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Rivera F.,Hospital General Universitario Of Ciudad Real | Illescas M.L.,Hospital General Universitario Of Albacete | Lopez-Rubio E.,Hospital General Universitario Of Albacete | Fulladosa J.,Hospital Universitari Of Bellvitge | And 14 more authors.
American Journal of Nephrology | Year: 2013

Background: Mycophenolate (MF) is effective as a maintenance therapy after induction therapy in patients with lupus nephritis (LN). However, little is known about its role in patients with impaired renal function. The purpose of this study was to evaluate the efficacy and safety of MF as a maintenance therapy for LN and its association with renal function. Methods: Data were obtained for 56 Spanish patients who were receiving MF as a maintenance therapy for LN. Patients were classified into two groups according to renal function at the initiation of MF treatment: group 1 [estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2] and group 2 (eGFR <60 ml/min/1.73 m2). The primary endpoints of the study were the rates of renal relapse and responses, and their relationship with baseline renal function. Secondary outcomes were the appearance of side effects during treatment. Results: At initiation of MF treatment, the only differences between the groups were for age, hemoglobin levels, anti-DNA antibody titer, proteinuria, and renal function. In group 1 (n = 38), the eGFR was 98 ± 34 ml/min/1.73 m 2 and in group 2 (n = 18) the eGFR was 43 ± 14 ml/min/1.73 m2. Only 3 cases had an eGFR <30 ml/min/1.73 m2. No significant differences were observed in the rate of relapse at 6 months (group 1: 20%; group 2: 23%) or at 12 months (group 1: 25%; group 2: 17%). Response rates were also similar in both groups. Side effects were unremarkable. Conclusions: MF is effective and safe as a maintenance therapy for LN both in patients with normal renal function and in those with renal impairment. Copyright © 2013 S. Karger AG, Basel. Source

Rivera F.,Hospital General Universitario Of Ciudad Real | Merida E.,Hospital Universitario 12 Of Octubre | Illescas M.L.,Hospital General Universitario Of Albacete | Lopez-Rubio E.,Hospital General Universitario Of Albacete | And 11 more authors.
American Journal of Nephrology | Year: 2014

Background: Mycophenolate (MF) is effective as induction and maintenance treatment in patients with lupus nephritis (LN). This study evaluates the efficacy and safety of MF in patients with refractory and relapsing LN. Methods: Data were retrospectively obtained for 85 patients (35 refractory and 50 relapsing) from 11 nephrology departments in Spain. The primary endpoints were the incidence and cumulative number of renal responses and relapses and their relationship with baseline clinical and analytical data. The secondary endpoint was the appearance of side effects. Results: The main clinical and analytical variables were similar both in refractory and relapsing LN. Most of the patients had received cyclophosphamide, and all of them switched to MF. 74 patients (87%) achieved a response (69% partial, 31% complete). Age at starting MF, gender, pathological classification, body mass index, blood pressure, baseline renal function, and proteinuria were not associated with achieving response. After stopping MF, 3 of 19 patients (15.7%) relapsed, all at 6 months of follow-up. No differences were found between clinical and analytical variables and number of relapses. Side effects were unremarkable, except for 1 patient, who died of thrombocytopenia and ovarian hemorrhage. Conclusions: Switching to MF from other immunosuppressive treatments is effective and safe in refractory and relapsing LN. © 2014 S. Karger AG, Basel. Source

Andres M.M.,Hospital Universitario Infantil la Fe | Wallace W.H.B.,Hospital Universitario Infantil la Fe
Paediatrics and Child Health | Year: 2010

The increasing number of paediatric cancer survivors in the last few decades has focused attention on minimizing long-term effects caused by oncological therapy without compromising survival rates. Loss of reproductive function is one of the most distressing potential adverse consequences of successful treatment. Several new reproductive techniques are now available for fertility preservation in these patients. Predicting the risk to fertility for an individual of a planned course of treatment is extremely difficult, particularly in the pediatric population. In this review we discuss the practical and ethical issues that must be addressed so that our patients can benefit from these new technologies. Multidisciplinary teams, specialized centers and decisions made in the "child and young person's best interests" form the basis of the optimal approach to fertility preservation. © 2009 Elsevier Ltd. All rights reserved. Source

Andres M.D.M.,Hospital Universitario Infantil la Fe | Costa E.,Hospital Infantil la Fe | Canete A.,Hospital Universitario Infantil la Fe | Moreno L.,Hospital Universitario Infantil la Fe | Castel V.,Hospital Universitario Infantil la Fe
Clinical and Translational Oncology | Year: 2010

Purpose: Solid ovarian tumours are uncommon in childhood. Our aim is to evaluate the outcomes in a single institution over 35 years. Methods: We reviewed their clinical presentation, management, pathology and outcomes from 1972 to 2007. Results: Fifty-three patients, with a median age of 9.2 years (range 0.9-14.2), were registered. Common symptoms at presentation were abdominal pain (75.8%) and abdominal mass (57.4%). Histopathological diagnoses were: 26 mature teratoma, 10 immature teratoma, 8 dysgerminoma, 5 granulosa cell tumours, 2 yolk sac tumours, 1 gonadoblastoma and 1 embryonal carcinoma. Staging (FIGO) for malignant/borderline tumours was: 17 stage I, 1 stage II, 8 stage III and 1 stage IV. Unilateral salpingo-oophorectomy was performed in 47 cases. Sixteen patients underwent chemotherapy after surgery (15 with platinum-based regimen) and postoperative radiotherapy was given in 5 cases. Recurrence was observed in 2 patients and one died (stage III immature teratoma) after a second relapse despite multiple chemotherapy, surgery and radiotherapy. Five-year OS and 5-year EFS were 97% and 94% respectively. Conclusions: Although rare, ovarian tumours must be included in the differential diagnosis of abdominal pain in childhood. Our results confirm their excellent prognosis using conservative surgery and platinum-based chemotherapy. The key point is to maintain excellent outcome while reducing associated morbidity and preserving fertility. © 2010 Feseo. Source

Moreno L.,Hospital Universitario Infantil la Fe | Fernandez-Navarro J.M.,Hospital Universitario Infantil la Fe | Del Mar Andres M.,Hospital Universitario Infantil la Fe | Bautista F.,Hospital Universitario Infantil la Fe | And 2 more authors.
Journal of Pediatric Hematology/Oncology | Year: 2012

Cytarabine (1000 mg/m/d intravenous for 5 d) and clofarabine (40 mg/m/d intravenous for 5 d) were given every 28 days to 9 children with relapsed acute myeloid leukemia at our institution. Among 19 courses, there were 18 infectious episodes. Median hospitalization time was 13 days (7.7 to 30.5 d) per cycle. Hepatobiliary abnormalities included alanine aminotransferase/aspartate aminotransferase elevation and hyperbilirubinemia. Four patients achieved complete remission (one after an earlier allogeneic Haematopoietic Progenitor Cell Transplant). Four patients are alive disease free. In summary, a proportion of children responded and was able to receive allogeneic Haematopoietic Progenitor Cell Transplant. Side effects were tolerable, although hospitalization time was prolonged. Copyright © 2011 by Lippincott Williams & Wilkins. Source

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