Tomás JF, Dang J, Pro B, Rodriguez MA, McLaughlin P, Romaguera J, Younes A, Hagemeister F, Cabanillas F, Podoloff D, Fayad L

Idioma: Ingles.
Referencias bibliográficas: 47
Paginas: 5-14
Archivo PDF: 154.91 Kb.

RESUMEN

Objetivo: evaluar la utilidad del tamizaje con galio como predictor de supervivencia y duración de la respuesta en pacientes con linfoma no Hodgkin agresivo.
Pacientes y método: participaron 190 pacientes con linfoma no-Hodgkin, entre 1992 y 1996, en dos diferentes protocolos de tratamiento con atraciclina. 116 pacientes (61%) tuvieron puntuación Internacional de Pronóstico (IPI) baja y de bajo riesgo intermedio, 74 (39%) la tuvieron alta intermedia y de alto riesgo. Antes del inicio de la quimioterapia todos los pacientes tenían resultados positivos de galio (Ga67), y después de dos (n = 139), cuatro (n = 113) y seis (n = 24) ciclos de quimioterapia se efectuaron exploraciones complementarias. Los pacientes también recibieron radiación en los sitios conocidos con tumor voluminoso.
Resultados: los pacientes en quienes el galio siguió siendo positivo después de dos ciclos de quimioterapia tuvieron una mediana de supervivencia global de sólo 23 meses, comparados con una mediana de 107 meses en quienes las exploraciones de galio fueron negativas (p = .00434). La positividad al Ga67 después de dos ciclos de quimioterapia se asoció con supervivencia libre de enfermedad de 6.6 meses, frente a 106 meses para quienes tuvieron Ga-67 negativo (p =. 00279). Después de cuatro ciclos de quimioterapia, el Ga67 positivo persistente se correlacionó con una media más corta (14.6 meses frente a 102.5 meses, respectivamente, p =. 00092) y supervivencia libre de enfermedad con media más corta (6.2 meses frente a 90 meses, respectivamente, p =. 00006). Mediante análisis de regresión de Cox, el resultado de la gammagrafía con galio es independiente del Índice Pronóstico Internacional (IPI) como un predictor de pobres resultados en el linfoma no Hodgkin agresivo.
Conclusiones: la positividad persistente del tamizaje con galio después de dos, cuatro, o seis ciclos de quimioterapia identifica a grupos de pacientes con gran tendencia a la progresión temprana de la enfermedad y pobre supervivencia global. El efecto parece ser independiente del IPI. El objetivo de esta prueba es identificar la resistencia intrínseca al tratamiento en los pacientes con la enfermedad para que puedan beneficiarse de un esquema más agresivo e innovador, como la intensificación temprana.

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