Alvarado-Ibarra M, Medina-Coral JE, Salazar-Ramírez Ó, López-Hernández M, Ortiz-Zepeda M, Álvarez-Vera JL, Ramos-León EM

Language: Spanish
References: 22
Page: 249-261
PDF size: 599.20 Kb.

ABSTRACT

Objective: To evaluate the complete remission (CR), relapse, overall survival (OS) and disease free survival (DFS) in patients with positive p-glycoprotein (Gp +) and its association with poor prognostic factors.
Patients and method: A retrospective case-control, longitudinal analysis including patients diagnosed with acute leukemia from 2004-2014, in the hematology department of the Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico City, treated with intensive chemotherapy called LAL 6, LAL 10 and LANOL 9. Two groups were considered for the analysis of results: positive p-glycoprotein (group 1) and negative p-glycoprotein (group 2). The variables analyzed were: age, sex, comorbidities, lactic dehydrogenase, initial blood count, blast in peripheral blood, bone marrow, lymphomatosum component, infiltration to central nervous system, the expression of Gp by flow cytometry, delay of more than 20% in the administration of chemotherapy cycles, CR, relapse, DFS and OS.
Results: We enrolled 54 patients with acute lymphoblastic leukemia (ALL) and 29 patients with acute non lymphoblastic leukemia (LANOL). They were divided into the groups Gp+ and Gp- 39 and 44, respectively. Variables of poor prognostic were analyzed: splenomegaly, age › 35 years, initial › 50 /mcL leukocytes, delay of more than 20% in the administration of chemotherapy cycles, blasts on day 14 of induction and diabetes mellitus (DM) as comorbidity. In the comparative analysis we found no statistically significant difference in the following variables (p›0.5): age, leukocytes, spleen and bone marrow blasts. CR and relapse were similar in both groups (p›0.55). In patients with ALL, OS was 14 months in the group Gp+ and 28 months in the group Gp- (p=0.02), and DFS was of 28 months in the group Gp+ and median was not reached in the group Gp- (p=0.03). OS in ›35 years in the group Gp+ was of 14 months and median was not reached in the Gp- (p=0.02).
Conclusions: Disease-free survival and overall survival in patients with Gp+ were lower than in the GP- group, this resulted mostly affected when the patients had DM, age ›35 and delayed chemotherapy.

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