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1.
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
2.
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
3.
Morris M Platell C McCaul K Millward M van Hazel G Bayliss E Trotter J Ransom D Iacopetta B 《International journal of colorectal disease》2007,22(8):887-895
Background and aims There is considerable uncertainty as to whether adjuvant 5-fluorouracil-based chemotherapy provides survival benefit for colon
cancer patients with stage II disease. Consequently, the current rates of chemotherapy use for this disease are low despite
5-year survival rates of only 70–80%. The aim of the present study is to compare the survival rate of stage II colon cancer
patients treated by surgery alone with that of patients also treated by chemotherapy.
Patients and methods A population-based observational study was conducted on the survival of stage II colon cancer patients (n = 812) diagnosed in Western Australia from 1993 to 2003. The study was restricted to patients aged ≤75 years, of whom 18%
(n = 142) were treated with chemotherapy. Only 0.9% of patients older than 75 years received chemotherapy.
Results Patients who received chemotherapy were significantly younger (mean age 6 years) than those treated by surgery alone (65 years,
P < 0.001), and their tumors were more often positive for vascular invasion (P = 0.007). Multivariate analysis that included all prognostic factors revealed adjuvant chemotherapy was associated with improved
survival (HR = 0.62, 95% CI [0.39–0.98], P = 0.043), with women gaining more benefit (HR = 0.48, 95% CI [0.20–1.22], P = 0.09) than men (HR = 0.94, 95% CI [0.54–1.64], P = 0.8).
Conclusions In view of the apparent survival benefit from chemotherapy for stage II colon cancer, the present study raises concerns about
the current low rates of adjuvant treatment for this disease in the community, particularly for female patients.
Melinda Morris was supported by a Surgeon–Scientist scholarship from the Royal Australasian College of Surgeons. 相似文献
4.
This study evaluated the prognostic value of minimal residual disease (MRD) monitoring by four-color flow cytometry (FCM)
in patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
MRD was examined with four-color FCM at different time points in 139 patients (including pediatric and adult patients) with
ALL after allo-HSCT. Real-time quantitative polymerase chain reaction (RQ-PCR) was applied to evaluate the MRD of Philadelphia
chromosome-positive ALL (Ph+ ALL) patients. Patients who were FCM-positive (FCM+) after transplantation had a lower event-free
survival (EFS) of 0.54 and a higher cumulative incidence of relapse (CIR) of 0.54 compared to an EFS of 0.80 and a CIR of
0.08 in FCM-negative (FCM−) patients (EFS, p < 0.001; CIR, p < 0.001). Similar results were obtained in high-risk patients and Ph+ ALL patients. Moreover, a FCM+ status after the second
month post-HSCT (defined as MRD positive) proved to be a predictor of leukemia relapse. Multivariate analysis for EFS, OS
and CIR showed that MRD status after transplantation was an independent prognostic factor (p < 0.001, p = 0.013, and p < 0.001, respectively). A good correlation was found between the MRD results of FCM and RQ-PCR (n = 126 pairs, Spearman r = 0.8139, p < 0.001). MRD monitoring by four-color FCM post-transplantation is an important tool for relapse prediction in ALL patients.
Prompt and appropriate pre-emptive anti-leukemia treatment could be considered based on the status of MRD after HSCT. 相似文献
5.
Mechanisms of resistance to methotrexate in childhood acute lymphoblastic leukemia: circumvention of thymidylate synthase inhibition 总被引:1,自引:0,他引:1
M. Weigand E. Frei N. Graf B. Buchholz C. Wolfrom A. Breuer M. Wiessler 《Journal of cancer research and clinical oncology》1999,125(8-9):513-519
Purpose: In about 25% of patients suffering from acute lymphoblastic leukemia (ALL) treatment failures occur that are most likely
due to development of resistance to methotrexate (MTX). Blasts from patients with ALL were evaluated for MTX uptake, formation
of long-chain MTX polyglutamates (MTX-Glu5+6), cytotoxicity and thymidylate synthase inhibition by MTX and compared to blasts from patients with acute myelogenous leukemia
(AML). Methods: Radioactively labeled MTX-Glu
n
were analyzed by means of HPLC. Thymidylate synthase activity was measured by a tritium-release assay. Cytotoxicity was determined
by trypan blue exclusion. Results: In most ALL blasts (n = 9) large amounts of MTX-Glu5+6 (1.06–7.03 pmol/107cells) and high cytotoxicity (43.5%–92.7%) were found, while in others small amounts of MTX-Glu5+6 (0.0–0.39 pmol/107cells) caused only weak cytotoxicity (6.0%–27.9%) (n = 5, 2 relapsed patients). Resistance to MTX in blasts from AML patients (n = 5) was also caused by reduced synthesis of MTX-Glu5+6 (0.0–0.42 pmol/107cells). In contrast, some ALL blasts (n = 7, 4 relapsed patients) were able to survive MTX treatment despite large amounts of MTX-Glu5+6 (1.5–5.05 pmol/107cells) and extensive thymidylate synthase inhibition. Conclusions: Since the majority of ALL patients were examined at first diagnosis, an inherent mechanism of resistance seems most likely.
We propose a mechanism based on the switch of thymidylate synthesis to the salvage pathway.
Received: 30 October 1998 / Accepted: 6 April 1999 相似文献
6.
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
7.
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
8.
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
9.
Cashen A Juckett M Jumonville A Litzow M Flynn PJ Eckardt J LaPlant B Laumann K Erlichman C DiPersio J 《Annals of hematology》2012,91(1):33-38
The inhibition of histone deacetylase (HDAC) can induce differentiation, growth arrest, and apoptosis in cancer cells. This
phase II multicenter study was undertaken to estimate the efficacy of belinostat, a potent inhibitor of both class I and class
II HDAC enzymes, for the treatment of myelodysplastic syndrome (MDS). Adults with MDS and ≤2 prior therapies were treated
with belinostat 1,000 mg/m2 IV on days 1–5 of a 21-day cycle. The primary endpoint was a proportion of confirmed responses during the first 12 weeks
of treatment. Responding patients could receive additional cycles until disease progression or unacceptable toxicity. Twenty-one
patients were enrolled, and all were evaluable. Patients were a median 13.4 months from diagnosis, and 14 patients (67%) had
less than 5% bone marrow blasts. Seventeen patients (81%) were transfusion dependent. Prior therapy included azacytidine (n = 7) and chemotherapy (n = 8). The patients were treated with a median of four cycles (range, 1–8) of belinostat. There was one confirmed response—hematologic
improvement in neutrophils—for an overall response rate of 5% (95% CI, 0.2–23). Median overall survival was 17.9 months. Grades
3–4 toxicities considered at least to be possibly related to belinostat were: neutropenia (n = 10), thrombocytopenia (n = 9), anemia (n = 5), fatigue (n = 2), febrile neutropenia (n = 1), headache (n = 1), and QTc prolongation (n = 1). Because the study met the stopping rule in the first stage of enrollment, it was closed to further accrual. 相似文献
10.
Takaaki Konuma Satoshi Takahashi Jun Ooi Akira Tomonari Nobuhiro Tsukada Seiko Kato Aki Sato Fumihiko Monma Senji Kasahara Tokiko Nagamura-Inoue Kaoru Uchimaru Tohru Iseki Arinobu Tojo Takuhiro Yamaguchi Shigetaka Asano 《Annals of hematology》2009,88(6):581-588
Increasing recipient age is a well-known risk factor for graft-versus-host disease (GVHD) and treatment-related mortality
(TRM) and has a negative impact on allogeneic hematopoietic stem cell transplantation. Since the incidence of severe GVHD
after cord blood transplantation (CBT) is lower than that after transplants using bone marrow or mobilized peripheral blood
grafts from adult cells, we should expect better outcomes from CBT in older patients. To evaluate the feasibility and efficacy
of myeloablative unrelated CBT in patients aged between 50 and 55 years, we performed a retrospective comparison of 100 patients
with acute leukemia who received cord blood grafts at our institution. Nineteen older patients (median age, 52; range, 50–55)
and 81 younger patients (median, 36; range, 16–49) received a myeloablative conditioning regimen including 12 Gy of total
body irradiation and chemotherapy. GVHD prophylaxis included cyclosporine with (n = 96) or without (n = 4) methotrexate. There were no significant differences in the incidences of grades II to IV acute GVHD, extensive-type
chronic GVHD, TRM, and the probability of overall and disease-free survival between these groups. These results suggest that,
in patients with acute leukemia, myeloablative CBT might be as safe and effective in patients aged between 50 and 55 years
as in younger patients. 相似文献
11.
Gastric cancer in very young adults: apropos four patients and a review of the literature 总被引:5,自引:0,他引:5
Kath R Fiehler J Schneider CP Höffken K 《Journal of cancer research and clinical oncology》2000,126(4):233-237
Whether gastric cancer in young adults differs from gastric cancer in older patients has been a controversial issue. It has
long been suspected that young patients with gastric cancer have different biological features with a more aggressive course
of disease and a poorer prognosis than older patients. This, however, has not been firmly substantiated. We report on the
clinical course of four patients (three female and one male) with locally advanced (n = 1) or metastasized (n = 3) non-resectable gastric cancer diagnosed under the age of 29 years (23, 25, 27, 28 years). Prior to diagnosis, all
three women had recently been pregnant (1–22 months). Diagnosis was endoscopically biopsy-proven and staging work-up was performed
by primary explorative surgery (n = 1), laparoscopy and explorative surgery (n = 1) or CAT scan and ultrasound (n = 2). The delay between initial symptoms and diagnosis was 8–22 weeks (median, 10 weeks). The histology was signet-ring
cell (n = 2) or undifferentiated (n = 2) gastric cancer. All patients had the diffuse type of gastric cancer according to Lauren. Patients were treated with
the FLAP polychemotherapy regimen consisting of leucovorin, 5-fluorouracil, doxorubicin and cisplatinum, as previously reported.
The best response after chemotherapy was partial in two patients. Two patients showed progressive disease. Secondary surgery
was performed in three responding patients (one of them responded only locally). One patient achieved no evidence of disease
after complete tumor resection (R0). In two patients surgery was palliative (R2/exploration). Three patients died 6, 4 and
8 months after diagnosis. One patient is still alive. In our series, very young adults with gastric cancer had adverse clinical
and pathological features. In accordance with other reports, we observed a predominance of female patients and a possible
association with recent pregnancies. Though the delay between the first symptoms and diagnosis in our patients was no different
from that reported for older patients, special emphasis should be given to prompt referral and diagnostic investigations,
ensuring the diagnosis of gastric cancer early in the course of disease.
Received: 3 August 1999 / Accepted: 8 September 1999 相似文献
12.
Buchholz S Dammann E Koenecke Ch Stadler M Franzke A Blasczyk R Bremer M Krauter J Hertenstein B Ganser A Eder M 《Annals of hematology》2008,87(7):551-556
Aplastic anaemia (AA) is a rare bone marrow failure syndrome treated either by immunosuppressive therapy or allogeneic stem
cell transplantation (SCT). At present, no randomised clinical trials evaluating both treatment options, and in particular
SCT from unrelated donors, are available. We here report the clinical course and outcome of allogeneic SCT for 20 consecutive
adult patients with AA. Newly diagnosed and untreated patients (n = 8) or patients pre-treated by immunosuppressive therapy (n = 12) were transplanted either from human-leukocyte-antigen (HLA) identical family donors (n = 13) or matched (n = 6) and mismatched (n = 1) unrelated donors, respectively. Conditioning varied depending on donor type and included cyclophosphamide with or without
anti-thymocyte globulin (ATG) and fludarabine–cyclophosphamide–ATG with or without low-dose total body irradiation. With a
median follow-up of more than 40 months, all patients have had favourable outcomes with stable haematopoietic engraftment
and high performance scores. Six patients developed acute (five I°–II°; one >II°) and four limited chronic graft-versus-host
disease. In this group of AA patients, allogeneic SCT has proven very successful, independent of donor type and pre-treatment.
Studies with greater cohorts of patients are warranted to better determine indication and timing of SCT especially from unrelated
donors in AA. 相似文献
13.
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
14.
Addition of rituximab to chemotherapy (R-chemo) has been shown to improve overall survival (OS) in patients with diffuse large
B cell lymphoma (DLBCL). Germinal center B cell-like (GCB) subtype of DLBCL has a significantly better clinical outcome than
those with non-germinal center B cell-like (non-GCB) subtype. Further research is needed to confirm this difference between
those two subtypes treated with R-chemo. We searched for randomized controlled trials that compared R-chemo with identical
chemotherapy alone in patients with newly diagnosed or relapsed DLBCL. A random versus fixed effects model was selected according
to heterogeneity. Six eligible trials involving 748 adult patients were included in this meta-analysis. Fixed-effects analysis
showed OS to be superior for the GCB patients treated with R-chemo (relative risk (RR) = 1.16, 95% confidence interval (CI) = 1.03–1.31,
P = 0.02). Superiority was also observed for the GCB subtype under R-chemo with respect to disease control (RR = 1.16, 95%
CI = 0.99–1.36) and overall response (RR = 1.19, 95% CI = 0.99–1.99). Both subtypes showed an increased OS (RR = 1.30, 95%
CI = 1.11–1.51; RR = 1.89, 95% CI = 1.52–2.35, respectively) and disease control rate (RR = 1.27, 95% CI = 1.05–1.54, P = 0.01; RR = 2.21, 95% CI = 1.68–2.90, respectively) following R-chemo. Therefore, treated with R-chemo, GCB patients still
has a significantly better clinical outcome than those with non-GCB subtype. 相似文献
15.
Hilgendorf I Wolff D Junghanss C Kahl C Leithaeuser M Steiner B Casper J Freund M 《Annals of hematology》2008,87(12):1009-1012
Liposomal cytarabine has been proven to be useful for the prevention and intrathecal treatment of neoplastic meningitis. It
has no demonstrable myelosuppressive effects and may therefore be an attractive alternative for prophylaxis and treatment
of the central nervous system (CNS) relapse after allogeneic haematopoietic stem cell transplantation (HSCT). The use of liposomal
cytarabine had not been reported in HSCT recipients. We retrospectively reviewed the feasibility of liposomal cytarabine in
the prophylaxis (n = 2) and treatment (n = 4) of neoplastic meningitis in a cohort of patients after allogeneic HSCT. This report focusses on neurological complications
after intrathecal application of liposomal cytarabine. Mild headache was the most commonly reported adverse event. Two patients
experienced sacral radiculopathy with irreversible cauda equina syndrome in one patient. Another patient progressed with pre-existing
leukencephalopathy. Intrathecal liposomal cytarabine should be used very cautiously in allogeneic HSCT recipients with a history
of CNS complications potentially involving cerebral-spinal fluid circulation, since significant neurotoxicity was observed
in patients with extensive CNS-directed pre-treatment. The feasibility and safety of liposomal cytarabine in HSCT recipients
has to be evaluated in a prospective study. 相似文献
16.
Aims/hypothesis
The glucose-lowering drug metformin has been shown to inhibit complex I of the mitochondrial electron transport chain in skeletal muscle. To investigate this effect in vivo we studied skeletal muscle mitochondrial respiratory capacity and content from patients with type 2 diabetes treated with metformin (n = 14) or sulfonylurea (n = 8) and healthy control (n = 18) participants. 相似文献17.
Annette Sauer-Heilborn Roland Kath Claus-Peter Schneider Klaus Höffken 《Journal of cancer research and clinical oncology》1999,125(11):637-640
The authors report that 4 out of a series of 56 patients (7.1%) treated with gemcitabine developed an unexplained non-cardiogenic
pulmonary distress syndrome most likely related to gemcitabine. One further patient developed ventricular arrhythmia immediately
after gemcitabine exposure, leading to cardiac arrest. Between 1995 and 1998 56 patients with locally advanced or metastatic
carcinoma were treated with gemcitabine. The patients suffered from breast cancer (n = 17), pancreatic cancer (n = 17), lung cancer (n = 12), cancer of unknown primary (n = 5), ovarian cancer (n = 2), oral cavity cancer (n = 2) and cancer of the bladder (n = 1). Their median age was 55 years, and there were 33 female and 23 male patients. Fifteen patients had been pretreated
with radiation therapy: 2 had received radiation therapy involving the mediastinum as treatment for non-small-cell lung cancer
and cancer of unknown origin respectively, 11 patients had had prior neoadjuvant or adjuvant radiation therapy of the chest
wall for breast cancer and 2 patients had received radiation therapy for head/neck cancer. All patients received gemcitabine
on days 1, 8 and 15 and this was repeated on day 29 at a dose of 1000 mg/m2 as a 30-min infusion in 250 ml isotonic NaCl. In 4 patients gemcitabine treatment was combined with cisplatinum, in 7 patients
with a somatostatin analogue and in 1 patient with epirubicin. All other patients received gemcitabine as a single agent.
We assume that the pulmonary or cardiac toxicity of 5 patients was related to gemcitabine. In 3 patients re-exposure resulted
in repeated toxicity. One patient did not receive gemcitabine again because of the life-threatening nature of the primary
response. Two patients had received prior radiation to the mediastinum with 62 Gy and 50 Gy respectively, 3 years and 1 year
before gemcitabine application. In our experience pulmonary toxicity after gemcitabine treatment is more common than initially
anticipated. Gemcitabine should be used with caution in patients who have received prior radiation to the mediastinum.
Received: 5 May 1999 / Accepted: 2 June 1999 相似文献
18.
Allogeneic hematopoetic stem cell transplantation (HSCT) is still the only curative therapeutic option for chronic myelogenous
leukemia (CML). To examine the development of allogeneic HSCT at our center over the past two decades (decade 1: 1984–1994;
decade 2: 1995–2005), all CML patients transplanted in first chronic phase (n = 234) were analyzed with respect to patient characteristics, overall survival, transplant-related mortality (TRM), and relapse
incidence. The median follow up time was 54 months (range 1–218). The incidence of acute graft vs host disease (GvHD) °II–IV
and extensive chronic GvHD were not different between the two decades (p = 0.894 and p = 0.422, respectively). There was also no difference in the relapse incidence (23 vs 26%, p = 0.869). One-year TRM and overall survival were improved in the later decade (33 vs 18%, p = 0.011 and 62 vs 73% at 5 years, p = 0.063, respectively). The major reason for improved outcome in decade 2 was the improved management of acute GvHD and infections
in the early phase after transplantation (p = 0.026). In conclusion, the past decade has seen significant improvement in the performance of allogeneic HSCT for CML. 相似文献
19.
We studied the clinical profile, laboratory parameters, disease course, and outcomes of patients with adult onset Still’s
disease (AOSD). A retrospective analysis of adult patients with Still’s disease diagnosed from 2000 to 2004 was carried out.
Their clinical features and laboratory findings at presentation, disease course, and outcomes were analyzed. Data of 14 patients
with Still’s disease were analyzed. The age at disease onset ranged from 16 to 59 years with a mean of 29.85, the male to
female ratio being 9:5. The mean duration of illness from onset of symptoms to presentation was 14.5 months (range). The most
common clinical manifestations were fever (n = 14), articular symptoms (n = 14), rash (n = 8), weight loss (n = 12), and sore throat (n = 5). Elevated ESR was present in all patients with a mean of 98.3 mm at 1 h. Hepatic enzymes were elevated in seven patients
at disease onset. The mean duration of follow up was 19.14 months (range). Three patients progressed to chronic arthropathy.
Cyclosporine led to dramatic recovery in five patients. Macrophage activation syndrome (MAS) was present in two patients,
one after sulfasalazine therapy. One patient with MAS died. Still’s disease, although uncommon, has characteristic constellation
of clinical and laboratory features and should be considered in the differential diagnosis of fever of unknown origin. Nonsteroidal
anti-inflammatory drugs, steroids, and methotrexate may not be always effective, and cyclosporine is an effective drug in
resistant cases. Sulfasalazine should be avoided in cases of AOSD. 相似文献
20.
Gowdak LH Schettert IT Rochitte CE Lisboa LA Dallan LA César LA de Oliveira SA Krieger JE 《Journal of cardiovascular translational research》2011,4(1):106-113
Incomplete revascularization is associated with worse long-term outcomes. Autologous bone marrow cells (BMC) have recently
been tested in patients with severe coronary artery disease. We tested the hypothesis that intramyocardial injection of autologous
BMC increases myocardial perfusion in patients undergoing incomplete coronary artery bypass grafting (CABG). Twenty-one patients
(19 men), 59 ± 7 years old, with limiting angina and multivessel coronary artery disease (CAD), not amenable to complete CABG
were enrolled. BMC were obtained prior to surgery, and the lymphomonocytic fraction separated by density gradient centrifugation.
During surgery, 5 mL containing 2.1 ± 1.3 × 108 BMC (CD34+ = 0.8 ± 0.3%) were injected in the ischemic non-revascularized myocardium. Myocardial perfusion was assessed by
magnetic resonance imaging (MRI) at baseline and 1 month after surgery. The increase in myocardial perfusion was compared
between patients with <50% (group A, n = 11) with that of patients with >50% (group B, n = 10) of target vessels (stenosis ≥ 70%) successfully bypassed. Injected myocardial segments included the inferior (n = 12), anterior (n = 7), and lateral (n = 2) walls. The number of treated vessels (2.3 ± 0.8) was significantly smaller than the number of target vessels (4.2 ± 1.0;
P < 0.0001). One month after surgery, cardiac MRI showed a similar reduction (%) in the ischemic score of patients in group
A (72.5 ± 3.2), compared to patients in group B (78.1 ± 3.2; P = .80). Intramyocardial injection of autologous BMC may help increase myocardial perfusion in patients undergoing incomplete
CABG, even in those with fewer target vessels successfully treated. This strategy may be an adjunctive therapy for patients
suffering from a more advanced (diffuse) CAD not amenable for complete direct revascularization. 相似文献