ALBERT

Description: Background: Severe skin manifestations, lacerations, ecchymoses and other extravasations have always been a medical problem in patients usually older than 65 y/o and sometimes are associated to depressive conditions. It is a common degenerative status as expression of aging and known as Senile Purpura (SP). Pathophysiological bases of this disorder have been associated with skin atrophy, loss of adipose tissue, elastin and collagen with decreased support of vascularity and blood extravasations. Despite early clinical recognition by Bateman in 1817, any topic nor systemic treatment has been successful. Material and Methods: Patient A.P. 67 y/o, MD, in good clinical conditions, consulted for multiples ecchymoses and several abrasions areas after minimal traumas on extensor surface of skin of both forearms and dorsum of hands. His blood counts revealed Hgb 12.9 g/dL, Hct 40.5%, WBC 8.2x103/ μ L Platelets 166x103/ μ L and normal differential count. Coagulation Profile was also normal (Mielke bleeding time 2 min.) normal clot retraction, PT 12”(Cont. 12.5”), PTT 29”(Cont. 30”) TT 10”(Cont. 9”). Blood chemistry and hepatic enzimes were normal. Diagnosis was made of SP and taking into account the severity of skin lesions and depressive status with anxiety and distress, we propose an autologous stem cell engraftment (ASCE) based on known good previous experiences on other tissues engrafted, especially in heart, pancreas, muscle and others. Requirement of patient consent was positive and procedure was undertaken, administering treatment with lenograstin (rHuG-CSF) SC 5 ug/Kg/day/5 doses, utilizing a cell-separator (Hemonetics) and 7.2% of stem cell CD34+/CD45+ was obtained on the cellular suspension identified in a B-D Flow Cytometer for the mentioned markers, corresponding to 5 x106/mL CD34+ cells. Multiple subdermic injections were performed on the extensor areas of forearms and hands, spacing at 0.5 to 1 cm using insulin syringes type 31 G x 8mm needles, with a previous aseptic preparation of the area to be treated. Results: The whole skin treated with ASCE in the mentioned areas, was initially very thin due to the degenerative process of aging. Besides, it was becoming progressively less wrinkled and therefore more elastic and resistant, without ecchymoses on the first week, and in two weeks the skin appeared almost normal. Subsequently, in a period of one month the patient’s skin did not show substantial differences with the skin of a normal person of a comparable age. Discussion: SP is an entity practically almost with no adequate treatment so far and for that reason this therapeutic approach is a new, valid, easy and effective alternative to treat patients, particularly those cases with severe clinical features and depressive behavior changes. No references were found in venezuelan, latin-american and international reviewed medical literature. In Venezuela this represents the first report on ASCE for dermal atrophy and SP with an obvious cure. Conclusions: Stem cells obtained by apheresis and appropriately injected in multiple subdermic sites of hands and forearms is a curative procedure and confer a normal appearance to the skin treated from two to four weeks. There is no available information on this subject, reason for which this report is probably the first in SP.

Description: Background: NHL is a heterogeneous lymphoid group, in respect of clinical, histological and biological point of view. Follicular Lymphoma (FL) and Diffuse Large B Cell (DLBCL) account together for two/thirds of pts. Inmunophenotypic studies allow separation in B and T, important criteria to decide therapy. Objectives basically were: To asses age, sex incidence, clinical staging, IPI, inmunohistochemical determinations to identify B NHL Evaluation of Chemotherapy and immunotherapy combined in Rituximab (R)-CHOP and R-ESHAP/MINE (R-E/M) as Induction Protocol in front line for newly diagnosed pts and salvage therapy for relapsed pts, determining Overall Survival (OS) and Disease Free Survival (DFS), applying p value to estimate significance. Patients and Methods: Twenty five pts, 10 males and 15 females, with 56.6±15.19 y/o [range (r) 33–83] were studied at Hematology Center of Central Hospital in the west of Venezuela (Maracaibo), from the standpoint of histology, inmunohistochemistry, staging (laboratory, imaging procedures) and optional investigations like chromosomal, molecular, monoclonal markers including CD20, CD45RO (all pts) and BCL-2 in 15 cases. Results: In 52% of pts were 60 y/o; I-IIA/B 9 pts, III-IVA/B 16 pts, IPI in the whole group was 1–2 in 18 pts, 3–4 in 7 pts. By histology 13 pts, were DLBCL and 12 FL. All cases were CD20+; 22 pts received R-CHOP and 3 previously treated pts were given R-E/M), achieving CR in 23 of the whole series (92%) and PR 2 (8%); 3/22 pts treated with R-CHOP relapsed and were placed on R-E/M, so there were 6 pts on this salvage schedule and CR was obtained in 5 with 1 PR. OS of R-CHOP × 6 cycles and R-CHOP × 8 cycles was not significant (ns). DFS in all pts was 26.3±15.9 (r 1–67 m) with ns difference between arms of 6 and 8 cycles. In 13 DLBCL pts OS was statistical ns; DFS in DLBCL and FL was ns. Pts 60 y/o OS was ns; 11 pts were placed on maintenance with R each/2 m/2 years, 10 of them have actually been reached 10–12 doses accomplished and 1 pt 6 doses; 14 pts have not received maintenance. Four pts died, 3 due to cardiac complications and 1 due to toxicity, pancytopenia and sepsis. Conclusion: The efficacy of R-CHOP is relevant in B-NHL and it is similar to the experience so far obtained at the majority institutions working with this kind of clinical trails. Despite E/M protocols have demonstrated efficacy in past experiences, when additional R is used, appears feasible to increase CR, and possibilities of cure as 5/6 pts achieved prolonged continuous CR (r 32–48 m) except for one patient with several relapses. DLBCL is aggressive disease and FL is indolent, but there are not significant differences from de statistical point of view in relation of OS and DFS, probably due to Rituximab incorporation to the classical and salvage chemotherapy.