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Medizinische Angaben/Medical Information

Ohne diese Angaben kann kein umfassender Behandlungsplan und Kostenvoranschlag erstellt werden. // Without these details we cannot provide comprehensive treatment plan and cost estimate.

 

Patientendaten/Patient Data

 

Anfrage von:

Request sent by: Sagina Olena.,òåë.+380663158222,Elina-Artem0208@mail.ru

Tel., fax no., email

 

Name des Patienten/der Patientin: Sagin Artem

 

 

Geburtsdatum/Date of birth: 28.07.2008

 

 

Wohnort/Place of residence: Ukraine, Luhansk region

 

Staatsangehörigkeit/Nationality: Ukrainian

 

 

Eltern/Parents: Name Kontaktdaten/Name Contact data: Tel., email

(Sorgeberechtige/r/person holding custody): Sagina Olena.,tel.+380663158222, Elina-Artem0208@mail.ru

Sagin Volodymyr. tel.+380664562409

 

 

 

 

Medizinische Angaben/Medical Information

Diagnose und Datum - Diagnosis and date (falls onkologisch, bitte auch behandelnden Onkologen angeben, siehe unten/if oncological, please add current oncologist, see below)

granulocytic sarcoma (without bone marrow involvement) with mediastinal localization and infiltration of thoracic soft tissues, pleura, pulmonary parenchyma with metastasis in liver. Disease progression after II very good remission. Status post autologous peripheral hematopoietic stem cells transplantation.

(auto PBSCT)

 

Fragestellung (zu welcher Maßnahme soll der Patient in unsere Klinik kommen) – Question (what do you expect from a treatment by our specialists):transplantation from non-related donor

 

 

 

Bitte fügen Sie einen Arztbrief/Histologie/Vorbefunde NICHT ÄLTER ALS 3 WOCHEN bei! (in Deutsch oder English)

Please attach doctors’ reports/histology/previous findings NOT OLDER THAN 3 WEEKS. (in German or English)

Vorbehandlung bis heute/Previous treatment to date:

It is known from medical history that from 14.07 till 04.12.10 patient has received therapy in the Department of oncohematology in the Center of Children’s Oncohematology and Bone Marrow Transplantation due to diagnosis: histiocytic sarcoma with involvement of mediastinum, liver and spleen. Grade III.

Patient received therapy according to the protocol NHL BFM 1995. Therapy was terminated in November, 2010. In February 2011 radical resection of residual tumor in mediastinum was performed.

March 2011 – radiotherapy to the mediastinal area in dose 15 Gy.

September 2011. Taking into consideration clinical picture, CT of chest and abdomen diagnosis of relapse was established. Biopsy of tumor-like mass was performed through the anterior chest wall.

Examination of bone marrow aspirate: tumor cells are not revealed.

20.09.11 Histological samples obtained during tumor biopsy were consulted in laboratory of pathological anatomy in Federal State Budgetary Institution “Hematological Scientific Center” of Ministry of Health and Social .Development of Russia (prof. Kovrygina A. M.). Conclusion: morphological picture corresponds to extramedullar mediastinal myeloid sarcoma.



Thus, the diagnosis was changed: Granulocytic extramedullar sarcoma with localization in mediastinum and infiltration of thoracic soft tissues, pleura, and pericardium.

Block of chemotherapy was administered (CHOEP) from 03.09 till 07.09.11.

From 25.09.11 till 29.09.11 block HAE was administered (AML BFM 2004). Control CT-examination 14.10.2011 – moderate positive dynamics.

On 25.10.11 the patient was transferred into the Department of BMT in order to prescribe intensive chemotherapy with further autologous SCT (family HLA-identical donor is lacking).

Block Jda-FLAG was administered from 27.10.11 till 01.11.11. Complication after this treatment: myelotoxicity grade IV (according to WHO-scale), toxic pulmonitis, febrile neutropenia, mucositis of gastrointestinal tract grade II. Complex antibacterial, antifungal and symptomatic therapy was prescribed. Substitutive transfusions of packed red cells, platelets concentrate, were administered as well as infusions of human immunoglobulin. Within 2 weeks the patient was on parenteral feeding. Stimulation of leucopoiesis was performed using G-CSF.

Control CT-examination (10.12.11) – negative dynamics, multiple nodular lesions of thoracic soft tissues, pleura, left pulmonary parenchyma, mediastinum.

From 13.12 till 22.12.11 block LD-ARA-C + LD-MEL + Mitox + VP-16 using priming with G-CSF was administered. Complications after this treatment: myelotoxicity grade IV, febrile neutropenia, mucositis grade I.

Control CT-examination of chest and abdominal cavity (10.01.12): negative dynamics, apart from abovementioned lesions of chest, pleura and left pulmonary parenchyma, there are revealed multiple lesions in liver.

Taking into account partial resistance of the tumor for 4 prescribed lines of salvage-chemotherapy, a board of doctors made a decision to prescribe a block of chemotherapy with cladribine and topotecan, and addition of Bevacizumab for potentiating antitumor effect. The block was administered from 15.01 till 23.01.12. Complications after this treatment: myelotoxicity grade IV, febrile neutropenia, mucositis of gastrointestinal tract grade III, significant abdominal pain syndrome was observed, which required administration of narcotic analgesics. Within three weeks the patient was on complete parenteral feeding.

At the control of the status of disease on the 20th day of block administration, there was therapeutical response, but during control CT-examination of chest and abdominal cavity (20.02.12) there was progression of the tumor in all its sites of localization.

Due to progression of the tumor after 5 lines of Salvage-chemotherapy, palliative therapy was indicated: LD-ARA-C 10 mg/m2 BID for 14 days. Block was administered from 22.02 till 06.03.12. After this block there was observed clinical response, specifically, diminution of lymph nodes size in chest. Taking into account such response to the therapy and good tolerability, it was decided to continue therapy using low doses of Cytarabine with addition of Bevacizumab.

2nd block LD-ARA-C from 27.03. till 06.04.12;

3rd block of LD-ARA-C from 28.04 till 12.05.12.

After three blocks of therapy good partial response was diagnosed (CT of chest and abdominal cavity 24.05.12), the beginning of transplantation procedure was indicated.

From 30.05.12 peripheral blood stem cells mobilization was started, regimen LD-ARA-C + 2 infusions of Bevacizumab + cyclophosphamide 1 g/m2 + G-CSF 10 μg/kg/day.

Collections of peripheral blood stem cells were performed on 25, 26, 27.06.12 using blood separator Spectra Optia. Concentrates of peripheral blood stem cells were crioconservated at temperature -80°C with 5% DMSO.

Conditioning: treosulfan 36 g/m2 + melphalan 180 mg/m2 11.07 – 14.07.12

Autologous PBHSCT (day 0) On 16.07.12 reinfusion of thawed peripheral blood stem cells concentrate (volume 264 ml) was performed. Quantity of CD 34+ mononuclears was 1.9 x 106/kg of body weight.

Neutrophil engraft – 29.07.12 (Day +13 of autologous PBHSCT),

Erythroid engraft – 30.07.12 (Day +14 of autologous PBHSCT).

Complications in early post-transplantation period: febrile neutropenia, mucositis of gastrointestinal tract grade II, toxic dermatitis grade I.

Platelets engraftment was not observed. Because of persisting severe throbocytopenia, that required repeated transfusions, blood test for antiplatelet antibodies was done (28.08.12 Dr. Rodher laboratory).

Using cytometric method high antibody (Ig G) load of platelets was revealed and moderate antibody load with Ig M. Result may indicate the presence of autoimmune thrombocytopenia.

From 31.08 till 04.09.12 the patient received 5-day course of high-dose immunoglobulin (Bioven-mono).

Procedure of plasma filtration was performed on 11.09.12 using the apparatus Spectra Optia and column Evaflux (removal of immune complexes).

Control CT-examination of chest and abdominal organs was performed on 15.10.12, negative dynamics was revealed. Progression of the disease was diagnosed (enlargement of mediastinal mass, enlargement of foci in liver).

Therapy with LD-ARA-C + Bevacizumab was initiated on 18.10.12, but taking into account progression of the disease after autologous PBHSCT, as the only radical therapy allogenic stem cell transplantation from non-related donor is indicated to the child. At the present time this type of therapy is not carried out in Ukraine.

On 29.11 and 10.12 Bevacizumab was administered. The patient did not receive Cytosar because of the thrombocytopenia (50,000-60,000 /mcL).

 

At present Artem's health conditions are satisfactory. There are no signs of tumor progression in mediastinum.

 

 

Aktueller Zustand des Patienten/der Patientin: (Karnovsky/Lansky Score/neurologische Störungen/Atemstörung)

Current status of the patient: (Karnovsky/Lansky Score/neurological-, respiratory dysfunction)

The fettle and feel of patient is satisfactory, there are not neurological and respirator signs

 

 

 

Liegen aktuell bei dem Patienten/bei der Patientin Infektionen vor?

Does the patient currently suffer from any type of infection?

 

no

 

 

Kontaktdaten des aktuell behandelnden Arztes (und des Onkologen falls Verdacht auf Krebs) im Heimatland:

Contact data of treating physician (and oncologist if applicable) in home country:

(Mail-address, Clinic, email-address, phone, fax)

Child's clinic Okhmatdet, separation the transplantation of marrow, Bazaluck Y.B., tel: +380442360214, pedbmt@ukr.net

Kontaktdaten des weiterbehandelnden Arztes (und des Onkologen falls Verdacht auf Krebs) im Heimatland:

Contact data of physician responsible for further treatment (and oncologist if applicable) in home country:

(Mail-address, Clinic, email-address, phone, fax)

Child's clinic Okhmatdet, separation the transplantation of marrow, Bazaluck Y.B., tel: +380442360214, pedbmt@ukr.net

 

 

 

Bitte beachten Sie: VOR Arzt- oder Aufnahmetermin ist die Vorauszahlung in Höhe des gesamten Kostenvoranschlags fällig. Nur dann kann eine Einladung für die Beantragung eines Visums ausgestellt und ein Aufnahmetermin vergeben werden.

Please note: BEFORE any consultation or admission you are expected to pay an advance payment according to cost estimate. After receipt of payment we can issue the invitation to obtain a visa and arrange for admission date.


Date: 2015-12-24; view: 543


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