Genistein (CAS 446-72-0), an isoflavone and phytoestrogen predominantly found in soy, is considered a promising natural bioactive to prevent post-menopausal bone loss. geniVida (previously ...Bonistein), a novel product containing of min. 98.5% synthetic genistein aglycone, was investigated in 12 healthy post-menopausal women to assess the safety and tolerability as well as to obtain pharmacokinetic data after 7 days of repeated intakes. 24 h pharmacokinetic profiles were determined after the first oral dose and after 7 days repeated intakes of 30 mg of the test formulation. Plasma genistein (aglycone) and its conjugates were determined by a standardised LC/MS analytical method using D4-genistein as the internal standard. The plasma-concentration time profiles for conjugated genistein showed a fast, monophasic one-peak course until T(max) (5.9 h (first dose), 5.3 h (steady state (SS)); C(max) (456.8 ng/ml (first dose), 498.5 ng/ ml (SS)). Elimination half-lives (t1/2) were calculated to be 10.8 h (first dose) and 8.2 h (SS), respectively. Determination of AUC(0-inf.)) (first dose) was good with a low percentage of extrapolation (3949.1 h ng/ ml). AUC(0-24h) at SS was 5923.3 h ng/ml. Steady state was reached after 4 to 5 days and no relevant accumulation occurred (R = 1.02). The test formulation was safe and very well tolerated.
Only a few data on frequency and character of late infectious complications after high-dose therapy (HDT) and autologous blood stem cell transplantation (ASCT) have been published. This prospective ...study was carried out to identify potential predictive factors for late infections (occurring after discharge following HDT) and to clarify the usefulness of prophylactic measures.
Clinical data of 192 consecutive patients treated with HDT and ASCT in a single hospital were analyzed on late infectious complications. After discharge following HDT, the 166 evaluable patients (84 with hematologic malignancies, 82 with solid tumors) had been examined and interviewed on infections every 4-12 weeks after ASCT. For Pneumocystis carinii prophylaxis, inhalation with pentamidine or oral cotrimoxazole was used for 3-4 months following ASCT.
In the first 6 months following ASCT (after discharge) we saw on average one infectious episode per patient (median, range 0-6), usually light infections (mostly banal upper airway infections). 17 patients had to be treated in hospital for infectious (15 of whom with hematologic malignancies), three of whom (only with hematologic malignancies) died in spite of intensive care as a result of pneumonias due to opportunistic causative agents (mainly Pneumocystis carinii PcP). In the second half of the year after ASCT, five patients (with hematologic malignancies) had to be hospitalized due to infections. No further infection-related death occurred. Early documented infections (pneumonia, bacteremia or Clostridium difficile colitis) were associated with an increased risk for late serious infections. Zoster occurred in 18% of patients within 12 months, more frequently after increased pretreatment (25% vs. 11% after less pretreatment), most frequently in patients with relapsed lymphomas (32%).
Significant late infectious complications after ASCT are uncommon. Patients with hematologic malignancies have a significantly increased risk of more serious infections and should be observed carefully. For risk patients with hematologic malignancies and possibly solid tumors, a strict PcP prophylaxis is required. Patients with relapsed lymphomas could possibly be treated preventively against zoster with low-dose aciclovir to reduce the extent of zoster disease. Each patient should be informed carefully that early signs of zoster require an effective zoster treatment as soon as possible.
