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J Esteve

Publications and source records attributed to J Esteve.

At least 55 records · Page 3Linked to original sources
PubMed2000

High-dose therapy autotransplantation/intensification vs continued standard chemotherapy in multiple myeloma in first remission. Results of a non-randomized study from a single institution.

The purpose of this study was to analyze the outcome of patients with multiple myeloma (MM) responding to initial chemotherapy who received intensification with high-dose therapy/autotransplantation (HDT) as compared to that of those who were continued on standard chemotherapy. From 1 January 1990 to 30 June 1998, 64 patients with MM who were younger than 65 years achieved a response to initial chemotherapy. Due to referral reasons, patients preference or inclusion in trials, 31 patients received HDT as early intensification while 33 were continued on standard chemotherapy. The presenting features were similar in both groups, except for the median age, which was lower in the HDT group (53 vs 58 years, P = 0.007). Complete response negative immunofixation - (CR) was achieved in 12 of 31 (39%) patients intensified with HDT and in two of 33 (6%) patients who were continued on conventional chemotherapy (P = 0.002). Event-free survival (EFS) was significantly longer in the HDT group (median, 43 vs 21 months; P = 0.007). Overall survival (OS) was not significantly different between groups (median, 62 vs 38 months; P = 0.21). However, patients in the HDT group who achieved CR had an EFS (median, 51 vs 31 months; P = 0.03) as well as an OS (median, not reached vs 50 months; P = 0.0006) significantly longer than those achieving a lower degree of response. In conclusion, this non-randomized study shows that early HDT increases CR rate and prolongs EFS. In addition, these results highlight CR as a crucial step for achieving long-lasting disease control and prolonged survival in patients with MM.

Adult↗
PubMed2000

Treatment approaches for relapsing and refractory multiple myeloma.

Relapsing patients with multiple myeloma show a response rate higher than 50% with the resumption of the initial chemotherapy. However, since the duration of second responses are short, HDT/autotransplantation is recommended in patients with sensitive relapse. In patients with primary refractory myeloma the best treatment approach seems to be early HDT/autotransplantation. It is crucial to recognize a subset of patients who do not respond to the initial chemotherapy but who have non-progressive disease in order to avoid the administration of salvage regimens until clinical disease progression occurs. The treatment of patients with refractory relapse is disappointing. The most promising agent in this situation is thalidomide. Patients with late relapse after autologous transplantation can benefit from a second autologous transplant. The results of the allogeneic transplantation after autotransplantation are disappointing. In heavily pretreated resistant patients a conservative approach with alternate day prednisone (30 to 50 mg) along with pulse cyclophosphamide (800 to 1,200 mg every 2 to 3 weeks) is recommended.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Rapid diagnosis of acute promyelocytic leukemia by analyzing the immunocytochemical pattern of the PML protein with the monoclonal antibody PG-M3.

The fusion protein, promyelocytic leukemia-retinoic acid receptor (PML-RAR)alpha, generated by the t(15;17) translocation has an abnormal cellular distribution with colocalization of RARalpha and PML proteins. We analyzed the immunostaining pattern of PML protein using the PG-M3 monoclonal antibody directed against the amino terminal portion of PML (retained in wild-type PML and PML-RARalpha fusion protein) in the diagnosis of acute promyelocytic leukemia (APL). In addition, we compared this test with other methods for detecting the PML-RARalpha fusion gene. A normal immunostaining pattern was observed in nonmyeloid disorders and in 78 of 111 acute myeloid leukemias (AMLs). A microgranular pattern was observed in 25 AMLs, all corresponding to APL. These results were concordant with the reverse transcriptase-polymerase chain reaction results for PML-RARalpha fusion gene. Only 1 case positive for the PML-RARalpha transcript showed a normal protein pattern by immunocytochemistry. PML immunostaining was helpful to rapidly differentiate 7 cases with borderline characteristics and to obtain the diagnosis in 2 cases with scarce material. The effectiveness and low cost of this technique support its routine use as a first-line procedure in the differential diagnosis of AML.

Antibodies, Monoclonal↗
PubMed1999

A modified AIDA protocol with anthracycline-based consolidation results in high antileukemic efficacy and reduced toxicity in newly diagnosed PML/RARalpha-positive acute promyelocytic leukemia. PETHEMA group.

The Spanish PETHEMA group designed a protocol for newly diagnosed PML/RARalpha-positive acute promyelocytic leukemia (APL) in which induction and consolidation followed the original AIDA regimen, except for the omission of cytarabine and etoposide from consolidation. Induction consisted of 45 mg/m(2) all-trans retinoic acid (ATRA) daily until complete remission (CR) and 12 mg/m(2) idarubicin on days 2, 4, 6, and 8. Patients in CR received 3 monthly chemotherapy courses: idarubicin 5 mg/m(2)/d x 4 (course no. 1), mitoxantrone 10 mg/m(2)/d x 5 (course no. 2), and idarubicin 12 mg/m(2)/d x 1 (course no. 3). Maintenance therapy consisted of 90 mg/m(2)/d mercaptopurine orally, 15 mg/m(2)/wk methotrexate intramuscularly, and, intermittently, 45 mg/m(2)/d ATRA for 15 days every 3 months. Between November 1996 and December 1998, 123 patients with newly diagnosed PML/RARalpha-positive APL from 39 centers were enrolled. A total of 109 patients achieved CR (89%; 95% confidence interval [CI], 83 to 95), 12 died of early complications, and the remaining 2 were resistant. Consolidation treatment was associated with very low toxicity and no deaths in remission were recorded. Molecular assessment of response by reverse transcriptase-polymerase chain reaction (RT-PCR) showed conversion to PCR-negative in 48 of 99 (51%) and 82 of 88 patients (93%) after induction and consolidation, respectively. The 2-year Kaplan-Meier estimates of overall survival and event-free survival were 82% +/- 4% and 79% +/- 4%, respectively. For patients who achieved CR, the 2-year disease-free survival (DFS) was 92% +/- 3%. These data indicate that a significant reduction in toxicity might be obtained in APL using a less intensive consolidation without apparently compromising the antileukemic effect. These results also suggest a minor role for cytarabine and etoposide in the treatment of newly diagnosed PML/RARalpha-positive APL patients.

Adolescent↗
PubMed1999

[The autologous transplantation of hematopoietic precursors on an outpatient basis: an analysis of its feasibility at the Hospital Clínic de Barcelona].

BACKGROUND: Autologous stem cell transplantation (ASCT) is increasingly performed on an outpatient basis. Preliminary results show a significant financial saving without modifying the therapeutic results. The aim of this study has been to evaluate the feasibility of this procedure in our the Hospital Clínic of Barcelona, Spain. PATIENTS AND METHODS: All patients in whom an ASCT due to a hematological malignancy, having a good performance status, a caregiver 24 h per day, a lodging near to the hospital and an appropriate cultural and social environment, were offered an outpatient management starting the day after stem cell administration (day +1). RESULTS: During the study period (April, 1997-June, 1998) 64 ASCT were performed. Fifteen patients (23%) were managed on an outpatient basis. The remaining patients were not included in the study due to patient preference (26%), medical reasons (22%), distant home (18%) and social problems (9%). Seven patients (47%) had to be readmitted in the hospital due to fever (n = 4), nausea (n = 2) or respiratory distress (n = 1). Patients receiving total body radiation (TBI) in the conditioning regimen did not have a higher readmission rate than those conditioned without TBI. The median hospital stay (since day +1) was 6 (range: 0-22) and 17 (13-117) days for outpatient and inpatients respectively (p = 0.0016). This reduction would imply a saving of 65% in hospitalization charges and of 12% in total charges. All patients having elected the outpatient management were very satisfied by having made that choice. CONCLUSION: With an appropriate patient selection, outpatient ASCT is a feasible method that may improve the quality of life of the patients and can reduce the costs of the procedure.

Adolescent↗
PubMed1999

Expression of potentially oncogenic HHV-8 genes in an EBV-negative primary effusion lymphoma occurring in an HIV-seronegative patient.

Primary effusion lymphoma (PEL) is a novel lymphoproliferative disorder associated with human herpesvirus 8 (HHV-8) infection. Most PELs develop in HIV-seropositive individuals and are nearly always positive for Epstein-Barr virus (EBV), a finding which obscures the role of HHV-8 in lymphomagenesis. However, rare EBV-negative PEL cases occurring in HIV-seronegative patients have been reported, suggesting that HHV-8 may be pathogenetic by itself. To investigate whether HHV-8 may contribute to PEL development in the absence of EBV, the expression of seven potentially oncogenic HHV-8 open reading frames (ORFs) (ORF72/viral cyclin D, ORF16/viral bcl-2, ORF74/viral G-protein coupled receptor, ORFK2/viral IL-6, ORFK13/viral FLICE inhibitory protein, ORFK9/viral interferon regulatory factor, and ORFK1, equivalent to the gene encoding herpesvirus saimiri transforming protein) was assessed by reverse transcriptase-polymerase chain reaction (RT-PCR) in an EBV-negative PEL presenting in an HIV-negative patient. RNA transcripts were demonstrated for the seven HHV-8 genes, and this was confirmed by hybridization to specific oligonucleotide probes. The expression of potentially oncogenic HHV-8 genes in this HIV-, EBV-negative PEL case suggests that HHV-8 may induce malignant transformation of B-lymphocytes through different molecular pathways in the absence of EBV infection.

Gene Expression↗
PubMed1999

Anaplastic large-cell lymphoma with rapid evolution to leukemic phase.

Anaplastic large-cell lymphoma (ALCL) is a lymphoproliferative disorder that frequently presents with disseminated disease and extranodal involvement. Rare atypical cells have been detected in the peripheral blood in occasional cases. However, the presence of a prominent leukemic phase is extremely rare in these patients. We describe a patient with a small-cell variant of ALCL of T-cell phenotype, ALK-1 positive, who developed a rapid leukemic phase in association with the progression of the disease. Similar to the nodal biopsy, the predominant cells in bone marrow and peripheral blood were small atypical lymphoid cells. The large tumor cells expressed ALK immunoreactivity with a cytoplasmic and nuclear pattern, whereas some of the small cells showed only a nuclear-restricted pattern of staining. An RT-PCR study detected the NPM-ALK chimeric product in the nodal biopsy and in a peripheral blood sample in the early phase of the disease, but it became negative in a peripheral blood sample obtained after completion of the chemotherapy treatment, suggesting that this assay may be useful in the follow-up of these patients. This case indicates that a prominent leukemic phase may develop in ALCL as a manifestation of tumor dissemination and that it may be composed of a predominant small-cell atypical component.

Adult↗
PubMed1999

Changing practice in systemic breast cancer adjuvant treatment in a well-defined French population.

Using the 2,208 non metastatic breast cancer diagnosed women who underwent breast surgery from the 2,432 first breast cancers recorded by the French département of Côte-d'Or cancer registry from 1982 to 1992, we described in this well-defined population, the trend in breast-cancer adjuvant treatment, and related practices with recommendations according to risk groups. Adjuvant treatment was received by 44.1% of the 2,208 women. Inflammatory tumors were systematically treated with chemotherapy. For the non-inflammatory M0 breast-cancer (2,167 women), the adjuvant treatment probability was mainly determined by the nodal involvement. After adjustment on the tumor- and host-characteristics, time period was associated with increased probability of adjuvant treatment in the whole group of patients and within each pN subgroup. In the group without nodal involvement, this increase was also associated with the SBR histologic grade. There was strong evidence of large changes in breast-cancer adjuvant treatment. Clinical practices in the Côte-d'Or region have paralleled the NIH recommendations. For node-negative breast cancers, these trends appeared despite persistent uncertainty in the definition of subgroups to treat. Over time, the SBR histologic grade became an apparent factor of treatment. This use as a treatment indicator was done without validation in any adjuvant treatment trial. The simultaneous recommendation to treat with the absence of guidelines could lead to the treating of an increasingly large group by extending the "high-risk" definition. This could be a non-optimal management of risk while putting strain on health care resources.

Adult↗
PubMed1998

Using relative risk models for estimating synergy between two risk factors.

The synergy between two risk factors measures the extent to which each of them is more harmful in combination with the other than when acting alone. Relative risk models which describe interaction between risk factors with a few parameters are well adapted to the quantification of synergy. A simple measure of synergy and a method for its estimation with the help of relative risk models are proposed. This concept of synergy provides a simple interpretation of the non-linear parameter of several classical relative risk models. The discussion is illustrated with examples taken from cancer epidemiology of the upper aerodigestive tract.

Alcohol Drinking↗
PubMed1998

Hematopoietic stem cell transplantation in chronic lymphocytic leukemia: a report of 12 patients from a single institution.

BACKGROUND: Stem-cell transplantation is a reasonable therapeutic approach for younger patients with high-risk CLL. PATIENTS AND METHODS: Twelve patients (seven males; median age 47 years, range 29-51) with high-risk CLL underwent transplantation (allo, n = 7; auto, n = 5). The conditioning regimen consisted of cyclophosphamide and total body irradiation in 11 patients, and BEAC in the remaining one. Minimal residual disease (MRD) was assessed by cytofluorometry and PCR. RESULTS: All 11 evaluable patients engrafted. Of the seven allografted patients, two died of treatment-related causes; three patients developed acute GVHD. No transplant-related mortality was observed in autografted patients. After transplantation, 10 of 11 patients evaluable for response achieved CR (91%; 95% CI 59%-100%) which was molecular in nine patients (82%; 95% CI 48%-98%). One patient in CR but MRD+ relapsed nine months after transplantation and died. Seven patients remain in molecular CR for a median of 16 months (range 1-58). Estimated actuarial survival and disease-free survival at two years is 81% (95% CI 43%-100%) and 71% (95% CI 43%-99%), respectively. Relapse risk at two years is 12.5% (95% CI 0%-35.5%). CONCLUSIONS: Patients with high-risk CLL can achieve long-lasting molecular CR after SCT. The role of transplants in CLL management deserves investigation in controlled trials.

Adult↗
PubMed1998

'Lymphoid' blast crisis of chronic myeloid leukaemia is associated with distinct clinicohaematological features.

It has been suggested that in blast crisis (BC) of chronic myeloid leukaemia (CML) the clinical and laboratory features of patients with 'lymphoid' phenotype differ from those of patients with non-lymphoid BC. In order to assess any differences, 97 patients consecutively diagnosed with BC that followed a known chronic phase of CML were analysed. 19 patients had 'lymphoid' BC: in 17 the blasts expressed a B-lineage phenotype: in the remaining two they corresponded to T lymphoblasts. Four cases of B-lineage phenotype BC were considered as biphenotypic, due to the co-expression of myeloperoxidase and one or two other myeloid markers (CD33, CD13 and CD68) on the blast cells; in the other six cases of B-lineage BC the blasts expressed one or both of the myeloid markers CD33 (n = 4) and CD13 (n = 3). Patients with 'lymphoid' BC seldom had an accelerated phase prior to BC (1/19 v 36/78 with non-lymphoid BC, P = 0.002), had less frequent splenomegaly (9/19 v 59/78, P = 0.03) and hepatomegaly (5/19 v 45/78, P = 0.02) and showed a higher degree of marrow blast infiltration (mean value 74 +/- 24% v 38 +/- 23%, P < 0.0001), lesser blood basophilia (2.2 +/- 2.5% v 8.2 +/- 7.8%, P < 0.0001), and higher serum albumin levels (P = 0.001) than those with non-lymphoid BC. 13 patients with 'lymphoid' BC (68.4%) showed a favourable response to chemotherapy regimens including vincristine and prednisone and, overall, 'lymphoid' BC patients survived significantly longer than the remainder (median survival 12 months v 4.7 months, P = 0.006). These results indicate that 'lymphoid' BC of CML has a distinct clinicohaematological profile and confirm the better prognosis of such patients.

Adolescent↗
PubMed1998

The changing profile of idiopathic myelofibrosis: a comparison of the presenting features of patients diagnosed in two different decades.

In an attempt to ascertain whether the presenting features of idiopathic myelofibrosis (IM) have changed in recent years, 2 groups of patients diagnosed with IM in a single institution in different time periods were compared. The first group included 53 patients diagnosed from 1975 to 1986, and the second included 56 patients diagnosed from 1987 to 1997. No significant differences were observed between the two groups with regard to age, gender, delay from first symptoms to disease diagnosis, peripheral blood hematological values and serum biochemical parameters. Patients diagnosed prior to 1987 presented more often with constitutional symptoms (fever, night sweats, weight loss), but the difference did not reach statistical significance. These latter patients had, however, a higher frequency of splenomegaly (91% vs. 73%, p=0.01) and hepatomegaly (79% vs. 48%, p=0.002), and were more often in the osteosclerotic phase at diagnosis (p=0.05) than patients more recently diagnosed. Finally, no significant differences were found between both groups in either the distribution by prognostic scores or survival. The above results seem to indicate a trend towards a less florid clinical picture of IM at presentation in recent years. This, however, does not result in a longer patient survival.

Adolescent↗
PubMed1998

Risk of relapse and clinico-pathological features in 103 patients with diffuse large-cell lymphoma in complete response after first-line treatment.

Patients with diffuse large-cell lymphoma (DLCL) achieve a complete response (CR) in most cases, but at least one-third of them eventually relapse. Such an event occurs most frequently within 2 yr from CR achievement. The aim of the present study was to analyse the risk and pattern of relapse of patients with DLCL in CR. One hundred and three patients with DLCL (53 male/50 female; median age: 55 yr) in CR after doxorubicin-containing first-line treatments were included in the study. Main clinicobiological characteristics at diagnosis and at relapse were analysed. Uni- and multivariate studies were performed. Forty-one patients (40%) eventually relapsed, in 27 cases within 2 yr from CR and 14 thereafter. Histological subtype was the same at diagnosis and at relapse in all the early relapsing patients and in 8 of 10 late relapsing patients with available biopsy. The most important variables at diagnosis for predicting relapse were advanced stage (p<0.01) and bone marrow infiltration (p=0.05), with stage (I-II vs. III-IV) (p=0.009; relative risk=2.28) being the only predictive variable in the multivariate analysis. No differences were found according to the treatment given. The second CR rate obtained in the late relapsing patients after salvage therapies was higher that in early relapsing (50% vs. 37%). Median survival from relapse was 1.4 yr for patients early relapsing and it was not achieved for those with late relapses (p=0.09). Late relapse is a quite common event in DLCL lymphomas, with those patients achieving more frequently a second CR and having better survival than early relapsed patients.

Aged↗
PubMed1998

Treatment of elderly patients with AML: results of an individualized approach.

BACKGROUND AND OBJECTIVE: AML treatment in elderly patients must be individualized according to their characteristics. We report the results of a tailored treatment approach in all consecutive AML patients older than 60 years diagnosed at our institution during the last 2 years. DESIGN AND METHODS: Between December 1994 and December 1996, 43 AML patients over 60 years of age (median, 72; range 61-89) were managed according to their performance status (PS) and associated diseases. Twenty patients (46%) were eligible for intensive chemotherapy and received combination chemotherapy including an anthracycline (Idarubicin or daunorubicin), ara-C and VP-16. After complete remission (CR), consolidation chemotherapy with mitoxantrone and intermediate-high-dose ara-C was given to 13 of the 15 patients in remission (65% of all patients candidates for intensive treatment). Twenty-three patients who were not eligible for intensive chemotherapy received palliative measures. RESULTS: Patients treated with one course of intensive chemotherapy had a CR rate of 70% (95% CI: 48-92%)(n = 14) with a mortality rate of 20% (n = 4) and a resistance of 10% (n = 2). An additional patient reached CR after rescue therapy. Median CR duration was 10.5 months. Median survival was 10.5 months. Patients above 70 years had a median survival of 5 months compared to the median not reached for those aged between 60 and 70 years (p = 0.03). This latter group had a probability of survival of 52 +/- 18% at 18 months. None of the patients treated with palliative measures achieved CR and the median survival in this group was only 1.5 months. INTERPRETATION AND CONCLUSIONS: Patients with AML aged 70 years or less with good PS and without severe associated diseases should be intensively treated due to the high probability of achieving CR and an acceptable median-term survival. By contrast, results in patients 70 years or older and in those suitable only for palliative treatment because of a poor PS or severe associated diseases are very poor. Alternative treatment approaches for these patients should be investigated.

Aged↗
PubMed1998

[Primary MALT-type lymphoma of the breast].

A 47 year old woman with a MALT lymphoma affecting the breast exclusively is reported. Complete response was achieved after CHOP chemotherapy but three years later a relapse was observed. Second-line chemotherapy (CNOP) and local radiotherapy were administered, and a second remission was obtained lasting for 1 year at last follow-up. A bibliographic search of MALT lymphomas of the breast showed that most such cases correspond to localized forms (stage I-II) and that from the radiologic point of view nodular lesions are almost the rule, although in the present case diffuse involvement was observed. MALT lymphomas of the breast tend to remain localized, and to relapse locally, and these facts appear as independent of the treatment applied (surgery, radiotherapy, chemotherapy or any combination).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Idiopathic myelofibrosis: initial features, evolutive patterns and survival in a series of 106 patients].

BACKGROUND: Idiopathic myelofibrosis (IM) is an infrequent myeloproliferative disorder with few large series published in the medical literature. Information on the characteristics of more recently diagnosed patients with IM is scarce. PATIENTS AND METHODS: The initial features, evolutive patterns and survival from 106 patients diagnosed with IM in a single institution between 1975 and 1996 were analyzed. RESULTS: Median age of the series was 64 years (range: 17-89); there were 61 males and 55 females. One third of the patients were asymptomatic at IM diagnosis. The most common presenting symptoms were related to hypermetabolism, anemia and splenomegaly. A palpable spleen was noted in 85% of patients, and 66% had hepatomegaly. Anemia was the most frequent hematologic abnormality (50% of cases). Bone marrow biopsy showed cellular phase IM in 50 patients, IM without osteosclerosis in 39, and osteosclerotic IM in the remaining 17. Evolution into acute leukemia was seen in 14 patients (actuarial probability at 7 years: 20%, 95% CI: 0-40%), 8 patients developed portal hypertension, 5 liver failure without portal hypertension and 14 heart failure. With 62 patients having died, the series' median survival was 59 months (95% CI: 41-75). CONCLUSION: IM is usually diagnosed in the old age. From the histologic point of view, a predominance of the cellular phase is observed at disease presentation. In recent years an increased proportion of patients asymptomatic at diagnosis is observed.

Adolescent↗