Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently... more Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently FDA approved for treatment of low and intermediate MDS with complete responses around 50%. And Acute myeloid leukemia (AML) in the eldery In the CALGB studies, the usual dose is 75mg/m2 in 28 day cycles, with dose modifications according to toxicity. In low income countries such as Mexico, one course of Azacitidine is around 500 dollars, median income in Mexico is 4,910 PPP (purchasing power parity); vs 30,616 in the USA. So, azacitidine treatment is far from reach for most of the common population, particularly those who do not have insurance. This is a retrospective observational study, of a compassionate use program of a fixed dose of Aza at 100mg. We analyzed data from patients that were treated with Aza between 2012 and 2016, and collected data in 2016. The aim of the study was to assess the effectivity of the fixed dose. For that purpose, we collected information from the physical and electronic file. We analyzed: Hemoglobin level before and after treatment, independence of transfusion, ANC recovery, number of courses, and overall survival. We conducted our research in a public institution in Mexico (Instituto Nacional de Cancerología) and a private institution (Medica Sur). We included acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients, regardless of age, previous treatment and comorbidities (we included patients with renal failure, hypertension etc.) We included 8 patients in our study, 6 males and 2 females, with a mean age of 69.9 years (49-87). We had 2 AML and 6 MDS. We had 2 high risk AML and according to IPSS-R: 1 very low, 2 low, 1 intermediate, 1 high and 1 very high risk MDS. As for the Karyotype we had 1 complex KT, 4 normal KT and 1 Del 7q Del 5q +8. All patients received at least one dose of Aza, with mean number of cycles of 4. We have a mean survival of 439 days (110-1385). 6/8 patients achieved transfusion independency within 3 doses of Aza. 6/8 patients achieved ANC but lost eventually lost response. 5/8 patients are alive in follow up. 3 patients died of infectious complications. 2 patients never achieved transfusion independence or ANC. The information recovered suggests that a fixed dose of 100mg is as feasible as a higher dose, at least when no other treatment or higher dose can be administered. We still are analyzing the survival data in order to find other bad prognosis factor within this population. Disclosures No relevant conflicts of interest to declare.
Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that c... more Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that combines hydralazine / valproate(Transkrip) in cancer patients with cutaneous T-cell lymphoma Determine toxicity, duration of response and time to progression of epigenetic therapy with hydralazine / valproate in patients with T-cell lymphomas Material and methods an open-label, phase II, prospective and longitudinal in the National Cancer Institute of Mexico was carried out, recruiting patients diagnosed with Cutaneous T based on WHO classification 2008, newly diagnosed untreated, demographic data were analyzed and vital and somatometry signs, assessment of efficacy was established according to the therapeutic response in lymphomas measured at each visit at the affected sites for each patient, using the m-SWAT system sorted in complete response (CR), partial response (PR ), stable disease (SD) and progression (PE) and is considered response to patients with complete or partial response, these data were collected in the form of case report at baseline in the first consultation, during treatment and at the end the study at each visit to the doctor. Statistical analysis was performed with SPSS version 13.0 software. results 16 patients were selected with diagnosis of cutaneous T-cell lymphoma, one patients discontinued the study at baseline and 4 patients had disease progression during the first months of the study, a total of 10 patients who completed 18 months of study continuing the compassionate use treatment. The median age of patients was 45.8 years analyzed (18-83 years) of which 8 are women (53%) and 7 men (47%) with an ECOG 1 in 93.3% of patients, with an average weight of 72.5 ± 15.99 kg, height 1.6 ± 0.1 m, body mass index 28.3 ± 5.7 kg / m2, 46.7% of overweight patients, systolic blood pressure an average of 116.2 ± 14.3 mmHg and diastolic 75.1 ± 11.04 mmHg with respiratory rate 19.43 ± 1.74 resp / min and 77.8 ± 12.3 cardiac beats / min. Of the 10 patients who completed the study, 100% had complete or partial response itching to 6 month continuing unchanged at month 18, the dream as an adverse event occurred in 33% of patients, this being more frequent, adverse events attributed to the drug were known, expected and mild. From 6 months of treatment, the percentage of partial response and complete response of m-SWAT and pruritus were greater than 90% of patients. conclusions: Hydralazine/Valproate (Transkrip) is a medication that offers patients with cutaneous T-cell lymphoma, both first-line and refractory, a therapeutic alternative with high efficiency and good safety profile. Disclosures No relevant conflicts of interest to declare.
Infectious complications are a major cause of morbidity and mortality in hematologic patients wit... more Infectious complications are a major cause of morbidity and mortality in hematologic patients with acute leukemia. In this paper we address the mayor infectious complications, at the Leukemia Clinic (LC) in the Instituto Nacional de Cancerologia (INCan) Material and Methods. This is a retrospective, observational study, carried on at INCan. We included all patients that attended the LC and died of an infectious complication between January 2012 and December 2014, regardless of status (new case/relapsed) at diagnosis, we included patients with Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Acute Biphenotypic Leukemia (ABL) and Acute Promyelocytic Leukemia (APML). The main objective of the study was to determine the most frequent causes of infectious complications in the treatment of acute leukemias. Results. We included 240 patients that were admitted to the LC between the study dates. 12 patients were excluded since they were later diagnosed with another hematologic malignancy rather than leukemia. 228 patients were analyzed. 132 males, 96 females, 36 years was the median age (14-85 years). 126 patients were new cases and 102 patients were treated for relapse. AML 69 patients, ALL 140 patients, ABL 9 patients, and APML 10 patients. We revised the data of all the deaths that occurred in the period of time. 100 cases were included in the study, of those, 30 that were not infectious related and were excluded. Of the 40 patients included, 41 were males and 29 females, with a mean age of 36.8 years (16-72). 44 ALL patients, 18 AML patients, 7 ABL patients and 1 APML patient. 32 patients were new cases and 38 were relapses. The media number of relapses was 1 (1-3). Septic Shock was stated as the cause of death on all electronic files, with Pneumonia as the most common cause of infection origin with 47 patients. As for determining the causal agent of the infection, we used the last positive culture 5 days prior to the death, we found a causal agent in only 47 patients; the most frequent agents involved were: Escherichia coli BLEE with 13 patients, Enterococus faecium with 6 patients, we also report 1 H1N1 and 1 H3N2 influenza infections. 14 patients did not received intensive chemotherapy prior to death, 11 were on supportive care, and 3 of them did not consent treatment. HyperCVAD was the most frequent regimen administered prior to death, with 13 patients, 7+3 followed with 11 patients. POMP in the setting of palliative regimen was also prevalent with 12 patients. 52% of the patients were in nadir of chemotherapy, with a mean of days of 19 (3-64). All patients that received intensive chemotherapy received GSFC and meropenem/vancomycin regimen once septic shock was diagnosed according to the data in the electronic file. All patients received treatment in the beginning, of the 70 patients only 19 were treated in the intensive care unit (ICU). Conclusions. We addressed the most frequent causes of infectious complications at the Acute Leukemia Clinic, as we thought, E. coli BLEE was the most frequent agent involved, perhaps diverting from reports in the literature, we have a low prevalence of gram positive cocci. Pneumonia is the most frequent site of infection, all our patients are admitted to for chemotherapy, hence all the pneumonia cases are hospital acquired. POMP is a prevalent regimen reported, since we use this regimen for palliative care we could relate mortality to relapse/refractory disease more than to toxicity itself. No maintenance regimens were reported in the results. Our study has certain limitations, no mycotic infections could be reported as the electronic file lacks reliable information. Disclosures No relevant conflicts of interest to declare.
Abstract 1701 Mutations within the BCR-ABL domain are the most frequent mechanism of imatinib (IM... more Abstract 1701 Mutations within the BCR-ABL domain are the most frequent mechanism of imatinib (IM) resistance. The second generation inhibitors (SGI) are indicated for imatinib intolerance or resistance and the initials trials showed similar response rates in IM resistant patients after IM failure, independent of mutation status, with exception of T315I. The aim of this work was to report the frequency of BCR-ABL mutations in chronic myeloid leukemia (CML) patients of a Latin American population and to evaluate the clinical impact of the presence and type of mutations in overall survival (OS), progression free survival (PFS) and in the response to second generation inhibitors (SGI). Methods: retrospective analysis of 17 centers from Latin America. A total of 529 CML patients with mutation analysis performed in samples collected between 2002 and 2011 were included. Mutations were detected by direct sequencing from bone marrow or peripheral blood samples, collected from CML patients. After imatinib resistance, patients were treated with SGI (69%) or other treatments. Overall survival (OS) was calculated from date of mutation detection until last follow-up or death, and progression-free survival (PFS) from date of mutation detection until progression to accelerated phase or blast crisis, last follow-up or death. Survival curves were calculated using the log-rang test (SPSS 14.0 software).Results: the median age of patients at diagnosis was 45 years (5–87). 81% were in chronic phase (CP), 13% in accelerated phase (AP), 6% in blast crisis (BC). According to Sokal score, patients were stratified in low (36%), intermediate (30%) and high risk (34%); 36% had previously used Interferon. The median time from diagnosis until Imatinib treatment was 8 months (0–310) and from Imatinib start until mutation detection was 31 months (1–104). Mutations were found in 188 patients, in the following sites: P-loop (75/40%), nucleotide contact site (34/18%), catalytic domain (44/23%), A-loop (11/6%) and others (24/13%). The most frequent mutations detected were: T315I (30/16%), F359V/C/I (27/14%), M244V (18/9.6%), E255K/V (17/9%), G250E (17/9%), Y253H/F/Y (15/8%), M351T/L (12/6%); Ten patients presented concomitant mutations. On dasatinib treatment 29 mutations (27% T315I) were detected whereas 18 during nilotinib (16.5% T315I). Overall survival in the total group was 61% (95%CI: 51–71%) with a median time of 12 months. There was a significant difference in OS and PFS between non-mutated and mutated patients (76% vs 44% and 64% vs 44% respectively (P= 0.008 and P= 0.001). There was no difference in survival comparing P-loop mutations and others, excluding T315I. Patients with T315I mutations had a poorer outcome in comparison with other mutations (OS 21% vs 62%; PFS 35% vs 55%) (P= 0.04 and 0.06, respectively). In the group with BCR-AL mutations, OS was superior in patients that received a SGI in comparison with other treatments after resistance (50% vs 36% P= 0.007). One hundred patients (19%) died due to: disease progression (72), infections (8), graft versus host disease (2), central nervous system bleeding (2), cardiac failure (1), second neoplasia (1). 14 causes were not reported. Conclusions: Patients with BCR-ABL mutations had an inferior OS and PFS. T315I mutations were associated to a poor outcome. Treatment with SGI prolonged survival of patients after imatinib failure. Disclosures: Pagnano: Novartis: Speakers Bureau; Bristol Myers Squibb: Speakers Bureau. Boquimpani:Novartis: Speakers Bureau; Bristol Myers Squibb: Speakers Bureau. Pasquini:Novartis: Membership on an…
This is the largest Latin American study of BCR-ABL mutations in chronic myeloid leukemia (CML) p... more This is the largest Latin American study of BCR-ABL mutations in chronic myeloid leukemia (CML) patients, resistant to imatinib (IM). In 195/467 (41%) patients, mutations were detected. The most frequent mutation was T315I (n = 31, 16%). Progression-free (PFS) and overall survival (OS) at 5 years were lower in patients with BCR-ABL mutations (43% vs. 65%, p = 0.07 and 47% vs. 72%, p = 0.03, respectively) and in those with the T315I mutation (p = 0.003 and p = 0.03). OS and PFS were superior in subgroup who switched to second generation inhibitors (SGIs) after IM failure (OS: 50% vs. 39% p = 0.01; PFS: 48% vs. 30% p = 0.02). BCR-ABL mutations conferred a significant poor prognosis in CML patients.
Abstract 1689 The increase dose of Imatinib, the shift to a Tyrosine Kinase (TKI) inhibitor of se... more Abstract 1689 The increase dose of Imatinib, the shift to a Tyrosine Kinase (TKI) inhibitor of second generation or hematopoietic stem cell transplantation are treatment options when there is loss or lack of response to IM in CML; However, in patients without access to these therapeutic alternatives, the use of alkylating drugs or investigational agents is indicated. NF Kappa B pathway is constitutively activated in CML patients therefore the combination of IM with a NF Kappa B inhibitor (as thalidomide) contributes a new very interesting field of research. We treated 21 patients (11 female) with CML Ph +− resistant (n=13) or intolerant (n=8) to IM, mean +− SD age was 44 + 11 years. At diagnosis 16 (79%) were classified as high risk, according with Eutos scale. Mean +− SD time of IM treatment before adding thalidomide (100mg daily) was 47.8 +− 31 months. At the time of this preliminary analysis, mean follow up since thalidomide addition was 5 (1–18 months) and only 13 patients are evaluable for response (Global response rate was 76%): Six had hematological response & Four achieved complete cytogenetic response (CCgR). The first case was a 53 year old female, who started treatment with IM in accelerated phase, was intolerant to IM and neither achieve CCgR with IM, but reached it after 6 months of adding thalidomide and remains with this treatment after 18 months. The second case was a 38 year old female, who achieved CCgR after 6 months within IM treatment, lasted 53 months, and finally thalidomide was added after losing CCgR; she achieved a 2nd CCgR after 7 months with this combination, and continues with thalidomide at 11 months. The third one is a 44 year old female, who only achieved partial CCgR (pCGR), and after indicating thalidomide on accelerated phase, she had CCgR after 4 months of this drug and remains at 6 months of treatment. Finally, the fourth case is a 26 year old female that received thalidomide because of a suboptimal response to IM; she achieved CCgR after 2 months within thalidomide. Eight patients are not evaluable for response yet, but are ongoing and all will be detailed at ASH meeting. Toxicity has been acceptable, mainly grade 1 neurotoxicity…
Trabajo presentado en el XLVI Congreso Anual de Hematología. Querétaro, Qro., 4 al 8 de mayo de... more Trabajo presentado en el XLVI Congreso Anual de Hematología. Querétaro, Qro., 4 al 8 de mayo de 2005. * Médico residente del 4° año de la especialidad de medicina interna. ** Médico residente del 3° año de la especialidad de Hematología. Instituto Nacional de ...
Revista de investigación clínica; organo del Hospital de Enfermedades de la Nutrición, 1990
To investigate the therapeutic efficacy of sodium benzoate (SB) in a cirrotic population with chr... more To investigate the therapeutic efficacy of sodium benzoate (SB) in a cirrotic population with chronic portal systemic encepalopathy (PSE), we performed a double blind, randomised, multicentric, clinical trial, comparing SB versus a standard therapy of lactitol (LA). To perform the study blind, syrups containing the two drugs were prepared. To date 27 patients have been studied. Of these, 12 received SB (5.6 g/day) and 15 received LA (29 g/day). Standard PSE parameters were assessed and hippurate urinary excretion was measured before and after the trial. For the SB group, basal and final PSE index were 0.39 +/- 0.16 and 0.17 +/- 0.1 respectively (p < 0.001). The Group on LA had a PSE index of 0.40 + 0.1 and 0.23 +/- 0.18 (basal and final respectively) (p < 0.001). The final hippurate excretion for SB group was 2498.9 mg/24 h. The hippurate excretion for the LA group suffer no changes (traces). No serious side effects were observed with either therapy. We suggested that SB is a ...
Chronic myeloid leukemia (CML) is a hematologic disorder characterized by the oncogene BCR-ABL1, ... more Chronic myeloid leukemia (CML) is a hematologic disorder characterized by the oncogene BCR-ABL1, which encodes an oncoprotein with tyrosine kinase activity. Imatinib, a BCR-ABL1 tyrosine kinase inhibitor, performs exceptionally well with minimal toxicity in CML chemotherapy. According to clinical trials, however, 20–30% of CML patients develop resistance to imatinib. Although the best studied resistance mechanisms are BCR-ABL1-dependent, P-glycoprotein (P-gp, a drug efflux transporter) may also contribute significantly. This study aimed to establish an imatinib-resistant human CML cell line, evaluate the role of P-gp in drug resistance, and assess the capacity of ketoconazole to reverse resistance by inhibiting P-gp. The following parameters were determined in both cell lines: cell viability (as the IC50) after exposure to imatinib and imatinib + ketoconazole, P-gp expression (by Western blot and immunofluorescence), the intracellular accumulation of a P-gp substrate (doxorubicin) b...
This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License
Background The present retrospective study reviewed acute promyelocytic leukemia (APL) cases reco... more Background The present retrospective study reviewed acute promyelocytic leukemia (APL) cases recorded in Mexico between January 2007 and January 2017. The primary objective of the study was to evaluate overall survival (OS) in Mexican patients with APL. Secondary objective was to evaluate the impact of induction treatment with different anthracyclines on OS, event-free survival (EFS) and complications in this patient population. Methods The medical charts of patients referred to medical institutions in Mexico from January 2007 through January 2017 for the treatment of suspected APL were reviewed retrospectively. Patients aged 15 - 75 years, in whom the diagnosis of APL was confirmed, who had an Eastern Cooperative Group performance status of 0 - 2, and who were eligible for combined treatment with intensive chemotherapy and all-trans retinoic acid (ATRA), were included in the study. Study participants received induction and consolidation treatment with ATRA plus either daunorubicin ...
7047 Background: Higher doses than 600 mg/day of I is the most recommended initial treatment of a... more 7047 Background: Higher doses than 600 mg/day of I is the most recommended initial treatment of advanced CML disease. Nevertheless clinical and molecular results are lower than on early chronic phase, challenging for new treatment developments in face to better results. Main objective of present trial was to increase the hematological (HR) and major cytogenetical responses (MCR) with the addition of Ara- C or Vp16 to I at doses higher than 600 mg/day as a frontline therapy of AP CML. Methods: on march, 2004 we began this multicentric, phase III randomized, clinical trial, comparing I (600 mg/day) plus Vp16 (50 mg PO/day for 7 days/ 21 days cycles) vs I (600 mg/day) plus subcutaneous Ara-C (10 mg/m2/day, for 7 days/21 days cycles), doses could be adjusted due to tolerance and toxicity and in case of failure to respond at 3 months, I doses could be escalated to 800 mg/day. Inclusion criteria: newly diagnosed AP (hematological or clonal evolution permitted) CML, not elective to allogen...
7048 Background: Imatinib is now worldwide accepted as the standard frontline therapy of CP CML. ... more 7048 Background: Imatinib is now worldwide accepted as the standard frontline therapy of CP CML. Regardless of their impressive clinical results and low toxicity profile, a small proportion of CP CML patients could develop primary or secondary resistance. Main objective of present trial was to increase the hematological (HR) and major cytogenetical responses (MCR) with the addition of Ara-C to standard doses of I as a frontline therapy of CP CML. Methods: on September, 2003 we began this multicentric, phase III randomized, clinical trial, comparing I (400 mg/day) vs I (400 mg/day) plus subcutaneous Ara-C (10 mg/m2/day, for 10 days/monthly cycles), doses could be adjusted due to tolerance and toxicity. Inclusion criteria: newly diagnosed CP CML, not elective to allogeneic transplant. Primary endpoint was the acquisition and time to acquisition of HR, MCR by conventional criteria. Secondary endpoints were main toxicities, dead to progression and overall survival. Results: 61 patients ...
Infectious complications are a major cause of morbidity and mortality in hematologic patients wit... more Infectious complications are a major cause of morbidity and mortality in hematologic patients with acute leukemia. In this paper we address the mayor infectious complications, at the Leukemia Clinic (LC) in the Instituto Nacional de Cancerologia (INCan) Material and Methods. This is a retrospective, observational study, carried on at INCan. We included all patients that attended the LC and died of an infectious complication between January 2012 and December 2014, regardless of status (new case/relapsed) at diagnosis, we included patients with Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Acute Biphenotypic Leukemia (ABL) and Acute Promyelocytic Leukemia (APML). The main objective of the study was to determine the most frequent causes of infectious complications in the treatment of acute leukemias. Results. We included 240 patients that were admitted to the LC between the study dates. 12 patients were excluded since they were later diagnosed with another hematolog...
Introduction: Acute Myeloid Leukemia is a clonal heterogeneous disease, where age is an important... more Introduction: Acute Myeloid Leukemia is a clonal heterogeneous disease, where age is an important risk factor to develop theses disease, PCR studies and next generation sequence have proven the diversity of these disease. A lot of genes mutations have been identifying to play a role in the DNA metilation, epigenetics a transcription. We initiate a screening to all acute myeloid leukemias that where the novo or relapse with a 28 gene panel of HEMAVISION a 28q; DNA diagnostic, for the detection al ARN gene fusion and alternatives of the: PML-RAR ALFA (bcr2,V), CBF-MYH11, RUNX1-RUNX1T1, PML-RAR alfa(bcr1,L), KMT2A-MLT3, PML-RAR alfa (bcr3,S), KMT2A-ELL, FUS-ERG, ETV6-MN1, DEK-NUP214, KMT2A-EPS15, KMT2A-AFDN, TCF3-PBX1, ETV6-RUNX1, KMT2A-MLLT1, KMT2A-AFF1, TCF3-HLF, STIL-TAL1, BCR/ABL(p190), SET-NUP214, BCR/ABL(p210), BCR/ABL(p230), ZBTB16-RARalfa, ETV6-ABL1, ETV6-PDGFRB, KMT2A-MLLT10, KMT2A-MLLT11,KMT2A-FOXO4, KMT2A-MLLT6, RUNX1-MECON, NPM1-RAR alfa, NMP1-MLF1, RUNX1-MECON. FLT3 ITD mu...
4291 CML accounts for approximately 15 percent of the cases of leukemia in adults. It has an annu... more 4291 CML accounts for approximately 15 percent of the cases of leukemia in adults. It has an annual incidence of 1 to 2 cases per 100000, with a slight male predominance. The median age at presentation is about 60 years and the incidence increases as a function of age, as reported in North American, Australian and European series. However, in our country we found a younger age at diagnosis. Herein we report our analysis of the age distribution of the patients included in the Mexican Cooperative Leukemia Group. We analyzed 356 patients with diagnosis of CML Ph+, from January 2001 to December 2008. The data analysis showed a median age at diagnosis of 37 years (range 16 to 64 years), with a male: female ratio of 1.1:1. There is a clear difference of age between Mexican patients with CML and those reported in the referred series (37 vs. 60 years) highlighting a geographical and/or ethnical pattern that may play a role as prognostic factor and response to treatment. Moreover, challenge ...
Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently... more Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently FDA approved for treatment of low and intermediate MDS with complete responses around 50%. And Acute myeloid leukemia (AML) in the eldery In the CALGB studies, the usual dose is 75mg/m2 in 28 day cycles, with dose modifications according to toxicity. In low income countries such as Mexico, one course of Azacitidine is around 500 dollars, median income in Mexico is 4,910 PPP (purchasing power parity); vs 30,616 in the USA. So, azacitidine treatment is far from reach for most of the common population, particularly those who do not have insurance. This is a retrospective observational study, of a compassionate use program of a fixed dose of Aza at 100mg. We analyzed data from patients that were treated with Aza between 2012 and 2016, and collected data in 2016. The aim of the study was to assess the effectivity of the fixed dose. For that purpose, we collected information from the physical...
Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that c... more Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that combines hydralazine / valproate(Transkrip) in cancer patients with cutaneous T-cell lymphoma Determine toxicity, duration of response and time to progression of epigenetic therapy with hydralazine / valproate in patients with T-cell lymphomas Material and methods an open-label, phase II, prospective and longitudinal in the National Cancer Institute of Mexico was carried out, recruiting patients diagnosed with Cutaneous T based on WHO classification 2008, newly diagnosed untreated, demographic data were analyzed and vital and somatometry signs, assessment of efficacy was established according to the therapeutic response in lymphomas measured at each visit at the affected sites for each patient, using the m-SWAT system sorted in complete response (CR), partial response (PR ), stable disease (SD) and progression (PE) and is considered response to patients with complete or partial response, ...
Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently... more Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently FDA approved for treatment of low and intermediate MDS with complete responses around 50%. And Acute myeloid leukemia (AML) in the eldery In the CALGB studies, the usual dose is 75mg/m2 in 28 day cycles, with dose modifications according to toxicity. In low income countries such as Mexico, one course of Azacitidine is around 500 dollars, median income in Mexico is 4,910 PPP (purchasing power parity); vs 30,616 in the USA. So, azacitidine treatment is far from reach for most of the common population, particularly those who do not have insurance. This is a retrospective observational study, of a compassionate use program of a fixed dose of Aza at 100mg. We analyzed data from patients that were treated with Aza between 2012 and 2016, and collected data in 2016. The aim of the study was to assess the effectivity of the fixed dose. For that purpose, we collected information from the physical and electronic file. We analyzed: Hemoglobin level before and after treatment, independence of transfusion, ANC recovery, number of courses, and overall survival. We conducted our research in a public institution in Mexico (Instituto Nacional de Cancerología) and a private institution (Medica Sur). We included acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients, regardless of age, previous treatment and comorbidities (we included patients with renal failure, hypertension etc.) We included 8 patients in our study, 6 males and 2 females, with a mean age of 69.9 years (49-87). We had 2 AML and 6 MDS. We had 2 high risk AML and according to IPSS-R: 1 very low, 2 low, 1 intermediate, 1 high and 1 very high risk MDS. As for the Karyotype we had 1 complex KT, 4 normal KT and 1 Del 7q Del 5q +8. All patients received at least one dose of Aza, with mean number of cycles of 4. We have a mean survival of 439 days (110-1385). 6/8 patients achieved transfusion independency within 3 doses of Aza. 6/8 patients achieved ANC but lost eventually lost response. 5/8 patients are alive in follow up. 3 patients died of infectious complications. 2 patients never achieved transfusion independence or ANC. The information recovered suggests that a fixed dose of 100mg is as feasible as a higher dose, at least when no other treatment or higher dose can be administered. We still are analyzing the survival data in order to find other bad prognosis factor within this population. Disclosures No relevant conflicts of interest to declare.
Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that c... more Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that combines hydralazine / valproate(Transkrip) in cancer patients with cutaneous T-cell lymphoma Determine toxicity, duration of response and time to progression of epigenetic therapy with hydralazine / valproate in patients with T-cell lymphomas Material and methods an open-label, phase II, prospective and longitudinal in the National Cancer Institute of Mexico was carried out, recruiting patients diagnosed with Cutaneous T based on WHO classification 2008, newly diagnosed untreated, demographic data were analyzed and vital and somatometry signs, assessment of efficacy was established according to the therapeutic response in lymphomas measured at each visit at the affected sites for each patient, using the m-SWAT system sorted in complete response (CR), partial response (PR ), stable disease (SD) and progression (PE) and is considered response to patients with complete or partial response, these data were collected in the form of case report at baseline in the first consultation, during treatment and at the end the study at each visit to the doctor. Statistical analysis was performed with SPSS version 13.0 software. results 16 patients were selected with diagnosis of cutaneous T-cell lymphoma, one patients discontinued the study at baseline and 4 patients had disease progression during the first months of the study, a total of 10 patients who completed 18 months of study continuing the compassionate use treatment. The median age of patients was 45.8 years analyzed (18-83 years) of which 8 are women (53%) and 7 men (47%) with an ECOG 1 in 93.3% of patients, with an average weight of 72.5 ± 15.99 kg, height 1.6 ± 0.1 m, body mass index 28.3 ± 5.7 kg / m2, 46.7% of overweight patients, systolic blood pressure an average of 116.2 ± 14.3 mmHg and diastolic 75.1 ± 11.04 mmHg with respiratory rate 19.43 ± 1.74 resp / min and 77.8 ± 12.3 cardiac beats / min. Of the 10 patients who completed the study, 100% had complete or partial response itching to 6 month continuing unchanged at month 18, the dream as an adverse event occurred in 33% of patients, this being more frequent, adverse events attributed to the drug were known, expected and mild. From 6 months of treatment, the percentage of partial response and complete response of m-SWAT and pruritus were greater than 90% of patients. conclusions: Hydralazine/Valproate (Transkrip) is a medication that offers patients with cutaneous T-cell lymphoma, both first-line and refractory, a therapeutic alternative with high efficiency and good safety profile. Disclosures No relevant conflicts of interest to declare.
Infectious complications are a major cause of morbidity and mortality in hematologic patients wit... more Infectious complications are a major cause of morbidity and mortality in hematologic patients with acute leukemia. In this paper we address the mayor infectious complications, at the Leukemia Clinic (LC) in the Instituto Nacional de Cancerologia (INCan) Material and Methods. This is a retrospective, observational study, carried on at INCan. We included all patients that attended the LC and died of an infectious complication between January 2012 and December 2014, regardless of status (new case/relapsed) at diagnosis, we included patients with Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Acute Biphenotypic Leukemia (ABL) and Acute Promyelocytic Leukemia (APML). The main objective of the study was to determine the most frequent causes of infectious complications in the treatment of acute leukemias. Results. We included 240 patients that were admitted to the LC between the study dates. 12 patients were excluded since they were later diagnosed with another hematologic malignancy rather than leukemia. 228 patients were analyzed. 132 males, 96 females, 36 years was the median age (14-85 years). 126 patients were new cases and 102 patients were treated for relapse. AML 69 patients, ALL 140 patients, ABL 9 patients, and APML 10 patients. We revised the data of all the deaths that occurred in the period of time. 100 cases were included in the study, of those, 30 that were not infectious related and were excluded. Of the 40 patients included, 41 were males and 29 females, with a mean age of 36.8 years (16-72). 44 ALL patients, 18 AML patients, 7 ABL patients and 1 APML patient. 32 patients were new cases and 38 were relapses. The media number of relapses was 1 (1-3). Septic Shock was stated as the cause of death on all electronic files, with Pneumonia as the most common cause of infection origin with 47 patients. As for determining the causal agent of the infection, we used the last positive culture 5 days prior to the death, we found a causal agent in only 47 patients; the most frequent agents involved were: Escherichia coli BLEE with 13 patients, Enterococus faecium with 6 patients, we also report 1 H1N1 and 1 H3N2 influenza infections. 14 patients did not received intensive chemotherapy prior to death, 11 were on supportive care, and 3 of them did not consent treatment. HyperCVAD was the most frequent regimen administered prior to death, with 13 patients, 7+3 followed with 11 patients. POMP in the setting of palliative regimen was also prevalent with 12 patients. 52% of the patients were in nadir of chemotherapy, with a mean of days of 19 (3-64). All patients that received intensive chemotherapy received GSFC and meropenem/vancomycin regimen once septic shock was diagnosed according to the data in the electronic file. All patients received treatment in the beginning, of the 70 patients only 19 were treated in the intensive care unit (ICU). Conclusions. We addressed the most frequent causes of infectious complications at the Acute Leukemia Clinic, as we thought, E. coli BLEE was the most frequent agent involved, perhaps diverting from reports in the literature, we have a low prevalence of gram positive cocci. Pneumonia is the most frequent site of infection, all our patients are admitted to for chemotherapy, hence all the pneumonia cases are hospital acquired. POMP is a prevalent regimen reported, since we use this regimen for palliative care we could relate mortality to relapse/refractory disease more than to toxicity itself. No maintenance regimens were reported in the results. Our study has certain limitations, no mycotic infections could be reported as the electronic file lacks reliable information. Disclosures No relevant conflicts of interest to declare.
Abstract 1701 Mutations within the BCR-ABL domain are the most frequent mechanism of imatinib (IM... more Abstract 1701 Mutations within the BCR-ABL domain are the most frequent mechanism of imatinib (IM) resistance. The second generation inhibitors (SGI) are indicated for imatinib intolerance or resistance and the initials trials showed similar response rates in IM resistant patients after IM failure, independent of mutation status, with exception of T315I. The aim of this work was to report the frequency of BCR-ABL mutations in chronic myeloid leukemia (CML) patients of a Latin American population and to evaluate the clinical impact of the presence and type of mutations in overall survival (OS), progression free survival (PFS) and in the response to second generation inhibitors (SGI). Methods: retrospective analysis of 17 centers from Latin America. A total of 529 CML patients with mutation analysis performed in samples collected between 2002 and 2011 were included. Mutations were detected by direct sequencing from bone marrow or peripheral blood samples, collected from CML patients. After imatinib resistance, patients were treated with SGI (69%) or other treatments. Overall survival (OS) was calculated from date of mutation detection until last follow-up or death, and progression-free survival (PFS) from date of mutation detection until progression to accelerated phase or blast crisis, last follow-up or death. Survival curves were calculated using the log-rang test (SPSS 14.0 software).Results: the median age of patients at diagnosis was 45 years (5–87). 81% were in chronic phase (CP), 13% in accelerated phase (AP), 6% in blast crisis (BC). According to Sokal score, patients were stratified in low (36%), intermediate (30%) and high risk (34%); 36% had previously used Interferon. The median time from diagnosis until Imatinib treatment was 8 months (0–310) and from Imatinib start until mutation detection was 31 months (1–104). Mutations were found in 188 patients, in the following sites: P-loop (75/40%), nucleotide contact site (34/18%), catalytic domain (44/23%), A-loop (11/6%) and others (24/13%). The most frequent mutations detected were: T315I (30/16%), F359V/C/I (27/14%), M244V (18/9.6%), E255K/V (17/9%), G250E (17/9%), Y253H/F/Y (15/8%), M351T/L (12/6%); Ten patients presented concomitant mutations. On dasatinib treatment 29 mutations (27% T315I) were detected whereas 18 during nilotinib (16.5% T315I). Overall survival in the total group was 61% (95%CI: 51–71%) with a median time of 12 months. There was a significant difference in OS and PFS between non-mutated and mutated patients (76% vs 44% and 64% vs 44% respectively (P= 0.008 and P= 0.001). There was no difference in survival comparing P-loop mutations and others, excluding T315I. Patients with T315I mutations had a poorer outcome in comparison with other mutations (OS 21% vs 62%; PFS 35% vs 55%) (P= 0.04 and 0.06, respectively). In the group with BCR-AL mutations, OS was superior in patients that received a SGI in comparison with other treatments after resistance (50% vs 36% P= 0.007). One hundred patients (19%) died due to: disease progression (72), infections (8), graft versus host disease (2), central nervous system bleeding (2), cardiac failure (1), second neoplasia (1). 14 causes were not reported. Conclusions: Patients with BCR-ABL mutations had an inferior OS and PFS. T315I mutations were associated to a poor outcome. Treatment with SGI prolonged survival of patients after imatinib failure. Disclosures: Pagnano: Novartis: Speakers Bureau; Bristol Myers Squibb: Speakers Bureau. Boquimpani:Novartis: Speakers Bureau; Bristol Myers Squibb: Speakers Bureau. Pasquini:Novartis: Membership on an…
This is the largest Latin American study of BCR-ABL mutations in chronic myeloid leukemia (CML) p... more This is the largest Latin American study of BCR-ABL mutations in chronic myeloid leukemia (CML) patients, resistant to imatinib (IM). In 195/467 (41%) patients, mutations were detected. The most frequent mutation was T315I (n = 31, 16%). Progression-free (PFS) and overall survival (OS) at 5 years were lower in patients with BCR-ABL mutations (43% vs. 65%, p = 0.07 and 47% vs. 72%, p = 0.03, respectively) and in those with the T315I mutation (p = 0.003 and p = 0.03). OS and PFS were superior in subgroup who switched to second generation inhibitors (SGIs) after IM failure (OS: 50% vs. 39% p = 0.01; PFS: 48% vs. 30% p = 0.02). BCR-ABL mutations conferred a significant poor prognosis in CML patients.
Abstract 1689 The increase dose of Imatinib, the shift to a Tyrosine Kinase (TKI) inhibitor of se... more Abstract 1689 The increase dose of Imatinib, the shift to a Tyrosine Kinase (TKI) inhibitor of second generation or hematopoietic stem cell transplantation are treatment options when there is loss or lack of response to IM in CML; However, in patients without access to these therapeutic alternatives, the use of alkylating drugs or investigational agents is indicated. NF Kappa B pathway is constitutively activated in CML patients therefore the combination of IM with a NF Kappa B inhibitor (as thalidomide) contributes a new very interesting field of research. We treated 21 patients (11 female) with CML Ph +− resistant (n=13) or intolerant (n=8) to IM, mean +− SD age was 44 + 11 years. At diagnosis 16 (79%) were classified as high risk, according with Eutos scale. Mean +− SD time of IM treatment before adding thalidomide (100mg daily) was 47.8 +− 31 months. At the time of this preliminary analysis, mean follow up since thalidomide addition was 5 (1–18 months) and only 13 patients are evaluable for response (Global response rate was 76%): Six had hematological response &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Four achieved complete cytogenetic response (CCgR). The first case was a 53 year old female, who started treatment with IM in accelerated phase, was intolerant to IM and neither achieve CCgR with IM, but reached it after 6 months of adding thalidomide and remains with this treatment after 18 months. The second case was a 38 year old female, who achieved CCgR after 6 months within IM treatment, lasted 53 months, and finally thalidomide was added after losing CCgR; she achieved a 2nd CCgR after 7 months with this combination, and continues with thalidomide at 11 months. The third one is a 44 year old female, who only achieved partial CCgR (pCGR), and after indicating thalidomide on accelerated phase, she had CCgR after 4 months of this drug and remains at 6 months of treatment. Finally, the fourth case is a 26 year old female that received thalidomide because of a suboptimal response to IM; she achieved CCgR after 2 months within thalidomide. Eight patients are not evaluable for response yet, but are ongoing and all will be detailed at ASH meeting. Toxicity has been acceptable, mainly grade 1 neurotoxicity…
Trabajo presentado en el XLVI Congreso Anual de Hematología. Querétaro, Qro., 4 al 8 de mayo de... more Trabajo presentado en el XLVI Congreso Anual de Hematología. Querétaro, Qro., 4 al 8 de mayo de 2005. * Médico residente del 4° año de la especialidad de medicina interna. ** Médico residente del 3° año de la especialidad de Hematología. Instituto Nacional de ...
Revista de investigación clínica; organo del Hospital de Enfermedades de la Nutrición, 1990
To investigate the therapeutic efficacy of sodium benzoate (SB) in a cirrotic population with chr... more To investigate the therapeutic efficacy of sodium benzoate (SB) in a cirrotic population with chronic portal systemic encepalopathy (PSE), we performed a double blind, randomised, multicentric, clinical trial, comparing SB versus a standard therapy of lactitol (LA). To perform the study blind, syrups containing the two drugs were prepared. To date 27 patients have been studied. Of these, 12 received SB (5.6 g/day) and 15 received LA (29 g/day). Standard PSE parameters were assessed and hippurate urinary excretion was measured before and after the trial. For the SB group, basal and final PSE index were 0.39 +/- 0.16 and 0.17 +/- 0.1 respectively (p < 0.001). The Group on LA had a PSE index of 0.40 + 0.1 and 0.23 +/- 0.18 (basal and final respectively) (p < 0.001). The final hippurate excretion for SB group was 2498.9 mg/24 h. The hippurate excretion for the LA group suffer no changes (traces). No serious side effects were observed with either therapy. We suggested that SB is a ...
Chronic myeloid leukemia (CML) is a hematologic disorder characterized by the oncogene BCR-ABL1, ... more Chronic myeloid leukemia (CML) is a hematologic disorder characterized by the oncogene BCR-ABL1, which encodes an oncoprotein with tyrosine kinase activity. Imatinib, a BCR-ABL1 tyrosine kinase inhibitor, performs exceptionally well with minimal toxicity in CML chemotherapy. According to clinical trials, however, 20–30% of CML patients develop resistance to imatinib. Although the best studied resistance mechanisms are BCR-ABL1-dependent, P-glycoprotein (P-gp, a drug efflux transporter) may also contribute significantly. This study aimed to establish an imatinib-resistant human CML cell line, evaluate the role of P-gp in drug resistance, and assess the capacity of ketoconazole to reverse resistance by inhibiting P-gp. The following parameters were determined in both cell lines: cell viability (as the IC50) after exposure to imatinib and imatinib + ketoconazole, P-gp expression (by Western blot and immunofluorescence), the intracellular accumulation of a P-gp substrate (doxorubicin) b...
This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License
Background The present retrospective study reviewed acute promyelocytic leukemia (APL) cases reco... more Background The present retrospective study reviewed acute promyelocytic leukemia (APL) cases recorded in Mexico between January 2007 and January 2017. The primary objective of the study was to evaluate overall survival (OS) in Mexican patients with APL. Secondary objective was to evaluate the impact of induction treatment with different anthracyclines on OS, event-free survival (EFS) and complications in this patient population. Methods The medical charts of patients referred to medical institutions in Mexico from January 2007 through January 2017 for the treatment of suspected APL were reviewed retrospectively. Patients aged 15 - 75 years, in whom the diagnosis of APL was confirmed, who had an Eastern Cooperative Group performance status of 0 - 2, and who were eligible for combined treatment with intensive chemotherapy and all-trans retinoic acid (ATRA), were included in the study. Study participants received induction and consolidation treatment with ATRA plus either daunorubicin ...
7047 Background: Higher doses than 600 mg/day of I is the most recommended initial treatment of a... more 7047 Background: Higher doses than 600 mg/day of I is the most recommended initial treatment of advanced CML disease. Nevertheless clinical and molecular results are lower than on early chronic phase, challenging for new treatment developments in face to better results. Main objective of present trial was to increase the hematological (HR) and major cytogenetical responses (MCR) with the addition of Ara- C or Vp16 to I at doses higher than 600 mg/day as a frontline therapy of AP CML. Methods: on march, 2004 we began this multicentric, phase III randomized, clinical trial, comparing I (600 mg/day) plus Vp16 (50 mg PO/day for 7 days/ 21 days cycles) vs I (600 mg/day) plus subcutaneous Ara-C (10 mg/m2/day, for 7 days/21 days cycles), doses could be adjusted due to tolerance and toxicity and in case of failure to respond at 3 months, I doses could be escalated to 800 mg/day. Inclusion criteria: newly diagnosed AP (hematological or clonal evolution permitted) CML, not elective to allogen...
7048 Background: Imatinib is now worldwide accepted as the standard frontline therapy of CP CML. ... more 7048 Background: Imatinib is now worldwide accepted as the standard frontline therapy of CP CML. Regardless of their impressive clinical results and low toxicity profile, a small proportion of CP CML patients could develop primary or secondary resistance. Main objective of present trial was to increase the hematological (HR) and major cytogenetical responses (MCR) with the addition of Ara-C to standard doses of I as a frontline therapy of CP CML. Methods: on September, 2003 we began this multicentric, phase III randomized, clinical trial, comparing I (400 mg/day) vs I (400 mg/day) plus subcutaneous Ara-C (10 mg/m2/day, for 10 days/monthly cycles), doses could be adjusted due to tolerance and toxicity. Inclusion criteria: newly diagnosed CP CML, not elective to allogeneic transplant. Primary endpoint was the acquisition and time to acquisition of HR, MCR by conventional criteria. Secondary endpoints were main toxicities, dead to progression and overall survival. Results: 61 patients ...
Infectious complications are a major cause of morbidity and mortality in hematologic patients wit... more Infectious complications are a major cause of morbidity and mortality in hematologic patients with acute leukemia. In this paper we address the mayor infectious complications, at the Leukemia Clinic (LC) in the Instituto Nacional de Cancerologia (INCan) Material and Methods. This is a retrospective, observational study, carried on at INCan. We included all patients that attended the LC and died of an infectious complication between January 2012 and December 2014, regardless of status (new case/relapsed) at diagnosis, we included patients with Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Acute Biphenotypic Leukemia (ABL) and Acute Promyelocytic Leukemia (APML). The main objective of the study was to determine the most frequent causes of infectious complications in the treatment of acute leukemias. Results. We included 240 patients that were admitted to the LC between the study dates. 12 patients were excluded since they were later diagnosed with another hematolog...
Introduction: Acute Myeloid Leukemia is a clonal heterogeneous disease, where age is an important... more Introduction: Acute Myeloid Leukemia is a clonal heterogeneous disease, where age is an important risk factor to develop theses disease, PCR studies and next generation sequence have proven the diversity of these disease. A lot of genes mutations have been identifying to play a role in the DNA metilation, epigenetics a transcription. We initiate a screening to all acute myeloid leukemias that where the novo or relapse with a 28 gene panel of HEMAVISION a 28q; DNA diagnostic, for the detection al ARN gene fusion and alternatives of the: PML-RAR ALFA (bcr2,V), CBF-MYH11, RUNX1-RUNX1T1, PML-RAR alfa(bcr1,L), KMT2A-MLT3, PML-RAR alfa (bcr3,S), KMT2A-ELL, FUS-ERG, ETV6-MN1, DEK-NUP214, KMT2A-EPS15, KMT2A-AFDN, TCF3-PBX1, ETV6-RUNX1, KMT2A-MLLT1, KMT2A-AFF1, TCF3-HLF, STIL-TAL1, BCR/ABL(p190), SET-NUP214, BCR/ABL(p210), BCR/ABL(p230), ZBTB16-RARalfa, ETV6-ABL1, ETV6-PDGFRB, KMT2A-MLLT10, KMT2A-MLLT11,KMT2A-FOXO4, KMT2A-MLLT6, RUNX1-MECON, NPM1-RAR alfa, NMP1-MLF1, RUNX1-MECON. FLT3 ITD mu...
4291 CML accounts for approximately 15 percent of the cases of leukemia in adults. It has an annu... more 4291 CML accounts for approximately 15 percent of the cases of leukemia in adults. It has an annual incidence of 1 to 2 cases per 100000, with a slight male predominance. The median age at presentation is about 60 years and the incidence increases as a function of age, as reported in North American, Australian and European series. However, in our country we found a younger age at diagnosis. Herein we report our analysis of the age distribution of the patients included in the Mexican Cooperative Leukemia Group. We analyzed 356 patients with diagnosis of CML Ph+, from January 2001 to December 2008. The data analysis showed a median age at diagnosis of 37 years (range 16 to 64 years), with a male: female ratio of 1.1:1. There is a clear difference of age between Mexican patients with CML and those reported in the referred series (37 vs. 60 years) highlighting a geographical and/or ethnical pattern that may play a role as prognostic factor and response to treatment. Moreover, challenge ...
Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently... more Azacitidine, a pyrimidine nucleoside analog of cytidine, causes hypomethilation of DNA. Currently FDA approved for treatment of low and intermediate MDS with complete responses around 50%. And Acute myeloid leukemia (AML) in the eldery In the CALGB studies, the usual dose is 75mg/m2 in 28 day cycles, with dose modifications according to toxicity. In low income countries such as Mexico, one course of Azacitidine is around 500 dollars, median income in Mexico is 4,910 PPP (purchasing power parity); vs 30,616 in the USA. So, azacitidine treatment is far from reach for most of the common population, particularly those who do not have insurance. This is a retrospective observational study, of a compassionate use program of a fixed dose of Aza at 100mg. We analyzed data from patients that were treated with Aza between 2012 and 2016, and collected data in 2016. The aim of the study was to assess the effectivity of the fixed dose. For that purpose, we collected information from the physical...
Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that c... more Objectives: To evaluate the therapeutic response to treatment with transcriptional therapy that combines hydralazine / valproate(Transkrip) in cancer patients with cutaneous T-cell lymphoma Determine toxicity, duration of response and time to progression of epigenetic therapy with hydralazine / valproate in patients with T-cell lymphomas Material and methods an open-label, phase II, prospective and longitudinal in the National Cancer Institute of Mexico was carried out, recruiting patients diagnosed with Cutaneous T based on WHO classification 2008, newly diagnosed untreated, demographic data were analyzed and vital and somatometry signs, assessment of efficacy was established according to the therapeutic response in lymphomas measured at each visit at the affected sites for each patient, using the m-SWAT system sorted in complete response (CR), partial response (PR ), stable disease (SD) and progression (PE) and is considered response to patients with complete or partial response, ...
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Papers by Eduardo Cervera