Allogeneic bone marrow transplantation (BMT) was performed in 17 patients with chronic lymphocytic leukemia (CLL): 15 resistant and two untreated forms. There were 12 males and five females with a mean age of 40 years (32-49). The conditioning regimens and graft-versus-host disease (GVHD) prophylaxis varied. Successful engraftment was obtained in 15 evaluable cases. Lymphocytosis and clinical symptoms subsided in all but one case. All 15 evaluable patients developed acute GVHD. Among the 17 patients grafted, one early death was observed at the 15th day post-BMT, and one refractory patient died 2 months after BMT. Of the remaining 15 patients in complete remission (CR), four died from GVHD, hemorrhage and graft failure, and two relapsed at 7 and 54 months after BMT and died. Nine patients are alive in CR with a mean follow-up of 25.6 months (4-48). Chimerism was complete in eight patients and partial in the two T cell-depleted cases. In one case, an immunoglobulin gene rearrangement study showed no residual disease. These results suggest that allogenic BMT might be an alternative and possible curative therapy for refractory CLL in young patients when performed relatively early in the disease. 相似文献
Our work concerned 15 patients (9 males, 6 females) with a mean age of 29.5 years, having a hematologic malignant disease and undergoing allogenic bone marrow transplantation.We studied :
1. The metabolic disorders induced by the conditioning regimen (chemotherapy and total body irradiation) pregraft accompanying cytolysis (day −7, −5, −2).
2. The corrective effect of a total parenteral nutrition introduced 2 days before the transplantation and pursued during 30 days post-graft (day −2 to day 30).
3. The interest of a high calorie intake (BEE × 2) and, after randomisation, of a variable nitrogen intake (24% of the total calorie intake for group A [8 patients] and 14% for group B [7 patients]). The patient characteristics of these two groups were closely comparable. Urinary parameters were studied daily (3-methylhistidine, cratinine, nitrogen) and blood parameters weekly (transferrin, pre-albumin, albumin, retinol binding protein).
We observed globally :
-- An excellent result of the nutritional support without significant weight loss;
-- protein catabolism stopped with a recovery of synthesis of RBP after day 7 and pre-albumin from day 7;
-- a decrease in muscle catabolism.
The randomized study showed :
-- a significant difference in nitrogen excretion between group A and group B;
-- earlier and better protein synthesis recovery in group A, particularly with regard to RBP and pre-albumin.
In conclusion, we recommend for the patients undergoing bone marrow transplantation :
-- nutritional support should be introduced before the conditioning regimen;
-- a high calorie intake (BEE × 2) with a nitrogen intake between 14% and 24% of the total calorie intake;
-- cyclic parenteral nutrition should be pursued during the second and third month post-graft.
Résumé
Nous avons étudié chez 15 malades (9 hommes, 6 femmes) d'âge moyen 29,5 ans, présentant une hémopathie maligne et nécessitant une greffe de moelle osseuse allogénique :
1. Les désordres métaboliques induits par la chimiothérapie et l'irradiation corporelle totale en période de prégreffe au cours de la cytolyse (J −7, J −5, J −2).
2. L'effet correcteur d'une nutrition parentérale introduite deux jours avant la greffe et exclusive durant les 30 jours post-greffe (J −2, J + 30).
3. L'intérêt d'un apport calorique élevé (BEE × 2) et, par randomisation, d'un apport azoté variable (24 % de l'apport calorique total pour le groupe A et 14 % pour le groupe B).
Nous avons étudié quotidiennement certains paramètres urinaires (3MeH, créatinine, azote) et les paramètres sanguins (transferrine, préalbumine, albumine, RBP) l'ont été de façon hebdomadaire.Nous avons constaté globalement un excellent résultat du support nutritif sans perte de poids significative, un arrêt du processus catabolique protéique avec reprise de synthèse après J +7 pour la RBP et pour la préalbumine et une réduction du catabolisme musculaire.L'étude randomisée a mis en évidence :
-- une différence statistique dans l'excrétion axotée, plus intense dans le groupe A,
-- une reprise des synthèses protéiques, plus précoce et plus performante dans ce même groupe pour la RBP et la préalbumine.
En conclusion et compte tenu de l'ensemble des éléments, nous préconisons chez ces malades devant subir une greffe de moelle osseuse allogénique :
-- une attitude préventive en ce qui concerne la nutrition à débuter avant le conditionnement,
-- un apport calorique élevé (BEE × 2) et un apport azoté situé entre 14 % et 24 % de l'apport calorique total,
-- une étude prospective quant à l'intérêt de certains acides aminés et d'une nutrition parentérale cyclique poursuivie au 2e et au 3e mois post-greffe.
Mots clés: greffe de moelle osseuse; nutrition parentérale totale; apport azotéKey-words: bone marrow transplantation; total parenteral nutrition; nitrogen intake 相似文献
This study took place between February 1984 and February 1985 in 76 febrile neutropenic patients. We evaluated the whole mycological and serological results, in 91 febrile episodes. We separated two groups: group I (acute leukemia, chronic myelo?d leukemia, medullar aplasia, lymphomas) and group II (chronic lympho?d leukemia, Hodgkin disease, myelomas, solid tumors). Patients were included in this study if they developed a temperature of 38.5 degrees C or greater and if they had less than five hundred neutrophils per mm3. They were treated with mono or bi-antibiotherapy. If the patient remained febrile more than 72 hours, an antifungal therapy was added (Amphotericin B IV). Through these weekly results, we conclude: the high frequency of digestive tract candidiasis in such patients; disseminated candidiasis occurs only in the first group patients with fungal digestive colonization; the overall response rate in this study was 77 per cent. This underlines the interest of empiric treatment with amphotericin B IV. 相似文献
The combination of discontinuous high-dose chlorambucil therapy with splenectomy greatly increased the prognosis of aggressive forms of chronic lymphocytic leukemia (CLL). The median survival for 43 patients was 84 months from diagnosis and 48 months from splenectomy. For 15 stages O, according to Rai classification, obtained after splenectomy, duration ranged from 3 to 105 months. The median survival of a group of patients showing "nodular splenic infiltration" was 104 months and superior to that of a group of patients showing "diffuse splenic infiltration" (72 months). In four of 15 cases studied, the peripheral blood lymphocytic clone disappeared after splenectomy. 相似文献
Acute myeloid leukaemia (AML) with t(6;9)(p23;q34) is a poor-risk entity, commonly associated with FLT3-ITD (internal tandem duplication). Allogeneic stem-cell tranplantation (allo-SCT) is recommended, although studies analysing the outcome of allo-SCT in this setting are lacking. We selected 195 patients with t(6;9) AML, who received a first allo-SCT between 2000 and 2016 from the EBMT (European Society for Blood and Marrow Transplantation) registry. Disease status at time of allo-SCT was the strongest independent prognostic factor, with a two-year leukaemia-free survival and relapse incidence of 57% and 19% in patients in CR1 (first complete remission), 34% and 33% in CR2 (second complete remission), and 24% and 49% in patients not in remission, respectively (P < 0·001). This study, which represents the largest one available in t(6;9) AML, supports the recommendation to submit these patients to allo-SCT in CR1. 相似文献
To assess the place of allogeneic hematopoietic stem cell transplantation (HSCT) in the advanced stage of acute myeloid leukemia (AML), we retrospectively analyzed 379 consecutive patients who underwent allogeneic HSCT for advanced AML. The median follow-up of the entire cohort was 7.5 years. Sixty-nine patients (18%) were transplanted with primary resistant disease. Three hundred and ten (82%) were relapsed patients, 94 (30%) of whom were in untreated relapse, 67 (22%) in refractory relapse and 149 (48%) in 2nd or 3rd complete remission at time of transplantation. The 5-year probabilities of overall survival (OS), disease-free survival (DFS), and transplant-related mortality (TRM) were 22 +/- 4%, 20 +/- 4%, 45 +/- 6%, respectively. In multivariate analysis, we demonstrated the favorable impact on OS, DFS and TRM of two factors over which we have no control (age <15 years, complete remission achievement) and three factors over which we have some control (female donor, acute and chronic graft-versus-host disease). The results of this study suggest that the graft-versus-leukemia effect is important in advanced AML and that new HSCT modalities are needed for some patients with this indication. 相似文献