摘要:

Active immunization against measles,Haemophilus influenzaB, tetanus, diphtheria, hepatitis B,influenza, poliomyelitis, and, when indicated varicella and pneumococcus induces long-lasting immunologic protection in most healthy pediatric vaccine recipients. Among children receiving immunosuppressive therapy for cancer, possible early loss of specific immunity acquired from prior vaccination or disease, and likely diminished responsiveness to initial or booster vaccination must be considered. In addition, the safety of vaccine administration requires separate study in this population.Published evidence demonstrates preservation of vaccine-induced antibody titers against tetanus, diphtheria, poliomyelitis and (in children treated for lymphoma) pneumococcus. In contrast, prior immunity to varicella,influenza, and hepatitis B (when naturally acquired), and measles (acquired by vaccination) is compromised during and/or after antineoplastic therapy. Studies of immunologic protection acquired by prior vaccination against hepatitis B, varicella, andH influenzahave not been published. The safety of administering toxoids and inactivated vaccines in this population is well documented. In contrast, morbidity must be expected if live attenuated vaccines (oral polio vaccine, attenuated measles vaccine or attenuated varicella vaccine) are administered to children receiving anti-cancer therapy. The risks of using live vaccines should be measured against demonstrable benefits in any vaccine program. The response to initial or booster immunizations against tetanus and diphtheria are similar to those in healthy children. For all other immunizations reviewed, responsiveness is diminished during periods of chemotherapy, more strikingly in children treated for leukemia than for solid tumors. Antibody responses to these vaccines range from slightly blunted (in the case ofH influenzaB) to marginal (influenza) or completely useless (pneumococcus and hepatitis B in children treated for leukemia).

ISSN:1042-8194    

DOI:10.3109/10428199309147369

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Empiric therapy is necessary for febrile, neutropenic patients in order to minimise morbidity and mortality. Certain agents are now available for monotherapy which offcrcomparable success to combinations of either an aminoglycoside with aβ-lactam or twoβ-lactams. However, no regimen offers complete treatment under all circumstances in all patients. It is also apparent that febrile, neutropenic patients comprise a more heterogeneous group than just those with bacteraemia, clinically apparent infection and unexplained fever. Localized infections occur in just under a third of cases at the onset of fever and a similar number will develop during the course of fever. Mortality is higher in infections that are accompanied by bacteraemia and also those that develop subsequently, especially when related to the lung. The aetiological agent also differs with each type of infection as does the duration of fever and symptoms. Consequently modifications are required more often. The length of treatment may also differ. Therefore, during the first 3-4 days of empiric therapy, every effort should be made to identify incipient localized infections in addition to detecting bacteraemia. Changes in therapy can then be based on objective grounds rather than continued fever offering more patients individual treatment than is possible when relying only on the temperature chart.

ISSN:1042-8194    

DOI:10.3109/10428199309147370

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Interleukin-4 (IL-4), originally identified as a B-cell growth factor, has been shown to inhibit certain stages of hematopoietic stem cells. Recently, IL-4 has been recognized as a negative regulatory factor in the growth of hematologic malignancy. In myeloid leukemias, IL-4 can suppress the growth of growth factor-dependent leukemic blast cells derived from acute myelogenous leukemia (AML). IL-4 also suppresses the growth of chronic myelomonocytic leukemia cells through inhibiting the“autocrine”production of IL-6 or granulocyte/macro-phage colony-stimulating factor. In lymphoid malignancies, IL-4 can inhibit the proliferation of neoplastic cells from Ph1-positive acute lymphoblastic leukemia, non-Hodgkin's B-cell lymphoma, and multiple myeloma. Thus, IL-4 is expected to be useful as a therapeutic agent for these hematologic malignancies.

ISSN:1042-8194    

DOI:10.3109/10428199309147371

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Twenty-three patients greater than age 60 years with acute myelogenous leukemia (AML) received induction therapy with continuous infusion cytosine arabinoside (1.5 g/m2/day, day 1-3), mitoxantrone (10 mg/m2/day, day 1-3) and etoposide (800 mg/m2, day 4). Patients entering complete remission (CR) were eligible to receive an identical consolidation cycle. Eighteen of the 23 patients (78%; 95% confidence interval 56% to 93%) entered CR. Twelve of these received consolidation therapy and 4 of these remain in remission at 3 to 20 months. Hematologic toxicity of the regimen was acceptable; only 1 patient died following therapy (having attained a CR). Non-hematologic toxicity was mostly mild (grade 2 or less) with one episode of grade 3 cerebellar toxicity. While this regimen induces a high CR rate in patients>age 60 years, relapses remain common and overall survival is too early to assess.

ISSN:1042-8194    

DOI:10.3109/10428199309147372

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Because of the lack of standard treatment in refractory and relapsed acute myelogenous leukemia (AML) several new drugs have been employed alone to evaluate their efficacy in this peculiar category of patient. Bisantrene, a new anthracene bishydrazone derivative, has shown antileukemic effect in phase I and II clinical trials with acceptable extrahaematological toxicity. Seven patients (six males and one female, median age 41.8 years) received Bisantrene (250 mg/sqm/daily 1-7) as a single agent in relapsed or refractory leukemia. 5 out of 7 patients achieved complete remission, one attained partial remission and one was resistant. However, haematological toxicity was severe with prolonged myelosuppression. Hepatic toxicity was the main extrahaematological side effect and occurred in 3 of 7 patients, however all of them recovered within 40 days. No cardiovascular dysfunction occurred although all the patients had been heavily previously treated with anthracyclines. Our data confirm that Bisantrere is active in relapsed and refractory AML and suggest the need for larger clinical trials to better evaluate its efficacy.

ISSN:1042-8194    

DOI:10.3109/10428199309147373

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The immunophenotype of 304 adult lymphoblastic leukemias (>18 years) diagnosed on the basis of the FAB criteria was determined at the time of diagnosis using a panel of monoclonal antibodies. The series comprised cases diagnosed and immunophenotyped in 43 Italian centers (GIMEMA Cooperative Group) between April 1988 and June 1991. The immunophenotypic characterization consisted of two consecutive steps. The initial screening was based on the reactivity for Tdt, HLA-Dr, CD7, CD10, CD13, CD19, CD24, CD33 and CD41. According to the results obtained, the second level of investigation assessed the positivity for intra cytoplasmic (Cy) Ig, CD la, CD2, CD3, CD4, CDS, CDS and CD20. Based on the hierarchial expression of the different B- and T-cell related antigens, each case was assigned to a given differentiation stage. B-lineage ALL were classified in five subgroups (B0-B4) and T-lineage ALL in four subgroups (T0-T3). Cases in which the blasts were lymphoid according to the FAB criteria, but expressed myeloid antigens in association with B- and T-lymphoid markers were defined as hybrid leukemias.As expected, CD10 + cases (B2-B3) were the most frequent within the B-lineage ALL (83.2% of cases). Cylg+ (B3) accounted for about 20% of CD10+ ALL. Twenty eight cases (13.4%) were at a pre-cALL stage (B0-B1) and of these, 8 (3.8% of the total series) were positive only for TdT and HLA-Dr (BO). Intermediate and mature thymic phenotypes (T2-T3) were predominant within the T-ALL (67.2%) groups. Five cases, were positive only for TdT and CD7 (CD5 +), and classified as T0. 9.2% of cases fulfilled the definition of hybrid leukemia, largely in view of the co-expression of B-lymphoid and myeloid markers. In most cases the cells were at a B2 stage of differentiation. Analysis at the DNA level, carried out in 6 cases, showed that all had a monoclonal rearrangement of the Ig heavy chain gene, sometimes coupled with concomitant TCR gene rearrangement.Mediastinal enlargement was found in 38.9% of the T-ALL cases, but was undetectable in the other subgroups. Anemia was more pronounced in B-lineage ALL while high WBC counts were more frequent in T-ALL., where a greater tumor load was documented. Overall, only 7 cases (2.3%) diagnosed as ALL on the basis of the FAB criteria were re-classified as AML after immunologic characterization. The diagnostic role of phenotypic and genotypic analyses is discussed.

ISSN:1042-8194    

DOI:10.3109/10428199309147374

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

DNA index (DI) and percentages of cells in S and G2/M phase were determined in Feulgen stained nuclei of blasts from 31 cases of childhood ALL at diagnosis. In 6 cases the results of DNA analysis and cytogenetics were concordant showing hyperdiploidy. Two other cases with normal karyotype were revealed as DNA aneuploid with image analysis. Cases with cytogenetic abnormalities like translocation, deletion or presence of single or double supernumerary chromosomes had DI within normal ranges. Nine ALL cases (29%) were found to be DNA aneuploid-8 hyperdiploid and 1 hypodiploid.The percentages of cells in S and G2/M phase for blasts from bone marrow (mean 17.6%) were significantly higher than those estimated in the peripheral blood (mean 1.57%). We conclude that analysis by image cytometry can detect aneuploid DNA content even in cases, which showed a normal karyotype and provides new information concerning the biological aspects of leukemic blasts.

ISSN:1042-8194    

DOI:10.3109/10428199309147375

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The clinical course of patients with hematological disease, especially after Treatment, is often complicated by gastrointestinal infections. Between 1986 and 1990 a total of 18 patients affected with hematologic disease and presenting with an acute abdomen were admitted to the surgery department at the University of Rome“La Sapienza”. Most patients were affected with acute or chronic myeloid leukemia (61 %) and lymphoma. Five patients with acute appendicitis, three with necrotizing enterocolitis, three with spontaneous hemoperitoneum, three with cholecystitis, two splenic infarctions and two intestinal occlusions were diagnosed.Symptoms were often vague and non specific and blood counts revealed neutropenia in all but two patients, while anemia was characteristic in spontaneous hemoperitoneum and in neutropenic enterocolitis. Fungemia occurred in only two cases while bacteremia was present in seven. The most critical patients were those affected by neutropenic enterocolitis and acute cholecystitis. Sonography was meaningful in the diagnosis of hemoperitoneuM., splenic infarct and acute cholecystitis. All patients underwent surgical procedures within 48 hours of admission to the department. In all cases peritoneal washing was performed and at least one peritoneal drainage was left. In all cases of necrotizing enterocolitis, intestinal resections, either ileal or colonic, were followed by an immediate anastomosis in two layers. Intensive hematological and antibiotic post surgical care was performed in all patients. Seven patients presented minor complications (38.8%), and only one died (5.5%).Emergency surgical treatment may be safely carried out in patients with hematological diseases presenting with an acute abdomen. Intensive postsurgical care is mandatory for the recovery of patients and the patient's critical condition should not be a deterrent to surgical intervention.

ISSN:1042-8194    

DOI:10.3109/10428199309147376

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The role of alpha-intcrferon (IFN) in initial treatment of multiple myeloma is controversial. We have conducted a trial of cyclophosphamide with and without low dose IFN in newly diagnosed myeloma. Thirty four patients, mean age 63 were all given cyclophosphamide 600mg/m2IV every 21 days while 17 were randomised to also receive IFN at a dose equivalent to 6mU per week. In the IFN group 8/15 assessable patients (53%) had a greater than 50% reduction in paraprotein compared with 4/16 (25%) of controls (p<0.05). However the median duration of response was the same in the two groups (IFN 8 months, controls 8.5 months). After a median follow up of 28 months there is no significant difference in survival. Toxicity including myelosuppression was commoner in the IFN group. These findings suggest that the addition of IFN to cyclophosphamide is not likely to offer major benefits in treating myeloma.

ISSN:1042-8194    

DOI:10.3109/10428199309147377

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Previously we have shown that multidrug resistant cells are cross-resistant to certain permanently charged cationic lipophilic compounds. In the present study we extend these observations to additional cationic lipophilic compounds with unrelated chemical structures. Study of the growth inhibitory activity of series of triphenylalkyl-phosphonium and alkyl-ammonium compounds revealed that cross-resistance to these compounds in multidrug resistant P-388 murine leukemia cells, was related to the presence of cationic charge but not to the molecular size/degree of lipophilicity.

ISSN:1042-8194    

DOI:10.3109/10428199309147378

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor