Fernando Solano

Tandem transplants with different high‐dose regimens improve the complete remission rates in multiple myeloma. Results of a Grupo Español de Síndromes Linfoproliferativos/Trasplante Autólogo de Médula Ósea phase II trial

Summary. Between 1994 and 1999, 88 multiple myeloma (MM) patients were included in a phase II study to evaluate a tandem autologous stem cell transplantation (ASCT) programme. The first was conditioned with melphalan 200 mg/m2 (MEL200‐ASCT1), and the second with cyclophosphamide, etoposide and BCNU (CBV‐ASCT2). All patients were in response after MEL200‐ASCT1. A control group of MM patients with response to a single ASCT was selected to compare outcomes. After MEL200‐ASCT1, 26 patients (30%) achieved complete remission (CR). Of the remaining 48 evaluable patients, 16 (33%) achieved CR with CBV‐ASCT2. The final CR rate was 48%. The 5‐year survival (OS) was 55%[95% confidence interval (CI) 43–67%] while the event‐free survival (EFS) was 28% (95% CI 15–39%). CR status after CBV‐ASCT2 was the most important prognostic factor for OS and EFS (P = 0·00001), although no differences in outcomes were detected when the patients in CR after MEL200‐ASCT1 were compared with those who obtained CR after CBV‐ASCT2. Univariate and multivariate analyses showed improved OS and EFS for the tandem series as compared with the control series treated with a single MEL200‐ASCT. However, in a stratified comparison by response, there were no prognostic differences between tandem patients and control patients treated with a single ASCT. In summary, our study suggests that the benefit of a second high‐dose therapy course depends on its capacity to result in CR for MM patients who have not attained CR after ASCT1.

Choice of the best equation for plasma osmolality calculation: Comparison of fourteen formulae

BACKGROUND Many different equations have been previously described to estimate plasma osmolality. The aim of this study is to compare 14 of these equations, in order to determine which results agree best with measured osmolality. OBJECTIVES Our aim is to elucidate which is the most accurate equation for osmolality calculation among the fourteen that were previously described. METHODS We measured osmolality by the freezing point depression method, and glucose, urea, sodium, potassium, calcium and magnesium concentrations with Unicell DXC 800 analyzer. Goodness-of-fit rates were calculated using the Passing-Bablok regression model and the t-paired sample test. In addition, we used survival curves in order to find the percentage of cases in which the difference between measured and calculated osmolality was under 10 mOsm/kg. Data were plotted using the Bland-Altman graphical approach. RESULTS The equation that provides the best fit between measured and calculated osmolality is 1.86(Na+K)+1.15(Glu/18)+(Urea/6)+14, followed by 2Na+1.15(Glu/18)+(Urea/6). CONCLUSIONS According to our results, the Dorwart-Chalmers equation should not be used for osmolality calculations. The equation 1.86(Na+K)+1.15(Glu/18)+(Urea/6)+14 is the most accurate. The widespread use of the equation 2(Na+K)+(Glu/18)+(Urea/6) is also acceptable.

Infiltración específica en el paladar por leucemia linfática crónica B

There are numerous ocular and neurological lesions in ECCL, which occur ipsilaterally to the skin lesions. Particularly common, however, are what are called epibulbar choristomas; histologically these choristomas, like the skin lesions, are epibulbar dermoids10 or fibrolipomas. The severity of associated neurological disorders is important for the prognosis. These disorders, which do not correlate with the extent of the skin lesions2 or with radiological anomalies,4 range from no abnormalities at all to convulsions and severe psychomotor dysfunction. In conclusion, nevus psiloliparus is both a marker for and the first visible sign of ECCL. Meticulous ophthalmologic and neurological examination is crucial for any infant presenting with this particular fatty tissue nevus. Imagining studies should also be performed to rule out associated disorders.

El síndrome del ATRA como complicación del tratamiento en la leucemia promielocítica aguda

Objective: To describe the retinoic acid syndrome, a complication of therapy with all-trans retinoic acid (ATRA) in acute promyelocitic leukemia (APL). Patients and methods: Retrospective study of five patients with a morphologic diagnosis of APL by the French-American-British (FAB) classification that were treated for remission induction with ATRA and developed the ATRA syndrome. Results: Three patients in newly diagnosed APL and two in leukemia relapse were analyzed. All patients received with ATRA 45 mgrs/m2/day, and three of them also received chemotherapy. Patients developed fever, respiratory distress, pulmonary infiltrates, weight gain and edemas. The onset of this symptom complex occurred from 1 to 11 days after starting treatment and was preceded by an increased in peripheral blood leukocytes. Infections or congestive heart failure were ruled out. The clinical course progressed while patients being treated with wide spectrum antibiotics. Four patients were treated with high doses corticosteroid therapy (dexame tasone 10 mgrs intravenously every 12 hours), in three of them full recovery was attained and one died. One patient that did not received steroids died. Conclusions: The use of all-trans retinoic acid to induce hematologic remission in APL patients is associated in same patients with the development of ATRA syndrome, a life threatening complication. Symptoms begin in the first days of treatment. If this syndrome is suspected, early treatment with high dose steroids should be iniciated.

Residual normal B-cell profiles in monoclonal B-cell lymphocytosis versus chronic lymphocytic leukemia

Minimal residual core binding factor AMLs by real time quantitative PCR—initial response to chemotherapy predicts event free survival and close monitoring of peripheral blood unravels the kinetics of relapse. Leuk Res. 2006;30:389–95. 8. Weisser M, Haferlach C, Hiddemann W, Schnittger S. The quality of molecular response to chemotherapy is predictive for the outcome of AML1-ETO-positive AML and is independent of pretreatment risk factors. Leukemia. 2007;21:1177–82. 9. Lane S, Saal R, Mollee P, Jones M, Grigg A, Taylor K, et al. A or =1 log rise in RQ-PCR transcript levels defines molecular relapse in core binding factor acute myeloid leukemia and predicts subsequent morphologic relapse. Leuk Lymphoma. 2008;49:517–23. 10. Narimatsu H, Iino M, Ichihashi T, Yokozawa T, Hayakawa M, Kiyoi H, et al. Clinical significance of minimal residual disease in patients with t(8;21) acute myeloid leukemia in Japan. Int J Hematol. 2008;88:154–8. 11. Yin JA, O’Brien MA, Hills RK, Daly SB, Wheatley K, Burnett AK. Minimal residual disease monitoring by quantitative RT-PCR in core binding factor AML allows risk stratification and predicts relapse: results of the United Kingdom MRC AML-15 trial. Blood. 2012;120:2826–35. 12. Zhu HH, Zhang XH, Qin YZ, Liu DH, Jiang H, Chen H, et al. MRD-directed risk stratification treatment may improve outcomes of t(8;21) AML in the first complete remission: results from the AML05 multicenter trial. Blood. 2013;121:4056–62. 13. Krauter J, Gorlich K, Ottmann O, Lubbert M, Dohner H, Heit W, et al. Prognostic value of minimal residual disease quantification by real-time reverse transcriptase polymerase chain reaction in patients with core binding factor leukemias. J Clin Oncol. 2003;21:4413–22. 14. Ragon BK, Daver N, Garcia-Manero G, Ravandi F, Cortes J, Kadia T, et al. Minimal residual disease eradication with epigenetic therapy in core binding factor acute myeloid leukemia. Am J Hematol. 2017;92:845–50. 15. Marcucci G, Mrozek K, Ruppert AS, Maharry K, Kolitz JE, Moore JO, et al. Prognostic factors and outcome of core binding factor acute myeloid leukemia patients with t(8;21) differ from those of patients with inv(16): a cancer and leukemia group B study. J Clin Oncol. 2005;23:5705–17.