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1.
Hirozumi Sano Ryoji Kobayashi Junji Tanaka Satoshi Hashino Shuichi Ota Yoshihiro Torimoto Yasutaka Kakinoki Satoshi Yamamoto Mitsutoshi Kurosawa Naoki Hatakeyama Yoshihito Haseyama Hajime Sakai Kazuya Sato Takashi Fukuhara 《British journal of haematology》2014,165(6):786-792
Haemophagocytic syndrome is often associated with malignant lymphoma; however, few studies have examined lymphoma‐associated haemophagocytic syndrome (LAHS). A total of 1239 patients with non‐Hodgkin lymphoma were analysed at 12 institutions in Hokkaido prefecture between January 2007 and December 2011 to assess the incidence, prognosis and risk factors of LAHS. The cumulative incidence rate of LAHS was 2·8% (35/1239). Overall survival (OS) in patients with LAHS was significantly inferior to those without LAHS (3‐year OS: 35·6 vs. 59·0% respectively, P < 0·0001). The cumulative incidence of LAHS was higher in patients with T/Natural Killer (NK)‐cell lymphoma than in those with B‐cell lymphoma (8·2 vs. 1·8% respectively, P < 0·0001). The characteristics of patients with and without early death (within the first 120 d after developing LAHS) were subsequently compared to evaluate the prognostic factor of LAHS. The results obtained showed that the rate of early death after developing LAHS was higher in patients with T/NK‐cell lymphoma than in those with B‐cell lymphoma (62·5 vs. 10·5%, P = 0·0033). In conclusion, the complication and mortality rates of LAHS were higher in patients with T/NK‐cell lymphoma after they developed LAHS than in those with B‐cell lymphoma. 相似文献
2.
Hohloch K Sahlmann CO Lakhani VJ Wulf G Glass B Hasenkamp J Meller J Riggert J Trümper L Griesinger F 《Annals of hematology》2011,90(11):1307-1315
A phase II trial evaluated safety, feasibility and efficacy of a sequential tandem approach combining myeloablative BEAM chemotherapy
and autologous stem cell transplantation (ASCT) with myeloablative radioimmunotherapy (HD-RIT), with 131I-anti-CD20 antibody (131I-rituximab), followed by a second ASCT in patients with relapsed or refractory CD20+ B-cell lymphoma. According to protocol,
16 patients with relapsed (n = 14) and refractory (n = 2) CD20+ B-cell lymphoma received salvage therapy with rituximab and Dexa-BEAM, followed by BEAM (HD chemotherapy) and
high-dose myeloablative radioimmunotherapy 2–6 months after BEAM. Nine of 16 patients received HD-RIT; seven patients were
excluded before HD-RIT because of toxicity or progressive disease. Disease histologies were follicular lymphoma (FL) grades
1 and 2 (n = 4), transformed follicular (FL 3b; n = 6), diffuse large B-cell (DLBCL; n = 4), mantle cell (n = 1) and marginal zone lymphoma (n = 1). After a median follow-up of 50.4 months for OS and 39.7 months for progression-free survival (PFS), estimated 4-year
OS and PFS were 67% and 64%, respectively. The estimated 4-year OS and PFS for patients with FL were 80% and 78%, respectively.
Toxicity was significant, including one fatal outcome due to pneumonitis. Tandem transplants consisting of HD chemotherapy
followed by HD-RIT with 131I-coupled anti-CD20 are manageable and effective but toxic treatment modalities for relapsed poor prognosis CD20+ B-NHL. 相似文献
3.
Sieniawski M Staak O Glossmann JP Reineke T Scheuss H Diehl V Engert A Josting A 《Annals of hematology》2007,86(2):107-115
We investigated the addition of rituximab to an intensified salvage program followed by a myeloablative course with autologous
stem cell transplantation (ASCT) in patients with relapsed or refractory aggressive non-Hodgkin lymphoma (NHL). Patients with
relapsed or progressive aggressive NHL were treated with two cycles of conventional salvage chemotherapy (DHAP) followed by
high-dose sequential chemotherapy (cyclophosphamide, methotrexate with vincristine and etoposide) and a final myeloablative
course (BEAM) with ASCT. Rituximab (375 mg/m2) was administered at each treatment cycle. This cohort was compared with a historical control group of patients treated with
the same chemotherapy but without rituximab. Patients from both groups were matched by duration of first remission and lactate
dehydrogenase serum levels. Forty-five patients were treated with chemotherapy and 22 with immunochemotherapy. The overall
response rates (ORR) at the final evaluation were 63% for the immunochemotherapy group and 42% for the chemotherapy group
(p = 0.330). In the historical controlled analysis freedom from second failure (FF2F) at 2 years in the immunochemotherapy group
was 57% and overall survival (OS) was 77%. FF2F in the chemotherapy group was 18% (p = 0.0051) and OS was 37% (p = 0.0051). In the matched-pair analysis, FF2F was 58% in the immunochemotherapy group compared to 16% in the chemotherapy
group (p = 0.0517); OS was 74 vs 33%, respectively (p = 0.0424). The toxicity was tolerable and comparable in both groups. The addition of rituximab to an intensified salvage
chemotherapy regimen seems to improve the prognosis. However, only prospective randomized trial can offer sufficient data
of the value of rituximab in relapsed and refractory aggressive NHL. 相似文献
4.
Ganser A Heil G Seipelt G Hofmann W Fischer JT Langer W Brockhaus W Kolbe K Ittel TH Brack N Fuhr HG Knuth P Höffken K Bergmann L Hoelzer D 《Annals of hematology》2000,79(1):30-35
Intensive chemotherapy followed by treatment with interleukin-2 (IL-2) was evaluated in a prospective, randomized, multicenter
trial including 18 patients with refractory anemia with excess of blasts in transformation (RAEB-T), 86 patients with acute
myeloid leukemia (AML) evolving from myelodysplastic syndromes, and six patients with secondary AML after previous chemotherapy.
Median age was 58 years (range: 18–76 years). Forty-nine patients (45%) achieved a complete remission (CR) after two induction
cycles with idarubicin, ara-C, and etoposide, 52% of them aged ≤60 years and 35% aged >60 years (p=0.06). After two consolidation courses, patients were randomized to four cycles of either high- or low-dose IL-2. Patients
aged up to 55 years with an HLA-identical sibling donor were eligible for allogeneic bone marrow transplantation. The median
relapse-free survival was 12.5 months, with a probability of ongoing CR at 6.5 years of 19%. Overall survival of all patients
was 8 months, and 21 months for the CR patients. Median survival was significantly longer among patients aged ≤60 years than
among the older patients (16 vs 6 months, p<0.001). Median duration of survival and relapse-free survival were not statistically different in the two IL-2 treatment
arms.
Received: March 23, 1999 / Accepted: June 23, 1999 相似文献
5.
Kim MK Kim S Lee SS Sym SJ Lee DH Jang S Park CJ Chi HS Huh J Suh C 《Annals of hematology》2007,86(6):435-442
Although the role of high dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT) in the treatment of aggressive
lymphoma has been established in several large prospective studies, its effectiveness in patients with peripheral T cell lymphoma
(PTCL) has not been defined. We aimed to evaluate the efficacy of HDT and ASCT and prognostic factors for survival in patients
with PTCL. We retrospectively analyzed the results of 40 PTCL patients treated with HDT and ASCT at Asan Medical Center between
January 1995 and December 2005. Twenty patients had PTCL-U (peripheral T cell lymphoma, unspecified), 10 had extranodal natural
killer/T cell lymphoma, 5 had anaplastic large cell lymphoma, 3 had angioimmunoblastic T cell lymphoma, 1 had hepatosplenic
γσ T cell lymphoma, and 1 had disseminated mycosis fungoides. Disease status at transplant was complete response (CR)1 in
3 patients, CR2 or greater in 8, partial remission in 25, and refractory in 4. At a median follow-up of 16 months (range,
5 to 135 months) for surviving patients, the median overall survival (OS) was 11.5 months and the 1-year probability of survival
was 46.1%. The median event free survival (EFS) was 3.6 months (95% confidence interval, 2.5 to 4.8 months). Ten patients
(25%) remain alive without evidence of disease. The median OS of 11 patients with CR at ASCT was not reached; of these, 7
patients (63.6%) were alive with CR. In multivariate analysis, CR at ASCT was a prognostic factor for EFS (P = 0.025) and OS (P = 0.027) and normal lactate dehydrogenase (LDH) at ASCT was a prognostic factor for improved OS (P = 0.025). Chemosensitive patients with PTCL who achieved CR before ASCT seem to benefit from HDT and ASCT. Pretransplant
values of LDH had potential to predict the survival. 相似文献
6.
Li JM Wang L Shen Y Xia ZG Chen Y Chen QS Chen Y Zeng XY You JH Qian Y Shen ZX 《Annals of hematology》2007,86(9):639-645
The objective of this study is to evaluate the long-term efficacy and safety of rituximab combined with cyclophosphamide,
doxorubicin, vincristine, and prednisone (CHOP) in Chinese patients with newly diagnosed diffuse large B cell lymphoma (DLBCL).
The study comprised a retrospective analysis of patients treated at a single center. Patients received four to six infusions
of rituximab (375 mg/m2 per dose) on day 1 of each cycle of CHOP chemotherapy. CHOP was initiated on day 3 of each cycle; cycles were repeated at
21-day intervals. A total of 82 patients with a median age of 45 years (range 18–76 years) was included. The overall response
(OR) and complete response (CR) rates were 90.2 and 70.7%, respectively. The estimated 5-year progression-free survival (PFS)
and overall survival (OS) rates were 56.4 ± 8.3% and 74.1 ± 7.4%, respectively. Patients with International Prognostic Index
(IPI) scores ≤2 had significantly higher OR, CR, PFS, and OS rates (p = 0.01, p = 0.02, p = 0.01, p < 0.001, respectively) compared with patients with IPI scores >2. The hematologic toxicity was mild. Five patients with a
history of chronic hepatitis B experienced a reactivation of viral hepatitis. The rituximab–CHOP combination was effective
and well tolerated in Chinese patients with newly diagnosed DLBCL.
This study was conducted in accordance with the Chinese Good Clinical Practice (GCP), including ethical approval. 相似文献
7.
Colovic N Tosic N Aveic S Djuric M Milic N Bumbasirevic V Colovic M Pavlovic S 《Annals of hematology》2007,86(10):741-747
Mutations in the fms-like tyrosine kinase 3 (FLT3) gene, such as internal tandem duplication (FLT3/ITD) in the juxtamembrane domain and point
mutations in the tyrosine kinase domain, are the most common abnormalities in acute myeloid leukemia (AML). FLT3/ITD and FLT3/D835
mutations were analyzed in 113 Serbian adult AML patients using polymerase chain reaction. Twenty patients were found to be
FLT3/ITD positive (17.7%). The mutations occurred most frequently in M5 and M0 subtypes of AML. They were mainly associated
with the normal karyotype. All patients harboring FLT3/ITD had a higher number of white blood cells than patients without
it (p = 0.027). FLT3/ITD mutations were associated with lower complete remission (CR) rate (χ
2 = 5.706; p = 0.017) and shorter overall survival (OS; Log rank = 8.76; p = 0.0031). As for disease-free survival, the difference between FLT3/ITD-positive and FLT3/ITD-negative patients was not
statistically significant (Log rank = 0.78; p = 0.3764). In multivariate analysis, the presence of FLT3/ITD mutations was the most significant prognostic factor for both
OS and CR rate (p = 0.0287; relative risk = 1.73; 95% CI = 1.06–2.82). However, in the group of patients with the intermediate-risk karyotype,
the mere presence of FLT3/ITD was not associated with inferior clinical outcome. FLT3/D835 point mutation was found in four
patients (3.5%) only. Follow-up of the FLT3/ITD-positive patients revealed stability of this mutation during the course of
the disease. However, changes in the pattern of FLT3/D835 mutations in initial and relapsed AML were observed. Our results
indicate an association of FLT3/ITD with the adverse outcome in AML patients treated with standard induction chemotherapy.
Because FLT3/ITD mutation is a target for specific therapeutic inhibition, its early detection could be helpful in clinical
practice.
Ms. Colovic and Ms. Tosic contributed equally to this work. 相似文献
8.
Yun HR Lee WY Lee WS Lee OS Cho YB Yun SH Chun HK 《International journal of colorectal disease》2007,22(11):1301-1310
Background and aims Approximately 20% of patients with colorectal cancer are initially diagnosed with stage IV. The majority has non-curative
metastases, and their chances of survival are pitiful. This study evaluated the prognostic factors of survival and the access
to the effective treatment in accordance with patients.
Materials and methods We retrospectively analyzed 503 patients for demographics, tumor characteristics, the treatment modality, and the survival
outcome. Curative operation was performed in 127 patients and palliative operation in 376 patients.
Results For the curative operation group, the 5-year survival rate was 34.5%, and the prognostic factors of survival and recurrence
were male gender (p = 0.003, 0.009), pathologic N stage (p < 0.001, p = 0.002), and perineural invasion (p = 0.003, p = 0.026), respectively. For the non-curative operation group, the 5-year survival rate was 0%, and the median survival duration
was 16.5 months. The potential predictors of survival for the palliative operation group were carcinoembryonic antigen level
(p = 0.013), differentiation of tumor (p = 0.011), resection of primary tumor (p < 0.001), and chemotherapy (p < 0.001). But for the 131 patients with asymptomatic incurable disease, only chemotherapy was related to survival (p < 0.001).
Conclusions The potential predictors of survival for curative stage IV colorectal cancer were male gender, pathologic N stage, and perineural
invasion. Resection of the primary tumor and chemotherapy showed benefit for the incurable patients. But for the asymptomatic
incurable patients, only chemotherapy prolonged the survival.
This study was presented at the 21st Biennial Congress of International Society of the University of Colon and Rectal Surgeons
held in Istanbul, Turkey in June 2006. 相似文献
9.
Wen-Xian Li Hai-Feng Pan Jian-Li Hu Chang-Zhong Wang Ning Zhang Jing Li Xiang-Pei Li Jian-Hua Xu Dong-Qing Ye 《Clinical rheumatology》2010,29(3):315-323
This study aims to explore the percentage of T-cell and NK-cell subsets, the expression of NKG2A and NKG2D on CD3+ T cells
and CD3−CD56+ NK cells on the total lymphocytes in new-onset systemic lupus erythematosus (SLE) patients, and explore clinical
significance of these cell subsets. Thirty-two SLE patients and 32 normal controls were enrolled. Flow cytometry was used
to count T- and NK-cell subsets and to detect the expression of NKG2A and NKG2D on CD3+ T cells and CD3−CD56+ NK cells in
patients with new-onset SLE. Results show that CD4+ T (t = 2.04, P < 0.05), CD4+/CD8+ T cell (t = 2.66, P < 0.05), CD4+ CD25+ T (t = 2.48, P < 0.05), CD3+CD56+ natural killer T (NKT) (t = 40.05, P < 0.01), CD3−CD56+CD16+ NK-cell subsets (t = 3.50, P < 0.01) were significantly decreased, CD8+ T-cell subsets was significantly increased in patients with new-onset SLE (t = 3.80, P < 0.01), as compared with healthy controls. CD8+ T-cell subset was significantly increased in patients with vasculitis (t = 2.47, P < 0.05), and CD3−CD56+CD16+ NK was increased in patients with arthritis (t = 3.21, P < 0.01). However, no statistically significant correlation was found among different PBMC subsets and SLEDAI activity scores.
Patients with SLE had a lower expression of NKG2A (U = 2.42, P < 0.05) as well as NKG2A/NKG2D ratio (t = 2.61, P < 0.05) and a higher expression of NKG2D (t = 2.21, P < 0.05) on CD3+ T cells, compared with normal controls. However, they had a higher expression of NKG2A (t = 2.59, P < 0.05) as well as NKG2A/NKG2D ratio (t = 49.45, P < 0.01) and a lower expression of NKG2D (t = 3.05, P < 0.01) on CD3−CD56+ NK cells. Taken together, the findings indicate the decreased CD4+ T-cell, CD4+/CD8+ T-cell, CD4+CD25+
T-cell, CD3+CD56+ NKT-, and CD3−CD56+CD16+ NK-cell subsets, increased CD8+ T-cell subsets as well as the abnormal expression
of NKG2A and NKG2D on CD3+ T and CD3−CD56 + NK cells may play a role in the etiology of SLE. 相似文献
10.
de Oca J Azuara D Sanchez-Santos R Navarro M Capella G Moreno V Sola A Hotter G Biondo S Osorio A Martí-Ragué J Rafecas A 《International journal of colorectal disease》2008,23(1):21-27
Background and aims The prognostic value of the degree of apoptosis in colorectal cancer is controversial. This study evaluates the putative clinical
usefulness of measuring caspase-3 activity as a prognostic factor in colonic cancer patients receiving 5-fluoracil adjuvant
chemotherapy.
Materials and methods We evaluated caspase-3-like protease activity in tumours and in normal colon tissue. Specimens were studied from 54 patients.
These patients had either stage III cancer (Dukes stage C) or high-risk stage II cancer (Dukes stage B2 with invasion of adjacent
organs, lymphatic or vascular infiltration or carcinoembryonic antigen [CEA] > 5). Median follow-up was 73 months. Univariate
analysis was performed previously to explore the relation of different variables (age, sex, preoperative CEA, tumour size,
Dukes stage, vascular invasion, lymphatic invasion, caspase-3 activity in tumour and caspase-3 activity in normal mucosa)
as prognostic factors of tumour recurrence after chemotherapy treatment. Subsequently, a multivariate Cox regression model
was performed.
Results Median values of caspase-3 activity in tumours were more than twice those in normal mucosa (88.1 vs 40.6 U, p = 0.001), showing a statistically significant correlation (r = 0.34). Significant prognostic factors of recurrence in multivariate analysis were: male sex (odds ratio, OR = 3.53 [1.13–10.90],
p = 0.02), age (OR = 1.09 [1.01–1.18], p = 0.03), Dukes stage (OR = 1.93 [1.01–3.70]), caspase-3 activity in normal mucosa (OR = 1.02 [1.01–1.04], p = 0.017) and caspase-3 activity in tumour (OR = 1.02 [1.01–1.03], p = 0.013).
Conclusion Low caspase-3 activity in the normal mucosa and tumour are independent prognostic factors of tumour recurrence in patients
receiving adjuvant 5-fluoracil-based treatment in colon cancer, correlating with poor disease-free survival and higher recurrence
rate. 相似文献
11.
van den Heuvel-Eibrink MM van der Holt B Burnett AK Knauf WU Fey MF Verhoef GE Vellenga E Ossenkoppele GJ Löwenberg B Sonneveld P 《Annals of hematology》2007,86(5):329-337
Clinical resistance to chemotherapy in acute myeloid leukemia (AML) is associated with the expression of the multidrug resistance
(MDR) proteins P-glycoprotein, encoded by the MDR1/ABCB1 gene, multidrug resistant-related protein (MRP/ABCC1), the lung resistance-related protein (LRP), or major vault protein
(MVP), and the breast cancer resistance protein (BCRP/ABCG2). The clinical value of MDR1, MRP1, LRP/MVP, and BCRP messenger RNA (mRNA) expression was prospectively studied in 154 newly diagnosed AML patients ≥60 years who were treated
in a multicenter, randomized phase 3 trial. Expression of MDR1 and BCRP showed a negative whereas MRP1 and LRP showed a positive correlation with high white blood cell count (respectively, p < 0.05, p < 0.001, p < 0.001 and p < 0.001). Higher BCRP mRNA was associated with secondary AML (p < 0.05). MDR1 and BCRP mRNA were highly significantly associated (p < 0.001), as were MRP1 and LRP mRNA (p < 0.001) expression. Univariate regression analyses revealed that CD34 expression, increasing MDR1 mRNA as well as MDR1/BCRP coexpression, were associated with a lower complete response (CR) rate and with worse event-free survival and overall survival.
When adjusted for other prognostic actors, only CD34-related MDR1/BCRP coexpression remained significantly associated with a lower CR rate (p = 0.03), thereby identifying a clinically resistant subgroup of elderly AML patients. 相似文献
12.
Valérie Frossard Nicolas Ketterer Anne Rosselet Pascal Meier Anne Cairoli Michel A. Duchosal Tibor Kovacsovics 《Annals of hematology》2009,88(7):681-685
Primary systemic amyloidosis (AL amyloidosis) continues to have a very poor prognosis. Most therapeutic strategies remain
unsatisfactory. Conventional chemotherapy is known to offer at best only moderate efficacy. Several studies have yielded higher
complete response rates after high-dose chemotherapy and autologous stem cell transplantation (ASCT) in addition to improving
outcomes in a subgroup of patients. However, the superiority of an intensive approach in AL amyloidosis has not been confirmed
in a randomised trial. The precise role of ASCT remains unclear. We report our experience in 16 patients diagnosed with AL
amyloidosis and treated in a multidisciplinary approach with high-dose melphalan and ASCT. Median age was 59 (39–71) years.
The kidneys were predominantly affected in 75% of cases; two or more organs were affected in 38%. Median time from diagnosis
to transplantation was 2 (1–4) months. Three patients (19%) developed acute renal failure and required transient dialysis.
Transplant-related mortality was 6% after 100 days. Haematological complete response (CR) was obtained in nine (56%) and organ
response in six (38%) patients. Nine out of 12 patients (75%) with kidney involvement exhibited a sustained clinical benefit
at 12 months. Half of all the patients (n = 8) were alive after a median follow-up of 33 months, including two in continuous CR. This suggests that high-dose chemotherapy
and ASCT are still valid treatment options in AL amyloidosis and that a significant number of patients with renal involvement
might benefit from this approach. 相似文献
13.
Michael Doubek Frantisek Folber Zdenek Koristek Yvona Brychtova Marta Krejci Miroslav Tomiska Milan Navratil Petra Mikulasova Jiri Mayer 《Annals of hematology》2009,88(9):881-887
The role of autologous hematopoietic stem cell transplantation (autoHSCT) in adult acute lymphoblastic leukemia (ALL) is still
unclear. We retrospectively analyzed the results of the autoHSCT and maintenance therapy, with oral 6-mercaptopurine and methotrexate,
in comparison to conventional-dose chemotherapy in the consolidation treatment of adult ALL and lymphoblastic lymphoma (LBL).
The patients, with HLA identical sibling donor, underwent allogeneic transplantation, while the others were treated with autoHSCT
and maintenance therapy with oral 6-mercaptopurine and methotrexate, or by conventional-dose chemotherapy (patient’s decision,
no autologous hematopoietic stem cells harvest). Sixty consecutive adult patients (median age 35.2 years; range 17.3 to 70.7)
with ALL (n = 52), LBL (n = 7), and acute biphenotypic leukemia (n = 1) were treated in our center from 1997 to 2007. Patients treated with chemotherapy alone (n = 35) had a shorter median progression-free survival (PFS) compared to patients who underwent autoHSCT plus maintenance therapy
(n = 18), 8.4 and 46.8 months, respectively (p = 0.017). Patients treated with chemotherapy alone had also a shorter median overall survival (OS) compared to patients treated
with autoHSCT: 13.0 vs. 46.8 months (p = 0.046). The differences remained statistically significant even after excluding patients with Ph positivity. We can conclude
that, in our case, autoHSCT followed by maintenance chemotherapy is a good option for adult patients with ALL and, in standard-risk
and high-risk patients, provides more favorable OS and PFS rates compared to patients treated by chemotherapy alone. However,
we are aware of the fact that our analysis may have been distorted by the fact that the analysis is retrospective, that treatment
with autoHSCT was based on patient’s decision, and that chemotherapy may have been administered to negatively selected patients. 相似文献
14.
Tsuneaki Hirakawa Hiroki Yamaguchi Norio Yokose Seiji Gomi Koiti Inokuchi Kazuo Dan 《Annals of hematology》2010,89(9):897-904
CHOP-like regimen combined with rituximab is a standard chemotherapy for diffuse large B-cell lymphoma (DLBCL). The relative
dose intensity (RDI) was proposed as an index of the dose and administration interval of agents. Previous studies reported
that the maintenance of the RDI during CHOP therapy improved the treatment results. However, few studies regarding RDI have
reviewed patients receiving combination therapy with CHOP and rituximab. We investigated the influence of RDI maintenance,
involving combination therapy with rituximab, on therapeutic effects in patients with DLBCL. We retrospectively examined 152
DLBCL patients who were treated with CHOP-like regimen combined with rituximab in whom the RDI could be followed up. Multivariate
analysis revealed that international prognosis index (IPI) high intermediate-high (HI-H) (p = 0.005) and RDI of less than 70% (p = 0.007) were independent prognostic factors for low progression free survival. Concerning overall survival, IPI HI-H (p = 0.027) and an RDI of less than 70% (p = 0.002) were involved in an unfavorable prognosis. In addition, age over 60 years (p = 0.003), R-THPCOP (p = 0.034), or the presence of febrile neutropenia (p = 0.004) made RDI maintenance difficult, and prophylactic G-CSF therapy (p = 0.026) was useful for maintaining the RDI. Maintaining the RDI is important even in the era of rituximab-combined chemotherapy
for DLBCL. 相似文献
15.
Mervi Putkonen Auvo Rauhala Tarja-Terttu Pelliniemi Kari Remes 《Annals of hematology》2009,88(7):673-680
Pegfilgrastim (PEGFIL) has been found to be comparable to daily filgrastim (FIL) in managing chemotherapy-induced neutropenia.
In the present study, we evaluated the ability of PEGFIL to mobilize stem cells in 38 consecutive patients with lymphoproliferative
diseases (multiple myeloma, n = 18; lymphomas, n = 15; chronic lymphocytic leukemia, n = 5). Patients were mobilized using PEGFIL (6–18 mg as a single dose) during 2005–2006; 32 then received high-dose chemotherapy
followed by autologous stem cell transplantation. PEGFIL-mobilized patients were matched by age, disease, and treatment line
at a ratio of 1:2 to historical FIL-mobilized controls. The primary study endpoint was the blood CD34+ concentration at onset of leukapheresis. Leukapheresis began a median of 10 days from the beginning of mobilization chemotherapy
in both groups. At the onset of leukapheresis, median blood CD34+ cell counts did not differ significantly in the FIL group compared with the PEGFIL group (79 × 106/L vs 64 × 106/L, respectively; p = 0.44). In the different disease categories, the respective CD34+ cell counts after FIL and PEGFIL mobilization were 72 × 106/L vs 123 × 106/L (p = 0.08) in myeloma, 51 × 106/L vs 62 × 106/L (p = 0.6) in lymphomas, and 27 × 106/L vs 30 × 106/L (p = 0.62) in CLL, respectively. The target CD34+ cell yield was harvested with one leukapheresis in 53% of PEGFIL-mobilized patients. Engraftment after autografting did not
differ significantly in the two groups. Stem cell mobilization with a single dose of PEGFIL was, therefore, comparable to
that achieved using daily FIL in patients with lymphoproliferative diseases. PEGFIL is a more practical way to mobilize stem
cells than daily FIL. 相似文献
16.
Kumar L Malik PS Prakash G Prabu R Radhakrishnan V Katyal S Hariprasad R 《Annals of hematology》2011,90(11):1317-1328
Limited information is available from developing countries about complications, pattern of infections, and long-term outcome
of patients following high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ASCT). Between April,
1990 and December 2009, 228 patients underwent ASCT. Patients’ median age was 48 years, ranging from 11 to 68 years. There
were 158 males and 70 females. Indications for transplant included multiple myeloma, n = 143; lymphoma, n = 44 (Hodgkin’s, n = 25 and non-Hodgkin’s, n = 19); leukemia, n = 22; and solid tumors, n = 18. Patients received HDCT as per standard protocols. Following ASCT, 175 (76.7%) patients responded; complete, 98 (43%);
very good partial response, 37 (16.2%); and partial response, 40 (17.5%). Response rate was higher for patients with good
Eastern Cooperative Oncology Group (ECOG) performance status (0–2 vs. 3–4, p < 0.001), pretransplant chemo-sensitive disease (p < 0.001) and those with diagnosis of hematological malignancies (p < 0.003). Mucositis, gastrointestinal, renal, and liver dysfunctions were major nonhematologic toxicities, 3.1% of patients
died of regimen-related toxicities. Infections accounted for 5.3% of deaths seen before day 30. At a median follow-up of 66 months
(range, 9–234 months), median overall (OS) and event-free survival (EFS) were 72 months (95% CI 52.4–91.6) and 24 months (95%
CI 17.15–30.9), respectively. For myeloma, OS and EFS were 79 months (95% CI 52.3–105.7) and 30 months (95% CI 22.6–37.4),
respectively. Pretransplant good performance status and achievement of significant response following transplant were major
predictors of survival. Our analysis demonstrates that such procedure can be successfully performed in a developing country
with results comparable to developed countries. 相似文献
17.
N. Kröger W. Zeller H. T. Hassan W. Krüger H. Renges K. Hummel K. Gutensohn C. Lölliger A. R. Zander 《Annals of hematology》1998,76(6):257-262
We investigated the feasibility of mobilizing peripheral blood stem cells (PBSC) with G-CSF alone in 24 patients with multiple
myeloma. The median age was 53 years (range 33–62). All patients had stage II/III disease and responded to standard first-line
(n=6) or salvage chemotherapy (n=18). The median number of previous chemotherapy cycles was 7 (4–18) and the median number of prior melphalan-cycles was 6
(0–14). Nine (35%) patients had experienced prior radiation therapy. The patients received either 10 μg/kg G-CSF (n=18) or 24 μg/kg G-CSF (n=7, including one patient with previous 10 μg/kg G-CSF stimulation) daily s.c. for 5 or more consecutive days until completion
of harvesting, starting apheresis on the fifth day. G-CSF treatment was well tolerated, with only slight bone pain in half
of the patients (51%). After a median of three (range 1–7) apheresis procedures, medians of 3.8 (0.3–17)×106 CD34+ cells/kg, 8.5 (4.5–24)×108 MNC/kg, 2.9 (0.6–39.4)×104 CFU-GM/kg, and 5.6 (0.9–49)×104 BFU-E/kg were harvested. Three patients (12%) with extensive melphalan pretreatment failed the target collection of at least
2.0×106 CD34+ cell/kg. Pretreatment with six or more cycles of melphalan yielded a smaller number of CD34+ cells than pretreatment
with fewer than six cycles (2.5 vs 5.3×106/kg;p=0.001). Nineteen patients underwent high-dose chemotherapy consisting of either total marrow irradiation (9 Gy)/busulfan
(12 mg/kg) and cyclophosphamide (120 mg/kg) (n=10), or busulfan (14 mg/kg)/cyclophosphamide (120 mg/kg) (n=5), or tandem melphalan (200 mg/m2). The median time for granulocyte (>1.0/nl) and platelet (>50/nl) recovery was 10 and 14 days (ranges 7–12 and 8–40), respectively.
G-CSF alone is a safe, alternative approach to mobilizing sufficient PBSC in patients with multiple myeloma and allows an
exact prediction of harvest time. G-CSF-mobilized PBSCs ensure rapid engraftment after myeloablative therapy. Melphalan treatment
should be avoided in patients who are candidates for high-dose chemotherapy.
Received: February 5, 1998 / Accepted: April 14, 1998 相似文献
18.
Ralf Konopke Stephan Kersting Alfred Bunk Janine Dietrich Axel Denz Jörg Gastmeier Hans-Detlev Saeger 《International journal of colorectal disease》2009,24(6):687-697
Background/aims Despite advances in diagnosis and treatment, the rate of complications after resection for colorectal liver metastases remains
high. An awareness of risk factors is essential for the rates of morbidity and mortality to fall to optimal levels.
Materials and methods Of the 240 patients who underwent resection for the first manifestation of colorectal liver metastases, 49 patients with lobectomy
or extended hepatectomy (major resections) and 58 with wedge resections within only one liver segment (minor resections) form
the basis of this report. A total of 16 variables were analyzed to find the risk factors linked to postoperative morbidity
and mortality.
Results/findings Thirty-four patients (31.8%) suffered postoperative complications, and one patient died during the hospital stay (0.9%). In
the major resection group, multivariate analysis showed that neoadjuvant chemotherapy [odds ratio (OR): 2.4; p = 0.005], vascular clamping (OR: 1.4; p = 0.008), and intraoperative blood loss with transfusion of three to six packed red cell units (OR: 1.2; p = 0.029) were significantly associated with postoperative morbidity. Vascular clamping was an independent predictor for biliary
fistula (OR: 1.2; p = 0.029). Postoperative temporary liver failure was influenced by neoadjuvant chemotherapy (OR: 3.4; p = 0.010), vascular clamping (OR: 1.5; p = 0.015), and requirement of blood transfusion (OR: 2.1; p = 0.016). After minor resections, only a decreased postoperative serum cholinesterase B level was an independent predictor
for complications (OR: 2.2; p = 0.001), as well as for hemorrhage (OR: 1.6; p = 0.023). Postoperative mortality was not predicted by any of the factors that were analyzed.
Interpretation/conclusion Factors for complications differ depending on the extent of colorectal liver metastasis resection. Only knowledge and particular
consideration of these factors may provide for an optimal postoperative outcome for the individual patient.
Ralf Konopke and Stephan Kersting contributed equally to this work 相似文献
19.
Chun-Hsiung Chen Hung-An Chen Hsien-Tzung Liao Chin-Hsiu Liu Chang-Youh Tsai Chung-Tei Chou 《Clinical rheumatology》2010,29(10):1155-1161
The objective of the study was to investigate the role of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin
(OPG) in ankylosing spondylitis (AS). Serum levels of soluble RANKL (sRANKL) and OPG were measured in 42 AS patients and 26
healthy controls. We evaluated the AS patient's disease activity, functional ability, global assessment, and physical mobility
and tested markers of systemic inflammation, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels. Serum
levels of sRANKL [mean (SD), 4.75 (1.88) vs. 3.70 (1.14) pmol/l, p = 0.015] and OPG [mean (SD), 5.18 (1.19) vs. 4.52 (0.85) pmol/l, p = 0.026] were significantly higher in the 42 AS patients than the 26 healthy controls. Interestingly, serum OPG levels correlated
significantly with ESR (r = 0.417, p = 0.007), CRP (r = 0.524, p < 0.001), tragus-to-wall distance (r = 0.556, p < 0.001), fingertip-to-floor distance (r = 0.423, p = 0.007), and occiput-to-wall distance (r = 0.465, p = 0.002) and correlated inversely with modified Schober index (r = −0.525, p = 0.001), cervical rotation (r = −0.403, p = 0.022), lateral lumbar flexion (r = −0.587, p < 0.001), and chest expansion (r = −0.553, p < 0.001). Moreover, in the AS patients with higher (≥4.925 pmol/l, n = 21) serum OPG levels, there were significant increases in the tragus-to-wall distance (p = 0.007), fingertip-to-floor distance (p = 0.023), and CRP levels (p = 0.014) and decreased in the modified Schober index (p = 0.012), lateral lumbar flexion (p = 0.019), and chest expansion (p = 0.005). Serum levels of sRANKL and OPG are increased in the AS patients and may participate in the disease process of AS.
Production of OPG has association with poor physical mobility and may reflect systemic inflammation in AS. 相似文献
20.
Belini E da Silva DG Torres Lde S de Almeida EA Cancado RD Chiattone C Bonini-Domingos CR 《Annals of hematology》2012,91(4):479-489
To evaluate, in a longitudinal study, the profile of lipid peroxidation and antioxidant capacity markers in sickle cell anaemia
patients receiving different treatments and medication over different time periods. The three groups were: patients undergoing
transfusion therapy and receiving iron chelator deferasirox (DFX group, n = 20); patients receiving deferasirox and hydroxyurea (DFX + HU group, n = 10), and patients receiving only folic acid (FA group, n = 15). Thiobarbituric acid-reactive substance (TBARS) assays and trolox-equivalent antioxidant capacity (TEAC) assays were
evaluated during two different periods of analysis, T0 and T1 (after ~388 days). Higher FA group TBARS values were observed
compared with the DFX + HU group (p = 0.016) at T0; and at T1, higher FA group TBARS values were also observed compared with both the DFX group (p = 0.003) and the DFX + HU group (p = 0.0002). No variation in TEAC values was seen between groups, at either T0 or T1. The mean values of TBARS and TEAC for
both the DFX and DFX + HU groups decreased at T1. The antioxidant effects of HU and DFX were observed by through an increase
in TEAC levels in DFX and DFX + HU groups when compared with those of normal subjects. Increased TEAC values were not recorded
in the FA group, and lipid peroxidation was seen to decrease after DFX and HU use. 相似文献