摘要:

Between February, 1970 and September, 1991, we performed splenectomies on 70 patients with chronic lymphoproliferative disorders including primary leukemias: 19 B-cell chronic lymphocytic leukemia, 1 B-cell prolymphocytic leukemia, 22 hairy cell leukemias, 4 large granular lymphocytic leukemias, 1 T-cell prolymphocytic leukemia, and non-Hodgkin's lym-phomas (NHL): 10 splenic lymphomas with villous lymphocytes, 4 follicular lymphomas, 5 mantle cell lymphomas, 3 lymphoplasmacytic and 1 large cell NHL. The primary indications for surgery in this series were therapy-resistant disease (40%) and therapeutic splenectomy (38%). Postsplenectomy, 70% of patients had a complete hematological response, 23% had a partial response, and 7% were nonresponsive. Median treatment-free survival correlated with the hematologic response postsplenectomy and the underlying diagnosis. Better treatment-free survivals were seen in patients with lesser degrees of anemia and thrombocytopenia. Overall, improvements were more pronounced in the B-cell than in the T-cell disorders. Indications for further therapy, postoperative morbidity and mortality, and survival times are discussed along with a review of the literature. These findings advocate a continuing role for splenectomy in symptomatic lymphoid malignancies running with splenomegaly and hyper-splenism.

ISSN:1042-8194    

DOI:10.3109/10428199309148547

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Chronic Lymphocytic Leukemia (CLL) is usually an indolent disorder which in some patients assumes an aggressive clinical course. In order to assess at presentation the prognosis of a given patient, several staging systems and prognostic variables have been proposed including the expression of the Proliferating Cell Nuclear Antigen (PCNA). PCNA is a 36 kd nuclear protein, the regulation of which is cell cycle-dependent. In CLL, PCNA levels correlate with cell proliferation, clinical stage and the lymphocyte doubling time (LDT). Furthermore, preliminary data suggests that PCNA expression may also predict response to Fludarabine-based chemotherapy. Since PCNA is a cofactor for Delta DNA polymerase, PCNA overexpression in CLL may also reflect the intrinsic DNA repair activity of the leukemic cells and thus their resistance to chemotherapy. Further studies aiming at modulation of PCNA expression in CLL cells may clarify this issue and may offer a future new therapeutic strategy with which to treat this disorder.

ISSN:1042-8194    

DOI:10.3109/10428199309148548

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

PTCL represents a diverse group of histological entities that defy classification schemes based on normal T cell differentiation, differ in their clinical presentation and behave unpredictably. Genetic analyses of this phenotypically heterogeneous group have clearly shown that histo-logically defined PTCL may be subdivided on the basis of clonal gene rearrangements. The absence of clonal gene rearrangements in a significant proportion of PTCL cases has increased the complexity of classification. The data presented in this review suggest that a molecular classification would allow true reflection of PTCL aetiology, but carefully coordinated studies are required to evaluate the clinical usefulness of such a classification scheme.

ISSN:1042-8194    

DOI:10.3109/10428199309148549

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The rare, indolent, but lethal malignancy, mycosis fungoides (MF), is amenable to durable remissions if treated topically at an early stage with nitrogen mustard, PUVA, or radiotherapy. A modification of conventional therapeutic irradiation which utilizes electron beams rather than photons, has been in use since 1951. This method, termed total skin electron irradiation (TSEI), has achieved consistently good CR rates (95–100%) at a variety of centres in the U.S.A., England, France, and Italy, despite troublesome differences in staging systems. In northern Israel we have treated 37 MF patients with TSEI during the past 13 years. All 21 of our early stage patients achieved CR, which is no longer regarded as an unusual result. However, most workers in the field acknowledge that issues of optimal dosing and curative potency remain unresolved.

ISSN:1042-8194    

DOI:10.3109/10428199309148550

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Magnetic resonance imaging (MRI) provides a non-invasive means to evaluate a large fraction of marrow in less than one hour. Marrow disorders produce non-specific changes in marrow signal intensities which primarily reflect changes in proportions of fat and cellular elements. The pattern of these signal changes narrows the differential diagnosis, and the combination of these features with the clinical context allows interpretations which are clinically useful in many ways. These include: I) the diagnosis of avascular necrosis (and its distinction from other causes of joint pain), 2) detection of osteomyelitis, 3) differential diagnosis of hypo-plastic disorders, 4) staging of lymphomas and myeloma, 5) selection of patients for autolo-gous bone marrow transplant, 6) objective measures of marrow response to therapy, 7) detection of leukemic transformation, and 8) improved detection of marrow disease (primary or secondary) in patients with otherwise unexplained bone pain.

ISSN:1042-8194    

DOI:10.3109/10428199309148551

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

In order to characterize the clinical, cytogenetiC., and outcome features of childhood acute megakaryoblastic leukemia (AMKL), we reviewed 24 cases; 14 were identified among 150 consecutive newly diagnosed acute myelogenous leukemia (AML) patients at St. Jude Children's Research Hospital, and 10 were cases referred to the National Institute of Cancer in Rio de Janeiro, Brazil. There were 5 Down syndrome patients and one patient with chronic myeloid leukemia (Ph+) in blastic crisis. Twelve patients had significant hepatosplenomegaly. Leukemic cell morphology and cytochemistry were consistent with the M7 classification in 17 cases, and all cases tested expressed megakaryocytic surface antigens. AMKL patients were significantly younger than other AML patients (P = 0.0001) and had poorer responses to therapy (P = 0.03, univariate analysis only). Ten of 24 failed induction, and only 5 are disease-free at 6 months to 4.5+ years. We conclude that AMKL usually affects young children, frequently producing marked organomegaly. It comprises approximately 10% of pe-diatric AML cases, and responds poorly to intensive AML therapies.

ISSN:1042-8194    

DOI:10.3109/10428199309148552

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

We investigated whether antisense oligodeoxynucleotides complementary tobcr/ablmRNA or protein kinase antagonists display antitumor activity on Ph -positive leukemia cell lines.bcr/ablantisense oligomers showed inhibitory effects on thein vitrogrowth of Ph1-positive leukemia cell lines in liquid culture, and further displayed an inhibitory effect on transformed murine hematopoietic cells using transfection with a retroviral vector expressing p210bcr/abloncoprotein. However,in vitrotreatment with abcr/ablantisense oligomer did not completely abolish the expression ofbcr/ablmRNA and did not display the desired“killing effect”on Ph1-positive leukemia cells. On the other hand, investigation of the effect on Ph1-positive leukemia cells by various types of protein kinase antagonists revealed that herbimycin A, a protein tyrosine kinase antagonist, displays preferential and remarkable suppression of the growth of Ph1-positive leukemia cells and P210bcr/ablassociated transformed cells by virtue of suppressingbcr/ablprotein tyrosine kinase activity. These results may provide important future insights in developing a new category of antitumor therapy by targeting oncogene products.

ISSN:1042-8194    

DOI:10.3109/10428199309148553

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The study objective was to identify prognostic factors associated with survival in patients treated for acute leukemias who developed invasive aspergillosis (IA) during induction therapy. This retrospective analysis involved 21 patients treated in two hematologic centers over a six-year period. All were treated in protective isolated rooms with high-dose amphotericin B as soon as fungal infection was suspected. Ten (45%) of the twenty-one patients died. There was no statistical difference between the patients who survived and those who died in relation to the mean time of onset of IA or the total and mean daily dose of amphotericin B. On the other hand a favourable outcome correlated strongly with complete leukemic remission (p<0.0001): all but one of the patients with objective residual leukemia died of IA, whereas all those who achieved complete hematological remission survived. In conclusion, it seems that the main vital prognostic factor in these leukemic patients with IA was the achievement of complete remission. We were unable to control IA in 10 of 11 patients with refractory leukemia, regardless of neutropenic status, despite early administration of high-dose amphotericin B. All the patients who achieved complete remission were successfully treated with amphotericin B.

ISSN:1042-8194    

DOI:10.3109/10428199309148554

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Since etoposide interacts with the nuclear enzyme topoisomerase II, the drug concentrations in the malignant cells during chemotherapy may have clinical correlates. Plasma protein binding of etoposide is extensive (94%) and alterations of the non-proteinbound fraction affect pharmacokinetic behavior of the drug. The pharmacokinetics of etoposide was therefore studied in plasma, total and non-proteinbound concentrations, and in leukemic cells isolated from peripheral blood samples from 22 patients after the first dose of the induction treatment for acute myelocytic leukemia. Fourteen patients received 100 mg/m2and eight patients 200 mg/ m2as a 1 h infusion. The mean area under the concentration versus time curve AUC(0-x)in plasma was at the lower dose level 78.4±29.1 (mean±S.D.)μg/ml x h and 201.0±56.5μg/ml x h at the higher dose level. The fraction of non-proteinbound etoposide in plasma was 5.2±3.4 and 5.4±2.1% in the two treatment groups. AUC(0–16h)in leukemic cells was 8.4±8.7 and 22.4±12.1μ/ml x h at the two dose levels, respectively. The cellular etoposide concentration was 12.1±7.9 and 14.7±5.1% of the plasma concentration at the end of the infusion. The interpatient variability in cellular drug levels was considerable and exceeded the variability in plasma concentrations. Cellular accumulation of etoposide could be important for treatment outcome.

ISSN:1042-8194    

DOI:10.3109/10428199309148555

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Forty three patients with relapsed, diffuse aggressive lymphoma (Working Formulation Categories G to J) were treated with a combination chemotherapy regimen consisting of mitox-antrone 10 mg/m2iv day 1, vincristine 1,4 mg/m2iv day 1 and 14, prednisolone 50 mg/ m2p.o. days 1–5 and etoposide 100 mg/m2p.o. days 1–5 of each cycle (NOPE). Fourteen patients (34%) achieved complete remission and another 6/43 (15%) achieved a partial response. Factors which significantly affected response were the presence of early stage, absence of systemic symptoms, non-bulky disease and serum LDH value<350 IU. Four patients are alive and in complete remission from 25+to 45+months after completion of therapy. Duration of response and survival was significantly influenced by the duration of the initial response to first chemotherapy. NOPE is an active and safe treatment regimen with a substantial complete remission rate in patients with relapsed non-Hodgkin's lymphoma.

ISSN:1042-8194    

DOI:10.3109/10428199309148556

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor