaAceptado" => "1999-11-30" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec220512" "palabras" => array:4 [ 0 => "Linfoma no hodgkiniano" 1 => "Trasplante de células progenitoras hematopoyéticas" 2 => "Quimioterapia" 3 => "Quimioterapia MACOP/UACOP-B" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La realizacion precoz del trasplante de celulas progenitoras hematopoyeticas (TPH)en pacientes con linfomas no hodgkinianos (LNH) agresivos es una indicacion controvertida.</p> <span class="elsevierStyleSectionTitle">Metodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Analisis retrospectivo de 86 pacientes con LNH agresivos tratados con quimioterapiaMACOP/VACOP-B. El TPH se utilizo como tratamiento de rescate en pacientes con edad inferioro igual a 65 anos con progresion o recaida quimiosensible. Se determinaron las supervivenciaslibre de progresion (SLP) y global (SG) con el metodo de Kaplan-Meier. Se compararon losporcentajes de respuesta y las funciones de supervivencia entre los grupos del Indice PronosticoInternacional (IPI) mediante las pruebas χ<span class="elsevierStyleSup">2</span> y log-rank, respectivamente</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La mediana de edad de los pacientes fue de 48 anos. El 22% tenian LNH-T y el57% tenian IPI de intermedio-alto y alto riesgo. Hubo 6 muertes por toxicidad (7%), y 42(48,8%) pacientes fracasaron al tratamiento de primera linea. De ellos, 31 fueron candidatos aTPH por edad inferior o igual a 65 anos, aunque finalmente se trasplantaron 21 (incluyendo13 de mayor riesgo). Se observo una asociacion estadisticamente significativa entre la SLP y elIPI: 61,9% para los grupos bajo y bajo-intermedio (menor riesgo) frente al 28,2% para los demayor riesgo (p = 0,0007). Con una mediana de seguimiento de 4,8 anos, la SG fue del80,5% para los grupos de menor riesgo frente al 52,6% (p = 0,01) para los de mayor riesgo, ydel 83,7% frente al 62,0% (p = 0,02) para los mismos grupos en pacientes con edad inferior oigual a 65 anos. La mediana de seguimiento posfracaso del tratamiento quimioterapico fue de42,7 meses.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En este analisis retrospectivo la SG de los pacientes con LNH agresivos utilizandoel TPH como tratamiento de rescate es similar a la comunicada utilizando el TPH mas precozmente.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The indication of early hematopoietic stem cell transplantation (HSCT) in patientswith aggressive non-Hodgkin's lymphoma (LNH) is controversial.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of 86 patients with aggressive NHL treated withMACOP/VACOP-B chemotherapy. HSCT was performed as salvage treatment to patients under65 years of age with proggressive disease or chemosensitive relapse. Progression free survival(PFS) and overall survival (OS) were determined by the Kaplan-Meier method. Rates of responseand survival functions were compared between the International Prognostic Index (IPI)groups using the Chi-square and log-rank tests, respectively.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Patients median age was 48 years; 22% had T cell NHL and 57% had intermediatehighand high risk (high risk) IPI. There were 6 toxic deaths (7%), and treatment failure wasobserved in 42 patients (48.8%). Thirty one of them were candidates for TPH due to age under65 years, although 21 were finally transplanted (including 13 with high risk IPI). A significantassociation between PFS and IPI was observed, 61.9% for low risk (low and low-intermediate)versus 28.2% for high risk groups (p = 0.0007). With a median follow up of 4.8 years, OS was64%; 80.5% for low risk versus 52.6% for high risk IPI groups (p = 0.01), and 83.7% versus62% for the same groups in patients under 65 years of age (p = 0.02). The median follow upafter failure to chemotherapy was 42.7 months.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In this retrospective study, OS rate in high risk IPI patients with NHL using HSCTas salvage treatment is similar to that reported using HSCT during earlier phases of treatment.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias Bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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