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Sample records for combinada con rituximab

  1. Linfoma hepático primario: Evolución favorable con quimioterapia combinada con rituximab Primary hepatic lymphoma: favorable outcome with chemotherapy plus rituximab

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    I. Serrano-Navarro

    2008-11-01

    Full Text Available Comunicamos el caso de una paciente con un linfoma hepático primario tratado con éxito con quimioterapia combinada con rituximab. Utilizando los "encabezamientos estándar para búsquedas bibliográficas informatizadas" (Medical Subject Heading revisamos los casos publicados hasta la fecha de esta infrecuente entidad.This article describes the case of a patient with a non-Hodgkin primary hepatic lymphoma who was successfully treated with chemotherapy combined with rituximab. Using the Medical Subject Headings the published reports of this rare entity were reviewed.

  2. Cirugía Combinada de Catarata y Glaucoma con Sutura Retirables

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    Oscar Vicente Beaujon-Balbi

    2015-02-01

    Full Text Available La asociación de catarata y glaucoma representa un reto para el oftalmólogo que debe decidir si realiza una cirugía de glaucoma o catarata o combinada. Presentamos nuestros resultados de cirugías de facoemulsificación de catarata, implante intraocular y trabeculectomía con MMC y suturas retirables. Se incluyen 60 ojos de 44 pacientes operados de Enero 2008 a Diciembre de 2011 con una edad promedio de 67,02 (+/-10,41 años. El 80% eran glaucomas de ángulo abierto (GAA y 20% por cierre angular (GPCA. La presión intraocular previa fue de 23,28 (+/- 5,89 mmHg en GPAA y  26,08 (+/- 10,66 en GPCA con una relación excavación/disco fue de 0,81 y 0,74 respectivamente. La agudeza visual preoperatoria mejor corregida (logmar fue de 0,581 (+/- 0,41 mejorando a 0,28 (+/- 0,38 en general y 0,60 (+/-0,41 a 0,25 (+/-0,37 en GPAA y 0,53 (+/- 0,44 a 0,39 (+/-0,40 en GPCA. La reducción de la Presión Intraocular fue de 48,24% en promedio siendo del 48,86% en GPAA y 52,72% en GPCA. La sobrevida de la cirugía fue de 0,91 en el glaucoma de ángulo abierto y de 0,90 en el glaucoma por cierre angular a los 50 y 30 meses de seguimiento respectivamente. En conclusión, la cirugía combinada por un solo puerto es efectiva en el control del paciente con glaucoma y catarata.

  3. Evaluación de pérdidas de grano en cosecha de arroz con combinada

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    José M. Chaparro C.

    2011-02-01

    Full Text Available Se realizó una investigación para evaluar las pérdidas de grano presentadas en la recolección de arroz con combinada en la región de Ambalema (Tolima. Se utilizaron las variedades CICA 8, CICA 9 e IR-22, y las combinadas John Deere 955R, Case 960 y Case 1200. Se tomaron datos climatológicos (humedad relativa, temperatura, velocidad del viento, etc., características del cultivo (humedad del grano (bh, densidad, altura de los tallos, etc., y parámetros de operación de la combinada (velocidad del cilindro, velocidad del molinete, índice del molinete, separación cilindro-cóncavo, etc. durante todo el tiempo del ensayo. Se evaluaron las pérdidas naturales, las pérdidas en el cabezote, las pérdidas en la trilla y las pérdidas en la separación y limpieza. Las pérdidas promedias presentadas en la combinada fueron: 1.44% en el cabezote, 1.56% en la trilla, 4.12% en la separación y limpieza, yen total el 7.17% en 39 observaciones realizadas. Las variables independientes que más influyeron en las pérdidas fueron la humedad del grano y la humedad relativa.

  4. Experiencia con rituximab en miopatía inflamatoria idiopática refractaria

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    Elmer R. García-Salazar

    2013-10-01

    Full Text Available Se describe las características clínicas y de laboratorio de dos pacientes que recibieron rituximab por miopatía inflamatoria idiopática (MII. Ellas eran refractarias a tratamiento convencional con DARMES, por lo que recibieron rituximab 1 gramo cada 14 días, en dos infusiones en ciclo semestral. En las historias clínicas se obtuvo los datos clínicos de fuerza muscular proximal, lesiones cutáneas patognomónicas, elevación de CPK, TGO, DHL y VSG, resultados de electromiografía, biopsia muscular y de piel. Ninguno de los dos casos presentó reacción medicamentosa ni infecciones durante y posterior a las infusiones. Rituximab mostró efectividad en la respuesta clínica y enzimática en estas pacientes con dermatomiositis refractarias a corticoides y DARMES tradicionales.

  5. Cirugía combinada cardiaca y pulmonar en un paciente con un histoplasmoma

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    Francisco J. Vázquez-Roque

    2016-09-01

    Full Text Available La histoplasmosis pulmonar y su diseminación hemática con el desarrollo de una endocarditis sobre la válvula pulmonar son extremadamente infrecuentes. Presentamos un niño de 10 años que, como complicaciones de una histoplasmosis pulmonar, desarrolló una caverna en la base del pulmón derecho que se fistulizó a un vaso sanguíneo pulmonar y que además presentaba vegetaciones en la válvula pulmonar con peligro de causar infartos pulmonares e insuficiencia valvular pulmonar severa, que obligaron a realizar una compleja intervención quirúrgica cardiopulmonar en un solo tiempo, donde se realizó la resección completa del lóbulo inferior del pulmón derecho, se cerró la comunicación interventricular y se reconstruyó la válvula pulmonar con 3 velos de pericardio autólogo. Seis meses después, el paciente está asintomático, con reexpansión de los lóbulos restantes del pulmón derecho, y la ecocardiografía transtorácica muestra un buen funcionamiento de la neoválvula pulmonar construida con el pericardio autólogo.

  6. Colecistectomía transvaginal (NOTES combinada con minilaparoscopia Transvaginal cholecystectomy (NOTES combined with minilaparoscopy

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    C. Dolz

    2007-12-01

    Full Text Available Objetivo: comunicar la primera colecistectomía transvaginal realizada en humanos en nuestro país. Pacientes y métodos: mujer de 35 años de edad con historia de cólicos hepáticos de repetición de etiología litiásica. La intervención la realizó un equipo multidisciplinar constituido por cirujanos, gastroenterólogos y ginecólogos. Consistió en crear un neumoperitoneo mediante una aguja de Veres colocada en el fondo umbilical con posterior colocación de un trócar de 5 mm. Se colocó un segundo trócar de 3 mm en el hipocondrio derecho. Se realizó una colpotomía y colocación de un trócar vaginal de 12 mm que permitió el paso de un videogastroscopio que alcanzó el hilio hepático. Resultados: se realizó la colecistectomía mediante la acción conjunta de instrumentos de trabajo que pasaron por las puertas de entrada de la minilaparoscopia y por el videogastroscopio. La extracción de la vesícula se realizó por vía transvaginal mediante el videogastroscopio. No aparecieron complicaciones postoperatorias siendo la paciente dada de alta al cabo de 24 horas. Conclusiones: la colecistectomía transvaginal mediante la acción conjunta de un equipo multidiscliplinar es posible y segura. La cirugía endoscópica transluminal a través de orificios naturales (NOTES, es una modalidad emergente que intenta ser menos invasiva, mejor tolerada y más respetuosa con el daño estético que la cirugía laparoscópica y probablemente será la puerta de entrada de innovaciones médicas y tecnológicas de gran trascendencia durante los próximos años.Objective: to report on the first transvaginal cholecystectomy performed on a human being in Spain. Patients and methods: a 35-year-old female with a history of recurrent bouts of biliary pain resulting from gallstones. A surgical procedure was performed by a multidisciplinary team composed of surgeons, gastroenterologists, and gynecologists. It involved creating a pneumoperitoneum by placing a

  7. Producción de etanol absoluto por destilación extractiva combinada con efecto salino

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    CÉSAR VÁSQUEZ

    2007-01-01

    Full Text Available Se presentan los resultados sobre la destilación extractiva de mezclas etanol-agua con polialcohol PAW y las sales CaCl2 y KCOOCH3 disueltas en él, utilizando una relación volumétrica 1:1 de etanol–agua a polialcohol y una concentración de 0.1 g/mL de sal en el polialcohol. Se encontró que el polialcohol PAW modificó el comportamiento azeotrópico de la mezcla etanol–agua según el tipo de sal usada y que presenta ventajas respecto a otros agentes de separación anteriormente reportados, desde el punto de vista de manipulación, costos y grado de modificación del azeótropo agua-etanol. Se propone un proceso industrial de destilación extractiva con sales disueltas en polialcohol PAW, que podría competir con los métodos tradicionales para producir etanol absoluto; el cual modificaría las volatilidades relativas de la mezcla, mejorando la eficiencia de separación, disminuyendo el consumo de energía, tamaño y costo de equipos, evitando problemas de corrosión y manejo de sólidos frecuentes en otros procesos.

  8. Terapia combinada con Trastuzumab en el tratamiento del Cáncer de mama: eficacia y efectos adversos

    OpenAIRE

    2015-01-01

    Introducción: El cáncer de mama es el más frecuente entre la población femenina. Entre un 25-30% de los cánceres de mama son HER2-positivo. Este tipo de cáncer, se ha relacionado con una mayor agresividad clínica e histológica, mayor riesgo de recurrencia y muerte asociada al cáncer de mama. Trastuzumab, es un anticuerpo monoclonal humanizado contra este receptor. Actualmente se dispone de cuatro agentes anti-HER2 autorizados: Trastuzumab, Pertuzumab, Lapatinib y Trastuzumab...

  9. Desempenho econômico do consórcio de coentro com beterraba, adubados com doses de jitirana, combinada com esterco bovino

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    W. B. Ramalho

    2016-01-01

    Full Text Available A análise econômica ajuda a interpretar os resultados obtidos nos diferentes sistemas de cultivo e deve ser empregada indicando o que e como plantar, de maneira a gerar lucro ao produtor. A utilização da mistura de adubos orgânicos constitui-se em alternativa para os agricultores que produzem em sistema agroecológico, pois contribui para a redução dos custos de produção e maior eficiência no uso dos insumos disponíveis na área. Diante do exposto, objetivou-se avaliar o desempenho econômico do consórcio de coentro com beterraba, adubados com doses de jitirana, combinada com esterco bovino. O experimento foi conduzido na Fazenda Experimental Rafael Fernandes, distrito de Alagoinha, zona rural de Mossoró – RN, no período de setembro a dezembro de 2014. O delineamento experimental utilizado foi de blocos completos casualizados com os tratamentos arranjados em esquema fatorial 2 x 5, com três repetições. O primeiro fator foi constituído pelo cultivo solteiro e consorciado do coentro e da beterraba. O segundo fator, pelas doses de jitirana, combinada com esterco bovino (0,0; 1,0; 2,0; 3,0 e 4,0 kg m-2 de canteiro. As características avaliadas para os indicadores econômicos foram: renda bruta e renda líquida, taxa de retorno e índice de lucratividade. O melhor desempenho econômico do sistema foi obtido na dose de 4,0 kg m-2 de canteiro, com renda bruta de R$ 14.940,00; custo de produção de R$ 3.306,00; renda líquida de R$ 11.634,00; taxa de retorno R$ 4,52; índice de lucratividade de 77,87%, para uma área de produção de 900 m2. Economic performance of coriander consortium with beet fertilized with doses of jitirana, combined with manureAbstract: The economic analysis helps to interpret the results obtained in different farming systems and should be employed indicating what and how to plant, in order to generate profit to the producer. The use of the mixture of organic fertilizers is up alternative for farmers who

  10. Comparación de la eficacia y seguridad de la terapia combinada de cardiomioplastia celular con el factor estimulante de colonias de granulocitos en pacientes con cardiopatía isquémica en dos vías de implatación

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    Juan M. Senior, MD., FACP

    2011-03-01

    Conclusión: En nuestro medio es factible realizar terapia combinada con cardiomioplastia celular y factor estimulante de colonias de granulocito; este es un procedimiento seguro con el que se obtiene una mejoría sostenida de la fracción de eyección y los MET más allá de los beneficios que se logran con la revascularización y la terapia farmacológica óptima.

  11. DEGENERACIÓN COMBINADA SUBAGUDA, ANEMIA MEGALOBLÁSTICA Y MANIFESTACIONES NEUROPSIQUIÁTRICAS Caracterización clínica de catorce casos con deficiencia de cianocobalamina

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    Tomás Omar Zamora Bastidas

    2012-04-01

    Full Text Available La degeneración combinada subaguda es un desorden neurológico que afecta los cordones posteriores de la médula y se manifiesta precozmente con disestesia, parestesias y astenia severa. En pacientes de riesgo, es la manifestación inicial (y a veces única de una deficiencia de vitamina B12. El cerebro, el nervio óptico y los nervios periféricos pueden afectarse igualmente. Presentamos catorce casos de degeneración combinada subaguda por deficiencia de vitamina B12, con niveles bajos y anemia en la mayor parte de pacientes. Una revisión de la literatura muestra también estados carenciales en grupos poblacionales pobres de adultos mayores con otros factores de riesgo; y deficiencias subclínicas con depósitos hepáticos de vitamina B12 casi exhaustos. Puede haber clínica neuropsiquiátrica en casos sin niveles bajos de vitamina B12 ni anemia.

  12. Efecto crónico de la práctica mental combinada con práctica física, sobre la memoria visual y auditiva y el tiempo de reacción en personas adultas mayores

    OpenAIRE

    Cordero Castro, Carolina

    2003-01-01

    Tesis texto completo. Con el propósito de identificar el efecto crónico de la práctica mental combinada con la práctica física, sobre la retención de una rutina de movimiento no locomotor y a su vez analizar la relación de esta práctica con los procesos cognitivos de la memoria auditiva, memoria visual y el tiempo de reacción, se escogieron por conveniencia a 50 personas adultas mayores entre 60 y 75 años de edad que son parte del programa de actividad física de Adulto Mayor del Instituto ...

  13. Hyperinfection by Strongyloides stercoralis probably associated with Rituximab in a patient with mantle cell lymphoma and hyper eosinophilia Hiperinfección por Strongyloides stercoralis probablemente asociada con Rituximab en una paciente con linfoma e hipereosinofilia

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    Renzo Nino Incani

    2010-08-01

    Full Text Available The first report to our knowledge, of hyperinfection by Strongyloides stercoralis (HS and hypereosinophilia, associated to immune suppression by Rituximab (the only drug received for the last one year and 10 months, in a patient with mantle-cell lymphoma (MCL, is presented. The patient has a 3-year history of MCL, and developed two accesses of HS during 2008, including meningitis, pneumonia and presence of larvae of S. stercoralis in the lungs. We had a unique chance to look at cytotoxicity of filariform larvae in the expectoration after Ivermectin treatment, showing immobilization and death of larvae, associated with eosinophils attached to the cuticle of the parasite.Se presenta el primer reporte, hasta donde tengamos información, de hiperinfección por Strongyloides stercoralis (HS e hipereosinofilia asociados a inmunosupresión por Rituximab (el único medicamento recibido durante 1 año y 10 meses, en un paciente con linfoma de células del manto (LCM. La paciente tuvo una historia de 3 años con LCM, y desarrolló 2 accesos de HS durante el 2008, incluyendo meningitis, neumonía y presencia de larvas de S. stercoralis en los pulmones. Se tuvo la oportunidad única de observar la citotoxicidad contra las larvas filariformes en la expectoración, luego del tratamiento con Ivermectina, mostrando la inmovilización y muerte de las larvas, asociada a la presencia de eosinófilos adheridos a la cutícula del parásito.

  14. Hiperlipidemia familiar combinada: documento de consenso

    OpenAIRE

    Pedro Mata; Rodrigo Alonso; Antonio Ruíz-Garcia; Jose L. Díaz-Díaz; Noemí González; Teresa Gijón-Conde; Ceferino Martínez-Faedo; Ignacio Morón; Ezequiel Arranz; Rocío Aguado; Rosa Argueso; Leopoldo Perez de Isla

    2014-01-01

    La hiperlipidemia familiar combinada (HFC) es un trastorno muy frecuente asociado a enfermedad coronaria prematura. Se transmite de forma autosómica dominante, aunque no existe un gen único asociado al trastorno. El diagnóstico se realiza mediante criterios clínicos, y son importantes la variabilidad del fenotipo lipídico y la historia familiar de hiperlipidemia. Es frecuente la asociación con diabetes mellitus tipo 2, hipertensión arterial y obesidad central. Los pacientes con HFC se cons...

  15. Con: Should all patients with anti-neutrophil cytoplasmic antibody-associated vasculitis be primarily treated with rituximab?

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    Kronbichler, Andreas; Jayne, David R W

    2015-07-01

    Rituximab has enriched our armamentarium in the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Two randomised controlled trials have shown that rituximab is non-inferior compared with cyclophosphamide followed by azathioprine for the induction of remission. The newly diagnosed patients in the Rituximab in ANCA-Associated Vasculitis (RAVE) and Rituximab Versus Cyclophosphamide in ANCA-Associated Vasculitis (RITUXVAS) trials had a numerically higher response rate in the cyclophosphamide/azathioprine arm, and the number of such patients treated with rituximab numbered cases and late-onset neutropaenia are complications not seen with cyclophosphamide. Over the longer term it is unclear what relapse prevention strategy should be employed after rituximab, and there was a trend to a higher relapse risk after rituximab in the RITUXVAS trial at 2 years. Further health economic studies are required to understand all the costs associated with rituximab. In the context of concomitant underlying infectious complications, in terms of fertility concerns, especially in young patients, and when malignancy is underlying we would recommend the use of rituximab as first-line therapy.

  16. Caracterización molecular de la cadena gama común y Jak3 en un individuo afectado con inmunodeficiencia severa combinada

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    Pablo Javier Patiño Grajales

    2001-04-01

    Full Text Available

    La Inmunodeficiencia Severa Combinada (IDSC es una enfermedad
    de origen genético, que se puede heredar de forma autosómica
    recesiva o ligada al cromosoma X. La IDSC se caracteriza por un
    defecto en el número y la diferenciación de los linfocitos T y NK. Los
    individuos afectados desarrollan diarrea crónica, infecciones persistentes y severas como neumonía, septicemia e infecciones fúngicas.
    Estos pacientes presentan retardo en el crecimiento y pueden morir a
    temprana edad si no se realiza una terapia de corrección genética o un
    trasplante de células hematopoyéticas. Las mutaciones responsables
    de la IDSC comprometen principalmente el gen de la cadena gama
    común (γc y la proteína Jak3 que son proteínas fundamentales en la
    transducción de señales de los receptores para varias citoquinas esenciales en la diferenciación y activación de células del sistema inmune, las cuales incluyen IL-2, IL-4, IL-7, IL-9 e IL-15 (1,2.

     

     

  17. Lesiones altas del plexo braquial. Reconstrucción con técnicas combinadas de neurotización e injertos nerviosos

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    Enrique Vergara-Amador

    2015-01-01

    Full Text Available Antecedentes. Las lesiones altas del plexo braquial son reconstruidas con neurotización e injerto nervioso. El nervio espinal accesorio, la raíz C7, las ramas del tríceps y los nervios mediano y cubital son los más usados para transferencias. Objetivo. Mostrar la experiencia con neurotización de la rama inferior del nervio espinal accesorio (NEA al nervio supraescapular (NSE, transferencia nerviosa de fascículos del nervio cubital o del mediano y, en ocasiones, injertos nerviosos hacia el nervio musculocutáneo y al tronco posterior, y reconstrucción del nervio axilar en algunos casos. Materiales y métodos. Se revisan 42 pacientes con lesiones altas de plexo braquial, operados mediante combinación de neurotización e injertos nerviosos. Se hizo un seguimiento mínimo de 15 meses. Resultados. Las lesiones de 40 pacientes fueron producidas por accidente en moto. En 22 solo se transfirió el NSE con el NEA; con esto, se recuperó abducción de hombro de 33º. A 8 pacientes se les combinó con reparación del axilar; mejorando la abducción a 81º. En 30 pacientes con neurotización del nervio cubital o mediano para el bíceps, se obtuvo respuesta a los 3 o 4 meses. Al final, la flexión del codo era de 116º y M4. Conclusión. Los mejores resultados en hombro fueron con la combinación de NSE y del nervio axilar; con esta, se logró 81º de abducción. La rotación externa mejoró en 28,5% de los pacientes, con respuesta tardía. Mientras que la neurotización del bíceps con fascículos del cubital consiguió una flexión de 116º, muy comparable con otras series. Hoy esta técnica es el gold estandard para la reconstrucción de flexión del codo.

  18. Evidencia experimental que soporta la conveniencia de la terapia combinada con insulina e hipoglucemiantes orales en pacientes diabéticos de tipo 2

    OpenAIRE

    Marra, Fernando Ariel; Tacconi de Alaniz, María Josefa; Marra, Carlos Alberto

    2012-01-01

    A pesar de lo recomendado en los protocolos internacionales de tratamiento farmacológico de la diabetes tipo 2 (DM2), al presente continúan utilizándose terapias a base de hipoglucemiantes orales (HO) -solos o combinados- con presindencia del empleo de insulina (Ins). Se sabe que la normalización de la glucemia evaluada por medio de biomarcadores convencionales no correlaciona con la calidad de vida ni con el nivel de complicaciones a largo plazo asociadas al curso clínico de la enfermedad.

  19. Lesiones altas del plexo braquial. Reconstrucción con técnicas combinadas de neurotización e injertos nerviosos

    OpenAIRE

    Enrique Vergara-Amador

    2015-01-01

    Antecedentes. Las lesiones altas del plexo braquial son reconstruidas con neurotización e injerto nervioso. El nervio espinal accesorio, la raíz C7, las ramas del tríceps y los nervios mediano y cubital son los más usados para transferencias. Objetivo. Mostrar la experiencia con neurotización de la rama inferior del nervio espinal accesorio (NEA) al nervio supraescapular (NSE), transferencia nerviosa de fascículos del nervio cubital o del mediano y, en ocasiones, injertos nerviosos hacia el n...

  20. Determinación combinada de proteína C reactiva y troponina I en pacientes que concurren a la Unidad de Emergencias con dolor precordial

    Directory of Open Access Journals (Sweden)

    José L. Navarro Estrada

    2005-01-01

    Full Text Available Introducción y objetivos Los hallazgos clínicos, electrocardiográficos y los niveles séricos de CK-MB son variables pronósticas en la evaluación de pacientes con dolor precordial. El objetivo de este trabajo fue determinar el valor pronóstico adicional de la troponina I (TnI y de la proteína C reactiva (PCR en una población de pacientes con dolor de precordial que consultan al Departamento de Emergencias. Material y métodos Se realizó el seguimiento de 784 pacientes consecutivos con dolor precordial durante 120 días para evaluar la frecuencia de muerte o IM no fatal. Se obtuvo sangre al ingreso para evaluar los niveles de TnI y PCR. Los investigadores fueron ciegos a estos resultados. Resultados Del total de pacientes, 394 (50,2% fueron dados de alta (dolor no coronario y 390 (49,8% fueron hospitalizados con diagnóstico de angina inestable o infarto. La frecuencia de muerte o infarto a los 120 días fue del 3,8%; la frecuencia más alta (14,9% se observó en el grupo con TnI y PCR elevadas (p = 0,0001. Se identificaron cuatro predictores independientes de muerte o infarto por regresión de Cox: enfermedad coronaria previa (HR 2,97, IC 95% 1,42- 6,25; p = 0,004; cambios del segmento ST (HR 3,01, IC 95% 1,31-7,14; p = 0,009; TnI = 0,4 ng/ml (HR 2,85, IC 95% 1,23-6,66; p = 0,015 y PCR = 5 mg/L (HR 2,42, IC 95% 1,45-5,26; p = 0,020. La combinación de TnI y PCR fue superior que la estratificación convencional por clínica y ECG, especialmente en el grupo de riesgo intermedio. Conclusiones En pacientes con dolor torácico, la combinación de TnI y PCR mejora la estratificación de riesgo en comparación con el uso convencional de la clínica y el ECG, especialmente en los pacientes con un nivel de riesgo intermedio.

  1. Evaluación toxicológica en ratas Sprague-Dawley de Interleuquina-2 y del candidato vacunal FPCR3, terapia combinada en pacientes con SIDA

    National Research Council Canada - National Science Library

    Aldana, L; Valenzuela, C; Duarte, C; Milá, L; Porras, D; Vázquez, A; Bacardí, D; Amaya, R; Castillo, J; Cosme, K; Rojo, G; Suárez, J; Merino, M

    2004-01-01

    ... proteínas anti-VIH, se ha diseñado un estudio clínico que combina la aplicación de este producto (FPCR3) con la terapia antirretroviral de alta eficiencia y dosis bajas de Interleuquina-2 humana recombinante...

  2. Evaluación toxicológica en ratas Sprague-Dawley de Interleuquina-2 y del candidato vacunal FPCR3, terapia combinada en pacientes con SIDA

    National Research Council Canada - National Science Library

    Aldana, L; Valenzuela, C; Duarte, C; Milá, L; Porras, D; Vázquez, A; Bacardí, D; Amaya, R; Castillo, J; Cosme, K; Rojo, G; Suárez, J; Merino, M

    2004-01-01

    ... de la obtención en el Centro de Ingeniería Genética y Biotecnología (La Habana, Cuba) de un candidato vacunal que utiliza como vector el virus de la viruela aviar modificado con genes que expresan...

  3. Evaluación toxicológica en ratas Sprague-Dawley de Interleuquina-2 y del candidato vacunal FPCR3, terapia combinada en pacientes con SIDA

    Directory of Open Access Journals (Sweden)

    D. Porras

    2004-01-01

    Full Text Available En busca de nuevas fórmulas terapéuticas para combatir la infección por el virus de inmunodeficiencia humana se han desarrollado diferentes tipos de vacunas, entre las que se encuentran las que estimulan la respuesta de linfocitos T citotóxicos contra antígenos del VIH. A partir de la obtención en el Centro de Ingeniería Genética y Biotecnología (La Habana, Cuba de un candidato vacunal que utiliza como vector el virus de la viruela aviar modificado con genes que expresan proteínas anti-VIH, se ha diseñado un estudio clínico que combina la aplicación de este producto (FPCR3 con la terapia antirretroviral de alta eficiencia y dosis bajas de Interleuquina-2 humana recombinante (IL-2hr. Antes de ensayar estos productos biotecnológicos en pacientes con el síndrome de inmunodeficiencia adquirida se hizo necesario realizar pruebas toxicológicas para evaluar su seguridad, para lo cual se diseñaron 2 estudios de toxicidad aguda en los que se evaluó la respuesta sistémica y local de ratas Sprague-Dawley a dosis superiores a la que se administrará en los pacientes incluidos en el estudio clínico piloto. Se utilizaron 50 ratas de la sublínea Cenp: SPRD (Sprague-Dawley en el estudio de toxicidad aguda de Interleuquina-2hr y 70 animales de esta misma especie y sublínea para el realizado al candidato vacunal FPCR3. Los productos se administraron por vía subcutánea e intramuscular respectivamente a niveles de 30, 60 y 90 veces la dosis terapéutica. En el estudio realizado al candidato vacunal FPCR3 se incluyeron 3 grupos en los que se realizaron administraciones repetidas, a fin de evaluar de forma preliminar la tolerancia local de este producto. En ambos estudios se incluyó un grupo control inoculado con el placebo de las formulaciones. Se realizó observación clínica diaria y se llevó a cabo el estudio histopatológico de los órganos diana y del sitio de administración. No se evidenciaron signos de toxicidad ni efectos adversos

  4. Ethanol reformation combined with CO{sub 2} absorption for the production of hydrogen; Reformacion de etanol combinada con absorcion de CO{sub 2} para produccion de hidrogeno

    Energy Technology Data Exchange (ETDEWEB)

    Beltran-Pina, B.B.; Delgado-Vigil, M.D.; Salinas-Gutierrez, J.M.; Lopez-Ortiz, A.; Collins-Martinez, V. [Centro de Investigacion en Materiales Avanzados S. C, Chihuahua, Chihuahua (Mexico)]. E-mail: bogdan.beltran@cimav.edu.mx

    2009-09-15

    This work studied the ethanol reforming reaction combined with carbonatation of a metallic oxide to produce hydrogen with CO{sub 2} capture in one single step. A catalyst mixture was used composed of 10 %wt Ni/Al{sub 2}O{sub 3} with a CO{sub 2} absorbent material such as calcined dolomite (CaO*MgO) and sodium zirconate (Na{sub 2}ZrO{sub 3}). The materials synthesized were characterized with x-ray diffraction (XRD), sweep electron microscopy (SEM) and surface area (BET isotherma). A catalyst with a very dispersed active phase and surface area of 170 m{sup 2}/gr was obtained. The evaluation of the ethanol steam reforming reaction was conducted considering a transient system and a stainless steel fixed-bed reactor where catalyst mixtures and CO{sub 2} absorbents were introduced. The reaction was carried out at a temperature of 600 degrees Celsius, with a water/alcohol ratio of 6:1. The quantification of the gases produced during the reaction (H{sub 2}, CO{sub 2}, CO and CH{sub 4}) was performed with gas chromatography. An increase was observed in the hydrogen selectivity when adding absorbent to the catalytic bed from 85% to 98% with dolomite and 97% with sodium zirconate. In addition, a considerable decrease was observed in the selectivity to by-products such as CH{sub 4} and CO{sub 2}. The amount of carbon deposited on the surface of the materials was determined. This increase in the production of hydrogen is attributable to a shift in the thermal dynamic equilibrium of the reforming reaction, according to the Chatelier's principle. [Spanish] Se ha estudiado la reaccion de reformacion de etanol combinada con la carbonatacion de un oxido metalico para la produccion de hidrogeno con captura de CO{sub 2} en un solo paso. Se utilizo una mezcla de un catalizador compuesto de 10 %wt Ni/Al{sub 2}O{sub 3} con un material absorbente de CO{sub 2}, tal como: CaO*MgO (dolomita calcinada) y Na{sub 2}ZrO{sub 3} (zirconato de sodio). Los materiales sintetizados fueron

  5. Terapia combinada con timolol/dorzolamida versus timolol/pilocarpina en el glaucoma primario de ángulo abierto Combined therapy with timolol and dorzolamide vs timolol and pilocarpine used in primary open-angle glaucoma

    Directory of Open Access Journals (Sweden)

    Frank García González

    2006-06-01

    Full Text Available El propósito de este trabajo fue evaluar la eficacia de la terapia combinada, timolol/dorzolamida, en comparación con timolol/pilocarpina. Se empleó tratamiento médico en 38 pacientes con glaucoma primario de ángulo abierto, a los que se les colocó en forma aleatoria timolol 0,5 %/dorzolamida 2 % (n. 19 o timolol 0,5 % y pilocarpina 2 % (n. 19 y posteriormente se analizaron los descensos de presión intraocular, efectividad durante cuatro semanas, efectos adversos locales y sistémicos. En el grupo de pacientes tratados con timolol/dorzolamida la presión intraocular media inicial (sin tratamiento descendió de 22,84 ± 1,77 mm Hg hasta 18,24 ± 1,84 mm Hg a las cuatro semanas de tratamiento, p. 0,01 (reducción de 4,60 mm Hg 22,14 %. En el grupo de pacientes tratados con timolol/pilocarpina la presión intraocular media inicial (sin tratamiento descendió de 23, 06 ± 1,29 mm Hg hasta 19,07 ± 1,23 mm Hg a la cuarta semana de tratamiento, p. 0,01 (reducción de 3,95 mm Hg /17,31 %, no se observaron diferencias significativas (p > 0,05 entre ambos tratamientos y fueron igualmente eficaces para reducir la presión intraocular. La calidad de vida de los pacientes que recibieron la dorzolamida como tratamiento coadyuvante fue superior, la dosificación disminuyó con respecto a la pilocarpina y no se presentaron efecto secundarios, tales como limitaciones para conducir y leer o dolor ocular, aunque refirieron sabor amargo cinco pacientes (26,31 % e irritación conjuntival dos pacientes (10,52 % relacionados con la dorzolamida. A mediano plazo se obtiene disminución de presión intraocular con dorzolamida como con la pilocarpina combinadas con el timolol. La dorzolamida demostró menos interferencia con la calidad de vida que la pilocarpinaThe objective of this study was to evaluate the efficacy of combined therapy with timolol and dorzolamide compared to timolol and pilocarpine. Thirty eight patients with primary open-angle glaucoma were

  6. Rituximab Injection

    Science.gov (United States)

    ... cells that normally fights infection) and chronic lymphocytic leukemia (CLL; a type of cancer that begins in ... fetus. You should use birth control to prevent pregnancy during your treatment with rituximab and for up ...

  7. Non-complicated cholelithiasis associated with GERD: Results of combined laparoscopic surgery in low risk patients Colelitiasis no complicada asociada con ERGE: Resultados de la cirugía laparoscópica combinada en pacientes con bajo riesgo quirúrgico

    Directory of Open Access Journals (Sweden)

    F. Pozo

    2004-04-01

    Full Text Available Objectives: the aim of this study was to evaluate the efficacy of combined laparoscopic surgery for non-complicated cholelithiasis and gastroesophageal reflux disease (GERD in patients with low surgical risk. Methods: a total of 680 cholecystectomies performed by means of laparoscopic surgery were retrospectively studied from February 1991 to February 2002. A total of 442 patients that fulfilled the inclusion criteria were divided into two groups: group A: non-complicated cholelithiasis (cholecystectomy alone, consisting of a total of 362 patients, and group B: non-complicated cholelithiasis and GERD (cholecystectomy and Toupet’s fundoplication in all cases in 80 patients. Demographic and clinical data, intraoperatory incidences, and post-surgical complications were prospectively collected and compared for all patients. The results of reflux surgery (group B were evaluated at 6 months by means of 24-hour pH-metry. Results: in spite of the fact that the group undergoing combined surgery consisted of patients with greater weight and older age (p Objetivos: el objetivo del presente estudio fue la valoración de la eficacia de la cirugía laparoscópica combinada de la colelitiasis no complicada y de la enfermedad por reflujo gastroesofágico (ERGE en pacientes con bajo riesgo quirúrgico. Métodos: desde febrero de 1991 a febrero de 2002 se realizaron 680 colecistectomías mediante cirugía laparoscópica, cumpliendo criterios de inclusión para el presente estudio un total de 442 pacientes que fueron divididos en dos grupos: grupo A: colelitiasis no complicada (colecistectomía sola con un total de 362 pacientes y grupo B: colelitiasis no complicada y ERGE (colecistectomía y reparación hiatal con funduplicatura tipo Toupet en 80 pacientes. En todos los pacientes se recogieron de forma prospectiva y se compararon datos demográficos y clínicos, incidencias peroperatorias y complicaciones post-intervención. Los resultados de la cirugía del

  8. Enfermedad pulmonar intersticial asociada a rituximab

    Directory of Open Access Journals (Sweden)

    Marcelo Fernández Casares

    2013-08-01

    Full Text Available La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evidencia de infección. Presentamos un caso de enfermedad pulmonar intersticial asociada a rituximab.

  9. Rituximab done

    DEFF Research Database (Denmark)

    Walker, Ulrich A; Jaeger, Veronika K; Chatzidionysiou, Katerina

    2016-01-01

    OBJECTIVE: To compare the effectiveness of biologics after rituximab (RTX) treatment in RA. METHODS: The effectiveness of TNF-α inhibitors (TNFi), abatacept (ABA) or tocilizumab (TCZ) was examined in patients previously treated with RTX using clinical data collected in the Collaborative Registries...... a greater decline of DAS28-ESR and clinical disease activity index than patients on TNFi (n = 89) or ABA (n = 90). This effect was also seen after adjusting for baseline prednisone use and the number of previous biologics. The mean DAS28-ESR scores in patients on TCZ were 1.0 (95% CI: 0.2, 1.7) and 1.8 (95......% CI: 1.0, 2.5) points lower than in patients on TNFi or ABA, respectively. In patients on TCZ, the clinical disease activity index was 9.4 (95% CI: 1.7, 16.1) and 8.1 (95% CI: 0.9, 15.3) points lower than on TNFi and ABA, respectively. Patients on TCZ more frequently had good EULAR responses than...

  10. Alteraciones metabólicas de la Hiperlipemia Familiar Combinada y su asociación con la obesidad abdominal y la inflamación de bajo grado

    OpenAIRE

    Díaz Ruiz, María

    2015-01-01

    La HFC es un síndrome dislipémico descrito por Goldstein et al en 1973 identificado al estudiar a jóvenes supervivientes de un infarto agudo de miocardio y a sus familias. Observaron en ellos diferentes fenotipos metabólicos y lipoproteicos, con presencia de elevaciones de los niveles de colesterol total y/o triglicéridos, junto con elevación de lipoproteínas VLDL, de LDL, o de ambas lipoproteínas. La HFC presenta el desarrollo de arteriosclerosis como la manifestación clínica responsable de...

  11. Polimorfismos Implicados en la Hiperlipemia Familiar Combinada

    OpenAIRE

    2015-01-01

    La Hiperlipemia Familar Combinada (HFC), es la hiperlipemia genética más frecuente asociada a enfermedad coronaria. Aunque fue descrita por Golstein et al en 1973, presenta un complejo fenotipo que no está bien entendido y que puede variar a lo largo de la vida. Se transmite de forma autosómica dominante, aunque no existe un único gen que la explique. Los pacientes presentan elevación de Colesterol Total y Triglicéridos así como una sobreproducción de VLDL y Apo B, y un deficiente aclaramien...

  12. Reporte de un caso clínico Técnica quirúrgica combinada de omentalización y drenaje transabdominal múltiple en un paciente canino con abscesos prostáticos

    OpenAIRE

    Diego Fernando Echeverry Bonilla; Edwin Fernando Buriticá Gaviria

    2006-01-01

    Se expone el caso clínico de un paciente canino mestizo de 7 años de edad, que fue presentado a consulta médica en la clínica de Pequeños Animales de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad del Tolima, por presentar un cuadro clínico consistente en: polaquiuria, disuria, tenesmo, fiebre, pérdida ponderal. La información obtenida a partir de la anamnesis, examen físico y estudios paraclínicos permitieron diagnosticar abscesos prostáticos, el tratamiento quirúrgico con...

  13. Enfermedad pulmonar intersticial asociada a rituximab

    OpenAIRE

    Marcelo Fernández Casares; Gisela Espósito; Alejandra González; Jaime Segovia; María de los Ángeles Galperín; Eduardo Del Valle

    2013-01-01

    La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evid...

  14. Reporte de un caso clínico Técnica quirúrgica combinada de omentalización y drenaje transabdominal múltiple en un paciente canino con abscesos prostáticos

    Directory of Open Access Journals (Sweden)

    Diego Fernando Echeverry Bonilla

    2006-12-01

    Full Text Available Se expone el caso clínico de un paciente canino mestizo de 7 años de edad, que fue presentado a consulta médica en la clínica de Pequeños Animales de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad del Tolima, por presentar un cuadro clínico consistente en: polaquiuria, disuria, tenesmo, fiebre, pérdida ponderal. La información obtenida a partir de la anamnesis, examen físico y estudios paraclínicos permitieron diagnosticar abscesos prostáticos, el tratamiento quirúrgico consistió en aplicar la combinación de dos técnicas quirúrgicas, la técnica de drenaje múltiple con dren de penrose mas omentalización.

  15. Bases científicas para el desarrollo de productos cárnicos funcionales con actividad biológica combinada Scientific bases for the development of functional meat products with combined biological activity

    Directory of Open Access Journals (Sweden)

    V. Palanca

    2006-04-01

    Full Text Available Las evidencias científicas sobre la relación entre la alimentación y la salud han dado lugar a la aparición de un nuevo mercado alimentario de rápido crecimiento desde hace algunos años: el mercado de los alimentos funcionales. Aunque el interés de mantener o mejorar el estado de salud mediante el consumo de alimentos tradicionales a los que se han incorporado ingredientes bioactivos es indudablemente alto, la población española, cada vez más formada e informada, es reticente a consumir alimentos funcionales, a menos que éstos posean una base científica rigurosa. En este artículo se presenta una revisión de las bases científicas sobre las que se ha sustentado el desarrollo de alimentos funcionales cárnicos con relación omega-6/omega-3 equilibrada y una combinación de antioxidantes sinérgicos, entre ellos un extracto de romero obtenido mediante extracción con CO2 supercrítico.The scientific evidences on the relationship between food and health have given place to a new food market of rapid growth in the last years: the market of the functional food. Though the interest of maintaining or improving the state of health by means of the consumption of traditional food with bioactive ingredients added is undoubtedly high, the Spanish population, increasingly formed and informed, is unwilling to consume functional food, until these possess a scientific rigorous base. This article presents a review of the scientific bases that support the development of functional meat products with balanced ratio omega-6/omega-3 and a combination of synergic antioxidants, among them an extract of rosemary obtained by means of extraction with supercritical CO2.

  16. Rituximab for Rheumatoid Arthritis.

    Science.gov (United States)

    Cohen, Marc D; Keystone, Edward

    2015-12-01

    Rituximab is a chimeric monoclonal antibody directed at the CD20 molecule on the surfaces of some but not all B cells. It depletes almost all peripheral B cells, but other niches of B cells are variably depleted, including synovium. Its mechanism of action in rheumatoid arthritis (RA) is only partially understood. Rituximab was efficacious in clinical trials of patients with RA, including those who are methotrexate naïve, those with an incomplete response to methotrexate, and those with an incomplete response to tumor necrosis factor inhibitors. The need for a concomitant traditional disease-modifying drug, the optimal dose of rituximab, and the optimal interval for retreatment remain somewhat uncertain. Rituximab seems to be most efficacious in seropositive patients and those with an incomplete response to only one tumor necrosis factor inhibitor. Rituximab has a reasonable safety profile, with a small risk of serious infectious events, which is stable over time and repeat courses. Opportunistic infections are rare. Reactivation of hepatitis B remains a concern. The possible association of rituximab and progressive multifocal leukoencephalopathy may still require vigilance. Malignancies and cardiovascular events do not appear to be increased. Infusion reactions are more likely with the initial infusion, and are usually mild. Rituximab may cause hypogammaglobulinemia, but any risk of subsequent risk of increased infectious events is not yet well established. Before initiating rituximab, patient screening for hypersensitivity to murine proteins, infections, congestive heart failure, pregnancy, and hypogammaglobulinemia is imperative. Vaccinations should be administered prior to treatment whenever possible. Rituximab has been a significant addition to the rheumatologists' armamentarium for the treatment of RA.

  17. Oxidación e inflamación en la hiperlipidemia familiar combinada.

    OpenAIRE

    Martínez Hervás, Sergio

    2007-01-01

    RESUMEN La hiperlipidemia familiar combinada (HFC) es una enfermedad muy frecuente, con una prevalencia estimada del 1-3% en la población general y hasta del 20% en pacientes con cardiopatía isquémica precoz. Su base metabólica y genética no ha sido todavía identificada, siendo el mecanismo más probable la interacción de diferentes genes y el ambiente. Se caracteriza por presentar varios fenotipos lipoproteicos en la misma familia, e incluso en el mismo individuo, a lo largo de su evolució...

  18. Rituximab para la oftalmopatía asociada a la tiroides

    Directory of Open Access Journals (Sweden)

    Neda Minakaran

    2013-09-01

    Conclusiones de los autores: Actualmente no hay pruebas suficientes para apoyar la administración de rituximab en los pacientes con OAT. Se necesitan ECA grandes que investiguen rituximab versus placebo o corticosteroides en pacientes con OAT activo para hacer valoraciones adecuadas sobre la eficacia y la seguridad de este tratamiento nuevo para esta enfermedad.

  19. [Novel uses of rituximab].

    Science.gov (United States)

    Frenzel, Laurent

    2013-12-01

    Since its approved by HAS in 1998, the use of rituximab increases every year. Marketed in France under the name MabThera, rituximab is used primarily in the treatment of B-cell malignancies including follicular lymphoma, diffuse large B-cell lymphoma and chronic lymphocytic leukemia and corresponding to the three main indications for treatment. However, given its action on B cells, rituximab also proves to be effective in rheumatoid arthritis. By extension as anti-B-cell, rituximab is actually used in other autoimmune diseases: in autoimmune cytopenias as idiopathic thrombocytopenic purpura and hemolytic anemia, in vasculitis, or multiple sclerosis, it is also used in organ transplantation as kidney in prophylaxy to rejection and treatment of EBV-mediated complications.

  20. Rituximab In Indolent Lymphomas

    Science.gov (United States)

    Sousou, Tarek; Friedberg, Jonathan

    2010-01-01

    Indolent Non Hodgkin's lymphoma (NHL) comprises a group of incurable, generally slow growing lymphomas highly responsive to initial therapy with a relapsing and progressive course. Rituximab, an anti CD-20 antibody, has had a large impact on treatment of indolent NHL. Its effectiveness as a single agent and in conjunction with known chemotherapy regimens has made it a standard of care in the treatment of NHL. Analysis of data obtained from NHL clinical trials as well as data from the National Cancer Institute indicates that the overall survival of indolent NHL has improved since the discovery of rituximab. Given its effectiveness and tolerability, it is currently being investigated as a maintenance agent with encouraging results. This review summarizes several landmark trials utilizing rituximab as a single agent and in combination with chemotherapy for treatment of NHL. In addition, a review of the studied rituximab maintenance dosing schedules and its impact on NHL will also be presented. Overall, rituximab has changed the landscape for treatment of indolent NHL however additional research is necessary to identify the optimal dosing schedule as well as patients most likely to respond to prolonged rituximab therapy. PMID:20350660

  1. Comparación de la eficacia y seguridad de la terapia combinada de cardiomioplastia celular con el factor estimulante de colonias de granulocitos en pacientes con cardiopatía isquémica en dos vías de implatación Comparison of efficacy and safety of combined therapy of cellular cardiomyoplasty and granulocyte colony stimulating factor in patients with ischemic cardiomyopathy in two routes of implantation

    Directory of Open Access Journals (Sweden)

    Juan M Senior

    2011-04-01

    Full Text Available Este estudio tiene como objetivo evaluar la eficacia y seguridad de la terapia combinada de cardiomioplastia celular con el factor estimulante de colonias de granulocitos en pacientes con cardiopatía isquémica, y explorar posibles diferencias entre la vía de implantación. METODOLOGÍA: se hizo un estudio de «antes y después» para datos longitudinales en el que se compararon variables ecocardiográficas y número de MET alcanzados en la prueba de esfuerzo antes, dos, seis y doce meses después del procedimiento; así mismo, se evaluaron la mortalidad y los efectos adversos de la terapia. Se exploraron diferencias en los resultados de acuerdo con la vía de implantación intracoronaria vs. epicárdica. RESULTADOS: se incluyeron dieciocho pacientes, 62,3% hombres, cuya edad promedio fue 49,4 ± 11,7 años y la fracción de eyección promedio fue 31% ± 0,04. La implantación se realizó por vía intracoronaria en doce pacientes y por vía epicárdica en seis. La mediana de fracción de eyección antes de la implantación de las células fue de 30% con un rango intercuartil de 28%-35% y la media de los MET fue de 6 con un rango intercuartil de 5-7; ambas variables, al igual que los volúmenes ventriculares de fin de diástole y sístole se incrementaron de forma significativa después del procedimiento, con tendencia a un mayor incremento de la fracción de eyección en el grupo de pacientes cuya vía de implantación fue la epicárdica en comparación con la vía intracoronaria; sin embargo, el número de pacientes en cada subgrupo impidió hacer análisis definitivos. Un paciente tuvo infección de la herida quirúrgica y tres murieron dos meses después de la implantación (uno de shock séptico y dos de shock cardiogénico. CONCLUSIÓN: en nuestro medio es factible realizar terapia combinada con cardiomioplastia celular y factor estimulante de colonias de granulocito; este es un procedimiento seguro con el que se obtiene una mejor

  2. Discovery – Development of Rituximab

    Science.gov (United States)

    NCI funded the development of rituximab, one of the first monoclonal antibody cancer treatments. With the discovery of rituximab, more than 70 percent of patients diagnosed with non-hodgkin lymphoma now live five years past their initial diagnosis.

  3. Epidemiologia das incontinências urinária e anal combinadas Epidemiología de las incontinencias urinaria y fecal combinadas Epidemiology of combined urinary and fecal incontinence

    Directory of Open Access Journals (Sweden)

    Claudia Regina de Souza Santos

    2009-06-01

    Full Text Available A baixa investigação pelos profissionais de saúde quanto às perdas urinárias e anais, combinadas ou não, dificultam as ações voltadas para sua prevenção e originam problemas com repercussões física, psicológica e econômica. A escassez de publicações nacionais e a reduzida literatura internacional sobre a epidemiologia dessas incontinências combinadas, motivou a realização deste artigo de atualização.Las pocas investigaciones realizadas por los profesionales de la salud en cuanto a las pérdidas urinarias y fecal, combinadas o no, dificultan las acciones volcadas a su prevención y originan problemas con repercusiones física, psicológica y económica. La escasez de publicaciones nacionales y la reducida literatura internacional sobre la epidemiología de esas incontinencias combinadas, motivó la realización de este artículo de actualización.The shortage of studies on urinary and fecal incontinence makes difficult the implementation of preventive and therapeutic interventions to address the physical, psychological, and economic problems among patients with these conditions. The lack of national publications and paucity of international literature on the epidemiology of combined urinary and fecal incontinence led to the performance of this literature review.

  4. Terapia combinada como estrategia en la prevención de la resistencia a los antimaláricos.

    Directory of Open Access Journals (Sweden)

    Pamela Orjuela

    2004-12-01

    Full Text Available La resistencia de Plasmodium falciparum a los antimaláricos es uno de los factores responsables del deterioro de la situación de la malaria en el mundo, que surge como resultado de la selección y posterior transmisión de mutantes espontáneos del parásito con susceptibilidad reducida a un fármaco. La terapia combinada es considerada como la principal estrategia para el control de la resistencia a los antimaláricos; actualmente, las terapias combinadas que incluyen derivados de la artemisinina son las más recomendadas. En Colombia se ha usado terapia combinada antimalárica por más de 20 años pero se desconoce su impacto en prevenir la diseminación de la resistencia. En este artículo se revisan las bases teóricas y los estudios clínicos que sustentan el uso de la terapia combinada y se discute su utilización en Colombia.

  5. Marcadores de inflamación e insulinorresistencia en la hiperlipemia familiar combinada

    OpenAIRE

    Carratalá Calvo, Arturo

    2014-01-01

    La hiperlipemia familiar combinada (HFC) es un modelo genético de dislipemia mixta con resistencia a la insulina (RI) y elevado riesgo de cardiopatía isquémica por el desarrollo precoz de arteriosclerosis. La RI es independiente del grado de obesidad y del fenotipo lipoproteico. Constituye, además, factor de riesgo cardiovascular en estos pacientes. Actualmente existe una gran evidencia de que en el desarrollo y progresión de la aterosclerosis subyacen mecanismos inmunológicos e inflamator...

  6. Tratamiento, mediante bloqueo de moléculas CD20 con Rituximab, en miopatías Inflamatorias Idiopáticas refractarias a tratamiento convencional

    OpenAIRE

    Chinchilla Palomares, Eduardo

    2012-01-01

    Las miopatías inflamatorias idiopáticas (MII) constituyen un grupo heterogéneo de enfermedades adquiridas, de probable mecanismo inflamatorio autoinmune, que se caracterizan por debilidad muscular e infiltrado inflamatorio local o difuso, junto con necrosis de las fibras musculares, en la biopsia muscular. Afectan preferentemente a la musculatura estriada. Dentro de este grupo se incluyen tres variantes principales: la dermatomiositis (DM), la polimiositis (PM) y la miositis con cuerpos de in...

  7. Rituximab in Minimal Change Disease

    Directory of Open Access Journals (Sweden)

    Nima Madanchi

    2017-03-01

    Full Text Available Treatment with rituximab, a monoclonal antibody against the B-lymphocyte surface protein CD20, leads to the depletion of B cells. Recently, rituximab was reported to effectively prevent relapses of glucocorticoid-dependent or frequently relapsing minimal change disease (MCD. MCD is thought to be T-cell mediated; how rituximab controls MCD is not understood. In this review, we summarize key clinical studies demonstrating the efficacy of rituximab in idiopathic nephrotic syndrome, mainly MCD. We then discuss immunological features of this disease and potential mechanisms of action of rituximab in its treatment based on what is known about the therapeutic action of rituximab in other immune-mediated disorders. We believe that studies aimed at understanding the mechanisms of action of rituximab in MCD will provide a novel approach to resolve the elusive immune pathophysiology of MCD.

  8. LA TEORÍA CONCEPTUAL COMBINADA APLICADA A LA ENSEÑANZA DE LA FÍSICA

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    Jorge Flores Herrera

    2016-02-01

    Full Text Available El propósito de este trabajo fue construir una red de integración conceptual utilizando la Teoría Conceptual Combinada de Gilles Fauconnier y Mark Turner, para lograr la integración de un dominio de la Física partiendo de un dominio de la Matemática. La red de integración conceptual se presenta con la entrada uno que engloba la integral de una función y con la entrada dos que engloba la integral del trabajo, el espacio genérico y el espacio combinado, con sus respectivas conexiones.

  9. Efecto de un anticuerpo monoclonal anti CD20 (Rituximab) en trombocitopenia inmune.

    OpenAIRE

    Untama, José; Médico, Departamento de Hematología, Hospital Nacional Edgardo Rebagliati Martins – EsSalud. Lima.; Del Carpio, Daniel; Médico, Departamento de Hematología, Hospital Nacional Edgardo Rebagliati Martins – EsSalud. Lima.

    2012-01-01

    Objetivo: Describir la respuesta terapéutica con un anticuerpo monoclonal anti CD20 (Rituximab), en pacientes con Trombocitopenia Inmune (PTI). Material y métodos: Estudio retrospectivo, descriptivo y observacional tipo serie de casos. Se revisaron las historias clínicas de pacientes adultos con PTI que recibieron el anticuerpo monoclonal anti CD20 (Rituximab), desde diciembre 2005 hasta diciembre 2010. Se definió respuesta: conteo plaquetario >30 mil, por lo menos duplicar el conteo plaqu...

  10. Hiperlipidemia familiar combinada: documento de consenso

    Directory of Open Access Journals (Sweden)

    Pedro Mata

    2014-10-01

    Es frecuente la asociación con diabetes mellitus tipo 2, hipertensión arterial y obesidad central. Los pacientes con HFC se consideran de riesgo cardiovascular alto y el objetivo terapéutico es un colesterol-LDL < 100 mg/dl, y < 70 mg/dl en presencia de enfermedad cardiovascular establecida o diabetes mellitus. Los pacientes con HFC requieren tratamiento con estatinas potentes y, a veces, tratamiento combinado. La identificación y el manejo de otros factores de riesgo cardiovascular, como la diabetes y la hipertensión, son fundamentales para reducir la carga de enfermedad cardiovascular. Este documento proporciona recomendaciones para el diagnóstico y el tratamiento integral de los pacientes con HFC especialmente dirigidas a médicos de atención primaria.

  11. Metodología de solución matheurística combinada con estrategias de reducción del espacio de solución para el problema de ruteamiento de vehículos eléctricos capacitados con estaciones de intercambio de baterías

    OpenAIRE

    Escobar Vargas, David

    2016-01-01

    El problema general de ruteamiento de vehículos (VRP) es un nombre genérico que hace referencia a una gran variedad de problemas aplicados en varias áreas del conocimiento como, transporte, cadena de suministros, planeamiento de producción, telecomunicaciones, entre otros. Lo que hace de este problema uno de los temas más estudiados del área de investigación de operaciones. Es un problema que se combina fácilmente con otros problemas pertenecientes a diversas áreas del conocimiento. En este c...

  12. Effects of dietary restriction combined with different exercise programs or physical activity recommendations on blood lipids in overweight adults Efectos de la restricción dietética combinada con diferentes programas de ejercicio o actividad física sobre los lípidos sanguíneos en adultos con sobrepeso

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    E. Morencos

    2012-12-01

    Full Text Available Background and aim: Many exercise studies, although generally showing the beneficial effects of supervised aerobic, resistance or combined exercise on blood lipids, have sometimes reached equivocal conclusions. The aim of this study is to evaluate the impact of different programs that combined exercise and dietary restriction on blood lipids versus a clinical practice intervention for weight loss, in overweight adults. Methods: For this study 66 subjects participated in a supervised 22 weeks training program, composed of three sessions per week and they were randomized in three groups: strength training (S; n = 19, endurance training (E; n = 25, a combination of E and S (SE; n = 22. Eighteen subjects served as physical activity group (PA that followed a clinical intervention consisted of physical activity recommendations. All groups followed the same dietary treatment, and blood samples were obtained for lipids measurements, at the beginning and end of the study. Results: Lipid profile improved in all groups. No significant differences for baseline and post-training values were observed between groups. In general, SE and PA decreased low-density lipoprotein cholesterol (LDL-C values (p Antecedentes y objetivo: Muchos estudios sobre ejercicio han proporcionado en ocasiones conclusiones equívocas, si bien, por lo general, han demostrado los efectos beneficiosos del ejercicio supervisado aeróbico, de resistencia o combinado. El propósito de este estudio fue evaluar el impacto de diferentes programas que combinan ejercicio y restricción dietética sobre los lípidos sanguíneos frente a una intervención de la práctica clínica de pérdida de ejercicio en los adultos con sobrepeso. Métodos: En este estudio participaron 66 individuos en un programa de entrenamiento supervisado de 22 semanas, compuesto por tres sesiones semanales y, posteriormente, se les distribuyó al azar en tres grupos: entrenamiento de fuerza (F; n = 19, entrenamiento de

  13. Terapias combinadas en la esquizofrenia, ¿Agregamos, mezclamos y confundimos, o bien, deconstruímos, y combinamos?.

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    Jorge Luis Tizón García

    2004-01-01

    Full Text Available Se realiza una reflexión sobre el estado actual de los programas terapéuticos o terapias que intentan combinar diversos tipos de terapias biológicas, psicológicas y psicosociales. Se ilustra el tema con viñetas clínicas de tratamientos de pacientes agorafóbicos y esquizofrénicos. La conclusión fundamental es que, hoy por hoy, con algunas excepciones, más que terapias combinadas se están practicando agregaciones de terapias o incluso mezclas más o menos confusas de terapias. Entre otros motivos, porque no se tienen en cuentan los criterios de calidad de una terapia, una consideración epistemológica más estricta de lo que debe ser una combinación de terapias, y la necesidad de de-construir las terapias previas y las combinadas y de investigar la eficacia, eficiencia, accesibilidad, etc de sus componentes. Con el fin de facilitar herramientas para la reflexión, se proponen una serie de tesis y principios para la organización de dichas terapias y se citan algunos intentos en tal sentido.

  14. Is rituximab effective for induction of remission in lupus nephritis?

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    Macarena Mac-Namara

    2014-08-01

    Full Text Available La combinación de ciclofosfamida y corticoides constituye el tratamiento estándar en pacientes con nefritis lúpica con indicación de terapia inmunosupresora mayor. Sin embargo, se asocia a importantes efectos adversos, por lo que existe interés en otros inmunosupresores como rituximab. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 19 bases de datos, identificamos 5 revisiones sistemáticas que en conjunto incluyen 24 estudios. Realizamos una síntesis mediante tablas de resumen de los resultados utilizando el método GRADE y concluimos que existe incertidumbre sobre la eficacia de rituximab en nefritis lúpica porque la certeza de la evidencia es muy baja, se asocia a efectos adversos importantes, y tiene alto costo. Rituximab no debiera utilizarse fuera de un estudio clínico, o sólo en casos en que otras alternativas han fracasado si es que no existen limitaciones de recursos.

  15. POR DESHIDRATACIÓN COMBINADA: OPTIMIZACION DEL PROCESO Y EVALUACIÓN DE LAEFICIENCIA ANTIOXIDANTE.

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    Mariana B. Laborde

    2015-01-01

    Full Text Available Se desarrolló un alimento deshidratado saludable de eleva da calidad nutricional y valor agregado: uva pasa de bajo contenido calórico, por deshidratación combinada asistida por ultrasonido mediante un tratamiento osmótico dual (D3S de dos etapas complementado por secado. U va rosada Red Globe producida en Mendoz a (Argentina se sometió a sustitución de sus azúcares por edulcorante natural Stevia en dos etapas osmóticas bajo diferentes condiciones ( tratamiento con/sin ultrasonido; concentración del edulcorante 18, 20, 22%p/p ; tiempo 35, 75 , 115 minutos , evaluando sólidos solubles (SS, humedad (M , polifenoles totales ( P F, eficiencia antioxidante (A E y perfil de azúcares. L a optimización múltiple del proceso por la metodología de superficie de respuesta y análisis de deseabilidad , permitió minimiza r M, maximizan do SS ( incorporación de Stevia y conservando la máxima cantidad PF. El tratamiento óptimo redujo un 32% los azúcares mayoritarios de la uva (sacarosa, glucosa tras la primera etapa, y el 57% de ellos al final del proceso.

  16. Efectos de una terapia combinada de ejercicio terapéutico basado en el método pilates y movilización neuromeníngea en pacientes con dolor lumbar crónico inespecífico. Estudio de casos.

    OpenAIRE

    González Sánchez, Andrea

    2014-01-01

    Trabajo Fin de Grado (TFG) Objetivo: Conocer los efectos de un programa de tratamiento que combina el ejercicio terapéutico basado en el método Pilates y la Movilización Neuromeníngea en pacientes con dolor lumbar crónico inespecífico irradiado a miembros inferiores. Diseño: Estudio de casos. Participantes: Muestra de 7 pacientes, todas ellas mujeres de entre 39 y 61 años de edad, que presentan dolor lumbar crónico inespecífico irradiado a miembros inferiores. Intervención: Se realizó un p...

  17. Efectos de una terapia combinada de ejercicio terapéutico basado en el método pilates y movilización neuromeníngea en pacientes con dolor lumbar crónico inespecífico. Estudio de casos.

    OpenAIRE

    González Sánchez, Andrea

    2014-01-01

    Trabajo Fin de Grado (TFG) Objetivo: Conocer los efectos de un programa de tratamiento que combina el ejercicio terapéutico basado en el método Pilates y la Movilización Neuromeníngea en pacientes con dolor lumbar crónico inespecífico irradiado a miembros inferiores. Diseño: Estudio de casos. Participantes: Muestra de 7 pacientes, todas ellas mujeres de entre 39 y 61 años de edad, que presentan dolor lumbar crónico inespecífico irradiado a miembros inferiores. Intervención: Se realizó un p...

  18. Análisis de falla para el mejor aprovechamiento de las instalaciones de la planta combinada maya de la refinería Fco. I. Madero

    OpenAIRE

    Salinas López, Gloria del Carmen

    2013-01-01

    El presente trabajo de investigación se centra en la realización de un análisis de falla como una perspectiva para el mejor aprovechamiento de las instalaciones de la planta combinada maya en la refinería Fco. I. Madero, para lo cual se efectuó un estudio en etapas, contemplando la reología del sistema y una metodología especifica, con la finalidad de conocer el mecanismo de daño en varias zonas de la línea de vapores de la torre 10005 y en el fondo de la torre 10005. El pre...

  19. Vulvovaginal pyoderma gangrenosum secondary to rituximab therapy.

    Science.gov (United States)

    Dixit, Shreya; Selva-Nayagam, Priya; Hamann, Ian; Fischer, Gayle

    2015-01-01

    Rituximab is being used increasingly for the treatment of B-cell malignancies and nonmalignant conditions. Pyoderma gangrenosum is a rare neutrophilic dermatosis, which can be either idiopathic or associated with underlying systemic inflammatory conditions. We present a series of 4 patients who presented with ulcerative pyoderma gangrenosum in the vulvovaginal area after treatment with rituximab.

  20. Tretamiento de rescate con Rituximab-CHOP seguido de Alemtuzumab en pacientes con elucemia linfática crónica refactarios o recaidos tras tratamiento con análogos de las purinas. | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available ab-CHOP seguido de Alemtuzumab (R-CHOP-A) en pacientes con leucemia linfática crónica refractarios o racaido...ión a formas citológicas o histológicas de mayor agresividad (leucemia prolinfocítica, linfoma de células gr...de cualquier procedimiento específico relacionado con el estudio.2.Edad >18 años y ...emia linfática crónica de acuerdo con los criterios diagnósticos establecidos (Apén

  1. Efecto de un anticuerpo monoclonal anti CD20 (Rituximab en trombocitopenia inmune

    Directory of Open Access Journals (Sweden)

    José Untama

    2012-10-01

    Full Text Available Objetivos: Describir la respuesta terapéutica con un anticuerpo monoclonal anti CD20 (Rituximab, en pacientes con Trombocitopenia Inmune (PTI. Material y métodos: Estudio retrospectivo, descriptivo y observacional tipo serie de casos. Se revisaron las historias clínicas de pacientes adultos con PTI que recibieron el anticuerpo monoclonal anti CD20 (Rituximab, desde diciembre 2005 hasta diciembre 2010. Se definió respuesta: conteo plaquetario >30 mil, por lo menos duplicar el conteo plaquetario inicial y no signos de sangrado, y respuesta completa: conteo plaquetario >100 mil y no signos de sangrado. Resultados: Se evaluaron 24 cursos de tratamiento. Hubo respuesta en 18 (75%, en una media de 11,9 semanas (rango 0,7 - 37,4, la duración media de respuesta fue 16 meses (rango 3,3 - 55,3. Se mantuvo la respuesta obtenida en 12 pacientes, seguimiento promedio de 22 meses (rango 4 - 62. Se logró respuesta completa en 13/23 (60% casos, en una media de 17 semanas (rango 0,7 - 62,3, con una duración media de respuesta completa de 10,1 meses (rango 2,3 - 25,2, 5 casos mantuvieron respuesta completa con una media de seguimiento de 20 meses (rango 8 - 29. Conclusiones: Se obtuvo una alta tasa de respuesta al tratamiento con Rituximab (hasta 75% en casos de PTI que fallaron al menos a una línea de tratamiento.

  2. Desensitization protocol for rituximab-induced serum sickness.

    Science.gov (United States)

    Fajt, Merritt L; Petrov, Andrej A

    2014-01-01

    Rituximab, a chimeric anti-CD20 monoclonal antibody, is used to treat rheumatologic and hematologic diseases. Serum sickness, a Type III delayed hypersensitivity reaction, has been reported with rituximab treatment. Traditionally, drug desensitization has been used to treat Type I IgE-mediated hypersensitivity reactions. We report the first case of successful drug desensitization to rituximab in a patient with medication-induced serum sickness. In our case, a 37-year-old woman with Sjogren's syndrome and papillary thyroid carcinoma developed serum sickness 72 hours following rituximab infusion for gastric mucosal associated lymphoma tissue (MALT). Her MALT progressed after stopping rituximab. She underwent a rapid 12-step intravenous rituximab desensitization without recurrence of serum sickness. Following the completion of 4 rituximab desensitizations, she had gastric MALT remission. She received 25 maintenance rituximab doses using this desensitization protocol quarterly without complications. This is the first report documenting rituximab desensitization for the treatment of delayed drug reactions like serum sickness.

  3. Hipolipemiantes y el uso de terapias combinadas en el tratamiento de las dislipidemias: una breve revisión

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    Julio César Fernández-Travieso

    2013-01-01

    Full Text Available El tratamiento de las dislipidemias tiene como objetivo fundamental disminuir la morbilidad y mortalidad cardiovascular, la cual constituye la primera causa de muerte en los países desarrollados, así como en Cuba. Diferentes estudios epidemiológicos han demostrado la correlación existente entre las concentraciones elevados de colesterol total y en particular, del transportado por las lipoproteínas de baja densidad (LDL - C, así como los beneficios clínicos de la terapia hipolipemiante a largo plazo en pacientes hipercolesterolémicos con o sin antecedentes cardiovasculares. El impacto de los hipolipemiantes en la reducción de la morbilidad y mortalidad cardiovascular ha sido demostrado en numerosos estudios. Los hipolipemiantes modifican las diferentes fracciones lipídicas mejorando su perfil y logrando una reducción de los eventos cardiovasculares. Su uso debe acompañarse siempre de cambios en los estilos de vida, ejercicio físico, así como de la valoración y tratamiento de otros factores de riesgo cardiovascular. Para poder aplicar de manera adecuada el tratamiento hipolipemiante, deben tomarse en consideración las recomendaciones de los paneles de expertos internacionales que ayudan a valorar al paciente desde el punto de vista del riesgo cardiovascular, así como tener en cuenta las características de los diferentes hipolipemiantes, sus indicaciones y contraindicaciones, a qué dosis pueden ser empleados, sus mecanismos de acción y sus eventos adversos, lo cual debe contribuir a lograr el perfil lipídico en cada paciente. En la presente revisión se reseñan brevemente las características de los diferentes hipolipemiantes, así como se aborda la aplicación de terapias combinadas en el tratamiento de las dislipidemias cuando es necesario. Se concluye que para un manejo más eficaz de las dislipidemias y el riesgo cardiovascular asociado se ha implementado la terapia farmacológica combinada con mecanismos de acci

  4. Rituximab in early systemic sclerosis.

    Science.gov (United States)

    Boonstra, Maaike; Meijs, Jessica; Dorjée, Annemarie L; Marsan, Nina Ajmone; Schouffoer, Anne; Ninaber, Maarten K; Quint, Koen D; Bonte-Mineur, Femke; Huizinga, Tom W J; Scherer, Hans U; de Vries-Bouwstra, Jeska K

    2017-01-01

    (1) Hypothesis testing of the potency of rituximab (RTX) in preventing fibrotic complications and (2) assessing acceptability and feasibility of RTX in early systemic sclerosis (SSc). A small, 24-month, randomised, double-blind, placebo-controlled, single-centre trial in patients with SSc diagnosed <2 years was conducted. Patients received RTX or placebo infusions at t=0, t=15 days and t=6 months. Patients were clinically evaluated every 3 months, with lung function tests and high-resolution CT every other visit. Skin biopsies were taken at baseline and month 3. Immunophenotyping of peripheral blood mononuclear cells was performed at every visit, except at months 9 and 18. Adverse events, course of skin and pulmonary involvement and B cell populations in skin and peripheral blood were evaluated. In total 16, patients (rituximab n=8, placebo n=8) were included. Twelve patients had diffuse cutaneous SSc. Eighty-eight adverse events (RTX n=53, placebo n=35, p=0.22) and 11 serious adverse events (RTX n=7, placebo n=4, p=0.36) occurred. No unexpected RTX-related events were observed. Mean skin score over time did not differ between the groups. Over time, forced vital capacity and extent of lung involvement slightly improved with RTX, but this difference was insignificant. In peripheral blood B cells depletion was demonstrated. No unexpected safety issues were observed with RTX in early SSc. Although this small trial could not confirm or reject potential efficacy of RTX in these patients, future placebo-controlled trials are warranted, specifically in the subgroup of patients with pulmonary involvement. EudraCT 2008-07180-16; Results.

  5. Rituximab-Induced Bronchiolitis Obliterans Organizing Pneumonia

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    Ahmet B. Ergin

    2012-01-01

    Full Text Available Rituximab-induced lung disease (R-ILD is a rare entity that should be considered in patients treated with rituximab who present with dyspnea, fever, and cough, but no clear evidence of infection. A variety of pathologic findings have been described in this setting. Bronchiolitis obliterans organizing pneumonia (BOOP is the most common clinicopathologic diagnosis, followed by interstitial pneumonitis, acute respiratory distress syndrome (ARDS, and hypersensitivity pneumonitis. Prompt diagnosis and treatment with corticosteroids are essential as discussed by Wagner et al. (2007. Here we present a case of an 82-year-old man who was treated with rituximab for recurrent marginal zone lymphoma. After the first infusion of rituximab, he reported fever, chills, and dyspnea. On computed tomography imaging, he was found to have bilateral patchy infiltrates, consistent with BOOP on biopsy. In our patient, BOOP was caused by single-agent rituximab, in the first week after the first infusion of rituximab. We reviewed the relevant literature to clarify the different presentations and characteristics of R-ILD and raise awareness of this relatively overlooked entity.

  6. Rituximab Retreatment for Low-Tumor Burden Follicular Lymphoma

    Science.gov (United States)

    A summary of results from a randomized clinical trial of patients with low–tumor burden follicular lymphoma that compared maintenance therapy with rituximab versus retreatment with rituximab only when there was evidence of disease progression.

  7. Desensitization to rituximab in a multidisciplinary setting.

    Science.gov (United States)

    Amorós-Reboredo, Patrícia; Sánchez-López, Jaime; Bastida-Fernández, Carla; do Pazo-Oubiña, Fernando; Borràs-Maixenchs, Núria; Giné, Eva; Valero, Antonio; Creus-Baró, Natàlia

    2015-10-01

    The need to offer first-line therapy to the increasing number of patients who have suffered an hypersensitivity reaction has stimulated the use of rapid desensitization protocols. To present our experience working as a multidisciplinary team using a rituximab rapid desensitization scheme. Patient demographics, allergic reaction, skin tests to rituximab, number of desensitizations, reactions during the desensitization protocol and actions taken, number of administered and completed cycles, were retrospectively collected in patients who received at least one desensitization to rituximab. Number of desensitizations successfully managed. Between 2012 and June 2013 five patients received a total of 19 desensitizations to rituximab using a 12 step rapid desensitization protocol. All patients received the scheduled chemotherapeutic cycles as inpatients, with no delay in administration dates. Three patients presented a hypersensitivity reaction during the first desensitization and in one patient the event occurred again during the second treatment cycle. All reactions occurred in the last step, when the infusion rate reached the maximum speed. The developed protocol for rapid desensitization was successful in five patients receiving rituximab. Patients could receive the full intended dose.

  8. Acquired Hemophilia A successfully treated with rituximab

    Directory of Open Access Journals (Sweden)

    Giovanni D'Arena

    2015-02-01

    Full Text Available Acquired hemophilia A (AHA is a rare bleeding disorder due to the development of specific autoantibodies against factor VIII. The anti-CD20 monoclonal antibody Rituximab has been proven to be effective in  obtaining a long-term suppression of inhibitors of AHA,  besides other immunosuppressive standard treatments. Here we describe a case of idiopathic AHA in a 60-year old man successfully treated with rituximab. He showed a complete clinical response with  a normalization of clotting  parameters after 5 weekly courses of rituximab given at a dose of 375 mg/sqm. , but after stopping rituximab, an initial worsening of coagulation  parameters  induced the addition of 3 further courses. At present, the patient is in complete clinical and hematological remission after 200 days.  This case confirms that Rituximab may be a safe and useful tool to treat AHA and, a prolonged administration can overcome the initial resistance. However, the precise position of this drug in the therapeutic strategy (first or second-line, alone or in combination with other drugs remains to be established and warrants further investigation.

  9. Rituximab in high-grade lymphoma.

    Science.gov (United States)

    Zwick, Carsten; Murawski, Niels; Pfreundschuh, Michael

    2010-04-01

    In 1997, the approval of the anti-CD20 antibody rituximab heralded a new era of combined immunochemotherapy for the treatment of malignant lymphoma. Until then, a combination of cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) had been the standard of treatment for aggressive B-cell lymphoma for more than 25 years. The addition of rituximab led to an impressive improvement of response rates and survival outcomes in patients with follicular and diffuse large B-cell lymphoma (DLBCL) that has been confirmed in several randomized trials. Remaining challenges in the rituximab era are the identification of the optimal chemotherapy partner with respect to synergistic effects, as well as to the lack of interference with its effector mechanisms. Finally, the question of the optimal dosage and schedule of rituximab has to be addressed in well-designed randomized trials. The outcome of patients relapsing after a rituximab-containing induction regimen is dismal even with high-dose therapy and autologous stem cell transplantation (ASCT). For these patients new modalities of second-line therapy are urgently warranted.

  10. Rituximab Administration and Reactivation of HBV

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    Yutaka Tsutsumi

    2010-01-01

    Full Text Available Rituximab is a drug used for the treatment of B-cell non-Hodgkin's lymphoma, and its range of use has expanded to the treatment of collagen diseases such as idiopathic thrombocytopenic purpura and rheumatoid arthritis. One serious complication of rituximab use is the reactivation of dormant hepatitis B virus, and prevention of this phenomenon has become an urgent issue. This paper provides a general outline of the problem through an analysis of patient cases that we and other groups have experienced to date.

  11. Rituximab induced hypoglycemia in non-Hodgkin's lymphoma

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    Lali V

    2006-12-01

    Full Text Available Abstract Background Hypoglycemia is a vary rare toxicity of rituximab. The exact mechanism of rituximab induced hypoglycemia is not clear. Case presentation A 50 year old female presented with a left tonsillar non Hodgkin's lymphoma and was started on R-CHOP chemotherapy. Twenty four hours after the first rituximab infusion, she developed hypoglycemia which was managed by IV glucose infusion. Conclusion Hypoglycemia following rituximab administration is rare. Possibilities of hypoglycemia should be kept in mind in patients developing symptoms like fatigue, restlessness, and sweating while on rituximab therapy.

  12. Immunotherapy with rituximab in follicular lymphomas.

    Science.gov (United States)

    Saguna, Carmen; Mut, Ileana Delia; Lupu, Anca Roxana; Tevet, Mihaela; Bumbea, Horia; Dragan, Cornel

    2011-04-01

    Non-Hodgkin Lymphomas (NHL) represent a recent and fascinating domain of hemato-oncology, in which remarkable progress has been made. The conventional treatments of indolent lymphomas do not extend the survival rate, nor do they cure. Recent directions are centered on using several new drugs that are capable of overcoming the mechanisms that are resistant to recovery. The initiation of immunotherapy (Rituximab in 1997) seems to have changed the natural evolution of follicular lymphomas (FL). It is possible that resistance to healing in follicular lymphomas may be neutralized with Rituximab by suppressing STAT-1 positive macrophages that are present in the cellular microenvironment.Thereinafter, the re-evaluation of recent models of prognostic and therapeutic paradigmas that were used in FL became compulsory.The purpose of the paper is to compare the evolution of patients with follicular lymphoma and the period of response, according to the treatments. The study group consisted of the 71 patients diagnosed with follicular lymphoma, out of a total of 767 malignant lymphatic proliferations with B cells, for a period of 7 years (2002-2008), at the Hematology Department, Hospital Coltea, Bucharest and Hematology Department, Universitary Hospital, BucharestResults and conclusions: Combining chemotherapy with Rituximab had better results compared to the same chemotherapy, administered alone, both in induction and in case of relapse. The overall response rate in our study group was 74.7%, out of which 42.3% complete remissions. The overall response rate was 84.61% in the Rituximab group, compared to 68.88% in patients without Rituximab.

  13. Estudio del manejo anestésico perioperatorio en los pacientes intervenidos por metástasis hepáticas de cáncer colorrectal: Anestesia general "versus" anestesia combinada

    OpenAIRE

    Pérez Navarro, Guillermo Ignacio; Serrablo Requejo, Alejandro; Martínez Ubieto, Javier; Borrego Estella, Vicente Manuel

    2013-01-01

    Introducción: En la actualidad, existe suficiente experiencia acumulada en estudios retrospectivos y prospectivos como para considerar la resección hepática como el tratamiento de elección para algunos pacientes con metástasis hepáticas de cáncer colorrectal. La técnica anestésica combinada (Anestesia general asociada a técnica analgésica epidural) es una opción anestésico-analgésica aceptada y utilizada frecuentemente para el manejo perioperatorio de cirugía abdominal mayor, torácica y cardi...

  14. Rituximab in treatment of idiopathic glomerulopathy

    Directory of Open Access Journals (Sweden)

    Kamel El-Reshaid

    2012-01-01

    Full Text Available The aim of our study was to assess the role of rituximab (Mabthera in the treatment of patients with corticosteroid-resistant and calcineurin-inhibitors ± cellcept refractory idiopathic nephrotic syndrome (INS. A total of 83 patients who had required the previous treatment for a minimum of two years were included in the study. Our protocol included the use of rituximab in four-weekly slow infusions. Five patients were excluded as they could not tolerate rituximab infusion for allergic reaction. As expected, none of the patients had a decline in the total circulating lymphocyte counts yet all had achieved decline of their initially normal CD20 to < 0.5% one month after infusion. The decline persisted for eight to ten months later. In the minimal change disease (MCD group, 31 of the 32 patients had complete remission (CR and were off any immunosuppressive therapy and one of the previous non-responders (NR did not respond. Excluding two patients who had required retreatment, the others remained in CR (17 up to 28 months and six up to 36 months. Treatment with rituximab resulted in amelioration of NS in 17 of the 18 patients with focal segmental glomerulosclerosis (FSGS, while only one patient remained NR. Although renal function remained stable, proteinuria reappeared by eight to 12 months. Retreatment with rituximab resulted in a similar response with stable kidney function. In the 28 patients with membranous glomerulopathy (MG, 24 had achieved CR. Two patients failed to respond and two had partial remission. By 12 months, all patients relapsed. The response was within one month following treatment in patient with MCD, but was gradual within three months in FSGS and MG. Relapsers in all groups responded in a similar pattern to repeat dosing with the drug subsequently. Our prospective study represents an adequate number of patients with biopsy-proven subgroups of INS in both children and adults with long-term follow-up of treatment with rituximab

  15. Rituximab use in the catastrophic antiphospholipid syndrome: descriptive analysis of the CAPS registry patients receiving rituximab.

    Science.gov (United States)

    Berman, Horacio; Rodríguez-Pintó, Ignasi; Cervera, Ricard; Morel, Nathalie; Costedoat-Chalumeau, Nathalie; Erkan, Doruk; Shoenfeld, Yehuda; Espinosa, Gerard

    2013-09-01

    The catastrophic variant of the antiphospholipid syndrome (APS) is characterized by thrombosis in multiple organs developing over a short period of time. First-line treatment for the catastrophic APS is the combination of anticoagulation plus corticosteroids plus plasma exchange and/or intravenous immunoglobulin. Despite this regimen, the mortality remains high and new treatment options are needed. By a systematic review of the Catastrophic APS Registry (CAPS Registry), we identified 20 patients treated with rituximab. The purpose of this study is to describe the clinical manifestations, laboratory features, and outcomes of rituximab-treated CAPS patients. In addition, the rationale for using rituximab in catastrophic APS is discussed. Copyright © 2013 Elsevier B.V. All rights reserved.

  16. Meningite após técnica combinada para analgesia de parto: relato de caso Meningitis después de técnica combinada para analgesia de parto: relato de caso Meningitis after combined spinal-epidural analgesia for labor: case report

    Directory of Open Access Journals (Sweden)

    Carlos Escobar Vásquez

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Meningite é uma complicação grave em anestesia regional, embora rara de ocorrer. O objetivo deste relato é mostrar um caso de uma paciente que evoluiu com meningite após realização de analgesia de parto pela técnica combinada (raqui-peridural com dupla punção. RELATO DO CASO: Paciente com 25 anos, segunda gestação e cesariana anterior, em trabalho de parto. Foi realizada analgesia de parto pela técnica combinada (raqui-peridural com dupla punção. Após 24 horas apresentou cefaléia em repouso, picos de hipertermia, calafrios discretos, que regrediram com medicação sintomática. No 5º dia a cefaléia piorou. No 10º dia surgiram vômitos e dor na nuca. No 13º dia os sintomas tornaram-se mais intensos. Foi realizada punção lombar. A história clínica e o exame do líquor foram compatíveis com meningite bacteriana. CONCLUSÕES: A técnica combinada (raqui-peridural para analgesia do parto está próxima do ideal. Cuidados com a técnica de anti-sepsia são necessários para realização de bloqueios espinhais. A complicação apresentada ocorreu sem a aparente falha na realização da técnica, sendo uma questão que é inerente ao risco-benefício que a técnica proporciona.JUSTIFICATIVA Y OBJETIVOS: Meningitis es una complicación grave en anestesia regional, no obstante, rara de ocurrir. El objetivo de este relato es mostrar un caso de una paciente que evolucionó con meningitis después de realización de analgesia de parto por la técnica combinada (raqui-peridural con dupla punción. RELATO DEL CASO: Paciente con 25 anos, segunda gestación y cesariana anterior, en trabajo de parto. Fue realizada analgesia de parto por la técnica combinada (raqui-peridural con dupla punción. Después de 24 horas presentó cefalea en reposo, picos de hipertermia, calofríos discretos, que mejoraron con medicación sintomática. En el 5º día la cefalea peoró. En el 10º día surgieron vómitos y dolor en la

  17. Update on the use of rituximab for intractable rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    R John Looney

    2009-07-01

    Full Text Available R John LooneyUniversity of Rochester, Rochester, New York, USAAbstract: It has been 3 years since rituximab, a mouse x human chimeric anti-CD20 monoclonal antibody that selectively depleted B cells, was approved by the FDA for the treatment of moderate to severe rheumatoid arthritis (RA with an inadequate response to anti-TNF therapies. Since approval rituximab has become a part of standard treatment, and additional data have become available on long-term efficacy and safety both from clinical trials and from post-marketing surveillance. In open long-term follow-up from clinical trials, patients treated with multiple courses of rituximab continued to respond in terms of signs and symptoms, and damage assessed radiographically was significantly inhibited. Moreover, the rate of serious infectious events was not increased as the number of courses increased. However, because of case reports of progressive multifocal leukoencephalopathy in patients treated with rituximab for non-malignant conditions, a black box warning has been added. Studies on the immunologic correlates of response to rituximab treatment including B cell subsets in peripheral blood and synovial biopsies are providing clues into how rituximab works for autoimmune disease. However, at this time we are not able to explain why some patients do not respond and cannot predict who will respond. Future challenges for the further development of rituximab for intractable RA will be discussed.Keywords: rheumatoid arthritis, rituximab, B cells, immunocompetency

  18. Rituximab treatment in patients with refractory inflammatory myopathies

    NARCIS (Netherlands)

    Mahler, E.A.; Blom, M.; Voermans, N.C.; Engelen, B.G. van; Riel, P.L. van; Vonk, M.C.

    2011-01-01

    Objective. To assess the efficacy of rituximab on disease activity and muscle strength in patients with inflammatory myopathies refractory to conventional therapy. Methods. Thirteen patients were treated with rituximab 1000 mg i.v., twice, with a 2-week interval and followed for a median of 27 month

  19. Low-dose rituximab is effective in pemphigus

    NARCIS (Netherlands)

    Horvath, B.; Huizinga, J.; Pas, H. H.; Mulder, A. B.; Jonkman, M. F.

    2012-01-01

    Background Rituximab, an anti-CD20 antibody, was shown in open series studies to be effective in treating pemphigus at a dose of 4 x 375 mg m(-2) as approved for B-cell malignancies. Objectives We investigated whether a lower dose of rituximab is also effective for pemphigus. Methods Patients with p

  20. Rapid Infusion Rituximab for Maintenance Therapy: Is It Feasible?

    Directory of Open Access Journals (Sweden)

    Jolly Patel

    2013-01-01

    Full Text Available Rituximab is an anti-CD-20 monoclonal antibody used in the management of lymphoproliferative disorders. The use of maintenance rituximab has improved progression free survival and overall survival in follicular lymphomas. Although rapid rituximab infusions have been studied extensively, there is little data on the use of rapid infusions during maintenance therapy for low grade lymphomas. The primary objective of this retrospective analysis was to evaluate the incidence of Grade 3 and 4 toxicities with maintenance rapid infusion rituximab according to the Common Terminology Criteria for Adverse Events version 4 (CTC v. 4. Secondary objectives included evaluating all grade infusion related adverse events and correlation of adverse events with varying schedules of rituximab maintenance therapy. All patients who received rapid infusion rituximab as maintenance therapy for low grade lymphoma between December 2007 and November 2011 were included. Rapid rituximab infusions were administered over 90 minutes. Demographic, laboratory and clinical data were collected. A total of 109 patients received 647 rapid rituximab infusions. Three patients experienced an adverse reaction which resulted in one grade 1 infusion reaction and three grade 3 infusion reactions. No patients required hospitalization. All 3 patients received pharmacological and/or supportive care to relieve symptoms associated with the reaction.

  1. B Cell Depletion: Rituximab in Glomerular Disease and Transplantation

    Directory of Open Access Journals (Sweden)

    S. Marinaki

    2013-12-01

    Full Text Available B cells play a central role in the pathogenesis of many autoimmune diseases. Selective targeting can be achieved with the use of the monoclonal antibody rituximab. In addition to being a drug for non-Hodgkin's lymphoma, rituximab is also an FDA-approved treatment for refractory rheumatoid arthritis and, since recently, ANCA vasculitis. It has shown efficacy in many autoimmune diseases. This review will discuss current evidence and the rationale of the use of rituximab in glomerular diseases, including randomized controlled trials. The focus will be on the use of rituximab in idiopathic membranous nephropathy, systemic lupus erythematosus and ANCA-associated vasculitis. The emerging role of rituximab in renal transplantation, where it seems to be important for the desensitization protocols for highly sensitized patients as well as for the preconditioning of ABO-incompatible recipients and the treatment of antibody-mediated rejection, will also be addressed.

  2. Rituximab and chlorambucil versus rituximab alone in gastric mucosa-associated lymphoid tissue lymphoma according to t(11;18) status: a monocentric non-randomized observational study.

    Science.gov (United States)

    Lévy, Michaël; Copie-Bergman, Christiane; Amiot, Aurélien; Dupuis, Jehan; Le Baleur, Yann; Belhadj, Karim; Hémery, François; Sobhani, Iradj; Delfau-Larue, Marie-Hélène; Leroy, Karen; Haioun, Corinne; Delchier, Jean-Charles

    2013-05-01

    Forty-nine patients, t(11;18)-positive (n = 31) and t(11;18)-negative (n = 18), were treated without randomization with rituximab-chlorambucil or rituximab alone. Evaluation was performed at week (W) 6, week (W) 25 and every 6 months (Wx). Comparing the rituximab-chlorambucil group to the rituximab-alone group, remission was obtained in 93% vs. 66% at W6 (p = 0.01), in 93% vs. 81% at W25 (p = 0.14) and in 93% vs. 76% at Wx (p = 0.07). Comparing the rituximab-chlorambucil group to the rituximab-alone group in t(11;18)-positive patients, remission was obtained in 100% vs. 45% at W6 (p = 0.0005), in 100% vs. 66% at W25 (p = 0.01) and in 96% vs. 55% at Wx (p = 0.01). Comparing the rituximab-chlorambucil group to the rituximab-alone group in t(11;18)-negative patients, remission was obtained in 66% vs. 83% at W6 (p = 0.32), in 66% vs. 92% at W25 (p = 0.22) and in 83% vs. 92% at Wx (p = 0.47). In conclusion, rituximab-chlorambucil is significantly more rapidly efficient than rituximab alone. In t(11;18)-positive patients, the combination is more efficient than rituximab alone. In t(11;18)-negative patients, rituximab alone is as efficient as rituximab-chlorambucil and may be an alternative treatment.

  3. Microcosting Study of Rituximab Subcutaneous Injection Versus Intravenous Infusion.

    Science.gov (United States)

    Mihajlović, Jovan; Bax, Pieter; van Breugel, Erwin; Blommestein, Hedwig M; Hoogendoorn, Mels; Hospes, Wobbe; Postma, Maarten J

    2017-06-01

    The goal of this study is to identify and compare all direct costs of intravenous and subcutaneous rituximab given to patients with diffuse large B-cell lymphoma in the Netherlands. Using a prospective, observational, bottom-up microcosting study, we collected primary data on the direct medical costs of the preparation, administration, and acquisition of rituximab. Drug costs and costs of drug wastage, labor costs, material costs, and outpatient costs were identified using standardized forms, structured using prices from official pricelists, and compared for the intravenous and subcutaneous forms of rituximab. Measurements were taken on 53 rituximab administrations (33 intravenous and 20 subcutaneous) and on 13 rituximab preparation (7 intravenous and 6 subcutaneous). The mean total costs were €2176.77 for the intravenous infusion and €1911.09 for the subcutaneous injection. The estimated difference of €265.17 (95% CI, €231.99-`€298.35) per administration was mainly attributable to differences in time spent in the chemotherapy unit, related outpatient costs, drug wastage, and drug costs. Rituximab administered in the form of subcutaneous injection is less costly than its intravenous form. With their equal effectiveness taken into account, subcutaneous rituximab administration can result in significant savings when transferred to the total diffuse large B-cell lymphoma population in the Netherlands. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

  4. The Evolving Role of Rituximab in Adult Minimal Change Glomerulopathy.

    Science.gov (United States)

    Brown, Landon C; Jobson, Meghan A; Payan Schober, Fernanda; Chang, Emily H; Falk, Ronald J; Nachman, Patrick H; Pendergraft, William F

    2017-01-01

    Minimal-change glomerulopathy is defined histologically by the presence of normal glomeruli on light microscopy and diffuse podocyte effacement on electron microscopy. Although effective in children, corticosteroid treatment in adults is more variable and time to response can be prolonged. Data to support rituximab use in adults with corticosteroid-dependent or resistant minimal-change glomerulopathy are limited. Here, we describe the clinical course of adults with corticosteroid-dependent or -resistant minimal-change glomerulopathy who received rituximab. Demographic and clinical data were collected and analyzed from all adult patients with native kidney, biopsy-proven, minimal-change glomerulopathy who were administered rituximab between 2009 and 2014 and cared for at the UNC Kidney Center. Ten patients with corticosteroid-resistant (n = 5) or corticosteroid-dependent (n = 5) idiopathic minimal-change glomerulopathy were treated with rituximab between 2009 and 2014. Rituximab treatment induced remission in all 10 patients with a median time to remission of 2 months. The median time from rituximab to corticosteroid discontinuation was 3.5 months. The median remission time was 29 months and follow-up time was 39.5 months. No serious adverse events attributable to rituximab were observed. Rituximab induced remission in all patients with corticosteroid-dependent or -resistant minimal-change glomerulopathy, and may hold great therapeutic potential with good efficacy and minimal toxicity. Mounting evidence implies that a well-conducted randomized controlled clinical trial using rituximab in adults with minimal-change glomerulopathy in both corticosteroid-resistant and corticosteroid-dependent patients is warranted. © 2017 S. Karger AG, Basel.

  5. The evaluation and optimal use of rituximab in lymphoid malignancies

    Directory of Open Access Journals (Sweden)

    Smolewski P

    2012-01-01

    Full Text Available Tadeusz Robak1, Pawel Robak2, Piotr Smolewski21Department of Hematology, 2Experimental Hematology, Medical University of Łódź, Łódź, PolandAbstract: Rituximab is an IgG1, chimeric monoclonal antibody (mAb containing murine light- and heavy-chain variable-region sequences and human constant-region sequences. Rituximab targets the CD20 molecule expressed on normal and malignant B-lymphocytes. At present, rituximab is the most important mAb of clinical value in patients with B-cell lymphoid malignancies. Since approval in 1997, rituximab has become widely used in chronic lymphocytic leukemia (CLL, follicular lymphoma (FL, mantle cell lymphoma (MCL, and diffused large B-cell lymphoma (DLBCL when combined with chemotherapy. Currently, rituximab is commonly combined with first-line chemotherapy for FL and should be offered as maintenance therapy to all appropriate patients with this disease. Randomized Phase III trials demonstrated the superiority of rituximab added to CHOP chemotherapy against CHOP chemotherapy alone in patients with DLBCL. Rituximab alone has limited activity in MCL but can be used in MCL in combination with chemotherapy, despite the benefits not being as impressive as when used against other lymphoma entities. In addition, for the less frequent B-cell lymphomas, small series show considerable activity for most of these entities. Fludarabine and rituximab combination therapies in CLL yielded promising results in several studies. Two large Phase III randomized trials demonstrated the superiority of chemoimmunotherapy with rituximab compared with chemotherapy alone in previously untreated and refractory/relapsed patients with CLL. Therefore, it can be concluded that rituximab, with only few exceptions, can generally be accepted as a standard component of anti B-cell non-Hodgkin's lymphoma therapies. In this review, the pharmacology, mode of action, pharmacokinetics, and current place in the therapy of B-cell lymphoid

  6. ENFERMEDAD DE BOWEN TRATADA CON CRIOTERAPIA COMBINADA CON IMIQUIMOD TOPICO AL 5%. TRATAMIENTO ALTERNATIVO A LA CIRUGÍA EN PACIENTES MAYORES CON CO-MORBILIDADES

    Directory of Open Access Journals (Sweden)

    Lezcano Liz

    2011-04-01

    Full Text Available Bowen's disease (BD is an in situ squamous cell carcinoma in which dysplastic changes occur throughout the full thickness of the epidermis. It usually affects fair-skinned people over 60 years. It is characterized by erythematous papules and plaques solitary or multiple, with a slow centrifugal growth. The differential diagnosis of BD should be established with chronic dermatoses such as psoriasis, chronic eczema, superficial basal cell carcinoma and Paget's disease of the skin. Only 5% of cases progress to invasive squamous cell carcinoma. We report the case of a woman of 63 years of age with BD treated with cryotherapy combined with topical 5% imiquimod who responded adequately to this combination therapy.

  7. Efecto de la fertilización orgánica y química en suelos degradados cultivados con maíz (zea mays l.) en el estado Yaracuy, Venezuela.

    OpenAIRE

    Arrieche Luna, Isabel Elena

    2011-01-01

    Se planteó mejorar los problemas de degradación de suelos cultivados con maíz en el estado Yaracuy, Venezuela, incrementando su rendimiento con la aplicación combinada de fertilización orgánica y química. Se caracterizaron tres abonos orgánicos agroindustriales: dos estiércoles de gallinaza y cachaza de caña de azúcar, se estudió el N mineralizado de dos suelos degradados: El Rodero y La Virgen, ambos alfisoles. Se determinaron dosis óptima y económica de rendimiento combinadas de NPK con cac...

  8. Is rituximab effective for induction of remission in ANCA-associated vasculitis?

    Directory of Open Access Journals (Sweden)

    Carmen Rain

    2015-08-01

    Full Text Available La adición de rituximab al tratamiento con corticoides se ha planteado como alternativa terapéutica para inducir remisión en las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos (ANCA, especialmente en pacientes con deseo de preservar fertilidad que persisten activos después del tratamiento estándar, o en aquellos que tienen contraindicación o mala tolerancia a ciclofosfamida. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos solo una revisión sistemática que incluye tres estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de rituximab podría resultar en poca o nula diferencia en mortalidad, mientras que existe incertidumbre sobre si disminuye las recaídas o aumenta los efectos adversos serios, como infecciones o neoplasias.

  9. Experience of polymyositis and antisynthetase syndrome treatment with rituximab

    Directory of Open Access Journals (Sweden)

    S. G. Palshina

    2012-01-01

    Full Text Available The patient with polymyositis and antisynthetase syndrome treated with rituximab (Mabtera is described. Rituximab was added to thehigh‑dose cyclophosphamide therapy due to an acute onset of the disease with a highly progressive interstitial lung disease and inability of the high‑dose corticosteroids therapy because of comorbidity. There was almost complete normalization of pulmonary and muscular pathological changes with more than 4‑fold decrease of anti‑Jo‑1 antibodies on the treatment. No complications and no side effects during rituximab therapy were noted. This case report demonstrates the positive effect of rituximab in combination with high‑dose cyclophosphamide in the treatment of acute AS syndrome. The results published in literature are discussed.

  10. Prolonged Remission in Neuromyelitis Optica Following Cessation of Rituximab Treatment.

    Science.gov (United States)

    Weinfurtner, Kelley; Graves, Jennifer; Ness, Jayne; Krupp, Lauren; Milazzo, Maria; Waubant, Emmanuelle

    2015-09-01

    Neuromyelitis optica is an autoimmune disease characterized by acute episodes of transverse myelitis and optic neuritis. Several small, open-label studies suggest rituximab, a monoclonal antibody against CD20, prevents relapses in neuromyelitis optica; however, there is little consensus on timing or duration of treatment. Here we report four patients with severe relapsing neuromyelitis optica who were stabilized on rituximab and, after discontinuing treatment, continued to experience prolonged remission of their disease. Remission ranged from 4.5 to 10.5 years total, including 3 to 9 years off all therapies. The patients had sustained clinical responses despite normal B-lymphocyte levels and, in at least 2 patients, continued seropositivity for aquaporin-4 antibodies. These cases suggest that rituximab may induce prolonged remission in certain neuromyelitis optica patients, and they highlight the need for further elucidation of rituximab's mechanism in neuromyelitis optica.

  11. Rituximab-induced interstitial lung disease

    DEFF Research Database (Denmark)

    Naqibullah, Matiuallah; Shaker, Saher B; Bach, Karen S

    2015-01-01

    Rituximab (RTX), a mouse/human chimeric anti-CD20 IgG1 monoclonal antibody has been effectively used as a single agent or in combination with chemotherapy regimen to treat lymphoma since 1997. In addition, it has been used to treat idiopathic thrombocytopenic purpura, systemic lupus erythematous......, rheumatoid arthritis, and autoimmune hemolytic anemia. Recently, RTX has also been suggested for the treatment of certain connective tissue disease-related interstitial lung diseases (ILD) and hypersensitivity pneumonitis. Rare but serious pulmonary adverse reactions are reported. To raise awareness about...... this serious side effect of RTX treatment, as the indication for its use increases with time, we report five cases of probable RTX-ILD and discuss the current literature on this potentially lethal association....

  12. Rituximab-Associated Inflammatory Progressive Multifocal Leukoencephalopathy

    Science.gov (United States)

    Schofield, Christina; Harris, Penelope

    2016-01-01

    Progressive multifocal leukoencephalopathy (PML) is a rare disease of the immunosuppression that results from neurotropic invasion of the JC virus which leads to demyelination of oligodendrocytes. Immune reconstitution inflammatory syndrome (IRIS), on the other hand, is a condition of inflammation that develops as the immune system reconstitutes. This case report describes a case of a 35-year-old HIV-negative male who presented with three weeks of right lower extremity paresthesias as well as right upper extremity apraxia. He was diagnosed with PML complicated by IRIS secondary to Rituximab, which he had completed four months prior to presentation. Despite the condition's poor prognosis, the patient recovered with only minor deficits. PMID:27965904

  13. Metabolomic profiling predicts outcome of rituximab therapy in rheumatoid arthritis

    OpenAIRE

    Sweeney, Shannon R; Kavanaugh, Arthur; Lodi, Alessia; Wang, Bo; Boyle, David; Tiziani, Stefano; Guma, Monica

    2016-01-01

    Objective: To determine whether characterisation of patients' metabolic profiles, utilising nuclear magnetic resonance (NMR) and mass spectrometry (MS), could predict response to rituximab therapy. 23 patients with active, seropositive rheumatoid arthritis (RA) on concomitant methotrexate were treated with rituximab. Patients were grouped into responders and non-responders according to the American College of Rheumatology improvement criteria, at a 20% level at 6 months. A Bruker Avance 700 M...

  14. Rituximab: An emerging therapeutic agent for kidney transplantation

    Directory of Open Access Journals (Sweden)

    Joseph Kahwaji

    2009-10-01

    Full Text Available Joseph Kahwaji, Chris Tong, Stanley C Jordan, Ashley A VoComprehensive Transplant Center, Transplant immunology Laboratory, HLA Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USAAbstract: Rituximab (anti-CD20, anti-B-cell is now emerging as an important drug for modification of B-cell and antibody responses in solid-organ transplant recipients. Its uses are varied and range from facilitating desensitization and ABO blood group-incompatible transplantation to the treatment of antibody-mediated rejection (AMR, post-transplant lymphoproliferative disorder (PTLD, and recurrent glomerular diseases in the renal allograft. Despite these uses, prospective randomized trials are lacking. Only case reports exist in regards to its use in de novo and recurrent diseases in the renal allograft. Recent reports suggests that the addition of rituximab to intravenous immunoglobulin (IVIG may have significant benefits for desensitization and treatment of AMR and chronic rejection. Current dosing recommendations are based on data from United States Food and Drug Administration-approved indications for treatment of B-cell lymphomas and rheumatoid arthritis. From the initial reported experience in solid organ transplant recipients, the drug is well tolerated and not associated with increased infectious risks. However, close monitoring for viral infections is recommended with rituximab use. The occurrence of progressive multifocal leukoencephalopathy (PML has been reported with rituximab use. However, this is rare and not reported in the renal transplant population. Here we will review current information regarding the effectiveness of rituximab as an agent for desensitization of highly human leukocyte antigen-sensitized and ABO-incompatible transplant recipients and its use in treatment of AMR. In addition, the post-transplant use of rituximab for treatment of PTLD and for recurrent and de novo glomerulonephritis in the allograft will be discussed. In

  15. Clinical evaluation of rituximab treatment for neuromyelitis optica.

    Science.gov (United States)

    Fernández-Megía, M J; Casanova-Estruch, B; Pérez-Miralles, F; Ruiz-Ramos, J; Alcalá-Vicente, C; Poveda-Andrés, J L

    2015-10-01

    Neuromyelitis optica is an inflammatory and usually relapsing demyelinating autoimmune disease of the central nervous system that targets the optic nerves and spinal cord. Rituximab has been used for different neurological diseases that are probably immune-mediated or involving humoural immunity. The objective of this study is to evaluate the efficacy and safety of rituximab as treatment for neuromyelitis optica in a tertiary hospital. Retrospective study of patients with neuromyelitis optica treated with rituximab 1000mg on days 1 and 15, repeated every 6 to 8 months. We recorded EDSS score, relapse rate, overall condition, CD19+ count, presence of anti-NMO antibodies, and possible adverse reactions. Six patients were treated; all were women with a median age of 46 years (range, 38-58). Anti-NMO antibodies were detected in 3 patients (50%). Baseline EDSS was 4 (range 2.0-5.5). Two patients had previously been treated with an immunomodulatory drug. Median time from the first rituximab infusion to first relapse was 3.7 years (range 1.7-6.9). Two patients had infusion reactions after the first dose of rituximab. Four patients remained relapse-free and their EDSS score did not progress during rituximab treatment, one patient showed no clinical improvement, and one patient could not be evaluated. Rituximab can be considered an attractive therapeutic alternative for patients with neuromyelitis optica as there are no approved treatments for this disease. Further studies with rituximab are needed to establish the role of this drug in treating neuromyelitis optica. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Acquired haemophilia A in a patient with chronic hepatitis C virus infection receiving treatment with pegylated interferon plus ribarivin: role of rituximab.

    Science.gov (United States)

    Fernández de Palencia Espinosa, M Á; Arocas Casañ, V; Garrido Corro, B; de la Rubia Nieto, A

    2013-01-01

    Antecedentes: la hemofilia adquirida es un trastorno infrecuente causado por el desarrollo de inhibidores del factor de coagulación. Para eliminarlos, se requiere tratamiento con corticoides y fármacos citotóxicos. Métodos: describimos el caso del uso de rituximab en hemofilia adquirida refractaria al tratamiento convencional en un hombre de 63 años con infección crónica por el virus de la hepatitis C y que estaba recibiendo tratamiento con interferón pegilado a-2a y ribarivina. Resultados: tras 21 semanas de tratamiento antivírico, el paciente fue ingresado en el hospital por un gran hematoma en la musculatura abdominal. La concentración de factor VIII era nula y el título de inhibidor fue de 345 unidades Bethesda. Se administró tratamiento inmunosupresor oral con metilprednisolona y ciclofosfamida durante 1 mes, con escasa mejoría. Así pues, se sustituyó la ciclofosfamida por una dosis semanal de rituximab intravenoso. Dos meses después, la concentración de factor VIII se normalizó y el título de inhibidor era indetectable. Conclusión: Rituximab puede ser útil en el tratamiento de la hemofilia adquirida resistente al tratamiento estándar.

  17. Reconstrucción de antebrazo con colgajo DIEP: caso clínico

    OpenAIRE

    2015-01-01

    Las heridas complejas del antebrazo con fracturas asociadas y pérdida circunferencial de piel, suponen un doble reto reconstructivo. Mostramos el tratamiento de una paciente con lesiones combinadas en el miembro superior tras atrapamiento por rodillos fríos industriales mediante el uso de un colgajo libre de perforante del eje epigástrico inferior profundo (DIEP), tras tratamiento de la fractura articular de la extremidad distal de radio guiado por artroscopia. Conseguimos la estabilización d...

  18. Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua Analgesia de parto: estudio comparativo entre anestesia combinada raqui-peridural versus anestesia peridural continua Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Figueiredo Côrtes

    2007-02-01

    ão necessários para avaliar diferença na incidência de cesarianas.JUSTIFICATIVA Y OBJETIVOS: El alivio del dolor en el trabajo de parto ha recibido una atención constante objetivando el bienestar materno, disminuyendo el estrés causado por el dolor y reduciendo las consecuencias de éste sobre el concepto. Innumerables técnicas pueden ser utilizadas para la analgesia de parto. Este trabajo tuvo como objetivo comparar la técnica peridural continua con la combinada, ambas con el uso de bupivacaína a 0,25% en exceso enantiomérico 50% y fentanil como agentes. MÉTODO: Participaron del estudio 40 parturientes en trabajo de parto con dilatación cervical entre 4 y 5 cm que se repartieron en de los grupos iguales de forma aleatoria. El Grupo I recibió anestesia peridural continua. El Grupo II recibió anestesia combinada. Se evaluaron: medidas antropométricas, edad de embarazo, dilatación cervical, tiempo entre el bloqueo y la ausencia de dolor a través de la escala analógica visual, posibilidad de deambulación, tiempo entre el inicio de la analgesia y la dilatación cervical completa, duración del período expulsivo, parámetros hemodinámicos maternos y vital edad del recién nacido. Posibles complicaciones como depresión respiratoria, hipotensión arterial materna, prurito, náuseas y vómitos también fueron observados. Para la comparación de los promedios se utilizó el teste t de Student y para la paridad y tipo de parto se utilizó el teste del Qui-cuadrado. RESULTADOS: No hubo diferencia estadística significativa entre los de los grupos con relación al tiempo entre el inicio de la analgesia y la dilatación cervical completa, como también con relación al tiempo de la duración del período expulsivo, incidencia de cesárea relacionada con la analgesia, parámetros hemodinámicos maternos y vital edad del recién nacido. CONCLUSIONES: Las dos técnicas fueron eficaces y seguras para la analgesia del trabajo de parto, aunque la técnica combinada haya

  19. Rituximab tolerability when given before or after CHOP.

    Science.gov (United States)

    Hannawa, Idan S; Bestul, Daniel J

    2011-12-01

    To determine the tolerability of rituximab, specifically cytokine release syndrome/acute infusion reactions (CRS), when it is administered before or after cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy in patients with non-Hodgkin's lymphoma (NHL). This study is a retrospective analysis of patients identified through pharmacy chemotherapy records. Inclusion criteria were diagnosis of NHL, first cycle of rituximab with CHOP or modified CHOP (mCHOP), treated between 1/1/04 and 6/30/09, age 18 years and greater, and inpatient status. Patients were excluded if their records/information were unavailable. Patients were divided into two groups based on practices observed at our institution: rituximab followed by CHOP (R-CHOP) or CHOP followed by rituximab (CHOP-R). Patient records were reviewed to determine demographic data, CRS, vital signs, evidence of chills/rigors, use of rescue medications, and rituximab infusion rates. One-hundred thirteen patients meeting the inclusion criteria were divided into two groups: R-CHOP (n=29) and CHOP-R (n=84). R-CHOP patients experienced numerically more CRS (65.5% vs. 42.9%, p=0.0517) and significantly more chills/rigors (p=0.0376). Maximum and minimum oxygen (O(2)) saturations were significantly lower in the R-CHOP group (p=0.0444 and 0.0165, respectively). Maximum temperature was significantly higher in the R-CHOP group (p=0.0047). There was no difference between groups in use of rescue medications (p=1). R-CHOP patients required significantly more rate reductions (p=0.0431) than CHOP-R patients, although there was no difference in final tolerated rate between groups. Patients with NHL who receive rituximab after CHOP experience significantly fewer chills/rigors, higher oxygen saturations, lower maximum temperatures, and fewer rate reductions than patients who receive rituximab before CHOP.

  20. Rituximab for children with immune thrombocytopenia: a systematic review.

    Directory of Open Access Journals (Sweden)

    Yi Liang

    Full Text Available BACKGROUND: Rituximab has been widely used off-label as a second line treatment for children with immune thrombocytopenia (ITP. However, its role in the management of pediatric ITP requires clarification. To understand and interpret the available evidence, we conducted a systematic review to assess the efficacy and safety of rituximab for children with ITP. METHODOLOGY/PRINCIPAL FINDINGS: We searched MEDLINE, EMBASE, Cochrane Library, CBM, CNKI, abstract databases of American Society of Hematology, American Society of Clinical Oncology and Pediatric Academic Society. Clinical studies published in full text or abstract only in any language that met predefined inclusion criteria were eligible. Efficacy analysis was restricted to studies enrolling 5 or more patients. Safety was evaluated from all studies that reported data of toxicity. 14 studies (323 patients were included for efficacy assessment in children with primary ITP. The pooled complete response (platelet count ≥ 100 × 10(9/L and response (platelet count ≥ 30 × 10(9/L rate after rituximab treatment were 39% (95% CI, 30% to 49% and 68% (95%CI, 58% to 77%, respectively, with median response duration of 12.8 month. 4 studies (29 patients were included for efficacy assessment in children with secondary ITP. 11 (64.7% of 17 patients associated with Evans syndrome achieved response. All 6 patients with systemic lupus erythematosus associated ITP and all 6 patients with autoimmune lymphoproliferative syndrome associated ITP achieved response. 91 patients experienced 108 adverse events associated with rituximab, among that, 91 (84.3% were mild to moderate, and no death was reported. CONCLUSIONS/SIGNIFICANCE: Randomized controlled studies on effect of rituximab for children with ITP are urgently needed, although a series of uncontrolled studies found that rituximab resulted in a good platelet count response both in children with primary and children secondary ITP. Most adverse events

  1. Sistema de tareas para la enseñanza combinada de la gramática comunicativa y la gramática tradicional de lengua inglesa

    Directory of Open Access Journals (Sweden)

    Nancy del Carmen Jiménez Figueredo

    2015-03-01

    Full Text Available Se realizó el diseño de un sistema de tareas para la enseñanza combinada de la gramática comunicativa y la gramática tradicional de lengua inglesa, con metodología cuali-cuantitativa, en la Facultad de Ciencias Médicas “Zoilo Marinello Vidaurreta” de la Universidad de Ciencias Médicas de Las Tunas, durante el período comprendido entre septiembre de 2011 y julio de 2014. El objetivo estuvo direccionado a perfeccionar la corrección lingüística en el proceso de enseñanza-aprendizaje del idioma Inglés. La realización del diseño contó con: una revisión bibliográfica de los principales enfoques utilizados en la enseñanza-aprendizaje del Inglés; la revisión documental, que permitió determinar las insuficiencias lingüísticas y la necesidad de combinar la gramática comunicativa con la gramática tradicional, en los estudiantes del cuarto año de la carrera de Estomatología; el intercambio con profesionales con más de quince años de experiencia, para obtener información acerca del proceso de enseñanza-aprendizaje de la gramática; y la aplicación de una valoración equivalente al juicio de expertos, método de agregados individuales, para valorar la propuesta. Los principales resultados fueron: la caracterización de las insuficiencias provocadas por la absolutización del enfoque comunicativo en la enseñanza de la gramática de la lengua inglesa y el diseño de un sistema de tareas para el proceso de enseñanza-aprendizaje de la gramática inglesa en estos estudiantes

  2. Severe Primary Raynaud's Disease Treated with Rituximab

    Science.gov (United States)

    Almoallim, Hani

    2016-01-01

    Raynaud's phenomenon refers to reversible spasms of the peripheral arterioles that can be primary Raynaud's phenomenon (PRP) or secondary Raynaud's phenomenon (SRP) to underlying connective tissue disease, both of which are characterized by a triphasic color response triggered by cold exposure or stress. PRP is typically a benign disease, whereas SRP may progress into digital ulcers and/or gangrene. Here, we report a case of a 55-year-old female diagnosed with PRP 7 years ago. Treatment with first-line agents, including calcium channel blocker, aspirin, and phosphodiesterase inhibitor, did not control her symptoms, which progressed to digital ulceration and gangrene. There were no symptoms of underlying autoimmune disease or malignancy, and autoimmune, serology, and immunology test results were normal; a biopsy of her left little finger was negative for vasculitis. Development to critical digital ischemia necessitated treatment with intravenous iloprost and heparin infusion followed by angioplasty, which led to a partial improvement. Due to persistent symptoms, rituximab therapy was initiated and two cycles induced a complete resolution of symptoms. PMID:27651971

  3. Infectious complications of rituximab therapy in renal disease.

    Science.gov (United States)

    Nixon, Andrew; Ogden, Leanne; Woywodt, Alexander; Dhaygude, Ajay

    2017-08-01

    Rituximab, an anti-CD20 monoclonal antibody, was originally used to treat B-cell malignancies. Its use has significantly increased in recent years, as it is now also used to treat a variety of autoimmune diseases including rheumatoid arthritis and ANCA-associated vasculitis (AAV). Initial studies suggested that the adverse effects of rituximab were minimal. Though the risk of malignancy with rituximab-based immunosuppressive regimens appears similar to that of the general population, there are now concerns regarding the risk of infectious complications. Rituximab has been associated with serious infections, including Pneumocystis jiroveci pneumonia (PJP) and the reactivation of hepatitis B virus (HBV) and tuberculosis (TB). The risk of infection appears to be the result of a variety of mechanisms, including prolonged B-cell depletion, B-cell-T-cell crosstalk, panhypogammaglobulinaemia, late-onset neutropenia and blunting of the immune response after vaccination. Importantly, the risk of infectious complications is also related to individual patient characteristics and the indication for rituximab. Individualization of treatment is, therefore, crucial. Particular attention should be given to strategies to minimize the risk of infectious complications, including vaccinating against bacterial and viral pathogens, monitoring white cell count and immunoglobulin levels, prophylaxis against PJP and screening for HBV and TB.

  4. Cytomegalovirus enterocolitis in a patient with diffuse large B-cell lymphoma after chemotherapy with rituximab

    Institute of Scientific and Technical Information of China (English)

    Jason Seewoodhary

    2006-01-01

    Rituximab has been associated with the development of cytomegalovirus enterocolitis in immunosuppressed patients. A 51-year-old patient with diffuse large B-cell lymphoma who received a conditioning chemotherapy regimen (RCVP and RICE) consisting of rituximab before bone marrow transplantation went on to develop cytomegalovirus enterocolitis. This supports evidence from previously described cases that rituximab may be associated with cytomegalovirus enterocolitis.

  5. Efectividad de la microonda, masoterapia y ejercicios de Williams en pacientes con dolor lumbar

    OpenAIRE

    Antonio del Valle Torres; Nadia Rosa Hechavarría Almaguer; Carlos López Peña; Raúl Barceló Reyna

    2015-01-01

    Fundamento: el dolor lumbar constituye un problema de salud a nivel mundial, su tratamiento constituye un reto en la práctica médica asistencial. Objetivo: evaluar la efectividad de la microonda, masoterapia y ejercicios de Williams en pacientes con dolor lumbar. Método: se realizó un estudio prospectivo experimental en una muestra de 60 pacientes con lumbalgia subaguda y crónica. Se asignaron dos esquemas de tratamiento: uno con microonda combinada con masoterapia y ejercicios de Wil...

  6. Efectividad de la microonda, masoterapia y ejercicios de Williams en pacientes con dolor lumbar

    OpenAIRE

    Antonio del Valle Torres; Nadia Rosa Hechavarría Almaguer; Carlos López Peña; Raúl Barceló Reyna

    2015-01-01

    Fundamento: el dolor lumbar constituye un problema de salud a nivel mundial, su tratamiento constituye un reto en la práctica médica asistencial. Objetivo: evaluar la efectividad de la microonda, masoterapia y ejercicios de Williams en pacientes con dolor lumbar. Método: se realizó un estudio prospectivo experimental en una muestra de 60 pacientes con lumbalgia subaguda y crónica. Se asignaron dos esquemas de tratamiento: uno con microonda combinada con masoterapia y ejercicios de Wil...

  7. RITUXIMAB: NEW POTENTIALITIES OF THERAPY FOR RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    D E Karateev

    2008-01-01

    Full Text Available Some patients with rheumatoid arthritis (RA are unresponsive or intolerant to both synthetic first-line anti-inflammatory drugs (FLAID and tumor necrosis factor (TNF а inhibitors already included into all the treatment standards . Along with the conventional methods for overcoming drug resistance - switching to another FLAID or another TNF а blocker, the use of biologicals with another mechanism of action rather than suppression of TNF а gives a good account of itself. Prominent among these agents is the anti-B-cell drug rituximab. The new possibilities of the therapy, which open up the use of rituximab in patients with RA, are discussed.

  8. Rituximab-based immunosuppression for autoimmune haemolytic anaemia in infants.

    Science.gov (United States)

    Svahn, Johanna; Fioredda, Francesca; Calvillo, Michaela; Molinari, Angelo C; Micalizzi, Concetta; Banov, Laura; Schmidt, Madalina; Caprino, Daniela; Marinelli, Doretta; Gallisai, Domenico; Dufour, Carlo

    2009-04-01

    We report a case series of four infants with severe autoimmune haemolytic anaemia (AIHA) who responded to treatment with rituximab and cyclosporine after having failed first line therapy with high-dose steroid (prednisolone 4-8 mg/kg/d). Rituximab was started at 11-90 d from onset due to continued haemolysis; three infants also received cyclosporine A. Three of four infants reached complete response, defined as normal haemoglobin, reticulocytes and negative indices of haemolysis, at 7-21 months from diagnosis. In long-term follow-up two infants remained disease-free with normal immunology, one had undefined immunodeficiency and one had autoimmune lymphoproliferative syndrome.

  9. Rituximab as a possible cause of posterior reversible encephalopathy syndrome

    Directory of Open Access Journals (Sweden)

    Ahmed Imran Siddiqi

    2011-09-01

    Full Text Available A 66-year-old woman presented with new onset generalisedtonic-clonic seizures following her first dose ofchemotherapy comprising Rituximab, Cyclophosphamide,Hydroxydaunorubicin, Oncovin and Prednisolone (R-CHOP10 days earlier for non-Hodgkin’s lymphoma. On admission,computed tomography (CT scan of the cranium showed noabnormality. The CT was repeated within 48 hours as thepatient developed status epilepticus and papilledema; therepeat scan showed characteristics of posterior reversibleencephalopathy syndrome (PRES. Association of rituximabwith this condition was suspected as there was norecurrence of PRES after receiving two more cycles of CHOPwithout rituximab. Contrary to previously published casereports, this patient had a delayed clinical presentation.

  10. Research demystifies the interaction between Rituximab and its target

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ As the first US FDA-approved monclonal antibody drug for the treatment of B-cell lymphomas and later on for the treatment of autoimmune diseases, Rituximab has been widely sold under the trade name of Rituxan ever since 1997 with an average sales volume over US$ 2 billion each year in the US.However, the recognition mechanism between Rituximab and its target CD20, an antigen expressed on the surface of mature B-cells, remained unclear. Now, an important step toward decoding the longstanding problem is achieved by scientists at the CAS Shanghai Institutes for Biological Sciences(SIBS) and their collaborators from the Second Military Medical University.

  11. Estudio del funcionamiento neurocognitivo en la infección por VIH en la era de las terapias antirretrovirales combinadas

    OpenAIRE

    Muñoz-Moreno, Jose Antonio

    2012-01-01

    La tesis titulada “Estudio del Funcionamiento Neurocognitivo en la Infección por VIH en la Era de las Terapias Antirretrovirales Combinadas" desarrollada por el doctorando Jose Antonio Muñoz-Moreno se planteó como objetivos principales a su inicio: 1.- Centrar la problemática de la disfunción neurocognitiva dentro del marco de la investigación científica en el ámbito de la infección por VIH. 2.- Recoger datos preliminares en España sobre la frecuencia de las alteraciones neurocognitiv...

  12. Estudio del funcionamiento neurocognitivo en la infección por VIH en la era de las terapias antirretrovirales combinadas

    OpenAIRE

    Muñoz-Moreno, Jose Antonio; Navarro Acebes, Xavier

    2013-01-01

    La tesis titulada "Estudio del Funcionamiento Neurocognitivo en la Infección por VIH en la Era de las Terapias Antirretrovirales Combinadas" desarrollada por el doctorando Jose Antonio Muñoz-Moreno se planteó como objetivos principales a su inicio: 1.- Centrar la problemática de la disfunción neurocognitiva dentro del marco de la investigación científica en el ámbito de la infección por VIH. 2.- Recoger datos preliminares en España sobre la frecuencia de las alteraciones neurocognitivas en la...

  13. Rituximab treatment in rheumatoid arthritis: how does it work?

    NARCIS (Netherlands)

    Boumans, M.J.H.; Tak, P.P.

    2009-01-01

    Treatment with the chimerical monoclonal antibody rituximab results in CD20-directed B cell depletion. Although this depletion is almost complete in the peripheral blood of nearly all patients with rheumatoid arthritis, a proportion of patients does not exhibit a clinical response. The paper by Nako

  14. Rituximab (MabThera) til behandling af aktiv reumatoid artritis

    DEFF Research Database (Denmark)

    Fassi, Daniel El; Nielsen, Claus Henrik; Bendtzen, Klaus

    2006-01-01

    Rituximab (RTX) is a murine/human monoclonal antibody to CD20, a protein expressed almost exclusively on human B-lymphocytes. RTX induces rapid and marked B-cell depletion with beneficial clinical effects in 1/3 to 1/2 of rheumatoid arthritis patients. Treatment is given as two iv. infusions with...

  15. Rituximab-Based Treatment, HCV Replication, and Hepatic Flares

    Directory of Open Access Journals (Sweden)

    Evangelista Sagnelli

    2012-01-01

    Full Text Available Rituximab, a chimeric mouse-human monoclonal antibody directed to the CD20 antigen expressed on pre-B lymphocytes and mature lymphocytes, causes a profound B-cell depletion. Due to its peculiar characteristics, this drug has been used to treat oncohaematological diseases, B cell-related autoimmune diseases, rheumatoid arthritis, and, more recently, HCV-associated mixed cryoglobulinaemic vasculitis. Rituximab-based treatment, however, may induce an increased replication of several viruses such as hepatitis B virus, cytomegalovirus, varicella-zoster virus, echovirus, and parvovirus B19. Recent data suggest that rituximab-based chemotherapy induces an increase in HCV expression in hepatic cells, which may become a target for a cell-mediated immune reaction after the withdrawal of treatment and the restoration of the immune control. Only a few small studies have investigated the occurrence of HCV reactivation and an associated hepatic flare in patients with oncohaematological diseases receiving R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. These studies suggest that the hepatic flares are frequently asymptomatic, but life-threatening liver failure occurs in nearly 10% of cases.

  16. Rituximab treatment in rheumatoid arthritis: how does it work?

    NARCIS (Netherlands)

    Boumans, M.J.H.; Tak, P.P.

    2009-01-01

    Treatment with the chimerical monoclonal antibody rituximab results in CD20-directed B cell depletion. Although this depletion is almost complete in the peripheral blood of nearly all patients with rheumatoid arthritis, a proportion of patients does not exhibit a clinical response. The paper by

  17. Microcosting Study of Rituximab Subcutaneous Injection Versus Intravenous Infusion

    NARCIS (Netherlands)

    Mihajloviç, Jovan; Bax, Pieter; van Breugel, Erwin; Blommestein, Hedwig M.; Hoogendoorn, Mels; Hospes, Wobbe; Postma, Maarten J.

    Purpose: The goal of this study is to identify and compare all direct costs of intravenous and subcutaneous rituximab given to patients with diffuse large B-cell lymphoma in the Netherlands.  Methods: Using a prospective, observational, bottom-up microcosting study, we collected primary data on the

  18. Rituximab for the treatment of patients with chronic lymphocytic leukemia

    Directory of Open Access Journals (Sweden)

    M Gentile

    2010-03-01

    Full Text Available M Gentile, E Vigna, C Mazzone, E Lucia, AG Recchia, L Morabito2, MG Bisconte, C Gentile, F Morabito1UOC di Ematologia, Azienda Ospedaliera di Cosenza, Italy; 2Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, La Laguna, Tenerife, SpainAbstract: Chronic lymphocytic leukemia (CLL is a lymphoproliferative disorder that originates from antigen-experienced B lymphocytes that do not die and hence accumulate due to external survival signals or undergo apoptosis and are replenished by proliferating precursors. These neoplastic lymphocytes exhibit a characteristic immunophenotype of CD5+/CD19+/CD20+/HLA-DR+/CD23+/sIgdim. Thus, the CD20 antigen has been an appealing target for therapy. The introduction of the monoclonal antibody rituximab (anti-CD20 enabled an outstanding advance in CLL treatment. The introduction of this monoclonal antibody into chemotherapy regimens has dramatically improved complete response rates and progression-free survival in patients with both untreated and relapsed CLL. Although only preliminary data from phase III confirmatory trials have been reported, the FCR regimen, which combines fludarabine and cyclophosphamide with rituximab, is currently the most effective treatment regimen for CLL patients, and has also been demonstrated to significantly improve overall survival . The success of rituximab and the identification of other CLL lymphocyte surface antigens have spurred the development of a multitude of monoclonal antibodies targeting distinct proteins and epitopes in an attempt to target CLL cells more effectively.Keywords: rituximab, chronic lymphocytic leukemia, chemotherapy

  19. Linfoma B de zona marginal extranodal tipo MALT de conjuntiva bilateral tratado con radioterapia y anticuerpo monoclonal en un paciente con orbitopatía distiroidea

    Directory of Open Access Journals (Sweden)

    Sara Isabel Plazola Hernández

    2014-04-01

    Full Text Available Una mujer de 42 años con orbitopatía distiroidea presenta aumento de volumen conjuntival bilateral con reporte de linfoma no hodgkiniano de patrón folicular tipo MALT CD45 y 20 positivos. Se trata del primer caso de orbitopatía distiroidea y el desarrollo de un linfoma extranodal de conjuntiva bilateral tratado con rituximab y radioterapia.

  20. Linfoma B de zona marginal extranodal tipo MALT de conjuntiva bilateral tratado con radioterapia y anticuerpo monoclonal en un paciente con orbitopatía distiroidea

    OpenAIRE

    Plazola Hernández, Sara Isabel; Pérez Terán, Saúl Alberto; Moreno Ferreyra, Luis Gerardo

    2014-01-01

    Una mujer de 42 años con orbitopatía distiroidea presenta aumento de volumen conjuntival bilateral con reporte de linfoma no hodgkiniano de patrón folicular tipo MALT CD45 y 20 positivos. Se trata del primer caso de orbitopatía distiroidea y el desarrollo de un linfoma extranodal de conjuntiva bilateral tratado con rituximab y radioterapia.

  1. Time Savings with Rituximab Subcutaneous Injection versus Rituximab Intravenous Infusion: A Time and Motion Study in Eight Countries.

    Directory of Open Access Journals (Sweden)

    Erwin De Cock

    Full Text Available Rituximab is a standard treatment for non-Hodgkin lymphoma. The SABRINA trial (NCT01200758 showed that a subcutaneous (SC rituximab formulation did not compromise efficacy or safety compared with intravenous (IV infusion. We aimed to quantify active healthcare professional (HCP time and patient chair time for rituximab SC and IV, including potential time savings.This non-interventional time and motion study was run in eight countries and 30 day oncology units. Rituximab SC data were collected alongside the MabCute trial (NCT01461928; IV data were collected per routine real-world practice. Trained observers recorded active HCP time for pre-specified tasks (stopwatch and chair time (time of day. A random intercept model was used to analyze active HCP time (by task and for all tasks combined in the treatment room and drug preparation area, drug administration duration, chair time and patient treatment room time by country and/or across countries. Active HCP and chair time were extrapolated to a patient's first year of treatment (11 rituximab sessions.Mean active HCP time was 35.0 and 23.7 minutes for IV and SC process, respectively (-32%, p <0.0001. By country, relative reduction in time was 27-58%. Absolute reduction in extrapolated active HCP time (first year of treatment was 1.1-5.2 hours. Mean chair time was 262.1 minutes for IV, including 180.9 minutes infusion duration, vs. 67.3 minutes for SC, including 8.3 minutes SC injection administration (-74%, p <0.0001. By country, relative reduction was 53-91%. Absolute reduction in extrapolated chair time for the first year of treatment was 3.1-5.5 eight-hour days.Compared with rituximab IV, rituximab SC was associated with reduced chair time and active HCP time. The latter could be invested in other activities, whereas the former may lead to more available appointments, reducing waiting lists and increasing the efficiency of day oncology units.ClinicalTrials.gov NCT01200758.

  2. Kinetics of Rituximab Excretion into Urine and Peritoneal Fluid in Two Patients with Nephrotic Syndrome

    Science.gov (United States)

    Schwarz, Anke; Wagner, A. D.; Haller, Hermann; Schiffer, Mario

    2017-01-01

    Clinical observations suggest that treatment of Rituximab might be less effective in patients with nephrotic range proteinuria when compared to nonnephrotic patients. It is conceivable that the reason for this is that significant amounts of Rituximab might be lost in the urine in a nephrotic patient and that these patients require a repeated or higher dosage. However, this has not been systematically studied. In this case report we describe two different patients with nephrotic range proteinuria receiving Rituximab. The first patient received Rituximab for therapy resistant cryoglobulinemic membranoproliferative glomerulonephritis and the other for second line treatment of Felty's syndrome. We employed flow cytometry to determine the amount of Rituximab excretion in both urine and peritoneal fluid specimens in these patients following administration of Rituximab. We found that a significant amount of Rituximab is lost from the circulation by excretion into the urine. Furthermore we saw a close correlation of the excretion of Rituximab to the excretion of IgG molecules suggesting selectivity of proteinuria as the determining factor of Rituximab excretion. Further larger scale clinical studies could have the potential to evaluate an optimal cut-off value of IgG urinary loss before a possible administration of Rituximab therefore contributing to a more individualized treatment approach in patients with nonselective and nephrotic range proteinuria.

  3. Kinetics of Rituximab Excretion into Urine and Peritoneal Fluid in Two Patients with Nephrotic Syndrome

    Directory of Open Access Journals (Sweden)

    Klaus Stahl

    2017-01-01

    Full Text Available Clinical observations suggest that treatment of Rituximab might be less effective in patients with nephrotic range proteinuria when compared to nonnephrotic patients. It is conceivable that the reason for this is that significant amounts of Rituximab might be lost in the urine in a nephrotic patient and that these patients require a repeated or higher dosage. However, this has not been systematically studied. In this case report we describe two different patients with nephrotic range proteinuria receiving Rituximab. The first patient received Rituximab for therapy resistant cryoglobulinemic membranoproliferative glomerulonephritis and the other for second line treatment of Felty’s syndrome. We employed flow cytometry to determine the amount of Rituximab excretion in both urine and peritoneal fluid specimens in these patients following administration of Rituximab. We found that a significant amount of Rituximab is lost from the circulation by excretion into the urine. Furthermore we saw a close correlation of the excretion of Rituximab to the excretion of IgG molecules suggesting selectivity of proteinuria as the determining factor of Rituximab excretion. Further larger scale clinical studies could have the potential to evaluate an optimal cut-off value of IgG urinary loss before a possible administration of Rituximab therefore contributing to a more individualized treatment approach in patients with nonselective and nephrotic range proteinuria.

  4. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial

    DEFF Research Database (Denmark)

    Salles, Gilles; Seymour, John Francis; Offner, Fritz

    2011-01-01

    Patients with follicular lymphoma can have long survival times, but disease progression typically occurs 3-5 years after initial treatment. We assessed the potential benefit of 2 years of rituximab maintenance after first-line treatment in patients with follicular lymphoma receiving a rituximab p...

  5. Tumour targeting and radiation dose of radioimmunotherapy with {sup 90}Y-rituximab in CD20+ B-cell lymphoma as predicted by {sup 89}Zr-rituximab immuno-PET: impact of preloading with unlabelled rituximab

    Energy Technology Data Exchange (ETDEWEB)

    Muylle, Kristoff [Vrije Universiteit Brussel, MIMA Research Group, Brussels (Belgium); Universite Libre de Bruxelles, Department of Nuclear Medicine, Jules Bordet Institute, Brussels (Belgium); Flamen, Patrick; Guiot, Thomas; Ghanem, Ghanem; Meuleman, Nathalie; Bourgeois, Pierre; Vanderlinden, Bruno; Vaes, Melanie; Bron, Dominique [Universite Libre de Bruxelles, Jules Bordet Institute, Brussels (Belgium); Vugts, Danielle J.; Dongen, Guus A.M.S. van [VU University Medical Centre, Amsterdam (Netherlands); Everaert, Hendrik [Vrije Universiteit Brussel, UZ Brussel, Brussels (Belgium); Vrije Universiteit Brussel, MIMA Research Group, Brussels (Belgium)

    2015-07-15

    To compare using immuno-PET/CT the distribution of {sup 89}Zr-labelled rituximab without and with a preload of unlabelled rituximab to assess the impact of preloading with unlabelled rituximab on tumour targeting and radiation dose of subsequent radioimmunotherapy with {sup 90}Y-labelled rituximab in CD20+ B-cell lymphoma. Five patients with CD20+ B-cell lymphoma and progressive disease were prospectively enrolled. All patients underwent three study phases: initial dosimetric phase with baseline {sup 89}Zr-rituximab PET/CT imaging without a cold preload, followed 3 weeks later by a second dosimetric phase with administration of a standard preload (250 mg/m{sup 2}) of unlabelled rituximab followed by injection of {sup 89}Zr-rituximab, and a therapeutic phase 1 week later with administration of unlabelled rituximab followed by {sup 90}Y-rituximab. PET/CT imaging and tracer uptake by organs and lesions were assessed. With a cold rituximab preload, the calculated whole-body dose of {sup 90}Y-rituximab was similar (mean 0.87 mSv/MBq, range 0.82-0.99 mSv/MBq) in all patients. Without a preload, an increase in whole-body dose of 59 % and 87 % was noted in two patients with preserved circulating CD20+ B cells. This increase in radiation dose was primarily due to a 12.4-fold to 15-fold higher dose to the spleen without a preload. No significant change in whole-body dose was noted in the three other patients with B-cell depletion. Without a preload, consistently higher tumour uptake was noticed in patients with B-cell depletion. Administration of the standard preload of unlabelled rituximab impairs radioconjugate tumour targeting in the majority of patients eligible for radioimmunotherapy, that is patients previously treated with rituximab-containing therapeutic regimens. This common practice may need to be reconsidered and further evaluated as the rationale for this high preload has its origin in the ''prerituximab era''. (orig.)

  6. Eficiency of different doses of rituximab in rheumatoid arthritis.

    Science.gov (United States)

    Mena-Vázquez, Natalia; Manrique-Arija, Sara; Ureña-Garnica, Inmaculada; Romero-Barco, Carmen M; Jiménez-Núñez, Francisco G; Coret, Virginia; Irigoyen-Oyarzábal, María Victoria; Fernández-Nebro, Antonio

    2016-01-01

    Evaluate the effectiveness, cost and safety of rituximab in patients with rheumatoid arthritis (RA) depending on the dose used. Retrospective observational study conducted on 52 patients with RA treated with at least one dose of rituximab for 135.3 patient-years were included. Three treatment groups were obtained: (G1) First course and following two 1g infusions separated by 15 days; (G2) First course 2 infusions of 1g followed by 2 infusions of 500mg; (G3) First course and followed by 2 infusions of 500mg separated by 15 days. Re-treatments were administered on-demand according to the clinical activity. The retention time (Log-Rank), retreats and adverse events rates (incidence rate ratio) and treatment costs per patient-month of rituximab were analysed by groups. Group 2 showed a better cost-effectiveness ratio than group 1, as it was associated with a longer retention of rituximab (mean [95% CI] 65.7 [60.8 to 70.7] months vs 33.5 [22.7 to 44.3]; P<.001) and a lower rate of severe adverse events with only a slight increase in the rate of retreatment (courses/patient-year [95% CI] 1.66 [1.39 to 1.93] vs. 1.01 [0.69 to 1.34]; P=.005), and in the costs (median/patient-month, €484.89 vs. €473.45). Although group 3 was €41.20/patient-month cheaper than group 2, it was associated with a higher rate of re-treatments and shorter retention of rituximab (P<.001). The use of full-dose rituximab at onset, followed by reduced doses in successive courses administered on-demand retreatment may be the most cost-effective option. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  7. EXPERIENCE OF RITUXIMAB TREATMENT IN A PATIENT WITH JUVENILE SCLERODERMA

    Directory of Open Access Journals (Sweden)

    E. I. Alexeeva

    2012-01-01

    Full Text Available A clinical case of severe juvenile scleroderma is represented in this article. The patient had a high activity and aggressive course of disease, he was resistant to steroid, cyclophosphomide and methotrexate therapy in combination with drugs, improving blood circulation. The authors describe the successful usage of chimeric monoclonal antibody against the protein CD20 — Rituximab. By the 4th week of the treatment the signs of intoxication and local manifestations of the disease (density and area of scleroderma patches have diminished. By the 24th week the immunological markers of activity have become normal. Afore-mentioned clinical case demonstrates high efficacy of Rituximab in patient with severe course of juvenile scleroderma. By now the stage of clinical and laboratory remission has maintained for 52 weeks.

  8. Rituximab Efficacy during a Refractory Polyarteritis Nodosa Flare

    Directory of Open Access Journals (Sweden)

    Emmanuel Ribeiro

    2009-01-01

    Full Text Available Polyarteritis nodosa (PAN is a systemic vasculitis whose severe forms are treated with glucocorticoids and cyclophosphamide. Refractory patients are exposed to many complications, notably accelerated atherosclerosis. We report a case report of 71-year-old man followed for polyarteritis nodosa refractory to glucocorticoids and cyclosphosphamide. Systemic vasculitis relapses are followed to accelerated atherosclerosis: severe ischemic lesions led to amputation of lower limbs. Remission of refractory PAN is obtained with rituximab. Disappearance of biological inflammatory is allowed to regression of ischemic lesions in upper limbs. In this situation, we recommend a systematic vascular work-up for patients suffered from refractory vasculitis. On the other hand, therapeutic trials are needed to determine the real efficacy and place of rituximab in the treatment of polyarteritis nodosa.

  9. Tratamiento de una lesión endoperiodontal tipo III (combinada o verdadera): reporte de un caso

    OpenAIRE

    M Alcota; Mondragón, R.; C Zepeda

    2011-01-01

    Se presenta un caso clínico de una lesión endoperiodontal tipo III (combinada o verdadera) en un paciente de sexo femenino de 41 años de edad sin antecedentes sistémicos. La paciente fue derivada del Curso de Especialización en Periodoncia de la Escuela de Graduados de la Universidad de Chile debido a una lesión periapical en la pieza 3.6. El pronóstico en este tipo de lesiones es dudoso, ya que es necesario que se efectúe el tratamiento endodóntico así como el periodontal, y el resultado rec...

  10. Rituximab in adult minimal change disease and focal segmental glomerulosclerosis.

    Science.gov (United States)

    Kronbichler, Andreas; Bruchfeld, Annette

    2014-01-01

    Treatment of nephrotic syndrome due to minimal change disease and focal segmental glomerulosclerosis remains a challenge since steroid dependence, steroid resistance and a relapsing disease course exhibits a high cumulative steroid dosage. The necessity of using alternative steroid-sparing immunosuppressive agents with potential toxic side effects also restricts their long-term use. Rituximab, a monoclonal antibody targeting CD20, has been increasingly used in the therapy of difficult-to-treat nephrotic syndrome. A clinical response has been shown for patients with steroid-dependent or frequently relapsing nephrotic syndrome, whereas the benefit seems to be limited in steroid-resistant patients, especially those with underlying focal segmental glomerulosclerosis. No potentially life-threatening adverse events have been observed in the treatment of adult minimal change disease and focal segmental glomerulosclerosis following rituximab administration. Since most reports are retrospective and evidence of efficacy is derived from small case series, more prospective trials in a controlled, randomized manner are highly desirable to delineate the use of rituximab or other B cell-depleting agents in steroid-dependent, frequently relapsing or steroid-resistant patients.

  11. Rituximab in the treatment of refractory lupus nephritis with vasculitis

    Directory of Open Access Journals (Sweden)

    Huseyin Kadikoy

    2012-01-01

    Full Text Available Dysfunction of the B lymphocyte, an important component of adaptive immunity, is thought to be important in the pathogenesis of lupus nephritis (LN. There are several novel strategies emerging including B-cell depletion by the monoclonal antibodies to B-cell markers, rituximab. We describe an unusual clinical response of a 22-year-old Hispanic woman with class IV LN with vasculitis while on dialysis to cyclophosphamide (CY and adjunct rituximab. The patient had a history of class III/V LN and was treated with nine months of CY and maintenance therapy with mycophenolate mofetil (MMF for three years. While on MMF, the patient deve-loped class IV LN with vasculitis leading to end-stage renal disease (ESRD. While the patient was on peritoneal dialysis, the patient was treated with two doses of rituximab and six doses of intravenous CY. The patient responded to this regimen and recovered kidney function within four months. The kidney function remained stable nine months after discontinuing peritoneal dialysis.

  12. Rituximab-Induced Splenic Rupture and Cytokine Release

    Science.gov (United States)

    Nair, Ranjit; Gheith, Shereen; Lamparella, Nicholas

    2016-01-01

    Patient: Female, 55 Final Diagnosis: Mantle cell lymphoma Symptoms: Cytokine release syndrome • hypoglycemia • hypotension • splenic rupture • splenomegaly • vision loss Medication: — Clinical Procedure: Case Report Specialty: Oncology Objective: Unusual clinical course Background: Rituximab is a therapeutic monoclonal antibody that is used for many different lymphomas. Post-marketing surveillance has revealed that the risk of fatal reaction with rituximab use is extremely low. Splenic rupture and cytokine release syndrome are rare fatal adverse events related to the use of therapeutic monoclonal antibodies, especially in aggressive malignancies with high tumor burden. Case Report: A 55-year-old woman presented with abdominal pain and type B symptoms and was diagnosed with mantle cell lymphoma. Initial peripheral blood flow cytometry showed findings that mimicked features of chronic lymphocytic leukemia. Further treatment with rituximab led to catastrophic treatment complications that proved to be fatal for the patient. Conclusions: Severe cytokine release syndrome associated with biologics carries a very high morbidity and case fatality rate. With this case report we aim to present the diagnostic challenge with small B-cell neoplasms, especially mantle cell lymphoma and chronic lymphocytic lymphomas, and underscore the importance of thorough risk assessment for reactions prior to treatment initiation. PMID:26972227

  13. Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny

    2012-01-01

    OBJECTIVES: To compare the effectiveness and safety of rituximab alone or in combination with either methotrexate or leflunomide.METHODS: 10 European registries submitted anonymised datasets with baseline, 3, 6, 9 and 12-month clinical data from patients who started rituximab.RESULTS: 1195 patients...... were treated with rituximab plus methotrexate, 177 with rituximab plus leflunomide and 505 with rituximab alone. Significantly more patients achieved a European League Against Rheumatism good response at 6 months when treated with rituximab plus leflunomide (29.1%) compared with rituximab plus...... methotrexate (21.1%) and rituximab alone (19.3%; p=0.02 and p=0.01, respectively). Similar results were observed at 12 months. Adverse events occurred in 10.2%, 13.2% and 13.9% of patients on rituximab plus leflunomide, rituximab plus methotrexate and rituximab alone, respectively.CONCLUSIONS: Leflunomide...

  14. Successful pregnancy after rituximab in a women with recurrent in vitro fertilisation failures and anti-phospholipid antibody positive.

    LENUS (Irish Health Repository)

    Ng, C T

    2012-02-01

    We report a case of successful pregnancy after rituximab in a patient with a history of in vitro fertilisation (IVF) failures and positive anti-cardiolipin antibody (ACA). Following a course of rituximab, her ACA became negative and she successfully conceived with IVF treatment. This is the first case in literature describing the use of rituximab therapy in this clinical scenario.

  15. Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Buch, Maya H; Smolen, Josef S; Betteridge, Neil;

    2011-01-01

    Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab...... in the treatment of RA....

  16. Tc-99m-labeled Rituximab for Imaging B Lymphocyte Infiltration in Inflammatory Autoimmune Disease Patients

    NARCIS (Netherlands)

    Malviya, G.; Anzola, K. L.; Podesta, E.; Lagana, B.; Del Mastro, C.; Dierckx, R. A.; Scopinaro, F.; Signore, A.

    2012-01-01

    The rationale of the present study was to radiolabel rituximab with 99m-technetium and to image B lymphocytes infiltration in the affected tissues of patients with chronic inflammatory autoimmune diseases, in particular, the candidates to be treated with unlabelled rituximab, in order to provide a r

  17. Rapid infusion with rituximab: short term safety in systemic autoimmune diseases

    DEFF Research Database (Denmark)

    Larsen, Janni Lisander; Jacobsen, Soren

    2013-01-01

    To describe the incidence, types and severity of adverse events, related to an accelerated regime of rituximab infusion in patients with various autoimmune diseases. Fifty-four patients with systemic autoimmune disease, to be treated with 1,000 mg of rituximab twice 2 weeks apart, participated. Pre...

  18. Treatment of Graves' disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Banga, J Paul; Gilbert, Jacqueline A

    2008-01-01

    methimazole alone (p=0.04 between groups). The overall levels of TRAbs decreased by around 15% in both groups. Within one year of follow-up, rituximab therapy mediated specific decreases in thyroid-peroxidase antibody- and IgM levels, whereas IgG levels were unaffected. The data indicate that rituximab...

  19. Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Buch, Maya H; Smolen, Josef S; Betteridge, Neil;

    2011-01-01

    Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab...

  20. The anti-CD20 antibody rituximab reduces the Th17 cell response

    NARCIS (Netherlands)

    Veerdonk, F.L. van de; Lauwerys, B.; Marijnissen, R.J.; Timmermans, K.; Padova, F.E. Di; Koenders, M.M.J.F.; Gutierrez-Roelens, I.; Durez, P.; Netea, M.G.; Meer, J.W. van der; Berg, W.B. van den; Joosten, L.A.B.

    2011-01-01

    OBJECTIVE: Rituximab has been shown to be successful in the treatment of rheumatoid arthritis (RA), and this unexpected finding indicates that B cells have an important role in this disease. The present study was undertaken to investigate the mechanism of action of rituximab in RA. METHODS: Twelve p

  1. Micro-costing study of rituximab subcutaneous injection versus intravenous infusion in dutch setting

    NARCIS (Netherlands)

    Mihajlović, J.; Bax, P.; Van Breugel, E.; Blommestein, H.M.; Hoogendoorn, M.; Hospes, W.; Postma, M.J.

    2015-01-01

    Background: Rituximab for subcutaneous (SC) administration has recently been approved for use in common forms of diffuse large B-cell lymphoma (DLBCL). This form of rituximab is supplied in ready-to-use vials that do not require individual dose adjustment. It is expected that SC-injection will

  2. Aprendizaje de nombres en una paciente con amnesia anterógrada.

    OpenAIRE

    A. Martínez; Robayo, M; Quintero, E.

    2008-01-01

    En este trabajo se describe la aplicación de algunas técnicas empleadas para la rehabilitación de la memoria en personas con daño cerebral, con el fin de facilitar el aprendizaje de nombres de personas cercanas y conocidas en una paciente de 55 años, universitaria, diestra y quien como secuela de una encefalitis herpética presentó lesión isquémica en territorio frontotemporal izquierdo y severas alteraciones cognoscitivas y funcionales. Aunque la aplicación combinada de técnicas favorece los ...

  3. Terapia inmunosupresora en pacientes con Nefropatía Membranosa Idiopática.

    OpenAIRE

    Llerena García, Giovanna; Lopez Lam, Tania Paloma; Miyahira Arakaki, Juan

    2012-01-01

    Objetivo: Evaluar la respuesta a la terapia combinada según el esquema de Ponticelli en pacientes con Nefropatía Membranosa (NM) idiopática, en la tasa de remisión de la proteinuria, la tasa de filtración glomerular (TFG) y la frecuencia de complicaciones. Material y métodos: Estudio observacional descriptivo tipo serie de casos en pacientes con NM idiopàtica durante los años 1995 – 2005 que recibieron terapia inmunosupresora, según esquema de Ponticelli. Se determinó la tasa de remisión de l...

  4. Prótesis maxilofacial, ¿prótesis mixta, o combinada?

    OpenAIRE

    Escuin Henar, Tomás J. (Tomás José); Torné Duran, Sergi; González González, Ignacio; Monreal Nieto, Julià

    1999-01-01

    Presentamos un caso clínico que sirve de base para la discusión de los conceptos protésicos que se relacionan con la restauración y rehabilitación de pacientes que han sufrido amplias resecciones maxilares y cuya extensión va más allá de los límites bucales. Se expone la realización de una prótesis labial, obturadora maxilar y dental que realizadas consecutivamente dan lugar a la recuperación (limitada) de funciones del sistema masticatorio.

  5. First-line chemoimmunotherapy with bendamustine and rituximab versus fludarabine, cyclophosphamide, and rituximab in patients with advanced chronic lymphocytic leukaemia (CLL10)

    DEFF Research Database (Denmark)

    Eichhorst, Barbara; Fink, Anna-Maria; Bahlo, Jasmin

    2016-01-01

    BACKGROUND: Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab is the standard therapy for physically fit patients with advanced chronic lymphocytic leukaemia. This international phase 3 study compared the efficacy and tolerance of the standard therapy with a potentially less to...

  6. Rituximab for subcutaneous delivery: Clinical management principles from a nursing perspective.

    Science.gov (United States)

    Carlson, Julia; Cox, Keith; Bedwell, Kylie; Ku, Mathew

    2015-12-01

    Nurses play an integral role in administering treatments to patients with non-Hodgkin's lymphomas. Intravenous (IV) rituximab was approved by the Australian Therapeutic Goods Administration in 1998, and a novel subcutaneous (SC) formulation was approved in 2014. Fixed-dose SC rituximab is highly concentrated; co-formulation with a fully human recombinant vorhyaluronidase alfa enzyme helps overcome the physiological barriers of the SC space, facilitating drug dispersion. Despite a different pharmacokinetic profile to the IV preparation, SC rituximab demonstrates a comparable efficacy/safety profile. Most frequently occurring rituximab-related adverse events include neutropenia, nausea and constipation, and administration-related reactions are more frequent with the SC preparation. Compared with IV, SC delivery reduces treatment times and nurse workload, and patients report greater comfort and convenience. This article sets out nursing considerations for optimal administration of SC rituximab, including premedication, drug handling/preparation, injection technique, after-care and management of adverse events, particularly administration-related reactions.

  7. Descompressão neural isolada ou associada à fusão póstero-lateral nas afecções degenerativas lombossacras: avaliação da qualidade de vida e incapacidade funcional pós-operatória Descompresión neural aislada o combinada con la fusión posterolateral en las enfermedades degenerativas lumbosacras: evaluación de la calidad de vida e incapacidad funcional después de la operación Neural decompression alone or combined with posterolateral fusion in lumbosacral degenerative diseases: assessment of postoperative quality of life and functional disability

    Directory of Open Access Journals (Sweden)

    Alberto Ofenhejm Gotfryd

    2012-01-01

    Full Text Available OBJETIVO: Comparar a qualidade de vida, a dor e a satisfação pessoal de pacientes submetidos à descompressão neural lombar isolada àqueles que tiveram a fusão póstero-lateral associada. MÉTODOS: Participaram do estudo 44 indivíduos com diagnóstico de hérnia de disco e/ou estenose degenerativa central ou foraminal da coluna lombossacra tratados cirurgicamente. Os pacientes foram divididos em 2 grupos: "descompressão" (D e "descompressão e fusão" (DF. O critério utilizado para definir a necessidade da artrodese foi a presença de deformidades ou instabilidade segmentar, mensurada através de radiografias simples e dinâmicas. Os pacientes preencheram questionários referentes ao acompanhamento pós-operatório (uso de medicamentos analgésicos e satisfação com o tratamento e escala analógica visual de dor lombar e ciática. Além disto, foram aplicados os questionários Oswestry e SF-36 para avaliação da qualidade de vida. RESULTADOS: Foram encontrados excelentes resultados no questionário Oswestry, bons níveis para os domínios "Dor" e "Capacidade Funcional" do SF-36, além de baixa intensidade de dor lombar e ciática em ambos os grupos analisados, não havendo diferenças estatisticamente significativas entre eles. CONCLUSÕES: Não encontramos diferenças em relação à qualidade de vida, à dor e à satisfação pessoal em pacientes submetidos à descompressão neural lombar isolada àqueles que tiveram a fusão associada, utilizando como critério indicativo para artrodese a presença de deformidades e/ou instabilidade segmentar.OBJETIVO: Comparar la calidad de vida, el dolor y la satisfacción personal de los pacientes sometidos a la descompresión neural aislada con aquellos que tuvieron la fusión posterolateral asociadas. MÉTODOS: El estudio reclutó a 44 pacientes con hernias discales y/o estenosis degenerativa central o foraminal de la columna lumbosacra, tratados quirúrgicamente. Los pacientes fueron divididos

  8. Should we consider MMF therapy after rituximab for nephrotic syndrome?

    Science.gov (United States)

    Filler, Guido; Huang, Shih-Han Susan; Sharma, Ajay P

    2011-10-01

    The management of steroid-dependent nephrotic syndrome, especially in patients who have failed to respond to cytotoxic drugs, such as cyclophosphamide, remains challenging. Rituximab represents a new (off-label) therapeutic option. In a significant portion of patients, it has a short serum half-life following the recovery of CD20-positive cells. The addition of mycophenolate mofetil (MMF) as a maintenance therapy is also an attractive option, but one which requires testing in a prospective randomized clinical trial with therapeutic drug monitoring and mechanistic ancillary studies.

  9. Rituximab (MabThera) til behandling af aktiv reumatoid artritis

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Nielsen, Claus Henrik; Bendtzen, Klaus

    2006-01-01

    Rituximab (RTX) is a murine/human monoclonal antibody to CD20, a protein expressed almost exclusively on human B-lymphocytes. RTX induces rapid and marked B-cell depletion with beneficial clinical effects in 1/3 to 1/2 of rheumatoid arthritis patients. Treatment is given as two iv. infusions...... with a two-week interval and in combination with methotrexate. Mild to moderate side-effects are frequent, particularly during the first infusion, but long-term side-effects are generally rare, although pulmonary events and reactivation of viral infections of the liver is of concern....

  10. Rituximab therapy in Greek patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Haralampos M Moutsopoulos

    2008-10-01

    Full Text Available Aristotelis P Tsiakalos*, Nestor K Avgoustidis*, Haralampos M MoutsopoulosDepartment of Pathophysiology, Medical School, National Univercity of Athens, Athens, Greece. *These authors contributed equally to this workObjective: An open-label, prospective, uncontrolled study created to investigate clinical response, serological changes and side effects in Greek patients with rheumatoid arthritis (RA, after B-cell depletion with rituximab.Methods: Patients with high disease activity (disease activity score [DAS]-28 > 5.1 were selected for treatment with rituximab and received two infusions, 1 gr each, 2 weeks apart. Different disease parameters (visual analog scale, DAS-28, C-reactive protein [CRP], erythrocyte sedimentation rate, health assessment questionnaire, complement (C3, C4, rheumatoid factor [RF], anti-cyclic citrullinated peptide antibody [anti-CCP], swollen joint count, tender joint count, immunoglobulin M [IgM], IgG, IgA were performed at base line, 2, 4, and 6 months post-treatment. Response was defined according to the American College of Rheumatology (ACR criteria.Results: Seventeen patients received therapy. Treatment led to a reduction in various disease parameters. ACR20 was achieved in 41.11% of patients by week 8, 52.94% by week 16, and 82.35% by week 24. ACR50 was achieved in 5.88% by week 8, 41.17% by week 16, and 64.7% by week 24. ACR70 was achieved only by week 24 in 23.52% of patients. Statistical analysis has shown no differences in clinical response, between RF positive/negative patients, and anti-CCP-positive/negative patients, while decline of RF was better correlated with reduction of DAS-28 than with anti-CCP.Conclusions: Rituximab is a well tolerated and effective treatment in RA. Response was not correlated to RF or anti-CCP positivity. Decline of RF was associated with clinical response and reduction of DAS-28 and CRP.Keywords: rituximab, Greek patients, rheumatoid arthritis

  11. Jogo patológico: uma abordagem terapêutica combinada Pathological gambling: a combined therapeutic strategy

    Directory of Open Access Journals (Sweden)

    Maria Engel de Oliveira

    2006-01-01

    Full Text Available Jogo patológico é um transtorno psiquiátrico inserido nos manuais diagnósticos há pouco mais de 20 anos, sendo até hoje pouco estudado. Pode ser considerado um transtorno do espectro impulsivo-compulsivo, apresentando características compartilhadas com os transtornos por uso de substâncias psicoativas. São identificadas três fases no comportamento de jogar: fase da vitória, da perda e do desespero. Neste artigo será apresentado o caso clínico de uma paciente com o diagnóstico de jogo patológico. Pretendemos com este caso discutir os aspectos relacionados com a abordagem combinada do caso (medicamentosa e psicológica e as teorias atuais a respeito do jogo patológico.Pathological gambling has been considered a psychiatric disorder for no longer than 20 years, still being not well studied. It can be considered an impulsive-compulsive spectrum disorder with shared characteristics with substance use disorder. There are three phases that can be identified in the gambling behavior: victory, loss and despair. This article will show a case report of a patient diagnosed as pathological gambler. We intend to discuss some aspects related to the combined approach (medication plus psychotherapy and present theories about pathological gambling.

  12. Rituximab in a child with autoimmune thrombotic thrombocytopenic purpura refractory to plasma exchange.

    Science.gov (United States)

    Narayanan, Parameswaran; Jayaraman, Aparna; Rustagi, Rashi S; Mahadevan, S; Parameswaran, Sreejith

    2012-07-01

    A nine-year-old girl presented with headache, purpura and mild left hemiparesis. Laboratory evaluation revealed thrombotic microangiopathy with ADAMTS13 deficiency, with auto-antibodies to ADAMTS13. She was treated with plasma exchange and steroids, following which she improved transiently, relapsing within 2 months. The relapse was refractory to conventional therapy and rituximab was tried. She had good response to rituximab and has been in remission for the past 12 months. Rituximab may be a promising option for children with acquired TTP refractory to plasma exchange and steroids.

  13. MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab

    DEFF Research Database (Denmark)

    Peterfy, Charles; Emery, Paul; Tak, Paul P

    2016-01-01

    Objective. To evaluate changes in structural damage and joint inflammation assessed by MRI following rituximab treatment in a Phase 3 study of patients with active rheumatoid arthritis (RA) despite methotrexate (MTX) who were naive to biological therapy. Methods. Patients were randomised to receive...... two infusions of placebo (n=63), rituximab 500 mg (n=62), or rituximab 1000 mg (n=60) intravenously on days 1 and 15. MRI scans and radiographs of the most inflamed hand and wrist were acquired at baseline, weeks 12 (MRI only), 24 and 52. The primary end point was the change in MRI erosion score from...

  14. Crescendo response to rituximab in oral pemphigus vulgaris: a case with 7-year follow-up.

    Science.gov (United States)

    Greenblatt, D T; Benton, E C; Groves, R W; Setterfield, J F

    2016-07-01

    Pemphigus vulgaris (PV) is an autoimmune blistering disease affecting the skin and mucous membranes. Rituximab, a CD20 chimeric monoclonal antibody, has efficacy in PV management. We report a case of severe oral PV that showed a progressive response to repeated courses of rituximab, culminating in a rapid response within 4 weeks following severe relapse 4 years after initial therapy. It demonstrates the progressively shorter time to achieve partial or complete remission following rituximab infusions, combined with minimal adjuvant therapy over a 7-year follow-up period.

  15. Estudio de los resultados del tratamiento con fármacos inmunomoduladores biológicos en la enfermedad autoinmune ocular

    OpenAIRE

    2014-01-01

    Establecer la e\\icacia y seguridad de los fármacos biológicos etenercept, in\\liximab, adalimumab y rituximab en la enfermedad autoinmune ocular en la Unidad de Inmunología Ocular del Hospital Clínico Universitario de Valladolid (HCUV) Diseño: Estudio retrospectivo de investigación clínica observacional. Material y método: Treinta y tres pacientes con enfermedad autoinmune ocular tratados con in\\liximab, adalimumab, etanercept y rituximab fueron identi\\icados de la Unidad de I...

  16. Productividad y eficiencia de uso de nitrógeno y energía en pollos de engorda alimentados con pasta de soya o pasta de canola

    OpenAIRE

    Sergio Gómez Rosales; María de Lourdes Angeles; Ericka Ramírez Rodríguez

    2012-01-01

    Se realizaron dos experimentos de sacrificio para evaluar el crecimiento, contenido y deposición de tejidos y retención de proteína y energía en la carne de la canal en pollos en crecimiento alimentados con pasta de canola (PCAN) en sustitución de pasta de soya (PSOY). En el Exp 1, seis pollos machos, de 43 días de edad, se sacrificaron al inicio y 36 pollos fueron asignados a tres dietas con cantidades crecientes de PCAN (0, 10 y 20 %) combinadas con dos niveles de lisina digestible (LD: 0.8...

  17. EXPERIENCE OF RITUXIMAB APPLICATION ON A PATIENT, SUFFERING FROM JUVENILE RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    E.I. Alexeeva

    2006-01-01

    Full Text Available The article describes the run of the severe systemic juvenile rheumatoid arthritis, which is resistant to the standard antirheumatic therapy. The disease was characterized by such systemic implications of the disease, as: fever, rash, pericarditis, lymphadenopathy, hepatomegaly accompanied by the generalized joint syndrome and high laboratory indices of activity. Introduction of rituximab into the treatment scheme allowed the researchers to decrease the general activity of the disease, arrest the systemic implications, improve functional status of the joints, and normalize the laboratory indices of activity. The effect duration was 5 months and 4 months after the first and second course of treatment by rituximab accordingly. The treatment results prove the perspective of rituximab application with in the complex therapy for the patients, suffering from juvenile rheumatoid arthritis. However, it is necessary to conduct further research to identify the location of antibodies to cd 20+ within the therapy scheme of this disease. Key words: children, treatment, rituximab, juvenile rheumatoid arthritis.

  18. Induction treatment of previously undiagnosed ANCA-associated vasculitis in a renal transplant patient with Rituximab

    Science.gov (United States)

    Graham-Brown, M. P. M.; Aljayyousi, R.; Baines, R. J.; Burton, J. O.; Brunskill, N. J.; Furness, P.; Topham, P.

    2016-01-01

    We report the case of a 40-year-old female transplant patient with undiagnosed ANCA-associated vasculitis (AAV) and renal allograft dysfunction who achieved disease remission with restoration of transplant function following induction therapy with rituximab. There are currently no trial data looking at the use of rituximab for induction of remission of renal transplant patients with AAV. Although recurrence of AAV following renal transplantation is rare, such patients have invariably had multiple previous exposures to induction and maintenance immunosuppressive regimens, often limiting treatment options post-transplantation. In this case, rituximab was well tolerated with no side effects, and was successful in salvaging transplant function. Optimal treatment regimens for relapsed AAV in the transplant population are not known, and clinical trials are needed to evaluate the efficacy and safety of rituximab at inducing and maintaining disease remission in relapsed AAV following transplantation. PMID:27699052

  19. Treatment of orbital inflammation with rituximab in Wegener's granulomatosis

    DEFF Research Database (Denmark)

    Baslund, Bo; Wiencke, Anne Katrine; Rasmussen, Niels

    2012-01-01

    inflammation. All patients were treated with 1000 mg of rituximab administered twice with an interval of 14 days between the infusions. Six months after therapy, a physical examination and a control computerised tomography (CT) scan was performed. RESULTS: All patients had orbital inflammation demonstrated...... by CT-scan before treatment (3 had bilateral and 7 unilateral orbital involvement). Orbital symptoms at study baseline included pain, pressure sensation behind the eyes, epiphora, diplopia, and affection of the visual acuity. Nine out of ten patients experienced subjective improvement. Four patients...... (seven eyes) with visual impairment responded to therapy, and the improvement in visual acuity was sustained throughout follow-up (median duration of follow-up: 17 months; range: 6-18 months). At the time of the control CT-scan, size-reduction of the orbital mass was observed in two patients, while...

  20. USE OF RITUXIMAB IN AUTOIMMUNE DISEASES: NEW ASPECTS

    Directory of Open Access Journals (Sweden)

    Dmitry Evgenyevich Karateyev

    2010-01-01

    Full Text Available It has been noted that off-label indication for Rituximab (RTX in rheumatological care indubitably requires its confirmation in the randomized clinical trials. A particular cautious approach should be taken in extending the indications for therapy with gene-engineering biologicals because of the intricacy and interaction of different immunoregulatory mechanisms. Nonetheless, it is stated that much clinical experience with RTX used in most severely ill therapy-resistant patients may serve as a basis for its prescription in a number of most complex inflammatory rheumatic diseases (RDs. There is new evidence for the use of RTX in various RDs differing in their clinical picture, course, and pathogenesis, such as spondyloarthritis, systemic lupus erythematosus, systemic vasculitis.

  1. Rituximab induction therapy in highly sensitized kidney transplant recipients

    Institute of Scientific and Technical Information of China (English)

    YIN Hang; WAN Hao; HU Xiao-peng; LI Xiao-bei; WANG Wei; LIU Hang; REN Liang; ZHANG Xiao-dong

    2011-01-01

    Background The number of highly sensitized patients is rising, and sensitization can lead to renal transplant failure.The present study aimed to investigate the safety and efficacy of renal transplantation following induction therapy with rituximab in highly sensitized kidney transplant recipients.Methods Seven highly sensitized kidney transplant recipients who underwent rituximab therapy from December 2008 to December 2009 were retrospectively analyzed. There were 3 men and 4 women, with a mean age of 38.5 years (range, 21-47 years). The duration of hemodialysis was 3-12 months, with a mean duration of 11 months. For 4 patients,this was the second transplant; the previous graft survival time was 2-11 years, with a mean survival time of 5.8 years. All the female recipients had history of multiple pregnancies, and all patients had previously received blood transfusions. All donors were men, with a mean age of 32.5 years (range, 25-37 years). In 2 of the 7 patients, both class I and class II of panel reactive antibody were high; the remaining 5 patients showed either high in class I or in class II of panel reactive antibody. The mean panel reactive antibody value was 31% for class I and 51% for class II respectively. The donors and the recipients had the same blood type, with low lymphocyte cytotoxicity ranging from 2% to 5%. The human leukocyte antigen (HLA) mismatch numbers were from 2 to 4. All patients received tacrolimus (0.1 mg·kg-1·d-1) and mycophenolate mofetil (750 mg twice per day) orally 3 days prior to surgery. All patients received a single dose of 600 mg rituximab (375 mg/m2) infusion on the day before surgery and polyclonal antibody (antithymocyte globulin) on the day of surgery.Postoperative creatinine, creatinine clearance rate, and occurrence of rejection by pathological biopsy confirmation were monitored.Results No patient had delayed graft function after surgery. Two patients had acute rejection, one on day 7 and the other on day 13 post

  2. Rituximab in the treatment of inflammatory myopathies: a review.

    Science.gov (United States)

    Fasano, Serena; Gordon, Patrick; Hajji, Raouf; Loyo, Esthela; Isenberg, David A

    2017-01-01

    Several uncontrolled studies have encouraged the use of rituximab (RTX) in patients with myositis. Unfortunately, the first placebo-phase trial to assess the efficacy of RTX in refractory myositis did not show a significant difference between the two treatment groups, and doubts have been expressed about its study design. In this review we present an up-to-date overview of the reported experiences of RTX therapy in myositis. A PubMed search was performed to find all the available cases of refractory myositis patients treated with RTX up to July 2015. The following terms were assessed: inflammatory myopathies OR anti-synthetase syndrome OR polymyositis OR dermatomyositis AND RTX. A total of 48 studies were included. We identified 458 patients with myositis treated with RTX. We found a rate of response to RTX of 78.3%. RTX can play a role in the management of patients with myositis, at least in those with positive myositis-specific autoantibodies.

  3. Rituximab in the treatment of refractory pemphigus vulgaris

    OpenAIRE

    Fernandes, I.; Sanches, M.; Velho, G; Selores, M.

    2012-01-01

    O pênfigo vulgar é uma doença bolhosa auto-imune rara, que atinge a pele e as mucosas. Geralmente tem um curso clínico severo, sendo necessário o recurso a terapêutica prolongada com corticóides sistémicos e outros fármacos imunossupressores, que podem conduzir a efeitos adversos graves. O rituximab é um anticorpo monoclo- nal quimérico dirigido ao antigénio CD20, expresso pelos linfócitos B. Recentemente, têm surgido alguns estudos que documentam o seu sucesso terapêutico no tratamento de pê...

  4. Four cases of recalcitrant pemphigus vulgaris salvaged with rituximab

    Directory of Open Access Journals (Sweden)

    Samyak Ganjre

    2017-01-01

    Full Text Available Although the long-term use of immunosuppressives – supplemented with more aggressive treatments such as immunoadsorption, intravenous immunoglobulins, or plasmapheresis in recalcitrant cases has dramatically improved the prognosis of pemphigus vulgaris, opportunistic infections secondary to immunosuppression continue to cause significant mortality. We report four cases– three old ones, who had accumulated significant morbidities over their disease duration ranging from 5 to 10 years, and the fourth, a teenage female intolerant to corticosteroids and idiosyncratic to methotrexate– who achieved complete remission on administration of rituximab by the lymphoma protocol. One of the old cases who had recalcitrant mucositis experienced its complete subsidence without any adjuvant whatsoever. All continue to remain asymptomatic for 11–20 months. None had infusion reactions or any delayed side effects.

  5. Future therapies for pemphigus vulgaris: Rituximab and beyond.

    Science.gov (United States)

    Huang, Amy; Madan, Raman K; Levitt, Jacob

    2016-04-01

    The conventional treatment for patients with pemphigus vulgaris (PV) centers on global immunosuppression, such as the use of steroids and other immunosuppressive drugs, to decrease titers of antidesmoglein autoantibodies responsible for the acantholytic blisters. Global immunosuppressants, however, cause serious side effects. The emergence of anti-CD20 biologic medications, such as rituximab, as an adjunct to conventional therapy has shifted the focus to targeted destruction of autoimmune B cells. Next-generation biologic medications with improved modes of delivery, pharmacology, and side effect profiles are constantly being developed, adding to the diversity of options for PV treatment. We review promising monoclonal antibodies, including veltuzumab, obinutuzumab (GA-101), ofatumumab, ocaratuzumab (AME-133v), PRO131921, and belimumab.

  6. Rituximab in anti-GBM disease: A retrospective study of 8 patients.

    Science.gov (United States)

    Touzot, Maxime; Poisson, Johanne; Faguer, Stanislas; Ribes, David; Cohen, Pascal; Geffray, Loic; Anguel, Nadia; François, Helene; Karras, Alexandre; Cacoub, Patrice; Durrbach, Antoine; Saadoun, David

    2015-06-01

    Anti-glomerular basement membrane (GBM) disease is a rare autoantibody-mediated disorder presenting as rapidly progressive glomerulonephritis, and often with pulmonary hemorrhage. Antibody removal with plasmapheresis and immunosuppressive drugs are the cornerstones of the treatment. Data regarding the use of specific B-cell depleting therapy such as rituximab are lacking. We conducted a retrospective observational study of 8 patients with severe and/or refractory GBM disease that received rituximab therapy. Eight patients (2 men, 6 women) with a mean age of 26 ± 13.1 years old were included. Seven had severe renal involvement [median creatinin level was 282 μmol/l, range (65-423)] requiring high immunosuppressive or plasmapheresis dependent, and two had relapse of pulmonary hemorrhage including one with renal failure. Patients received an initial immunosuppressive treatment including steroid and cyclosphosphamide (n = 8) and plasmapheresis (n = 5). Except one late relapse, rituximab therapy was started within two months after diagnosis. All patients except one received 4 weekly dose of rituximab (375 mg(2)). Anti-GBM antibodies were still present in 6/8 patients, at rituximab initiation. Complete remission was observed in 7 out of 8 patients, mostly 3 months after rituximab therapy. After a mean follow-up of 25.6 months (range 4-93), patient and renal survival were 100% and 75% respectively, but rituximab use did not improve GFR. Anti-GBM antibodies remained negative for all patients during follow-up. Only one patient developed a severe bacterial infection but no opportunistic or viral infections were reported. Rituximab may represent an additional and/or alternative therapy in the induction treatment of anti-GBM disease. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Critical appraisal of rituximab in the maintenance treatment of advanced follicular lymphoma

    Directory of Open Access Journals (Sweden)

    Aguiar-Bujanda D

    2015-10-01

    Full Text Available David Aguiar-Bujanda, María Jesús Blanco-Sánchez, María Hernández-Sosa, Saray Galván-Ruíz, Samuel Hernández-Sarmiento Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain Abstract: Rituximab is an IgG1, chimeric monoclonal antibody specifically designed to recognize the CD20 antigen expressed on the surface of normal and malignant B-lymphocytes, from the B-cell precursor to the mature B-cells of the germinal center, and by most neoplasms derived from B-cells. After 2 decades of use, rituximab is firmly positioned in the treatment of follicular lymphoma (FL, both in the front line and in the relapsing disease, improving previous results by including it in classical chemotherapy regimens. However, the pharmacology of rituximab continues to generate controversial issues especially regarding the mechanisms of action in vivo. The contribution of rituximab as a maintenance treatment in FL has been significant progress in the management of this disease without an increase in side effects or a decrease in the quality of life of patients. With the widespread use of rituximab, there are new security alerts and side effects not previously detected in the pivotal trials that clinicians should learn to recognize and manage. In this article, we will review the pharmacokinetics and pharmacodynamics of rituximab, the management issues in the treatment of advanced FL focusing on maintenance rituximab, its long-term efficacy and safety profile, and its effect on the quality of life. Keywords: follicular lymphoma, long-term efficacy, maintenance, rituximab, toxicity

  8. Long-term treatment with rituximab in severe juvenile idiopathic arthritis-associated uveitis.

    Science.gov (United States)

    Miserocchi, Elisabetta; Modorati, Giulio; Berchicci, Luigi; Pontikaki, Irene; Meroni, Pierluigi; Gerloni, Valeria

    2016-06-01

    To evaluate retrospectively the long-term efficacy of rituximab in patients with severe juvenile idiopathic arthritis (JIA)-associated uveitis. Eight patients (15 eyes) with severe and longstanding JIA uveitis, who had an inadequate response in controlling uveitis to one or more biologic agents including tumour necrosis factor blockers and abatacept, received rituximab therapy. Rituximab was given at a dose of 1000 mg per infusion on days 1 and 15 and then every 6 months. Clinical responses to treatment, including decrease in uveitis activity, visual acuity changes, reduction of concomitant local and systemic corticosteroid and/or immunosuppressants, and occurrence of adverse events, were assessed. Eight patients with a mean±SD age of 22.8±5.5 years were treated. The mean ocular disease duration was 17.7 years; the mean±SD follow-up time on rituximab was 44.75±4.9 months; and the mean number of rituximab infusions received was 8.75 (range 6-12). All patients achieved complete control of uveitis, but in two patients rituximab was discontinued due to inefficacy in treating arthritis. The decrease in uveitis activity was evident 4-5 months after the first infusion. Systemic corticosteroids and immunosuppressants used in association with rituximab were discontinued in five patients at the end of follow-up. None of the patients experienced visual worsening during the follow-up. No drug-related complications were encountered. Rituximab may be a promising effective treatment option for refractory uveitis associated with JIA leading to long-term quiescence of uveitis, particularly for patients who have not previously responded to other biologic therapies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. Efficacy and safety of rituximab in the treatment of refractory pemfigus vulgaris

    Directory of Open Access Journals (Sweden)

    Aslı Bilgiç Temel

    2015-06-01

    Full Text Available Background and Design: Pemphigus vulgaris (PV is a severe, chronic, potentially life-threatening autoimmune blistering disease that affects the skin and mucous membranes, associated with the loss of cell-cell adhesion and blister formation. Systemic steroids in combination with immunosuppressive agents are the mainstay of therapy in pemphigus. Rituximab is a chimeric monoclonal anti- CD20 antibody, has been tried increasingly for the treatment of PV. Objective: We sought to test the efficacy and safety of rituximab as an adjuvant therapy by retrospective analysis of clinical and immunological data of patients. Method: A retrospective analysis is presented of 13 patients with refractory pemphigus vulgaris who were treated with rituximab at Akdeniz University Hospital, Dermatology and Venereology Department, Bullous Disease Unit. We evaluated clinical and immunological data with last treatments. Results: Patients were treated with one cycle of two biweekly infusions of rituximab at a dose of 1000 mg on days 1 and 15, except one received four doses of 375 mg / m2 intravenously weekly. The mean follow-up time was 18.5 months. All patients had a decrease in antibody titers or antibodies were completely undetected after treatment. Rituximab use resulted in a significant reduction in steroid dosage during follow-up. At the end of the follow-up period, 7 patients achieved complete disease remission without therapy, 1 patient achieved partial disease remission without therapy, 2 patients achieved complete remission on minimal therapy, 1 patient achieved complete remission on therapy, 1 patient achieved partial remission on minimal therapy, and one patient had no follow-up. Rituximab was well tolerated by all patients. Clinical relapse had seen 53.8% by the mean period of 13.8 months. Relapses have been managed with additional infusions of rituximab. Conclusion: Rituximab is beneficial in the management of refractory PV, induces prolonged clinical

  10. Intermediate doses of rituximab used as adjuvant therapy in refractory pemphigus

    Directory of Open Access Journals (Sweden)

    Pradnya J Londhe

    2014-01-01

    Full Text Available Background: Rituximab, a monoclonal anti-CD20 antibody, has been used with encouraging results in pemphigus. We describe herein refractory cases of pemphigus vulgaris (n = 23 and pemphigus foliaceus (n = 1 treated with rituximab in addition to steroids and immunosuppressants. Aims: To assess the response to treatment, the duration of clinical remission, serology of the response and adverse effects of rituximab in pemphigus patients. Methods: We recorded observations of 24 patients with pemphigus having either refractory disease in spite of high dose of steroids and immunosuppressants, corticosteroid-dependent disease, strong contraindications to corticosteroids, or severe disease. The patients were treated with infusions of one injection per week for three consecutive weeks of 375 mg of rituximab per m 2 of body-surface area. One similar infusion was repeated after 3 months of 3 rd dose. We observed the clinical outcome after 6 months of 3 rd dose of rituximab and looked for complete healing of cutaneous and mucosal lesions (complete remission. Observations: After follow-up of 7-24 months, five patients showed only partial improvement while 19 of 24 patients had a complete remission 3 months after rituximab. Of these 19 patients, 12 patients achieved complete remission and are off all systemic therapy, and the rest are continuing with no or low dose of steroids with immunosuppressants. Two patients relapsed after initial improvement; one was given moderate dose of oral steroids and immunosuppressant and the other was given repeat single dose of rituximab to control relapse. Conclusion: Rituximab is able to induce a prolonged clinical remission in pemphigus after a single course of four infusions. The high cost and limited knowledge of long term adverse effects are limitations to the use of this biologic agent.

  11. Effective treatment of refractory pulmonary hemorrhage with monoclonal anti-CD20 antibody (rituximab).

    Science.gov (United States)

    Pinto, Luis Fernando; Candia, Liliana; Garcia, Patricia; Marín, Juan Ignacio; Pachón, Ines; Espinoza, Luis R; Marquez, Javier

    2009-01-01

    We report a 19-year-old female with systemic lupus erythematosus and lupus nephritis who developed pulmonary hemorrhage (PH) refractory to conventional immunosuppressive treatment. She was initially treated with intravenous methylprednisolone and cyclophosphamide pulses. She required mechanical ventilation due to a lack of responsiveness and her disease was considered refractory to conventional treatment. Rituximab was administered and this was followed by clinical improvement in both PH and nephritis. Rituximab may be a useful therapeutic option for the treatment of refractory PH.

  12. Rituximab is an efficient and safe treatment in adults with steroid-dependent minimal change disease.

    Science.gov (United States)

    Munyentwali, Helene; Bouachi, Khedidja; Audard, Vincent; Remy, Philippe; Lang, Philippe; Mojaat, Rachid; Deschênes, Georges; Ronco, Pierre M; Plaisier, Emmanuelle M; Dahan, Karine Y

    2013-03-01

    Development of steroid dependency in patients with nephrotic syndrome may require a long-term multi-drug therapy at risk of drug toxicity and renal failure. Rituximab treatment reduces the steroid dosage and the need for immunosuppressive therapy in pediatric patients. Here we retrospectively analyze the efficacy and safety of rituximab in adult patients with steroid-dependent minimal change disease. To do this, we analyzed the outcome of all adult patients treated with rituximab for steroid-dependent minimal change nephrotic syndrome over a mean follow-up of 29.5 months (range 5.1-82 months). Seventeen patients with steroid-dependent or frequently relapsing minimal change nephrotic syndrome, unresponsive to several immunosuppressive medications, were treated with rituximab. Eleven patients had no relapses after rituximab infusion (mean follow-up 26.7 months, range 5.1-82 months) and nine of them were able to come off all other immunosuppressive drugs and steroids during follow-up. Six patients relapsed at least once after a mean time of 11.9 months (mean follow-up 34.5 months, range 16.9-50.1 months), but their immunosuppressive drug treatment could be stopped or markedly reduced during this time. No adverse events were recorded. Thus, rituximab is efficient and safe in adult patients suffering from severe steroid-dependent minimal change disease. Prospective randomized trials are needed to confirm this study.

  13. Use of Rituximab in Children with Steroid- and Calcineurin-Inhibitor-Dependent Idiopathic Nephrotic Syndrome

    Science.gov (United States)

    Ravani, Pietro; Ponticelli, Alessandro; Siciliano, Chiara; Fornoni, Alessia; Magnasco, Alberto; Sica, Felice; Bodria, Monica; Caridi, Gianluca; Wei, Changli; Belingheri, Mirco; Ghio, Luciana; Merscher-Gomez, Sandra; Edefonti, Alberto; Pasini, Andrea; Montini, Giovanni; Murtas, Corrado; Wang, Xiangyu; Muruve, Daniel; Vaglio, Augusto; Martorana, Davide; Pani, Antonello; Scolari, Francesco; Reiser, Jochen; Ghiggeri, Gian Marco

    2013-01-01

    In children with idiopathic nephrotic syndrome rituximab can maintain short-term remission with withdrawal of prednisone and calcineurin-inhibitors. Long-term effects including number of repeated infusions to maintain remission are unknown. We treated with rituximab 46 consecutive children with idiopathic nephrotic syndrome lasting for at least one year (6.3±4.1 years), who were maintained in remission with oral prednisone and calcineurin inhibitors. They received 1–5 rituximab courses during a median follow-up of three years (range 1–5). Oral agents were tapered after each infusion, and completely withdrawn within 45 days. Rituximab was well tolerated. Six-month probabilities of remission were 48% after the first infusion and 37% after subsequent infusions. One- and two-year-remission probabilities were respectively 20% and 10%. Median time intervals between complete oral-agent withdrawal and relapse were 5.6 and 8.5 months respectively following the first and subsequent courses. Time to reconstitution of CD20 cells correlated with the duration of remission, but was not associated with variation in FcyR, CD20 or SMPDL-3B polymorphisms. Podocyte Src phosphorylation was normal. Rituximab can be safely and repeatedly used as prednisone and calcineurin-inhibitor-sparing therapy in a considerable proportion of children with dependent forms of idiopathic nephrotic syndrome. Further research is needed to identify patients who will benefit most from rituximab therapy. PMID:23739238

  14. The Factors That May Predict Response to Rituximab Therapy in Recurrent Focal Segmental Glomerulosclerosis: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Carlos E. Araya

    2011-01-01

    Full Text Available Recurrence of FSGS occurs in 30–40% of allografts. Therapies for recurrence are not well established. We retrieved all published reports depicting kidney transplant recipients with focal segmental glomerulosclerosis (FSGS recurrence, treated with rituximab, to determine factors associated with treatment response. We found 18 reports of 39 transplant recipients who received rituximab. By univariate analysis for two outcomes (no response versus any response, fewer rituximab infusions and normal serum albumin at recurrence were associated with treatment response. For 3 outcomes (no response, partial and complete remission, male gender, fewer rituximab infusions, shorter time to rituximab treatment, and normal serum albumin were associated with remission. Multivariate analysis for both models revealed that normal serum albumin at FSGS recurrence and lower age at transplant were associated with response. Rituximab for recurrence of FSGS may be beneficial for only some patients. A younger age at transplant and normal serum albumin level at recurrence diagnosis may predict response.

  15. Reconstrucción de antebrazo con colgajo DIEP: caso clínico

    Directory of Open Access Journals (Sweden)

    J. Balaguer-Cambra

    2015-06-01

    Full Text Available Las heridas complejas del antebrazo con fracturas asociadas y pérdida circunferencial de piel, suponen un doble reto reconstructivo. Mostramos el tratamiento de una paciente con lesiones combinadas en el miembro superior tras atrapamiento por rodillos fríos industriales mediante el uso de un colgajo libre de perforante del eje epigástrico inferior profundo (DIEP, tras tratamiento de la fractura articular de la extremidad distal de radio guiado por artroscopia. Conseguimos la estabilización de las fracturas y la cobertura completa del defecto. El colgajo DIEP permite la cobertura de áreas extensas con escasa morbilidad en la zona donante y con un correcto resultado estético.

  16. Método simplex supermodificado como estratégia de otimização para respostas combinadas em sistemas alimentares

    OpenAIRE

    Rosângela Aguilar da SILVA; Borsato, Dionísio; Silva,Rui Sérgio Ferreira da

    2000-01-01

    O presente trabalho teve como objetivo combinar modelagem pela superfície de resposta com otimização simplex supermodificado, para tratamento de casos de interesse na ciência e tecnologia de alimentos, com o emprego da função de Derringer & Suich para respostas combinadas. Um programa para microinformática, denominado MULTIPLEX, foi desenvolvido e testado na otimização multirresposta de três sistemas alimentares selecionados na literatura especializada: 1) inativação da lipoxigenase e lip...

  17. Técnica combinada de articulación y thrust para disfunción de cóndilo posterior

    National Research Council Canada - National Science Library

    Guirao Cano, Dídac

    2008-01-01

    ... técnicas de elección es la combinada de articulación y thrust para disfunción en cóndilo posterior en decúbito, ya que permite ejercer y graduar en todo momento la fuerza necesaria para facilitar la liberación y la normalización ar- ticular, paso previo hacia una correcta función. Palabras clave: Articulación temporomandibular. Torsión ma...

  18. Tratamiento de rehabilitación en niños con escoliosis

    OpenAIRE

    Fonseca, Galia; Martínez Roo, Nelly Patricia

    2011-01-01

    Existe una amplia gama de intervenciones únicas o combinadas que van a garantizar que la curvatura en la mayoría de los casos permanezca estable y en otros que disminuya hasta que se complete el periodo de crecimiento del niño. La elección del tipo de intervención (observación, ortesis, vendaje en yeso o quirúrgico) dependerá de la madurez esquelética y de la clasificación que se haga de la escoliosis. Cada vez que se inicia la intervención en un paciente con escoliosis se debe realizar un an...

  19. Tratamiento de una lesión endoperiodontal tipo III (combinada o verdadera: reporte de un caso Treatment of type III periodontal-endodontic lesion (combined or true: a case report

    Directory of Open Access Journals (Sweden)

    M Alcota

    2011-04-01

    Full Text Available Se presenta un caso clínico de una lesión endoperiodontal tipo III (combinada o verdadera en un paciente de sexo femenino de 41 años de edad sin antecedentes sistémicos. La paciente fue derivada del Curso de Especialización en Periodoncia de la Escuela de Graduados de la Universidad de Chile debido a una lesión periapical en la pieza 3.6. El pronóstico en este tipo de lesiones es dudoso, ya que es necesario que se efectúe el tratamiento endodóntico así como el periodontal, y el resultado recae más en el tratamiento periodontal. La pieza fue tratada endodónticamente dejando medicamento intraconducto a base de Clorhexidina al 2% en gel por 7 días. Una vez obturado el diente se citó a la paciente 3 meses después para un control radiográfico. Actualmente el diente está totalmente asintomático, sin movilidad y con señales de reparación.We report a case of a type III periodontal-endodontic lesion (combined or true in a 41-year-old female patient without systemic history. The patient was transferred from the Specialization Course in Periodontology at the Graduate School of the University of Chile due to a periapical lesion in the tooth 3.6. The prognosis for this type of lesion is uncertain, since it is necessary to perform endodontic and periodontal treatment, and the result depends more on the periodontal treatment. The piece was treated endodontically leaving intracanal medication based on 2% Chlorhexidine gel for 7 days. Once the tooth obturated, we gave the patient an appointment 3 months later for a control radiography. Currently, the tooth is completely asymptomatic, without mobility and with signs of repair.

  20. Lymphoid nodular hyperplasia in a patient with severe combined immunodeficiency disease; Hiperplasia nodular linfoide en un paciente con inmunodeficiencia combinada grave

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez-Alegre, M. L.; Casanova, A.; Delgado, J.; Relanzon, S. [Hospital General Universitario Gregorio Maranon. Madrid (Spain)

    2001-07-01

    We describe a case of lymphoid nodular hyperplasia in a woman with severe combined immunodeficiency disease. the patient complained of constipation and episodes of abdominal pain, and examination revealed the presence of a large abdominal mass. The diagnosis was suspected on the basis of the initial radiological studies, but intestinal biopsy was necessary to rule out lymphomatous involvement. We point out the radiological features of this entity which, despite the fact that it may be a chance finding of no pathological significance, requires special attention, especially in immuno deficient individuals. (Author) 10 refs.

  1. Alteraciones metabólicas en individuos mexicanos con hiperlipidemia familiar combinada y las variantes del polimorfismo de nucleótido único rs1424032 /

    OpenAIRE

    Almeda Valdes, Paloma

    2012-01-01

     tesis que para obtener el grado de Doctorado en Ciencias Medicas, presenta Paloma Almeda Valdes ; asesor Carlos Aguilar Salinas68 páginas : ilustracionesDoctorado en Ciencias Medicas UNAM, Facultad de Medicina, 2012

  2. Rituximab in the treatment of B-cell non-Hodgkin lymphoma, focus on outcomes and comparative effectiveness

    Directory of Open Access Journals (Sweden)

    Firas Badin

    2010-04-01

    Full Text Available Firas Badin, John HayslipUniversity of Kentucky, Markey Cancer Center, Lexington, KY, USAAbstract: Rituximab is an important and well established component in the treatment of many patients with B-cell non-Hodgkin lymphoma. In this paper we review recent clinical trials investigating the addition of rituximab to standard chemotherapy regimens for treatment of patients with diffuse large B cell lymphoma and follicular lymphoma. This report focuses upon treatment efficacy, quality of life, and safety of rituximab or rituximab-containing regimens. More uniquely, we review economic aspects of lymphoma treatments, including the cost of standard chemotherapy regimens with or without rituximab, cost effectiveness of rituximab in both induction and maintenance treatment, and lymphoma’s impacts on patient’s productivity and their caregivers. We conclude that adding rituximab to standard chemotherapy treatment for patients with B-cell non-Hodgkin lymphoma is safe and cost-effective in numerous settings during both induction and maintenance therapies. Despite extensive review of the literature, many important questions have yet to be answered in the rituximab era and these represent important directions for future study.Keywords: rituximab, lymphoma, cost effectiveness, transplant, safety

  3. Rituximab efficiently depletes B cells in lung tumors and normal lung tissue [version 1; referees: 2 approved

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    Albane Joly-Battaglini

    2016-01-01

    Full Text Available Rituximab is a monoclonal antibody that targets the CD20 B-cell-specific antigen and is widely used as therapy for B-cell lymphoma. Since rituximab depletes both malignant and normal B cells, it is increasingly being used to treat various conditions in which normal B cells have a pathogenic role, such as rheumatoid arthritis and multiple sclerosis. It is well-established that rituximab efficiently eliminates B cells in blood, lymph nodes, and spleen. In contrast, the effect of rituximab in non-lymphoid tissues remains poorly documented and is debated. Here, we report a rheumatoid arthritis patient who was treated with rituximab before receiving thoracic surgery for non-small cell lung cancer. Using flow cytometry and immunohistochemistry, we show that rituximab efficiently depleted CD20-positive B cells in a primary lung tumor, in lung-associated lymph nodes, and in normal lung tissue. We conclude that rituximab may be very efficient at depleting normal B cells in the lungs. This property of rituximab may potentially be exploited for the treatment of conditions in which pathogenic B cells reside in the lungs. On the other hand, the clearance of lung B cells may provide an explanation for the rare cases of severe non-infectious pulmonary toxicity of rituximab.

  4. Role of rituximab in first-line treatment of chronic lymphocytic leukemia

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    Jeffrey Bryan

    2010-12-01

    Full Text Available Jeffrey Bryan, Gautam BorthakurDepartment of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USAAbstract: Chronic lymphocytic leukemia (CLL is a biologically heterogeneous illness that primarily afflicts the elderly. For many decades, the initial therapy for most patients requiring treatment was limited to single-agent alkylator therapy. Within the last two decades, we have seen remarkable progress in understanding the biology of CLL and the development of more effective treatment strategies that have employed monoclonal antibodies, such as rituximab (anti-CD20. Furthermore, recognition of the synergy between fludarabine, cyclophosphamide, and rituximab (FCR prompted investigators to explore the clinical activity of FCR in Phase II and III trials in patients with relapsed/refractory or previously untreated CLL. On the basis of these findings, the US Food and Drug Administration (FDA recently approved rituximab in combination with fludarabine and cyclophosphamide for the treatment of patients with relapsed/refractory or previously untreated CD20-postive CLL. Recent data from a randomized Phase III trial has confirmed improved overall survival with FCR in patients with previously untreated CLL. However, FCR is not for everyone. More tolerable regimens using rituximab for the elderly and less fit patients are being pursued in clinical trials. Recent Phase II trials have explored potentially less myelosuppressive approaches by using lower doses of fludarabine and cyclophosphamide, replacing fludarabine with pentostatin, and combining rituximab with chlorambucil. Furthermore new biomarkers predictive of early disease progression have prompted investigators to explore the benefits of early treatment with rituximab combined with other agents. In addition to the proven utility of rituximab as a frontline agent for CLL, rituximab has a favorable toxicity profile both as a single agent and in combination with chemotherapy. The

  5. Ajuste de tiempos de inmersión en técnicas combinadas de deshidratado de duraznos

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    Urfalino, D.P

    2014-04-01

    Full Text Available En el presente trabajo se desarrolló una técnica combinada de deshidratado osmótico-convectivo para duraznos. El objetivo fue ajustar los tiempos de inmersión en las soluciones de sacarosa empleadas para generar un proceso de fácil adopción y económico que brinde productos de alta calidad que mantengan dichas características durante todo su período de almacenaje. Para ello, se realizó una primera inmersión de los duraznos pelados en mitades en una solución de metabisulfito de sodio al 5% durante tres minutos y, posteriormente, se colocaron en una solución de sacarosa a 55º Brix variando los tiempos de inmersión (T1: 24 horas; T2: 12 horas; T3: 6 horas y T4: 0 horas. Transcurridos dichos intervalos de tiempo, los duraznos se escurrieron, se enjuagaron y se deshidrataron a 55º C hasta 20% de humedad final en un horno eléctrico. Cada tratamiento se realizó por duplicado. Durante la realización de los ensayos se determinó peso y volumen, antes y después de la etapa de deshidratado osmótico (DO y de la etapa de deshidratado convectivo. Una vez obtenido el producto final se evaluó color y dióxido de azufre residual cada tres meses por un plazo total de 10 meses. Los resultados reflejaron que los tratamientos que tuvieron mayores tiempos de inmersión en la solución hipertónica presentaron mayor volumen y rendimiento en el producto final, los cuales fueron directamente proporcionales al tiempo de inmersión. Por otro lado, los tratamientos que tuvieron la etapa de DO presentaron un contenido de sulfitos considerablemente menor en el producto final, respecto al testigo y una menor degradación del color a través del tiempo. El tratamiento 1 se destacó por presentar la mayor estabilidad del parámetro de color L* (el cual refleja la luminosidad durante los 10 meses de almacenaje evaluados.

  6. Vértigo con nistagmo vertical por administración de morfina intratecal y reversión con naloxona

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    Jorge De All

    2011-10-01

    Full Text Available La anestesia regional combinada es utilizada frecuentemente como herramienta para el tratamiento del dolor postoperatorio. Los efectos secundarios de los opioides utilizados por esta vía son similares a los que se presentan luego de la administración sistémica. La aparición de vértigo con nistagmo vertical es un efecto adverso muy pocas veces descripto con el uso de morfina por vía intratecal, epidural o endovenosa. Comunicamos el caso de un paciente que presentó esta complicación en el postoperatorio de una nefrectomía parcial, luego de la administración de morfina intratecal, con resolución completa mediante el uso de naloxona endovenosa.

  7. Safety and efficacy of combined cyclophosphamide and rituximab treatment in recalcitrant childhood lupus.

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    Ale'ed, Ashwaq; Alsonbul, Abdullah; Al-Mayouf, Sulaiman M

    2014-04-01

    To report the safety and efficacy of combined cyclophosphamide and rituximab treatment in Saudi children with systemic lupus erythematosus (SLE). Medical records of all children with SLE treated with cyclophosphamide and rituximab between June 2007 and June 2012 at King Faisal Specialist Hospital and Research Center, Riyadh, were reviewed for demographic characteristics, age at diagnosis, concomitant treatments, indication of using rituximab and adverse events during the treatment period. Clinical and serologic response parameters included SLE Disease Activity Index (SLEDAI), complement, anti-ds DNA antibody and ANA levels, and mean daily corticosteroid dose assessed 3 months before combined cyclophosphamide and rituximab infusion course and at 6-month interval afterward. Sixteen patients (13 girls) with refractory SLE treated with cyclophosphamide and rituximab were included. The mean age at onset of SLE was 7.8 + 3.3 years, while the mean age at diagnosis was 8.1 + 3.4 years; the mean disease duration was 4.7 + 3.2 years. All patients were treated with corticosteroid and immunosuppressive drugs. Nephritis (8 patients) was the most frequent indication; other indications included refractory arthritis, thrombocytopenia, severe mucocutaneous lesions and central nervous system involvement. All patients received 2 doses, but 4 required 4-8 extra doses. All patients showed improvement in response parameters. There was significant reduction in SLEDAI (P < 0.0002) and corticosteroid dose (P < 0.005). A total of 4 adverse events were notified; 2 developed infusion-related reactions. One patient had severe soft tissue fungal infection, and other patient had pancreatitis. Our data showed beneficial therapeutic and steroid-sparing effects of rituximab as adjunctive treatment for children with refractory SLE including both renal and extrarenal manifestations. Although rituximab was well tolerated by the majority of patients, it may associated with various adverse events.

  8. Efficacy and safety of rituximab in neuromyelitis optica: Review of evidence

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    Masoud Etemadifar

    2017-01-01

    Full Text Available Neuromyelitis optica (NMO is an autoimmune inflammatory disease of the central nervous system with preferential involvement in the optic nerve and spinal cord with a widespread spectrum of clinical features; multiple therapeutic agents have been used with different results. Recent evidence points to B-cell-mediated humoral immunity in the pathogenesis of NMO. Rituximab targets the CD20 antigen on B-cells. Treatment leads to profound B-cell depletion, principally over an antibody-dependent cell cytotoxicity mechanism. The aim of our study was to review clinical trials to elucidate the impact of rituximab on the relapse rate, Expanded Disability Status Scale (EDSS, and progression of disability in NMO. We performed a comprehensive review of all studies that evaluated clinical and paraclinical effects of rituximab on NMO. MEDLINE-PubMed, Web of Sciences, EMBASE, and Cochrane databases up to June 2016 included in our searches. In addition, reference lists from articles identified by search as well as a key review article to identify additional articles included in the study. Rituximab targets the CD20 antigen on B-cells and decreases attack frequency and severity in patients with NMO; however, it does not remove attacks, even when modifying treatment to achieve B-cell depletion. Most of the investigations revealed that EDSS significantly in all patients with rituximab treatment will be decreased after treatment with rituximab. No new or enlarged lesions or pathological gadolinium enhancement was observed in serial brain and spinal cord magnetic resonance imaging, except for those observed concomitantly with clinical relapses and the median length of spinal cord lesions was significantly reduced after therapy. Rituximab targets the CD20 antigen and decreases attack frequency and severity in patients with NMO.

  9. A comprehensive analysis of treatment outcomes in patients with pemphigus vulgaris treated with rituximab.

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    Ahmed, A Razzaque; Shetty, Shawn

    2015-04-01

    Approximately 500 treatment recalcitrant pemphigus vulgaris patients have been treated with rituximab. They were treated according to the lymphoma protocol (N=224) or rheumatoid arthritis protocol (RAP) (N=209) patients. Others were treated with modifications or combinations of the two. The mean duration of follow-up with the lymphoma protocol was 28.9months and 21.9 in the rheumatoid arthritis protocol. The majority of the patients received corticosteroids and immunosuppressive therapy before, during, and after rituximab therapy. A clinical remission on therapy was observed in 90%-95% of patients within less than six weeks. A complete resolution occurred within three to four months. A small percentage of patients were able to stay in clinical remission without the need for additional systemic therapy. The incidence of relapse was at least 50%. The number of patients who required additional rituximab was 60% to 90%. A majority of patients in clinical remission post-rituximab therapy, were still on CS and ISA, albeit at lower doses. Serious adverse events were reported in a mean of five patients (range 2-9), the most important was infection and frequently resulting in septicemia. The mortality rate related to rituximab was a mean of 2 patients (range 1-3). Hence, the preliminary conclusions that can be drawn are that rituximab is an excellent agent to induce early remission. The protocols that were used were not ideal for producing a prolonged and sustained remission without additional therapy. The advantages and specificity of targeting B-cells demonstrate that rituximab is one of the best biological agents, currently available for treating recalcitrant pemphigus. Its further use is encouraged. Future research needs to focus on modifying, improving and possibly adding additional agents, so that prolonged and sustained remissions can be obtained by its use.

  10. Anti CD20 (Rituximab therapy in refractory pediatric rheumatic diseases

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    Joel Reis

    2016-01-01

    Full Text Available Objectives: We aim to report the efficacy and safety of rituximab (RTX in patients diagnosed with juvenile systemic lupus erythematosus (JSLE or juvenile idiopathic arthritis (JIA refractory to conventional treatment. Methods: A retrospective review was made of all medical records of patients with JSLE or JIA treated with RTX between January 2009 and January 2015 in the Pediatric Rheumatology Unit of a central hospital. Results: Five patients, 4 with JSLE and 1 with extended oligoarticular JIA, received 10 cycles of RTX (23 infusions. The scheme of RTX frequently used was 750 mg/m2 two weeks apart. The median follow-up time after receiving the first cycle of RTX was 24 months (12 – 70. The four patients with JSLE were female (three caucasian and one black. The patient with JIA was a caucasian male. The median age at diagnosis was 10 years (16 months – 17years. The median evolution time until receiving RTX was 6 years (5 months – 15 years. Refractory class IV lupus nephritis was the most common indication for receiving RTX. Previous treatment to RTX included nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, immunosuppressive drugs and corticosteroids in all patients and anti-TNFα (etanercept in the patient with JIA. It was possible to reduce the mean oral corticosteroid dose after RTX, ranging from 23 mg/day (20-25mg/day before RTX to 11 mg/day (0–20 mg/day at the last evaluation. Disease activity before RTX and at last evaluation also improved. The SLEDAI score, for JSLE, decreased from a median of 15, 5 (11 – 18 to 3 (0 – 6, and the JADAS-27 score, for JIA, also diminished from 40.4 to 3.5. Adverse events occurred in 2 patients, including delayed second dose after the diagnosis of cryptococcosis and respiratory tract infection with concomitant hypogammaglobulinemia needing of immunoglobulin replacement and antibiotic therapy. Conclusions: Rituximab might have a role in the treatment of JSLE and JIA

  11. Absolute lymphocyte count predicts response to rituximab-containing salvage treatment for relapsed/refractory B-cell non-Hodgkin's lymphoma with prior rituximab exposure

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    Man-Hsin Hung

    2013-04-01

    Conclusion: Our study results show that for patients with relapsed/refractory B-cell NHL, rituximab-containing salvage treatment is feasible and generally tolerable. A high ALC-R value was significantly associated with a better response to this treatment.

  12. Alterações neurorradiológicas cerebrais na degeneração combinada de medula: relato de caso

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    SILVA MARCUS TULIUS TEIXEIRA DA

    2000-01-01

    Full Text Available A carência da vitamina B12 em muitas situações manifesta-se também por alterações neuropsiquiátricas, sendo a mais comum a degeneração combinada subaguda da medula espinhal. No sistema nervoso central a repercussão maior é na mielina, sendo a degeneração esponjosa e a desmielinização difusa das colunas lateral e posterior da medula as mais típicas alterações patológicas. O mesmo ocorre nos hemisférios cerebrais, sendo que anormalidades nas imagens por ressonância magnética são esperadas. No entanto muito pouco tem sido relatado e a carência da cobalamina não figura habitualmente na lista de diagnósticos diferenciais de lesões desmielinizantes. Relatamos caso de anemia perniciosa com manifestações neurológicas em que a ressonância magnética mostrou alterações compatíveis com desmielinização do feixe piramidal, consequentes, possivelmente, à carência da vitamina B12. Discutimos os achados neuropatológicos da hipovitaminose. Sugerimos que a degeneração combinada subaguda da medula deve fazer parte do diagnóstico diferencial radiológico das lesões desmielinizantes no sistema nervoso central.

  13. Inflammation and autoantibody markers identify rheumatoid arthritis patients with enhanced clinical benefit following rituximab treatment.

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    Lal, Preeti; Su, Zheng; Holweg, Cecile T J; Silverman, Gregg J; Schwartzman, Sergio; Kelman, Ariella; Read, Simon; Spaniolo, Greg; Monroe, John G; Behrens, Timothy W; Townsend, Michael J

    2011-12-01

    Rituximab significantly improves the signs and symptoms of rheumatoid arthritis (RA) and slows the progression of joint damage. The aim of this study was to identify clinical characteristics and biomarkers that identify patients with RA in whom the clinical benefit of rituximab may be enhanced. The study group comprised 1,008 RA patients from 2 independent randomized placebo-controlled phase III clinical trials (REFLEX [Randomized Evaluation of Long-Term Efficacy of Rituximab in Rheumatoid Arthritis] and SERENE [Study Evaluating Rituximab's Efficacy in Methotrexate Inadequate Responders]). A novel threshold selection method was used to identify baseline candidate biomarkers present in at least 20% of patients that enriched for placebo-corrected American College of Rheumatology 50% improvement (ACR50 response; a high clinical efficacy bar) at week 24 after the first course of rituximab. The presence of IgM rheumatoid factor (IgM-RF), IgG-RF, IgA-RF, and IgG anti-cyclic citrullinated peptide (anti-CCP) antibodies together with an elevated C-reactive protein (CRP) level were associated with enhanced placebo-corrected ACR50 response rates in the REFLEX patients with RA who had an inadequate response to anti-tumor necrosis factor therapies. These findings were independently replicated using samples from patients in SERENE who had an inadequate response to disease-modifying antirheumatic drug treatment. The combination of an elevated baseline CRP level together with an elevated level of any RF isotype and/or IgG anti-CCP antibodies was further associated with an enhanced benefit to rituximab. The presence of any RF isotype and/or IgG anti-CCP autoantibodies together with an elevated CRP level identifies a subgroup of patients with RA in whom the benefit of rituximab treatment may be enhanced. Although the clinical benefit of rituximab was greater in the biomarker-positive population compared with the biomarker-negative population, the clinical benefit of rituximab

  14. Rituximab maintenance therapy for patients with diffuse large B-cell lymphoma: A meta-analysis

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    Li, Juan

    2017-01-01

    Purpose The addition of rituximab to standard chemotherapy has significantly improved survival in patients with lymphoma. Recently, maintenance therapy with rituximab has been shown to prevent relapse and provide survival benefits for patients with follicular or mantle cell lymphoma. However, the effects of rituximab in patients with diffuse large B-cell lymphoma (DLBCL) remain unclear. Two new studies involving rituximab in the treatment of DLBCL were performed this past year. We performed a meta analysis to evaluate the effects of rituximab maintenance treatment of patients with DLBCL. Methods Several databases (PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) databases were reviewed for relevant randomized controlled trials published prior to May, 2016. Two reviewers assessed the quality of the included studies and extracted data independently. The hazard ratios (HRs) for time-to-event data and relative risks (RRs) for the other data were pooled and estimated. Results Totally 5 studies including 1740 patients were eligible for the meta-analysis. Compared to the observation group, patients who received rituximab maintenance therapy had significantly improved event-free survival (EFS) (HR = 0.80, 95% CI: 0.65–0.98) and progression-free survival (PFS) (HR = 0.72, 95% CI: 0.54–0.94). However, there was no statistically significant difference in overall survival (OS) (HR = 0.66, 95% CI: 0.27–1.29). A subgroup analysis suggested that male patients may benefit from rituximab maintenance therapy with a better EFS (HR = 0.53, 95% CI: 0.34–0.82-), while this advantage was not observed in female patients (HR = 0.99, 95% CI: 0.64–1.52). Conclusions Rituximab maintenance may provide survival benefits beyond that afforded by first- and second-line chemotherapy alone, especially in male patients. However, maintenance rituximab treatment may cause more adverse events. It is recommended that both survival benefits and adverse events should

  15. Severe Primary Raynaud’s Disease Treated with Rituximab

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    Mohammed Shabrawishi

    2016-01-01

    Full Text Available Raynaud’s phenomenon refers to reversible spasms of the peripheral arterioles that can be primary Raynaud’s phenomenon (PRP or secondary Raynaud’s phenomenon (SRP to underlying connective tissue disease, both of which are characterized by a triphasic color response triggered by cold exposure or stress. PRP is typically a benign disease, whereas SRP may progress into digital ulcers and/or gangrene. Here, we report a case of a 55-year-old female diagnosed with PRP 7 years ago. Treatment with first-line agents, including calcium channel blocker, aspirin, and phosphodiesterase inhibitor, did not control her symptoms, which progressed to digital ulceration and gangrene. There were no symptoms of underlying autoimmune disease or malignancy, and autoimmune, serology, and immunology test results were normal; a biopsy of her left little finger was negative for vasculitis. Development to critical digital ischemia necessitated treatment with intravenous iloprost and heparin infusion followed by angioplasty, which led to a partial improvement. Due to persistent symptoms, rituximab therapy was initiated and two cycles induced a complete resolution of symptoms.

  16. Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab

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    D. Ernst

    2012-01-01

    Full Text Available A 25-year-old patient was referred due to subclavian stenosis, identified on echocardiography. She presented with exertional dizziness and dyspnoea. Questioning revealed bilateral arm claudication. Examination demonstrated an absent right ulnar pulse and asymmetrical brachial blood pressure. Bruits were evident over both common carotid arteries. Doppler ultrasound and MRI angiograms revealed occlusion or stenosis in multiple large arteries. Takayasu arteritis (TA was diagnosed and induction therapy commenced: 1 mg/kg oral prednisolone and 500 mg/m2 intravenous cyclophosphamide (CYC. Attempts to reduce prednisolone below 15 mg/d proved impossible due to recurring disease activity. Adjuvant azathioprine 100 mg/d was subsequently added. Several weeks later, the patient was admitted with a left homonymous hemianopia. The culprit lesion in the right carotid artery was surgically managed and the patient discharged on azathioprine 150 mg/d and prednisolone 30 mg/d. Despite this, deteriorating exertional dyspnoea and angina pectoris were reported. Reimaging confirmed new stenosis in the right pulmonary artery. Surgical treatment proved infeasible. Given evidence of refractory disease activity on maximal standard therapy, we initiated rituximab, based on recently reported B-cell activity in TA.

  17. Rituximab as Single Agent in Primary MALT Lymphoma of the Ocular Adnexa

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    Ombretta Annibali

    2015-01-01

    Full Text Available Ocular Adnexal Lymphomas are the first cause of primary ocular malignancies, and among them the most common are MALT Ocular Adnexal Lymphomas. Recently systemic immunotherapy with anti-CD20 monoclonal antibody has been investigated as first-line treatment; however, the optimal management for MALT Ocular Adnexal Lymphomas is still unknown. The present study evaluated retrospectively the outcome of seven consecutive patients with primary MALT Ocular Adnexal Lymphomas, of whom six were treated with single agent Rituximab. All patients received 6 cycles of Rituximab 375 mg/mq every 3 weeks intravenously. The overall response rate was 100%; four patients (67% achieved a Complete Remission, and two (33% achieved a partial response. In four patients an additional Rituximab maintenance every 2-3 months was given for two years. After a median follow-up of 29 months (range 8–34, no recurrences were observed, without of therapy- or disease-related severe adverse events. None of the patients needed additional radiotherapy or other treatments. Rituximab as a single agent is highly effective and tolerable in first-line treatment of primary MALT Ocular adnexal Lymphomas. Furthermore, durable responses are achievable with the same-agent maintenance. Rituximab can be considered the agent of choice in the management of an indolent disease in whom the “quality of life” matter is of primary importance.

  18. Rituximab as Single Agent in Primary MALT Lymphoma of the Ocular Adnexa.

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    Annibali, Ombretta; Chiodi, Francesca; Sarlo, Chiara; Cortes, Magdalena; Quaranta-Leoni, Francesco M; Quattrocchi, Carlo; Bianchi, Antonella; Bonini, Stefano; Avvisati, Giuseppe

    2015-01-01

    Ocular Adnexal Lymphomas are the first cause of primary ocular malignancies, and among them the most common are MALT Ocular Adnexal Lymphomas. Recently systemic immunotherapy with anti-CD20 monoclonal antibody has been investigated as first-line treatment; however, the optimal management for MALT Ocular Adnexal Lymphomas is still unknown. The present study evaluated retrospectively the outcome of seven consecutive patients with primary MALT Ocular Adnexal Lymphomas, of whom six were treated with single agent Rituximab. All patients received 6 cycles of Rituximab 375 mg/mq every 3 weeks intravenously. The overall response rate was 100%; four patients (67%) achieved a Complete Remission, and two (33%) achieved a partial response. In four patients an additional Rituximab maintenance every 2-3 months was given for two years. After a median follow-up of 29 months (range 8-34), no recurrences were observed, without of therapy- or disease-related severe adverse events. None of the patients needed additional radiotherapy or other treatments. Rituximab as a single agent is highly effective and tolerable in first-line treatment of primary MALT Ocular adnexal Lymphomas. Furthermore, durable responses are achievable with the same-agent maintenance. Rituximab can be considered the agent of choice in the management of an indolent disease in whom the "quality of life" matter is of primary importance.

  19. Novel use of rituximab in a case of Riedel's thyroiditis refractory to glucocorticoids and tamoxifen.

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    Soh, Shui-Boon; Pham, Alan; O'Hehir, Robyn E; Cherk, Martin; Topliss, Duncan J

    2013-09-01

    A 42-year-old woman presented with a rapidly enlarging right-sided thyroid mass and underwent hemithyroidectomy. Riedel's thyroiditis was only diagnosed upon surgical decompression of the right carotid artery 2 years later. She became more symptomatic as Riedel's thyroiditis progressed, and mediastinal fibrosclerosis developed over the next 12 months. Oral prednisolone failed to improve her condition, and she was commenced on tamoxifen. Despite initial improvement, her symptoms recurred 2 years later, mainly arising from compression of the trachea and esophagus at the thoracic inlet. Fluorodeoxyglucose positron emission tomographic scan showed locally advanced active invasive fibrosclerosis in the neck and mediastinum. An elevated activin-A level of 218 pg/mL was consistent with active inflammation. IgG subtypes (including IgG4) were normal. Two courses of iv methylprednisolone were given but only produced transient improvement. Subsequently, the patient received 3 doses of i.v. rituximab at monthly intervals and had prompt sustained symptomatic improvement. Activin-A level decreased to 122 pg/mL 10 months after rituximab therapy. Fluorodeoxyglucose positron emission tomographic scan 6 weeks after therapy showed reduction in inflammation. A further scan at 10 months demonstrated ongoing response to rituximab. This is a case of refractory Riedel's thyroiditis with symptomatic, biochemical, and radiological improvement that has persisted 14 months after rituximab. The likelihood and duration of response to rituximab in Riedel's thyroiditis requires further study.

  20. Practical considerations on the use of rituximab in autoimmune neurological disorders

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    Kosmidis, Mixalis L.; Dalakas, Marinos C.

    2010-01-01

    Rituximab (Mabthera, Rituxan) is a chimeric human/murine monoclonal antibody against CD-20 surface antigen expressed on B-cells. Rituximab, by causing B-cell depletion, appears to be effective in several autoimmune disorders; it has been approved for rheumatoid arthritis and is a promising new agent in the treatment of several autoimmune neurological disorders. A controlled study in patients with relapsing remitting multiple sclerosis has shown that rituximab significantly reduces the number of new MRI lesions and improves clinical outcome; it also showed some promise in a subset of patients with primary progressive MS. The drug is also effective in a number of patients with Devic’s disease, myasthenia gravis, autoimmune neuropathies, and inflammatory myopathies. The apparent effectiveness of rituximab has moved B-cells into the center stage of clinical and laboratory investigation of autoimmune neurological disorders. We review the evidence-based effectiveness of rituximab in neurological disorders based on controlled trials and anecdotal reports, including our own experience, and address the immunobiology of B-cells in autoimmune central nervous system (CNS) and peripheral nervous system (PNS) disorders. In addition, we provide practical guidelines on how best to use this drug in clinical practice and highlight its potential toxicity. PMID:21179602

  1. Practical considerations on the use of rituximab in autoimmune neurological disorders.

    Science.gov (United States)

    Kosmidis, Mixalis L; Dalakas, Marinos C

    2010-03-01

    Rituximab (Mabthera, Rituxan) is a chimeric human/murine monoclonal antibody against CD-20 surface antigen expressed on B-cells. Rituximab, by causing B-cell depletion, appears to be effective in several autoimmune disorders; it has been approved for rheumatoid arthritis and is a promising new agent in the treatment of several autoimmune neurological disorders. A controlled study in patients with relapsing remitting multiple sclerosis has shown that rituximab significantly reduces the number of new MRI lesions and improves clinical outcome; it also showed some promise in a subset of patients with primary progressive MS. The drug is also effective in a number of patients with Devic's disease, myasthenia gravis, autoimmune neuropathies, and inflammatory myopathies. The apparent effectiveness of rituximab has moved B-cells into the center stage of clinical and laboratory investigation of autoimmune neurological disorders. We review the evidence-based effectiveness of rituximab in neurological disorders based on controlled trials and anecdotal reports, including our own experience, and address the immunobiology of B-cells in autoimmune central nervous system (CNS) and peripheral nervous system (PNS) disorders. In addition, we provide practical guidelines on how best to use this drug in clinical practice and highlight its potential toxicity.

  2. Place in therapy of rituximab in the treatment of granulomatosis with polyangiitis and microscopic polyangiitis.

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    Shah, Shivani; Geetha, Duvuru

    2015-01-01

    Granulomatosis with polyangiitis and microscopic polyangiitis are small vessel vasculitides characterized by circulating antineutrophil circulating antibodies. Standard treatment for active severe disease has consisted of cyclophosphamide with glucocorticoids with or without plasmapheresis, which achieves approximately 75% sustained remission, but carries significant adverse effects such as malignancy, infertility, leukopenia, and infections. The role of B cells in the pathogenesis of anti-neutrophil circulating antibodies-associated vasculitis has been established, and as such, rituximab, a monoclonal anti-CD20 antibody, has been studied in treatment of active granulomatosis with polyangiitis and microscopic polyangiitis (induction) and in maintaining remission. Rituximab has been shown to be effective in inducing remission in several retrospective studies in patients with refractory disease or cyclophosphamide intolerance. The RAVE and RITUXVAS trials demonstrated rituximab is a noninferior alternative to standard cyclophosphamide-based therapy; however, its role in elderly patients and patients with severe renal disease warrants further investigation. Rituximab has been compared with azathioprine for maintaining remission in the MAINRITSAN trial and may be more efficacious in maintaining remission in patients treated with cyclophosphamide induction. Rituximab is not without risks and carries a similar adverse event risk rate as cyclophosphamide in randomized control trials. However, its use can be considered over cyclophosphamide in patients who have relapsing or refractory disease or in young patients seeking to preserve fertility.

  3. RM en el diagnóstico y control evolutivo de la degeneración combinada subaguda: A propósito de un caso MRI in the diagnostic and evolutive control of subacute combined degeneration: A case report

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    R. Saiz-Mendiguren

    2012-08-01

    Full Text Available El déficit de vitamina B12, consecuencia generalmente de la anemia perniciosa, puede dar lugar a trastornos de la médula espinal, cerebro, nervios ópticos y periféricos. El principal síndrome neurológico es la degeneración combinada subaguda de la médula (DCS, que puede causar alteraciones motoras y/o sensitivas progresivas, inestabilidad e incontinencia, debido a la desmielinización de los cordones posteriores de la médula. La identificación por resonancia magnética (RM de una hiperintensidad de señal en secuencias potenciadas en T2 a nivel de los cordones posteriores de la médula cervical y/o dorsal, puede ser de gran utilidad en la orientación diagnóstica del paciente con DCS, sobre todo cuando los síntomas son leves o inespecíficos, y el paciente no tiene alteraciones hematológicas o gastrointestinales. Además, la evolución de la alteración de la señal del cordonal posterior en RM puede ser de utilidad para valorar la eficacia del tratamiento, ya que su normalización se relaciona con la mejoría clínica.A deficit of vitamin B12, generally resulting from pernicious anaemia, can give rise to disorders of the spinal cord, brain, optic and peripheral nerves. The principal neurological syndrome is subacute combined degeneration of the spinal cord (SCD, which can cause progressive motor and/or sensitive alterations, instability and incontinency, due to the demyelination of the posterior horn of the spinal cord. The identification by magnetic resonance (MR of signal hyperintensity in T2 weighted sequences at the level of the posterior horns of the spinal and/or cervical cord can be of great use in diagnosising the patient with SCD, above all when the symptoms are mild or nonspecific, and the patient does not have haematological or gastrointestinal alterations. Besides, the evolution of the altered signal of the posterior horns in MR can be of use in evaluating the efficacy of treatment, since their normalization is related

  4. Superior activity of fusion protein scFvRit : sFasL over cotreatment with rituximab and Fas agonists

    NARCIS (Netherlands)

    Bremer, Edwin; ten Cate, Bram; Samplonius, Douwe F.; Mueller, Nicole; Wajant, Harald; Stel, Aja J.; Chamuleau, Martine; de Loosdrecht, Arjan A. van; Stieglmaier, Julia; Fey, Georg H.; Helfrich, Wijnand

    2008-01-01

    The clinical efficacy of the CD20-specific chimeric monoclonal antibody rituximab is significantly hampered by intrinsic or acquired resistance to therapy. Rituximab activates antibody-dependent cellular cytotoxicity/complement-dependent cytotoxicity-dependent lysis but also induces apoptosis by cro

  5. Prescripción de hidroclorotiazida en pacientes con diabetes mellitus e hipertensión arterial sistémica en consulta externa

    OpenAIRE

    Pinilla Roa, Análida Elizabeth; Cano Arenas, Nairo; Spinel Bejarano, Néstor Leonardo; Peñaranda Parada, Édgar Alfonso; Granados Gómez, Carlos Eduardo

    2014-01-01

    Introducción: la morbilidad y mortalidad por eventos cardiovasculares en diabéticos disminuye con un adecuado control de la hipertensión. Cuando las metas de presión arterial no se logran con monoterapia, se recomienda la adición un diurético tiazida como primera opción para terapia combinada, dada su eficacia farmacológica, seguridad y bajo costo. Objetivo: determinar la prevalencia del uso de hidroclorotiazida en el tratamiento antihipertensivo en diabéticos tipo 2, describir el tratamient...

  6. Modelación numérica del oleaje en zonas costeras con batimetría no constante mediante elementos finitos

    OpenAIRE

    Modesto Galende, David

    2009-01-01

    En el presente documento se modela la propagaci´on de ondas lineales bajo una batimetr´ıa variable haciendo uso de la ecuaci´on Mild Slope en su formulaci´on frecuencial. El m´etodo num´erico escogido es Elementos Finitos con una aproximaci´on por Galerkin Continua. El tratamiento del dominio de resoluci´on infinito se lleva a cabo mediante la acci´on combinada de un truncamiento con un contorno artificial y un material absorbente num´erico (PML). Se impone una condici´on de ra...

  7. A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Abdullateef Abdulkareem

    2017-01-01

    Full Text Available Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrobial therapy and emergent fasciotomy with extensive debridement, his hospital course was complicated by septic shock and he required an above-the-knee amputation. Physicians need to be aware of the possibility of necrotizing fasciitis in patients presenting with skin infections after rituximab therapy.

  8. Detecting CD20-Rituximab specific interactions on lymphoma cells using atomic force microscopy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Elucidating the underlying mechanisms of cell physiology is currently an important research topic in life sciences. Atomic force microscopy methods can be used to investigate these molecular mechanisms. In this study, single-molecule force spectroscopy was used to explore the specific recognition between the CD20 antigen and anti-CD20 antibody Rituximab on B lymphoma cells under near-physiological conditions. The CD20-Rituximab specific binding force was measured through tip functionalization. Distribution of CD20 on the B lymphoma cells was visualized three-dimensionally. In addition, the relationship between the intramolecular force and the molecular extension of the CD20-Rituximab complex was analyzed under an external force. These results facilitate further investigation of the mechanism of Rituximab’s anti-cancer effect.

  9. The Efficacy and Safety of Rituximab in a Patient with Rheumatoid Spondylitis

    Directory of Open Access Journals (Sweden)

    Şenol Kobak

    2013-01-01

    Full Text Available Rheumatoid arthritis (RA is considered as a connective tissue disease while ankylosing spondylitis (AS is a prototype of spondyloarthritis. These diseases are seen concomitantly only very rarely. Also, rituximab has proven efficacy in the treatment of RA while its role in the treatment of AS is unclear. In this presentation, the concomitant presence of RA and AS in a 43-year-old male patient as well as the efficacy and safety of rituximab is discussed. Rituximab was given due to lack of response to treatment with anti-TNF-alpha. Evaluations made at the 6th and 12th months of treatment showed complete response for RA and partial response for AS.

  10. Rituximab as maintenance therapy for ANCA associated vasculitis: how, when and why?

    Science.gov (United States)

    Alba, Marco A; Flores-Suárez, Luis Felipe

    2016-01-01

    ANCA-associated vasculitides (AAV) are chronic autoimmune diseases characterized by inflammation and destruction of small vessels. Rituximab is now licensed for use as a remission-induction agent in the treatment of these disorders. During recent years, several non-controlled studies have suggested that rituximab may be of value in maintaining disease remission in AAV. In these series, 3 techniques have been tried: "watch-and-wait", repeated cycles in fixed intervals, or administration based on proposed biomarkers. More importantly, the results of the MAINRITSAN trial showed that this anti-CD20 agent is superior to azathioprine for preventing major relapses in AAV. This review summarizes current information regarding the effectiveness, timing, dosing, duration and safety of rituximab as a valid option for remission maintenance. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  11. Rituximab Not Effective for Hearing Loss in Cogan’s Syndrome

    Directory of Open Access Journals (Sweden)

    Daniel R. Bunker

    2016-01-01

    Full Text Available Importance. Rituximab was not effective in ameliorating the hearing loss in a patient with atypical Cogan’s syndrome. Observations. We report the case of a patient who developed acute bilateral uveitis and sensorineural hearing loss. A diagnosis of atypical Cogan’s syndrome was made. The patient’s hearing loss did not improve despite high dose steroids and azathioprine. Rituximab was administered given a recent report of its efficacy in a patient with refractory disease; however, our patient’s hearing loss did not improve. Conclusion. Hearing loss in Cogan’s syndrome is difficult to treat. Though rituximab was ineffective in our case, earlier administration in the disease course could be effective for future patients.

  12. Rituximab in Adult –Onset Still’s Disease: Case Report

    Directory of Open Access Journals (Sweden)

    G Mehrpoor

    2009-01-01

    Full Text Available Summary: Adult-onset Still’s disease (AOSD is a rare systemic inflammatory disorder of unknown etiology. It is characterized by high grade fever, skin rash, arthritis, leukocytosis, increased ESR, CRP and liver enzyme levels and high levels of ferritin. The treatment of AOSD includes NSAIDs, steroids, and disease-modifying antirheumatic drugs (DMARDs. Recently biologic agents have been used for treatment of some rheumatologic disorders. Rituximab(MabThera, an anti-CD20 monoclonal antibody is one of the biologic agents which is used by only a few researchers for treatment of refractory AOSD. Herein, we describe a 23 year old woman, who was treated with Rituximab ,three years after diagnosis of AOSD .She did not respond to Metotroxate and Cellcept .After administration of Rituximab, clinical and laboratory remission was achieved .

  13. Rituximab: an emerging treatment for recurrent diffuse alveolar hemorrhage in systemic lupus erythematosus.

    Science.gov (United States)

    Tse, J R; Schwab, K E; McMahon, M; Simon, W

    2015-06-01

    Diffuse alveolar hemorrhage (DAH) is a rare manifestation of systemic lupus erythematosus (SLE) and is associated with high mortality rates. Treatment typically consists of aggressive immunosuppression with pulse-dose steroids, cyclophosphamide, and plasma exchange therapy. Mortality rates remain high despite use of multiple medical therapies. We present a case of recurrent DAH in a 52-year-old female with SLE after a deceased donor renal transplant who was successfully treated with rituximab. Our report highlights the pathophysiologic importance of B-cell-mediated immunosuppression in SLE-associated DAH and suggests that rituximab may represent a viable alternative to cyclophosphamide in the treatment of this disease. We also review eight other reported cases of rituximab use in SLE-associated DAH.

  14. Hiperalgesia asociada al tratamiento con opioides

    Directory of Open Access Journals (Sweden)

    A. Gil Martín

    2014-10-01

    opioide o la asociación al tratamiento de otro tipo de analgésico. Otras opciones son los antagonistas del receptor NMDA o la terapia combinada con los inhibidores de la COX-2. En el presente trabajo se revisan los avances recientes en el conocimiento de los mecanismos subyacentes que la producen, los estudios clínicos realizados así como las diferentes estrategias de tratamiento disponibles.

  15. Rituximab as a first-line agent for the treatment of dermatomyositis.

    LENUS (Irish Health Repository)

    2012-02-01

    B cells may play a pivotal role in the pathophysiology of DM, and reports have claimed that targeting B cells is a viable treatment option in patients with dermatomyositis. A 20-year-old girl presented in October 2007, with few weeks\\' history of proximal muscle weakness. Gottron\\'s papules were noted on her knuckles. She had normal inflammatory markers and negative autoantibody screen. Her CPK was 7,000 U\\/L (normal range 0-170) with an LDH of 1,300 U\\/L (normal range 266-500). EMG and muscle biopsy was consistent with active myositis. She had normal pulmonary function tests. HRCT showed no interstitial lung disease. She was started with 60 mg glucocorticoids (1 mg\\/kg), with a good clinical response. However, any attempt to taper down the steroid dose led to recurrence of her symptoms. The options of available immunosuppressive therapies, including the experimental usage of rituximab, were discussed with her; averse to long-term systemic treatments, she opted to try a course of rituximab. She had rituximab 1,000 mg on days 0 and 14, and her glucocorticoids were tapered in next few weeks. Now, 24 months since her rituximab infusions, she remains in complete clinical and biochemical remission and is naive to other immunosuppressive agents apart from glucocorticoids and rituximab. Depleting peripheral B cells with rituximab (one course) in our patient has led not only to complete resolution of muscle and skin disease (induction) but also remains off all immunosuppressives including glucocorticoids.

  16. Place in therapy of rituximab in the treatment of granulomatosis with polyangiitis and microscopic polyangiitis

    Directory of Open Access Journals (Sweden)

    Shah S

    2015-08-01

    Full Text Available Shivani Shah, Duvuru Geetha Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Granulomatosis with polyangiitis and microscopic polyangiitis are small vessel vasculitides characterized by circulating antineutrophil circulating antibodies. Standard treatment for active severe disease has consisted of cyclophosphamide with glucocorticoids with or without plasmapheresis, which achieves approximately 75% sustained remission, but carries significant adverse effects such as malignancy, infertility, leukopenia, and infections. The role of B cells in the pathogenesis of anti-neutrophil circulating antibodies-associated vasculitis has been established, and as such, rituximab, a monoclonal anti-CD20 antibody, has been studied in treatment of active granulomatosis with polyangiitis and microscopic polyangiitis (induction and in maintaining remission. Rituximab has been shown to be effective in inducing remission in several retrospective studies in patients with refractory disease or cyclophosphamide intolerance. The RAVE and RITUXVAS trials demonstrated rituximab is a noninferior alternative to standard cyclophosphamide-based therapy; however, its role in elderly patients and patients with severe renal disease warrants further investigation. Rituximab has been compared with azathioprine for maintaining remission in the MAINRITSAN trial and may be more efficacious in maintaining remission in patients treated with cyclophosphamide induction. Rituximab is not without risks and carries a similar adverse event risk rate as cyclophosphamide in randomized control trials. However, its use can be considered over cyclophosphamide in patients who have relapsing or refractory disease or in young patients seeking to preserve fertility. Keywords: rituximab, ANCA-associated vasculitis, GPA, MPA, induction therapy, maintenance therapy

  17. A case of "refractory" lupus erythematosus profundus responsive to rituximab [case report].

    LENUS (Irish Health Repository)

    McArdle, Adrian

    2012-02-01

    Lupus erythematosus profundus is a rare complication of systemic lupus erythematosus characterized by the presence of deep, tender subcutaneous nodules. A 22-year-old African-American female with extensive lupus profundus resistant to conventional therapies was treated with two infusions of the anti-CD20 monoclonal antibody, rituximab, at a dosage of 1,000 mg each. The patient demonstrated a remarkable clinical response as indicated by the disappearance of the nodules. B-cell depletion therapy with rituximab used alone or in combination with other therapies may be a viable option in patients with lupus profundus refractory to current therapies.

  18. Preliminary analysis of mortality associated with rituximab use in autoimmune diseases.

    Science.gov (United States)

    Shetty, Shawn; Ahmed, A R

    2013-12-01

    Normal antibodies and pathogenic autoantibodies are produced by B-cells and plasma cells. Rituximab is a chimeric monoclonal antibody that targets the CD20 molecule on cells that express them on their surface and kills them. Rituximab has been increasingly used to treat several autoimmune diseases. Studies on fatal outcomes associated with rituximab therapy are lacking. A comprehensive and detailed analysis in which the multiple factors that could contribute to a fatal outcome in all the autoimmune diseases in which rituximab has been used would be cumbersome, lack uniformity and would prove difficult in making certain definitive conclusions and comparisons, but more importantly it would not allow to provide specific precautions and recommendations to prevent mortality. Hence, autoimmune mucocutaneous blistering diseases (AMBD) were used as model to study fatal outcomes in patients treated with rituximab between 2000 and 2013, using uniform 13 criteria. Fatal outcomes were found in 14 patients with autoimmune blistering diseases out of 134 patients (10.4%). Patients died due to infections (75%), gastrointestinal (17%) and cardiac events (8%). Causes of death were reported in 101 patients with other autoimmune diseases out of 4320 with a mortality rate of 2.4%. Among them, 44 patients (43.6%) died from infections. A statistical analysis of the data demonstrated that a statistically significant higher mortality rate was observed in patients with AMBD compared to patients with other autoimmune diseases. Similarly, a statistically significant higher rate of death due to infections was reported in patients with AMBD compared to patients with other autoimmune diseases. Use of systemic corticosteroids and immunosuppressive agents as concomitant therapy with rituximab enhanced immunosuppression. In many patients, B-cells were depleted for prolonged periods, even after clinical recovery was observed. Although its main action is depletion of B-cells, rituximab has a

  19. Positive experience of the usage of Rituximab in management of refractory myasthenia gravis in Russia

    Directory of Open Access Journals (Sweden)

    N. I. Shcherbakova

    2015-01-01

    Full Text Available A subset of patients (15 to 20% with myasthenia gravis (MG remains refractory to standard types of treatment. Analysis of efficiency of rituximab, a chimeric monoclonal antibody to surface antigen of B lymphocytes (CD20, in 16 patients suffering from refractory MG was performed. In all cases, the drug was injected weekly and intravenously in the dosage of 375 mg/m2, for 4 weeks. All patients were dependent on intake of corticosteroids and cyclosporin. During rituximab therapy, the gradation of MG has significantly changed, being transformed from severe forms (IV and V MGFA class into moderate and mild forms (III, II, and I MGFA class. Improvement of the clinical state included cease of myasthenic exacerbation, increased respiratory muscle strength; significant reduction of dosages (and even canceling of basic pathogenetic and symptomatic treatment. Complete remission with cancellation of basic therapy was recorded in 4 (25 % of patients within 2-year period. However, 2 of them manifested with aggravation of MG after the first course of rituximab, in 9 and 24 months, correspondingly, which required resumption of corticosteroid therapy and repeating of courses of rituximab, with positive result. In 9 (56.25 % cases, pharmacological remission was recorded; in 3 (18.75 % cases, there was a significant improvement of initially severe forms. In all patients rituximab therapy lead to the clinical improvement: prior to completion of the course, after the 1st and the 2nd infusion - in 12 (75 % patients; 1 to 3 weeks after completion of the course – in 4 (25 % patients. Maximal improvement was registered in 1 to 12 month after completion of the course of rituximab intake (at the terms of 4. ± 2.0 months. There were the following stages of basic therapy cancellation: during first 1 to 3 months of rituximab treatment, pyridostigmine and cyclosporine were cancelled; corticosteroids were dropped off gradually, according to the clinical status of

  20. The role of rituximab in adults with warm antibody autoimmune hemolytic anemia.

    Science.gov (United States)

    Dierickx, Daan; Kentos, Alain; Delannoy, André

    2015-05-21

    Warm antibody hemolytic anemia is the most common form of autoimmune hemolytic anemia. When therapy is needed, corticosteroids remain the cornerstone of initial treatment but are able to cure only a minority of patients (hemolytic anemia in adults, although no prospective study convincingly supports this attitude. A recent randomized study strongly suggests that in first-line treatment, rituximab combined with steroids is superior to monotherapy with steroids. If this finding is confirmed, rituximab will emerge as a major component of the management of warm antibody hemolytic anemia not only after relapse but as soon as treatment is needed.

  1. Durability of the Rituximab Response in Acetylcholine Receptor Autoantibody-Positive Myasthenia Gravis.

    Science.gov (United States)

    Robeson, Kimberly R; Kumar, Aditya; Keung, Benison; DiCapua, Daniel B; Grodinsky, Emily; Patwa, Huned S; Stathopoulos, Panos A; Goldstein, Jonathan M; O'Connor, Kevin C; Nowak, Richard J

    2017-01-01

    Myasthenia gravis (MG), an autoimmune disorder of neuromuscular transmission, is treated by an array of immunotherapeutics, many of which are nonspecific. Even with current therapies, a subset of patients has medically refractory MG. The benefits of B-cell-targeted therapy with rituximab have been observed in MG; however, the duration of these benefits after treatment is unclear. To evaluate the durability of response to rituximab in the treatment of acetylcholine receptor autoantibody-positive (AChR+) generalized MG. This retrospective case series study included 16 patients with AChR+ MG referred to an MG clinic from January 1, 2007, to December 31, 2015. The patients were treated with rituximab and followed up for 18 to 84 months after treatment. Assessment of long-term clinical response, durability of response and/or relapse rate, AChR autoantibody levels, adverse effects, and inflammatory markers. In the 16 patients (6 men and 10 women; median age, 42 [range, 18-69] years), clinical improvement was observed in parallel with complete withdrawal or reduction of other immunotherapies, with all patients achieving complete stable remission, pharmacologic remission, or minimal manifestations based on the Myasthenia Gravis Foundation of America postintervention status criteria. Nine patients (56%) had a relapse during a mean follow-up of 36 (range, 24-47) months. Seven patients (44%) remained relapse free with a mean follow-up of 47 (range, 18-81) months since the last rituximab treatment. All values were normalized to a pretreatment anti-AChR antibody level of 100% and the mean levels after each rituximab cycle were calculated. A 33% decrease was seen after cycle 1 of rituximab treatment (100% vs 67%; P = .004); 20% after cycle 2 (compared with cycle 1) (67% vs 47%; P = .008); and 17% after cycle 3 (compared with cycle 2) (47% vs 30%; P = .02). However, the serum cytokine levels measured were found to be unchanged. Rituximab therapy appears to be an

  2. Inhibición Combinada del Factor de Necrosis Tumoral (TNF y Factor de Crecimiento Vascular Endotelial para el Tratamiento del Edema Macular de Variadas Etiologías: Un Estudio Piloto a Corto Plazo

    Directory of Open Access Journals (Sweden)

    J Fernando Arevalo

    2013-03-01

    Full Text Available Objetivo: Reportar la respuesta anatómica y de agudeza visual mejor corregida (AVMC posterior a la combinación del adalimumab intravítreo (Humira y bevacizumab (Avastin en pacientes con edema macular de variadas etiologías. Métodos: Serie retrospectiva intervencional de casos. Se revisaron los registros médicos de 5 pacientes consecutivos (7 ojos con edema macular de variadas etiologías, incluyendo edema macular pseudofáquico, papiloflebitis diabética, oclusión de la vena central de la retina, oclusión de rama venosa retiniana, y degeneración macular relacionada con la edad. Todos los pacientes fueron tratados con al menos una inyección intravítrea de 1,25 mg/0,05 mL de bevacizumab y 2 mg/0,08 mL de adalimumab. A los pacientes se les cuantificó su AVMC por cartilla del Estudio del Tratamiento Temprano de la Retinopatía Diabética (EDTRS, examen oftalmológico, tomografía de coherencia óptica (TCO y angiografía fluoresceínica (AGF al inicio, y a las visitas en el primer, tercer y sexto mes. Los resultados se basaron en las modificaciones de la AVMC y la TCO. Resultados: La edad media de los pacientes fue de 71,5 ± 9,4 años. La media de inyecciones combinadas de bevacizumab y adalimumab fue de 2,14 por ojo (rango: 1 a 4 inyecciones a 6 meses. La AVMC basal mejoró de 1,19 ± 0,6 logaritmo del mínimo ángulo de resolución (logMAR a 0,94 ± 0,59 logMAR a 6 meses (P < 0,05. Cuatro (57,1% de los siete ojos ganaron ≥ 3 líneas ETDRS de AVMC. El espesor macular central (EMC al inicio por TCO tuvo una media de 416 ± 150 µm, el cual se redujo a una media de 354 ± 205 µm a 6 meses (P < 0,05. No hubo complicaciones oculares o sistémicas. Conclusiones: El tratamiento intravítreo combinado de bevacizumab y adalimumab a dosis de 1,25 mg y 2,0 mg respectivamente impresiona proporcionar mejoría o estabilidad en la AVMC, TCO y AGF en edema macular de variadas etiologías sin complicaciones sistémicas a los 6 meses de seguimiento

  3. Inhibición Combinada del Factor de Necrosis Tumoral (TNF y Factor de Crecimiento Vascular Endotelial para el Tratamiento del Edema Macular de Variadas Etiologías: Un Estudio Piloto a Corto Plazo

    Directory of Open Access Journals (Sweden)

    J Fernando Arevalo

    2013-04-01

    Full Text Available Objetivo: Reportar la respuesta anatómica y de agudeza visual mejor corregida (AVMC posterior a la combinación del adalimumab intravítreo (Humira y bevacizumab (Avastin en pacientes con edema macular de variadas etiologías. Métodos: Serie retrospectiva intervencional de casos. Se revisaron los registros médicos de 5 pacientes consecutivos (7 ojos con edema macular de variadas etiologías, incluyendo edema macular pseudofáquico, papiloflebitis diabética, oclusión de la vena central de la retina, oclusión de rama venosa retiniana, y degeneración macular relacionada con la edad. Todos los pacientes fueron tratados con al menos una inyección intravítrea de 1,25 mg/0,05 mL de bevacizumab y 2 mg/0,08 mL de adalimumab. A los pacientes se les  cuantificó su AVMC por cartilla del  Estudio del Tratamiento Temprano de la Retinopatía Diabética (EDTRS, examen oftalmológico, tomografía de coherencia óptica (TCO y angiografía fluoresceínica (AGF al inicio, y a las visitas en el primer, tercer y sexto mes. Los resultados se basaron en las modificaciones de la AVMC y la TCO. Resultados: La edad media de los pacientes fue de 71,5  ± 9,4 años. La media de inyecciones combinadas de bevacizumab y adalimumab fue de 2,14 por  ojo (rango: 1 a 4 inyecciones a 6 meses. La AVMC basal mejoró de 1,19 ± 0,6 logaritmo del mínimo ángulo de resolución (logMAR a 0,94 ± 0,59 logMAR a 6 meses (P < 0,05. Cuatro (57,1% de los siete ojos ganaron  ≥ 3 líneas ETDRS de AVMC. El espesor macular central (EMC al inicio por TCO tuvo una media de 416 ± 150 µm, el cual se redujo a una media de 354 ± 205 µm a 6 meses (P < 0,05. No hubo complicaciones oculares o sistémicas. Conclusiones: El tratamiento intravítreo combinado de bevacizumab y adalimumab a dosis de 1,25 mg y 2,0 mg respectivamente impresiona proporcionar mejoría o estabilidad en la AVMC, TCO y AGF en edema macular de variadas etiologías sin complicaciones sistémicas a los 6 meses de

  4. Evaluación de estrategias combinadas para la producción sostenible de biocombustibles líquidos

    OpenAIRE

    Jiménez Arenas, Beatriz

    2015-01-01

    El presente trabajo estudia la obtención de bioetanol a partir de paja de trigo. El proceso está formado por diferentes etapas: pretratamiento mediante extrusión-ozono, detoxificación, hidrólisis enzimática y fermentación con Pichia stipitis.El pretratamiento de extrusión-ozonolisis mejora el rendimiento de la hidrólisis enzimática con respecto al material sin tratar de 8'4% a 30% para glucosa y de 3'7% a 29'0% para la xilosa. Para mejorar la eficacia, se han estudiado varias estrategias de d...

  5. Anestesia combinada e extubação precoce em paciente com persistência do canal arterial: relato de caso

    OpenAIRE

    Paulo Antônio de Mattos Gouvêa; Cassiano Franco Bernardes

    2001-01-01

    JUSTIFICATIVA E OBJETIVOS: O canal arterial é uma estrutura que integra a circulação fetal. Fatores como prematuridade, hipóxia, acidose e sepse contribuem para a sua patência. O objetivo deste relato é demonstrar a utilização da anestesia combinada em cirurgia para correção da persistência do canal arterial. RELATO DO CASO: Paciente masculino, 14 meses, 11 kg,estado físico ASA II com infecções respiratórias de repetição, foi submetido à correção cirúrgica de PCA. Utilizou-se midazolam (0,5 m...

  6. Paresia transitória unilateral combinada do nervo hipoglosso e do nervo lingual após intubação para anestesia

    Directory of Open Access Journals (Sweden)

    Hulya Ulusoy

    2014-04-01

    Full Text Available Lesões de nervos podem ocorrer na região faringolaríngea durante a anestesia geral. Os nervos mais comumente lesionados são o hipoglosso, lingual e laríngeo recorrente. As lesões podem surgir em decorrência de vários fatores, como, por exemplo, durante a laringoscopia, intubação endotraqueal e inserção de tubo e por pressão do balão, ventilação com máscara, manobra aérea tripla, via aérea orofaríngea, modo de inserção do tubo, posição da cabeça e do pescoço e aspiração. As lesões nervosas nessa região podem acometer um único nervo isolado ou causar a paralisia de dois nervos em conjunto, como a do nervo laríngeo recorrente e hipoglosso (síndrome de Tapia. No entanto, a lesão combinada dos nervos lingual e hipoglosso após intubação para anestesia é uma condição muito mais rara. O risco dessa lesão pode ser reduzido por meio de medidas preventivas. Descrevemos um caso de paresia unilateral combinada dos nervos hipoglosso e lingual após intubação para anestesia.

  7. Chlorambucil plus rituximab with or without maintenance rituximab as first-line treatment for elderly chronic lymphocytic leukemia patients.

    Science.gov (United States)

    Foà, Robin; Del Giudice, Ilaria; Cuneo, Antonio; Del Poeta, Giovanni; Ciolli, Stefania; Di Raimondo, Francesco; Lauria, Francesco; Cencini, Emanuele; Rigolin, Gian Matteo; Cortelezzi, Agostino; Nobile, Francesco; Callea, Vincenzo; Brugiatelli, Maura; Massaia, Massimo; Molica, Stefano; Trentin, Livio; Rizzi, Rita; Specchia, Giorgina; Di Serio, Francesca; Orsucci, Lorella; Ambrosetti, Achille; Montillo, Marco; Zinzani, Pier Luigi; Ferrara, Felicetto; Morabito, Fortunato; Mura, Maria Angela; Soriani, Silvia; Peragine, Nadia; Tavolaro, Simona; Bonina, Silvia; Marinelli, Marilisa; De Propris, Maria Stefania; Starza, Irene Della; Piciocchi, Alfonso; Alietti, Alessandra; Runggaldier, Eva Josephine; Gamba, Enrica; Mauro, Francesca Romana; Chiaretti, Sabina; Guarini, Anna

    2014-05-01

    In a phase II trial, we evaluated chlorambucil and rituximab (CLB-R) as first-line induction treatment with or without R as maintenance for elderly chronic lymphocytic leukemia (CLL) patients. Treatment consisted of eight 28-day cycles of CLB (8 mg/m(2) /day, days 1-7) and R (day 1 of cycle 3, 375 mg/m(2) ; cycles 4-8, 500 mg/m(2) ). Responders were randomized to 12 8-week doses of R (375 mg/m(2) ) or observation. As per intention-to-treat analysis, 82.4% (95% CI, 74.25-90.46%) of 85 patients achieved an overall response (OR), 16.5% a complete response (CR), 2.4% a CR with incomplete bone marrow recovery. The OR was similar across Binet stages (A 86.4%, B 81.6%, and C 78.6%) and age categories (60-64 years, 92.3%; 65-69, 85.2%; 70-74, 75.0%; ≥75, 81.0%). CLB-R was well tolerated. After a median follow-up of 34.2 months, the median progression-free survival (PFS) was 34.7 months (95% CI, 33.1-39.5). TP53 abnormalities, complex karyotype, and low CD20 gene expression predicted lack of response; SF3B1 mutation and BIRC3 disruption low CR rates. IGHV mutations significantly predicted PFS. R maintenance tended towards a better PFS than observation and was safe and most beneficial for patients in partial response and for unmutated IGHV cases. CLB-R represents a promising option for elderly CLL patients. Copyright © 2014 Wiley Periodicals, Inc.

  8. Comparative assessment of clinical response in patients with rheumatoid arthritis between PF‐05280586, a proposed rituximab biosimilar, and rituximab

    Science.gov (United States)

    Williams, Jason H.; Hutmacher, Matthew M.; Zierhut, Matthew L.; Becker, Jean‐Claude; Gumbiner, Barry; Spencer‐Green, George; Melia, Lisa A.; Liao, Kai‐Hsin; Suster, Matthew; Li, Ruifeng; Meng, Xu

    2016-01-01

    Aims To evaluate potential differences between PF‐05280586 and rituximab sourced from the European Union (rituximab‐EU) and USA (rituximab‐US) in clinical response (Disease Activity Score in 28 Joints [DAS28] and American College of Rheumatology [ACR] criteria), as part of the overall biosimilarity assessment of PF‐05280586. Methods A randomised, double‐blind, pharmacokinetic similarity trial was conducted in patients with active rheumatoid arthritis refractory to anti‐tumour necrosis factor therapy on a background of methotrexate. Patients were treated with 1000 mg of PF‐05280586, rituximab‐EU or rituximab‐US on days 1 and 15 and followed over 24 weeks for pharmacokinetic, clinical response and safety assessments. Key secondary end points were the areas under effect curves for DAS28 and ACR responses. Mean differences in areas under effect curves were compared against respective reference ranges established by observed rituximab‐EU and rituximab‐US responses using longitudinal nonlinear mixed effects models. Results The analysis included 214 patients. Demographics were similar across groups with exceptions in some baseline disease characteristics. Baseline imbalances and group‐to‐group variation were accounted for by covariate effects in each model. Predictions from the DAS28 and ACR models tracked the central tendency and distribution of observations well. No point estimates of mean differences were outside the reference range for DAS28 or ACR scores. The probabilities that the predicted differences between PF‐05280586 vs. rituximab‐EU or rituximab‐US lie outside the reference ranges were low. Conclusions No clinically meaningful differences were detected in DAS28 or ACR response between PF‐05280586 and rituximab‐EU or rituximab‐US as the differences were within the pre‐specified reference ranges. TRIAL REGISTRATION Number: NCT01526057. PMID:27530379

  9. Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Lan LAN; Fei HAN; Jiang-hua CHEN

    2012-01-01

    Objective:To review the efficacy and safety of rituximab therapy for systemic lupus erythematosus (SLE).Methods:We searched for randomized controlled trails and observational studies that evaluated the effect of rituximab based on the systemic lupus erythematosus disease activity index (SLEDAI),British Isles lupus assessment group index (BILAG),urine protein levels,and the prednisolone dose,and had adequate data to calculate the mean,standard deviation (SD),and 95% confidence intervals,and to systematically review and meta-analyze observational studies with fixed effects model or random effects model.Results:We included 2 randomized controlled studies and 19observational clinical studies.We summarized the data from the 19 observational studies,analyzed the heterogeneity of the literature,and then used fixed effect model or random effect model for statistical analysis.The SLEDAI,BILAG,and urine protein levels and the prednisolone dosage were decreased after rituximab treatment,and the decreases in the BILAG,urine protein levels,and the prednisolone dose were found to be significant (P<0.05),when compared with baseline level.Rituximab's adverse effects generally could be controlled with an effective dosing regimen.Conclusions:Although there are still controversies about rituximab's treatment on SLE,but our study had showed that rituximab had favorable effects on refractory lupus.The long-term efficacy and safety of rituximab require further study.

  10. Rituximab treatment for adults with refractory nephrotic syndrome: a single-center experience and review of the literature.

    Science.gov (United States)

    Kisner, Tuelay; Burst, Volker; Teschner, Sven; Benzing, Thomas; Kurschat, Christine E

    2012-01-01

    Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are common causes of nephrotic syndrome (NS) in adults. However, induction of remission and sustained control of proteinuria is often difficult. Recently, B cell-directed therapy using the anti-CD20 antibody rituximab has been suggested as induction regimen in pediatric FSGS and MCD patients. Data on rituximab use in adults are still limited. We report on rituximab use in five consecutively treated adult patients (mean age 42.2 ± 9.9 years) with FSGS or relapsing MCD (2 FSGS, 3 MCD) who failed to respond to standard immunosuppressive treatment. Median follow-up was 8 months (3-25). Rituximab induced complete remission in 2 MCD patients and partial remission in 3 patients. Proteinuria was reduced by 86.8% (42.9-95.2) 3 months and by 73.0% (60.1-95.5) 6 months after therapy. In 1 patient with severe FSGS, partial remission was not evident before 6 months after rituximab treatment. Relapses occurred in 2 patients. No severe adverse events related to rituximab were observed. Our findings suggest that B cell-directed therapies are novel treatment options for adults with refractory NS. Response to rituximab varied, with MCD patients exhibiting a faster and more pronounced response compared to FSGS patients. Copyright © 2012 S. Karger AG, Basel.

  11. A pioneer experience in Malaysia on In-house Radio-labelling of (131)I-rituximab in the treatment of Non-Hodgkin's Lymphoma and a case report of high dose (131)I-rituximab-BEAM conditioning autologous transplant.

    Science.gov (United States)

    Kuan, Jew Win; Law, Chiong Soon; Wong, Xiang Qi; Ko, Ching Tiong; Awang, Zool Hilmi; Chew, Lee Ping; Chang, Kian Meng

    2016-10-01

    Radioimmunotherapy is an established treatment modality in Non-Hodgkin's lymphoma. The only two commercially available radioimmunotherapies - (90)Y-ibritumomab tiuxetan is expensive and (131)I-tositumomab has been discontinued from commercial production. In resource limited environment, self-labelling (131)I-rituximab might be the only viable practical option. We reported our pioneer experience in Malaysia on self-labelling (131)I-rituximab, substituting autologous haematopoietic stem cell transplantation (HSCT) and a patient, the first reported case, received high dose (131)I-rituximab (6000MBq/163mCi) combined with BEAM conditioning for autologous HSCT.

  12. Rituximab-induced depletion of anti-PLA2R autoantibodies predicts response in membranous nephropathy.

    Science.gov (United States)

    Beck, Laurence H; Fervenza, Fernando C; Beck, David M; Bonegio, Ramon G B; Malik, Fahim A; Erickson, Stephen B; Cosio, Fernando G; Cattran, Daniel C; Salant, David J

    2011-08-01

    Autoantibodies to the M-type phospholipase A(2) receptor (PLA(2)R) are sensitive and specific for idiopathic membranous nephropathy. The anti-B cell agent rituximab is a promising therapy for this disease, but biomarkers of early response to treatment currently do not exist. Here, we investigated whether levels of anti-PLA(2)R correlate with the immunological activity of membranous nephropathy, potentially exhibiting a more rapid response to treatment than clinical parameters such as proteinuria. We measured the amount of anti-PLA(2)R using Western blot immunoassay in serial serum samples from a total of 35 patients treated with rituximab for membranous nephropathy in two distinct cohorts. Pretreatment samples from 25 of 35 (71%) patients contained anti-PLA(2)R, and these autoantibodies declined or disappeared in 17 (68%) of these patients within 12 months after rituximab. Those who demonstrated this immunologic response fared better clinically: 59% and 88% attained complete or partial remission by 12 and 24 months, respectively, compared with 0% and 33% among those with persistent anti-PLA(2)R levels. Changes in antibody levels preceded changes in proteinuria. One subject who relapsed during follow-up had a concomitant return of anti-PLA(2)R. In summary, measuring anti-PLA(2)R levels by immunoassay may be a method to follow and predict response to treatment with rituximab in membranous nephropathy.

  13. MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab

    DEFF Research Database (Denmark)

    Peterfy, Charles; Emery, Paul; Tak, Paul P;

    2014-01-01

    OBJECTIVE: To evaluate changes in structural damage and joint inflammation assessed by MRI following rituximab treatment in a Phase 3 study of patients with active rheumatoid arthritis (RA) despite methotrexate (MTX) who were naive to biological therapy. METHODS: Patients were randomised to receive...

  14. Salvage therapy for primary CNS lymphoma with a combination of rituximab and temozolomide

    NARCIS (Netherlands)

    Enting, Roeline; Demopoulos, A; DeAngelis, LM; Abrey, LE

    2004-01-01

    The authors evaluated the efficacy of a combination of rituximab and temozolomide for recurrent or refractory primary CNS lymphoma (PCNSL). Fifteen patients with a median age of 69 years had a 53% objective response rate with acceptable toxicity. Median overall survival is 14 months and median progr

  15. Off-label use of rituximab for systemic lupus erythematosus in Europe

    DEFF Research Database (Denmark)

    Ryden-Aulin, Monica; Boumpas, Dimitrios T; Bultink, Irene

    2016-01-01

    Objectives: Rituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy. Method...

  16. Two courses of rituximab (anti-CD20 monoclonal antibody) for recalcitrant pemphigus vulgaris

    DEFF Research Database (Denmark)

    Faurschou, A.; Gniadecki, R.

    2008-01-01

    Background Pemphigus vulgaris (PV) is a severe autoimmune blistering disease involving the skin and mucous membranes. The response to therapy varies greatly amongst patients and treatment may be challenging. Rituximab is a chimeric monoclonal antibody that selectively targets cell surface antigen...

  17. A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction.

    Science.gov (United States)

    Lafayette, Richard A; Canetta, Pietro A; Rovin, Brad H; Appel, Gerald B; Novak, Jan; Nath, Karl A; Sethi, Sanjeev; Tumlin, James A; Mehta, Kshama; Hogan, Marie; Erickson, Stephen; Julian, Bruce A; Leung, Nelson; Enders, Felicity T; Brown, Rhubell; Knoppova, Barbora; Hall, Stacy; Fervenza, Fernando C

    2017-04-01

    IgA nephropathy frequently leads to progressive CKD. Although interest surrounds use of immunosuppressive agents added to standard therapy, several recent studies have questioned efficacy of these agents. Depleting antibody-producing B cells potentially offers a new therapy. In this open label, multicenter study conducted over 1-year follow-up, we randomized 34 adult patients with biopsy-proven IgA nephropathy and proteinuria >1 g/d, maintained on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers with well controlled BP and eGFRIgA1 or antibodies against galactose-deficient IgA1 did not change. In this trial, rituximab therapy did not significantly improve renal function or proteinuria assessed over 1 year. Although rituximab effectively depleted B cells, it failed to reduce serum levels of galactose-deficient IgA1 and antigalactose-deficient IgA1 antibodies. Lack of efficacy of rituximab, at least at this stage and severity of IgA nephropathy, may reflect a failure of rituximab to reduce levels of specific antibodies assigned salient pathogenetic roles in IgA nephropathy. Copyright © 2017 by the American Society of Nephrology.

  18. Rituximab therapy in steroid-resistant severe hypothyroid Grave′s ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Aditi Pandit

    2013-01-01

    Full Text Available Association of Grave′s ophthalmopathy with hyperthyroidism is well known, and it has also been reported in euthyroid or hypothyroid autoimmune thyroiditis, which rarely requires treatment. Here, we report a case of bilaterally symmetrical severe corticosteroid-resistant hypothyroid Grave′s ophthalmopathy successfully treated with rituximab.

  19. Early plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Nassim Kamar; Laurence Lavayssière; Fabrice Muscari; Janick Selves; Céline Guilbeau-Frugier; Isabelle Cardeau; Laure Esposito; Olivier Cointault; Marie Béatrice Nogier; Jean Marie Peron; Philippe Otal; Marylise Fort; Lionel Rostaing

    2009-01-01

    Acute humoral rejection (AHR) is uncommon after ABOcompatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Liver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab.Liver enzymes returned to within normal range 18 dafter diagnosis. Liver biopsies, at 3 and 9 mo post-transplant,showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.

  20. Relapsing or refractory idiopathic thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: the role of rituximab.

    Science.gov (United States)

    Caramazza, Domenica; Quintini, Gerlando; Abbene, Ignazio; Malato, Alessandra; Saccullo, Giorgia; Lo Coco, Lucio; Di Trapani, Rosa; Palazzolo, Roberto; Barone, Rita; Mazzola, Giuseppina; Rizzo, Sergio; Ragonese, Paolo; Aridon, Paolo; Abbadessa, Vincenzo; Siragusa, Sergio

    2010-12-01

    Idiopathic thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) is a rare disease responsive to treatment with plasma exchange (PE) but with a high percentage of relapse or refractory patients. A severe deficiency of ADAMTS-13 (<5% of normal activity), congenital or caused by an autoantibody, may be specific for TTP and it has been proposed that severe ADAMTS-13 deficiency now defines TTP. B cells play a key role in both the development and the perpetuation of autoimmunity, suggesting that B-cell depletion could be a valuable treatment approach for patients with idiopathic TTP-HUS. This review of the literature focuses on the role of rituximab, a chimeric monoclonal antibody directed against CD20 antigen expressed by B lymphocytes, in patients with relapsing or refractory TTP-HUS with or without ADAMTS-13 deficiency, suggesting that rituximab may produce clinical remission in a significant proportion of patients. Rituximab therapy reduces plasma requirement and avoids complications related to salvage-immunosuppressive therapy. In conclusion, rituximab provides an effective, well-tolerated, and safe treatment option for patients with idiopathic TTP-HUS, thus giving an alternative approach to the current treatment based on PE.

  1. Phase 2 study of cladribine followed by rituximab in patients with hairy cell leukemia

    Science.gov (United States)

    O'Brien, Susan; Jorgensen, Jeffrey; Pierce, Sherry; Faderl, Stefan; Ferrajoli, Alessandra; Koller, Charles; Challagundla, Pramoda; York, Sergernne; Brandt, Mark; Luthra, Rajyalakshmi; Burger, Jan; Thomas, Deborah; Keating, Michael; Kantarjian, Hagop

    2011-01-01

    We conducted this study to determine the feasibility and safety of cladribine followed by rituximab in patients with hairy cell leukemia including the vari-ant form (HCLv). Cladribine 5.6 mg/m2 given IV over 2 hours daily for 5 days was followed ∼ 1 month later with rituximab 375 mg/m2 IV weekly for 8 weeks. Responses were recorded and BM minimal residual disease (MRD) was evaluated after the completion of rituximab. Thirty-six patients have been treated including 5 with HCLv. Median age was 57 years (range, 37-89). All patients (100%) have achieved complete response (CR), defined as presence of no hairy cells in BM and blood with normalization of counts (absolute neutrophil count [ANC]> 1.5 × 109/L, hemoglobin [Hgb] > 12.0 g/dL, platelets [PLT] > 100 × 109/L), as well as resolution of splenomegaly. There were no grade 3 or 4 nonhematologic adverse events directly related to the treatment. Only 1 patient (with HCLv) has relapsed; median CR duration has not been reached (range,1+-63+ months). Three patients with HCLv died including 1 with relapsed disease and 2 from unrelated malignancies. Median survival duration has not been reached (range, 2+-64+ months). Treatment with clad-ribine followed by rituximab is effective tk;4and may increase CR rate. This study was registered at www.clinicaltrials.gov as NCT00412594. PMID:21821712

  2. Fludarabine, cyclophosphamide, and rituximab chemoimmunotherapy is highly effective treatment for relapsed patients with CLL

    Science.gov (United States)

    Badoux, Xavier C.; Keating, Michael J.; Wang, Xuemei; O'Brien, Susan M.; Ferrajoli, Alessandra; Faderl, Stefan; Burger, Jan; Koller, Charles; Lerner, Susan; Kantarjian, Hagop

    2011-01-01

    Optimal management of patients with relapsed/refractory chronic lymphocytic leukemia (CLL) is dictated by patient characteristics, prior therapy, and response to prior therapy. We report the final analysis of combined fludarabine, cyclophosphamide, and rituximab (FCR) for previously treated patients with CLL and identify patients who benefit most from this therapy. We explore efficacy of FCR in patients beyond first relapse, patients with prior exposure to fludarabine and alkylating agent combinations, and patients with prior exposure to rituximab. The FCR regimen was administered to 284 previously treated patients with CLL. Patients were assessed for response and progression by 1996 National Cancer Institute–Working Group (NCI-WG) criteria for CLL and followed for survival. The overall response rate was 74%, with 30% complete remission. The estimated median overall survival was 47 months and median progression-free survival for all patients was 21 months. Subgroup analyses indicated that the following patients were most suitable for FCR treatment: patients with up to 3 prior treatments, fludarabine-sensitive patients irrespective of prior rituximab exposure, and patients without chromosome 17 abnormalities. FCR is an active and well-tolerated therapy for patients with relapsed CLL. The addition of rituximab to FC improved quality and durability of response in this patient population. PMID:21245487

  3. Individualized rituximab treatment for relapsing neuromyelitis optica: a pediatric case report.

    Science.gov (United States)

    He, Dian; Yu, YunLi; Yan, WeiBo; Dai, QingQing; Xu, Zhu; Chu, Lan

    2014-08-01

    Neuromyelitis optica is an autoimmune inflammatory disorder of the central nervous system. Current therapeutic approaches are based on small uncontrolled trials, case series, or case reports. There are only a few case reports describing rituximab for pediatric neuromyelitis optica. A 7-year-old girl with neuromyelitis optica had high disease activity with recurrent myelitis and steroid dependence. A remarkable increase of CD19(+) B-cell count in the peripheral blood mononuclear cells and seropositivity for anti-aquaporin 4 antibody were detected at each attack. After induction therapy with rituximab, the CD19(+) B-cell number was significantly reduced and sustained at low levels. The level of serum anti-aquaporin 4 antibody normalized. She was relapse-free over 1-year follow-up period. An individualized maintenance therapy scheme is underway. Treatment with rituximab for relapsing neuromyelitis optica requires an individualized regimen to optimize the frequency and dosage of administration to maximize efficacy yet minimize overtreatment and cost. Personal levels of CD19(+) B cells in peripheral blood mononuclear cells at previous attacks and responsiveness to rituximab in induction therapy may be two useful indicators in establishing individualized maintenance therapy schemes for relapsing neuromyelitis optica. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Neuromyelitis optica spectrum disorders: long-term safety and efficacy of rituximab in Caucasian patients.

    Science.gov (United States)

    Radaelli, M; Moiola, L; Sangalli, F; Esposito, F; Barcella, V; Ferrè, L; Rodegher, M; Colombo, B; Fazio, R; Martinelli, V; Comi, G

    2016-04-01

    To assess the long-term benefit-risk profile of repeated courses of rituximab in Caucasian patients affected by neuromyelitis optica (NMO) and related disorders, in everyday clinical practice. This is a prospective observational study performed at San Raffaele Hospital, Milan, Italy. From February 2006, we recruited 21 patients affected by NMO and NMO spectrum of disorders (NMOSD) whom underwent at least one cycle of intravenous (i.v.) rituximab and then were followed for at least 2 years. At a mean follow-up time of 48 months, we observed a significant reduction of the annualized relapse rate (ARR), from 2.0 to 0.16 (p < 0.01); and of the median Expanded Disability Status Scale (EDSS), from 5.5 to 4.0 (p < 0.013). There were 12 patients (57%) who remained disease free during the follow-up period. Five patients (24%) reported mild hematological adverse events. Serious infectious adverse events were reported by another four patients: These were all wheelchair bound at the beginning of their rituximab treatment. A fixed treatment scheme of rituximab, with re-treatment every 6 months, was efficacious for NMO and NMOSD, with a good safety profile; however, to obtain an even better benefit-risk ratio, close monitoring of CD19(+) B cells should be performed before the re-treatment of patients with high-level disability, concomitant leukopenia and hypogammaglobulinemia. © The Author(s), 2015.

  5. TMA secondary to SLE: rituximab improves overall but not renal survival.

    Science.gov (United States)

    Sun, Fangfang; Wang, Xiaodong; Wu, Wanlong; Wang, Kaiwen; Chen, Zhiwei; Li, Ting; Ye, Shuang

    2017-08-30

    Thrombotic microangiopathy (TMA) includes a series of life-threatening disorders. Systemic lupus erythematosus (SLE) is one of the most common acquired causes. To identify predictors of prognosis in patients with TMA secondary to SLE, we conducted a single-center historical study. From January 2013 to June 2016, of 2182 SLE hospitalized patients in the Ren Ji Hospital, a total of 21 consecutive patients with TMA secondary to SLE were identified. The 90-day short-term mortality was 33.3%. The kidney involvement (66.7%) was associated with poor prognosis, while the administration of rituximab (n = 13) was an independent protective factor according to logistic regression analysis. Compared to conventional treatment, i.e., plasma exchange, high-dose glucocorticoids, and intravenous immunoglobulin, the overall survival is significantly higher among patients receiving rituximab add-on (92.2 vs 33.3%, p = 0.0173); however, five out of seven patients with renal involvement in the rituximab group were eventually hemodialysis dependent. Our data indicated that add-on rituximab in the background of conventional therapy may improve the overall but not the renal survival in SLE-TMA patients.

  6. B lymphocyte depletion with the monoclonal antibody rituximab in Graves' disease: a controlled pilot study

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen J

    2007-01-01

    Graves' disease (GD) is a common TSH receptor autoantibody (TRAb)-mediated disorder. Because B lymphocytes are important self-antigen presenting cells and precursors for antibody-secreting plasma cells, temporary B-lymphocyte depletion with the monoclonal antibody rituximab (RTX) might be of bene...

  7. Rituximab purging and/or maintenance in patients undergoing autologous transplantation for relapsed follicular lymphoma

    DEFF Research Database (Denmark)

    Pettengell, Ruth; Schmitz, Norbert; Gisselbrecht, Christian

    2013-01-01

    The objective of this randomized trial was to assess the efficacy and safety of rituximab as in vivo purging before transplantation and as maintenance treatment immediately after high-dose chemotherapy and autologous stem-cell transplantation (HDC-ASCT) in patients with relapsed follicular lympho...

  8. Preclinical safety, pharmacokinetics, pharmacodynamics, and biodistribution studies with Ad35K++ protein: a novel rituximab cotherapeutic

    Directory of Open Access Journals (Sweden)

    Maximilian Richter

    2016-01-01

    Full Text Available Rituximab is a mouse/human chimeric monoclonal antibody targeted toward CD20. It is efficient as first-line therapy of CD20-positive B-cell malignancies. However, a large fraction of treated patients relapse with rituximab-resistant disease. So far, only modest progress has been made in treatment options for rituximab refractory patients. One of the mechanisms for rituximab resistance involves the upregulation of CD46, which is a key cell surface protein that blocks the activation of complement. We have recently developed a technology that depletes CD46 from the cell surface and thereby sensitizes tumor cells to complement-dependent cytotoxicity. This technology is based on a small recombinant protein, Ad35K++ that binds with high affinity to CD46. In preliminary studies using a 6 × histidinyl tagged protein, we had demonstrated that intravenous Ad35K++ injection in combination with rituximab was safe and increased rituximab-mediated killing of CD20-positive target cells in mice and nonhuman primates (NHPs. The presence of the tag, while allowing for easy purification by Ni-NTA chromatography, has the potential to increase the immunogenicity of the recombinant protein. For clinical application, we therefore developed an Ad35K++ protein without His-tag. In the present study, we performed preclinical studies in two animal species (mice and NHPs with this protein demonstrating its safety and efficacy. These studies estimated the Ad35K++ dose range and treatment regimen to be used in patients. Furthermore, we showed that intravenous Ad35K++ injection triggers the shedding of the CD46 extracellular domain in xenograft mouse tumor models and in macaques. Shed serum CD46 can be measured in the serum and can potentially be used as a pharmacodynamic marker for monitoring Ad35K++ activity in patient undergoing treatment with this agent. These studies create the basis for an investigational new drug application for the use of Ad35K++ in combination with

  9. ‘Les liaisons dangereuses’: Hepatitis C, Rituximab and B-cell non-Hodgkin’s lymphomas

    Institute of Scientific and Technical Information of China (English)

    Massimo; Marignani; Michela; di; Fonzo; Paola; Begini; Elia; Gigante; Ilaria; Deli; Adriano; M; Pellicelli; Sara; Gallina; Emanuela; de; Santis; Gianfranco; Delle; Fave; M; Christina; Cox

    2012-01-01

    Rituximab has provided a revolutionary contribution to the treatment of B-cell non-Hodgkin’s lymphomas (NHL). A high prevalence of hepatitis C virus (HCV) infection has been described in B-cell NHL patients. Cases of liver dysfunction in HCV-positive patients have been reported with Rituximab-containing regimens. In this paper we review the recent data regarding the effects of Rituximab in NHL patients with HCV infection. We also added a section devoted to improving communication between oncohaematologists and hepatologists. Furthermore, we propose a common methodological ground to study hepatic toxicity emerging during chemotherapy.

  10. Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy.

    Science.gov (United States)

    Ruggenenti, Piero; Debiec, Hanna; Ruggiero, Barbara; Chianca, Antonietta; Pellé, Timothee; Gaspari, Flavio; Suardi, Flavio; Gagliardini, Elena; Orisio, Silvia; Benigni, Ariela; Ronco, Pierre; Remuzzi, Giuseppe

    2015-10-01

    Rituximab induces nephrotic syndrome (NS) remission in two-thirds of patients with primary membranous nephropathy (MN), even after other treatments have failed. To assess the relationships among treatment effect, circulating nephritogenic anti-phospholipase A2 receptor (anti-PLA2R) autoantibodies and genetic polymorphisms predisposing to antibody production we serially monitored 24-hour proteinuria and antibody titer in patients with primary MN and long-lasting NS consenting to rituximab (375 mg/m(2)) therapy and genetic analyses. Over a median (range) follow-up of 30.8 (6.0-145.4) months, 84 of 132 rituximab-treated patients achieved complete or partial NS remission (primary end point), and 25 relapsed after remission. Outcomes of patients with or without detectable anti-PLA2R antibodies at baseline were similar. Among the 81 patients with antibodies, lower anti-PLA2R antibody titer at baseline (P=0.001) and full antibody depletion 6 months post-rituximab (hazard ratio [HR], 7.90; 95% confidence interval [95% CI], 2.54 to 24.60; PPLA2R antibody depletion. On average, 50% anti-PLA2R titer reduction preceded equivalent proteinuria reduction by 10 months. Re-emergence of circulating antibodies predicted disease relapse (HR, 6.54; 95% CI, 1.57 to 27.40; P=0.01), whereas initial complete remission protected from the event (HR, 6.63; 95% CI, 2.37 to 18.53; PPLA2R1 and HLA-DQA1 polymorphisms and of previous immunosuppressive treatment. Therefore, assessing circulating anti-PLA2R autoantibodies and proteinuria may help in monitoring disease activity and guiding personalized rituximab therapy in nephrotic patients with primary MN.

  11. Infectious complications in kidney-transplant recipients desensitized with rituximab and intravenous immunoglobulin.

    Science.gov (United States)

    Kahwaji, Joseph; Sinha, Aditi; Toyoda, Mieko; Ge, Shili; Reinsmoen, Nancy; Cao, Kai; Lai, Chih-Hung; Villicana, Rafael; Peng, Alice; Jordan, Stanley; Vo, Ashley

    2011-12-01

    Rituximab and intravenous Ig (IVIG) are commonly used for desensitization of HLA and blood group-incompatible (ABOi) transplants. However, serious infections have been noted in association with rituximab administration. In this study, we retrospectively compared infectious outcomes in those who received rituximab plus IVIG for HLA or ABOi transplants (RIT group) with a group of nonsensitized, ABO-compatible transplant recipients (non-RIT group). Patients undergoing kidney transplantation at Cedars-Sinai Medical Center were included in the analysis. A total of 361 patients were identified. All received antimicrobial prophylaxis and viral surveillance. The primary outcome was infection. Overall patient survival was 97 and 96%, and graft survival was 91 and 89% in the RIT and non-RIT groups, respectively, after an average follow-up of 18 months. There were equal rates of bacterial (34.7% versus 39.1%), viral (21.8% versus 25.1%), fungal (5.9% versus 5.2%), and serious infections (22.9% versus 25.5%) in the RIT and non-RIT groups respectively. Urinary tract infection was the most common infection, accounting for 50% of all bacterial infections. Cytomegalovirus viremia was nonsignificantly more common in the nonrituximab-treated group (15.2% versus 10%), whereas BK viremia was marginally more frequent in the rituximab-treated group (10.6% versus 5.8%). There were no graft losses caused by BK-associated nephropathy. There were two deaths in each group related to infection (1%). Rituximab does not increase infection risk when used with intravenous Ig for desensitization.

  12. Impact of rituximab therapy on response to tetanus toxoid vaccination in kidney-transplant patients.

    Science.gov (United States)

    Puissant-Lubrano, Benedicte; Rostaing, Lionel; Kamar, Nassim; Abbal, Michel; Fort, Marylise; Blancher, Antoine

    2010-03-01

    Rituximab is used after kidney transplant to prevention or treat kidney-allograft rejection. However, the impact of rituximab on the ability of patients to respond to tetanus toxoid vaccination has not yet been studied. The response to tetanus toxoid vaccination was analyzed in 39 kidney transplant recipients immunosuppressed by corticoids, antiproliferative agents, and/or calcineurin inhibitors. Thirteen patients had previously received rituximab (group 1), 26 patients had not (group 2). Response to control bacterial antigens and immunologic parameters (lymphocyte count, B-cell subsets, serum immunoglobulin level) were analyzed before and at 1 month after vaccination. Thirty healthy blood donors were used as controls for the before-vaccination immunologic parameters. Before vaccination, neither patient group differed from controls in serum levels of immunoglobulins and antibodies against bacterial antigens, but they did display lower levels of CD4 T cells and B cells compared with controls. Responders to the tetanus toxoid vaccination were slightly fewer in group 1 (4/13) than in group 2 (16/26), but the intensity of the anti-tetanus toxoid response was not significantly different between these 2 groups. None of the parameters studied at the time of vaccination (anti-tetanus toxoid level, peripheral B or CD4 T-cell count, memory B-cell subsets, treatment with rituximab, time since transplant) were associated with an ability to respond to vaccination. The ability to respond to vaccination and graft outcomes were not correlated in each patient group. Rituximab impaired the secondary immune response after tetanus toxoid vaccination, but did not abolish it in all patients.

  13. Barriers to the Access and Use of Rituximab in Patients with Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia: A Physician Survey

    Directory of Open Access Journals (Sweden)

    William H. Baer II

    2014-05-01

    Full Text Available Biologics such as rituximab are an important component of oncology treatment strategies, although access to such therapies is challenging in countries with limited resources. This study examined access to rituximab and identified potential barriers to its use in the United States, Mexico, Turkey, Russia, and Brazil. The study also examined whether availability of a biosimilar to rituximab would improve access to, and use of, rituximab. Overall, 450 hematologists and oncologists completed a survey examining their use of rituximab in patients with non-Hodgkin’s lymphoma (NHL and chronic lymphocytic leukemia (CLL. Less than 40% of physicians considered rituximab as easy to access from a cost perspective. Furthermore, many physicians chose not to treat, were unable to treat, or had to modify treatment with rituximab despite guidelines recommending its use in NHL and CLL patients. Insurance coverage, reimbursement, and cost to patient were commonly reported as barriers to the use of rituximab. Across all markets, over half of physicians reported that they would increase use of rituximab if a biosimilar was available. We conclude that rituximab use would increase across all therapy types and markets if a biosimilar was available, although a biosimilar would have the greatest impact in Brazil, Mexico, and Russia.

  14. An evaluation of the potential for drug-drug interactions between bendamustine and rituximab in indolent non-Hodgkin lymphoma and mantle cell lymphoma.

    Science.gov (United States)

    Darwish, Mona; Burke, John M; Hellriegel, Edward; Robertson, Philmore; Phillips, Luann; Ludwig, Elizabeth; Munteanu, Mihaela C; Bond, Mary

    2014-06-01

    Bendamustine plus rituximab has been reported to be effective in treating lymphoid malignancies. This analysis investigated the potential for drug-drug interactions between the drugs in patients with indolent non-Hodgkin lymphoma or mantle cell lymphoma. Data were derived from a bendamustine-rituximab combination therapy study, a bendamustine monotherapy study, and published literature on rituximab monotherapy and combination therapy. Analysis of the potential for rituximab to affect bendamustine systemic exposure included comparing bendamustine concentration-time profile following monotherapy to that following combination therapy and comparing model-predicted Bayesian bendamustine clearance in the presence and absence of rituximab. Analysis of the potential for bendamustine to affect rituximab systemic exposure included plotting observed minimum, median, and maximum serum rituximab concentrations at the end of rituximab infusion (EOI) and 24 h and 7 days post-infusion in patients receiving combination therapy versus concentrations reported in literature following rituximab monotherapy. The established population pharmacokinetic model following bendamustine monotherapy was evaluated to determine its applicability to combination therapy for the purpose of confirming lack of pharmacokinetic interaction. The model adequately described the bendamustine concentration-time profile following monotherapy and combination therapy in adults. There was no statistically significant difference in estimated bendamustine clearance either alone or in combination. Also, rituximab concentrations from EOI to 24 h and 7 days demonstrated a pattern of decline similar to that seen in rituximab studies without bendamustine, suggesting that bendamustine does not affect the rituximab clearance rate. Neither bendamustine nor rituximab appears to affect systemic exposure of the other drug when coadministered.

  15. Reestructurados de pollo saludables, evaluación del efecto de varias estrategias tecnológicas combinadas.

    OpenAIRE

    2014-01-01

    La innovación juega un rol clave en el desarrollo de nuevos productos y extensiones de línea. La reformulación de productos cárnicos es una estrategia, que aplica la industria actual, basada en el conocimiento de las necesidades y expectativas de los consumidores. Siguiendo estas tendencias se desarrolla un reestructurado de pollo con fibra soluble y omega 3, sin el agregado de grasa y sal. Para proteger los omega 3 de la autoxidación se emplean métodos de cocción a calor moderado y vacío en...

  16. Evaluación del desempeño dinámico de estructuras mixtas de bambú estructural y concreto armado mediante ensayos a escala con un simulador de aceleraciones sísmicas

    OpenAIRE

    Puma Alvarez, Eduardo

    2015-01-01

    Esta investigación tuvo como objetivo cohesionar la seguridad del diseño convencional con el diseño sustentable y sostenible investigando el comportamiento dinámico combinado de estructuras fabricadas con bambú estructural y concreto armado ante los sismos. Se realizaron dos tipos de análisis: 1) Análisis dinámico teórico considerando las propiedades combinadas del bambú y concreto armado presentes en la estructura mixta.2) Análisis dinámico real a escala mediante la utilización de un simulad...

  17. Análisis de coste-efectividad de dapagliflozina en comparación con los inhibidores de la DPP4 y otros antidiabéticos orales en el tratamiento de la diabetes mellitus tipo 2 en España

    OpenAIRE

    2015-01-01

    Objetivo: Evaluar la eficiencia de la terapia combinada de metformina y dapagliflozina, un nuevo antidiabético oral con un mecanismo de acción independiente de la insulina, en el tratamiento de la diabetes mellitus tipo 2 (DM2) en comparación con inhibidores de DPP4, sulfonilureas y tiazolidindionas, combinados también con metformina. Diseño: Análisis de coste-efectividad utilizando un modelo de simulación de eventos discretos a partir de los resultados de los ensayos clínicos disponibles ...

  18. Sustained complete remission of steroid- and cyclophosphamide-resistant minimal-change disease with a single course of rituximab therapy.

    Science.gov (United States)

    Janardan, Jyotsna; Ooi, Khai; Menahem, Solomon

    2014-06-01

    We report a case of steroid- and cyclophosphamide-resistant nephrotic syndrome secondary to minimal-change disease occurring in an otherwise healthy 19-year-old female, responding rapidly to two doses of rituximab therapy. Complete disease remission has been sustained up to last follow-up (32 months) despite CD19 recovery. Literature review suggests emerging evidence that rituximab may have a role to play in recurrent and/or refractory minimal-change disease.

  19. Sustained complete remission of steroid- and cyclophosphamide-resistant minimal-change disease with a single course of rituximab therapy

    OpenAIRE

    Janardan, Jyotsna; Ooi, Khai; Menahem, Solomon

    2014-01-01

    We report a case of steroid- and cyclophosphamide-resistant nephrotic syndrome secondary to minimal-change disease occurring in an otherwise healthy 19-year-old female, responding rapidly to two doses of rituximab therapy. Complete disease remission has been sustained up to last follow-up (32 months) despite CD19 recovery. Literature review suggests emerging evidence that rituximab may have a role to play in recurrent and/or refractory minimal-change disease.

  20. Efficacy and Safety of Rituximab in the Treatment of Vasculitic Leg Ulcers Associated with Hepatitis C Virus Infection

    Directory of Open Access Journals (Sweden)

    Fabio Bonilla-Abadía

    2012-01-01

    Full Text Available Vasculitic leg ulcers are a cutaneous manifestation of hepatitis C virus (HCV infection often associated with cryoglobulinemia. Their treatment is difficult and is based on steroids and immunosuppressive drugs with an erratic response and a high probability of adverse reaction. We report three patients with vasculitic leg ulcers associated with hepatitis C virus infection who were treated successfully with rituximab. The pain control and healing were achieved quickly. No adverse effects with rituximab in these patients were presented.

  1. Sustained complete remission of steroid- and cyclophosphamide-resistant minimal-change disease with a single course of rituximab therapy

    OpenAIRE

    Janardan, Jyotsna; Ooi, Khai; Menahem, Solomon

    2014-01-01

    We report a case of steroid- and cyclophosphamide-resistant nephrotic syndrome secondary to minimal-change disease occurring in an otherwise healthy 19-year-old female, responding rapidly to two doses of rituximab therapy. Complete disease remission has been sustained up to last follow-up (32 months) despite CD19 recovery. Literature review suggests emerging evidence that rituximab may have a role to play in recurrent and/or refractory minimal-change disease.

  2. Anestesia combinada e extubação precoce em paciente com persistência do canal arterial: relato de caso

    Directory of Open Access Journals (Sweden)

    Paulo Antônio de Mattos Gouvêa

    2001-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O canal arterial é uma estrutura que integra a circulação fetal. Fatores como prematuridade, hipóxia, acidose e sepse contribuem para a sua patência. O objetivo deste relato é demonstrar a utilização da anestesia combinada em cirurgia para correção da persistência do canal arterial. RELATO DO CASO: Paciente masculino, 14 meses, 11 kg,estado físico ASA II com infecções respiratórias de repetição, foi submetido à correção cirúrgica de PCA. Utilizou-se midazolam (0,5 mg.kg-1 por via oral, no pré-anestésico, seguido de indução inalatória com halotano 1-2%. A hidratação foi feita com solução de Ringer com lactato (8 ml.kg-1.h-1. Após intubação orotraqueal foi iniciada ventilação mecânica em sistema circular pediátrico com reabsorvedor de CO2. Procedeu-se bloqueio peridural torácico no espaço T1-T2 com injeção única de bupivacaína a 0,125% com adrenalina 1:800.000 no volume de 0,5 ml.kg-1. A manutenção foi feita com halotano (0,5-0,6 CAM. O procedimento cirúrgico durou 70 minutos e foi feito por toracotomia látero-posterior com boa estabilidade cardiovascular. A criança foi extubada na sala cirúrgica e encaminhada para SRPA em boas condições. CONCLUSÕES: A técnica de anestesia combinada em anestesia pediátrica promove melhora na qualidade da analgesia per e pós-operatória. O bloqueio peridural torácico, com indicação criteriosa, pode ser utilizado com bons resultados.

  3. Rituximab-induced interleukin-15 reduction associated with clinical improvement in rheumatoid arthritis

    Science.gov (United States)

    Díaz-Torné, César; Ortiz de Juana, M Angels; Geli, Carme; Cantó, Elisabet; Laiz, Ana; Corominas, Héctor; Casademont, Jordi; de Llobet, Josep M; Juárez, Cándido; Díaz-López, César; Vidal, Sílvia

    2014-01-01

    Rituximab therapy alters all aspects of B-cell participation in the disturbed immune response of rheumatoid arthritis patients. To determine the impact of B-cell depletion on other immune compartments, we analysed levels of soluble and surface interleukin-15 (IL-15) along with the frequency of IL-15-related subsets after rituximab treatment. We then studied the correlation of observed changes with clinical activity. Heparinized blood samples from 33 rheumatoid arthritis patients were collected on days 0, 30, 90 and 180 after each of three rituximab cycles. Serum cytokine levels were determined by ELISA. Interleukin-15 trans-presentation was analysed by cytometry. Flow cytometry with monoclonal antibodies was performed to analyse circulating cell subsets. Interleukin-15 was detected in the serum of 25 patients before initiating the treatment. Rituximab then progressively reduced serum IL-15 (138 ± 21 pg/ml at baseline, 48 ± 18 pg/ml after third cycle, P = 0·03) along with IL-17 (1197 ± 203 pg/ml at baseline, 623 ± 213 pg/ml after third cycle, P = 0·03) and tended to increase the frequency of circulating regulatory T cells (3·1 ± 1 cells/μl at baseline, 7·7 ± 2 cells/μl after third cycle). Rituximab also significantly decreased IL-15 trans-presentation on surface monocytes of patients negative for IL-15 serum (mean fluorescence intensity: 4·82 ± 1·30 at baseline, 1·42 ± 0·69 after third cycle P = 0·05). Reduction of serum IL-15 was associated with decrease in CD8+ CD45RO+/RA+ ratio (1·17 ± 0·21 at baseline, 0·36 ± 0·06 at third cycle, P = 0·02). DAS28, erythrocyte sedimentation rate and C-reactive protein correlated significantly with CD8+ CD45RO+/RA+ ratio (R = 0·323, R = 0·357, R = 0·369 respectively, P < 0·001). Our results suggest that sustained clinical improvement after rituximab treatment is associated with IL-15/memory T-cell-related mechanisms beyond circulating B cells. PMID:24219764

  4. High-dose therapy and autologous stem cell transplant for transformed non-Hodgkin lymphoma in the rituximab era

    Science.gov (United States)

    Ban-Hoefen, Makiko; Kelly, Jennifer L.; Bernstein, Steven H.; Liesveld, Jane; Constine, Louis; Becker, Michael; Milner, Laurie; Phillips, Gordon; Friedberg, Jonathan W.

    2013-01-01

    The impact of rituximab on outcome of high dose therapy and autologous stem cell transplantation (HD-ASCT) for transformed NHL has not been previously described. We analyzed eighteen consecutive patients with indolent NHL who transformed to diffuse large B-cell lymphoma (DLBCL), received rituximab-containing therapy either before or after transformation and underwent subsequent HD-ASCT. With a median follow-up of 40 months, the 2-year PFS was 59% and the 2-year OS was 82%. Six patients did not receive rituximab pre-transformation; this group had a significantly better PFS at 2 years post HD-ASCT compared to 12 patients who were exposed to rituximab pre-transformation (p=0.03). HD-ASCT remains an effective therapeutic option for transformed NHL in the rituximab era. However, patients exposed to rituximab pre-transformation appear to have inferior HD-ASCT outcomes, and thus may benefit from novel conditioning and maintenance regimens in the setting of HD-ASCT. PMID:22023518

  5. Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab

    Science.gov (United States)

    Schmajuk, Gabriela; Tonner, Chris; Trupin, Laura; Li, Jing; Sarkar, Urmimala; Ludwig, Dana; Shiboski, Stephen; Sirota, Marina; Dudley, R. Adams; Murray, Sara; Yazdany, Jinoos

    2017-01-01

    Abstract Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown. We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety net health system, including diagnosis grouper codes, problem lists, medications, laboratory results, procedures codes, clinical encounter notes, and scanned documents. We identified all patients who received rituximab between 6/1/2012 and 1/1/2016. We calculated the proportion of rituximab users with inadequate screening for HBV according to the Centers for Disease Control guidelines for detecting latent HBV infection before their first rituximab infusion during the study period. We also assessed the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events. We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis at the university and safety net, respectively. We found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients. Interventions should be developed to improve patient safety procedures in this high-risk patient population. PMID:28353614

  6. Rituximab and escalated chemotherapy in elderly patients with aggressive diffuse large-cell lymphoma: a controlled clinical trial.

    Science.gov (United States)

    Avilés, Agustin; Nambo, María Jesus; Castañeda, Claudia; Cleto, Sergio; Neri, Natividad; Murillo, Edgar; Huerta-Guzmán, Judith; Contreras, Margarita

    2007-04-01

    The treatment of elderly patients with aggressive malignant lymphoma has not been defined. The addition of rituximab to conventional chemotherapy has been reported to improve the outcome, but most patients have good prognostic factors (performance status < 2, no severe associated diseases, low or low-intermediate clinical risk). Thus, we developed a combined regimen, including escalated doses of anthracycline and rituximab. The endpoint was to improve event-free survival (EFS) and overall survival. Two hundred and four (204) patients were randomly assigned to receive an escalated chemotherapy regimen (CEOP) with escalated dose of epirubicin, compared to the same regimen and addition of rituximab. All patients had poor prognostic factors: high- or high-intermediate clinical risk, poor performance status, bulky disease, and more than 2 with extranodal involvement. In an intent-to-treat analysis, all patients were evaluable for efficacy and toxicity. The complete response rates were similar in both arms: 74% in chemotherapy and 78% in the rituximab + chemotherapy program. EFS and overall survival were similar: 77% and 84%, respectively, in combined chemotherapy and 75% and 81% in the rituximab-chemotherapy regimen. Toxicity was mild and well tolerated. In elderly patients with diffuse large-cell lymphoma and poor prognostic factors, rituximab did not improve their outcome.

  7. Efecto de una intervención basada en dieta hipocalórica sola o combinada con entrenamiento de fuerza sobre el peso, la composición corporal y el riesgo cardiovascular en mujeres obesas con hipercolesterolemia2

    OpenAIRE

    Garcia-Unciti, M. (M.); Martinez, J. A.; Ibañez, J. (J.)

    2016-01-01

    A hypocaloric diet and regular physical exercise are recognized as effective non-pharmacological interventions to reduce body fat mass and mange cardiovascular disease. In this context, resistance training with or without a concomitant hypocaloric diet is gaining acceptance as a useful tool in weight reduction interventions and in cardiovascular disease therapy. The purpose of this study was to ascertain the effects of a weight loss diet (WL) with a caloric restriction of 500 kcal/day alon...

  8. Diseño de un material compuesto con fibra natural para sustituir la utilización de la fibra de vidrio

    OpenAIRE

    Gómez P., José Santiago

    2009-01-01

    El creciente desarrollo de materiales compuestos en aplicaciones donde se requieran características combinadas de resistencia y bajo peso, ha propiciado la utilización de varias resinas reforzadas con fibra de vidrio, debido a que éstas son de fácil procesabilidad, tienen bajos costos y brindan una buena resistencia mecánica. Sin embargo, dadas las características de las fibras naturales como son: fácil obtención, costos competitivos, aspectos ambientales y de salud, se fabricaron materiales ...

  9. Diseño de un material compuesto con fibra natural para sustituir la utilización de la fibra de vidrio

    OpenAIRE

    Gómez P., José Santiago

    2009-01-01

    El creciente desarrollo de materiales compuestos en aplicaciones donde se requieran características combinadas de resistencia y bajo peso, ha propiciado la utilización de varias resinas reforzadas con fibra de vidrio, debido a que éstas son de fácil procesabilidad, tienen bajos costos y brindan una buena resistencia mecánica. Sin embargo, dadas las características de las fibras naturales como son: fácil obtención, costos competitivos, aspectos ambientales y de salud, se fabricaron materiales ...

  10. Rituximabe para o tratamento da artrite reumatoide: revisão sistemática

    Directory of Open Access Journals (Sweden)

    Lívia Lovato Pires de Lemos

    2014-06-01

    Full Text Available Introdução: A artrite reumatoide (AR é uma doença autoimune crônica caracterizada por inflamação articular sistêmica que, com frequência, leva a significativa incapacitação. Vários agentes anti-TNF têm sido usados efetivamente, mas alguns pacientes demonstraram resposta inadequada. Rituximabe é um anticorpo monoclonal terapêutico indicado em tais casos. Métodos: Realizou-se uma revisão sistemática para avaliar a eficácia e a segurança de rituximabe em pacientes com AR ativa previamente tratados ou não com agentes anti-TNF e para relacionar o desfecho com a sorologia para FR e anti-CCP. Pesquisaram-se importantes bancos de dados eletrônicos e a literatura não convencional, além de se fazer uma busca manual de referências. Para a meta-análise, utilizou-se o programa Review Manager® 5.1. Resultados: Consideramos seis ERCs comparando rituximabe 1000 mg com placebo. Em ambos os grupos usou-se Metotrexato. O tratamento com rituximabe foi mais efetivo em pacientes jamais tratados e nos que não obtiveram sucesso com a terapia anti-TNF - critérios ACR 20/50/70 e EULAR. No grupo de rituximabe, observaram-se mudanças menos expressivas nos escores de Sharp/Genant, de erosão e de estreitamento do espaço articular; nesse grupo, os escores SF-36, FACIT-T e HAQ-DI também foram melhores. Não foram notadas diferenças entre grupos com relação aos desfechos de segurança, com exceção das reações agudas à infusão, que foram mais comuns no grupo de rituximabe. Ainda no grupo de rituximabe, um número maior de pacientes soropositivos para FR/anti-CCP alcançou ACR20, em comparação com pacientes negativos para RF/anti-CCP. Conclusão: Os dados disponíveis falam em favor do uso de rituximabe para o tratamento da AR, como opção efetiva e segura para pacientes jamais tratados ou que não obtiveram sucesso com o tratamento anti-TNF. FR e anti-CCP parecem influenciar os resultados do tratamento, mas essa inferência ainda est

  11. Rituximab-induced neutropenia in a patient with inflammatory myopathy and systemic sclerosis overlap disease.

    Science.gov (United States)

    Akram, Qasim; Roberts, Mark; Oddis, Chester; Herrick, Arianne; Chinoy, Hector

    2016-01-01

    Rituximab (RTX) is a monoclonal chimeric antibody directed against the CD20 antigen of B lymphocytes. Late onset neutropenia (LON) is a recognised complication of rituximab usually occurring 4 weeks after the last dose and is reported in both haematological and rheumatological conditions. However, it has never been described in a patient with myositis and systemic sclerosis overlap disease. We describe a case of LON in a 54-year-old man who was diagnosed with myositis and then systemic sclerosis overlap disease. It resolved within 7 days, and the patient did not suffer neutropenic sepsis or any other complications. We propose similar mechanisms for LON as described in other conditions and routine blood monitoring in such patients.

  12. Posterior reversible encephalopathy syndrome masquerading as progressive multifocal leukoencephalopathy in rituximab treated neuromyelitis optica.

    Science.gov (United States)

    Berger, Joseph R; Neltner, Janna; Smith, Charles; Cambi, Franca

    2014-11-01

    Both progressive multifocal leukoencephalopathy (PML) and posterior reversible encephalopathy syndrome (PRES) have been reported as complications of rituximab therapy. These disorders may appear indistinguishable on magnetic resonance imaging (MRI). We report on a 42 year old woman with neuromyelitis optica (NMO) of 10 years duration who developed extensive white matter disease affecting chiefly both parietal lobes 6 months after her first and only dose of rituximab. The MRI findings suggested the diagnosis of PML, but her history was more consistent with PRES. Ultimately, a brain biopsy was performed which was consistent with the diagnosis of PRES. PRES and PML may have overlapping symptomatology and be indistinguishable on MRI. An approach to distinguishing between these two disorders is addressed.

  13. Rituximab therapy for factor II inhibitor in a patient with antiphospholipid antibody syndrome.

    Science.gov (United States)

    Guddati, Achuta K; Kuter, David J

    2014-04-01

    Factor II inhibitors have been associated with an increased risk of bleeding. The management of patients with factor II inhibitors has not been adequately described. We describe a patient with an increased bleeding tendency due to factor II inhibitor who was unable to undergo surgery due to her bleeding tendency. The patient was successfully treated with a course of rituximab, which markedly reduced her factor II inhibitor: the factor II level rose from 12 to 61%; prothrombin time decreased from 20 to 14.7 s; and partial thromboplastin time (PTT) decreased from 148 to 38.8 s. She was able to undergo abdominal surgery without any hemorrhagic complications. This case exemplifies the possibility of treating patients with factor II inhibitors with rituximab therapy.

  14. Response to rituximab in a refractory case of thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Niaz Faraz

    2010-01-01

    Full Text Available Thrombotic thrombocytopenic purpura (TTP is a serious disorder with a significant morbidity and mortality. Majority of cases of TTP are idiopathic, but some cases may be secon-dary to connective tissue diseases. TTP has been rarely associated with systemic lupus erythe-matosus (SLE and may be refractory to treatment with plasma exchange, requiring immuno-suppressive therapy. We describe a patient with TTP and SLE who was refractory to plasma exchange and corticosteroids but responded to anti-CD20 antibody rituximab with continued re-mission after eight months of follow-up. Rituximab appears to be an effective treatment in re-fractory cases of TTP associated with SLE.

  15. Severe multi-resistant pemphigus vulgaris: prolonged remission with a single cycle of rituximab.

    Science.gov (United States)

    Corral, Isabela Soubhia; Freitas, Thais Helena Proença de; Aquino, Renata Telles Rudge de; Koller, Daniella Abbruzzini S; Magliari, Maria Elisa Ruffolo; Muller, Helena

    2013-01-01

    Pemphigus vulgaris is an autoimmune bullous disease whose therapy is based on systemic corticosteroids, with or without immunosuppressants. Rituximab is a chimeric monoclonal antibody of the IgG class, directed at a specific CD20 B cell surface antigen, used in pemphigus vulgaris empirically since 2002, with success in 90% of the cases and long periods of remission. Male patient, 33 years old, diagnosed with pemphigus vulgaris, confirmed by histopathology and direct immunofluorescence. He was treated for seven months with numerous treatments, including immunosuppressive drugs, with an unsatisfactory response, until he had complete remission with the use of rituximab. During a 34-month follow-up period, the patient presented a slight clinical relapse, which was successfully controlled with prednisone in a daily dose of 120 mg, soon reduced to 20mg.

  16. First-line use of rituximab correlates with increased overall survival in late post-transplant lymphoproliferative disorders: retrospective, single-centre study.

    Science.gov (United States)

    Martínez-Calle, Nicolás; Alfonso, Ana; Rifón, José; Herrero, Ignacio; Errasti, Pedro; Rábago, Gregorio; Merino, Juana; Panizo, Ángel; Pardo, Javier; Prósper, Felipe; García-Muñoz, Ricardo; Lecumberri, Ramón; Panizo, Carlos

    2017-01-01

    This retrospective study evaluates the impact of rituximab on PTLD response and survival in a single-centre cohort. PTLD cases between 1984 and 2009, including heart, kidney, liver and lung transplant recipients, were included. Survival was analysed taking into account the type of PTLD (monomorphic vs. polymorphic), EBV infection status, IPI score, Ann Arbor stage and use of rituximab. Among 1335 transplanted patients, 24 developed PTLD. Median age was 54 yr (range 29-69), median time to diagnosis 50 months (range 0-100). PTLD type was predominantly late/monomorphic (79% and 75%), mostly diffuse large B-cell type. Overall response rate (ORR) was 62% (66% rituximab vs. 50% non-rituximab; P = 0.5). R-CHOP-like regimens were used most frequently (72% of patients treated with rituximab). Median overall survival was 64 months (CI 95% 31-96). OS was significantly increased in patients treated with rituximab (P = 0.01; CI 95% rituximab 58-79 months; non-rituximab 1-30 months). Post-transplant immunosuppression regimen had no effect on survival or time to PTLD, except for cyclosporine A (CyA), which associated with increased time to PTLD (P = 0.02). Rituximab was associated with increased survival in our single-centre series, and it should be considered as first-line therapy for PTLD patients. The possible protective effect of CyA for development of PTLD should be prospectively evaluated.

  17. [Icteric hepatitis in a patient with non-Hodgkin's lymphoma treated by rituximab-based chemotherapy].

    Science.gov (United States)

    Coppola, Nicola; Masiello, Addolorata; Tonziello, Gilda; Macera, Margherita; Iodice, Valentina; Caprio, Nunzio; Pasquale, Giuseppe

    2010-06-01

    We report the case of a patient with non-Hodgkin's lymphoma who, during chemotherapy according to the r-CHOP schedule (rituximab-cyclophosphamide-doxorubicin-vincristine and prednisone), showed a hepatic flare with jaundice. Given the patient's state of asymptomatic carrier of HBsAg, we began a treatment of telbivudine (600 mg/die), resulting in a regression of hepatitis flare and negativization of HBV viraemia.

  18. Steroid-resistant autoimmune thrombocytopenia in systemic lupus erythematosus treated with rituximab

    Directory of Open Access Journals (Sweden)

    Vasudha V Sardesai

    2015-01-01

    Full Text Available Systemic Lupus Erythematosus (SLE is a multisystem disorder characterized by production of numerous autoantibodies, some of which have pathogenic consequences and result in considerable morbidity. Herein, we present a case of 48-year-old female with SLE having autoimmune hemolytic anemia, autoimmune thrombocytopenia, renal involvement, and recurrent flares of skin manifestations. She did not respond to the conventional therapy and was controlled and treated with Rituximab, a chimeric, monoclonal antiCD20 antibody, which specifically depletes B lymphocytes.

  19. Rituximab Treatment for Membranous Nephropathy: A French Clinical and Serological Retrospective Study of 28 Patients

    Directory of Open Access Journals (Sweden)

    Pierre-Antoine Michel

    2011-12-01

    Full Text Available The development of well-tolerated and effective therapies that target the pathogenesis of membranous nephropathy (MN would be useful. Our objective was to evaluate the efficacy of rituximab in MN. We analyzed the outcome of 28 patients treated with rituximab for idiopathic MN. Anti-PLA2R antibodies in serum and PLA2R antigen in kidney biopsy were assessed in 10 and 9 patients, respectively. Proteinuria was significantly decreased by 56, 62 and 87% at 3, 6 and 12 months, respectively. At 6 months, 2 patients achieved complete remission (CR and 12 partial remission (PR; overall renal response, 50%. At 12 months (n = 23, CR was achieved in 6 patients and PR in 13 patients (overall renal response, 82.6%. Three patients suffered a relapse of nephrotic proteinuria 27–50 months after treatment. Univariate analysis suggested that the degree of renal failure (MDRD estimated glomerular filtration rate 2 is an independent factor that predicts lack of response to rituximab. Anti-PLA2R antibodies were detected in the serum of 10 patients, and PLA2R antigen in immune deposits in 8 of 9 patients. Antibodies became negative in all 5 responsive patients with available follow-up sera. In this retrospective study, a high rate of remission was achieved 12 months after treatment.

  20. Effects of hypertonic buffer composition on lymph node uptake and bioavailability of rituximab, after subcutaneous administration.

    Science.gov (United States)

    Fathallah, Anas M; Turner, Michael R; Mager, Donald E; Balu-Iyer, Sathy V

    2015-03-01

    The subcutaneous administration of biologics is highly desirable; however, incomplete bioavailability after s.c. administration remains a major challenge. In this work we investigated the effects of excipient dependent hyperosmolarity on lymphatic uptake and plasma exposure of rituximab as a model protein. Using Swiss Webster (SW) mice as the animal model, we compared the effects of NaCl, mannitol and O-phospho-L-serine (OPLS) on the plasma concentration of rituximab over 5 days after s.c. administration. An increase was observed in plasma concentrations in animals administered rituximab in hypertonic buffer solutions, compared with isotonic buffer. Bioavailability, as estimated by our pharmacokinetic model, increased from 29% in isotonic buffer to 54% in hypertonic buffer containing NaCl, to almost complete bioavailability in hypertonic buffers containing high dose OPLS or mannitol. This improvement in plasma exposure is due to the improved lymphatic trafficking as evident from the increase in the fraction of dose trafficked through the lymph nodes in the presence of hypertonic buffers. The fraction of the dose trafficked through the lymphatics, as estimated by the model, increased from 0.05% in isotonic buffer to 13% in hypertonic buffer containing NaCl to about 30% for hypertonic buffers containing high dose OPLS and mannitol. The data suggest that hypertonic solutions may be a viable option for improving s.c. bioavailability. Copyright © 2014 John Wiley & Sons, Ltd.

  1. Rituximab Therapy for Severe Cutaneous Leukocytoclastic Angiitis Refractory to Corticosteroids, Cellcept and Cyclophosphamide

    Directory of Open Access Journals (Sweden)

    Kamel El-Reshaid

    2013-04-01

    Full Text Available We report our clinical experience with rituximab in the treatment of 2 patients with idiopathic cutaneous angiitis who relapsed after treatment with high-dose corticosteroids and cyclophosphamide. A 39-year-old woman and a 51-year-old man presented with ulcerating maculopapular rash in both lower limbs which relapsed 6 months after treatment with a combination of high-dose corticosteroids and cyclophosphamide. After treatment with 2 g of rituximab, the first patient has still been in clinical remission for 32 months while the second has finished 28 months. Interestingly, CD19 which had dropped to 0.5% 8 months later in both patients. Despite that, our patients are still in clinical remission. No significant side effects were noted during infusions and up to the period of follow-up. In conclusion, rituximab is a useful and safe agent in the treatment of idiopathic cutaneous angiitis refractory to conventional therapy. Clinical remission persists years after improvement of B-cell suppression.

  2. Assessment of Physicochemical Properties of Rituximab Related to Its Immunomodulatory Activity

    Directory of Open Access Journals (Sweden)

    Mariana P. Miranda-Hernández

    2015-01-01

    Full Text Available Rituximab is a chimeric monoclonal antibody employed for the treatment of CD20-positive B-cell non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, granulomatosis with polyangiitis and microscopic polyangiitis. It binds specifically to the CD20 antigen expressed on pre-B and consequently on mature B-lymphocytes of both normal and malignant cells, inhibiting their proliferation through apoptosis, CDC, and ADCC mechanisms. The immunomodulatory activity of rituximab is closely related to critical quality attributes that characterize its chemical composition and spatial configuration, which determine the recognition of CD20 and the binding to receptors or factors involved in its effector functions, while regulating the potential immunogenic response. Herein, we present a physicochemical and biological characterization followed by a pharmacodynamics and immunogenicity study to demonstrate comparability between two products containing rituximab. The physicochemical and biological characterization revealed that both products fit within the same response intervals exhibiting the same degree of variability. With regard to clinical response, both products depleted CD20+ B-cells until posttreatment recovery and no meaningful differences were found in their pharmacodynamic profiles. The evaluation of anti-chimeric antibodies did not show differential immunogenicity among products. Overall, these data confirm that similarity of critical quality attributes results in a comparable immunomodulatory activity.

  3. Rituximab induces sustained reduction of pathogenic B cells in patients with peripheral nervous system autoimmunity

    Science.gov (United States)

    Maurer, Michael A.; Rakocevic, Goran; Leung, Carol S.; Quast, Isaak; Lukačišin, Martin; Goebels, Norbert; Münz, Christian; Wardemann, Hedda; Dalakas, Marinos; Lünemann, Jan D.

    2012-01-01

    The B cell–depleting IgG1 monoclonal antibody rituximab can persistently suppress disease progression in some patients with autoimmune diseases. However, the mechanism underlying these long-term beneficial effects has remained unclear. Here, we evaluated Ig gene usage in patients with anti–myelin-associated glycoprotein (anti-MAG) neuropathy, an autoimmune disease of the peripheral nervous system that is mediated by IgM autoantibodies binding to MAG antigen. Patients with anti-MAG neuropathy showed substantial clonal expansions of blood IgM memory B cells that recognized MAG antigen. The group of patients showing no clinical improvement after rituximab therapy were distinguished from clinical responders by a higher load of clonal IgM memory B cell expansions before and after therapy, by persistence of clonal expansions despite efficient peripheral B cell depletion, and by a lack of substantial changes in somatic hypermutation frequencies of IgM memory B cells. We infer from these data that the effectiveness of rituximab therapy depends on efficient depletion of noncirculating B cells and is associated with qualitative immunological changes that indicate reconfiguration of B cell memory through sustained reduction of autoreactive clonal expansions. These findings support the continued development of B cell–depleting therapies for autoimmune diseases. PMID:22426210

  4. Rituximab and new regimens for indolent lymphoma: a brief update from 2012 ASCO Annual Meeting

    Directory of Open Access Journals (Sweden)

    Zhao Jiangning

    2012-08-01

    Full Text Available Abstract Indolent lymphoma (IL, the second most common lymphoma, remains incurable with chemotherapy alone. While R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone remains the standard frontline regimen for diffuse Large B –cell lymphoma, the optimal chemotherapy regimen for frontline therapy of advanced IL remains uncertain. FCR (fludarabine, cyclophosphamide, rituximab has been shown to be better than fludarabine alone and fludarabine plus cyclophosphamide for IL. In FOLL05 trial, R-CHOP was compared with R-CVP (cyclophosphamide, vincristine, prednisone and R-FM (fludarabine, mitoxantrone. The study showed that R-CHOP appears to have the best risk-benefit ratio for IL. The StiL NHL1 trial showed that BR (bendamustine, rituximab has longer progression free survival and is better tolerated than R-CHOP. Long-term complications with secondary malignancies between the two regimens appear to be comparable. In this review, new combination regimens reported at 2012 ASCO annual meeting were evaluated for frontline and salvage therapy of indolent lymphoma.

  5. Prospective phase 1/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura

    Science.gov (United States)

    Bennett, Carolyn M.; Rogers, Zora R.; Kinnamon, Daniel D.; Bussel, James B.; Mahoney, Donald H.; Abshire, Thomas C.; Sawaf, Hadi; Moore, Theodore B.; Loh, Mignon L.; Glader, Bertil E.; McCarthy, Maggie C.; Mueller, Brigitta U.; Olson, Thomas A.; Lorenzana, Adonis N.; Mentzer, William C.; Buchanan, George R.; Feldman, Henry A.; Neufeld, Ellis J.

    2006-01-01

    We assessed safety and efficacy of rituximab in a prospective study of 36 patients, age 2.6 to 18.3 years, with severe chronic immune thrombocytopenic purpura (ITP). The primary outcome of sustained platelets above 50 × 109/L (50 000/mm3) during 4 consecutive weeks, starting in weeks 9 to 12, was achieved by 11 of 36 patients (31%, confidence interval [CI], 16% to 48%). Median response time was 1 week (range, 1 to 7 weeks). Attainment of the primary outcome was not associated with age, prior pharmacologic responses, prior splenectomy, ITP duration, screening platelet count, refractoriness, or IgM reduction. First-dose, infusion-related toxicity was common (47%) despite premedication. Significant drug-related toxicities included third-dose hypotension (n = 1) and serum sickness (n = 2). Peripheral B cells were depleted in all subjects. IgM decreased 3.4% per week, but IgG did not significantly decrease. Rituximab was well tolerated, with manageable infusion-related side effects, but 6% of subjects developed serum sickness. Rituximab is beneficial for some pediatric patients with severe, chronic ITP. PMID:16352811

  6. Prospective phase 1/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura.

    Science.gov (United States)

    Bennett, Carolyn M; Rogers, Zora R; Kinnamon, Daniel D; Bussel, James B; Mahoney, Donald H; Abshire, Thomas C; Sawaf, Hadi; Moore, Theodore B; Loh, Mignon L; Glader, Bertil E; McCarthy, Maggie C; Mueller, Brigitta U; Olson, Thomas A; Lorenzana, Adonis N; Mentzer, William C; Buchanan, George R; Feldman, Henry A; Neufeld, Ellis J

    2006-04-01

    We assessed safety and efficacy of rituximab in a prospective study of 36 patients, age 2.6 to 18.3 years, with severe chronic immune thrombocytopenic purpura (ITP). The primary outcome of sustained platelets above 50 x 10(9)/L (50,000/mm3) during 4 consecutive weeks, starting in weeks 9 to 12, was achieved by 11 of 36 patients (31%, confidence interval [CI], 16% to 48%). Median response time was 1 week (range, 1 to 7 weeks). Attainment of the primary outcome was not associated with age, prior pharmacologic responses, prior splenectomy, ITP duration, screening platelet count, refractoriness, or IgM reduction. First-dose, infusion-related toxicity was common (47%) despite premedication. Significant drug-related toxicities included third-dose hypotension (n = 1) and serum sickness (n = 2). Peripheral B cells were depleted in all subjects. IgM decreased 3.4% per week, but IgG did not significantly decrease. Rituximab was well tolerated, with manageable infusion-related side effects, but 6% of subjects developed serum sickness. Rituximab is beneficial for some pediatric patients with severe, chronic ITP.

  7. Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia

    DEFF Research Database (Denmark)

    Gudbrandsdottir, Sif; Birgens, Henrik Sverre; Frederiksen, Henrik

    2013-01-01

    In this study, we report the results from the largest cohort to date of newly diagnosed adult immune thrombocytopenia patients randomized to treatment with dexamethasone alone or in combination with rituximab. Eligible were patients with platelet counts ≤25×10(9)/L or ≤50×10(9)/L with bleeding...... symptoms. A total of 133 patients were randomly assigned to either dexamethasone 40 mg/day for 4 days (n = 71) or in combination with rituximab 375 mg/m(2) weekly for 4 weeks (n = 62). Patients were allowed supplemental dexamethasone every 1 to 4 weeks for up to 6 cycles. Our primary end point, sustained...... response (ie, platelets ≥50×10(9)/L) at 6 months follow-up, was reached in 58% of patients in the rituximab + dexamethasone group vs 37% in the dexamethasone group (P = .02). The median follow-up time was 922 days. We found longer time to relapse (P = .03) and longer time to rescue treatment (P = .007...

  8. Rituximab induces resolution of recurrent diffuse alveolar hemorrhage in a patient with primary antiphospholipid antibody syndrome.

    Science.gov (United States)

    Scheiman Elazary, A; Klahr, P P; Hershko, A Y; Dranitzki, Z; Rubinow, A; Naparstek, Y

    2012-04-01

    Diffuse alveolar hemorrhage (DAH) is a rare manifestation of primary antiphospholipid antibody syndrome (APS). We describe a patient with primary APS and refractory recurrent episodes of DAH. The patient was admitted 15 times due to recurrent episodes of DAH in a period of 18 months. Multiple immunosuppressive drugs did not improve his condition. Two years after his presentation, he was treated with rituximab (two doses of 1 g, 2 weeks apart). Six months later, the attacks of DAH have gradually disappeared. In a follow-up of more than 2 years after he received rituximab, the patient has had no further admissions due to DAH. Levels of antiphospholipid antibodies were measured during follow-up of 4 years. Anti-β2 glycoprotein IgG titer decreased to normal 6 months after therapy but anticardiolipin (aCL) antibody titer increased. We conclude that rituximab caused a dramatic clinical response in this patient. Anti-β2 glycoprotein IgG correlated better with the clinical response in this patient than aCL.

  9. ROLE OF MULTIPLEX CYTOKINE ANALYSIS IN THE EVALUATION OF THE EFFICACY OF RITUXIMAB DURING TREATMENT FOR RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    A. A. Novikov

    2011-01-01

    Full Text Available Along with its basic activity in removing B-lymphocytes, rituximab (RTM causes depletion of a population of CD20+ T cells that can pro- duce a variety of immunoregulatory and proinflammatory cytokines and chemokines. Objective: to define a role of multiplex cytokine analysis in the evaluation of the efficiency of using RMT in rheumatoid arthritis (RA. Subjects and methods. Thirty-four patients with the valid diagnosis of RA according to the ACR criteria of 1987 were examined. The con- centrations of cytokines were measured using the xMAP technology (27-plex. Results and discussion. In the group of patients with a clinical response to therapy with the gene engineering biological agent, there was a decrease in the concentrations of interleukins (IL 1β, 1ra, 2, 4, 6, 9, and 13, granulocyte macrophage colony-stimulating factor (GM- CSF, γ-interferon (IFN-γ, monocyte chemoattractant 1 at week 8 of therapy; that in IL 1β, 1ra, 2, 5, 6, 9, 10, 12, 13, and 15, fibroblast growth factor 2 (FGF-2, GM-CSF, IFN-γ, and tumor necrosis factor-α at week 24, and that in IL-9 at week 40. The no-clinical response group showed a reduction in GM-CSF at week 8 and in IL-2 and macrophage inflammatory protein 1β (MIP-1β at week 40, and an increase in IL-8 at week 8. At week 8 after drug infusion, the elevated levels of IL-17 and MIP-1β can be identified as possible early pre- dictors of a response (at week 40. Comparison of the baseline cytokine levels in the groups with different clinical response demonstrated a more than three-fold increase in the concentrations of IL 4, 5, 7, 8, 10, 12, 13, 15, 17, IFN-γ, and vascular endothelial growth factor, and IL-8 at weeks 8 and 40, respectively. 

  10. Rituximab therapy in pulmonary alveolar proteinosis improves alveolar macrophage lipid homeostasis

    Directory of Open Access Journals (Sweden)

    Malur Anagha

    2012-06-01

    Full Text Available Abstract Rationale Pulmonary Alveolar Proteinosis (PAP patients exhibit an acquired deficiency of biologically active granulocyte-macrophage colony stimulating factor (GM-CSF attributable to GM-CSF specific autoantibodies. PAP alveolar macrophages are foamy, lipid-filled cells with impaired surfactant clearance and markedly reduced expression of the transcription factor peroxisome proliferator-activated receptor gamma (PPARγ and the PPARγ-regulated ATP binding cassette (ABC lipid transporter, ABCG1. An open label proof of concept Phase II clinical trial was conducted in PAP patients using rituximab, a chimeric murine-human monoclonal antibody directed against B lymphocyte specific antigen CD20. Rituximab treatment decreased anti-GM-CSF antibody levels in bronchoalveolar lavage (BAL fluid, and 7/9 patients completing the trial demonstrated clinical improvement as measured by arterial blood oxygenation. Objectives This study sought to determine whether rituximab therapy would restore lipid metabolism in PAP alveolar macrophages. Methods BAL samples were collected from patients pre- and 6-months post-rituximab infusion for evaluation of mRNA and lipid changes. Results Mean PPARγ and ABCG1 mRNA expression increased 2.8 and 5.3-fold respectively (p ≤ 0.05 after treatment. Lysosomal phospholipase A2 (LPLA2 (a key enzyme in surfactant degradation mRNA expression was severely deficient in PAP patients pre-treatment but increased 2.8-fold post-treatment. In supplemental animal studies, LPLA2 deficiency was verified in GM-CSF KO mice but was not present in macrophage-specific PPARγ KO mice compared to wild-type controls. Oil Red O intensity of PAP alveolar macrophages decreased after treatment, indicating reduced intracellular lipid while extracellular free cholesterol increased in BAL fluid. Furthermore, total protein and Surfactant protein A were significantly decreased in the BAL fluid post therapy. Conclusions Reduction in GM

  11. Seleção combinada univariada e multivariada aplicada ao melhoramento genético da seringueira Univariate and multivariate combined selection applied to Hevea breeding

    Directory of Open Access Journals (Sweden)

    REGINALDO BRITO DA COSTA

    2000-02-01

    Full Text Available Este trabalho objetivou estimar os coeficientes de herdabilidade e de predição genética, pelo método multivariado, e comparar os ganhos genéticos obtidos por meio da seleção entre e dentro de progênies, individual e combinada, em seringueira (Hevea brasiliensis (Willd. ex Adr. de Juss. Müell. Arg.. Vinte e duas progênies de meios-irmãos foram plantadas na Estação Experimental de Votuporanga, SP, no delineamento de blocos ao acaso, com cinco repetições e dez plantas por parcela. Aos três anos de idade foram avaliados os caracteres: número de anéis de vasos laticíferos (NA, produção de borracha seca (PB, espessura de casca (EC e circunferência do caule (CC. Os resultados demonstraram haver variabilidade significativa entre progênies quanto aos caracteres PB, EC e CC. As estimativas de coeficientes de herdabilidade e de predição genética foram mais elevadas nas progênies, com valores mais expressivos quanto aos coeficientes de predição genética. Ganhos genéticos adicionais foram obtidos pela seleção combinada. Embora os referidos ganhos tenham sido de pequena magnitude, recomenda-se o uso do método, por propiciar maior acurácia e ganho genético. Os valores mais expressivos de acurácia e ganho genético foram estimados pelo método multivariado.The objective of this paper was to estimate the heritability coefficients by the univariate method and genetic prediction by the multivariate method, as well as to compare the genetic gain obtained by individual and combined selection between and within progenies, in rubber tree (Hevea brasiliensis Willd. ex Adr. de Juss. Müell. Arg.. Twenty two half-sib progenies were established at the Experimental Station, in Votuporanga, São Paulo State, Brazil, following the randomized block design, with five replications and ten plants per plot. Three years after planting, number of latex vessel rings (NR, yield of dry rubber (YB, bark thickness (BT and stalk circunference (SC were

  12. A multi-centre retrospective study of rituximab use in the treatment of relapsed or resistant warm autoimmune haemolytic anaemia.

    LENUS (Irish Health Repository)

    Maung, Su W

    2013-10-01

    This retrospective analysis assessed the response, safety and duration of response to standard dose rituximab 375 mg\\/m(2) weekly for four weeks as therapy for patients with primary or secondary warm autoimmune haemolytic anaemia (WAIHA), who had failed initial treatment. Thirty-four patients received rituximab for WAIHA in seven centres in the Republic of Ireland. The overall response rate was 70·6% (24\\/34) with 26·5% (9\\/34) achieving a complete response (CR). The time to response was 1 month post-initiation of rituximab in 87·5% (21\\/24) and 3 months in 12·5% (3\\/24) of patients. The median duration of follow-up was 36 months (range 6-90 months). Of the patients who responded, 50% (12\\/24) relapsed during follow up with a median time to next treatment of 16·5 months (range 6-60 months). Three patients were re-treated with rituximab 375 mg\\/m2 weekly for four weeks at relapse and responded. There was a single episode of neutropenic sepsis. Rituximab is an effective and safe treatment for WAIHA but a significant number of patients will relapse in the first two years post treatment. Re-treatment was effective in a small number of patients, suggesting that intermittent pulse treatment or maintenance treatment may improve long-term response.

  13. Dose dense (CEOP-14) vs dose dense and rituximab (CEOP-14 +R) in high-risk diffuse large cell lymphoma.

    Science.gov (United States)

    Avilés, Agustin; Nambo, María J; Neri, Natividad; Cleto, Sergio; Castañeda, Claudia; Huerta-Guzmàn, Judith; Murillo, Edgar; Contreras, Margarita; Talavera, Alejandra; González, Martha

    2007-01-01

    To assess efficacy and toxicity of rituximab and dose chemotherapy in high-risk diffuse large cell lymphoma, we conducted a controlled clinical trial to assess efficacy and toxicity of a dose-dense regimen CEOP- 14 (cyclophosphamide, epirubicin, vincristine, and prednisone every 14 d) compared to CEOP-14 plus rituximab. One hundred and ninety-six patients were randomized to received CEOP-rituximab (cyclophosphamide 1500 mg/m2, epirubicin 120 mg/m2, vincristine, and prednisone at standard dose and rituximab at 375 mg/m2) compared with the same chemotherapy administered every 14 d (CEOP-14). In an intent-to-treat analysis all patients were available for efficacy and toxicity. Complete response in CEOP-14 was observed in 73 cases (74%) and in 75 patients (76%) in the CEOP-R regimen (76%) (p = 0.8). With a median follow-up of 53.4 mo, median has not been reached in time to tumor-progression (TTP) and overall survival (OS). Actuarial curves at 5 yr showed that TTP and OS in patients treated with CEOP-R were 74% and 67%, respectively, that were not statistical different when compared to CEOP-14, 72% and 65%, respectively (p = 0.8). Acute toxicity was mild and well tolerated. The use of a dense-dose regimen is useful and well tolerated in patients with very high risk diffuse large cell lymphoma. The addition of rituximab did not improve outcome in these setting of patients.

  14. Subcutaneous absorption of monoclonal antibodies: role of dose, site of injection, and injection volume on rituximab pharmacokinetics in rats.

    Science.gov (United States)

    Kagan, Leonid; Turner, Michael R; Balu-Iyer, Sathy V; Mager, Donald E

    2012-02-01

    To determine the effect of dose, the anatomical site of injection, and the injection volume on subcutaneous absorption of rituximab in rats and to explore absorption mechanisms using pharmacokinetic modeling. Rituximab serum concentrations were measured following intravenous and subcutaneous administration at the back, abdomen, and foot of rats. Several pharmacokinetic models were developed that included linear and saturable absorption, and degradation and/or protective binding at the injection site. Rituximab exhibited linear kinetics following intravenous administration; however, bioavailability following subcutaneous injection was inversely related to the dose level. For the 1 mg/kg dose, bioavailability was approximately 70% at all tested injection sites, with faster absorption from the foot (T(max) = 12 h for foot vs. 4.6 days for back). Bioavailability for the 10 mg/kg dose was 44 and 31% for the abdomen and back sites and 18% for 40 mg/kg injected at the back. A pharmacokinetic model that included binding as part of the absorption mechanism successfully captured the nonlinearities in rituximab absorption. The anatomical site of subcutaneous injection influences the rate of absorption and bioavailability of rituximab in rats. Saturable binding may be a major determinant of the nonlinear absorptive transport of monoclonal antibodies.

  15. Phase I/II trial of everolimus in combination with bortezomib and rituximab (RVR) in relapsed/refractory Waldenstrom macroglobulinemia.

    Science.gov (United States)

    Ghobrial, I M; Redd, R; Armand, P; Banwait, R; Boswell, E; Chuma, S; Huynh, D; Sacco, A; Roccaro, A M; Perilla-Glen, A; Noonan, K; MacNabb, M; Leblebjian, H; Warren, D; Henrick, P; Castillo, J J; Richardson, P G; Matous, J; Weller, E; Treon, S P

    2015-12-01

    We examined the combination of the mammalian target of rapamycin inhibitor everolimus with bortezomib and rituximab in patients with relapsed/refractory Waldenstrom macroglobulinemia (WM) in a phase I/II study. All patients received six cycles of the combination of everolimus/rituximab or everolimus/bortezomib/rituximab followed by maintenance with everolimus until progression. Forty-six patients were treated; 98% received prior rituximab and 57% received prior bortezomib. No dose-limiting toxicities were observed in the phase I. The most common treatment-related toxicities of all grades were fatigue (63%), anemia (54%), leucopenia (52%), neutropenia (48%) and diarrhea (43%). Thirty-six (78%) of the 46 patients received full dose therapy (FDT) of the three drugs. Of these 36, 2 (6%) had complete response (90% confidence interval (CI): 1-16). In all, 32/36 (89%) of patients experienced at least a minimal response (90% CI: 76-96%). The observed partial response or better response rate was 19/36 (53, 90 CI: 38-67%). For the 36 FDT patients, the median progression-free survival was 21 months (95% CI: 12-not estimable). In summary, this study demonstrates that the combination of everolimus, bortezomib and rituximab is well tolerated and achieved 89% response rate even in patients previously treated, making it a possible model of non-chemotherapeutic-based combination therapy in WM.

  16. Long-term maintenance therapy using rituximab-induced continuous B-cell depletion in patients with ANCA vasculitis.

    Science.gov (United States)

    Pendergraft, William F; Cortazar, Frank B; Wenger, Julia; Murphy, Andrew P; Rhee, Eugene P; Laliberte, Karen A; Niles, John L

    2014-04-01

    Remission in the majority of ANCA vasculitis patients is not sustained after a single course of rituximab, and risk of relapse warrants development of a successful strategy to ensure durable remission. A retrospective analysis of ANCA vasculitis patients who underwent maintenance therapy using rituximab-induced continuous B-cell depletion for up to 7 years was performed. Maintenance therapy with rituximab was initiated after achieving remission or converting from other prior maintenance therapy. Continuous B-cell depletion was achieved in all patients by scheduled rituximab administration every 4 months. Disease activity, serologic parameters, adverse events, and survival were examined. In the study, 172 patients (mean age=60 years, 55% women, 57% myeloperoxidase-ANCA) treated from April of 2006 to March of 2013 underwent continuous B-cell depletion with rituximab. Median remission maintenance follow-up time was 2.1 years. Complete remission (Birmingham Vasculitis Activity Score [BVAS] = 0) was achieved in all patients. Major relapse (BVAS ≥ 3) occurred in 5% of patients and was associated with weaning of other immunosuppression drugs. Remission was reinduced in all patients. Survival mirrored survival of a general age-, sex-, and ethnicity-matched United States population. This analysis provides evidence for long-term disease control using continuous B-cell depletion. This treatment strategy in ANCA vasculitis patients also seems to result in survival rates comparable with rates in a matched reference population. These findings suggest that prospective remission maintenance treatment trials using continuous B-cell depletion are warranted.

  17. Efectividad de la microonda, masoterapia y ejercicios de Williams en pacientes con dolor lumbar

    Directory of Open Access Journals (Sweden)

    Antonio del Valle Torres

    2015-06-01

    Full Text Available Fundamento: el dolor lumbar constituye un problema de salud a nivel mundial, su tratamiento constituye un reto en la práctica médica asistencial. Objetivo: evaluar la efectividad de la microonda, masoterapia y ejercicios de Williams en pacientes con dolor lumbar. Método: se realizó un estudio prospectivo experimental en una muestra de 60 pacientes con lumbalgia subaguda y crónica. Se asignaron dos esquemas de tratamiento: uno con microonda combinada con masoterapia y ejercicios de Williams (Grupo A, otro con medicamentos y reposo (Grupo B. Se aplicó la escala analógica visual y la escala de Oswestry en la consulta inicial y al culminar el tratamiento. Resultados: se obtuvo mejores resultados en el grupo A (estudio que en el grupo B (control en cuanto a reducción del dolor e independencia para las actividades de la vida diaria. Conclusiones: el protocolo de tratamiento fisioterapéutico resultó ser beneficioso, pues la recuperación y el alivio del dolor resultaron ser más rápidos y permitió la sustitución de fármacos.

  18. Highest clinical effectiveness of rituximab in autoantibody-positive patients with rheumatoid arthritis and in those for whom no more than one previous TNF antagonist has failed

    DEFF Research Database (Denmark)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny;

    2011-01-01

    To assess the 6-month effectiveness of the first rituximab (RTX) course in rheumatoid arthritis (RA) and to identify possible predictors of response.......To assess the 6-month effectiveness of the first rituximab (RTX) course in rheumatoid arthritis (RA) and to identify possible predictors of response....

  19. A Case of Fulminant Hepatitis due to Echovirus 9 in a Patient on Maintenance Rituximab Therapy for Follicular Lymphoma

    Directory of Open Access Journals (Sweden)

    Ceri Morgan

    2015-01-01

    Full Text Available Rituximab is a CD20 monoclonal antibody commonly used in the treatment of haematological malignancies. It causes lymphopenia with subsequent compromised humoral immunity resulting in an increased risk of infection. A number of infections and viral reactivations have been described as complicating Rituximab therapy. We report an apparently unique case of echovirus 9 (an enterovirus infection causing an acute hepatitis and significant morbidity in an adult patient on maintenance treatment of Rituximab for follicular lymphoma. We also describe potential missed opportunities to employ more robust screening for viral infections which may have prevented delays in the appropriate treatment and thus may have altered the patient’s clinical course. We also make suggestions for lowering the threshold of viral testing in similar patients in the future.

  20. Venetoclax plus rituximab in relapsed or refractory chronic lymphocytic leukaemia: a phase 1b study

    Science.gov (United States)

    Seymour, John F; Ma, Shuo; Brander, Danielle M; Choi, Michael Y; Barrientos, Jacqueline; Davids, Matthew S; Anderson, Mary Ann; Beaven, Anne W; Rosen, Steven T; Tam, Constantine S; Prine, Betty; Agarwal, Suresh K; Munasinghe, Wijith; Zhu, Ming; Lash, L Leanne; Desai, Monali; Cerri, Elisa; Verdugo, Maria; Kim, Su Young; Humerickhouse, Rod A; Gordon, Gary B; Kipps, Thomas J; Roberts, Andrew W

    2017-01-01

    Summary Background Selective BCL2 inhibition with venetoclax has substantial activity in patients with relapsed or refractory chronic lymphocytic leukaemia. Combination therapy with rituximab enhanced activity in preclinical models. The aim of this study was to assess the safety, pharmacokinetics, and activity of venetoclax in combination with rituximab. Methods Adult patients with relapsed or refractory chronic lymphocytic leukaemia (according to the 2008 Modified International Workshop on CLL guidelines) or small lymphocytic lymphoma were eligible for this phase 1b, dose-escalation trial. The primary outcomes were to assess the safety profile, to determine the maximum tolerated dose, and to establish the recommended phase 2 dose of venetoclax when given in combination with rituximab. Secondary outcomes were to assess the pharmacokinetic profile and analyse efficacy, including overall response, duration of response, and time to tumour progression. Minimal residual disease was a protocol-specified exploratory objective. Central review of the endpoints was not done. Venetoclax was dosed daily using a stepwise escalation to target doses (200–600 mg) and then monthly rituximab commenced (375 mg/m2 in month 1 and 500 mg/m2 in months 2–6). Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for adverse events version 4.0. Protocol-guided drug cessation was allowed for patients who achieved complete response (including complete response with incomplete marrow recovery) or negative bone marrow minimal residual disease. Analyses were done per protocol for all patients who commenced drug and included all patients who received at least one dose of venetoclax. Data were pooled across dose cohorts. Patients are still receiving therapy and follow-up is ongoing. The trial is registered at ClinicalTrials.gov, number NCT01682616. Findings Between Aug 6, 2012, and May 28, 2014, we enrolled 49 patients. Common grade 1–2 toxicities

  1. Medical resource utilization in dermatomyositis/polymyositis patients treated with repository corticotropin injection, intravenous immunoglobulin, and/or rituximab.

    Science.gov (United States)

    Knight, Tyler; Bond, T Christopher; Popelar, Breanna; Wang, Li; Niewoehner, John W; Anastassopoulos, Kathryn; Philbin, Michael

    2017-01-01

    Dermatomyositis and polymyositis (DM/PM) are rare, incurable inflammatory diseases that cause progressive muscle weakness and can be associated with increased medical resource use (MRU). When corticosteroid treatment is unsuccessful, patients may receive intravenous immunoglobulin (IVIg), rituximab, or repository corticotropin injection (RCI). This study compared real-world, non-medication MRU between patients treated with RCI and those treated with IVIg and/or rituximab for DM/PM. Claims of DM/PM patients were analyzed from the combination of three commercial health insurance databases in the United States from July 2009 to June 2014. Patients treated with RCI were propensity score matched to those treated with IVIg, rituximab, and both (IVIg+rituximab) based on demographics, prior clinical characteristics, and prior MRU. Per-patient per-month (PPPM) MRU and costs were compared using Poisson regression and generalized linear modeling, respectively. One-hundred thirty-two RCI, 1,150 IVIg, and 562 rituximab patients had an average age of 52.6, 46.6, and 51.7 years, respectively, and roughly two-thirds were female. After matching, there were no significant differences in demographics or prior clinical characteristics. RCI patients had fewer PPPM hospitalizations (0.09 vs 0.17; P=0.049), shorter length of stay (LOS; 3.24 days vs 4.55 days; P=0.004), PPPM hospital outpatient department (HOPD) visits (0.60 vs 1.39; PMRU and costs than those treated with IVIg and/or rituximab, particularly in the hospital setting where significant costs are incurred.

  2. Comparative Study on Rituximab Combined with Chemotherapy and Single Chemotherapy for Diffuse Large B Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    Ji-feng FENG

    2015-06-01

    Full Text Available Objective: To explore the clinical efficacy and safety of rituximab combined with chemotherapy and single chemotherapy for diffuse large B cell lymphoma (DLBCL. Methods: A total of 97 patients with DLBCL were selected. Patients treated by single chemotherapy were designed as control group, while those by rituximab combined with chemotherapy as observational group. All patients were treated for at least 4 cycles. The short-term and long-term efficacy and related adverse reactions of 2 groups were observed. Results: The rate of complete remission (CR in observational group was significantly higher than in control group (χ2=4.6589, P=0.0309. However, there was no significant difference in objective remission rate (ORR between 2 groups (P=0.3651. The rates of 3-year overall survival (OS, progression-free survival (PFS and disease-free survival (DFS were 80.30% (53/66, 69.70% (46/66 and 59.09% (39/66 in observational group, and 61.29% (19/31, 58.06% (18/31 and 58.06% (18/31 in control group, respectively. The OS in observational group was significantly longer than in control group (P=0.035. However, there was no significant difference in PFS, DFS and rate adverse reactions between 2 groups (P=0.089; P=0.438; χ2=0.1562, P=0.6927. Conclusion: Rituximab combined with chemotherapy can improve the efficacy of DLBCL without increasing the adverse reactions, which can be used as the first-line treatment for DLBCL, thus deserving to be widely applied in clinic.

  3. Efficacy, outcomes, and cost-effectiveness of desensitization using IVIG and rituximab.

    Science.gov (United States)

    Vo, Ashley A; Petrozzino, Jeffrey; Yeung, Kai; Sinha, Aditi; Kahwaji, Joseph; Peng, Alice; Villicana, Rafael; Mackowiak, John; Jordan, Stanley C

    2013-03-27

    Transplantation rates are very low for the broadly sensitized patient (panel reactive antibody [PRA]>80%; HS). Here, we examine the efficacy, outcomes, and cost-effectiveness of desensitization using high-dose intravenous immunoglobulin (IVIG) and rituximab to improve transplantation rates in HS patients. From July 2006 to December 2011, 207 HS (56 living donors/151 deceased donors) patients (donor-specific antibody positive, PRA>80%) were desensitized using IVIG and rituximab. After desensitization, responsive patients proceeded to transplantation with an acceptable crossmatch. Cost and outcomes of desensitization were compared with dialysis. Of the 207 treated patients, 146 (71%) were transplanted. At 48 months, patient and graft survival by Kaplan-Meier were 95% and 87.5%, respectively. The total 3-year cost for patients treated in the desensitization arm was $219,914 per patient compared with $238,667 per patient treated in the dialysis arm. Thus, each patient treated with desensitization is estimated to save the U.S. healthcare system $18,753 in 2011 USD. Overall, estimated patient survival at the end of 3 years was 96.6% for patients in the desensitization arm of the model (based on Cedars-Sinai survival rate) compared with 79.0% for an age, end-stage renal disease etiology, and PRA matched group of patients remaining on dialysis during the study period. We conclude that desensitization with IVIG+rituximab is clinically and cost-effective, with both financial savings and an estimated 17.6% greater probability of 3-year survival associated with desensitization versus dialysis alone. However, the benefits of desensitization and transplantation are limited by organ availability and allocation policies.

  4. Comparative Study on Rituximab Combined with Chemotherapy and Single Chemotherapy for Diffuse Large B Cell Lymphoma

    Institute of Scientific and Technical Information of China (English)

    FENG Ji-feng

    2015-01-01

    Objective:To explore the clinical efifcacy and safety of rituximab combined with chemotherapy and single chemotherapy for diffuse large B cell lymphoma (DLBCL). Methods:A total of 97 patients with DLBCL were selected. Patients treated by single chemotherapy were designed as control group, while those by rituximab combined with chemotherapy as observational group. All patients were treated for at least 4 cycles. The short-term and long-term efifcacy and related adverse reactions of 2 groups were observed. Results:The rate of complete remission (CR) in observational group was signiifcantly higher than in control group (χ2=4.6589,P=0.0309). However, there was no signiifcant difference in objective remission rate (ORR) between 2 groups (P=0.3651). The rates of 3-year overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS) were 80.30% (53/66), 69.70% (46/66) and 59.09% (39/66) in observational group, and 61.29% (19/31), 58.06% (18/31) and 58.06% (18/31) in control group, respectively. The OS in observational group was signiifcantly longer than in control group (P=0.035). However, there was no signiifcant difference in PFS, DFS and rate adverse reactions between 2 groups (P=0.089;P=0.438;χ2=0.1562,P=0.6927). Conclusion: Rituximab combined with chemotherapy can improve the efficacy of DLBCL without increasing the adverse reactions, which can be used as the ifrst-line treatment for DLBCL, thus deserving to be widely applied in clinic.

  5. Refractory myasthenia gravis – clinical profile, comorbidities and response to rituximab

    Science.gov (United States)

    Sudulagunta, Sreenivasa Rao; Sepehrar, Mona; Sodalagunta, Mahesh Babu; Settikere Nataraju, Aravinda; Bangalore Raja, Shiva Kumar; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Introduction: Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications. Methods: Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated. Results: Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27–53 years. In our study 25 patients (32.89%) belonged to the age group of 21–30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA1C was found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% (p=3.3x10–8) to 94.6% (p=2.2x10–14) after the third cycle of rituximab treatment. Conclusion: The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA1C >8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low. PMID:27790079

  6. Efficacy of rituximab in gastric diffuse large B cell lymphoma patients

    Institute of Scientific and Technical Information of China (English)

    Davide; Leopardo; Giuseppe; Di; Lorenzo; Amalia; De; Renz

    2010-01-01

    AIM:To evaluate retrospectively the efficacy of rituximab plus chemotherapy in gastric diffuse large B cell lymphoma(DLBCL).METHODS:Sixty patients(median age:58 years)with histologically confirmed gastric DLBCL treated at four Italian institutions between 2000 and 2007,were included in this analysis.Patients were selected by stage (Ⅰ-Ⅳ,Lugano staging system),European Cooperative Oncology Group performance status(0-2)and treatment strategies.Treatment strategies were chemotherapy alone(group A,n=30)[schedule...

  7. Hematopoietic stem cell transplantation conditioning with use of rituximab in EBV related lymphoproliferative disorders.

    Science.gov (United States)

    Shamriz, Oded; Vilk, Shoshana Revel; Wolf, Dana G; Ta-Shma, Asaf; Averbuch, Diana; Weintraub, Michael; Stepensky, Polina

    2014-04-01

    X-linked lymphoproliferative disease (XLP) and IL-2-inducible T cell kinase (ITK) deficiency are rare immunodeficiencies with a spectrum of clinical manifestations. Although there are no official guidelines for allogeneic hematopoietic stem cell transplantation (HSCT) in these patients, previous reports have shown that reduced intensity conditioning regimens provide successful engraftment with limited toxicity. Here, we report on three children with XLP and one with ITK deficiency, who underwent successful HSCT using a rituximab containing conditioning regimen, and review the current literature. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Systemic adverse events following rituximab therapy in patients with Graves' disease

    DEFF Research Database (Denmark)

    El Fassi, D; Nielsen, Claus Henrik; Junker, Michael Peter;

    2011-01-01

    Background and aim: Rituximab (RTX) therapy has shown promising results in Graves´ disease (GD), with or without ophthalmopathy. We examined the occurrence of adverse events in GD patients treated with RTX. Subjects and methods: Ten patients received RTX and methimazole, while ten patients received...... had the third highest increase in immunoglobulin deposition on monocytes by day 14. The arthralgias persisted in two of the patients, despite glucocorticoid rescue therapy. Conclusions: We report articular adverse events in three and gastrointestinal symptoms in two out of ten GD patients who received...

  9. Off-label use of rituximab for systemic lupus erythematosus in Europe

    DEFF Research Database (Denmark)

    Rydén-Aulin, Monica; Boumpas, Dimitrios; Bultink, Irene

    2016-01-01

    OBJECTIVES: Rituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy. METHODS...... organ manifestations for which either RTX or conventional therapy was initiated were lupus nephritis followed by musculoskeletal and haematological. The reason for treatment was, besides disease control, corticosteroid-sparing for patients treated with conventional therapy. CONCLUSIONS: RTX use for SLE...

  10. Desenvolvimento e validação de métodos analíticos e bioanalíticos para os fármacos anlodipino e olmesartana medoxomila, em dose fixa combinada

    OpenAIRE

    Mariana de Oliveira Almeida

    2013-01-01

    O tratamento da hipertensão com apenas um fármaco é eficiente, somente, para um terço dos pacientes. Para maximizar a eficácia do tratamento, associam-se fármacos que atuam em diferentes mecanismos fisiopatológicos. A associação de olmesartana medoxomila e besilato de anlodipino, um antagonista do receptor AT1 de angiotensina II e um bloqueador dos canais de cálcio, respectivamente, em comprimidos de dose fixa combinada é efetiva, segura e bem tolerada. Por ser uma associação nova e que ainda...

  11. Modelado de la transferencia de calor por convección natural y radiación combinadas mediante el método de los volúmenes finitos

    OpenAIRE

    Rebollo, Daniel; Sánchez Manuel

    2007-01-01

    En este trabajo se ha simulado numéricamente un proceso de transferencia de calor por conducción, convección y radiación en forma combinada. Se ha estudiado una cavidad cuadrada bidimensional rellena de aire que absorbe, emite y dispersa isotrópicamente la radiación térmica. Además, se han considerado una gran variedad de situaciones térmicas, convectivas y radiantes. Para realizar la simulación numérica se ha utilizado el método de los volúmenes finitos el cual ha sido extensamen...

  12. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia

    DEFF Research Database (Denmark)

    Birgens, Henrik Sverre; Frederiksen, Henrik; Hasselbalch, Hans C;

    2013-01-01

    The impact of first-line treatment with the anti-CD 20 chimeric monoclonal antibody rituximab in patients with warm-antibody reactive autoimmune haemolytic anaemia (WAIHA) is unknown. We report the first randomized study of 64 patients with newly diagnosed WAIHA who received prednisolone and ritu......The impact of first-line treatment with the anti-CD 20 chimeric monoclonal antibody rituximab in patients with warm-antibody reactive autoimmune haemolytic anaemia (WAIHA) is unknown. We report the first randomized study of 64 patients with newly diagnosed WAIHA who received prednisolone...

  13. Severe autoimmune hemolytic anemia after unrelated umbilical cord blood transplant for familial hemophagocytic lymphohistiocytosis: significant improvement after treatment with rituximab.

    Science.gov (United States)

    Radhi, Mohamed; Rumelhart, Steve; Tatman, David; Goldman, Fred

    2007-02-01

    A 4-month-old girl diagnosed with familial hemophagocytic lymphohistiocytosis underwent a matched unrelated, umbilical cord blood transplant. Six weeks later she developed severe acute autoimmune hemolytic anemia and thrombocytopenia requiring multiple transfusions. This was refractory to high-dose steroid and intravenous immunoglobulin, but did respond to Rituximab (anti-CD20 monoclonal antibody) 375 mg/m2. Hemolysis recurred after steroid tapering but responded to a second course of Rituximab. This case report highlights the difficulty in managing posttransplant autoimmune hemolytic anemia.

  14. Successful treatment of mature B-cell lymphoma with rituximab-based chemotherapy in a patient with Bloom syndrome.

    Science.gov (United States)

    Jastaniah, Wasil

    2017-07-01

    This report presents a case of Bloom syndrome (BS) in a consanguineous Saudi family. The patient, an 11-year-old male with mature B-cell lymphoma, had minimal therapeutic response and significant dose-limiting toxicity with standard chemotherapy treatment. He later responded successfully to a rituximab-based chemotherapy protocol. This case highlights that the rituximab-based chemotherapy protocol is an effective and safe treatment alternative for mature B-cell lymphoma in patients with BS. Further trials are warranted to investigate this modality of treatment. © 2016 Wiley Periodicals, Inc.

  15. B-lymphocyte reconstitution after repeated rituximab treatment in a child with steroid-dependent autoimmune hemolytic anemia

    Directory of Open Access Journals (Sweden)

    Esther de Vries

    2011-09-01

    Full Text Available We report the detailed long-term reconstitution of B-lymphocyte subpopulations, immunoglobulins, and specific antibody production after two courses of rituximab in a young, previously healthy girl with steroid-dependent autoimmune hemolytic anemia. B-lymphocyte subpopulations were surprisingly normal directly after reconstitution. However, there was a slower reconstitution after the second rituximab course, especially of non-switched and switched memory B-lymphocytes, and a temporary decline in IgM below age-matched reference values.

  16. Análisis de polimorfismos asociados con pérdida de susceptibilidad al Coartem® (Artemeter/Lumefantrina) en aislados de Plasmodium falciparum, provenientes de tres localidades endémicas para malaria en Colombia

    OpenAIRE

    Bernal Espinosa, Sindy Durley

    2014-01-01

    La aparición de la resistencia a los antimaláricos ha sido un gran problema para controlar la malaria a nivel mundial y la disminución de la susceptibilidad a las Terapias Combinadas con derivados de Artemisininas (TCA) hace necesario definir un marcador molecular que facilite monitorear la propagación de poblaciones resistentes. Los genes Pfatp6 y Pfmdr1 han sido propuestos como candidatos a marcadores moleculares. El objetivo de este trabajo fue evaluar la presencia de polimorfismos en esto...

  17. Cirurgia combinada de catarata e glaucoma com ponto escleral perilímbico: técnica cirúrgica e resultados a longo prazo

    Directory of Open Access Journals (Sweden)

    Luciano Sólia Násser

    2012-08-01

    Full Text Available OBJETIVO: Analisar os resultados da cirurgia combinada de catarata e glaucoma (FACO-TREC e apresentar a técnica com o ponto escleral perilímbico. MÉTODOS: Estudo retrospectivo por levantamento de prontuários com informações sobre a pressão intraocular, acuidade visual, medicação hipotensora antes e depois da cirurgia e descrição do ato cirúrgico combinado (FACO-TREC, com acompanhamento mínimo de seis meses. Foram selecionados 10 pacientes com glaucoma e catarata (15 olhos, acompanhados de janeiro de 2005 a junho de 2007, no Departamento de Glaucoma da Santa Casa Olhos de Montes Claros (MG. A cirurgia de TREC utilizada foi a de base fórnix, sem uso de Mitomicina C, com a incisão principal da cirurgia de catarata realizada no mesmo sítio da TREC. A confecção do ponto escleral perilímbico se dá como uma sutura que se inicia na esclera nua, passa por cima do retalho escleral e é ancorada na esclera do outro lado do retalho. A conjuntiva é suturada com pontos simples por sobre o ponto. RESULTADOS: A acuidade visual, após seis meses da cirurgia mostrou-se melhor em 86,6% (13 dos olhos, inalterada em 6,66% (1 olho e pior em 6,66%. A pressão intraocular média pré-operatória foi de 18,02 mmHg, a pós-operatória após 6 meses foi de 15,06 mmHg. Cinquenta por cento dos olhos operados ficaram livres dos colírios. CONCLUSÃO: Conclui-se que o ponto escleral perilímbico apresentou resultados favoráveis na obtenção de uma melhora na acuidade visual, redução da pressão intraocular e uma diminuição significativa no uso de drogas hipotensoras à custa de um número muito pequeno de complicações.

  18. Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial

    NARCIS (Netherlands)

    M.H.J. van Oers; R. Klasa; R.E. Marcus; M. Wolf; E. Kimby; R.D. Gascoyne; A. Jack; M. van't Veer; A. Vranovsky; H. Holte; M. van Glabbeke; I. Teodorovic; C. Rozewicz; A. Hagenbeek

    2006-01-01

    We evaluated the role of rituximab (R) both in remission induction and maintenance treatment of relapsed/resistant follicular lymphoma (FL). A total of 465 patients were randomized to induction with 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) (every 3 weeks) or R-CH

  19. Neuromyelitis optica: Contribution of therapeutic responses markers monitoring in patients given rituximab.

    Science.gov (United States)

    Romero, G; Ticchioni, M; Cohen, M; Rosenthal-Allieri, M A; Mondot, L; Lebrun Frenay, C

    2016-03-01

    Neuromyelitis optica (NMO) is a central nervous system inflammatory autoimmune disease characterized by medullary and/or optical nerve damage. It is rare but life-threatening. Concerning the treatment of NMO, many drugs have been used in background therapy. Some studies have shown efficacy of rituximab (an antiCD20 monoclonal anti-body) either on the reduction of the annual number of exacerbation or the mean score EDSS. In 2013, a Korean team reported a new protocol during which they administered rituximab only when memory B lymphocytes CD27+ were detectable in the bloodstream. In our patient, institution of this protocol led to clinical benefit with a major decrease in the EDSS score over time (7 in August 2012 vs. 1 in October 2015), a reduction of the total administered dose (4g in 2013 vs. 1.375g in 2014 vs. 0g in 2015) and side effects. Compared with the rate of theoretical administration, health expenditure savings reached 1700 Euros per month over the 11-month treatment. Monitoring therapeutic response markers with memory B lymphocyte counts appear to be an efficient cost-effective way to measure clinical efficiency, reduce total doses, and limit side effects.

  20. Rituximab plus liposomal doxorubicin in HIV-infected patients with KSHV-associated multicentric Castleman disease

    Science.gov (United States)

    Polizzotto, Mark N.; Aleman, Karen; Wyvill, Kathleen M.; Marshall, Vickie; Whitby, Denise; Wang, Victoria; Pittaluga, Stefania; O’Mahony, Deirdre; Steinberg, Seth M.; Little, Richard F.; Yarchoan, Robert

    2014-01-01

    Kaposi sarcoma (KS) herpesvirus–associated multicentric Castleman disease (KSHV-MCD) is a lymphoproliferative disorder, most commonly seen in HIV-infected patients, that has a high mortality if untreated. Concurrent KS is common. Although rituximab has reported activity in KSHV-MCD, its use is often associated with KS progression. Within a natural history study of KSHV-MCD, we prospectively evaluated rituximab 375 mg/m2 combined with liposomal doxorubicin 20 mg/m2 (R-Dox) every 3 weeks in 17 patients. Patients received a median of 4 cycles (range 3-9). All received antiretroviral therapy, 11 received consolidation interferon-α, and 6 received consolidation high-dose zidovudine with valganciclovir. Using NCI KSHV-MCD response criteria, major clinical and biochemical responses were attained in 94% and 88% of patients, respectively. With a median 58 months’ potential follow-up, 3-year event-free survival was 69% and 3-year overall survival was 81%. During R-Dox therapy, cutaneous KS developed in 1 patient, whereas 5 of 6 patients with it had clinical improvement. R-Dox was associated with significant improvement in anemia and hypoalbuminemia. KSHV viral load, KSHV viral interleukin-6, C-reactive protein, human interleukin-6, and serum immunoglobulin free light chains decreased with therapy. R-Dox is effective in symptomatic KSHV-MCD and may be useful in patients with concurrent KS. This trial was registered at www.clinicaltrials.gov as #NCT00092222. PMID:25331113

  1. Cyclophosphamide, fludarabine, alemtuzumab, and rituximab as salvage therapy for heavily pretreated patients with chronic lymphocytic leukemia

    Science.gov (United States)

    Badoux, Xavier C.; Keating, Michael J.; Wang, Xuemei; O'Brien, Susan M.; Ferrajoli, Alessandra; Faderl, Stefan; Burger, Jan; Koller, Charles; Lerner, Susan; Kantarjian, Hagop

    2011-01-01

    Patients with relapsed chronic lymphocytic leukemia (CLL) and high-risk features, such as fludarabine refractoriness, complex karyotype, or abnormalities of chromosome 17p, experience poor outcomes after standard fludaradine-based regimens. Alemtuzumab is a chimeric CD52 monoclonal antibody with activity in CLL patients with fludarabine-refractory disease and 17p deletion. We report the outcome for 80 relapsed or refractory patients with CLL enrolled in a phase 2 study of cyclophosphamide, fludarabine, alemtuzumab, and rituximab (CFAR). All patients were assessed for response and progression according to the 1996 CLL-working group criteria. For the intention-to-treat analysis, the overall response rate was 65%, including 29% complete response. The estimated progression-free survival was 10.6 months and median overall survival was 16.7 months. Although we noted higher complete response in high-risk patients after CFAR compared with a similar population who had received fludarabine, cyclophosphamide, and rituximab as salvage therapy, there was no significant improvement in progression-free survival and overall survival appeared worse. CFAR was associated with a high rate of infectious complications with 37 patients (46%) experiencing a serious infection during therapy and 28% of evaluable patients experiencing late serious infections. Although CFAR produced good response rates in this highly pretreated high-risk group of patients, there was no benefit in survival outcomes. PMID:21670470

  2. Obinutuzumab: A Review in Rituximab-Refractory or -Relapsed Follicular Lymphoma.

    Science.gov (United States)

    Dhillon, Sohita

    2017-03-21

    Obinutuzumab (Gazyva(®), Gazyvaro(®)) is a recombinant, monoclonal, humanized and glycoengineered, type II, anti-CD20, IgG1 antibody. It has recently been granted an additional indication for the treatment of patients with follicular lymphoma who relapsed after, or are refractory to, a rituximab-containing regimen. In the primary analysis of the large, phase III GADOLIN study, induction therapy with obinutuzumab plus bendamustine followed by obinutuzumab maintenance prolonged progression-free survival (PFS) to a statistically significant extent relative to induction with bendamustine monotherapy in patients with indolent non-Hodgkin's lymphoma (iNHL). The improvement in PFS was largely driven by the subgroup of patients with follicular lymphoma, who also had prolonged overall survival (OS) in a planned updated analysis. Obinutuzumab had a generally manageable tolerability profile in these patients; mild to moderate infusion-related reactions (IRRs) were the most common treatment-emergent adverse events (AEs) and neutropenia the most common grade 3 or 4 treatment-related AEs. Although additional studies and longer-term data are needed to further assess treatment benefits with obinutuzumab, current evidence indicates that obinutuzumab is a useful treatment option for patients with rituximab-refractory or -relapsed follicular lymphoma.

  3. Clinical and economic aspects of the use of rituximab in non-Hodgkin's lymphoma

    Directory of Open Access Journals (Sweden)

    Camila Bezerra Melo Figueirêdo

    2014-09-01

    Full Text Available Non-Hodgkin's lymphoma (NHL consists of a group of neoplasias involving mainly B cells and represents 90% of all lymphomas. The current available therapy is based on chemotherapy associated with the monoclonal antibody rituximab (Mab Thera(r, which targets the CD20 protein, present in over 80% of NHL mature B cells. Recent clinical reports show a preference for combining the benefits of immunotherapy and adjuvant chemotherapy, thus generating safe and effective alternative treatments. The current review aimed at evaluating various aspects related to the use of rituximab for NHL, highlighting the possible inhibitory mechanisms of cell proliferation, the achieved clinical results, and the expected clinical and economic outcomes of treatments. The results from clinical tests indicate the need for a better understanding of the critical mechanisms of action of this antibody, which may maximize its therapeutic efficacy. This therapy not only represents a viable option to treat most types of NHLs, especially when associated with conventional chemotherapy, but also offers cost-utility and cost-effectiveness advantages.

  4. Rituximab therapy for flare-up of rheumatoid arthritis after total knee replacement surgery.

    Science.gov (United States)

    Mirza, Rabeea; Ishaq, Saliha; Khan, Muhammad Owais; Memon, Adil

    2012-10-01

    A variety of drug types are used alone or in combination to manage Rheumatoid Arthritis along with physiotherapy. We report herein the case of a 51 year old female patient with a history of Rheumatoid Arthritis whose disease remained active despite being on routinely used multiple disease modifying antirheumatic drugs. The patient underwent bilateral total knee arthroplasty with subtotal synovectomy due to the severe pain caused by her concomitant age related osteoarthritis which was only aggravated by her active rheumatoid arthritis disease. Three months following surgery, the patient's knee pain with typical rheumatoid flare and swelling reappeared for which a B cell monoclonal antibody, rituximab, was given. Her number of tender and swollen joints reduced to less than three and her C-reactive protein levels and erythrocyte sedimentation rate reduced significantly along with considerable improvement in her Global Assessment score. Her severity of pain also decreased to 3 from an initial score of 8 on the Visual Analog Scale. Thus, Rituximab helped improve our patient's symptoms from recurrence of synovitis after total knee replacement.

  5. Use of Rituximab in Autoimmune Hemolytic Anemia Associated with Non-Hodgkin Lymphomas

    Directory of Open Access Journals (Sweden)

    Claudio Fozza

    2011-01-01

    Full Text Available The association between non-Hodgkin lymphomas and autoimmune disorders is a well-known event. Also autoimmune hemolytic anemia (AHA, although much more frequent in patients with chronic lymphocytic leukemia (CLL, has been described in this group of patients. In recent years, among the more traditional therapeutic options, rituximab, an anti-CD20 monoclonal antibody, has shown interesting results in the treatment of primary AHA. Although this drug has been frequently used for AHA in patients with CLL, much less data are available on its use in NHL patients. However, considering that the main pathogenetic mechanism of AHA in course of lymphoproliferative disorders seems to be an antibody production directly or indirectly mediated by the neoplastic clone, this monoclonal antibody represents an ideal therapeutic approach. In this paper we will briefly describe some biological and clinical features of NHL-patients with AHA. We will then analyze some studies focusing on rituximab in primary AHA, finally reviewing the available literature on the use of this drug in NHL related AHA.

  6. Common variable immunodeficiency unmasked by treatment of immune thrombocytopenic purpura with Rituximab

    DEFF Research Database (Denmark)

    Mogensen, Trine H; Jensen, Jens Magnus Bernth; Petersen, Charlotte C;

    2013-01-01

    BACKGROUND: Hypogammaglobulinemia may be part of several different immunological or malignant conditions, and its origin is not always obvious. Furthermore, although autoimmune cytopenias are known to be associated with common variable immunodeficiency (CVID) and even may precede signs of immunod......BACKGROUND: Hypogammaglobulinemia may be part of several different immunological or malignant conditions, and its origin is not always obvious. Furthermore, although autoimmune cytopenias are known to be associated with common variable immunodeficiency (CVID) and even may precede signs...... of immunodeficiency, this is not always recognized. Despite novel insight into the molecular immunology of common variable immunodeficiency, several areas of uncertainty remain. In addition, the full spectrum of immunological effects of the B cell depleting anti-CD20 antibody Rituximab has not been fully explored....... To our knowledge this is the first report of development of CVID in a patient with normal immunoglobulin prior to Rituximab treatment. CASE PRESENTATION: Here we describe the highly unusual clinical presentation of a 34-year old Caucasian male with treatment refractory immune thrombocytopenic purpura...

  7. A Phase 2 Study of Concurrent Fludarabine and Rituximab for the Treatment of Marginal Zone Lymphomas

    Science.gov (United States)

    Brown, Jennifer R; Friedberg, Jonathan W.; Feng, Yang; Scofield, Sarah; Phillips, Kimberly; Cin, Paola Dal; Joyce, Robin; Takvorian, Ronald W; Fisher, David C; Fisher, Richard I; Liesveld, Jane; Marquis, Diana; Neuberg, Donna; Freedman, Arnold S

    2009-01-01

    SUMMARY The marginal zone lymphomas are a recently defined group of related diseases likely arising from a common cell of origin, the marginal zone B cell. Data on therapy for subtypes other than gastric MALT has been largely limited to retrospective case series. We therefore undertook this prospective phase 2 study of fludarabine and rituximab for the treatment of marginal zone lymphomas. 26 patients were enrolled, 14 with nodal MZL, 8 with MALT lymphomas and 4 with splenic MZL; 81% were receiving initial systemic therapy. Only 58% (95% CI 37–77%) of patients completed the planned six cycles, due to significant hematologic, infectious and allergic toxicity. Four late toxic deaths occurred due to infections (15% (95% CI 4.3–35%), two related to delayed bone marrow aplasia and two related to MDS. Nonetheless, the ORR was 85% (95% CI 65–96%), with 54% CRs. The progression-free survival at 3.1 years of follow-up is 79.5% (95% CI, 63–96%). We conclude that although concurrent fludarabine and rituximab given at this dose and schedule is a highly effective regimen in the treatment of marginal zone lymphomas, the significant hematologic and infectious toxicity observed both during and after therapy is prohibitive in this patient population, emphasizing the need to study marginal zone lymphomas as a separate entity. PMID:19344412

  8. Productividad y eficiencia de uso de nitrógeno y energía en pollos de engorda alimentados con pasta de soya o pasta de canola

    Directory of Open Access Journals (Sweden)

    Sergio Gómez Rosales

    2012-01-01

    Full Text Available Se realizaron dos experimentos de sacrificio para evaluar el crecimiento, contenido y deposición de tejidos y retención de proteína y energía en la carne de la canal en pollos en crecimiento alimentados con pasta de canola (PCAN en sustitución de pasta de soya (PSOY. En el Exp 1, seis pollos machos, de 43 días de edad, se sacrificaron al inicio y 36 pollos fueron asignados a tres dietas con cantidades crecientes de PCAN (0, 10 y 20 % combinadas con dos niveles de lisina digestible (LD: 0.85 y 0.95 %. En el Exp 2, seis hembras y seis machos, de 28 días de edad, se sacrificaron al inicio y 72 pollos fueron asignados, por sexo, a dos dietas (PSOY o PCAN como único ingrediente proteico combinadas con tres niveles de energía (3.0, 3.1 y 3.2 Mcal de EM/kg de alimento. Cada experimento duró dos semanas y al final todos los pollos fueron sacrificados. En el Exp 1, no hubo diferencias estadísticas en la productividad o retención de proteína y energía en la canal entre niveles de PCAN (P>0.05. En el Exp 2, el consumo de alimento, proteína y energía y la deposición de grasa fueron mayores (P<0.05 con PSOY, pero la ganancia de peso, eficiencia alimenticia y retención de proteína y energía en la canal fueron similares entre dietas. Los resultados indican que es factible sustituir parcial o totalmente la pasta de soya por pasta de canola en la dieta de pollos de engorda en crecimiento.

  9. Efficacy of a rituximab regimen based on B cell depletion in thrombotic thrombocytopenic purpura with suboptimal response to standard treatment: Results of a phase II, multicenter noncomparative study.

    Science.gov (United States)

    Benhamou, Ygal; Paintaud, Gilles; Azoulay, Elie; Poullin, Pascale; Galicier, Lionel; Desvignes, Céline; Baudel, Jean-Luc; Peltier, Julie; Mira, Jean-Paul; Pène, Frédéric; Presne, Claire; Saheb, Samir; Deligny, Christophe; Rousseau, Alexandra; Féger, Frédéric; Veyradier, Agnès; Coppo, Paul

    2016-12-01

    The standard four-rituximab infusions treatment in acquired thrombotic thrombocytopenic purpura (TTP) remains empirical. Peripheral B cell depletion is correlated with the decrease in serum concentrations of anti-ADAMTS13 and associated with clinical response. To assess the efficacy of a rituximab regimen based on B cell depletion, 24 TTP patients were enrolled in this prospective multicentre single arm phase II study and then compared to patients from a previous study. Patients with a suboptimal response to a plasma exchange-based regimen received two infusions of rituximab 375 mg m(-2) within 4 days, and a third dose at day +15 of the first infusion if peripheral B cells were still detectable. Primary endpoint was the assessment of the time required to platelet count recovery from the first plasma exchange. Three patients died after the first rituximab administration. In the remaining patients, the B cell-driven treatment hastened remission and ADAMTS13 activity recovery as a result of rapid anti-ADAMTS13 depletion in a similar manner to the standard four-rituximab infusions schedule. The 1-year relapse-free survival was also comparable between both groups. A rituximab regimen based on B cell depletion is feasible and provides comparable results than with the four-rituximab infusions schedule. This regimen could represent a new standard in TTP. This trial was registered at www.clinicaltrials.gov (NCT00907751). Am. J. Hematol. 91:1246-1251, 2016. © 2016 Wiley Periodicals, Inc.

  10. Combining interventions: improved chimney stoves, kitchen sinks and solar disinfection of drinking water and kitchen clothes to improve home hygiene in rural Peru L’association d’interventions - améliorer les cuisinières à bois, mettre en place des éviers, désinfecter l’eau domestique et le linge de cuisine par le solaire – permet d’améliorer l’hygiène dans les foyers ruraux du Pérou Intervenciones combinadas: mejorar las cocinas a leña, instalar fregaderos y desinfectar el agua para beber y los paños de cocina con energía solar para mejorar la higiene en hogares rurales en Perú

    Directory of Open Access Journals (Sweden)

    Ana I. Gil

    2012-05-01

    hygiène à domicile à l’aide de méthodes qualitatives et quantitatives. De nouvelles cuisinières avec ventilation ont permis de réduire la consommation de bois de 16 %. La majorité des participants ont choisi la désinfection solaire de l’eau comme moyen de HWT lors d’un essai à l’aveugle. Des entretiens approfondis sur l’amélioration de l’hygiène ont en outre révélé une forte demande d’éviers. Un an après leur installation, les nouvelles cuisinières et les éviers sont tous utilisés. Le programme d’interventions a été adapté avec succès aux coutumes locales, à la gestion de la cuisine, du foyer et de l’hygiène. Le haut degré de satisfaction des utilisateurs résulte en premier lieu des bénéfices obtenus en termes de commodité dus aux améliorations techniques, et, en second lieu, des bénéfices obtenus en termes de santé.Las intervenciones en los hogares en áreas rurales se recomiendan para luchar contra una variedad de enfermedades. Combinar distintas intervenciones puede tener efectos de sinergia en cuanto a mejorar la salud y la rentabilidad. Sin embargo, es indispensable lograr la aceptación cultural. El objeto de este estudio fue desarrollar un paquete de intervención en el hogar eficaz y culturalmente aceptado para reducir la diarrea y las enfermedades de las vías respiratorias inferiores en niños. En dos comunidades rurales en Perú, se evaluó el rendimiento y la aceptación de dispositivos de cocina, tratamientos de agua doméstica (HWT e intervenciones de higiene del hogar, con métodos cualitativos y cuantitativos. El nuevo diseño de las cocinas reduce el consumo de madera en un 16 %. La mayoría de los participantes eligió la desinfección solar del agua como método de HWT en una cata ciega. Las entrevistas detalladas acerca de las mejoras de la higiene también revelaron una alta demanda de fregaderos. Un año después de ser instaladas, las cocinas mejoradas y los fregaderos estaban todos en uso. El paquete

  11. Effectiveness of two different doses of rituximab for the treatment of rheumatoid arthritis in an international cohort

    DEFF Research Database (Denmark)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny;

    2016-01-01

    BACKGROUND: The approved dose of rituximab (RTX) in rheumatoid arthritis is 1000 mg × 2, but some data have suggested similar clinical efficacy with 500 mg × 2. The purpose of this study was to compare the effectiveness of the regular and low doses given as first treatment course. METHODS: Twelve...

  12. Responsiveness of disease activity indices ESSPRI and ESSDAI in patients with primary Sjogren's syndrome treated with rituximab

    NARCIS (Netherlands)

    Meiners, P. M.; Arends, S.; Brouwer, E.; Spijkervet, F. K. L.; Vissink, A.; Bootsma, H.

    2012-01-01

    Objective To evaluate the responsiveness of the EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI) and EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) in patients with primary Sjogren's syndrome (pSS) treated with rituximab. Methods Twenty-eight patients with pSS treated with rituxima

  13. Rituximab Can Induce Remission in a Patient with Ankylosing Spondylitis Who Failed Anti-TNF-α Agent

    Science.gov (United States)

    AlDhaheri, Fahmi; Almteri, Talal; Dwid, Naji; Majdali, Ahd; Janoudi, Nahed; Almoallim, Hani

    2017-01-01

    Patient: Male, 38 Final Diagnosis: Ankylosing spondylitis Symptoms: Back pain • morning stiffness Medication: — Clinical Procedure: Not applicable Specialty: Rheuamatology Objective: Unusual or unexpected effect of treatment Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease that predominantly affects the axial skeleton. The ability of anti-TNF-α agents to reduce disease activity in patients with axial spondyloarthritis (axSpA), including AS, has been demonstrated in multiple randomized trials and several meta-analyses. Reports on the efficacy of rituximab in treatment of AS have described good results. We report on a patient with AS who failed anti-TNF-α therapy but showed good clinical improvement with rituximab therapy. Case Report: A 38-year-old male patient was diagnosed with AS and showed poor response to sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs). Infliximab was initiated with marked improvement as per the Bath ankylosing spondylitis disease activity index (BASDAI). Due to disease flare, the patient was switched to etanercept. He subsequently acquired papillary thyroid cancer and etanercept was discontinued. He underwent a total thyroidectomy followed by radioiodine therapy. For his ongoing active disease, NSAIDs and sulfasalazine were resumed with a lack of response (BASDAI=7.1). Rituximab was started and resulted in significant improvement (BASDAI=2.3). Conclusions: Rituximab can be a potential target therapy for patients who start to lose response to TNF-inhibitors or for those who develop solid malignancies. Further placebo-controlled studies are required. PMID:28179619

  14. Effects and safety of rituximab in systemic sclerosis : An analysis from the European Scleroderma Trial and Research (EUSTAR) group

    NARCIS (Netherlands)

    Jordan, Suzana; Distler, Jörg H W; Maurer, Britta; Huscher, Dörte; Van Laar, Jacob M.; Allanore, Yannick; Distler, Oliver; Kvien, Tore K.; Airo, Paolo; Sancho, Juan José Alegre; Ananjeva, Lidia; Ancuta, Codrina Michaela; Aringer, Martin; Balbir-Gurman, Alexandra; Cantatore, Francesco Paolo; Caramaschi, Paola; Chatelus, Emmanuel; Codullo, Veronica; Farge-Bancel, Dominique; Foti, Rosario; Gabrielli, Armando; Henes, Jörg; Herrgott, Ilka; Iannone, Florenzo; Ingegnoli, Francesca; Loyo, Esthela; Matucci-Cerinić, Marco; Mohamed, Walid Ahmed Abdel Atty; Müller-Ladner, Ulf; Palm, Øyvind; Popa, Sergiu; Riemekasten, Gabriela; Rednic, Simona; Rosato, Edoardo; Saracco, Marta; Scheja, Agneta; Smith, Vanessa; Mihai, Carina; Szucs, Gabriela; Tomšić, Matija; Valentini, Gabriele; Walker, Ulrich A.; Westhovens, Rene; Yavuz, Sule Kurhan; Zenone, Thierry

    2015-01-01

    Objectives: To assess the effects of Rituximab (RTX) on skin and lung fibrosis in patients with systemic sclerosis (SSc) belonging to the European Scleroderma Trial and Research (EUSTAR) cohort and using a nested case-control design. Methods: Inclusion criteria were fulfilment of American College of

  15. A combination therapy with fludarabine, mitoxantrone and rituximab induces complete immunophenotypical remission in B-cell prolymphocytic leukaemia

    OpenAIRE

    Tempescul, Adrian; Feuerbach, Johanna; Ianotto, Jean-Christophe; Dalbies, Florence; Marion, Veronique; Bris, Marie-Josée; De Braekeleer, Marc; Berthou, Christian

    2008-01-01

    A combination therapy with fludarabine, mitoxantrone and rituximab induces complete immunophenotypical remission in B-cell prolymphocytic leukaemia phone: +33-298-223504 (Tempescul, Adrian) (Tempescul, Adrian) Department of Clinical Hematology, Institute of Cancerology and Hematology - CHU Morvan, Avenue Foch - 29609 - Brest - FRANCE (Tempescul, Adrian) Department of Clinical Hematology, Institute of Cancerology and Hematology - CHU Morvan, Avenue Foch - 2...

  16. Chemokine/cytokine profiling after rituximab: reciprocal expression of BCA-1/CXCL13 and BAFF in childhood OMS.

    Science.gov (United States)

    Pranzatelli, Michael R; Tate, Elizabeth D; Travelstead, Anna L; Verhulst, Steven J

    2011-03-01

    The aim of the study was to test the hypothesis that B-cell repopulation following rituximab (anti-CD20) therapy is orchestrated by chemokines and non-chemokine cytokines. Twenty-five children with opsoclonus-myoclonus syndrome (OMS) received rituximab with or without conventional agents. A comprehensive panel of 40 chemokines and other cytokines were measured in serum by ELISA and multiplexed fluorescent bead-based immunoassay. Serum BAFF concentration changed dramatically (even after first infusion) and inversely with B-cell depletion/repopulation and CXCL13 concentration at 1, 3, and 6 months. Negative correlations were found for BAFF concentration vs blood B cell percentage and serum CXCL13 concentration; positive correlations with serum rituximab concentrations. Six months after initiation of therapy, no significant difference in the levels of APRIL, CXCL10, IL-6, or 17 other cytokines/chemokines were detected. These data reveal a major role for BAFF in peripheral B cell repopulation following rituximab-induced B-cell depletion, and novel changes in CXCL13. ClinicalTrials.gov NCT0024436.

  17. Effects and safety of rituximab in systemic sclerosis : An analysis from the European Scleroderma Trial and Research (EUSTAR) group

    NARCIS (Netherlands)

    Jordan, Suzana; Distler, Jörg H W; Maurer, Britta; Huscher, Dörte; Van Laar, Jacob M.; Allanore, Yannick; Distler, Oliver; Kvien, Tore K.; Airo, Paolo; Sancho, Juan José Alegre; Ananjeva, Lidia; Ancuta, Codrina Michaela; Aringer, Martin; Balbir-Gurman, Alexandra; Cantatore, Francesco Paolo; Caramaschi, Paola; Chatelus, Emmanuel; Codullo, Veronica; Farge-Bancel, Dominique; Foti, Rosario; Gabrielli, Armando; Henes, Jörg; Herrgott, Ilka; Iannone, Florenzo; Ingegnoli, Francesca; Loyo, Esthela; Matucci-Cerinić, Marco; Mohamed, Walid Ahmed Abdel Atty; Müller-Ladner, Ulf; Palm, Øyvind; Popa, Sergiu; Riemekasten, Gabriela; Rednic, Simona; Rosato, Edoardo; Saracco, Marta; Scheja, Agneta; Smith, Vanessa; Mihai, Carina; Szucs, Gabriela; Tomšić, Matija; Valentini, Gabriele; Walker, Ulrich A.; Westhovens, Rene; Yavuz, Sule Kurhan; Zenone, Thierry

    2015-01-01

    Objectives: To assess the effects of Rituximab (RTX) on skin and lung fibrosis in patients with systemic sclerosis (SSc) belonging to the European Scleroderma Trial and Research (EUSTAR) cohort and using a nested case-control design. Methods: Inclusion criteria were fulfilment of American College of

  18. Changes in salivary gland immunohistology and function after rituximab monotherapy in a patient with Sjogren's syndrome and associated MALT lymphoma

    NARCIS (Netherlands)

    Pijpe, J; van Imhoff, GW; Vissink, A; van der Wal, JE; Kluin, PM; Spijkervet, FKL; Kallenberg, CGM; Bootsma, H

    2005-01-01

    Objectives: To report the successful use of rituximab on salivary gland immunohistology and function in a patient with Sjogren's syndrome ( SS) and associated MALT lymphoma. Case report: The patient was a 42 year old woman with primary SS and associated MALT lymphoma located in the parotid gland and

  19. Rearrangements of MYC gene facilitate risk stratification in diffuse large B-cell lymphoma patients treated with rituximab-CHOP

    DEFF Research Database (Denmark)

    Tzankov, Alexandar; Xu-Monette, Zijun Y; Gerhard, Marc;

    2014-01-01

    In order to address the debatable prognostic role of MYC rearrangements in diffuse large B-cell lymphoma patients treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone, we evaluated MYC rearrangements by fluorescence in situ hybridization in 563 cases using br...

  20. Medical resource utilization in dermatomyositis/polymyositis patients treated with repository corticotropin injection, intravenous immunoglobulin, and/or rituximab

    Directory of Open Access Journals (Sweden)

    Knight T

    2017-05-01

    Full Text Available Tyler Knight,1 T Christopher Bond,1 Breanna Popelar,2 Li Wang,3 John W Niewoehner,4 Kathryn Anastassopoulos,1 Michael Philbin4 1Covance Market Access Services Inc., Gaithersburg, MD, 2Xcenda, LLC, Palm Harbor, FL, 3STATinMED Research, Ann Arbor, MI, 4Mallinckrodt, LLC, Hazelwood, MO, USA Background: Dermatomyositis and polymyositis (DM/PM are rare, incurable inflammatory diseases that cause progressive muscle weakness and can be associated with increased medical resource use (MRU. When corticosteroid treatment is unsuccessful, patients may receive intravenous immunoglobulin (IVIg, rituximab, or repository corticotropin injection (RCI. This study compared real-world, non-medication MRU between patients treated with RCI and those treated with IVIg and/or rituximab for DM/PM.Methods: Claims of DM/PM patients were analyzed from the combination of three commercial health insurance databases in the United States from July 2009 to June 2014. Patients treated with RCI were propensity score matched to those treated with IVIg, rituximab, and both (IVIg+rituximab based on demographics, prior clinical characteristics, and prior MRU. Per-patient per-month (PPPM MRU and costs were compared using Poisson regression and generalized linear modeling, respectively.Results: One-hundred thirty-two RCI, 1,150 IVIg, and 562 rituximab patients had an average age of 52.6, 46.6, and 51.7 years, respectively, and roughly two-thirds were female. After matching, there were no significant differences in demographics or prior clinical characteristics. RCI patients had fewer PPPM hospitalizations (0.09 vs 0.17; P=0.049, shorter length of stay (LOS; 3.24 days vs 4.55 days; P=0.004, PPPM hospital outpatient department (HOPD visits (0.60 vs 1.39; P<0.001, and PPPM physician office visits (2.01 vs 2.33; P=0.035 than IVIg. RCI had fewer PPPM HOPD visits (0.56 vs 0.92; P<0.001 than rituximab. Patients treated with RCI had shorter LOS (2.18 days vs 5.15; P<0.001 and less PPPM HOPD

  1. Long-Term Maintenance Therapy Using Rituximab-Induced Continuous B-Cell Depletion in Patients with ANCA Vasculitis

    Science.gov (United States)

    Pendergraft, William F.; Cortazar, Frank B.; Wenger, Julia; Murphy, Andrew P.; Rhee, Eugene P.; Laliberte, Karen A.; Niles, John L.

    2014-01-01

    Background and objectives Remission in the majority of ANCA vasculitis patients is not sustained after a single course of rituximab, and risk of relapse warrants development of a successful strategy to ensure durable remission. Design, setting, participants, & measurements A retrospective analysis of ANCA vasculitis patients who underwent maintenance therapy using rituximab-induced continuous B-cell depletion for up to 7 years was performed. Maintenance therapy with rituximab was initiated after achieving remission or converting from other prior maintenance therapy. Continuous B-cell depletion was achieved in all patients by scheduled rituximab administration every 4 months. Disease activity, serologic parameters, adverse events, and survival were examined. Results In the study, 172 patients (mean age=60 years, 55% women, 57% myeloperoxidase–ANCA) treated from April of 2006 to March of 2013 underwent continuous B-cell depletion with rituximab. Median remission maintenance follow-up time was 2.1 years. Complete remission (Birmingham Vasculitis Activity Score [BVAS]=0) was achieved in all patients. Major relapse (BVAS≥3) occurred in 5% of patients and was associated with weaning of other immunosuppression drugs. Remission was reinduced in all patients. Survival mirrored survival of a general age-, sex-, and ethnicity-matched United States population. Conclusion This analysis provides evidence for long-term disease control using continuous B-cell depletion. This treatment strategy in ANCA vasculitis patients also seems to result in survival rates comparable with rates in a matched reference population. These findings suggest that prospective remission maintenance treatment trials using continuous B-cell depletion are warranted. PMID:24626432

  2. 335. Cirugía de recambio valvular aórtico con prótesis biológica autoexpandible Perceval S. experiencia inicial

    Directory of Open Access Journals (Sweden)

    J. García-Puente

    2012-04-01

    Conclusiones: El desarrollo de nuevas tecnologías, como es la válvula Perceval S en la cirugía de recambio valvular aórtico con/sin cirugía coronaria combinada, ofrece al cirujano nuevas posibilidades para acortar tiempos quirúrgicos buscando una reducción de la morbimortalidad, sin disminuir la seguridad, con unos buenos resultados clínicos y hemodinámicos en pacientes de alto riesgo quirúrgico. Suponen una mejora técnica cuando existe una calcificación valvular aórtica extrema y/o anillos aórticos pequeños.

  3. 300. Cirugía de recambio valvular aórtico con prótesis biológica autoexpandible perceval s. experiencia inicial

    Directory of Open Access Journals (Sweden)

    J. García-Puente

    2012-04-01

    Conclusiones: El desarrollo de nuevas tecnologías, como es la válvula Perceval S en la cirugía de recambio valvular aórtico con/sin cirugía coronaria combinada, ofrece al cirujano nuevas posibilidades para acortar tiempos quirúrgicos buscando una reducción de la morbimortalidad, sin disminuir la seguridad, con unos buenos resultados clínicos y hemodinámicos en pacientes de alto riesgo quirúrgico. Suponen una mejora técnica cuando existe una calcificación valvular aórtica extrema y/o anillos aórticos pequeños.

  4. Valuación de opciones arcoíris sobre canastas de activos bajo procesos de difusión con saltos

    Directory of Open Access Journals (Sweden)

    Adriana Zambrano Reyes

    2016-01-01

    Full Text Available En este trabajo se estudia la valuación de opciones sobre el máximo o el mínimo (precio o rendimiento de 2 activos riesgosos, conocidas como opciones arcoíris. Se extiende la valuación de estos contratos al caso en que los activos presentan difusiones combinadas con saltos. Los parámetros de los procesos de saltos son estocásticos, y específicamente el tama ̃ no del salto sigue una distribución normal, lo cual hace necesario recurrir a los procesos de Lévy. Se desarrolla una metodología numérica con MATLAB para valuar una opción cesta (o canasta de venta, y un put sobre el máximo y en el mínimo de 2 activos riesgosos; los resultados se pueden extender para el caso de n activos.

  5. A multicenter randomized open-label study of rituximab plus rhTPO vs rituximab in corticosteroid-resistant or relapsed ITP.

    Science.gov (United States)

    Zhou, Hai; Xu, Miao; Qin, Ping; Zhang, Hai-yan; Yuan, Cheng-lu; Zhao, Hong-guo; Cui, Zhong-guang; Meng, Yue-sheng; Wang, Lei; Zhou, Fang; Wang, Xin; Li, Da-qi; Bi, Ke-hong; Zhu, Chuan-sheng; Guo, Cheng-shan; Chu, Xiao-xia; Wu, Qing-chao; Liu, Xin-guang; Dong, Xiao-yuan; Li, Jie; Peng, Jun; Hou, Ming

    2015-03-05

    This study aimed to compare the efficacy and safety of rituximab (RTX) plus recombinant human thrombopoietin (rhTPO) with RTX alone in patients with immune thrombocytopenia (ITP) who had failed to respond to corticosteroids or relapsed. Recruited patients were randomized at a ratio of 2:1 into 2 groups: the combination group (RTX + rhTPO, n = 77) and the monotherapy group (RTX, n = 38). Overall response was achieved in 79.2% of patients in the combination group vs 71.1% in the monotherapy group (P = .36), and the complete response (CR) rate was 45.4% in the combination group compared with 23.7% in the monotherapy group (P = .026). The combination group had significantly shorter time to response (TTR; median and range, 7 and 4-28 days) compared with the monotherapy group (28 and 4-90 days) (P rhTPO significantly increased the CR rate and shortened TTR compared with RTX monotherapy in the treatment of corticosteroid-resistant or relapsed ITP but failed to show a beneficial effect on the long-lasting response. This study is registered at www.clinicaltrials.gov as #NCT01525836.

  6. Fcγ-Receptor IIIA Polymorphism p.158F Has No Negative Predictive Impact on Rituximab Therapy with and without Sequential Chemotherapy in CD20-Positive Posttransplant Lymphoproliferative Disorder

    Directory of Open Access Journals (Sweden)

    Heiner Zimmermann

    2014-01-01

    Full Text Available We retrospectively analyzed the p.V158F polymorphism of Fcγ-receptor IIIA (FCGR3A, CD16 in patients with PTLD treated with rituximab monotherapy. Previous reports had indicated that the lower affinity F allele affects rituximab-mediated antibody-dependent cellular cytotoxicity (ADCC and is linked to inferior outcome of rituximab monotherapy in B cell malignancies. 25 patients with PTLD after solid organ transplantation were included in this analysis. They had received 4 weekly doses of rituximab as part of two clinical trials, which had a rituximab monotherapy induction regimen in common. 16/25 patients received further treatment with CHOP-21 after rituximab monotherapy (PTLD-1, NCT01458548. The FCGR3A status was correlated to the response after 4 cycles of rituximab monotherapy. Response to rituximab monotherapy was not affected by F carrier status. This is in contrast to previous findings in B cell malignancies where investigators found a predictive impact of FCGR3A status on outcome to rituximab monotherapy. One explanation for this finding could be that ADCC is impaired in transplant recipients receiving immunosuppression. These results suggest that carrying a FCRG3A F allele does not negatively affect rituximab therapy in immunosuppressed patients.

  7. Resultados do tratamento da ambliopia com levodopa combinada à oclusão Results of amblyopia treatment with levodopa associated with occlusion therapy

    Directory of Open Access Journals (Sweden)

    Edson Procianoy

    2004-10-01

    Full Text Available OBJETIVO: Verificar a melhora da acuidade visual com levodopa/benzerazida combinada à oclusão parcial e seguida por oclusão total, em pacientes com ambliopia considerada irreversível. MÉTODOS: Realizou-se estudo experimental aberto, envolvendo 37 pacientes entre 7 e 40 anos de idade, com ambliopia por estrabismo ou anisometropia, durante 9 semanas. Todos os pacientes foram tratados com levodopa (0,70 mg/kg/dia e benzerazida 25% associada à oclusão de 4 horas/dia do olho dominante por 5 semanas e, nas 4 semanas seguintes foi realizada somente a oclusão total (24 h do olho dominante. A acuidade visual foi medida na tabela do ETDR (Early Treatment Diabetic Retinopathy com escala logMAR (logaritmo do mínimo ângulo de resolução antes de iniciar o tratamento e após 1, 3, 5 e 9 semanas de tratamento. As adesões ao tratamento de oclusão e a ingesta do me-dicamento foram verificadas por meio de questionário e pela contagem das cápsulas. Os efeitos adversos foram avaliados por exame clínico e questionário. RESULTADOS: Após 9 semanas de tratamento, a acuidade visual média melhorou em logMAR de 0,58 ± 0,16 para 0,23 ± 0,16 (melhora de 4 linhas na tabela ETDR. CONCLUSÃO: Levodopa, na dose de 0,70 mg/kg/dia, é bem tolerada e associada à oclusão produz melhora significativa na acuidade visual de pacientes com ambliopia considerada irreversível.PURPOSE: To evaluate visual acuity improvement with levodopa/benzerazide associated with partial occlusion and followed by total occlusion therapy in patients with amblyopia considered irreversible. METHODS: A 9-week experimental open study was performed involving 37 patients, between 7 and 40 years old, with strabismic and/or anisometropic amblyopia. All patients were treated with levodopa (0.70 mg/kg/day and 25% benzerazide associated with 4-hour/day occlusion of the dominant eye for 5 weeks. In the last 4 weeks, only the total occlusion (24 h of the dominant eye was performed. Visual acuity

  8. Arteterapia con personas con discapacidad intelectual

    OpenAIRE

    Lorenzo Pipkau, Milena

    2015-01-01

    Este proyecto pretende hacer una aproximaci??n al mundo del Arte Terapia y los beneficios que esta disciplina puede aportar a las personas con discapacidad intelectual. La idea surge de la experiencia previa de la autora en este ??mbito y con este colectivo. A trav??s de la documentaci??n bibliogr??fica se busca ampliar el conocimiento en cuanto al concepto de arteterapia y sus antecedentes, con la finalidad de elaborar una propuesta pr??ctica que se basar?? en el dise??o de un taller de arte...

  9. The efficacy and safety of rituximab in treatment of Epstein-Barr virus disease post allogeneic hematopoietic stem-cell transplantation

    Institute of Scientific and Technical Information of China (English)

    许兰平

    2013-01-01

    Objective To investigate the efficacy and safety of rituximab on Epstein-Barr virus(EBV) disease post allogeneic hematopoietic stem-cell transplantation. Methods A retrospective analysis was performed based on clinical

  10. Mutational profile and prognostic significance of TP53 in diffuse large B-cell lymphoma patients treated with rituximab-CHOP

    DEFF Research Database (Denmark)

    Xu-Monette, Zijun Y; Wu, Lin; Visco, Carlo

    2012-01-01

    TP53 mutation is an independent marker of poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL) treated with cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (CHOP) therapy. However, its prognostic value in the rituximab immunochemotherapy era remains undefined. ...

  11. B-cell depletion with rituximab in the treatment of autoimmune diseases. Graves' ophthalmopathy the latest addition to an expanding family

    DEFF Research Database (Denmark)

    Nielsen, Claus H; El Fassi, Daniel; Hasselbalch, Hans C;

    2007-01-01

    of 10 Graves' disease patients remained in remission 400 days after rituximab treatment versus none in the control group, and remarkable improvements in the eye symptoms of patients with Graves' ophthalmopathy were observed. This supports a role for B cells in the pathogenesis of Graves' ophthalmopathy......In this review, the authors summarise the clinical results obtained after therapy with rituximab in autoimmune diseases, including Graves' disease and Graves' ophthalmopathy. On the basis of qualitative and quantitative analyses of B- and T-cell subsets, and autoantibody levels obtained in other...... diseases before and after rituximab therapy, the authors interpret the results of the only two clinical investigations of the efficacy of rituximab in the treatment of Graves' disease and Graves' opthalmopathy reported so far. No significant effect on autoantibody levels was observed. Nonetheless, 4 out...

  12. Rituximab induction therapy, survival benefits, and the increasing selection of radiotherapy as the postinduction treatment in patients with primary mediastinal large B-cell lymphoma

    Directory of Open Access Journals (Sweden)

    Sheng-Hsiang Yang

    2015-07-01

    Conclusion: Rituximab improved the CR and OS rates of patients with PMBCL, but these improvements may be attributable to the increased use of radiotherapy (which may have also resulted from FDG-PET evaluation.

  13. The risk of CNS involvement in aggressive lymphomas in the rituximab era.

    Science.gov (United States)

    Benevolo, Giulia; Chiappella, Annalisa; Vitolo, Umberto

    2013-12-01

    The risk of CNS dissemination and CNS prophylaxis strategies in aggressive non-Hodgkin lymphoma (NHL) is still debated. CNS dissemination is a rare but fatal event. A CNS prophylaxis is common for Burkitt and B-cell lymphoblastic lymphoma; however, in other NHLs, prophylactic treatments are not systematically warranted. Current risk models showed low sensitivity in predicting CNS involvement, implying overtreatment in roughly 70% of high-risk patients. Risk models in the rituximab era were modulated for the detection of occult CNS disease at diagnosis using flow cytometry. The optimal regimen for CNS prophylaxis in aggressive lymphoma patients has not been established thus far and should be modulated at different levels of 'intensity' such as standard intrathecal chemotherapy, 'active' intrathecal chemotherapy with liposomal cytarabine or more aggressive systemic treatment with high doses of drugs having good CNS bioavailability reserved for patients who are truly at high risk of CNS dissemination.

  14. Childhood immune thrombocytopenia: role of rituximab, recombinant thrombopoietin, and other new therapeutics.

    Science.gov (United States)

    Journeycake, Janna M

    2012-01-01

    Childhood immune thrombocytopenia (ITP) is often considered a benign hematologic disorder. However, 30% of affected children will have a prolonged course and 5%-10% will develop chronic severe refractory disease. Until recently, the only proven therapeutic option for chronic severe ITP was splenectomy, but newer alternatives are now being studied. However, because immunosuppressive agents such as rituximab are not approved for use in ITP and the thrombopoietin receptor agonists are not yet approved in children, the decision to use alternatives to splenectomy needs to be considered carefully. This review describes the factors that should affect decisions to treat ITP at diagnosis and compares the options for the occasional child in whom ITP does not resolve within the first year.

  15. [C-ANCA positive necrotising scleritis and multiple sclerosis compatible with ocular Wegener: treatment with rituximab].

    Science.gov (United States)

    Aldasoro-Cáceres, V; Aldasoro-Cáceres, I; Pérez-Moreiras, J V; Murié-Fernández, M; Ibáñez-Bosch, R

    2014-01-01

    A patient diagnosed with necrotizing scleritis, c-ANCA+ an orbital pseudotumour, and possible multiple sclerosis in 2003 was treated with oral cyclophosphamide and steroids with partial response. Between 2005-2010 she suffered self-limited episodes. In 2010 a first scleral transplant was performed with poor outcome. She was treated with rituximab, and a second graft was performed with good results. At 12 months there was no change in magnetic resonance and the second graft healed. Wegener's disease with limited involvement of the orbit and/or the eye is a rare condition. The histopathology, blood analysis, symptoms and good response to treatment are the key to its diagnosis. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  16. Fatal Cytomegalovirus Disease after Combination Therapy with Corticosteroids and Rituximab for Granulomatosis with Polyangiitis

    Directory of Open Access Journals (Sweden)

    Talal Hilal

    2015-01-01

    Full Text Available The association of cytomegalovirus (CMV with autoimmune disease is poorly understood with suggested causality and reported viral reactivation coinciding with active inflammation. We report a case of a patient who presented with diffuse alveolar hemorrhage and acute renal failure from rapidly progressive glomerulonephritis ultimately diagnosed with granulomatosis with polyangiitis (GPA. She was acutely managed with plasmapheresis to reduce antibody-mediated end-organ damage, hemodialysis for worsening hyperkalemia and acidosis, and high-dose intravenous methylprednisolone. She was transitioned to oral prednisone and started on weekly rituximab with resultant remission induction over a three-week period at which point she developed reactivation of CMV causing severe fatal lung disease and viremia. The case highlights the multiple factors associated with CMV reactivation in cases of severe systemic inflammatory states and the need for further research to help establish practice guidelines regarding antimicrobial prophylaxis in patients with autoimmune diseases on prolonged courses of corticosteroids and biologic agents.

  17. Complicações rinossinusais após descompressão orbital em técnica externa e endonasal combinada Sinus complications after orbital decompression by combined external and endonasal technique

    Directory of Open Access Journals (Sweden)

    Rogério Pezato

    2004-06-01

    Full Text Available Muitas técnicas de descompressão orbital têm sido utilizadas no tratamento da oftalmopatia por Graves. Recentemente, introduziu-se a cirurgia endoscópica endonasal na descompressão de órbita, como técnica isolada ou combinada com as já existentes, acreditando proporcionar melhor visão da parede medial da órbita e menor incidência de infecção bacteriana quando a parede medial é acessada por endoscópio. OBJETIVO: Avaliar as complicações após a descompressão orbital por técnica combinada assistida por endoscopia na prevenção de infecção rinossinusal. FORMA DE ESTUDO: Clínico Prospectivo. MATERIAL E MÉTODO: 16 pacientes 18 órbitas foram submetidos à descompressão orbital no Setor de Órbita do Departamento de Oftalmologia da Escola Paulista de Medicina UNIFESP. RESULTADOS: Quatro pacientes, durante o acompanhamento por tomografia no pós-operatório, apresentaram velamento do seio maxilar ou frontal, sem sintomatologia. CONCLUSÃO: A descompressão orbital por via externa combinada com a via endonasal auxiliada por endoscopia mostrou-se eficaz na prevenção de sinusite clinicamente manifesta e suas complicações, embora no acompanhamento tomográfico 22% dos pacientes apresentaram velamento do seio maxilar ou frontal.Many techniques of orbital decompression have been used in the treatment of Graves ophthalmopathy. Recently endonasal endoscope surgery was introduced in the orbital decompression, as an isolated technique, or combined with existing techniques hopefully to give better visualization of medial wall and a lower incidence infection when the medial wall is acessed. AIM: To evaluate orbital decompression combined with endoscope in prevention of bacterial infection, we relate three cases of assyntomatic patients with computer tomography control of facial sinus presenting opacification of maxillary or frontal sinus. STUDY DESIGN: Clinical Prospective. MATERIAL AND METHOD: 16 patients with 18 orbita procedures

  18. Efeitos da terapia combinada com ácido zoledrônico e propranolol na resistência mecânica em um modelo de rato com osteoporose por desuso

    Directory of Open Access Journals (Sweden)

    Deepak Kumar Khajuria

    2015-12-01

    Full Text Available Resumo Objetivos: Investigar os efeitos aditivos do agente antirreabsorção ácido zoledrônico (ZOL, isolado e em combinação ao propranolol (PRO, em um modelo de rato com osteoporose por desuso. Métodos: Usou-se um modelo de pata traseira direita de rato privada de descarga de peso para estudar as consequências da falta de descarga de peso sobre o esqueleto durante várias condições, como missões espaciais e repouso prolongado no leito em idosos. Ratos Wistar machos de três meses de idade foram submetidos à imobilização da pata traseira direita (IPTD por 10 semanas para induzir à osteopenia; em seguida, foram divididos aleatoriamente em quatro grupos: 1 – IPTD para controle positivo; 2 – IPTD mais ZOL (50 μg/kg, dose única intravenosa; 3 – IPTD mais PRO (0,1 mg/kg, via subcutânea, cinco dias na semana; 4 – IPTD mais PRO (0,1 mg/kg, via subcutânea, cinco dias na semana mais ZOL (50 μg/kg, dose única intravenosa por outras 10 semanas. Um grupo de ratos não imobilizados foi usado como controle negativo. No fim do tratamento, os fêmures foram removidos e testaram-se a porosidade do osso e suas propriedades mecânicas, além do peso seco e das cinzas do osso. Resultados: No que diz respeito à melhoria da resistência mecânica da diáfise femoral média, a terapia combinada com ZOL mais PRO foi mais eficaz do que a monoterapia com ZOL ou PRO. Além disso, a terapia combinada com ZOL mais PRO foi mais eficaz na melhoria do peso seco do osso e preservou melhor a porosidade do osso cortical do que a monoterapia com ZOL ou PRO em ratos submetidos à imobilização da pata traseira direita. Conclusões: Esses dados sugerem que a terapia combinada com ZOL mais PRO deve ser recomendada para o tratamento da osteoporose por desuso.

  19. Effective treatment with rituximab for the maintenance of remission in frequently relapsing minimal change disease

    Science.gov (United States)

    Shendi, Ali M.; Salama, Alan D.; Khosravi, Maryam; Connolly, John O.; Trompeter, Richard

    2016-01-01

    Abstract Aim Treatment of frequently relapsing or steroid‐dependent minimal change disease (MCD) in children and adults remains challenging. Glucocorticoids and/or other immunosuppressive agents are the mainstay of treatment, but patients often experience toxicity from prolonged exposure and may either become treatment dependent and/or resistant. Increasing evidence suggests that rituximab (RTX) can be a useful alternative to standard immunosuppression and allow withdrawal of maintenance immunosuppressants; however, data on optimal treatment regimens, long‐term efficacy and safety are still limited. Methods We undertook a prospective study of RTX to allow immunosuppression minimization in 15 young adults with frequently relapsing or steroid‐dependent, biopsy‐proven MCD. All patients were in remission at the start of treatment and on a calcineurin inhibitor. Two doses of RTX (1 gr) were given 6 months apart. A subset of patients also received an additional dose 12 months later, in order to examine the benefit of re‐treatment. Biochemical and clinical parameters were monitored over an extended follow‐up period of up to 43 months. Results Median steroid‐free survival after RTX was 25 months (range 4–34). Mean relapse frequency decreased from 2.60 ± 0.28 to 0.4 ± 0.19 (P < 0.001) after RTX. Seven relapses occurred, five of which (71%) when CD19 counts were greater than 100 µ. Immunoglobulin levels remained unchanged, and no major side effects were observed throughout the follow‐up period. Conclusions Rituximab therapy is effective at maintaining prolonged steroid‐free remission and reducing relapse frequency in this group of patients. Our study lends further support for the role of RTX in the treatment of patients with frequently relapsing or steroid‐dependent MCD. PMID:26860320

  20. Endogenous neurotrophins and Trk signaling in diffuse large B cell lymphoma cell lines are involved in sensitivity to rituximab-induced apoptosis.

    Directory of Open Access Journals (Sweden)

    Cynthia Bellanger

    Full Text Available BACKGROUND: Diffuse large B-cell lymphoma (DLBCL is a common and often fatal malignancy. Immunochemotherapy, a combination of rituximab to standard chemotherapy, has resulted in improved survival. However a substantial proportion of patients still fail to reach sustained remission. We have previously demonstrated that autocrine brain-derived neurotrophic factor (BDNF production plays a function in human B cell survival, at least partly via sortilin expression. As neurotrophin receptor (Trks signaling involved activation of survival pathways that are inhibited by rituximab, we speculated that neurotrophins may provide additional support for tumour cell survival and therapeutic resistance in DLBCL. METHODOLOGY/PRINCIPAL FINDINGS: In the present study, we used two DLBCL cell lines, SUDHL4 and SUDHL6, known to be respectively less and more sensitive to rituximab. We found by RT-PCR, western blotting, cytometry and confocal microscopy that both cell lines expressed, in normal culture conditions, BDNF and to a lesser extent NGF, as well as truncated TrkB and p75(NTR/sortilin death neurotrophin receptors. Furthermore, BDNF secretion was detected in cell supernatants. NGF and BDNF production and Trk receptor expression, including TrkA, are regulated by apoptotic conditions (serum deprivation or rituximab exposure. Indeed, we show for the first time that rituximab exposure of DLBCL cell lines induces NGF secretion and that differences in rituximab sensitivity are associated with differential expression patterns of neurotrophins and their receptors (TrkA. Finally, these cells are sensitive to the Trk-inhibitor, K252a, as shown by the induction of apoptosis. Furthermore, K252a exhibits additive cytotoxic effects with rituximab. CONCLUSIONS/SIGNIFICANCE: Collectively, these data strongly suggest that a neurotrophin axis, such NGF/TrkA pathway, may contribute to malignant cell survival and rituximab resistance in DLBCL.

  1. Preclinical activity of the type II CD20 antibody GA101 (obinutuzumab) compared with rituximab and ofatumumab in vitro and in xenograft models.

    Science.gov (United States)

    Herter, Sylvia; Herting, Frank; Mundigl, Olaf; Waldhauer, Inja; Weinzierl, Tina; Fauti, Tanja; Muth, Gunter; Ziegler-Landesberger, Doris; Van Puijenbroek, Erwin; Lang, Sabine; Duong, Minh Ngoc; Reslan, Lina; Gerdes, Christian A; Friess, Thomas; Baer, Ute; Burtscher, Helmut; Weidner, Michael; Dumontet, Charles; Umana, Pablo; Niederfellner, Gerhard; Bacac, Marina; Klein, Christian

    2013-10-01

    We report the first preclinical in vitro and in vivo comparison of GA101 (obinutuzumab), a novel glycoengineered type II CD20 monoclonal antibody, with rituximab and ofatumumab, the two currently approved type I CD20 antibodies. The three antibodies were compared in assays measuring direct cell death (AnnexinV/PI staining and time-lapse microscopy), complement-dependent cytotoxicity (CDC), antibody-dependent cell-mediated cytotoxicity (ADCC), antibody-dependent cell-mediated phagocytosis (ADCP), and internalization. The models used for the comparison of their activity in vivo were SU-DHL4 and RL xenografts. GA101 was found to be superior to rituximab and ofatumumab in the induction of direct cell death (independent of mechanical manipulation required for cell aggregate disruption formed by antibody treatment), whereas it was 10 to 1,000 times less potent in mediating CDC. GA101 showed superior activity to rituximab and ofatumumab in ADCC and whole-blood B-cell depletion assays, and was comparable with these two in ADCP. GA101 also showed slower internalization rate upon binding to CD20 than rituximab and ofatumumab. In vivo, GA101 induced a strong antitumor effect, including complete tumor remission in the SU-DHL4 model and overall superior efficacy compared with both rituximab and ofatumumab. When rituximab-pretreated animals were used, second-line treatment with GA101 was still able to control tumor progression, whereas tumors escaped rituximab treatment. Taken together, the preclinical data show that the glyoengineered type II CD20 antibody GA101 is differentiated from the two approved type I CD20 antibodies rituximab and ofatumumab by its overall preclinical activity, further supporting its clinical investigation.

  2. Overcoming rituximab drug-resistance by the genetically engineered anti-CD20-hIFN-α fusion protein: Direct cytotoxicity and synergy with chemotherapy

    Science.gov (United States)

    VEGA, GABRIEL G.; FRANCO-CEA, LUZ ARELI; HUERTA-YEPEZ, SARA; MAYANI, HÉCTOR; MORRISON, SHERIE L.; BONAVIDA, BENJAMIN; VEGA, MARIO I.

    2015-01-01

    Treatment of patients with B-NHL with rituximab and CHOP has resulted in significant clinical responses. However, a subset of patients develops resistance to further treatments. The mechanism of unresponsiveness in vivo is not known. We have reported the development of rituximab-resistant clones derived from B-NHL cell lines as models to investigate the mechanism of resistance. The resistant clones exhibit hyper-activated survival/anti-apoptotic pathways and no longer respond to a combination of rituximab and drugs. Recent studies reported the therapeutic efficacy in mice bearing B-cell lymphoma xenografts following treatment with the anti-CD20-hIFNα fusion protein. We hypothesized that the fusion protein may bypass rituximab resistance and inhibit survival signaling pathways. Treatment of the rituximab-resistant clones with anti-CD20-hIFNα, but not with rituximab, IFNα, or rituximab+IFNα resulted in significant inhibition of cell proliferation and induction of cell death. Treatment with anti-CD20-hIFNα sensitized the cells to apoptosis by CDDP, doxorubicin and Treanda. Treatment with anti-CD20-hIFNα inhibited the NF-κB and p38 MAPK activities and induced the activation of PKC-δ and Stat-1. These effects were corroborated by the use of the inhibitors SB203580 (p38 MAPK) and Rottlerin (PKC-δ). Treatment with SB203580 enhanced the sensitization of the resistant clone by anti-CD20-hIFNα to CDDP apoptosis. In contrast, treatment with Rotterin inhibited significantly the sensitization induced by anti-CD20-hIFNα. Overall, the findings demonstrate that treatment with anti-CD20-hIFNα reverses resistance of B-NHL. These findings suggest the potential application of anti-CD20-hIFNα in combination with drugs in patients unresponsive to rituximab-containing regimens. PMID:26398317

  3. [Efficacy and safety of rituximab in the treatment of primary antiphospholipid syndrome: analysis of 24 cases from the bibliography review].

    Science.gov (United States)

    Pons, Isaac; Espinosa, Gerard; Cervera, Ricard

    2015-02-02

    Antiphospholipid syndrome (APS) is characterized by the presence of antiphospholipid antibodies (aPL) and thrombotic and/or obstetric manifestations. Patients without another associated autoimmune disease are considered to have primary APS. Some patients develop thrombosis recurrence despite anticoagulant treatment and some clinical features do not respond to standard therapy. Rituximab may be an alternative in these cases. We review the published scientific evidence on the use of rituximab in the treatment of primary APS. Description of a case and review of the literature with descriptive analysis of the demographic, clinical, and immunologic features, treatment and outcome of patients. We identified 24 patients (15 women [62.5%]), with a mean age of 37.0 ± 13.4 years. The reasons for the use of rituximab were thrombocytopenia (41.7%), skin involvement (33.3%), neurologic and heart valve involvement (12.5%), hemolytic anemia (8.3%) and pulmonary and renal involvement (4.2%). Lupus anticoagulant was present in 72.7% of the cases, the IgG and IgM isotypes of anticardiolipin antibodies in 75 and 50%, respectively, and the anti-β2GPI (IgG e IgM) antibodies in 80% of patients. Thirteen (54.1%) patients received 2 doses of 1,000 mg of rituximab fortnightly, 10 (41.7%) 4 doses of 375 mg/m(2) weekly and one (4.2%) 8 doses of 375 mg/m(2) weekly. Eleven (45.8%) patients presented a complete clinical response, 7 (29.2%) a partial response and 6 (25%) did not respond to rituximab. Four patients with clinical improvement presented with aPL titer decrease and in one patient, aPL levels did not change. In one patient without clinical response, aPL remained positive. A clinical-immunologic dissociation existed in 2 additional cases. The results obtained suggest a possible potential benefit of rituximab in the treatment of some clinical manifestations of primary APS such as thrombocytopenia, skin and heart valve involvement. Copyright © 2013 Elsevier España, S.L.U. All rights

  4. Comparação a longo prazo entre a facectomia extracapsular combinada à trabeculectomia e à facotrabeculectomia Longterm comparison between extracapsular cataract extraction combined with trabeculectomy and combined phacofiltration surgery

    Directory of Open Access Journals (Sweden)

    Carmo Mandia Jr.

    2002-12-01

    Full Text Available Objetivo: Comparar os resultados a longo prazo entre a cirurgia extracapsular da catarata combinada à trabeculectomia (FEC/TREC e a facotrabeculectomia (FACO/TREC. Métodos: Os prontuários de 46 pacientes (53 olhos submetidos à cirurgia combinada na Santa Casa de São Paulo entre janeiro de 1996 e novembro de 1999 foram revisados; dados relativos à pressão ocular (PO, acuidade visual (AV e número de medicações foram analisados. Resultados: Em ambos os grupos, após seguimento médio de 18 meses, a acuidade visual melhorou e a pressão ocular diminuiu em relação aos valores pré-operatórios (PPurpose: To compare the safety and efficacy of extracapsular cataract extraction (ECCE combined with trabeculectomy and combined phacoemulsification/trabeculectomy. Methods: The records of 46 patients (53 eyes who underwent combined glaucoma and cataract surgery at the Santa Casa de São Paulo between January 1996 and November 1999 were reviewed. Results: After a mean follow-up of 18 months, visual acuity improved and intraocular pressure decreased in both groups after surgery (P<0.05. In the phacofiltration group 55.5% of eyes achieved intraocular pressure < 22 mmHg without medication as compared to 46.1% in the extracapsular cataract extraction/trabeculectomy group (P=0.3. Conclusion: Both techniques proved to be safe and efficacious in the treatment of glaucoma and cataract. However, the phacofiltration surgery seems to promote lower intraocular pressure without additional medication in a larger number of eyes.

  5. In vitro therapy study combined with low doses of radiation (Rn-222) and chemotherapy (taxol); Estudio in vitro de terapia combinada con bajas dosis de radiacion (Rn-222) y quimioterapia (taxol)

    Energy Technology Data Exchange (ETDEWEB)

    Soto, J.; Sainz, C.; Cos, S.; Gonzalez-Lamuno, D. [Universidad de Cantabria, Santander (Spain). Facultad de Medicina

    2004-07-01

    A study was carried out to test the possibility that breast cancer cells show increased sensitivity to the chemotherapeutic agent taxol when they have been treated with low radiation doses from the gas radon. To this end, the cells were cultivated in a medium containing dissolved radon and then in a second medium containing a concentration of taxol. After the culture phase the surviving cells were counted and their viability was assessed. The results obtained indicate that the cells treated with low doses of radon exhibit increased sensitivity when treated with certain concentrations of taxol; in particular a lower survival rate and lower viability were observed in cells treated with radon and 50 nM of taxol in cells treated with the same concentration of taxol alone. These effects seem to result from the influence of the radon on the expression of apoptosis -related genes, which is complementary to the action of taxol on bcl-x related genes. (author)

  6. “Eficacia y seguridad clínica de Ebastina 20mg y Ebastina 10mg contra Loratadina 10mg solas o combinadas en pacientes con Rinitis Alérgica Persistente”

    OpenAIRE

    2012-01-01

    Introducción: Las enfermedades alérgicas como la rinitis y el asma son un problema de salud importante, estas enfermedades ocupan los primeros lugares de atención médica y hospitalización entre las enfermedades crónicas de los niños y adolescentes, esto incrementa los costos, el ausentismo escolar-laboral y suelen tener otras repercusiones sociales negativas. La nariz constituye la parte superior del aparato respiratorio y es la que establece un contacto inicial y más directo c...

  7. Action mechanisms of antineoplastics of new synthesis and their possible use in therapy combined with radiation; Mecanismos de accion de antineoplasicos de nueva sintesis y su posible uso en terapia combinada con radiacion

    Energy Technology Data Exchange (ETDEWEB)

    Brena V, M.; Serment G, J. [ININ, Departamento de Biologia, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico); Ruiz A, L., E-mail: jorge.serment@inin.gob.m [UNAM, Facultad de Quimica, Departamento de Quimica Inorganica y Nuclear, Ciudad Universitaria, 04510 Mexico D. F. (Mexico)

    2010-07-01

    In this work is described one research line of the Molecular Biology Laboratory of the Biology Department of the Instituto Nacional de Investigaciones Nucleares (ININ), in which microorganisms or human cells cultivations are used as model to study the effect of a compounds group of new synthesis that it will be use in the treatment against the cancer, as well as the possible synergism of these pharmaceuticals with the ionizing radiation. The results show that, without to reach discarding other cellular structures, an important target for these substances in the DNA, and to this respect other hypothesis are exposed to explain some possible mechanisms of its action. Also, the preliminary data are presented as for the additive effect with the gamma radiation of two of the compounds that are candidates for their next clinical application. This research is part of a project in collaboration with the Chemistry Faculty of the UNAM. (Author)

  8. Hepatitis C-Induced Hepatitis Flare in a Patient with Non-Hodgkin B-Cell Lymphoma Treated by Rituximab Including Chemotherapy (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin - Vincristine, Prednisolone Regimen

    Directory of Open Access Journals (Sweden)

    Asim Ulcay

    2014-06-01

    Full Text Available Hepatitis virus infections can lead to more critical outcomes such as severe hepatic dysfunction, failure and fulminancy in immunosuppressive patients compared to immunocompetent individuals. It is globally accepted that reactivation of both Hepatitis B virus [HBV ] and Hepatitis C virus [HCV] occurs after chemotherapy and antibody treatments of malignant diseases or solid organ/ bone marrow transplant in recipient patients. Especially among B-cell Non Hodgkin Lymphoma [NHL] patients, according to various studies, the seroprevelance of HCV is higher than that of the general population. On the other hand the role of HCV in the pathogenesis and etiology of NHL has been suggested. Today, cytotoxic drugs, corticosteroids, rituximab and hepatotoxic regimens are administered to NHL patients. Specifically, it has been emphasized that the utilization of rituximab [Anti CD20 antibody ] regiments for B-cell NHL patients may result with flares in HCV patients conspicuously. Here, we report the case of an acute flare up due to HCV infection in a patient who underwent a 4 month course of rituximab containing chemotherapy against a B cell NHL [CD20+ ] disease and a dramatic recovery from HCV infection at the end. [Dis Mol Med 2014; 2(3.000: 51-54

  9. The CXCR4 antagonist plerixafor enhances the effect of rituximab in diffuse large B-cell lymphoma cell lines

    DEFF Research Database (Denmark)

    Reinholdt, Linn; Laursen, Maria Bach; Schmitz, Alexander;

    2016-01-01

    . Accordingly, the fraction of apoptotic/dead cells significantly increased following addition of plerixafor to rituximab treatment. Furthermore, exposure of DLBCL cells to plerixafor resulted in a significant decrease in CXCR4 fluorescence intensity. CONCLUSIONS: Based on our results, implying that the anti......BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease with variable clinical outcome, accounting for at least 25-30 % of adult non-Hodgkin lymphomas. Approximately one third of DLBCL patients are not cured by the currently used treatment regimen, R-CHOP. Hence, new treatment......-proliferative/pro-apoptotic effect of rituximab on DLBCL cells can be synergistically enhanced by the CXCR4 antagonist plerixafor, addition of plerixafor to the R-CHOP regimen can be suggested to improve treatment outcome for DLBCL patients....

  10. Refractory heparin induced thrombocytopenia with thrombosis (HITT) treated with therapeutic plasma exchange and rituximab as adjuvant therapy.

    Science.gov (United States)

    Schell, Amy M; Petras, Melissa; Szczepiorkowski, Zbigniew M; Ornstein, Deborah L

    2013-10-01

    We report a case of refractory heparin-induced thrombocytopenia with thrombosis (HITT) with prolonged thrombocytopenia and multiple thrombotic complications that failed to improve despite aggressive treatment. A 60 year old female with a prior history of venous thromboembolism was admitted with an acute pulmonary embolism, and developed HITT after several days on heparin therapy. She suffered multiple complications including bilateral venous limb gangrene, acute renal failure, and refractory thrombocytopenia, leading us to use multimodality therapy including therapeutic plasma exchange (TPE) and rituximab immunosuppression. The patient had transient improvements in her thrombocytopenia with TPE, and rituximab was added in an attempt to reduce antibody production. She eventually required bilateral limb amputation, and only after removal of the gangrenous limbs did her platelet count show sustained improvement. We discuss the possible contribution of infection to her prolonged course.

  11. Unexpected and persistent depletion of B lymphocytes CD20 following a minimum dose of anti-CD20 antibody (Rituximab

    Directory of Open Access Journals (Sweden)

    V. Bruzzese

    2011-06-01

    Full Text Available Rituximab is a chemeric murine/human anti-B lymphocyte antigen CD20 monoclonal antibody used in the treatment of rheumatoid arthritis resistant to treatment by one or more anti TNF-alpha therapies (1. The recommended dose for an efficient depletion of the B CD 20 lymphocytes in rheumatoid arthritis is two infusions of 1000 mg, with the second infusion being administered two weeks after the first. At this dose, one obtains a rapid and persistent depletion of CD 20 cells, with repopulation occurring, on the average, in about eight months (2. Here, we present a case of a woman treated with only 50 mg of rituximab, who underwent both a rapid and pronounced reduction of B CD 20 lymphocytes...

  12. Fludarabine, cyclophosphamide and rituximab plus granulocyte macrophage colony-stimulating factor as frontline treatment for patients with chronic lymphocytic leukemia.

    Science.gov (United States)

    Strati, Paolo; Ferrajoli, Alessandra; Lerner, Susan; O'Brien, Susan; Wierda, William; Keating, Michael J; Faderl, Stefan

    2014-04-01

    Fludarabine, cyclophosphamide and rituximab (FCR), the standard of care for the frontline treatment of patients with chronic lymphocytic leukemia (CLL), is associated with a high rate of neutropenia and infectious complications. Granulocyte macrophage colony-stimulating factor (GM-CSF) reduces myelosuppression and can potentiate rituximab activity. We conducted a clinical trial combining GM-CSF with FCR for frontline treatment of 60 patients with CLL. Eighty-six percent completed all six courses and 18% discontinued GM-CSF for toxicity: grade 3-4 neutropenia was observed in 30% of cycles, and severe infections in 16% of cases. The overall response rate was 100%. Both median event-free survival (EFS) and overall survival (OS) have not been reached. Longer EFS was associated with favorable cytogenetics. GM-CSF led to a lower frequency of infectious complications than in the historical FCR group, albeit similar EFS and OS.

  13. Rituximab-associated progressive multifocal leukoencephalopathy derived from non-Hodgkin lymphoma: neuropathological findings and results of mefloquine treatment.

    Science.gov (United States)

    Sano, Yasuteru; Nakano, Yuta; Omoto, Masatoshi; Takao, Masaki; Ikeda, Eiji; Oga, Atsunori; Nakamichi, Kazuo; Saijo, Masayuki; Maoka, Takashi; Sano, Hironori; Kawai, Motoharu; Kanda, Takashi

    2015-01-01

    A 66-year-old man with non-Hodgkin lymphoma (NHL) developed progressive multifocal leukoencephalopathy (PML) after undergoing chemotherapy including rituximab. Although the administration of mefloquine at a dose of 500 mg weekly temporarily led to a dramatic decrease in the copy number of JC Virus DNA in the cerebrospinal fluid, the patient's symptoms gradually worsened. The CD4(+) T count remained continuously low, at least until approximately five months after the last cycle of chemotherapy. A postmortem examination performed 10 months after the onset of PML disclosed a severe condition associated with rituximab-treated PML originating from NHL and a high mefloquine concentration in the brain. The accumulation of further data regarding mefloquine treatment in PML cases may help to elucidate the optimal dosage and time window for effectively treating PML.

  14. One year follow-up of children and adolescents with chronic immune thrombocytopenic purpura (ITP) treated with rituximab.

    Science.gov (United States)

    Mueller, Brigitta U; Bennett, Carolyn M; Feldman, Henry A; Bussel, James B; Abshire, Thomas C; Moore, Theodore B; Sawaf, Hadi; Loh, Mignon L; Rogers, Zora R; Glader, Bertil E; McCarthy, Maggie C; Mahoney, Donald H; Olson, Thomas A; Feig, Stephen A; Lorenzana, Adonis N; Mentzer, William C; Buchanan, George R; Neufeld, Ellis J

    2009-02-01

    We previously showed in a prospective study that rituximab appears to be effective in some children and adolescents with severe chronic immune thrombocytopenia. Eleven of 36 patients achieved and maintained platelet counts over 50,000/mm(3) within the first 12 weeks. These patients were followed for the next year. Platelet counts were monitored monthly and all subsequent bleeding manifestations and need for further treatment was noted. Eight of the 11 initial responders maintained a platelet count over 150,000/mm(3) without further treatment intervention. Three patients had a late relapse. One initial non-responder achieved a remission after 16 weeks, and two additional patients maintained platelet counts around 50,000/mm(3) without the need for further intervention. Rituximab resulted in sustained efficacy with platelet counts of 50,000/mm(3) or higher in 11 of 36 patients (31%). (c) 2008 Wiley-Liss, Inc.

  15. Progressive Multifocal Leukoencephalopathy in a HIV-Negative Patient with Small Lymphocytic Leukemia following Treatment with Rituximab

    Directory of Open Access Journals (Sweden)

    Subhankar Chakraborty

    2011-03-01

    Full Text Available We describe a case of progressive multifocal leukoencephalopathy (PML caused by infection with the human polyomavirus JC virus in a patient with B-cell small lymphocytic leukemia who was treated with rituximab. The first symptoms of PML appeared immediately following the last of five cycles of rituximab, cyclophosphamide and pentostatin. Magnetic resonance imaging revealed changes consistent with PML, although JC virus DNA was not detected by polymerase chain reaction assay of the cerebrospinal fluid. A stereotactic biopsy of the brain showed histological changes consistent with PML, while electron microscopy revealed JC virus particles attached to the nuclei of astrocytes. The patient was treated supportively but died 53 days after the initial onset of symptoms.

  16. An update on the evidence for the efficacy and safety of rituximab in the management of neuromyelitis optica

    Science.gov (United States)

    Collongues, Nicolas; de Seze, Jérôme

    2016-01-01

    Neuromyelitis optica spectrum disorders (NMOSDs) is a new concept which includes classical neuromyelitis optica (NMO) and partial forms of NMO such as recurrent optic neuritis with positive aquaporin-4 antibodies (AQP4) or brainstem symptoms (intractable hiccups or vomiting). This disease is clearly distinguished from multiple sclerosis (MS) and the therapeutic approach is clearly different. Rituximab is actually considered to be one of the most efficient treatments of NMOSD, even if class I studies are clearly lacking. In the present review, we describe the state of the art about rituximab treatment in NMOSD, including adults and children, plus its efficacy and tolerance and we also underline the questions that should be addressed in the near future. PMID:27134673

  17. Severe infection in patients with rheumatoid arthritis taking anakinra, rituximab, or abatacept: a systematic review of observational studies

    Directory of Open Access Journals (Sweden)

    Vanderlea Poeys Cabral

    Full Text Available ABSTRACT A question is raised about an increased risk of severe infection from the use of biological drugs in patients with rheumatoid arthritis. This systematic review of observational studies aimed at assessing the risk of severe infection associated with the use of anakinra, rituximab, and abatacept in patients with rheumatoid arthritis. The following databases were searched: PubMed, Science Direct, Scopus, Web of Knowledge, Scirus, Cochrane, Exerpta Medica Database, Scielo, and Lilacs up to July 2010. Severe infections were defined as those life-threatening ones in need of the use of parenteral antibiotics or of hospitalization. Longitudinal observational studies were selected without language restriction, involving adult patients diagnosed with rheumatoid arthritis and who used anakinra, rituximab, or abatacept. In four studies related to anakinra, 129 (5.1% severe infections were related in 2896 patients, of which three died. With respect to rituximab, two studies reported 72 (5.9% severe infections in 1224 patients, of which two died. Abatacept was evaluated in only one study in which 25 (2.4% severe infections were reported in 1046 patients. The main site of infection for these three drugs was the respiratory tract. One possible explanation for the high frequency of severe infections associated with anakinra may be the longer follow-up time in the selected studies. The high frequency of severe infections associated with rituximab could be credited to the less strict inclusion criteria for the patients studied. Therefore, infection monitoring should be cautious in patients with rheumatoid arthritis in use of these three drugs.

  18. Comparability of Antibody-Mediated Cell Killing Activity Between a Proposed Biosimilar RTXM83 and the Originator Rituximab.

    Science.gov (United States)

    Cuello, Hector A; Segatori, Valeria I; Alberto, Marina; Pesce, Analía; Alonso, Daniel F; Gabri, Mariano R

    2016-06-01

    Biosimilars are described as biological products that resemble the structure of original biologic therapeutic products, with no clinically meaningful differences in terms of safety and effectiveness from the original. A wide range of biosimilars are under development or are already licensed in many countries. Biosimilars are earning acceptance and becoming a reality for immunotherapy treatments mainly based on the alternatives for the commercial anti-CD20 monoclonal antibody rituximab. The most important mechanism of action reported for this antibody is the induction of antibody-dependent cell cytotoxicity (ADCC), which is associated with the polymorphisms present at the 158 position in the IgG receptor FcγRIIIa. The aim of the study was to validate the functional comparability between the proposed rituximab biosimilar RTXM83 and the original product. To achieve this we assessed the binding capacity and ADCC induction of this biosimilar, taking into account the different FcγRIIIa-158 polymorphisms. Binding capacity was evaluated by flow cytometry using CD20 positive cells and a wide range of antibody concentrations. The FcγRIIIa-158 polymorphisms were analyzed by polymerase chain reaction (PCR) followed by allele-specific restriction enzyme digestion. ADCC was measured by a colorimetric lactate dehydrogenase-release assay, using effector cells from donors with different FcγRIIIa-158 polymorphisms. Binding capacity assay showed no differences between both products. Regarding ADCC, a similar relative potency was obtained between both antibodies, showing a higher response for the FcγRIIIa-158 valine/valine (V/V) polymorphism compared to the phenylalanine/phenylalanine (F/F), for both rituximab and RTXM83. Our data strongly suggest the biocomparability between the proposed biosimilar and the originator rituximab, in antibody recognition and ADCC activity. Additionally, our results suggest that donors with the FcγRIIIa-158V/V polymorphism induce a higher ADCC

  19. Sustained clinical response to rituximab in a case of life-threatening overlap subepidermal autoimmune blistering disease.

    Science.gov (United States)

    Li, Yaohan; Foshee, J B; Sontheimer, Richard D

    2011-04-01

    The conventional treatment for the autoimmune bullous skin diseases is broad-spectrum immunosuppressive regimen typically combining systemic corticosteroids with adjuvant immunosuppressive therapeutic agents. Orphan diseases in the pemphigus, pemphigoid, and epidermolysis bullosa acquisita groups of clinical disorders are often clinically severe, requiring long-term treatment with such drugs or drug combinations. Rituximab, a chimeric recombinant monoclonal antibody targeting CD20(+) B cells, has recently been suggested to be effective in the treatment of pemphigus with relatively few adverse effects. The clinical value of rituximab in other immune-mediated blistering diseases has been less thoroughly examined. We report a case of a woman who presented initially with the Brunsting-Perry phenotype of cicatricial pemphigoid who subsequently developed severe generalized subepidermal blisters healing with scarring and milia formation thought to be clinically compatible with epidermolysis bullosa acquisita, although type VII collagen autoantibodies were never identified. Treatment with a number of conventional systemic agents was unsuccessful and complicated by methicillin-resistant Staphylococcus aureus-induced cutaneous ulcers and near-fatal gram-negative sepsis. This woman has enjoyed an 18-month complete clinical remission after a single inductive 4-week cycle of intravenous rituximab. This outcome supports the idea that systemic memory B-cell depletion with drugs such as rituximab should be considered for therapeutically refractory subepidermal autoimmune blistering diseases in addition to intraepidermal autoimmune blistering diseases. A potential role for the immunologic phenomenon of epitope spreading in the generation of overlapping features of autoimmune blistering diseases, and its contribution to therapeutic refractoriness ("hardening"), is discussed.

  20. KIR/HLA interactions negatively affect rituximab- but not GA101 (obinutuzumab)-induced antibody-dependent cellular cytotoxicity.

    Science.gov (United States)

    Terszowski, Grzegorz; Klein, Christian; Stern, Martin

    2014-06-15

    Ab-dependent cellular cytotoxicity (ADCC) mediated by NK cells is regulated by inhibitory killer cell Ig-like receptors (KIRs), which interact with target cell HLA class I. We analyzed how KIR/HLA interactions influence ADCC induced by rituximab and by GA101, a novel type II CD20 Ab glycoengineered for increased FcgRIII binding and ADCC capacity. We found that KIR/HLA interactions strongly and selectively inhibit rituximab-induced in vitro ADCC toward target cells expressing cognate HLA KIR ligands. NK cells of donors carrying all three ligands to inhibitory KIR showed weak activation and target cell depletion capacity when incubated with rituximab and KIR-ligand matched target B cells. In contrast, NK cells from individuals missing one or more KIR ligands activated more strongly and depleted KIR ligand-matched target B cells more efficiently in the presence of rituximab. NK cells expressing a KIR for which the ligand was absent were the main effectors of ADCC in these donors. Notably, the influence of KIR/HLA interactions on NK cell activation was synergistic with the effect of the V158F FCGR3A single nucleotide polymorphism. In contrast, GA101 induced activation of NK cells irrespective of inhibitory KIR expression, and efficiency of target cell depletion was not negatively affected by KIR/HLA interactions. These data show that modification of the Fc fragment to enhance ADCC can be an effective strategy to augment the efficacy of therapeutic mAbs by recruiting NK cells irrespective of their inhibitory KIR expression.

  1. Rituximab Treatment Strategy for Patients with Diffuse Large B-Cell Lymphoma after First-Line Therapy: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yuan-Rong Ren

    2015-01-01

    Full Text Available Background: Rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP significantly prolonged event-free survival in first-line chemotherapy for patients with diffuse large B-cell lymphoma (DLBCL. But relapse and refractory DLBCL occur frequently. Although rituximab is effective, its role in salvage therapy after autologous transplant remains unclear. Maintenance therapy with rituximab in responding patients after first line chemotherapy may be a useful novel approach capable of eradicating minimal residual disease and to bring survival benefit. This systematic review and meta-analysis evaluated the effects of rituximab maintenance treatment and salvage therapy of patients with DLBCL. Methods: We performed a systematic review and meta-analysis of randomized controlled trials and compared rituximab maintenance or salvage therapy at relapse with observation. We searched the Cochrane Library, PubMed, EMBASE, conference proceedings, databases of ongoing trials, and references of published trials. Two reviewers independently assessed the quality of the trials and extracted data. Hazard ratios for time-to-event data were estimated and pooled. Results: Seven trials including 1470 DLBCL patients were included in this systematic review and meta-analysis. Patients treated with maintenance rituximab have better overall survival (OS and event-free survival (EFS than patients in the observation arm, but there was no statistical significance. Patients who received rituximab salvage therapy for relapse or refractory DLBCL have statistically significantly better OS [HR of death = 0.72, 95% CI (0.55-0.94, P = 0.02], progression-free survival (PFS [HR = 0.61, 95% CI (0.52-0.72, P < 0.05], odds ratio (OR [RR = 1.26, 95% CI (1.07-1.47, P = 0.004] than patients in the observation arm. The rate of infection-related adverse events was higher with rituximab treatment [RR = 1.37, 95% CI = (1.14 - 1.65 P =0.001]. Conclusions: After

  2. Combination of rituximab with chlorambucil as first line treatment in patients with mantle cell lymphoma: a highly effective regimen.

    Science.gov (United States)

    Sachanas, Sotirios; Pangalis, Gerassimos A; Vassilakopoulos, Theodoros P; Korkolopoulou, Penelope; Kontopidou, Flora N; Athanasoulia, Maria; Yiakoumis, Xanthi; Kalpadakis, Christina; Georgiou, Georgios; Masouridis, Stavroula; Moschogiannis, Maria; Tsirkinidis, Pantelis; Pappis, Vassiliki; Kokoris, Styliani I; Siakantaris, Marina P; Panayiotidis, Panayiotis; Angelopoulou, Maria K

    2011-03-01

    The optimal treatment approach for patients with mantle cell lymphoma (MCL) is not well defined. Intensive therapeutic regimens result in high response rates and prolonged progression-free survival but at the expense of significant toxicity. We report here our results of the administration of rituximab plus chlorambucil (R-Chl) as first line treatment in patients with MCL. Twenty consecutively diagnosed patients were treated with this combination in which an induction and a maintenance arm were included. During induction, rituximab was administered at a dose of 375 mg/m(2) on day 1, while chlorambucil was given afterward at a dose of 10 mg/day for 10 consecutive days for eight cycles and then as a single agent for an additional four cycles. Maintenance consisted of rituximab administration every 2 months for 1 year. Most patients had indolent disease features such as a low mantle-cell international prognostic index (MIPI) score. The overall response rate was 95% (90% CR, 5% PR). Among patients in CR, 78% presented a molecular remission. The 3-year progression-free survival was 89%. There were no serious side effects. These results show that the R-Chl combination could be an effective therapeutic option as first line treatment in MCL, especially for patients with indolent disease characteristics.

  3. Clinical experience with lenalidomide alone or in combination with rituximab in indolent B-cell and mantle cell lymphomas.

    Science.gov (United States)

    Ruan, J; Shah, B; Martin, P; Schuster, S J

    2016-07-01

    Lenalidomide is an oral immunomodulatory drug with significant activity in indolent B-cell and mantle cell lymphomas. Lenalidomide has a manageable safety profile whether administered as a single agent or in combination with rituximab. The combination of lenalidomide with rituximab, known as the 'R(2)' regimen, enhances efficacy over what has been shown with monotherapy and has demonstrated activity in patients considered resistant to rituximab. Tolerability of these regimens has been consistent among studies. Asymptomatic neutropenia is the most common grade 3/4 adverse event, typically managed by dose interruption, followed by dose reduction once neutrophils have recovered. Nonhematologic toxicities (e.g. fatigue) are generally low-grade, manageable with concomitant treatment, and/or lenalidomide dose modification. More frequent with R(2), immune-related symptoms such as rash and tumor flare are important to recognize as lenalidomide-associated treatment effects in patients with lymphoma who require supportive care and potential dose modifications. Severe tumor flare reactions with painful lymphadenopathy are not typically observed outside of chronic lymphocytic leukemia/small lymphocytic lymphoma. Venous thromboembolism is uncommon in lymphomas, though prophylaxis is recommended. The general safety profile, differences between lenalidomide monotherapy and R(2) treatment, and optimal strategies for managing adverse events are discussed here.

  4. Final Results of the IELSG-19 Randomized Trial of Mucosa-Associated Lymphoid Tissue Lymphoma: Improved Event-Free and Progression-Free Survival With Rituximab Plus Chlorambucil Versus Either Chlorambucil or Rituximab Monotherapy.

    Science.gov (United States)

    Zucca, Emanuele; Conconi, Annarita; Martinelli, Giovanni; Bouabdallah, Reda; Tucci, Alessandra; Vitolo, Umberto; Martelli, Maurizio; Pettengell, Ruth; Salles, Gilles; Sebban, Catherine; Guillermo, Armando Lopez; Pinotti, Graziella; Devizzi, Liliana; Morschhauser, Franck; Tilly, Hervé; Torri, Valter; Hohaus, Stefan; Ferreri, Andrés J M; Zachée, Pierre; Bosly, André; Haioun, Corinne; Stelitano, Caterina; Bellei, Monica; Ponzoni, Maurilio; Moreau, Anne; Jack, Andrew; Campo, Elias; Mazzucchelli, Luca; Cavalli, Franco; Johnson, Peter; Thieblemont, Catherine

    2017-06-10

    Purpose There is no consensus on the optimal systemic treatment of patients with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. The IELSG-19 phase III study, to our knowledge, was the first such study to address the question of first-line treatment in a randomized trial. Patients and Methods Eligible patients were initially randomly assigned (1:1 ratio) to receive either chlorambucil monotherapy (6 mg/m(2)/d orally on weeks 1 to 6, 9 to 10, 13 to 14, 17 to 18, and 21 to 22) or a combination of chlorambucil (same schedule as above) and rituximab (375 mg/m(2) intravenously on day 1 of weeks 1, 2, 3, 4, 9, 13, 17, and 21). After the planned enrollment of 252 patients, the protocol was amended to continue with a three-arm design (1:1:6 ratio), with a new arm that included rituximab alone (same schedule as the combination arm) and with a final sample size of 454 patients. The main end point was event-free survival (EFS). Analysis of chlorambucil versus the combination arm was performed and reported separately before any analysis of the third arm. Results At a median follow-up of 7.4 years, addition of rituximab to chlorambucil led to significantly better EFS (hazard ratio, 0.54; 95% CI, 0.38 to 0.77). EFS at 5 years was 51% (95% CI, 42 to 60) with chlorambucil alone, 50% (95% CI, 42 to 59) with rituximab alone, and 68% (95% CI, 60 to 76) with the combination ( P = .0009). Progression-free survival was also significantly better with the combination ( P = .0119). Five-year overall survival was approximately 90% in each arm. All treatments were well tolerated. No unexpected toxicities were recorded. Conclusion Rituximab in combination with chlorambucil demonstrated superior efficacy in mucosa-associated lymphoid tissue lymphoma; however, improvements in EFS and progression-free survival did not translate into longer overall survival.

  5. Intensified chemotherapy with ACVBP plus rituximab versus standard CHOP plus rituximab for the treatment of diffuse large B-cell lymphoma (LNH03-2B): an open-label randomised phase 3 trial.

    Science.gov (United States)

    Récher, Christian; Coiffier, Bertrand; Haioun, Corinne; Molina, Thierry Jo; Fermé, Christophe; Casasnovas, Olivier; Thiéblemont, Catherine; Bosly, André; Laurent, Guy; Morschhauser, Franck; Ghesquières, Hervé; Jardin, Fabrice; Bologna, Serge; Fruchart, Christophe; Corront, Bernadette; Gabarre, Jean; Bonnet, Christophe; Janvier, Maud; Canioni, Danielle; Jais, Jean-Philippe; Salles, Gilles; Tilly, Hervé

    2011-11-26

    The outcome of diffuse large B-cell lymphoma has been substantially improved by the addition of the anti-CD20 monoclonal antibody rituximab to chemotherapy regimens. We aimed to assess, in patients aged 18-59 years, the potential survival benefit provided by a dose-intensive immunochemotherapy regimen plus rituximab compared with standard treatment plus rituximab. We did an open-label randomised trial comparing dose-intensive rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP) with subsequent consolidation versus standard rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisone (R-CHOP). Random assignment was done with a computer-assisted randomisation-allocation sequence with a block size of four. Patients were aged 18-59 years with untreated diffuse large B-cell lymphoma and an age-adjusted international prognostic index equal to 1. Our primary endpoint was event-free survival. Our analyses of efficacy and safety were of the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00140595. One patient withdrew consent before treatment and 54 did not complete treatment. After a median follow-up of 44 months, our 3-year estimate of event-free survival was 81% (95% CI 75-86) in the R-ACVBP group and 67% (59-73) in the R-CHOP group (hazard ratio [HR] 0·56, 95% CI 0·38-0·83; p=0·0035). 3-year estimates of progression-free survival (87% [95% CI, 81-91] vs 73% [66-79]; HR 0·48 [0·30-0·76]; p=0·0015) and overall survival (92% [87-95] vs 84% [77-89]; HR 0·44 [0·28-0·81]; p=0·0071) were also increased in the R-ACVBP group. 82 (42%) of 196 patients in the R-ACVBP group experienced a serious adverse event compared with 28 (15%) of 183 in the R-CHOP group. Grade 3-4 haematological toxic effects were more common in the R-ACVBP group, with a higher proportion of patients experiencing a febrile neutropenic episode (38% [75 of 196] vs 9% [16 of 183]). Compared with standard R

  6. Terapia combinada de ejercicio terapéutico y Kinesiotape en el dolor lumbar crónico inespecífico. Estudio de Casos

    OpenAIRE

    Rama Quijano, Paula

    2013-01-01

    Objetivo: Conocer los efectos de una terapia que combina Ejercicio Terapéutico Grupal con Kinesiotape en pacientes con Lumbalgia Crónica Inespecífica. Diseño: Estudio de Casos. Participantes: Muestra de 8 pacientes formada por un hombre y siete mujeres de entre 25 y 60 años de edad que presentan Lumbalgia Crónica Inespecífica. Intervención: Se llevaron a cabo 15 sesiones diarias de Ejercicio Terapéutico de 40 minutos de duración y una aplicación de dos bandas en “I” de Kinesiotape en la regió...

  7. Rituximab, fludarabine, and total body irradiation as conditioning regimen before allogeneic hematopoietic stem cell transplantation for advanced chronic lymphocytic leukemia: long-term prospective multicenter study.

    Science.gov (United States)

    Michallet, Mauricette; Socié, Gerard; Mohty, Mohamad; Sobh, Mohamad; Bay, Jacques-O; Morisset, Stéphane; Labussière-Wallet, Hélène; Tabrizi, Reza; Milpied, Noel; Bordigoni, Pierre; El-Cheikh, Jean; Blaise, Didier

    2013-02-01

    To evaluate the efficacy and toxicity of reduced-intensity conditioning (RIC) combining fludarabine, low-dose total body irradiation (TBI) and rituximab before allogeneic hematopoietic stem cell transplantation (allo-HSCT) from human leucocyte antigen (HLA) identical siblings, we conducted a prospective study in patients ≤65 years old with advanced chronic lymphocytic leukemia (CLL) stage B or C in response after a salvage treatment. Conditioning included rituximab (375 mg/m² on day 5), fludarabine (30 mg/m² from day 4 to day 2), TBI (2 Gy on day 0), and rituximab (500 mg/m² on days 1 and 8). Forty patients were included, 34 (85%) were male with a median age of 54 years (range, 35-65 years), 38 (95%) were in B stage, and 2 were in stage C; only 7 patients (17%) were in complete response. Seven (17%) patients did not receive rituximab. Thirty-nine (98%) patients engrafted, 17 patients developed acute graft-versus-host disease (GVHD) grade ≥II with a cumulative incidence at 3 months of 44% (36-52) with a significant protective effect of rituximab (p = 0.02). The cumulative incidence of chronic GVHD was 29% (21-36) at 12 months for both limited and extensive forms. The median overall survival was not reached with 5-years probability of 55% (41-74). The multivariate analysis showed a positive effect of rituximab on overall survival and event-free survival (hazard ratio [HR] = 0.1 [0-0.6], p = 0.02; and HR = 0.1 [0-0.4], p = 0.035, respectively). The association of fludarabine, TBI, and rituximab is feasible, well tolerated, and allows better outcomes in advanced CLL.

  8. Adding rituximab to CODOX-M/IVAC chemotherapy in the treatment of HIV-associated Burkitt lymphoma is safe when used with concurrent combination antiretroviral therapy.

    Science.gov (United States)

    Alwan, Ferras; He, Annie; Montoto, Silvia; Kassam, Shireen; Mee, Matthew; Burns, Fiona; Edwards, Simon; Wilson, Andrew; Tenant-Flowers, Melinda; Marcus, Robert; Ardeshna, Kirit M; Bower, Mark; Cwynarski, Kate

    2015-05-15

    CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin-methatrexate/ifusamide, etoposide, cytarabine) chemotherapy is commonly used to treat Burkitt lymphoma and in the HIV-negative population. Rituximab is often added with suggested survival benefits. Concerns over increased toxicity in an already immunocompromized population have prevented its routine addition in people living with HIV (PLWH). This study evaluated the effect on treatment-related toxicity and efficacy of adding rituximab to CODOX-M/IVAC chemotherapy in PLWH. Retrospective review of 91 PLWH (74 men) with Burkitt lymphoma treated in five London centers between 2003 and 2013. All patients received combination antiretroviral therapy. Forty-nine patients received CODOX-M/IVAC and 42 rituximab (R)-CODOX-M/R-IVAC. The addition of rituximab did not confer any significant increase in grade 3/4 toxicities including infections, mucositis, diarrhea, renal impairment, and tumor lysis syndrome. There was no significant difference in toxic deaths between groups (P = 0.14). The 2-year overall survival (OS) was greater for patients receiving rituximab {2-year OS 72% [95% confidence interval (CI) 0.22-0.92, hazard ratio 0.46] vs. 55% [95% CI 1.1-4.5, hazard ratio 2.2]; log-rank P = 0.04}. Similarly, the 2-year progression-free survival (PFS) was greater in the rituximab cohort [2-year PFS 81% (95% CI 0.21-0.99, hazard ratio 0.46) vs. 55% (95% CI 1.0-4.8, hazard ratio 2.2); log-rank P = 0.04]. Our multicenter analysis is the largest to date in this population and showed that the addition of rituximab to CODOX-M/IVAC chemotherapy confers no increase in toxicity and results in significantly improved OS and PFS in PLWH with Burkitt lymphoma who receive concomitant combination antiretroviral therapy.

  9. Targeting the CD20 and CXCR4 pathways in non-hodgkin lymphoma with rituximab and high-affinity CXCR4 antagonist BKT140.

    Science.gov (United States)

    Beider, Katia; Ribakovsky, Elena; Abraham, Michal; Wald, Hanna; Weiss, Lola; Rosenberg, Evgenia; Galun, Eithan; Avigdor, Abraham; Eizenberg, Orly; Peled, Amnon; Nagler, Arnon

    2013-07-01

    Chemokine axis CXCR4/CXCL12 is critically involved in the survival and trafficking of normal and malignant B lymphocytes. Here, we investigated the effect of high-affinity CXCR4 antagonist BKT140 on lymphoma cell growth and rituximab-induced cytotoxicity in vitro and in vivo. In vitro efficacy of BKT140 alone or in combination with rituximab was determined in non-Hodgkin lymphoma (NHL) cell lines and primary samples from bone marrow aspirates of patients with NHL. In vivo efficacy was evaluated in xenograft models of localized and disseminated NHL with bone marrow involvement. Antagonizing CXCR4 with BKT140 resulted in significant inhibition of CD20+ lymphoma cell growth and in the induction of cell death, respectively. Combination of BKT140 with rituximab significantly enhanced the apoptosis against the lymphoma cells in a dose-dependent manner. Moreover, rituximab induced CXCR4 expression in lymphoma cell lines and primary lymphoma cells, suggesting the possible interaction between CD20 and CXCR4 pathways in NHL. Primary bone marrow stromal cells (BMSC) further increased CXCR4 expression and protected NHL cells from rituximab-induced apoptosis, whereas BKT140 abrogated this protective effect. Furthermore, BKT140 showed efficient antilymphoma activity in vivo in the xenograft model of disseminated NHL with bone marrow involvement. BKT140 treatment inhibited the local tumor progression and significantly reduced the number of NHL cells in the bone marrow. Combined treatment of BKT140 with rituximab further decreased the number of viable lymphoma cells in the bone marrow, achieving 93% reduction. These findings suggest the possible role of CXCR4 in NHL progression and response to rituximab and provide the scientific basis for the development of novel CXCR4-targeted therapies for refractory NHL. ©2013 AACR.

  10. Spotlight on rituximab in the treatment of antineutrophil cytoplasmic antibody-associated vasculitis: current perspectives

    Directory of Open Access Journals (Sweden)

    Moog P

    2015-11-01

    Full Text Available Philipp Moog, Klaus Thuermel Abteilung für Nephrologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Abstract: A 54-year-old patient presented to his general practitioner because of strong muscle pain in both thighs. Inflammatory parameters (CRP 16.3 mg/dL and white blood cells (15 g/L were elevated. The patient reported a weight loss of 10 kg in 4 weeks. There was no fever or any other specific symptoms. Urine dipstick examination and computed tomography of the chest were unremarkable. Because of increasing symptoms, the patient was referred to our department. Magnetic resonance tomography showed diffuse inflammatory changes of the muscles of both thighs. Neurological examination and electrophysiology revealed axonal sensorimotor neuropathy and ground-glass opacities of both lungs had occurred. Serum creatinine increased to 229 µmol/L within a few days, with proteinuria of 3.3 g/g creatinine. Kidney biopsy showed diffuse pauci-immune proliferative glomerulonephritis. Proteinase 3-specific antineutrophil cytoplasmic antibodies were markedly increased. Birmingham Vasculitis Activity Score was 35. Within 2 days, serum creatinine further increased to 495 µmol/L. Plasma exchange, high-dose glucocorticosteroids, and hemodialysis were started. The patient received cyclophosphamide 1 g twice and rituximab 375 mg/m2 four times according to the RITUXVAS protocol. Despite ongoing therapy, hemodialysis could not be withdrawn and had to be continued over 3 weeks until diuresis normalized. Glucocorticosteroids were tapered to 20 mg after 2 months, and serum creatinine was 133 µmol/L. However, nephritic urinary sediment reappeared. Another dose of 1 g cyclophosphamide was given, and glucocorticosteroids were raised for another 4 weeks. After 6 months, the daily prednisolone dose was able to be tapered to 5 mg. Serum creatinine was 124 µmol/L, proteinuria further decreased to 382 mg/g creatinine, and the Birmingham

  11. Cost-effectiveness of adding rituximab to fludarabine and cyclophosphamide for treatment of chronic lymphocytic leukemia in Ukraine

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    Mandrik O

    2015-08-01

    Full Text Available Olena Mandrik,1 Isaac Corro Ramos,2 Saskia Knies,1,3 Maiwenn Al,1,2 Johan L Severens1,2 1Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; 2Institute of Medical Technology Assessment (iMTA, Erasmus University Rotterdam, Rotterdam, the Netherlands; 3National Health Care Institute, Diemen, the Netherlands Abstract: The aim of this study was to assess the cost-effectiveness, from a health care perspective, of adding rituximab to fludarabine and cyclophosphamide scheme (FCR versus FC for treatment-naïve and refractory/relapsed Ukrainian patients with chronic lymphocytic leukemia. A decision-analytic Markov cohort model with three health states and 1-month cycle time was developed and run within a life time horizon. Data from two multinational, prospective, open-label Phase 3 studies were used to assess patients' survival. While utilities were generalized from UK data, local resource utilization and disease-associated treatment, hospitalization, and side effect costs were applied. The alternative scenario was performed to assess the impact of lower life expectancy of the general population in Ukraine on the incremental cost-effectiveness ratio (ICER for treatment-naïve patients. One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the robustness of the results. The ICER (in US dollars of treating chronic lymphocytic leukemia patients with FCR versus FC is US$8,704 per quality-adjusted life year gained for treatment-naïve patients and US$11,056 for refractory/relapsed patients. When survival data were modified to the lower life expectancy of the general population in Ukraine, the ICER for treatment-naïve patients was higher than US$13,000. This value is higher than three times the current gross domestic product per capita in Ukraine. Sensitivity analyses have shown a high impact of rituximab costs and a moderate impact of differences in utilities on the ICER

  12. Clarificación combinada y evaluación sensorial de jugo de marañón (Anacardium occidentale L.

    Directory of Open Access Journals (Sweden)

    Jorge Osorio M.

    2013-10-01

    Full Text Available Objetivo. Obtener jugo clarificado de marañón, evaluar sensorialmente jugos clarificados optimizados y establecer diferencias químicas entre el jugo integral y el clarificado. Materiales y métodos. Los pseudofrutos se separaron manualmente de la nuez, fueron seleccionados y lavados, luego se realizó escaldado y extracción del jugo. El jugo integral y el de mayor aceptación fueron caracterizados químicamente. Los jugos se evaluaron sensorialmente (aceptación con una escala hedónica de 9 puntos y una prueba de ordenamiento por 30 catadores. Se empleó un diseño factorial de tres niveles combinado con la metodología de superficie de respuesta; las características químicas de los jugos se analizaron por prueba de homogeneidad de varianzas de Levene y la prueba T-Student de comparación de medias para muestras independientes. Resultados. Los jugos evaluados sensorialmente no presentaron diferencias estadísticas significativas entre sí (p≤0.05, p≤0.01; sin embargo el mayor porcentaje de aceptación fue del tratamiento 0.20% p/v Rapidasa® CX y 14.27 horas a 30ºC, se presentaron diferencias estadísticas significativas para las variables pH, °Brix, azúcares reductores y ácido ascórbico (p≤0.05; además, el contenido de ácido ascórbico se redujo notablemente en un 41.01% con respecto al jugo inicial. Conclusiones. El jugo clarificado con alto contenido de vitamina C, obtenido por tratamiento enzimático, constituye una forma de aprovechamiento agroindustrial del pseudofruto, teniendo aceptación para su consumo y sin presentar astringencia, con buen sabor, aroma, mediante tratamiento 0.20% p/v Rapidasa® CX y 14.27 horas a 30ºC.

  13. Rituximab Treatment Strategy for Patients with Diffuse Large B-Cell Lymphoma after First-Line Therapy: A Systematic Review and Meta-Analysis

    Institute of Scientific and Technical Information of China (English)

    Yuan-Rong Ren; Yong-Dong Jin; Zhi-Hui Zhang; Li Li; Ping Wu

    2015-01-01

    Background:Rituximab in combination with cyclophosphamide,doxorubicin,vincristine,and prednisone (CHOP) significantly prolonged event-free survival in first-line chemotherapy for patients with diffuse large B-cell lymphoma (DLBCL).But relapse and refractory DLBCL occur frequently.Although rituximab is effective,its role in salvage therapy after autologous transplant remains unclear.Maintenance therapy with rituximab in responding patients after first line chemotherapy may be a useful novel approach capable of eradicating minimal residual disease and to bring survival benefit.This systematic review and meta-analysis evaluated the effects of rituximab maintenance treatment and salvage therapy of patients with DLBCL.Methods:We performed a systematic review and meta-analysis of randomized controlled trials and compared rituximab maintenance or salvage therapy at relapse with observation.We searched the Cochrane Library,PubMed,EMBASE,conference proceedings,databases of ongoing trials,and references of published trials.Two reviewers independently assessed the quality of the trials and extracted data.Hazard ratios for time-to-event data were estimated and pooled.Results:Seven trials including 1470 DLBCL patients were included in this systematic review and meta-analysis.Patients treated with maintenance rituximab have better overall survival (OS) and event-free survival (EFS) than patients in the observation arm,but there was no statistical significance.Patients who received rituximab salvage therapy for relapse or refractory DLBCL have statistically significantly better OS [HR of death =0.72,95% CI (0.55-0.94),P=0.02],progression-free survival (PFS) [HR =0.61,95% CI (0.52-0.72),P< 0.05],odds ratio (OR) [RR =1.26,95% CI (1.07-1.47),P =0.004] than patients in the observation arm.The rate of infection-related adverse events was higher with rituximab treatment [RR =1.37,95% CI =(1.14-1.65) P =0.001].Conclusions:After first-line chemotherapy,the two rituximab

  14. [Rituximab (MabThera)--a new biological medicine in rheumatoid arthritis therapy].

    Science.gov (United States)

    Nemec, P

    2007-11-01

    Rheumatoid arthritis (RA) is a serious, chronic, inflammatory disorder that damages the joints. The chronic destructive process causes pain to patients with RA and leads to the development of permanent disability. At present, great emphasis is placed on timely and effective therapy for RA, which is able to halt or slow the development of the disorder. At present we do not have any means of curing RA, the main objective for treatment is to induce remission of the disorder and prevent structural damage to the joints and the development of permanent disability. The relatively frequent failure of disease modifying medications (DMARDs) lead to efforts to find new resources for the treatment of RA. So called biological medicines were recently introduced into therapeutic use. These were mainly TNFalpha blockers. Experience has shown that approximately a third of patients with RA do not respond even to treatment with such medicines. Rituximab (MabThera), a monoclonal antibody against CD20 positive B-lymphocytes, is a new biological medicine approved for RA therapy. It represents a new hope for patients with active RA, for whom earlier therapy with TNFa blockers has failed.

  15. Fludarabine, cyclophosphamide, and rituximab in salvage therapy of Waldenström's macroglobulinemia.

    Science.gov (United States)

    Tedeschi, Alessandra; Ricci, Francesca; Goldaniga, Maria Cecilia; Benevolo, Giulia; Varettoni, Marzia; Motta, Marina; Pioltelli, Pietro; Gini, Guido; Barate', Claudia; Luraschi, Annamaria; Vismara, Eleonora; Frustaci, Anna Maria; Nichelatti, Michele; Vitolo, Umberto; Baldini, Luca; Morra, Enrica

    2013-04-01

    The combination FCR (fludarabine, cyclophosphamide, and rituximab) proved to be active in Waldenström's macroglobulinemia in a mixed population of untreated and previously treated patients. Prolonged myelosuppression and concerns about purine analogue treatment led to the conclusion that this regimen should be avoided in younger patients in first-line treatment. In this retrospective study on 40 patients we observed a response rate of 80% (32) after FCR salvage treatment with 32.5% (13) of patients reaching at least a very good partial remission. None of the prognostic variables had a significant effect on response or good quality of response achievement. Median event-free survival was reached at 77 months; median progression-free survival was not reached after a median follow-up of 51 months with any difference when categorizing patients according to quality of response. The results of this study suggest that the FCR regimen might overcome poor prognostic features and should be taken into account as salvage treatment. Tardive immunosuppression and myelosuppression warrant accurate patient follow-up.

  16. Rituximab for the therapy of systemic sclerosis: a series of 10 cases in a single center.

    Science.gov (United States)

    Vilela, Verônica Silva; Maretti, Giselle Baptista; Silva Gama, Lívia Marques da; Costa, Claudia Henrique da; Rufino, Rogério Lopes; Levy, Roger A

    2016-06-26

    Systemic sclerosis (SSc) is a chronic autoimmune disease with a high morbidity and mortality. Although cyclophosphamide is effective for severe and refractory cases, there is demand for new treatments. The biological treatment with B-cell depletion with rituximab (RTX) has demonstrated efficacy for this demand in open-label studies. This study was conducted with the aim to retrospectively evaluate all patients who used RTX for the treatment of SSc in our center. We retrospectively evaluated medical records of all patients with SSc who used RTX to treat this disease from January 2009 to January 2015. Systemic, cutaneous, and pulmonary involvement data and laboratory results before and six months after the first infusion of RTX were collected. Ten patients received treatment during the study period and were included in this series. All patients had a diffuse form of the disease. Five patients suffered from an early (duration of disease shorter or equal to four years), rapidly progressive disease, and another five received RTX at late stages of the disease. In both groups of patients, stabilization of the pulmonary picture was observed, with a fall in the skin score in those patients with early forms of the disease. Similar to findings in previous studies, RTX was effective in treating early and rapidly progressive forms of SSc. We also found that patients with long-term illness may benefit from the treatment. Copyright © 2016. Published by Elsevier Editora Ltda.

  17. Long-term follow-up of different refractory systemic vasculitides treated with rituximab.

    Science.gov (United States)

    Rees, Frances; Yazdani, Ramin; Lanyon, Peter

    2011-09-01

    There is increasing interest in rituximab (RTX) as an alternative to cyclophosphamide (CYC) for remission induction in systemic vasculitis. Recent studies have reported high remission rates, but it is not clear how long the initial remission lasts [1, 2]. A retrospective study was undertaken of 15 cases of refractory systemic vasculitis (11 Wegener's granulomatosis, 1 Churg-Strauss syndrome, 1 cutaneous polyarteritis nodosa and 2 cryoglobulinaemic vasculitis) treated with RTX, with a mean follow-up of 34 months. All had previously received CYC, and 14, at least one other immunosuppressive drug. All had active disease when treated (median Birmingham Vasculitis Activity Score (BVAS) 2003, 13). All cases achieved remission (BVAS 2003, 0). Thirteen required re-treatment, nine due to relapse (mean, 9 months after initial treatment) and four because of repopulation or rising ANCA in the context of CYC intolerance or previous CYC refractory disease. Relapsing cases have been successfully re-treated up to five further cycles, either at B cell repopulation or at six monthly intervals. Infections were rare. Mean IgG levels fell significantly, and IgM levels became subnormal in six cases. There were three cases of neutropenia, one severe at 10 months post-treatment. These results provide further evidence that RTX is an effective induction agent in systemic vasculitis. The optimal and long-term outcome of re-treatment remains to be defined.

  18. Frontline chemoimmunotherapy with fludarabine, cyclophosphamide, alemtuzumab, and rituximab for high-risk chronic lymphocytic leukemia

    Science.gov (United States)

    Parikh, Sameer A.; Keating, Michael J.; O'Brien, Susan; Wang, Xuemei; Ferrajoli, Alessandra; Faderl, Stefan; Burger, Jan; Koller, Charles; Estrov, Zeev; Badoux, Xavier; Lerner, Susan

    2011-01-01

    Frontline chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) is associated with superior overall survival (OS) for patients with chronic lymphocytic leukemia (CLL). Alemtuzumab (A) was added to FCR (CFAR) in a phase 2 trial for high-risk untreated patients < 70 years with serum β-2 microglobulin (β2M) ≥ 4 mg/L. Sixty patients were enrolled; median age was 59 years (range, 42-69); 75% were male; median β2M was 5.1 mg/L (range, 4-11.6); and 51% were Rai III-IV. Complete remission (CR) was achieved in 70%, partial remission (PR) in 18%, nodular PR in 3%, for an overall response of 92%. Of 14 patients with 17p deletion, CR was achieved by 8 (57%). Of 57 BM samples evaluated by 3-color flow cytometry at the end of treatment, 41 (72%) were negative for residual disease. Grade 3-4 neutropenia and thrombocytopenia occurred with 33% and 13% courses, respectively. The median progression-free survival was 38 months and median OS was not reached. In conclusion, CFAR is an active frontline regimen for high-risk CLL. Response rates and survival are comparable with historic high-risk FCR-treated patients. CFAR may be a useful frontline regimen to achieve CR in patients with 17p deletion before allogeneic stem cell transplantation. PMID:21750315

  19. Off-label use of rituximab for systemic lupus erythematosus in Europe

    Science.gov (United States)

    Rydén-Aulin, Monica; Boumpas, Dimitrios; Bultink, Irene; Callejas Rubio, Jose Luis; Caminal-Montero, Luis; Castro, Antoni; Colodro Ruiz, Agustín; Doria, Andrea; Dörner, Thomas; Gonzalez-Echavarri, Cristina; Gremese, Elisa; Houssiau, Frederic A; Huizinga, Tom; Inanç, Murat; Isenberg, David; Iuliano, Annamaria; Jacobsen, Søren; Jimenéz-Alonso, Juan; Kovács, Lászlo; Mariette, Xavier; Mosca, Marta; Nived, Ola; Oristrell, Joaquim; Ramos-Casals, Manuel; Rascón, Javier; Sáez-Comet, Luis; Salvador Cervelló, Gonzalo; Sebastiani, Gian Domenico; Squatrito, Danilo; Szücs, Gabriella; Voskuyl, Alexandre; van Vollenhoven, Ronald

    2016-01-01

    Objectives Rituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy. Methods Data on patients with SLE receiving RTX were taken from the International Registry for Biologics in SLE retrospective registry and complemented with data on patients with SLE treated with conventional therapy. For nationwide estimates of RTX use in patients with SLE, investigators were asked to provide data through case report forms (CRFs). Countries for which no data were submitted through CRFs, published literature and/or personal communication were used, and for European countries where no data were available, estimates were made on the assumption of similarities with neighbouring countries. Results The estimated off-label use of RTX in Europe was 0.5%–1.5% of all patients with SLE. In comparison with patients with SLE on conventional therapy, patients treated with RTX had longer disease duration, higher disease activity and were more often treated with immunosuppressives. The most frequent organ manifestations for which either RTX or conventional therapy was initiated were lupus nephritis followed by musculoskeletal and haematological. The reason for treatment was, besides disease control, corticosteroid-sparing for patients treated with conventional therapy. Conclusions RTX use for SLE in Europe is restrictive and appears to be used as a last resort in patients for whom other reasonable options have been exhausted. PMID:27651920

  20. Efficiency of using rituximab in a patient with generalized granulomatosis with polyangiitis: A case report

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    Gulazyk Malikovna Koilubaeva

    2014-01-01

    Full Text Available Systemic vasculitides (SVs are characterized by inflammation of the blood vessels wall; the spectrum of their clinical manifestations depends on the type, extent, and location of affected vessels and the activity of systemic inflammation. The etiology of most primary SVs is unknown. Antineutrophil cytoplasmic antibodies (ANCAs are implicated in its pathogenesis. The presence of ANCAa in patients' serum and the correlation of their level with the severity of clinical manifestations served as a basis for identifying a subgroup of systemic necrotizing vasculitides associated with ANCA synthesis: granulomatosis with polyangiitis (GPA, microscopic polyangiitis, and Churg – Strauss syndrome. GPA is characterized by systemic granulomatous necrotizing vasculitis involving the small vessels of the upper respiratory tract, lung, and kidney.The paper describes a case of difficult diagnosis and successful rituximab (RTM treatment of generalized GPA in a 45-year-old female patients. The disease occurred with local damage to the upper respiratory tract, granulomatous inflammation of the pulmonary vessels to form multiple infiltrates with lung tissue destruction elements and necrotizing glomerulonephritis. Despite intensive immunosuppressive treatment, there was a rapid GPA progression with the further development of respiratory failure, which had been induced by stenotic laryngitis subglottica leading to tracheostoma. Damage to the organ of vision could lead to severe complications, including amaurosis. RMT was shown to be effective in treating generalized GPA with a poor prognosis.

  1. Anti-tumor activity of obinutuzumab and rituximab in a follicular lymphoma 3D model.

    Science.gov (United States)

    Decaup, E; Jean, C; Laurent, C; Gravelle, P; Fruchon, S; Capilla, F; Marrot, A; Al Saati, T; Frenois, F-X; Laurent, G; Klein, C; Varoqueaux, N; Savina, A; Fournié, J-J; Bezombes, C

    2013-08-09

    Follicular lymphomas (FLs) account for 35-40% of all adult lymphomas. Treatment typically involves chemotherapy combined with the anti-CD20 monoclonal antibody (MAb) rituximab (RTX). The development of the type II anti-CD20 MAb obinutuzumab (GA101) aims to further improve treatment. Here, using FL cells we show that RTX and GA101 display a similar activity on RL cells cultured in 2D. However, 2D culture cannot mimic tumor spatial organization and conventional 2D models may not reflect the effects of antibodies as they occur in vivo. Thus, we created a non-Hodgkin's lymphoma (NHL) 3D culture system, termed multicellular aggregates of lymphoma cells (MALC), and used it to compare RTX and GA101 activity. Our results show that both antibodies display greater activity towards FL cells in 3D culture compared with 2D culture. Moreover, we observed that in the 3D model GA101 was more effective than RTX both in inhibiting MALC growth through induction of (lysosomal) cell death and senescence and in inhibiting intracellular signaling pathways, such as mammalian target of rapamycin, Akt, PLCgamma (Phospholipase C gamma) and Syk. Altogether, our study demonstrates that spatial organization strongly influences the response to antibody treatment, supporting the use of 3D models for the testing of therapeutic agents in NHL.

  2. Immune tolerance induced using plasma exchange and rituximab in an infantile Pompe disease patient.

    Science.gov (United States)

    Deodato, Federica; Ginocchio, Virginia Maria; Onofri, Alfredo; Grutter, Giorgia; Germani, Alessandro; Dionisi-Vici, Carlo

    2014-06-01

    Infantile Pompe disease, resulting from deficiency of lysosomal acid α-glucosidase, requires enzyme replacement therapy with recombinant human acid α-glucosidase. Most patients develop antirecombinant human acid α-glucosidase antibodies, leading to reduced response to enzyme therapy in a subgroup of them. Aiming to improve treatment response, several immune tolerance induction strategies have been explored. We describe a patient with life-threatening infusion-associated reactions presenting anti-recombinant human acid α-glucosidase antibodies. He was successfully treated with an immune tolerance induction protocol, consisting of plasma exchange combined with a single dose of rituximab. Immediate reduction of antibody titer was obtained and enzyme therapy was resumed without infusion-associated reactions. Twenty-two months later, immunoglobulin G titer remained below 1:100. In conclusion, we applied a short-course immune tolerance induction strategy in a patient with severe infusion-associated reactions and anti-recombinant human acid α-glucosidase antibodies, leading to early and persisting reduction of antibody titer, in the absence of significant adverse events.

  3. Radioimmunotherapy with {sup 131}I-Rituximab in a Patient with Diffuse Large B-Cell Lymphoma Relapsed After Treatment with {sup 90}Y-Ibritumomab Tiuxetan

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    Kang, Geon Wook; Kang, Hye Jin; Shin, Dongyeop; Gu, Ha Ra; Choi, Hong Seok; Lim, Sang Moo [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2013-12-15

    We report a case that demonstrates the efficacy of radioimmunotherapy (RIT) with radioiodinated rituximab ({sup 131}I-rituximab) for relapsed diffuse large B-cell lymphoma (DLBCL). A 79-year-old male patient with DLBCL initially achieved a complete response (CR) after six cycles of RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) therapy. However, the lymphoma relapsed 20 months later. Although the patient had achieved a second and a third CR after two cycles of {sup 90}Y-ibritumomab tiuxetan, he experienced a third relapse approximately 3 years later. Between March and June 2011, the patient received three cycles of {sup 131}I-rituximab. Although he had achieved partial response after the second cycle, the disease progressed after the third cycle, and the total progression. Free survival was thus 5 months. The patient suffered only relatively mild toxicity (grade 1 thrombocytopenia) during treatment. RIT with {sup 131}I-rituximab is therefore potentially effective in patients with relapsed DLBCL, even after the failure of {sup 90}Y-ibritumomab tiuxetan therapy.

  4. Vértigo con nistagmo vertical por administración de morfina intratecal y reversión con naloxona Vertigo and vertical nystagmus associated with intrathecal morphine administration and resolution by naloxone

    Directory of Open Access Journals (Sweden)

    Jorge De All

    2011-10-01

    Full Text Available La anestesia regional combinada es utilizada frecuentemente como herramienta para el tratamiento del dolor postoperatorio. Los efectos secundarios de los opioides utilizados por esta vía son similares a los que se presentan luego de la administración sistémica. La aparición de vértigo con nistagmo vertical es un efecto adverso muy pocas veces descripto con el uso de morfina por vía intratecal, epidural o endovenosa. Comunicamos el caso de un paciente que presentó esta complicación en el postoperatorio de una nefrectomía parcial, luego de la administración de morfina intratecal, con resolución completa mediante el uso de naloxona endovenosa.Combined regional anesthesia is frequently used as a tool for management of postoperative pain. The profile of side effects of the opioids used via this route is similar to those occurring after systemic administration. The onset of vertigo with vertical nystagmus is an adverse effect rarely described after the use of intrathecal, epidural or intravenous morphine. We report the case of a patient who presented this complication in the postoperative period of a partial nephrectomy, after the administration of intrathecal morphine, with complete resolution by intravenous naloxone.

  5. Educar con significado o con sentido

    Directory of Open Access Journals (Sweden)

    José Joaquín García García

    2017-01-01

    Full Text Available Hoy día, tres tendencias influyen directamente en la conformación de la escuela. En primer lugar, el afán de encontrar la esencia de todo encumbró a la razón e hizo de la racionalidad el único valor a defender en las aulas. En segundo lugar, el sistema capitalista hizo lo mismo con aquello que tiene valor de uso y valor de cambio, es decir, con la mercancía, validando solo lo que puede tener una utilidad económica conocida o posible. Esto convirtió a la educación en un proceso para certificar y ganar dinero, desdibujando así su intención de formar personas. Finalmente, la visión masculina y eurocéntrica con su locura por quererlo dominar todo, y de pensar que el hombre era el dueño del planeta e inclusive la vida y el destino de los otros hombres, mutiló culturas y eliminó a la naturaleza de los currículums en los centros educativos.

  6. con turbinas de disco con paletas planas

    Directory of Open Access Journals (Sweden)

    D. García-Cortés

    2006-01-01

    Full Text Available Las turbinas de disco con paletas planas son los impelentes de flujo radial más ampliamente utilizados en la industria por constituir el impelente que forma parte de la configuración geométrica estándar para obtener este patrón de flujo en los tanques agitados. El estudio detallado de la hidrodinámica en este sistema de agitación es fundamental para continuar obteniendo conocimientos básicos imprescindibles para la síntesis y la modelación matemática de diferentes procesos complejos que se llevan a cabo en los tanques agitados, por ejemplo, la cristalización esférica. El propósito de este artículo es hacer una revisión de la información publicada sobre la hidrodinámica y la modelación matemática de la dinámica de fluidos en los tanques agitados con turbinas de disco con paletas planas y señalar los avances logrados en cada uno de los aspectos abordados y aquellos en los cuales es necesario seguir investigando.

  7. Terapia inmunosupresora en pacientes con Nefropatía Membranosa Idiopática

    Directory of Open Access Journals (Sweden)

    Giovanna Llerena García

    2009-04-01

    Full Text Available Objetivo: Evaluar la respuesta a la terapia combinada según el esquema de Ponticelli en pacientes con Nefropatía Membranosa (NM idiopática, en la tasa de remisión de la proteinuria, la tasa de filtración glomerular (TFG y la frecuencia de complicaciones. Material y métodos: Estudio observacional descriptivo tipo serie de casos en pacientes con NM idiopàtica durante los años 1995 - 2005 que recibieron terapia inmunosupresora, según esquema de Ponticelli. Se determinó la tasa de remisión de la proteinuria y la evolución de la TFG. Resultados: Diez pacientes con NM idiopática cumplieron los criterios de inclusión. La mitad de los casos tuvo remisión parcial (RP al finalizar la terapia; no hubo casos con remisión completa (RC. Al último control, 10% presentó RC y 70% RP. El 80% de los pacientes presentó efectos adversos. Conclusiones: Al finalizar la terapia inmunosupresora según esquema de Ponticelli, se evidencia reducción de la proteinuria (p>0,05, y remisión al último control (p < 0,05, probablemente asociado al uso de bloqueadores del eje renina-angiotensina-aldosterona. Los efectos adversos asociados a la terapia inmunosupresora son frecuentes, sin embargo ningún paciente descontinuó el tratamiento. (Rev Med Hered 2009;20:60-69.

  8. Toxicidade hepática é rara em pacientes com artrite reumatoide usando terapia combinada de leflunomida e metotrexato Liver toxicity is rare in rheumatoid arthritis patients using combination therapy with leflunomide and methotrexate

    Directory of Open Access Journals (Sweden)

    Jorge Augusto Nunes Rodrigues Alves

    2011-04-01

    Full Text Available OBJETIVO: De acordo com alguns estudos, a associação de leflunomida (LEF a pacientes portadores de artrite reumatoide não responsivos a metotrexato (MTX aumentou a eficácia do tratamento, elevando, porém, o risco de toxicidade hepática. Este estudo objetiva avaliar a incidência de toxicidade hepática no tratamento da artrite reumatoide ativa usando terapia combinada de LEF e MTX em comparação com monoterapia com MTX. MÉTODOS: Entre fevereiro e setembro de 2009, foram arrolados 97 pacientes consecutivos acompanhados pelo Hospital Universitário da Universidade Federal de Santa Catarina, Brasil. Pacientes com artrite reumatoide em uso de MTX somente ou em combinação com LEF tiveram seus prontuários sistematicamente revisados. As enzimas alanino/aspartato aminotransferases foram analisadas retrospectivamente desde o tratamento com MTX ou MTX mais LEF. Hepatotoxicidade foi definida como um aumento das enzimas hepáticas acima de duas vezes o limite superior da normalidade. RESULTADOS: 71 pacientes foram incluídos no estudo: 36,6% usavam 20-25 mg/semana de MTX e 63,4% usavam 20-25 mg/semana de MTX associado a 20 mg/ dia de LEF. Dos pacientes em terapia combinada, 11,1% tinham níveis anormais das enzimas hepáticas versus 11,5% daqueles em monoterapia (P = 1,0. Níveis anormais de aminotransferases têm sido observados em pacientes com artrite reumatoide tanto em monoterapia com MTX quanto com LEF. Em nosso estudo, não encontramos diferença entre as percentagens de elevação das aminotransferases em pacientes tratados somente com MTX ou com terapia combinada. CONCLUSÃO: A combinação de MTX e LEF em pacientes com artrite reumatoide é geralmente segura e bem tolerada.OBJECTIVE: Some studies have reported that adding leflunomide (LEF to the treatment of rheumatoid arthritis (RA in patients who do not respond to methotrexate (MTX improved efficacy but increased the risk of liver toxicity. This study aimed at assessing the incidence

  9. Eficacia de una intervención computerizada para mejorar la atención en un niño con TDAH

    OpenAIRE

    Molina, Jonatan; Martínez González, Agustín Ernesto

    2015-01-01

    El Trastorno por Déficit de Atención e Hiperactividad (TDAH) es uno de los problemas del comportamiento más prevalente en niños. En este estudio se evalúa una intervención dirigida a mejorar la inatención y la competencia lecto-escritora de un niño de 9 años con TDAH en presentación combinada. Para la evaluación se administró el test EMLE-TALE 2000, el EMAV y el test d2. Se aplicó el programa computerizado Fíjate y Concéntrate Más, que ha demostrado ser efectivo para mejorar la atención soste...

  10. Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients: results of a 1-year follow-up study from the CERERRA collaboration.

    NARCIS (Netherlands)

    Chatzidionysiou, K.; Lie, E.; Nasonov, E.; Lukina, G.; Hetland, M.L.; Tarp, U.; Riel, P.L.C.M. van; Nordstrom, D.C.; Gomez-Reino, J.; Pavelka, K.; Tomsic, M.; Kvien, T.K.; Vollenhoven, R.F. van; Gabay, C.

    2012-01-01

    OBJECTIVES: To compare the effectiveness and safety of rituximab alone or in combination with either methotrexate or leflunomide. METHODS: 10 European registries submitted anonymised datasets with baseline, 3, 6, 9 and 12-month clinical data from patients who started rituximab. RESULTS: 1195 patient

  11. Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients : results of a 1-year follow-up study from the CERERRA collaboration

    NARCIS (Netherlands)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny; Lukina, Galina; Hetland, Merete Lund; Tarp, Ulrik; van Riel, Piet L. C. M.; Nordstrom, Dan C.; Gomez-Reino, Juan; Pavelka, Karel; Tomsic, Matija; Kvien, Tore K.; van Vollenhoven, Ronald F.; Gabay, Cem

    2012-01-01

    Objectives To compare the effectiveness and safety of rituximab alone or in combination with either methotrexate or leflunomide. Methods 10 European registries submitted anonymised datasets with baseline, 3, 6, 9 and 12-month clinical data from patients who started rituximab. Results 1195 patients w

  12. Highest clinical effectiveness of rituximab in autoantibody-positive patients with rheumatoid arthritis and in those for whom no more than one previous TNF antagonist has failed: pooled data from 10 European registries

    DEFF Research Database (Denmark)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny;

    2011-01-01

    To assess the 6-month effectiveness of the first rituximab (RTX) course in rheumatoid arthritis (RA) and to identify possible predictors of response.......To assess the 6-month effectiveness of the first rituximab (RTX) course in rheumatoid arthritis (RA) and to identify possible predictors of response....

  13. Método simplex supermodificado como estratégia de otimização para respostas combinadas em sistemas alimentares The use of super-modified simplex as an optimisation strategy for combined responses in food systems

    Directory of Open Access Journals (Sweden)

    Rosângela Aguilar da SILVA

    2000-12-01

    Full Text Available O presente trabalho teve como objetivo combinar modelagem pela superfície de resposta com otimização simplex supermodificado, para tratamento de casos de interesse na ciência e tecnologia de alimentos, com o emprego da função de Derringer & Suich para respostas combinadas. Um programa para microinformática, denominado MULTIPLEX, foi desenvolvido e testado na otimização multirresposta de três sistemas alimentares selecionados na literatura especializada: 1 inativação da lipoxigenase e lipase preservando-se a atividade da fitase durante o processamento hidrotérmico da cevada; 2 desidratação instantânea de maçã por expansão; 3 extração da proteína da linhaça com hexametafosfato. Uma análise estatística rigorosa foi realizada para testar a capacidade preditiva dos modelos. O método simplex supermodificado, com inicialização automática, foi o instrumento para a solução numérica da função de Derringer & Suich para respostas combinadas. O programa desenvolvido mostrou ser eficiente e confiável para a otimização de multirrespostas, sendo executável em microcomputador que disponha de processador 486 e ambiente MS-DOS.The objective of this work was to combine response surface methodology (RSM with super-modified simplex optimisation for treatment of cases that are interesting for food science and technology through the application of the function of Derringer & Suich for combined responses. A microcomputer program called MULTIPLEX was developed and tested in the multiresponse optimisation of three food systems selected in specialised literature: 1 inactivated lipoxygenase and lipase and preserve phytase activity in barley during soaking; 2 vapor induced puffing in apple dehydration; 3 hexametaphosphate-assisted extraction of flaxseed protein. A rigorous statistics analysis was accomplished in order to test the predictive ability of the models. The super-modified simplex method with automatic initialisation was the

  14. Progressive multifocal leukoencephalopathy secondary to rituximab-induced immunosuppression and the presence of John Cunningham virus: a case report and literature review.

    Science.gov (United States)

    Kelly, Deirdre; Monaghan, Bernadette; McMahon, Eileen; Watson, Geoffrey; Kavanagh, Eoin; O'Rourke, Killian; McCaffrey, John; Carney, Desmond

    2016-09-01

    We present the case of a 60-year-old man who developed subacute neurologic changes, in the setting of stage III non-Hodgkin's follicular lymphoma, and was treated with induction chemotherapy, followed by a year of maintenance rituximab. Magnetic resonance imaging of the brain with gadolinium was pathognomonic for progressive multifocal leukoencephalopathy (PML). He was treated with sequential plasmapheresis and intravenous immunoglobulin with clinical improvement. A literature review of the diagnostic workup of rituximab-induced PML was undertaken. This case and the literature review demonstrate the important role of magnetic resonance imaging of the brain in diagnosis and follow-up of rituximab-induced PML. Specific radiologic features in combination with cerebrospinal fluid can be diagnostic and avoid the morbidity and mortality of a diagnostic brain biopsy. Plasmapheresis and intravenous immunoglobulin have a therapeutic role and demonstrate symptom improvement and disease control. Follow-up imaging in combination with clinical response is important in demonstrating a treatment response.

  15. Cyclophosphamide-refractory scleroderma-associated interstitial lung disease: remarkable clinical and radiological response to a single course of rituximab combined with high-dose corticosteroids.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2011-10-01

    We would like to report our experience of using rituximab in cyclophosphamide refractory, rapidly progressive interstitial lung disease (ILD) in a patient with limited scleroderma. A 40-year-old man presented with 10-week history of inflammatory polyarthritis, which responded to a short course of oral corticosteroids. However, 3 weeks later, he developed new onset of exertional dyspnoea. High-resolution CT of the thorax was suggestive of early ILD. Surgical lung biopsy showed features of fibrotic non-specific interstitial pneumonia. He was diagnosed with scleroderma on the basis of: presence of anticentromere antibodies, Raynaud\\'s phenomenon, pulmonary fibrosis, digital oedema and hypomotility along with a dilated oesophagus. He was treated aggressively with pulse doses of corticosteroids and cyclophosphamide; however, his ILD continued to deteriorate. At this stage, he received rituximab (two pulses of 1 g each), which led to a gradual clinical improvement. Now, 12 months since his rituximab infusion, he walks 2 miles daily without any exertional dyspnoea.

  16. Investigando con personas con dificultades de aprendizaje

    Directory of Open Access Journals (Sweden)

    Borja González Luna

    2013-12-01

    Full Text Available El artículo muestra los orígenes de lo que Walmsley (2008 denomina «investigación inclusiva». Para comprender qué se entiende por investigación inclusiva tenemos que remontarnos a los debates epistemológicos sobre las metodologías cuantitativas y cualitativas, acontecidos en la década de los 90, en torno a la revista Disability & Society. A partir de una síntesis de dichos debates, focalizados en el ámbito de la «discapacidad intelectual y del desarrollo», se exponen dos estrategias de colaboración con dicha población: a una aproximación etnográfica (de trabajo grupal, y b una aproximación biográfica (de trabajo individual. A continuación se esboza un posible diseño de trabajo de campo que intenta superar el paradigma cualitativo «clásico» con el objetivo de incluir a dicho colectivo más allá del rol de «sujetos de la investigación». Para finalizar se recoge el debate sobre la accesibilidad de los resultados de la investigación a los participantes en dichas investigaciones, y con ello la necesaria innovación en el ámbito de las «devoluciones» de los resultados, cuando se trata de incluir a personas que presentan limitaciones para la comprensión del lenguaje abstracto oral y/o escrito.

  17. Rituximab Extended Schedule or Re-Treatment Trial for Low–Tumor Burden Follicular Lymphoma: Eastern Cooperative Oncology Group Protocol E4402

    Science.gov (United States)

    Kahl, Brad S.; Hong, Fangxin; Williams, Michael E.; Gascoyne, Randy D.; Wagner, Lynne I.; Krauss, John C.; Habermann, Thomas M.; Swinnen, Lode J.; Schuster, Stephen J.; Peterson, Christopher G.; Sborov, Mark D.; Martin, S. Eric; Weiss, Matthias; Ehmann, W. Christopher; Horning, Sandra J.

    2014-01-01

    Purpose In low–tumor burden follicular lymphoma (FL), maintenance rituximab (MR) has been shown to improve progression-free survival when compared with observation. It is not known whether MR provides superior long-term disease control compared with re-treatment rituximab (RR) administered on an as-needed basis. E4402 (RESORT) was a randomized clinical trial designed to compare MR against RR. Patients and Methods Eligible patients with previously untreated low–tumor burden FL received four doses of rituximab, and responding patients were randomly assigned to either RR or MR. Patients receiving RR were eligible for re-treatment at each disease progression until treatment failure. Patients assigned to MR received a single dose of rituximab every 3 months until treatment failure. The primary end point was time to treatment failure. Secondary end points included time to first cytotoxic therapy, toxicity, and health-related quality of life (HRQOL). Results A total of 289 patients were randomly assigned to RR or MR. With a median follow-up of 4.5 years, the estimated median time to treatment failure was 3.9 years for patients receiving RR and 4.3 years for those receiving MR (P = .54). Three-year freedom from cytotoxic therapy was 84% for those receiving RR and 95% for those receiving MR (P = .03). The median number of rituximab doses was four patients receiving RR and 18 for those receiving MR. There was no difference in HRQOL. Grade 3 to 4 toxicities were infrequent in both arms. Conclusion In low–tumor burden FL, a re-treatment strategy uses less rituximab while providing disease control comparable to that achieved with a maintenance strategy. PMID:25154829

  18. A phase I-II trial of fludarabine, bendamustine and rituximab (FBR) in previously treated patients with CLL.

    Science.gov (United States)

    Jain, Nitin; Balakrishnan, Kumudha; Ferrajoli, Alessandra; O'Brien, Susan M; Burger, Jan A; Kadia, Tapan M; Cortes, Jorge E; Ayres, Mary L; Tambaro, Francesco Paolo; Keating, Michael J; Gandhi, Varsha; Wierda, William G

    2016-09-15

    Chemoimmunotherapy regimens have been the standard first-line therapy for patients with chronic lymphocytic leukemia (CLL). For young, fit patients the standard of care is combination of fludarabine, cyclophosphamide, and rituximab (FCR). Based on the preclinical work demonstrating that bendamustine combined with fludarabine resulted in increased DNA damage, we designed a phase I-II clinical trial with fludarabine, bendamustine, and rituximab (FBR) for patients with relapsed/refractory CLL. Treatment consisted of fludarabine 20 mg/m2 daily x 3 days and rituximab 375-500 mg/m2 x 1 day. Phase I included bendamustine at increasing doses of 20, 30, 40, or 50 mg/m2 daily x 3 days; phase II was with FR, and B at the selected dose. DNA damage response (H2AX phosphorylation) was evaluated in a subset of patients. Fifty-one patients were enrolled. The median age was 62 years; median number of prior therapies was 2; 40% had del(11q); and 41 patients had received prior FCR-based therapies. Hematologic toxicity was more common in ≥40 mg/m2 dose cohorts. Maximum tolerated dose (MTD) was not identified. Bendamustine-elicited H2AX phosphorylation was not dose-dependent, but markedly increased after fludarabine. We identified bendamustine 30 mg/m2 as the safe dose for phase II. The overall response rate (ORR) was 67% with 36% complete response (CR) / CR with incomplete count recovery (CRi). Younger patients (<65 years) had significantly higher ORR (81% vs. 50%; p=0.038). The median progression-free survival was 19 months, and the median overall survival was 52.5 months. FBR is an effective and tolerable CIT regimen for patients with relapsed CLL.

  19. Cholestatic liver disease after rituximab and adalimumab and the possible role of cross-reacting antibodies to Fab 2 fragments.

    Directory of Open Access Journals (Sweden)

    Joerg Latus

    Full Text Available BACKGROUND: Millions of patients are treated with therapeutic monoclonal antibodies (Tmabs for miscellaneous diseases. We investigated sera from six patients who received immune globulin, from one patient with refractory anti-neutrophil-cytoplasmic antibody (ANCA-associated granulomatosis with polyangiitis (GPA who developed two episodes of acute cholestatic liver disease, one after treatment with rituximab and a second after adalimumab and a healthy control group. METHODS: Three sera from the patient and six sera from patients who received immune globulin were analyzed for antibodies to rituximab and adalimumab by ELISA. Additionally, sera from the patients and from nine healthy blood donors were coated with the Fab fragment of an unrelated humanized monoclonal antibody, with human Fc proteins as well as a mouse IgG globulin. RESULTS: Viral serology for hepatitis A, B, C and autoantibodies specific for autoimmune liver disorders were negative. In all three sera from the patient antibodies to rituximab could be detected, but also antibodies to adalimumab were present even at time points when the patient had not yet received adalimumab, indicating cross reactivity between both substances. Testing against an unrelated human Fab fragment revealed positive results, indicating that the patient had antibodies against human Fab fragments in general. The Fc proteins were negative, and patients' sera did also not react with mouse IgG globulins. Remarkably, 2 out of 5 patients which were treated with immune globulin had antibodies against human Fab fragments in general whereas in none of the samples from healthy controls antibodies to Fab fragment could be detected. CONCLUSION: This is the first study demonstrating cholestatic liver disease induced by two different Tmabs. Cross - reacting antibodies to Fab2 fragments in general are probably involved. Further studies must show if these Fab2 antibodies in general are related with drug-induced side effects

  20. Successful treatment of autoimmune and lymphoproliferative complications of patients with intrinsic B-cell immunodeficiencies with Rituximab.

    Science.gov (United States)

    Hennig, Christian; Baumann, Ulrich; Ilginus, Claudia; Horneff, Gerd; Foell, Juergen; Hansen, Gesine

    2010-02-01

    The heterogeneous group of primary immunodeficiencies requires personalized diagnosis and therapy to acheive an optimal outcome for each patient. This was exemplified by two patients with intrinsic B-cell class-switch defects (subclass of Hyper-IgM syndromes), where lymphoproliferation and autoimmunity determined the clinical course for many years due to lack of exact diagnosis. Based on genetics or a novel functional diagnostic approach, a definite individual diagnosis was established for each patient and they started Rituximab therapy. Autoimmune phenomena and generalized lymphadenopathy disappeared and remained well controlled during the observation period (3-4 years) without adverse effects. Quality of life increased remarkably in both patients.

  1. Salmonella Enteritidis Empyema Preceding the Diagnosis of Non-Hodgkin’s Lymphoma and Subsequent Contralateral Chylothorax Treated with Radiolabeled Rituximab

    Directory of Open Access Journals (Sweden)

    Syed Ali

    2015-12-01

    Full Text Available Salmonella infection is common, but pleural involvement has rarely been reported. Only seven cases of Salmonella enteritidis pleural empyema have been reported; all had an associated preexisting underlying immunosuppresion or malignancy. We report the case of an apparently healthy man who developed S. enteritidis empyema. On further follow-up and surveillance, he eventually presented with non-Hodgkin’s lymphoma and a contralateral recurrent chylothorax. The latter was successfully controlled with radiolabeled rituximab, which has never been described for the above purpose in literature before.

  2. Successful treatment of severe myasthenia gravis developed after allogeneic hematopoietic stem cell transplantation with plasma exchange and rituximab.

    Science.gov (United States)

    Unal, Sule; Sag, Erdal; Kuskonmaz, Baris; Kesici, Selman; Bayrakci, Benan; Ayvaz, Deniz C; Tezcan, Ilhan; Yalnızoglu, Dilek; Uckan, Duygu

    2014-05-01

    Myasthenia gravis is among the rare complications after allogeneic hematopoietic stem cell transplantation and is usually associated with chronic GVHD. Herein, we report a 2-year and 10 months of age female with Griscelli syndrome, who developed severe myasthenia gravis at post-transplant +22nd month and required respiratory support with mechanical ventilation. She was unresponsive to cyclosporine A, methylprednisolone, intravenous immunoglobulin, and mycophenolate mofetil and the symptoms could only be controlled after plasma exchange and subsequent use of rituximab, in addition to cyclosporine A and mycophenolate mofetil maintenance. She is currently asymptomatic on the 6th month of follow-up.

  3. Myelosuppression After Frontline Fludarabine, Cyclophosphamide, and Rituximab in Patients With Chronic Lymphocytic Leukemia

    Science.gov (United States)

    Strati, Paolo; Wierda, William; Burger, Jan; Ferrajoli, Alessandra; Tam, Constantine; Lerner, Susan; Keating, Michael J.; O’Brien, Susan

    2015-01-01

    BACKGROUND The combination of fludarabine, cyclophosphamide, and rituximab (FCR) has produced improved response rates and a prolonged survival in patients with chronic lymphocytic leukemia (CLL). However, its therapeutic power is counterbalanced by significant hematologic toxicity. Persistent and new-onset cytopenia after the completion of FCR raise concern about disease recurrence, the development of therapy-related myeloid malignancies (TRMM), and infections. METHODS A total of 207 patients with CLL who achieved complete response, complete response with incomplete bone marrow recovery, or nodular partial remission were analyzed after frontline FCR therapy. RESULTS Three months after the completion of therapy, 35% of patients had developed grade 2 to 4 cytopenia (according to Common Terminology Criteria for Adverse Events [version 4.0]). Factors found to be associated with cytopenia at 3 months after therapy were older age, advanced Rai stage disease, and lower baseline blood counts. Moreover, patients with cytopenia were less likely to have completed 6 courses of therapy with FCR. At 6 months and 9 months after therapy, the prevalence of grade 2 to 4 cytopenia was 24% and 12%, respectively. No differences in progression-free survival and overall survival were noted between cytopenic and noncytopenic patients or between patients with persistent and new-onset cytopenia. The prevalence of TRMM was 2.3% and did not differ significantly between cytopenic and noncytopenic patients or between those with persistent and new-onset disease. Late infections were more common in patients who were cytopenic at 9 months (38%) and were mostly bacterial (67%). CONCLUSIONS Cytopenia after the completion of therapy is a common complication of frontline FCR that improves over time, particularly for new-onset cases. The presence of persistent cytopenia (lasting up to 9 months after the completion of therapy) should not raise concern about CLL recurrence of the development of TRMM, but

  4. Rituximab in systemic lupus erythematosus: an updated systematic review and meta-analysis.

    Science.gov (United States)

    Duxbury, B; Combescure, C; Chizzolini, C

    2013-12-01

    The wide spectrum of clinical manifestations and high relapse rate represent a therapeutic challenge in systemic lupus erythematosus (SLE). Observational studies suggested efficacy of rituximab (RTX), a B-cell-targeting antibody, to control the activity of SLE. Two randomized trials controlled by placebo did not prove the superiority of RTX when used in addition to conventional treatment in nonrenal (EXPLORER) and renal (LUNAR) lupus. A systematic review of studies exploring the efficacy of RTX in SLE patients was conducted. The pooled percentages of response were assessed. Thirty studies with 1243 patients were analyzed. In studies using the British Isles Lupus Assessment Group (BILAG), the complete response (CR) rate was 46.7% (95% CI 36.8%-56.8%) and the partial response (PR) was 37.9% (95% CI 30.6%-45.8%). With the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), the CR was 56.6% (95% CI 32.4%-78.1%) and the PR was 30.9% (95% CI 8.9%-46%). In renal lupus the CR was 36.1% (95% CI 25.2%-48.6%); PR was 37.4% (95% CI 28.5%-47.3%). In EXPLORER, CR was 12.4% and PR was 17.2%; in LUNAR CR was 26.4% and PR was 30.6%, in both cases not different from controls. Assessment and standardization of SLE response to treatment remain a challenge. The discrepancy in the perceived efficacy of RTX between controlled and observational studies reflects the heterogeneity of lupus and stringency in criteria of response. Further randomized trials focusing on selected SLE manifestations and using composite response indices are warranted.

  5. Protein A immunoadsorption combined with rituximab in highly sensitized kidney transplant recipients

    Institute of Scientific and Technical Information of China (English)

    YIN Hang; HU Xiao-peng; LI Xiao-bei; LIU Hang; WANG Wei; REN Liang; WANG Yong; ZHANG Xiao-dong

    2009-01-01

    Background The number of highly sensitized patients is rising, and sensitization can lead to renal transplant failure.The present study aimed to investigate the safety and efficacy of protein A immunoadsorption combined with rituximab (RTX) in highly sensitized recipients of kidney transplants.Methods Seven highly sensitized recipients of living-related renal transplants (4 men and 3 women, mean aged 42.5 years old (range 33-51)) were pretreated with this combination. Human leukocyte antigen (HLA) mismatch number was 2-5. Panel reactive antibody (PRA) of class 1 was high in 2 cases and that of class Ⅱ was high in 1 case. All patients were pretreated with immunoadsorption 2-10 times. Immunoglobulin and PRA changes were monitored before and after absorption. The operation was conducted when PRA or immunoglobulin levels were at or below normal levels.Immunosuppressive drugs were provided 3-5 days before the operation, and one dose of RTX (375 mg/m~2) was infused with polyclonal antibody on the day of operation. Postoperative creatinine (Cr), creatinine clearance rate (Ccr), PRA ratio,and immunoglobulin changes were monitored.Results All 7 patients had good recovery without delayed graft function. Acute rejection occurred in 3 cases at postoperative days 8, 10, and 14, respectively. The Banff 07 biopsy grades were la in 1 case and lla C4d0 in 2 cases.Successful reversion was achieved after giving methylprednisolone or antithymocyte immunoglobulin + cyclophosphamide. All patients were discharged with normal renal function, mean class 1 PRA was 14% and mean class Ⅱ PRA was 35%. PRA was completely negative in 3 cases.Conclusion Protein A immunoadsorption combined with RTX can safely reduce the occurrence of humoral rejection in highly sensitized renal transplant recipients.

  6. Benefit from B-lymphocyte depletion using the anti-CD20 antibody rituximab in chronic fatigue syndrome. A double-blind and placebo-controlled study.

    Directory of Open Access Journals (Sweden)

    Øystein Fluge

    Full Text Available BACKGROUND: Chronic fatigue syndrome (CFS is a disease of unknown aetiology. Major CFS symptom relief during cancer chemotherapy in a patient with synchronous CFS and lymphoma spurred a pilot study of B-lymphocyte depletion using the anti-CD20 antibody Rituximab, which demonstrated significant clinical response in three CFS patients. METHODS AND FINDINGS: In this double-blind, placebo-controlled phase II study (NCT00848692, 30 CFS patients were randomised to either Rituximab 500 mg/m(2 or saline, given twice two weeks apart, with follow-up for 12 months. Xenotropic murine leukemia virus-related virus (XMRV was not detected in any of the patients. The responses generally affected all CFS symptoms. Major or moderate overall response, defined as lasting improvements in self-reported Fatigue score during follow-up, was seen in 10 out of 15 patients (67% in the Rituximab group and in two out of 15 patients (13% in the Placebo group (p = 0.003. Mean response duration within the follow-up period for the 10 responders to Rituximab was 25 weeks (range 8-44. Four Rituximab patients had clinical response durations past the study period. General linear models for repeated measures of Fatigue scores during follow-up showed a significant interaction between time and intervention group (p = 0.018 for self-reported, and p = 0.024 for physician-assessed, with differences between the Rituximab and Placebo groups between 6-10 months after intervention. The primary end-point, defined as effect on self-reported Fatigue score 3 months after intervention, was negative. There were no serious adverse events. Two patients in the Rituximab group with pre-existing psoriasis experienced moderate psoriasis worsening. CONCLUSION: The delayed responses starting from 2-7 months after Rituximab treatment, in spite of rapid B-cell depletion, suggests that CFS is an autoimmune disease and may be consistent with the gradual elimination of autoantibodies preceding

  7. Cost-Effectiveness Analysis of Bendamustine Plus Rituximab as a First-Line Treatment for Patients with Follicular Lymphoma in Spain.

    Science.gov (United States)

    Sabater, Eliazar; López-Guillermo, Armando; Rueda, Antonio; Salar, Antonio; Oyagüez, Itziar; Collar, Juan Manuel

    2016-08-01

    Follicular lymphoma (FL) is the second most common type of lymphoid cancer in Western Europe. The aim of this study was to evaluate the cost utility of rituximab-bendamustine treatment compared with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) treatment as a first-line therapy for patients with advanced FL in Spain. A Markov model was developed to estimate the cost effectiveness of rituximab-bendamustine compared with R-CHOP as first-line treatment for patients with advanced FL in the Spanish National Health System (NHS). Transitions between health states (progression-free, including induction and maintenance; first relapse; second relapse; and death) were allowed for the patient cohort in 4-week-long cycles. Clinical data for the extrapolation of progression-free survival curves were obtained from randomized trials. Mortality rates and utilities were obtained from the literature. Outcomes were measured as quality-adjusted life-years (QALYs). The total costs (€, 2013) included drug costs (ex-factory prices with mandatory deductions), disease management costs and adverse event-associated costs. Costs and outcomes were discounted at a 3 % annual rate. Probabilistic sensitivity analysis was performed using 10,000 Monte Carlo simulations to assess the model robustness. Treatment and administration costs during the induction phase were higher for rituximab-bendamustine (€17,671) than for R-CHOP (€11,850). At the end of the 25-year period, the rituximab-bendamustine first-line strategy had a total cost of €68,357 compared with €69,528 for R-CHOP. Health benefits were higher for rituximab-bendamustine treatment (10.31 QALYs) than for R-CHOP treatment (9.82 QALYs). In the probabilistic analysis, rituximab-bendamustine was the dominant strategy over treatment with R-CHOP in 53.4 % of the simulations. First-line therapy with rituximab-bendamustine in FL patients was the dominant strategy over treatment with R-CHOP; it showed cost

  8. Lenalidomide-bendamustine-rituximab in untreated mantle cell lymphoma > 65 years, the Nordic Lymphoma Group phase I+II trial NLG-MCL4

    DEFF Research Database (Denmark)

    Albertsson-Lindblad, Alexandra; Kolstad, Arne; Laurell, Anna;

    2016-01-01

    For elderly patients with mantle cell lymphoma (MCL), there is no defined standard therapy. In this multicenter open-label phase I/II trial we evaluated the addition of lenalidomide (LEN) to rituximab-bendamustine (R-B) as first-line treatment to elderly MCL patients. Patients >65 years with untr......For elderly patients with mantle cell lymphoma (MCL), there is no defined standard therapy. In this multicenter open-label phase I/II trial we evaluated the addition of lenalidomide (LEN) to rituximab-bendamustine (R-B) as first-line treatment to elderly MCL patients. Patients >65 years...

  9. Alternativas para la selección masal y selección combinada de familias de medios hermanos en maíz Alternatives for mass selection and combined selection of half families in maize

    Directory of Open Access Journals (Sweden)

    Fidel Márquez Sánchez

    2011-04-01

    Full Text Available Se describen métodos alternativos para realizar la selección masal y familial en maíz. En la selección masal se busca disminuir la diferencia entre los efectos de interacción genético-ambiental entre plantas y se propone hacer la selección de las mejores mazorcas contiguas a lo largo del surco completo. En el método de selección combinada de familias de medios hermanos, si no se desespiga la endogamia derivada de la autofecundación no es afectada, lo cual significa un ahorro importante en el pago de mano de obra.In this work alternative methods to carry out bulk and family selection in corn are described. The aim of mass selection is to diminish difference among effects of genetic-environmental interaction between plants and it is proposed to make selection of the best contiguous ears along complete furrow. In the method of combined selection of half siblings families, if detasseling is not applied the derived endogamy of the self-fecundation is not affected, which means an important saving in manpower payment.

  10. Procesamiento cognitivo y valoración de las nuevas advertencias combinadas antitabaco propuestas por la Comisión Europea: estudio empírico en una muestra española

    Directory of Open Access Journals (Sweden)

    Antonio Crespo

    2007-01-01

    Full Text Available El tabaquismo es uno de los principales problemas de salud pública en la Unión Europea. La presencia de mensajes de advertencia en el empaquetado es una estrategia habitual para alertar sobre los riesgos asociados al consumo de tabaco. El objetivo de este trabajo fue valorar el nivel de activación emocional y la potencial utilidad de las nuevas advertencias antitabaco combinadas (texto y foto que la Comisión Europea ha propuesto para ser incluidas en los paquetes de tabaco. 106 participantes valoraron mediante una escala Likert el nivel de activación que les generaba cada una de las advertencias, así como su posible utilidad en una campaña antitabaco. Los datos obtenidos han permitido realizar una ordenación de las advertencias según los niveles de activación y de utilidad. Además, los resultados indicaron que las puntuaciones obtenidas por algunas advertencias estuvieron influenciadas por ciertos factores, tales como la presencia/ausencia del mensaje de texto que le acompaña, el hábito de fumar (fumadores vs. no fumadores y el sexo de los participantes. Finalmente, se descubrió una relación positiva entre activación emocional y utilidad. Tomados en conjunto, estos resultados pueden ayudar a elaborar directivas sanitarias más eficaces para la prevención del tabaquismo.

  11. en pacientes con obesidad

    Directory of Open Access Journals (Sweden)

    Alcia María Alvarado Sánchez

    2005-01-01

    Full Text Available El objetivo de este estudio fue evaluar la eficacia de una intervención psicológica en pacientes con obesidad. Se utilizó un diseño cuasiexperimental con un grupo de estudio y un grupo control. Después de la intervención, se encontró una diferencia significativa en la reducción de peso entre los grupos. Asimismo, hubo un incremento significativo en la autoestima del grupo estudiado.

  12. Soledad con espectador

    OpenAIRE

    2011-01-01

    Este proyecto se plantea como una investigación de las posibilidades del dibujo como una herramienta para relatar una historia propia que se empapa de realidad y de ficción con el deseo de confundir al espectador y suscitarle preguntas. Para ello me he servido de mi propia imagen como personaje central. Éste se presenta duplicado, multiplicado, repetido e interactúa consigo mismo en un espacio imaginario con intención de simular aquello que se revela en el interior de la psique. Mi trabajo se...

  13. Funcionando con la computadora

    OpenAIRE

    Álvarez, Eduardo; Astiz, Mercedes; Medina, Perla; Montero, Y.; Oliver, María; Rocerau, M. Cristina; VALDEZ, Guillermo; Vecino, María; Vilanova, Silvia

    2004-01-01

    En este trabajo se presenta la descripción y resultados de la segunda etapa de una experiencia planteada con el objetivo de indagar la manera en que los alumnos determinan e interpretan funciones que explican situaciones problemáticas valiéndose de una nueva forma de trabajo en el aula: la utilización de la computadora como herramienta y un programa asistente matemático. La primera etapa consistió en el desarrollo de un taller optativo con alumnos de entre 14 y 15 años de edad del Colegio Dr....

  14. Giochiamo con i robot

    Directory of Open Access Journals (Sweden)

    Andrea Bonarini

    2009-01-01

    Full Text Available "Giochiamo con i robot" e' un laboratorio interattivo per grandi e piccini realizzato per l'edizione 2007 del Festival della Scienza di Genova. Lungo un percorso che va dalla telerobotica alla robotica evolutiva, il laboratorio sviluppa il tema di dare intelligenza ai robot. Questo percorso, le cui tappe sono le varie installazioni, si conclude nella "bottega" dove e' possibile costruire e programmare i propri robot o smontare e modificare quelli esposti durante il percorso didattico. I visitatori sono coinvolti in attivita' ludiche grazie alle quali possonoentrare in contatto con alcune delle idee potenti della robotica,

  15. Glycoengineered CD20 antibody obinutuzumab activates neutrophils and mediates phagocytosis through CD16B more efficiently than rituximab.

    Science.gov (United States)

    Golay, Josée; Da Roit, Fabio; Bologna, Luca; Ferrara, Claudia; Leusen, Jeanette H; Rambaldi, Alessandro; Klein, Christian; Introna, Martino

    2013-11-14

    Obinutuzumab (GA101) is a glycoengineered type 2 CD20 antibody with enhanced CD16A-binding and natural killer-mediated cytotoxicity. CD16B is highly homologous to CD16A and a major FcγR on human polymorphonuclear neutrophils (PMNs). We show here that glycoengineered obinutuzumab or rituximab bound CD16B with approximately sevenfold higher affinity, compared with nonglycoengineered wild-type parental antibodies. Furthermore, glycoengineered obinutuzumab activated PMNs, either purified or in chronic lymphoblastic leukemia whole blood, more efficiently than wild-type rituximab. Activation resulted in a 50% increase in CD11b expression and 70% down-modulation of CD62L on neutrophils and in release of tumor necrosis factor alpha, IL-6, and IL-8. Activation was not accompanied by generation of reactive oxygen species or antibody-dependent cellular cytotoxicity activity, but led to up to 47% phagocytosis of glycoengineered anti-CD20 opsonized chronic lymphoblastic leukemia targets by purified PMNs. Significant phagocytosis was observed in whole blood, but only in the presence of glycoengineered antibodies, and was followed by up to 50% PMN death. Finally we show, using anti-CD16B and anti-CD32A Fab and F(ab')2 fragments, that both of these receptors are involved in PMN activation, phagocytosis, and cell death induced by glycoengineered antibodies. We conclude that phagocytosis by PMNs is an additional mechanism of action of obinutuzumab mediated through its higher binding affinity for CD16B.

  16. Low-dose rituximab in adult patients with idiopathic autoimmune hemolytic anemia: clinical efficacy and biologic studies.

    Science.gov (United States)

    Barcellini, Wilma; Zaja, Francesco; Zaninoni, Anna; Imperiali, Francesca Guia; Battista, Marta Lisa; Di Bona, Eros; Fattizzo, Bruno; Consonni, Dario; Cortelezzi, Agostino; Fanin, Renato; Zanella, Alberto

    2012-04-19

    This prospective study investigated the efficacy, safety, and response duration of low-dose rituximab (100 mg fixed dose for 4 weekly infusions) together with a short course of steroids as first- or second-line therapy in 23 patients with primary autoimmune hemolytic anemia (AIHA). The overall response was 82.6% at month +2, and subsequently stabilized to ∼ 90% at months +6 and +12; the response was better in warm autoimmune hemolytic anemia (WAIHA; overall response, 100% at all time points) than in cold hemagglutinin disease (CHD; average, 60%); the relapse-free survival was 100% for WAIHA at +6 and +12 months versus 89% and 59% in CHD, respectively, and the estimated relapse-free survival at 2 years was 81% and 40% for the warm and cold forms, respectively. The risk of relapse was higher in CHD and in patients with a longer interval between diagnosis and enrollment. Steroid administration was reduced both as cumulative dose (∼ 50%) and duration compared with the patient's past history. Treatment was well tolerated and no adverse events or infections were recorded; retreatment was also effective. The clinical response was correlated with amelioration biologic markers such as cytokine production (IFN-γ, IL-12, TNF-α, and IL-17), suggesting that low-dose rituximab exerts an immunomodulating activity. This study is registered at www.clinicaltrials.gov as NCT01345708.

  17. Rituximab in combination with high-dose methylprednisolone for the treatment of fludarabine refractory high-risk chronic lymphocytic leukemia

    Science.gov (United States)

    Castro, JE; Sandoval-Sus, JD; Bole, J; Rassenti, L; Kipps, TJ

    2017-01-01

    We examined the clinical response of fludarabine-refractory CLL patients treated with high-dose methylprednisolone (HDMP) and rituximab. Fourteen patients were treated with three cycles of rituximab (375mg/m2 weekly for 4 weeks) in combination with HDMP (1gm/m2 daily for 5 days). All patients were refractory to fludarabine and 86% had high-risk disease by the modified Rai classification. In all, 79% of the patients had CLL cells that expressed ZAP-70 and three patients had poor prognostic cytogenetics. The overall response rate was 93% and the complete remission rate was 36%. The median time-to-progression was 15 months and the median time-to-next treatment was 22 months. Median survival has not been reached after a median follow up of 40 months. Four patients have died of progressive disease. Patients tolerated the treatment well and serious adverse events were rare. This allowed patients to receive all planned treatments on schedule with no dose modifications. All but one patient responded to treatment and the overall survival and time-to-progression were superior to those of other published salvage regimens. PMID:18754025

  18. Rehabilitación Cognitiva en pacientes con Enfermedad de Alzheimer

    Directory of Open Access Journals (Sweden)

    Carlos José De los Reyes Aragón

    2012-01-01

    Full Text Available La enfermedad de Alzheimer (EA es una enfermedad crónica que se caracteriza por la presencia de síntomas cognitivos, problemas físicos y alteraciones emocionales y/o comportamentales. Actualmente más de 24 millones de personas en el mundo han sido diagnosticadascon EA, y se calcula que para 2040 el número será de 81 millones. El objetivo de este artículo es hacer una revisión detallada de las diferentes técnicas y/o tratamientos cognitivos que se han venido utilizando en la rehabilitación de las alteraciones cognitivas de personas con EA, así como de los estudios existentes que evalúan su eficacia. Los principales resultadosde la revisión evidencian la aplicación de tratamientos cognitivos mediante técnicas como estimulación cognitiva, aprendizaje sin error, recuperación espaciada, imaginería visual, desvanecimiento de pistas y ayudas externas. La mayoría de tratamientos revisados utilizaron técnicas de manera combinada, las cuales se implementaron en etapas iniciales de la EA; varios de los estudios revisados demostraron el mantenimiento a largo plazo de las ganancias obtenidas en algunos tratamientos.

  19. ESTUDIO SOBRE PASTAS Y MORTEROS DE CEMENTO PORTLAND CON REEMPLAZO POR LOZA SANITARIA

    Directory of Open Access Journals (Sweden)

    Silvina Zito

    2016-01-01

    Full Text Available En este trabajo se analiza el uso de Loza Sanitaria como reemplazo del cemento portland. Los reemplazos utilizados fueron 8, 24 y 40 % en peso; los ensayos empleados contemplaron la evolución de la hidratación desde los primeros minutos (hasta 48 horas a través de la calori metría , y a partir de los dos días (hasta 28 días por medio de la velocidad de fijación del hidróxido de calcio, el agua químicamente combinada, la resistencia mecánica a flexión y a compresión y la porosidad. Los resultados mostraron que a medida que aum enta el porcentaje de reemplazo, a las primeras edades d el efecto de dilución solapa y se contrapone con el de estimulación física ; y a la edad de 28 días todas las mezclas presentan además de la estimulación física también la química , por la reactividad puzolánica.

  20. Pacientes con leucemia linfática crónica (LLC) en primera linea o segunda línea (máximo de una línea de tratamiento previa) con necesidad de tratamiento. (En España, solo se incluirán pacientes en segunda línea). First line or second line (maximum of 1 line of previous treatment) patients with chronic lymphocytic leukemia (CLL) with need for treatment. | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available n fase IIIb de MabThera® (rituximab) agregado a quimioterápia, bendamustina o clorambucilo, en pacientes con leucemia...ical condition(s) being investigated Pacientes con leucemia linfática crónica (LL...las grandes B, síndrome de Richter o leucemia prolinfocítica de estirpe B [LPL])....iente tratamiento de la leucemia (TSTL), duración de la respuesta, supervivencia global (SG), respuesta mole... de enfermedad (SLE), supervivencia libre de eventos (SLEv), tiempo hasta el sigu

  1. Nephrotic syndrome; is rituximab the light at the end of the tunnel in the treatment of adult steroid-dependent minimal change disease and focal segmental glomerulosclerosis?

    Science.gov (United States)

    Kronbichler, Andreas; Mayer, Gert

    2014-01-01

    Implication for health policy/practice/research/medical education: Reports on patients with steroid-dependent nephrotic syndrome and underlying minimal change disease or focal segmental glomerulosclerosis have shown promising results. There is a strong need for more trials conducted in a prospective, controlled manner to clearly recommend rituximab therapy in this indication on a regular basis.

  2. Treatment of EBV-associated nodular sclerosing Hodgkin lymphoma in a patient with ataxia telangiectasia with brentuximab vedotin and reduced COPP plus rituximab.

    Science.gov (United States)

    Meister, Michael T; Voss, Sandra; Schwabe, Dirk

    2015-11-01

    Patients with ataxia telangiectasia (AT) with malignancies face poor prognosis due to increased treatment-related toxicity. Here, we report a 14-year-old male with AT and Hodgkin lymphoma (HL) who received brentuximab vedotin and reduced COPP plus rituximab courses. This treatment resulted in complete remission and showed no severe toxicity. © 2015 Wiley Periodicals, Inc.

  3. Rituximab plus fludarabine and cyclophosphamide prolongs progression-free survival compared with fludarabine and cyclophosphamide alone in previously treated chronic lymphocytic leukemia

    DEFF Research Database (Denmark)

    Robak, Tadeusz; Dmoszynska, Anna; Solal-Céligny, Philippe

    2010-01-01

    Rituximab, a monoclonal antibody that targets the CD20 cell surface antigen, has clinical activity in patients with non-Hodgkin's lymphoma and other B-lymphocyte disorders when administered alone or in combination with chemotherapy. Promising results have previously been reported in nonrandomized...

  4. B cell activation biomarkers as predictive factors for the response to rituximab in rheumatoid arthritis: a six-month, national, multicenter, open-label study.

    Science.gov (United States)

    Sellam, Jérémie; Hendel-Chavez, Houria; Rouanet, Stéphanie; Abbed, Karim; Combe, Bernard; Le Loët, Xavier; Tebib, Jacques; Sibilia, Jean; Taoufik, Yassine; Dougados, Maxime; Mariette, Xavier

    2011-04-01

    To examine whether serum B cell markers can predict response to rituximab, a B cell-depleting monoclonal antibody, in patients with refractory rheumatoid arthritis (RA). This rituximab re-treatment dose study (SMART [eSsai MAbthera sur la dose de Re-Traitement]) involved 208 patients with refractory RA. Serum markers of B cell activation (anti-cyclic citrullinated peptide [anti-CCP] antibodies, rheumatoid factor [RF], serum IgG, IgA, and IgM levels, serum κ and λ free light chains, and serum BAFF) were assessed before the first rituximab cycle (1,000 mg on days 1 and 15). Univariate and multivariate analyses were performed to identify factors associated with a European League Against Rheumatism (EULAR) response at 24 weeks. There were 149 responders (72%). Two baseline factors were associated with a EULAR response at 24 weeks in multivariate analysis: the presence of anti-CCP antibodies or RF (odds ratio 3.5 [95% confidence interval 1.6-7.6]) and a serum IgG concentration above normal (odds ratio 2.11 [95% confidence interval 1.02-4.33]), with synergy between them (odds ratio 6.0 [95% confidence interval 2.2-16.2]). The presence of RF or anti-CCP antibodies and elevated IgG are 2 simple biomarkers that can be used routinely before therapy to predict response to rituximab in patients with refractory RA. Copyright © 2011 by the American College of Rheumatology.

  5. Dynamic contrast-enhanced, extremity-dedicated MRI identifies synovitis changes in the follow-up of rheumatoid arthritis patients treated with rituximab

    DEFF Research Database (Denmark)

    Cimmino, Marco A; Parodi, Massimiliano; Zampogna, Giuseppe

    2014-01-01

    OBJECTIVES: The aim of this study is to assess prospectively the effect of rituximab (RTX) on MRI features of wrist joint disease in patients affected by rheumatoid arthritis (RA). METHODS: Ten patients (6F/4M, mean age 52.9±15.5 years) diagnosed with IgM rheumatoid factor, anti-CCP positive, RA ...

  6. B-cell depletion with rituximab in the treatment of autoimmune diseases. Graves' ophthalmopathy the latest addition to an expanding family

    DEFF Research Database (Denmark)

    Nielsen, Claus H; El Fassi, Daniel; Hasselbalch, Hans K;

    2007-01-01

    In this review, the authors summarise the clinical results obtained after therapy with rituximab in autoimmune diseases, including Graves' disease and Graves' ophthalmopathy. On the basis of qualitative and quantitative analyses of B- and T-cell subsets, and autoantibody levels obtained in other...

  7. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial.

    Science.gov (United States)

    Chihara, Dai; Kantarjian, Hagop; O'Brien, Susan; Jorgensen, Jeffrey; Pierce, Sherry; Faderl, Stefan; Ferrajoli, Alessandra; Poku, Rebecca; Jain, Preetesh; Thompson, Phillip; Brandt, Mark; Luthra, Rajyalakshmi; Burger, Jan; Keating, Michael; Ravandi, Farhad

    2016-09-01

    Nucleoside analogues are highly active in patients with hairy cell leukaemia (HCL); however, patients continue to relapse. This phase II study evaluated the efficacy and safety of cladribine followed by rituximab in patients with untreated HCL (N = 59), relapsed HCL (N = 14) and HCL variant (HCLv, N = 7). Cladribine 5·6 mg/m(2) was given intravenously (IV) daily for 5 d and was followed approximately 1 month later with rituximab 375 mg/m(2) IV weekly for 8 weeks. Complete response rate in patients with untreated HCL, relapsed HCL and HCLv was 100%, 100% and 86%, respectively. With a median follow up of 60 months, 5-year failure-free survival (FFS) in patients with untreated HCL, relapsed HCL and HCLv was 95%, 100% and 64%, respectively. Median duration of response to the cladribine followed by rituximab was significantly longer than the first-line cladribine single agent in patients who received this treatment as second-line treatment (72 months vs not reached, P = 0·004). Almost all patients (94%) achieved negative minimal residual disease (MRD) after the treatment. Positive MRD during the follow up did not necessarily result in clinically relevant relapse. Cladribine followed by rituximab is highly effective even in patients with relapsed disease and HCLv, and can achieve durable remission.

  8. [Development of syndrome of inappropriate secretion of ADH and reversible posterior leukoencephalopathy during initial rituximab-CHOP therapy in a patient with diffuse large B-cell lymphoma].

    Science.gov (United States)

    Mizutani, Minoru; Nakamori, Yoshiki; Sakaguchi, Haruna; Kageyama, Yuki; Oya, Eiko; Ino, Kazuko; Suzuki, Kei; Sekine, Takao

    2013-03-01

    A 61-year-old woman presented with a right mandibular tumor and was diagnosed with DLBCL clinical stage IIIA from the biopsy results of the tumor and CT examination. An initial rituximab was administrated a week after the first CHOP treatment. During the infusion of rituximab, she exhibited disorientation, seizure, and consciousness disturbance. Hyponatremia due to SIADH and hypertension were coincidentally observed. MRI revealed T2 and FLAIR hyperintense signals involving the bilateral occipital, parietal, frontal lobes and the cerebellum that were consistent with reversible posterior leukoencephalopathy syndrome (RPLS). Her consciousness level recovered in parallel with corrections in serum sodium levels and blood pressure. Although she presented with transient cortical blindness, all neurological abnormalities disappeared 40 hours after the occurrence of seizure. She received a further 7 cycles of CHOP followed by 7 cycles of rituximab treatment with no relapse of RPLS. After irradiation for a residual abdominal tumor, she has maintained complete remission for 2 years. Although RPLS is a rare complication of rituximab-CHOP chemotherapy, it should be considered in patients with DLBCL who present with acute neurological deterioration.

  9. Follicular lymphoma: in vitro effects of combining lymphokine-activated killer (LAK) cell-induced cytotoxicity and rituximab- and obinutuzumab-dependent cellular cytotoxicity (ADCC) activity.

    Science.gov (United States)

    García-Muñoz, Ricardo; López-Díaz-de-Cerio, Ascensión; Feliu, Jesus; Panizo, Angel; Giraldo, Pilar; Rodríguez-Calvillo, Mercedes; Grande, Carlos; Pena, Esther; Olave, Mayte; Panizo, Carlos; Inogés, Susana

    2016-04-01

    Follicular lymphoma (FL) is a disease of paradoxes-incurable but with a long natural history. We hypothesized that a combination of lymphokine-activated killer (LAK) cells and monoclonal antibodies might provide a robust synergistic treatment and tested this hypothesis in a phase II clinical trial (NCT01329354). In this trial, in addition to R-CHOP, we alternated the administration of only rituximab with rituximab and autologous LAK cells that were expanded ex vivo. Our objective was to determine the in vitro capability of LAK cells generated from FL patients to produce cytotoxicity against tumor cell lines and to determine rituximab- and obinutuzumab-induced cytotoxicity via antibody-dependent cellular cytotoxicity (ADCC) activity. We analyzed the LAK cell-induced cytotoxicity and rituximab (R)- and obinutuzumab (GA101)-induced ADCC activity. We show that LAK cells generated from FL patients induce cytotoxicity against tumor cell lines. R and GA101 enhance cytolysis through ADCC activity of LAK cells. Impaired LAK cell cytotoxicity and ADCC activity were detected in 50 % of patients. Percentage of NK cells in LAK infusions were correlated with the R- and GA101-induced ADCC. Our results indicate that the combination of R or GA101 and LAK cells should be an option as frontline maintenance therapy in patients with FL.

  10. Neutralization of (NK-cell-derived) B-cell activating factor by Belimumab restores sensitivity of chronic lymphoid leukemia cells to direct and Rituximab-induced NK lysis.

    Science.gov (United States)

    Wild, J; Schmiedel, B J; Maurer, A; Raab, S; Prokop, L; Stevanović, S; Dörfel, D; Schneider, P; Salih, H R

    2015-08-01

    Natural killer (NK) cells are cytotoxic lymphocytes that substantially contribute to the therapeutic benefit of antitumor antibodies like Rituximab, a crucial component in the treatment of B-cell malignancies. In chronic lymphocytic leukemia (CLL), the ability of NK cells to lyse the malignant cells and to mediate antibody-dependent cellular cytotoxicity upon Fc receptor stimulation is compromised, but the underlying mechanisms are largely unclear. We report here that NK-cells activation-dependently produce the tumor necrosis factor family member 'B-cell activating factor' (BAFF) in soluble form with no detectable surface expression, also in response to Fc receptor triggering by therapeutic CD20-antibodies. BAFF in turn enhanced the metabolic activity of primary CLL cells and impaired direct and Rituximab-induced lysis of CLL cells without affecting NK reactivity per se. The neutralizing BAFF antibody Belimumab, which is approved for treatment of systemic lupus erythematosus, prevented the effects of BAFF on the metabolism of CLL cells and restored their susceptibility to direct and Rituximab-induced NK-cell killing in allogeneic and autologous experimental systems. Our findings unravel the involvement of BAFF in the resistance of CLL cells to NK-cell antitumor immunity and Rituximab treatment and point to a benefit of combinatory approaches employing BAFF-neutralizing drugs in B-cell malignancies.

  11. Early Failure of Frontline Rituximab-Containing Chemo-immunotherapy in Diffuse Large B Cell Lymphoma Does Not Predict Futility of Autologous Hematopoietic Cell Transplantation

    NARCIS (Netherlands)

    Hamadani, Mehdi; Hari, Parameswaran N.; Zhang, Ying; Carreras, Jeanette; Akpek, G??rg??n; Aljurf, Mahmoud D.; Ayala, Ernesto; Bachanova, Veronika; Chen, Andy I.; Chen, Yi Bin; Costa, Luciano J.; Fenske, Timothy S.; Freytes, C??sar O.; Ganguly, Siddhartha; Hertzberg, Mark S.; Holmberg, Leona A.; Inwards, David J.; Kamble, Rammurti T.; Kanfer, Edward J.; Lazarus, Hillard M.; Marks, David I.; Nishihori, Taiga; Olsson, Richard; Reddy, Nishitha M.; Rizzieri, David A.; Savani, Bipin N.; Solh, Melhem; Vose, Julie M.; Wirk, Baldeep; Maloney, David G.; Smith, Sonali M.; Montoto, Silvia; Saber, Wael

    2014-01-01

    The poor prognosis for patients with diffuse large Bcell lymphoma (DLBCL) who relapse within 1year of initial diagnosis after first-line rituximab-based chemo-immunotherapy has created controversy about the role of autologous transplantation (HCT) in this setting. We compared autologous HCT outcomes

  12. Rituximab plus fludarabine and cyclophosphamide prolongs progression-free survival compared with fludarabine and cyclophosphamide alone in previously treated chronic lymphocytic leukemia

    DEFF Research Database (Denmark)

    Robak, Tadeusz; Dmoszynska, Anna; Solal-Céligny, Philippe;

    2010-01-01

    Rituximab, a monoclonal antibody that targets the CD20 cell surface antigen, has clinical activity in patients with non-Hodgkin's lymphoma and other B-lymphocyte disorders when administered alone or in combination with chemotherapy. Promising results have previously been reported in nonrandomized...

  13. Rituximab improves the treatment results of DHAP-VIM-DHAP and ASCT in relapsed/progressive aggressive CD20+ NHL: A prospective randomized HOVON trial

    NARCIS (Netherlands)

    E. Vellenga (Edo); W.L.J. van Putten (Wim); M.B. van 't Veer (Mars); J.M. Zijlstra (Josée); W.E. Fibbe (Willem); M.H.J. van Oers (Marinus); L.F. Verdonck (Leo); P.W. Wijermans (Pierre); G. van Imhoff (Gustaaf); P.J. Lugtenburg (Pieternella); P.C. Huijgens (Peter)

    2008-01-01

    textabstractWe evaluated the role of rituximab during remission induction chemotherapy in relapsed aggressive CD20+non-Hodgkin lymphoma. Of 239 patients, 225 were evaluable for analysis. Randomized to DHAP (cisplatin-cytarabine- dexamethasone)-VIM (etoposide-ifosfamide-methotrexate)-DHAP (cisplatin-

  14. Rituximab improves the treatment results of DHAP-VIM-DHAP and ASCT in relapsed/progressive aggressive CD20(+) NHL : a prospective randomized HOVON trial

    NARCIS (Netherlands)

    Vellenga, Edo; van Putten, Wim L. J.; van't Veer, Mars B.; Zijlstra, Josee M.; Fibbe, Willem E.; van Oers, Marinus H. J.; Verdonck, Leo F.; Wijermans, Pierre W.; van Imhoff, Gustaaf W.; Lugtenburg, Pieternella J.; Huijgens, Peter C.

    2008-01-01

    We evaluated the role of rituximab during remission induction chemotherapy in relapsed aggressive CD20(+) non-Hodgkin lymphoma. Of 239 patients, 225 were evaluable for analysis. Randomized to DHAP (cisplatin-cytarabine-dexamethasone)-VIM (etoposide-ifosfamide-methotrexate)-DHAP (cisplatin-cytarabine

  15. An approach for conjugation of 177 Lu- DOTA-SCN- Rituximab (BioSim & its evaluation for radioimmunotherapy of relapsed & refractory B-cell non Hodgkins lymphoma patients

    Directory of Open Access Journals (Sweden)

    Parul Thakral

    2014-01-01

    Interpretation & conclusions: A favourable radiochemical purity, stability and biodistribution of the radiolabelled immunoconjugate indicate that clinical trials for evaluation of toxicity and efficacy of 177 Lu-DOTA-antiCD20 antibody-Rituximab (BioSim in patients of relapsed and refractory non Hodgkin′s lymphoma can be considered.

  16. Addition of rituximab to chemotherapy overcomes the negative prognostic impact of cyclin E expression in diffuse large B-cell lymphoma

    DEFF Research Database (Denmark)

    Frei, E; Visco, C; Xu-Monette, Z Y;

    2013-01-01

    High levels of cyclin E (CCNE) are accompanied by shorter survival in cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (CHOP)-treated diffuse large B-cell lymphomas (DLBCL), independent of the international prognostic index (IPI). Data on the prognostic role of CCNE in the 'rituximab...

  17. Combination therapy with rituximab and cyclophosphamide in the treatment of anti-neutrophil cytoplasmic antibodies (ANCA positive pulmonary hemorrhage: case report

    Directory of Open Access Journals (Sweden)

    Lehman Thomas JA

    2011-10-01

    Full Text Available Abstract Anti-neutrophil cytoplasmic antibody (ANCA-associated vasculitis (AAV with pulmonary hemorrhage is rare in childhood. Standard treatment includes corticosteroids and cyclophosphamide (CYC, which is associated with a high level of toxicity. We report a white female with ANCA positive pulmonary hemorrhage who was treated with cyclophosphamide (CYC and rituximab (RTX combination therapy.

  18. Budget impact analysis of the use of rituximab in the treatment of rheumatoid arthritis in Italy

    Directory of Open Access Journals (Sweden)

    Maurizio Benucci

    2009-01-01

    Full Text Available Objective: a Budget Impact analysis was performed to evaluate cost implications for the Italian National Health Service (NHS of the introduction of rituximab (RTX in the treatment of rheumatoid arthritis (RA. Methods: RA patients eligible to treatment with a second-line biologic DMARD (Disease Modifying Antirheumatic Drugs were identified and quantified and available strategies for their management were explored. Costs associated with the different alternatives were estimated, and the impact on the NHS budget was estimated using a cohort simulation based on a Markov chain with a time horizon of 5 years and 1-year cycles. Seven alternative strategies were analyzed, each of them starting after the failure of a first anti-TNFα: 1 the use of a second and a third anti-TNFα; 2 the use of a second anti-TNFα followed by RTX; 3 the use of a second anti-TNFα followed by abatacept (ABAT; 4 the use of RTX as a second biological line, followed by an anti-TNFα; 5 the use of ABAT as a second biological line, followed by an anti-TNFα; 6 the use of RTX as a second biological line, followed by ABAT; 7 the use of ABAT as a second biological line, followed by RTX. Only direct medical costs were considered: drug acquisition, administration, incidental premedication and monitoring exams. Results: Italian patients eligible to second biological line therapies (RA patients refractory or intolerant to at least one anti-TNFα therapy were estimated in about 650 per year. The adoption of RTX as a second line therapy produced a substantial saving in total costs (-33% at the fifth year with respect to the strategy with RTX as third line and the one with only anti-TNFα (the last two resulting substantially cost-equivalent. The number of patients in active treatment (biologic DMARD per unit cost resulted of about 8.1 patient-years/100,000 € with the strategy based only on anti-TNFα and increased of 10% with RTX as a third line. The strategy of RTX as a second line

  19. fertilizada con diferentes abonos

    Directory of Open Access Journals (Sweden)

    Jorge Alberto Elizondo-Salazar

    2007-01-01

    Full Text Available Producción y calidad de la biomasa de morera (Morus alba fertilizada con diferentes abonos. Se llevó a cabo un experimento en la Estación Experimental “Alfredo Volio Mata” de la Universidad de Costa Rica con el fi n de evaluar la aplicación de 150 kg de N/ha/año proveniente de dos abonos orgánicos: lombriabono y compostaje; y de un fertilizante químico, sobre la producción y calidad de la biomasa de morera. El periodo experimental comprendió un ciclo de 12 meses, iniciando en julio del 2003 y fi nalizando en julio del 2004. Se utilizó una plantación de morera de 12 años de establecida con una densidad de siembra de 27.777 plantas/ ha. Se empleó un diseño de bloques completos al azar con cuatro tratamientos: dos abonos orgánicos, nitrato de amonio (33,5% N y un control. Las plantas se podaron a 0,6 m sobre el nivel del suelo al inicio del ensayo. Durante el periodo experimental, las plantas fueron podadas consecutivamente cada 90 días. Las hojas y los tallos fueron separados y analizados para determinar el contenido de materia seca y proteína cruda. La producción de materia seca fue 23% superior y el contenido de proteína cruda fue signifi cativamente mayor con el nitrógeno químico, mientras que el contenido de materia seca fue menor. No se encontraron diferencias signifi cativas entre el tratamiento control y los tratamientos orgánicos.

  20. INCREMENTOS EN LOS RENDIMIENTOS DEL CULTIVO DE BONIATO POR LA UTILIZACIÓN COMBINADA DEL FITOESTIMULANTE FITOMAS-E Y EL BIOFERTILIZANTE ECOMIC® EN CONDICIONES DE PRODUCCIÓN

    Directory of Open Access Journals (Sweden)

    L. R. Fundora

    2009-01-01

    en comparación con el testigo. Con este trabajo se demostró, de forma general, que la aplicación conjunta del fitoestimulante FitoMas-E combinado con una cepa eficiente de HMA y el 50 % de la fertilización mineral con NPK, incrementan el desarrollo y los rendimientos de este cultivo en condiciones de producción.

  1. High treatment efficacy by dual targeting of Burkitt's lymphoma xenografted mice with a {sup 177}Lu-based CD22-specific radioimmunoconjugate and rituximab

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Tobias; Boetticher, Benedikt; Keller, Armin; Schlegelmilch, Anne; Jaeger, Dirk; Krauss, Juergen [Heidelberg University Hospital, Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg (Germany); Mier, Walter; Kraemer, Susanne; Leotta, Karin [Heidelberg University Hospital, Department of Nuclear Medicine, Heidelberg (Germany); Sauter, Max; Haberkorn, Uwe [Heidelberg University Hospital, Department of Nuclear Medicine, Heidelberg (Germany); German Cancer Research Center (DKFZ), Clinical Cooperation Unit Nuclear Medicine, Heidelberg (Germany); Grosse-Hovest, Ludger [University of Tuebingen, Department of Immunology, Tuebingen (Germany); Arndt, Michaela A.E. [Heidelberg University Hospital, Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg (Germany); German Cancer Research Center (DKFZ), Immunotherapy Program, National Center for Tumor Diseases, Heidelberg (Germany)

    2016-03-15

    Dual-targeted therapy has been shown to be a promising treatment option in recurrent and/or refractory B-cell non-Hodgkin's lymphoma (B-NHL). We generated radioimmunoconjugates (RICs) comprising either a novel humanized anti-CD22 monoclonal antibody, huRFB4, or rituximab, and the low-energy β-emitter {sup 177}Lu. Both RICs were evaluated as single agents in a human Burkitt's lymphoma xenograft mouse model. To increase the therapeutic efficacy of the anti-CD22 RIC, combination therapy with unlabelled anti-CD20 rituximab was explored. The binding activity of CHX-A''-DTPA-conjugated antibodies to target cells was analysed by flow cytometry. To assess tumour targeting of {sup 177}Lu-labelled antibodies, in vivo biodistribution experiments were performed. For radioimmunotherapy (RIT) studies, non-obese diabetic recombination activating gene-1 (NOD-Rag1{sup null}) interleukin-2 receptor common gamma chain (IL2r γ {sup null}) null mice (NRG mice) were xenografted subcutaneously with Raji Burkitt's lymphoma cells. {sup 177}Lu-conjugated antibodies were administered at a single dose of 9.5 MBq per mouse. For dual-targeted therapy, rituximab was injected at weekly intervals (0.5 - 1.0 mg). Tumour accumulation of RICs was monitored by planar scintigraphy. Conjugation of CHX-A''-DTPA resulted in highly stable RICs with excellent antigen-binding properties. Biodistribution experiments revealed higher tumour uptake of the {sup 177}Lu-labelled anti-CD22 IgG than of {sup 177}Lu-labelled rituximab. Treatment with {sup 177}Lu-conjugated huRFB4 resulted in increased tumour growth inhibition and significantly longer survival than treatment with {sup 177}Lu-conjugated rituximab. The therapeutic efficacy of the anti-CD22 RIC could be markedly enhanced by combination with unlabelled rituximab. These findings suggest that dual targeting with {sup 177}Lu-based CD22-specific RIT in combination with rituximab is a promising new treatment option for

  2. Formulaciones con combinación de ingredientes activos para el control de Armadillidium vulgare (Crustacea: Isopoda, plaga en el cultivo de colza

    Directory of Open Access Journals (Sweden)

    LÓPEZ, A.N.

    2012-04-01

    Full Text Available ResumenLa colza (Brassica napus, B. campestris en siembra directa (SD representa una alternativa en los sistemas de rotación actuales. Armadillidium vulgare es una de las plagas principales de los cultivos en SD. El objetivo de este trabajo fue evaluar cebos de acción combinada como estrategia alternativa de control de dicha especie.Se realizaron ensayos de laboratorio y de campo con los siguientes tratamientos: testigo sin tratamiento químico; testigo químico (4 kg/ha de Carbaryl 8%, MataBiBos Acay; 3, 4 y 5 kg/ha de cebo de acción combinada (Carbaryl 8% + Metaldehído 4%, Dual Acay. Se evaluó el número de individuos de A. vulgare muertos, de plantas dañadas y de plantas sanas. En el laboratorio, a los 2, 3, 7 y 9 días después de la aplicación de los cebos, los tratamientos químicos se diferenciaron del testigo y no mostraron diferencias significativas entre ellos. Los tratamientos con aplicaciones de cebos presentaron un número de plantas sanas y totales mayorcon respecto al testigo. En el campo, se detectaron diferencias en el número de individuos muertos entre los tratamientos químicos y el testigo. No se observaron diferencias en la proporción de individuos muertos ni de plantas dañadas entre los tratamiento químicos, sí respecto al testigo. La presencia del molusquicida en el cebo de acción combinada no interfirió en el control de A. vulgare. Se concluye que el cebo de acción combinada representa una alternativa de control de A. vulgare eficaz, que permite la protección del cultivo de colza. AbstractOilseed rape (Brassica napus, B. campestris under No-Tillage (NT represents an alternative in the current crop rotation systems. Armadillidium vulgare is a principal pest in crops under NT. The aim of this study was to evaluate combined action baits as alternative strategy in the control of that species. Laboratory and fields traits were carried out with five treatments: control treatment without chemicals, positive

  3. Chemoimmunotherapy With a Modified Hyper-CVAD and Rituximab Regimen Improves Outcome in De Novo Philadelphia Chromosome–Negative Precursor B-Lineage Acute Lymphoblastic Leukemia

    Science.gov (United States)

    Thomas, Deborah A.; O'Brien, Susan; Faderl, Stefan; Garcia-Manero, Guillermo; Ferrajoli, Alessandra; Wierda, William; Ravandi, Farhad; Verstovsek, Srdan; Jorgensen, Jeffrey L.; Bueso-Ramos, Carlos; Andreeff, Michael; Pierce, Sherry; Garris, Rebecca; Keating, Michael J.; Cortes, Jorge; Kantarjian, Hagop M.

    2010-01-01

    Purpose The adverse prognosis of CD20 expression in adults with de novo precursor B-lineage acute lymphoblastic leukemia (ALL) prompted incorporation of monoclonal antibody therapy with rituximab into the intensive chemotherapy regimen hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone). Other modifications (irrespective of CD20 expression) included early anthracycline intensification, alterations in number of risk-adapted intrathecal chemotherapy treatments for CNS prophylaxis, additional early and late intensifications, and extension of maintenance phase chemotherapy by 6 months. Patients and Methods Two hundred eighty-two adolescents and adults with de novo Philadelphia chromosome (Ph)–negative precursor B-lineage ALL were treated with standard or modified hyper-CVAD regimens. The latter incorporated standard-dose rituximab if CD20 expression ≥ 20%. Results The complete remission (CR) rate was 95% with 3-year rates of CR duration (CRD) and survival (OS) of 60% and 50%, respectively. In the younger (age hyper-CVAD and rituximab regimens compared with standard hyper-CVAD (70% v 38%; P hyper-CVAD regimens were similar (72% v 68%, P = not significant [NS] and 64% v 65%, P = NS, respectively). Older patients with CD20-positive ALL did not benefit from rituximab-based chemoimmunotherapy (rates of CRD 45% v 50%, P = NS and OS 28% v 32%, P = NS, respectively), related in part to deaths in CR. Conclusion The incorporation of rituximab into the hyper-CVAD regimen appears to improve outcome for younger patients with CD20-positive Ph-negative precursor B-lineage ALL. PMID:20660823

  4. Activatory and inhibitory Fcγ receptors augment rituximab-mediated internalization of CD20 independent of signaling via the cytoplasmic domain.

    Science.gov (United States)

    Vaughan, Andrew T; Chan, Claude H T; Klein, Christian; Glennie, Martin J; Beers, Stephen A; Cragg, Mark S

    2015-02-27

    Type I anti-CD20 mAb such as rituximab and ofatumumab engage with the inhibitory FcγR, FcγRIIb on the surface of B cells, resulting in immunoreceptor tyrosine-based inhibitory motif (ITIM) phosphorylation. Internalization of the CD20·mAb·FcγRIIb complex follows, the rate of which correlates with FcγRIIb expression. In contrast, although type II anti-CD20 mAb such as tositumomab and obinutuzumab also interact with and activate FcγRIIb, this interaction fails to augment the rate of CD20·mAb internalization, raising the question of whether ITIM phosphorylation plays any role in this process. We have assessed the molecular requirements for the internalization process and demonstrate that in contrast to internalization of IgG immune complexes, FcγRIIb-augmented internalization of rituximab-ligated CD20 occurs independently of the FcγRIIb ITIM, indicating that signaling downstream of FcγRIIb is not required. In transfected cells, activatory FcγRI, FcγRIIa, and FcγRIIIa augmented internalization of rituximab-ligated CD20 in a similar manner. However, FcγRIIa mediated a slower rate of internalization than cells expressing equivalent levels of the highly homologous FcγRIIb. The difference was maintained in cells expressing FcγRIIa and FcγRIIb lacking cytoplasmic domains and in which the transmembrane domains had been exchanged. This difference may be due to increased degradation of FcγRIIa, which traffics to lysosomes independently of rituximab. We conclude that the cytoplasmic domain of FcγR is not required for promoting internalization of rituximab-ligated CD20. Instead, we propose that FcγR provides a structural role in augmenting endocytosis that differs from that employed during the endocytosis of immune complexes.

  5. Lipidic profile among rats submitted to total splenectomy isolated or combined with splenic autotransplant Perfil lipídico em ratos submetidos a esplenectomia total isolada ou combinada com auto-implante esplênico

    Directory of Open Access Journals (Sweden)

    Fernanda Correia Simões

    2007-01-01

    Full Text Available PURPOSE: To evaluate the alterations on plasmatic lipids levels among rats submitted to total splenectomy isolated or combined with splenic autotransplant receiving standard chow during the postoperative period. METHODS: Thirty Wistar rats were divided into three groups: control (C - sham-operated, total splenectomy - isolated (TS or combined with splenic autotransplantation (SA. Since the postoperative period, all animals received standard rat chow manipulated in accordance to the American Institute of Nutrition Rodents Diets (1993. The plasmatic levels of total cholesterol (TC, triglycerides (TG, high-density lipoprotein (HDL, low-density lipoprotein (LDL, very-low-density lipoprotein (VLDL, and glucose (GLUC were analyzed before the surgical procedure and after 6 and 12 weeks. RESULTS: All the animals presented significant increase of TG and VLDL levels. In relation to the other parameters there was no difference among the weeks 0 and 12 in the animals of group C. In TS group significant increase was observed in TC and GLUC levels during the experiment. In SA group TC, HDL, and GLUC levels remained unaffected while HDL levels increased. CONCLUSION: Our findings suggest that isolated total splenectomy alters lipids metabolism in rats fed with standard chow and splenic autotransplantation is effective in restoring its control.OBJETIVO: Avaliar as alterações nos níveis de lipídios plasmáticos em ratos submetidos a esplenectomia total isolada ou combinada com auto-implante esplênico, recebendo dieta padrão no período pós-operatório. MÉTODOS: Trinta ratos Wistar foram distribuídos em três grupos: controle (C - operação simulada, esplenectomia total isolada (ET ou combinada com auto-implante esplênico (AE. A partir do período pós-operatório, todos os animais receberam ração padrão, manipulada segundo o American Institute of Nutrition (1993. Os níveis plasmáticos de colesterol total (CT, triglicerídeos (TG, lipoproteína de

  6. Topdressing fertilization with nitrogen and potassium levels in sweet-potatoAdubação de cobertura na batata-doce com doses combinadas de nitrogênio e potássio

    Directory of Open Access Journals (Sweden)

    José Salvador Simoneti Foloni

    2013-03-01

    interação com 0, 30, 60 e 120 kg ha-1 de K2O (KCl, aplicados em cobertura aos 39 dias após o plantio. A cultura da batata-doce é responsiva à adubação nitrogenada e potássica de cobertura, porém, os maiores incrementos de produtividade são alcançados com as doses de N e K combinadas. A adubação de cobertura com N e K não acarreta em aumento da quantidade de raízes tuberosas impróprias para a comercialização. O maior incremento de produtividade da batata-doce é alcançado com a adubação de cobertura combinada com 100 kg de N ha-1 mais 120 kg de K2O ha-1.

  7. LA BIOFERTILIZACIÓN CON RIZOBACTERIAS Y HONGOS MICORRÍZICOS ARBUSCULARES EN LA PRODUCCIÓN DE POSTURAS DE TOMATE (Lycopersicon esculentum Mill. Y CEBOLLA (Allium cepa L.. I. CRECIMIENTO VEGETATIVO

    Directory of Open Access Journals (Sweden)

    L. E. Pulido

    2003-01-01

    Full Text Available En áreas experimentales de la Universidad de Ciego de Ávila, sobre un suelo Ferralítico Rojo compactado eútrico y durante dos campañas hortícolas sucesivas, se estudió el efecto de la inoculación, simple y combinada, mediante recubrimiento de las semillas y prescindiendo de la fertilización mineral, con cuatro y cinco especies, respectivamente, de rizobacterias promotoras del crecimiento vegetal -RPCV- (Azospirillum brasilense, Azotobacter chroococcum, Burkholderia cepacia y Pseudomonas fluorescens y de hongos micorrízicos arbusculares -HMA- (Glomus clarum, G. fasciculatum, G. mosseae, G. agregatum y G. versiculiferum, sobre algunos indicadores del crecimiento de posturas de tomate y cebolla, tomando como criterio de evaluación la altura y la longitud radical de las plántulas. Los resultados mostraron que, para el tomate, la inoculación con Azospirillum brasilense, Azotobacter chroococcum y Burkholderia cepacia permitió obtener posturas de calidad equivalente a la alcanzada con la fertilización mineral, mientras que para la cebolla, solo Azospirillum brasilense y Azotobacter chroococcum lograron que las posturas tuvieran dicha calidad. En relación con la inoculación con HMA, las especies Glomus clarum, G. fasciculatum y G. mosseae, para ambos cultivos, produjeron posturas con valores de altura y longitud radical considerados óptimos. Con las coinoculaciones de RPCV + HMA se lograron posturas de calidad superior a la alcanzada con las mejores variantes de inoculación simple, destacándose las combinaciones de G. clarum y G. fasciculatum con A. brasilense para el tomate y de G. clarum y G. fasciculatum con A. chroococcum para la cebolla.

  8. sistema Web con JSP

    Directory of Open Access Journals (Sweden)

    César Viloria Núñez

    2014-01-01

    Full Text Available Este artículo presenta el desarrollo de un sistema de información que permite la adquisición y la administración de información relacionada con los signos vitales como la presión arterial, la frecuencia cardiaca y respiratoria, y la saturación de oxígeno en la sangre de un paciente. La implementación del sistema se basa en una solución Web, permitiendo así que médicos especialistas puedan monitorear a sus pacientes desde cualquier punto conectado a la red en tiempo real y, al mismo tiempo, dar indicaciones críticas al personal médico que se encuentra en el lugar con el paciente.

  9. Trabajando fractales con Winlogo

    OpenAIRE

    Sabogal, Sonia; Arenas, Gilberto

    2007-01-01

    Después de una breve introducción en la cual se establecerán algunos conceptos teóricos básicos de la geometría fractal, se realizarán talleres en los cuales, con ayuda de las herramientas que trabaja el software WinLogo, se construirán diversos fractales, analizando sus principales características (autosimilitud, dimensión, etc.)

  10. Transporte forestal con cables

    OpenAIRE

    Anaya L. Héctor J.

    2012-01-01

    La explotación forestal es un problema fundamentalmente de transporte. El apeo y la preparación de las trozas, aunque a veces presentan algunas dificultades, son operaciones fáciles de resolver comparadas con la operación de transporte la cual absorbe del 60% al 70% o más del costo total del aprovechamiento del bosque. El 30% o 40% restante es absorbido por las faenas previas de apeo y troceo.

  11. Encuentros con Elena Poniatowska

    OpenAIRE

    Uzquiza González, José Ignacio

    2008-01-01

    El autor analiza, desde su encuentro con Elena Poniatowska, la vertiente de la literatura testimonial como literatura de mujeres. Un análisis interior de la relación entre realidad y ficción, entre Elena, Jesusa o Tinísima. The author analyzes testimonial literature from the perspective of female literature through his meeting with Elena Poniatowska. An analysis of reality vs. Fiction in Elena, Jesusa and Tinisima.

  12. pacientes con falla cardiaca

    Directory of Open Access Journals (Sweden)

    Diana Marcela Achury Saldaña

    2007-01-01

    Full Text Available Objetivo: determinar la adherencia al tratamiento de pacientes con falla cardiaca hospitalizados, al aplicar un plan educativo quefomenta el autocuidado.Método: estudio cuasiexperimental (entrevistas enfermera-paciente realizado entre diciembre de 2004 y mayo de 2006, con unamuestra de 50 pacientes seleccionados por conveniencia. Se diseñó un instrumento para evaluar los comportamientos de los pacientes,con base en algunos resultados de la adherencia y sus respectivos indicadores de la taxonomía NOC (Nursing out comes classification. Laadherencia al tratamiento fue medida en dos momentos: el primero durante la hospitalización, seguido de la aplicación del plan educativoantes del alta, que proporcionaba información en el manejo de su enfermedad desde una dimensión física, psicológica y social quepromueve el autocuidado; y el segundo un mes después del alta en su domicilio.Resultados: diferencias estadísticamente significativas (P=0,0001 que demuestran cómo mediante la capacitación al paciente enel manejo de su tratamiento farmacológico y no farmacológico, el establecimiento de una sana relación entre el profesional de enfermeríay el paciente, y la participación de la familia, se logra una total adherencia al tratamiento.Conclusiones: para lograr una adherencia total del paciente con falla cardiaca al tratamiento es necesario un proceso educativo y unseguimiento continuo y personalizado que motive permanentemente al paciente y se le reconozca el papel protagónico en su cuidado y manejo de la enfermedad.

  13. Rituximab Effectiveness and Safety for Treating Primary Sjogren's Syndrome (pSS: Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Francine Bertolais do Valle Souza

    Full Text Available Primary Sjögren's Syndrome (pSS is a systemic autoimmune disease that involves the exocrine glands and internal organs. pSS leads to destruction and loss of secretory function due to intense lymphoplasmacytic infiltration. Therapeutic options include mainly symptomatic and supportive measures, and traditional immunosuppressant drugs have shown no effectiveness in randomized trials. Rituximab (RTX is a chimeric antibody anti-CD20 that leads to B cell depletion by diverse mechanisms. There is evidence that this drug may be effective for treating pSS. The objective of this systematic review was to evaluate Rituximab effectiveness and safety for treating pSS.We conducted a systematic review of RCTs published until December 2015, with no language restriction. We registered a protocol on Plataforma Brasil (40654814.6.0000.5505 and developed search strategies for the following scientific databases: MEDLINE, EMBASE, CENTRAL and LILACS. We included adults with established pSS diagnosis and considered the use of Rituximab as intervention and the use of other drugs or placebo as control. Four studies met our eligibility criteria: three with low risk of bias and one with uncertain risk of bias. The total number of participants was 276 (145 RTX, 131 placebo. We assessed the risk of bias of each included study and evaluated the following as primary outcomes: lacrimal gland function, salivary gland function, fatigue improvement and adverse events. We found no significant differences between the groups in the Schirmer test at week 24 meta-analysis (MD 3.59, 95% CI -2.89 to 10.07. Only one study evaluated the lissamine green test and reported a statistically significant difference between the groups at week 24 (MD -2.00, 95% CI -3.52 to -0.48. There was a significant difference between the groups regarding salivary flow rate (MD 0.09, 95% CI 0.02 to 0.16 and improvement in fatigue VAS at weeks 6 (RR 3.98, 95% CI 1.61 to 9.82 and week 16 (RR 3.08, 95% CI 1.21 to

  14. Macroglobulinemia de Waldenström - remissão completa após tratamento com rituximabe Successful outcome in Waldenström's macroglobulinemia treated with rituximab

    Directory of Open Access Journals (Sweden)

    Flavia C. F. Pimenta

    2008-10-01

    Full Text Available A macroglobulinemia de Waldenström (MW é uma patologia rara dos linfócitos B caracterizada pela produção monoclonal de IgM, e que pode manifestar-se clinicamente com fadiga, astenia, perda de peso, sangramento de mucosas e do trato gastrintestinal, lifonodonomegalias, hepatoesplenomegalia e alterações neurológicas. A doença é mais comum em pacientes idosos, e seus sintomas são decorrentes da hiperviscosidade sangüínea. Na MW observa-se hipergamaglobulinemia com pico monoclonal na eletroforese de proteínas séricas, níveis elevados de IgM e demais imunoglobulinas normais ou diminuídas, imunofenotipagem com linfócitos B CD19+, CD20+ e CD24+, aspirado de medula óssea hipercelular, e biópsia de medula óssea hipercelular com infiltração difusa de linfócitos, linfócitos plasmocitóides e plasmócitos. Atualmente, anticorpos monoclonais estão sendo usados na terapêutica da MW com grande sucesso. O rituximabe, anticorpo monoclonal anti -CD20, tem mostrado excelentes resultados no tratamento da MW, inclusive naqueles indivíduos que não obtiveram resposta adequada ao tratamento convencional. Nós reportamos o caso de uma mulher de 78 anos de idade com história de fadiga, astenia, anorexia, sonolência, inquietação, urticária, dificuldade para deambular e perda excessiva de peso, aproximadamente 22 kg em um período de cinco meses, cujo tratamento foi realizado com rituximabe. O objetivo deste relato é apresentar uma paciente com diagnóstico de MW e revisar aspectos clínicos e terapêutico atual da doença.Waldenström's macroglobulinemia is a rare pathology of B lymphocytes characterized by the production of monoclonal IgM, causing clinical manifestations which may include fatigue, asthenia, weight loss, bleeding of the mucosa and intestinal tract, lymphadenomegaly, hepatosplenomegaly and neurological alterations. The disease is more frequent among elderly patients and its symptoms are a result of the hyperviscosity of

  15. Lectura con adolescentes

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    Silvia Méndez Anchía

    2007-01-01

    Full Text Available Con base en la premisa de que la lectura de textos literarios tiene una función formadora y que esta se acentúa en la adolescencia, me propongo demostrar que el cuento “Rapunzel” puede utilizarse como estrategia para explorar algunas situaciones que los sujetos adolescentes perciben como particulares en relación con su vida, pero que se inscriben dentro de grandes problemáticas estudiadas por varias disciplinas. Para ello, he identificado, desde dos marcos de referencia (sociológico y psicoanalítico, diversas problemáticas y discursos que se desprenden de la lectura del cuento realizada por dos mujeres adolescentes, quienes respondieron una guía de lectura y participaron en una entrevista a profundidad. Concluyo que la lectura y comentario del cuento hacen posible que una serie de experiencias que los sujetos adolescentes viven como únicas (como el embarazo de una amiga, las críticas de las personas adultas y las exigencias de padres y madres, ingresen en el circuito de los conocimientos generales al relacionarlas con los discursos y problemáticas en que se inscriben (por ejemplo, el discurso de la “crisis” de la adolescencia, el enfoque de derechos humanos, el mundo fantasmático materno. Por ello, recomiendo la lectura y comentario de textos literarios como estrategia didáctica para contribuir a la elaboración de la subjetividad de personas adolescentes.

  16. Trombocitopenia de difícil manejo en niño preescolar con LES: Reporte de un caso

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    Mario Nicolás Albani Pérez

    2009-01-01

    Full Text Available El lupus eritematoso sistémico (LES es una enfermedad autoinmune del tejido conectivo, infrecuente en el sexo masculino y durante la infancia. La trombocitopenia se presenta en 15% de los casos de LES, y como forma de inicio es poco común. Se reporta el caso de preescolar masculino de 3 años de edad con inicio de enfermedad a los 18 meses de edad que presentó diarrea, rash cutáneo, equimosis y trombocitopenia, ameritando transfusión de concentrado plaquetario obteniendo mejoría parcial y en control con hematólogo. A los 2 años de edad reaparece equimosis y se diagnostica Púrpura Trombocitopénica Idiopática, tratado con inmunoglobulinas y esteroides sin respuesta satisfactoria. Es referido a Inmunología donde solicitan estudios y los resultados son compatibles con LES, por lo cual recibió prednisona sin respuesta satisfactoria. En Febrero de 2009, presenta epistaxis requiriendo hospitalización y tratamiento con inmunoglobulinas. En Mayo de 2009, presenta otorragia derecha ameritando nuevamente hospitalización y tratamiento con inmunoglobulinas. Se emplea Danazol con buena respuesta. En caso que en el futuro no ofrezca mejoría, se plantea el uso alternativo de ciclosporinas o anticuerpos monoclonales Anti- CD20 (Rituximab dejando como último recurso la esplenectomía. Se presenta el caso clínico considerando la importancia con respecto a la edad de presentación y el manejo no convencional que se debió adoptar para tratar al paciente.

  17. Trombocitopenia de difícil manejo en niño preescolar con LES: Reporte de un caso

    Directory of Open Access Journals (Sweden)

    Mario Nicolás Albani Pérez

    2010-08-01

    Full Text Available El lupus eritematoso sistémico (LES es una enfermedad autoinmune del tejido conectivo, infrecuente en el sexo masculino y durante la infancia. La trombocitopenia se presenta en 15% de los casos de LES, y como forma de inicio es poco común. Se reporta el caso de preescolar masculino de 3 años de edad con inicio de enfermedad a los 18 meses de edad que presentó diarrea, rash cutáneo, equimosis y trombocitopenia; ameritando transfusión de concentrado plaquetario obteniendo mejoría parcial y en control con hematólogo. A los  2 años de edad reaparece equimosis y se diagnostica Púrpura Trombocitopénica Idiopática, tratado con inmunoglobulinas y esteroides sin respuesta satisfactoria. Es referido a Inmunología donde solicitan estudios y los resultados son compatibles con LES, por lo cual recibió prednisona sin respuesta satisfactoria. En Febrero de 2009, presenta epistaxis requiriendo hospitalización y tratamiento con inmunoglobulinas. En Mayo de 2009, presenta otorragia derecha ameritando nuevamente hospitalización y tratamiento con inmunoglobulinas. Se emplea Danazol con buena respuesta. En caso que en el futuro no ofrezca mejoría, se plantea el uso alternativo de ciclosporinas o anticuerpos monoclonales Anti-CD20 (Rituximab dejando como último recurso la esplenectomía. Se presenta el caso clínico considerando la importancia con respecto a la edad de presentación y el manejo no convencional que se debió adoptar para tratar al paciente.

  18. High-Grade Salivary-Gland Involvement, Assessed by Histology or Ultrasonography, Is Associated with a Poor Response to a Single Rituximab Course in Primary Sjögren's Syndrome: Data from the TEARS Randomized Trial

    National Research Council Canada - National Science Library

    Divi Cornec; Sandrine Jousse-Joulin; Sebastian Costa; Thierry Marhadour; Pascale Marcorelles; Jean-Marie Berthelot; Eric Hachulla; Pierre-Yves Hatron; Vincent Goeb; Olivier Vittecoq; Emmanuel Nowak; Jacques-Olivier Pers; Valérie Devauchelle-Pensec; Alain Saraux

    2016-01-01

    ...]. Materials and Methods Among the 120 patients with pSS enrolled in the randomised TEARS trial of rituximab versus placebo, 35 underwent either centralised minor salivary-gland biopsy or SGUS at inclusion...

  19. [Successful treatment of B-cell prolymphocytic leukemia (B-PLL) with FCR-Lite (fludarabine, cyclophosphamide, rituximab) protocol].

    Science.gov (United States)

    Telek, Béla; Batár, Péter; Rejto, László; Udvardy, Miklós

    2010-08-01

    B-cell prolymphocytic leukemia (B-PLL) is a rare disorder characterized by marked lymphocytosis in the peripheral blood, matured lymphocytic infiltration in the bone marrow and splenomegaly. It has a distinct immunophenotype (CD19, CD20, CD22, FMC7, intensive surface immunoglobulin positivity) which helps to differentiate from other lymphoproliferative malignancies. It has a poor prognosis and its treatment is unsettled. The authors present a case of a patient with typical B-PLL treated with FCR-Lite (fludarabine, cyclophosphamide, rituximab) protocol achieving complete hematological (and immunophenotypic) remission. The treatment was well tolerated. Neither major infective complication nor tumor lysis syndrome was observed. According to the author's experience the FCR-Lite protocol can not only be used in patients with CLL but it also can be effective in patients with B-PLL. No clinical experience has been reported yet in the literature with this protocol.

  20. Rituximab for the treatment of refractory simultaneous anti-glomerular basement membrane (anti-GBM) and membranous nephropathy.

    Science.gov (United States)

    Bandak, Ghassan; Jones, Bruce A; Li, Jian; Yee, Jerry; Umanath, Kausik

    2014-02-01

    Antibody-mediated anti-glomerular basement membrane (anti-GBM) disease occurs rarely in the presence of another B-cell disorder, membranous nephropathy. The coexistence of these two autoimmune disorders would be anticipated to require differing, specific therapies targeted to each disease process. We describe a case of concomitant membranous nephropathy and anti-GBM disease in which conventional therapy, including steroids, plasmapheresis and cyclophosphamide, failed to attenuate the anti-GBM disease, yet responded to an alternative treatment of rituximab. This B-cell directed, monoclonal, chimeric antibody treatment substantially reduced anti-GBM antibody titers and led to discontinuation of plasmapheresis, while maintaining the remission of membranous nephropathy and anti-GBM disease.

  1. Ibrutinib plus rituximab for patients with high-risk chronic lymphocytic leukaemia: a single-arm, phase 2 study

    Science.gov (United States)

    Burger, Jan A.; Keating, Michael J.; Wierda, William G.; Hartmann, Elena; Hoellenriegel, Julia; Rosin, Nathalie Y.; de Weerdt, Iris; Jeyakumar, Ghayathri; Ferrajoli, Alessandra; Cardenas-Turanzas, Marylou; Lerner, Susan; Jorgensen, Jeffrey L; Nogueras-González, Graciela M.; Zacharian, Gracy; Huang, Xuelin; Kantarjian, Hagop; Garg, Naveen; Rosenwald, Andreas; O’Brien, Susan

    2014-01-01

    Summary Background Ibrutinib, an orally administered covalent inhibitor of Bruton tyrosine kinase (BTK), is an effective therapy for patients with relapsed chronic lymphocytic leukemia (CLL). We investigated the activity and safety of the combination of ibrutinib with the monoclonal antibody rituximab (iR) in patients with high-risk CLL. Methods In this single-arm, phase 2 studywe enrolled 40 patients with high-risk CLL at MD Anderson Cancer Center, Houston, Texas, USA. Patients with symptomatic CLL requiring therapy received 28 day cycles of once-daily ibrutinib 420 mg , together with rituximab (weekly during cycle 1, then once per cycle until cycle 6), followed by continuous single-agent ibrutinib. The primary endpoint was progression-free survival (PFS) in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01520519 and is no longer accruing patients. Findings Between February 28, 2012 and September 11, 2012, we enrolled 40 CLL patients with high-risk disease features. 20 patients had del17p or TP53 mutations (16 previously treated, 4 untreated), 13 had relapsed CLL with del11q, and 7 patients a PFS < 36 months after frontline chemo-immunotherapy. Toxicity was mainly of mild to moderate severity (grade 1–2). 10 (25%) patients had diarrhea (grade 1 in 9 [22.5%] patients, grade 2 in 1 [2.5%]), bleeding events occurred in 14 (35%) patients (8 [20%] patients with grade 1, 5 [12.5%] patients grade 2, and 1 [2.5%] grade 3), nausea in 15 (37.5) patients (10 [25%] grade 1, 5 [12.5%] grade 2), and fatigue in 7 (17.5%) patients (4 [10%] grade 1, 3 [7.5%] grade 2). Grade 3 infections occurred in 4 patients (10%), no grade 4 or 5 infections occurred. At 18 months, the Kaplan Meier estimate of progression-free survival was 78% (95% CI 60.6–88.5) (del[17p] or TP53 mutation: 72%, 95% CI: 45.6–87.6) Interpretation Ibrutinib in combination with rituximab is a well-tolerated regimen for patients with high-risk CLL. It induces high

  2. Fludarabine, cyclophosphamide, and rituximab (FCR) plus GM-CSF as frontline treatment for patients with Chronic Lymphocytic Leukemia

    Science.gov (United States)

    Strati, Paolo; Ferrajoli, Alessandra; Lerner, Susan; O’Brien, Susan; Wierda, William; Keating, Michael J; Faderl, Stefan

    2015-01-01

    FCR, the standard of care for frontline treatment of CLL patients, is associated with a high rate of neutropenia and infectious complications. GM-CSF reduces myelosuppression and can potentiate rituximab activity. We conducted a clinical trial combining GM-CSF with FCR for frontline treatment of 60 CLL patients. Eighty-six percent completed all 6 courses and 18% discontinued GM-CSF for toxicity; grade 3–4 neutropenia was observed in 30% of cycles, and severe infections in 16% of cases. ORR was 100%. Both median EFS and OS have not been reached. Longer EFS was associated with favorable cytogenetic. GM-CSF led to a lower frequency of infectious complications than the historical FCR group, albeit similar EFS and OS. PMID:23808813

  3. Effective Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease by B-Cell Targeted Therapy with Rituximab

    Directory of Open Access Journals (Sweden)

    Wolfgang Hartung

    2012-01-01

    Full Text Available Rheumatoid arthritis- (RA- associated interstitial lung disease (RA-ILD is the extra-articular complication with most adverse impact on the quality of life and survival in RA patients. However, treatment options are limited and controlled studies are lacking. Here, we present the case of a 66-year-old patient suffering from severe RA-ILD, which has been successfully treated with Rituximab (RTX. After failure of conventional DMARD therapy, our patient showed sustained improvement of clinical pulmonary parameters as well as joint inflammation following B-cell depletion with RTX. The six-minute-walk test improved from 380 meters to 536 meters and the forced vital capacity from 2.49 liters to 3.49. The disease activity score could be reduced from 7.7 to 2.8. Therefore, RTX might be considered as an alternative treatment for RA-ILD in patients not responding to conventional DMARD therapy.

  4. Radiolabeling of rituximab with {sup 188}Re and {sup 99m}Tc using the tricarbonyl technology

    Energy Technology Data Exchange (ETDEWEB)

    Dias, Carla Roberta [Instituto de Pesquisas Energeticas e Nucleares, Av. Professor Lineu Prestes 2242, 05508-000 Sao Paulo (Brazil); Jeger, Simone [Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI (Switzerland); Osso, Joao Alberto [Instituto de Pesquisas Energeticas e Nucleares, Av. Professor Lineu Prestes 2242, 05508-000 Sao Paulo (Brazil); Mueller, Cristina; De Pasquale, Christine; Hohn, Alexander; Waibel, Robert [Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI (Switzerland); Schibli, Roger, E-mail: roger.schibli@psi.c [Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI (Switzerland); Department of Chemistry and Applied Biosciences of the ETH, 8093 Zurich (Switzerland)

    2011-01-15

    Introduction: The most successful clinical studies of immunotherapy in patients with non-Hodgkin's lymphoma (NHL) use the antibody rituximab (RTX) targeting CD20{sup +} B-cell tumors. Rituximab radiolabeled with {beta}{sup -} emitters could potentiate the therapeutic efficacy of the antibody by virtue of the particle radiation. Here, we report on a direct radiolabeling approach of rituximab with the {sup 99m}Tc- and {sup 188}Re-tricarbonyl core (IsoLink technology). Methods: The native format of the antibody (RTX{sub wt}) as well as a reduced form (RTX{sub red}) was labeled with {sup 99m}Tc/{sup 188}Re(CO){sub 3}. The partial reduction of the disulfide bonds to produce free sulfhydryl groups (-SH) was achieved with 2-mercaptoethanol. Radiolabeling efficiency, in vitro human plasma stability as well as transchelation toward cysteine and histidine was investigated. The immunoreactivity and binding affinity were determined on Ramos and/or Raji cells expressing CD20. Biodistribution was performed in mice bearing subcutaneous Ramos lymphoma xenografts. Results: The radiolabeling efficiency and kinetics of RTX{sub red} were superior to that of RTX{sub wt} ({sup 99m}Tc: 98% after 3 h for RTX{sub red} vs. 70% after 24 h for RTX{sub wt}). {sup 99m}Tc(CO){sub 3}-RTX{sub red} was used without purification for in vitro and in vivo studies whereas {sup 188}Re(CO){sub 3}-RTX{sub red} was purified to eliminate free {sup 188}Re-precursor. Both radioimmunoconjugates were stable in human plasma for 24 h at 37{sup o}C. In contrast, displacement experiments with excess cysteine/histidine showed significant transchelation in the case of {sup 99m}Tc(CO){sub 3}-RTX{sub red} but not with pre-purified {sup 188}Re(CO){sub 3}-RTX{sub red}. Both conjugates revealed high binding affinity to the CD20 antigen (K{sub d}=5-6 nM). Tumor uptake of {sup 188}Re(CO){sub 3}-RTX{sub red} was 2.5 %ID/g and 0.8 %ID/g for {sup 99m}Tc(CO){sub 3}-RTX{sub red} 48 h after injection. The values for other

  5. Successful experience of rituximab therapy for systemic sclerosis-associated interstitial lung disease with concomitant systemic lupus erythematosus.

    Science.gov (United States)

    Sumida, Hayakazu; Asano, Yoshihide; Tamaki, Zenshiro; Aozasa, Naohiko; Taniguchi, Takashi; Takahashi, Takehiro; Toyama, Tetsuo; Ichimura, Yohei; Noda, Shinji; Akamata, Kaname; Miyazaki, Miki; Kuwano, Yoshihiro; Yanaba, Koichi; Sato, Shinichi

    2014-05-01

    Previous studies have demonstrated that B cells play critical roles in autoimmune disorders including systemic sclerosis (SSc) and systemic lupus erythematosus (SLE). However, the effectiveness of rituximab (RTX), a chimeric anti-CD20 antibody, for SSc-associated interstitial lung disease (ILD) or SLE disease activity remains controversial. We herein report an SSc patient with severely progressed ILD and concomitant SLE treated by two cycles of RTX at baseline and half a year later. This treatment improved ILD and SLE activities, along with reduction of dermal sclerosis and serum anti-topoisomerase I antibody levels. In addition, our detailed time-course data indicate that half a year may be appropriate as an interval between each cycle of RTX therapy aimed at SSc-associated ILD or SLE. Overall, the current report could pave the way to establish RTX as a disease-modifying drug for patients with SSc and/or SLE showing resistance to other already approved medications.

  6. Targeted biological therapies for Graves' disease and thyroid-associated ophthalmopathy. Focus on B-cell depletion with Rituximab

    DEFF Research Database (Denmark)

    Hegedüs, Laszlo; Douglas, Raymond S; Nielsen, Claus H

    2011-01-01

    Based on experience from the treatment of other autoimmune diseases and because of the limitations imposed by existing therapeutic options for Graves' disease (GD) and thyroid-associated ophthalmopathy (TAO), rituximab (RTX) was recently proposed as a novel therapy option. Here, we summarize...... the rationale for using RTX; give an overview of the possible mechanisms of action; and give an account of its effects and side-effects when used in GD and TAO. Scant evidence, originating from only a few methodologically inhomogeneous studies, suggests that RTX may prolong remission for hyperthyroidism over...... favourably to conventional therapy. It is the first in what is likely to be a series of new and emerging treatments specifically targeting relevant components of the immune system. Further studies will hopefully lead to improved and better tailored, individualized therapy for GD and especially TAO....

  7. Lymphomatoid Granulomatosis of Central Nervous System and Lung Driven by Epstein Barr Virus Proliferation: Successful Treatment with Rituximab

    Directory of Open Access Journals (Sweden)

    Ruben Fernandez

    2014-02-01

    Full Text Available Lymphomatoid granulomatosis (LYG is a very rare Epstein-Barr virus (EBV associated B-cell lymphoproliferative disorder. We report the case of a 41-year-old man who presented with fever and respiratory symptoms. Computed tomography showed multiple nodules in both lung fields. Polymerase chain reaction (PCR analysis of the bronchoalveolar lavage was positive for EBV and biopsy of lung node yielded a diagnosis of LYG, grade III. Shortly after initiation of treatment with chemotherapy, neurologic deterioration appeared. Radiologic findings revealed hydrocephalus and PCR analysis of the cerebrospinal fluid (CSF was positive for EBV. Treatment with intravenous rituximab led to rapid reduction of EBV load in CSF, along with radiological and clinical improvement. After completion of treatment with immunochemotherapy, an autologous stem cell transplantation was performed. Patient stays in remission one year after diagnosis.

  8. Rituximab treatment in a case of antisynthetase syndrome with severe interstitial lung disease and acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Zappa Maria

    2011-08-01

    Full Text Available Abstract We present a case of severe interstitial pneumonitis, mild polyarthritis and polymyositis, and Raynaud's syndrome with the presence of anti-Jo-1 antibodies, which had been diagnosed as anti-synthetase syndrome. The presence, however, of anti-Ro/SSA antibodies led us to understand that we were dealing here with a more severe form of interstitial lung disease. The patient was treated for acute respiratory failure but he showed resistance to glucocorticoids and cyclosporine. Thus, he was treated with infusions of anti-CD20 therapy (rituximab: his clinical conditions improved very rapidly and a significant decrease in the activity of pulmonary disease was detected using high-resolution computerized tomography (HRCT of the thorax and pulmonary function tests.

  9. Pre-emptive treatment with rituximab of molecular relapse after autologous stem cell transplantation in mantle cell lymphoma

    DEFF Research Database (Denmark)

    Andersen, Niels S; Pedersen, Lone B; Laurell, Anna

    2009-01-01

    transplantation (ASCT). PATIENTS AND MATERIALS: MCL patients enrolled onto the study, who had polymerase chain reaction (PCR) detectable molecular markers and underwent ASCT, were followed with serial PCR assessments of MRD in consecutive bone marrow and peripheral blood samples after ASCT. In case of molecular......PURPOSE: Minimal residual disease (MRD) is predictive of clinical progression in mantle-cell lymphoma (MCL). According to the Nordic MCL-2 protocol we prospectively analyzed the efficacy of pre-emptive treatment using rituximab to MCL patients in molecular relapse after autologous stem cell...... ASCT. Of the CR patients, 36 underwent a molecular relapse up to 6 years (mean, 18.5 months) after ASCT. Ten patients did not receive pre-emptive treatment mainly due to a simultaneous molecular and clinical relapse, while 26 patients underwent pre-emptive treatment leading to reinduction of molecular...

  10. Cementos con cenizas volantes

    Directory of Open Access Journals (Sweden)

    Ossa M., Mauricio

    1984-03-01

    additions of 20 and 30% .

    Casi la generalidad de los estudios realizados sobre cementos con adición de cenizas volantes se refieren a sus características y comportamiento en pastas, morteros y hormigones, siempre en relación con aquéllos del cemento portland. Esta vez, se desarrolló un trabajo experimental orientado a relacionar entre sí los cementos con adiciones de cenizas volantes y de puzolana natural. Para ello se fabricaron a escala de laboratorio cementos de ambos tipos, empleando como materias primas comunes clinker y yeso y, como variables, diferentes porcentajes de las dos adiciones, que cumplieron previamente los requisitos normalizados en cuanto a sus actividades puzolánicas. La calidad de los cementos fabricados resultó adecuada y concordante con la del cemento portland-puzolánico obtenido a escala industrial con los mismos clinker, yeso y puzolana natural de este estudio. Posteriormente, se determinaron las características de los cementos experimentales y se confeccionaron morteros normales para la realización de ensayos físicos y mecánicos. Los resultados de ensayos indicaron que los cementos con adición de cenizas volantes (CCV requieren menos agua para consistencia normal, presentan tiempos de fraguado mayores y expansiones en autoclave menores que los cementos con adición de puzolana (CP. Los calores de hidratación a 7 y 28 días de edad fueron aproximadamente similares para ambos tipos de cemento. En morteros normales, los cementos CCV mostraron menor retracción de secado, mayor retentividad y mayor fluidez (para igual cantidad de agua que los cementos CP. En los ensayos de exudación se observó que ésta depende más de la finura que el tipo de adición. Finalmente, los ensayos mecánicos señalaron que las resistencias a compresión y flexotracción de los morteros con cementos CCV son menores a edades inferiores que 14 días (del orden de 5 a 10% a un día de edad, pero que a partir de entonces pasan a ser mayores que las de

  11. Multicenter Retrospective Analysis of the Effectiveness and Safety of Rituximab in Korean Patients with Refractory Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    So-Young Bang

    2012-01-01

    Full Text Available Objective. Although two recent randomized placebo-controlled trials of rituximab (RTX failed to demonstrate efficacy in systemic lupus erythematosus (SLE, clinicians continue to use off-label RTX for cases refractory to current treatments. We evaluated the effectiveness and safety of rituximab for patients with refractory SLE in Korea. Methods. We retrospectively analyzed multicenter patients treated with RTX in Korea. Results. 39 SLE patients treated with RTX were included in the following manner: lupus nephritis 43.6%, hematologic 33.3%, arthritis 7.8%, myositis 7.8%, and others 7.7%. All patients had responded poorly to at least one conventional immunosuppressive agent (mean 2.5 ± 1.1, cyclophosphamide 43.6%, mycophenolate mofetil 48.7%, and other drugs before RTX. Clinical improvements (complete or partial remission occurred in patients with renal disease, hematologic disease, arthritis, myositis, and other manifestations at 6 months after RTX. The SLEDAI score was significantly decreased from 10.8±7.1 at baseline to 6.7±4.0 at 6 months, 6.2±4.1 at 12 months, and 5.5±3.6 at 24 months after RTX (P<0.05. Among 28 clinical responders, 4 patients experienced a relapse of disease at 25±4 months. Infections were noted in 3 patients (7.7%. Conclusion. RTX could be an effective and relatively safe therapeutic option in patients with severe refractory SLE until novel B-cell depletion therapy is available.

  12. Primary Therapy of Waldenström Macroglobulinemia With Bortezomib, Dexamethasone, and Rituximab: WMCTG Clinical Trial 05-180

    Science.gov (United States)

    Treon, Steven P.; Ioakimidis, Leukothea; Soumerai, Jacob D.; Patterson, Christopher J.; Sheehy, Patricia; Nelson, Marybeth; Willen, Michael; Matous, Jeffrey; Mattern, John; Diener, Jakow G.; Keogh, George P.; Myers, Thomas J.; Boral, Andy; Birner, Ann; Esseltine, Dixie L.; Ghobrial, Irene M.

    2009-01-01

    Purpose We examined the activity of bortezomib, dexamethasone, and rituximab (BDR) in patients with symptomatic, untreated Waldenström macroglobulinemia (WM). Patients and Methods A cycle of therapy consisted of bortezomib 1.3 mg/m2 intravenously; dexamethasone 40 mg on days 1, 4, 8, and 11; and rituximab 375 mg/m2 on day 11. Patients received four consecutive cycles for induction therapy and then four more cycles, each given 3 months apart, for maintenance therapy. Twenty-three patients received a median of seven cycles of treatment. Results Median bone marrow disease involvement declined from 55% to 10% (P = .0004), serum immunoglobulin M levels declined from 4,830 to 1,115 mg/dL (P < .0001), and hematocrit increased from 29.8% to 38.2% (P = .0002) at best response. The overall response rates and major response rates were 96% and 83% with three complete responses, two near complete responses, three very good partial responses, 11 partial responses, and three minor responses. Responses occurred at a median of 1.4 months. With a median follow-up of 22.8 months, 18 of 23 patients remained free of disease progression. Peripheral neuropathy was the most common toxicity, and it resolved to grade ≤ 1 in 13 of 16 patients at a median of 6.0 months. Four of the first seven treated patients developed herpes zoster, resulting in the institution of prophylactic antiviral therapy. Conclusion The results demonstrate that BDR produces rapid and durable responses, along with high rates of response and complete remissions in WM. Herpes zoster prophylaxis is necessary with BDR, and reversible peripheral neuropathy was the most common toxicity leading to premature discontinuation of bortezomib in 61% of patients. Exploration of alternative schedules for bortezomib administration that includes weekly dosing should be pursued. PMID:19506160

  13. Analysis of anti-HLA antibodies in sensitized kidney transplant candidates subjected to desensitization with intravenous immunoglobulin and rituximab.

    Science.gov (United States)

    Lobashevsky, Andrew L; Higgins, Nancy G; Rosner, Kevin M; Mujtaba, Muhammad A; Goggins, William C; Taber, Tim E

    2013-07-27

    Preexisting donor-specific antibodies against human leukocyte antigens are major risk factors for acute antibody-mediated and chronic rejection of kidney transplant grafts. Immunomodulation (desensitization) protocols may reduce antibody concentration and improve the success of transplant. We investigated the effect of desensitization with intravenous immunoglobulin and rituximab on the antibody profile in highly sensitized kidney transplant candidates. In 31 transplant candidates (calculated panel-reactive antibody [cPRA], 34%-99%), desensitization included intravenous immunoglobulin on days 0 and 30 and a single dose of rituximab on day 15. Anti-human leukocyte antigen antibodies were analyzed before and after desensitization. Reduction of cPRA from 25% to 50% was noted for anti-class I (5 patients, within 20-60 days) and anti-class II (3 patients, within 10-20 days) antibodies. After initial reduction of cPRA, the cPRA increased within 120 days. In 24 patients, decrease in mean fluorescence intensity of antibodies by more than 50% was noted at follow-up, but there was no reduction of cPRA. Rebound occurred in 65% patients for anti-class I antibodies at 350 days and anti-class II antibodies at 101 to 200 days. Probability of rebound effect was higher in patients with mean fluorescence intensity of more than 10,700 before desensitization, anti-class II antibodies, and history of previous transplant. The desensitization protocol had limited efficacy in highly sensitized kidney transplant candidate because of the short period with antibody reduction and high frequency of rebound effect.

  14. Severe multiorganic flare of systemic lupus erythematosus successfully treated with rituximab and cyclophosphamide avoiding high doses of prednisone.

    Science.gov (United States)

    Gonzalez-Echavarri, C; Pernas, B; Ugarte, A; Ruiz-Irastorza, G

    2014-03-01

    Both acute pancreatitis and diffuse alveolar haemorrhage are rare conditions associated with systemic lupus erythematosus (SLE). In this case report, a 23-year-old female with SLE was diagnosed with lupus-associated pancreatitis and, within a few days and despite initial therapy with pulse methyl-prednisolone, subsequently suffered an acute respiratory failure due to a diffuse alveolar haemorrhage. The patient was admitted to the intensive care unit and treatment was intensified with cyclophosphamide and rituximab, which shortly induced the complete remission of SLE with resolution of both clinical conditions. She completed treatment with six pulses of cyclophosphamide followed by azathioprine, hydroxychloroquine and prednisone at initial doses of 20 mg/d with rapid tapering to 5 mg/d, without relapse of the disease during the following year. This case can illustrate that, even in severe, life-threatening SLE flares, it is possible to avoid high-dose prednisone, which has been associated with severe side effects, including infections. Acute pancreatitis and diffuse alveolar haemorrhage are rare conditions caused by SLE. DAH can be a life-threatening complication, with an early mortality of at least 50%. When facing such severe SLE activity, there is a general tendency to use high doses of prednisone as the initial therapy, maintaining such high doses for long periods of time, even after the clinical situation has subsided. We report a case of a young woman with SLE, suffering from acute pancreatitis and diffuse alveolar haemorrhage, who was successfully treated with pulse methyl-prednisolone, hydroxychloroquine, cyclophosphamide and rituximab, combined with medium doses of prednisone.

  15. Discrepancy of B cell frequency between periphery and spleen after rituximab treatment in ABO-incompatible liver transplantation.

    Science.gov (United States)

    Iso, Yukihiro; Sawada, Tokihiko; Kita, Junji; Shiraki, Takayuki; Sakuraoka, Yuki; Kato, Masato; Shimoda, Mitsugi; Kubota, Keiichi

    2013-10-01

    ABO-incompatible living-donor liver transplantation (ABO-LDLT) is generally more difficult to perform than ABO-incompatible kidney transplantation. Despite introduction of rituximab, ABO-LDLT in non-responders is a still difficult issue. A 23-year-old woman with primary sclerosing cholangitis underwent LDLT. The recipient's blood type was 0(+) and the donor's was B(+). Rituximab was infused twice on preoperative day (POD) 14 and 7. Plasma exchange (PE) was performed on PODs 5, 3, 2, and 1. However, repeated PE failed to decrease the anti-B antibody titer. On the other hand, preoperative esophagogastroscopy revealed esophageal varices with red color sign. Therefore, simultaneous liver transplantation and Hassab operation were performed. The donor left lobe of the liver was orthotopically transplanted into the recipient following Hassab operation. Flow cytometry on the day of surgery showed that the frequencies of B cells (CD20+) and memory B cells (CD20+/CD27+) in the peripheral blood were 0.9% and 0.3%, respectively; flow cytometry of cells recovered from the spleen revealed that the frequencies of B cells and memory B cells were 2.5% and 2.4%, respectively. Acute cellular rejection occurred on POD 15, and was treated by steroid pulse therapy, leading to a decrease in the anti-B antibody titer. The liver was functioning well on POD 390 (AST 19, ALT 34). In non-responders to ABO-LDLT, anti-donor blood type antibody-producing cells remains in the spleen after the conventional preoperative regimen. Splenectomy is an option for ABO-LDLT non-responders.

  16. Combination of bendamustine and rituximab in the management of relapsed and refractory chronic lymphocytic leukemia: the results of retrospective study

    Directory of Open Access Journals (Sweden)

    S. V. Semochkin

    2015-01-01

    Full Text Available Efficacy and safety results of rituximab and bendamustine combination (Scheme BR in patients with relapsed and refractory chronic lymphocytic leukemia (CLL are presented. From 01.2012 to 04.2013, the treatment was initiated in 43 patients (21 with relapses are sensitive to the last line of therapy; 22 – with refractory CLL. Median age at start of therapy was 63.5 years (range from 43 to 81 years. In 40 patients response was evaluated according to NCI-WG criteria (1996. Complete remission (CR is documented in 5 (12.5 % cases, partial (PR or nodular partial remission (nPR in 17 (42.5 % cases. MRD-negative CR was achieved in 1 (20.0 % of 5 patients with CR. With 23.5 months of median follow-up for surviving patients 2-year progression-free survival (PFS was 47.2 ± 8.5 % (median – 18.5 months, overall survival (OS – 66.9 ± 7.9 % (median not achieved. Hematological toxicity Grade 3–4 occurred in 15 (34.9 % cases, same degree infectious complicationsin 5 (11.6 % cases. Patients received 3 or more therapy lines before this treatment (37.5 ± 16.1 % against 74.7 ± 8.3 %; p = 0.016, with «bulky disease» more than 10 cm (0.0 % vs. 75.4 ± 7.5 %; p < 0.001 and received rituximab in combination with chemotherapy in the previous lines, compared to the «naive» cases (44.1 ± 10.5 % against 92.9 ± 6.9 %; p = 0.009 have significantly worsened 2-year OS.

  17. Microencapsulación con alginato en alimentos. Técnicas y aplicaciones

    Directory of Open Access Journals (Sweden)

    Bryshila Lupo Pasin

    2012-06-01

    Full Text Available El objetivo de este trabajo fue realizar una revisión de las técnicas de microencapsulación con alginato para aplicaciones en alimentos. El alginato ha sido uno de los polímeros más empleado en la microencapsulación, este forma una matriz altamente versátil, biocompatible y no tóxica para la protección de componentes activos, células o microorganismos sensibles al calor, pH, oxígeno y luz, entre otros factores, a los que son expuestos los alimentos durante el procesamiento y almacenaje. El proceso de microencapsulación con alginato se lleva a cabo a través de dos mecanismos de gelificación iónica: la gelificación externa y la gelificación interna, dependiendo de si el calcio se suministra desde fuera de las cápsulas o en el interior de las mismas. Para la preparación de microcápsulas de alginato de calcio con aplicaciones alimentarias, se tienen las técnicas por extrusión, en emulsión y secado por atomización. Aunque el secado por atomización ha sido para la industria un proceso práctico y económico, su aplicación con alginato se ha visto limitada por la viscosidad y velocidad de gelificación. Por el contrario, la técnica por extrusión ha sido la técnica tradicional empleada en las últimas décadas, debido a la uniformidad de las microcápsulas en su forma y tamaño. En este sentido, la técnica en emulsión es la aplicada más recientemente, la cual ha demostrado ser sencilla y de producción a gran escala. En la actualidad se desarrollan nuevas tecnologías a fin de disminuir el tamaño de las microcápsulas para así ampliar sus usos en la industria. Entre las últimas tendencias de microencapsulación, se estudian sistemas mixtos de matrices poliméricas con la finalidad de obtener propiedades físico-químicas combinadas, permitiendo hacer el proceso de encapsulación más eficiente tanto para la protección como para la liberación controlada del principio activo.

  18. Microencapsulación con alginato en alimentos. Técnicas y aplicaciones

    Directory of Open Access Journals (Sweden)

    Bryshila Lupo Pasin

    2012-01-01

    Full Text Available El objetivo de este trabajo fue realizar una revisión de las técnicas de microencapsulación con alginato para aplicaciones en alimentos. El alginato ha sido uno de los polímeros más empleado en la microencapsulación, este forma una matriz altamente versátil, biocompatible y no tóxica para la protección de componentes activos, células o microorganismos sensibles al calor, pH, oxígeno y luz, entre otros factores, a los que son expuestos los alimentos durante el procesamiento y almacenaje. El proceso de microencapsulación con alginato se lleva a cabo a través de dos mecanismos de gelificación iónica: la gelificación externa y la gelificación interna, dependiendo de si el calcio se suministra desde fuera de las cápsulas o en el interior de las mismas. Para la preparación de microcápsulas de alginato de calcio con aplicaciones alimentarias, se tienen las técnicas por extrusión, en emulsión y secado por atomización. Aunque el secado por atomización ha sido para la industria un proceso práctico y económico, su aplicación con alginato se ha visto limitada por la viscosidad y velocidad de gelificación. Por el contrario, la técnica por extrusión ha sido la técnica tradicional empleada en las últimas décadas, debido a la uniformidad de las microcápsulas en su forma y tamaño. En este sentido, la técnica en emulsión es la aplicada más recientemente, la cual ha demostrado ser sencilla y de producción a gran escala. En la actualidad se desarrollan nuevas tecnologías a fin de disminuir el tamaño de las microcápsulas para así ampliar sus usos en la industria. Entre las últimas tendencias de microencapsulación, se estudian sistemas mixtos de matrices poliméricas con la finalidad de obtener propiedades físico-químicas combinadas, permitiendo hacer el proceso de encapsulación más eficiente tanto para la protección como para la liberación controlada del principio activo.

  19. Atender con ansiedad

    Directory of Open Access Journals (Sweden)

    Alberto Acosta

    2009-10-01

    Full Text Available Tener una personalidad ansiosa o estar ansioso en una determinada situación hace que atendamos de modo diferente a lo que acontece. Investigaciones recientes están descubriendo las relaciones específicas de la ansiedad-rasgo y de la ansiedad-estado con diferentes procesos atencionales. La intervención terapéutica para aliviar los trastornos de ansiedad, tan frecuentes en nuestra época, se va a beneficiar de este conocimiento.

  20. Arquitectura con discurso

    OpenAIRE

    Schaposnik, Viviana

    2001-01-01

    En particular a la Carrera Arquitectura le compete un doble rol social: uno general, "educar" desde la Universidad y otro, específico, el que le es propio: dar respuesta a las necesidades planteadas por la sociedad haciéndole su lugar: construyéndolo junto con ella. Aparece la figura del "alumno de arquitectura"' nuestro destinatario específico. El alumno de arquitectura, también deberá tomar conciencia, entender, que el "espacio" que él deberá dominar a través d...