摘要:

Abstract: Autologous bone marrow transplantation (ABMT) is now so widely applied in the treatment of relapsed high‐ and intermediate‐grade non‐Hodgkin's lymphoma (NHL) that it is very important to analyse the evidence on which this practice is based and ask in precise terms what the place of this technique should be. This article will review the data that have been published and discuss the randomised studies now in progress. The possible use of ABMT in other areas such as consolidation of remission and its use in low‐grade lymphoma will also be examined. The EBMT data quoted are taken from the 1990 review of the register for ABMT in malignant lymphoma which was presented to the XVIth meeting of the EBMT in the Hagu

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01265.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: In order to study the physiological response to phlebotomies for autotransfusion, an autotransfusion program was designed for 10 patients undergoing hip‐joint replacement surgery for arthrosis. 4 phlebotomies of 450 ml each were performed within 12 days. Blood samples were taken immediately before phlebotomy for blood hemoglobin (Hb), serum erythropoietin (Epo), reticulocyte count (ret) and erythrocyte 2,3‐diphospho‐glycerate (DPG). All 4 phlebotomies could be performed in 9/10 patients, and only 1 patient had significant symptoms (fatigue). The operation was performed 2 weeks after the last phlebotomy. None of the patients had recovered the initial Hb level at operation (24.8 ± 9 per liter lower than initially), and they were all even more anemic after the operation (36.8 ± 16.9 g/1 lower than initially). Serum Epo increased from 13.6 ± 7.2 IU to 30.6 ± 12.2 (SD) IU per liter, and reticulocyte counts increased to a maximum of 3.68 ± 1.69%. DPG increased in all patients except the one who had significant fatigue. It is concluded that the patients tolerated the phlebotomy program well but that a significant anemia developed. The compensatory increase in erythropoietin and reticulocyte count, adequate for this degree of anemia, was small compared to the increase seen at more severe anemia, indicating that there may be a role for pharmacological stimulation of erythropoiesis in blood predepo

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01266.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: The effects of hematopoietic cytokines on the expression of transforming growth factors (TGFβ) mRNA and the effect of TGFβ on cytokine and on a major extracellular matrix protein, collagen I, mRNA expression was studied in human marrow stromal cells. As with other cultured mesenchymal cells, stromal cells constitutively express TGFβ1but not TGFα mRNA. In simian virus 40 (SV40)‐transformed stromal cells downregulation of TGFβ1expression was observed 2 hours after incubation with recombinant human (rh) tumor‐necrosis factor α (TNFα) and 144 h after addition of rh granulocyte macrophage colony‐stimulating factor (GM‐CSF). Neither interleukin‐(IL‐1)β nor IL‐6 had an observable effect on TGFβ1mRNA expression. TGFβ upregulated collagen I mRNA expression. These data suggest that cytokines may influ

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01267.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: In this prospective study we investigated the frequency of CD10+, TdT+and CD10+TdT+mononuclear cells in the bone marrow (BM) and peripheral blood (PB) before and after autologous bone marrow transplantation (ABMT). 49 patients treated for acute lymphoblastic or myeloblastic leukaemia, malignant lymphoma or multiple myeloma were included. A significant increase in CD10+cells occurred in BM in both children and adults after ABMT. In children, we also found a significant increase in CD10+cells in PB. In individual patients remaining in remission, up to 34% CD10+cells having a normal Ig kappa/lambda light chain ratio were recorded after ABMT. In children, the percentage of TdT+and CD10+TdT+cells increased significantly in BM. In most cases the CD10/TdT‐ratio was greater than 1.0, but during early regeneration after ABMT this ratio was less than 1.0 in several patients remaining in complete remission. In patients remaining in remission, CD10+TdT+cells were detected in the blood in only 2 out of 140 samples tested, and the proportion of these cells never exceeded 0.03%. We conclude that quantitation of CD10+TdT+cells in peripheral blood is helpful in the evaluation of complete remission in patients treated for pre‐

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01268.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: The small‐dose iron tolerance test (SD‐ITT) was performed in 37 healthy subjects (20 females and 17 males). The area under the curve (AUC) of serum iron variations after the test dose (10 mg of iron as iron sulphate) was corrected by the expected plasma iron disappearance rate, the expected subject's plasma volume and the measured spontaneous time‐dependent serum iron variations, and was used as a summary measure of the outcome, Q‐ITT. Q‐ITT correlated strictly with the maximum serum iron increase (SImax). Q‐ITT gave positive (greater than zero) values in only 14 out of the 37 subjects (11 females and 3 males). Serum ferritin proved to be the best discriminating parameter between positive and non‐positive subjects, and was inversely correlated with Q‐ITT in the positive ones. In 2 male subjects, aged 43 and 34 years, SD‐ITT proved to be highly sensitive to the progressive decrease of mobilzable body iron content during repeated venesections. In these patients the threshold for a positive test result was obtained at values lower than 1050 and 950 mg of body iron content, respectively. The threshold‐dependent sensitivity, simplicity, and repeatability of this method favor its becoming a useful technique for studying the up‐regulation of iron absorption in normal subjects and in

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01269.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: The effects of interferon (IFN) alpha‐2a treatment on platelet function were evaluated in 20 patients affected by essential thrombo‐cythaemia (ET). Baseline data documented the well‐known abnormalities ofin vitroplatelet aggregation and the constant presence of a Δ‐storage pool deficiency. The therapy in all patients reduced the platelet count, and in the majority of them caused a partial improvement ofin vitroplatelet aggregation. Although the mean intraplatelet ADP level improved during treatment, it always remained below the normal range documenting persistence of the Δ‐storage pool deficiency. The plasma β‐TG levels, which initially were high, significantly decreased during treatment, but the β‐TG ratio and the platelet β‐TG values always remained within the normal range ‐ this suggests an absence of platelet activation either before or during therapy. Our results demonstrate that, despite significantly reducing the platelet count, IFN alpha‐2a treatment only partially corrects the qualitative pl

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01270.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: During a 10‐month period, 10 couples originating from Africa (3), the tropics (1) and the thalassemia‐belt region (6), living in Switzerland, requested prenatal diagnosis of hemoglobinopathies. Hb SS (twice), Hb Bart's (Hydrops fetalis) and β‐thalassemia major were diagnosed either by gene mapping or by direct detection of the mutations in DNA amplified by the PCR procedure. Whenever it was possible to obtain fetal blood or tissue, diagnosis was confirmed. In one Vietnamese man, concomitant existence of α‐thal 1 with β‐thalassemia resulted in an unusually high Hb level because of balanced α and β globin synthesis. The 10 couples examined originated from 7 different countries and presented at least 7 different Hb pathologies. This variety of pathologies represents the main difficulty for prenatal diagnosis of hemoglobinopathies in a non‐endemic country. A diagnostic approach to overcome this pr

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01271.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: Southern blot analyses were performed in sequential DNA samples from 4 patients with Ph' + chronic myeloid leukaemia (CML) who underwent lymphoid or mixed blast crisis (BC). Genomic rearrangements at the breakpoint cluster region (bcr) and immunoglobulin heavy chain (IgH) gene level provided, in these cases, a sensitive and specific evaluation of response to therapy both in terms of blasts and Ph' + cell suppression. Recurrent BC was molecularly characterized in the 4 patients, showing each time identical individual specific DNA rearrangement patterns. Residual blasts were detected in 2 cases during intervening chronic phases by IgH rearrangements. Such findings highlight the specificity of these molecular markers, clearly indicating the failure of ablative therapy in eradicating the neoplastic clone. Finally, molecular and phenotypic identity in individual recurrent BC also suggested, in our cases, a lack of clonal evolution during disease progressio

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01272.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: From a retrospective multivariate study on 107 multiple myeloma (MM) patients, serum β2‐microglobulin (β2M) proved to be the best prognostic discriminator, better than each of the currently used staging systems (Durie and Salmon's [DS], Merlini, Waldenström and Jayakar's [MWJ]and the British Medical Research Council's [BMRC]). The predictive ability of each staging system is better improved by combining consideration of β2M as a continuous rather than a binary variable (even at its best prognostic cut‐off). The combination of BMRC with β2M demonstrated the highest prognostic value, followed by those involving DS or MWJ. Ease and measurability of clinical parameters at diagnosis, parametric type of statistical model assumed for description of survival, and supply of direct estimate of expected survival are the characteristics of the MWJ system that suggest it is best able to integrate β2M correctly in a prognostic index. The basic concepts and the clinical use of the available staging systems for MM are criticized along the following lines: a) the need to include new and homogeneously weighted parameters in future prognostic systems ‐ b) the lack of direct correspondence between treatment requirements (according to stage) and available therapeutic resources ‐ c) evidence of the rough stratification of the actual survival expectancy, as permitted by the current staging systems. A direct, and as accurate as possible estimate of prognosis ‐ based on easy and measurable parameters evaluable at diagnosis ‐ should replace the current classification of patients according to stages. This estimate should mark the clinical evaluation at diagnosis, should flexibly indicate treatment even according to different protocols or centers, and should allow very accurate statistical corrections for different survival expectancy at diagnosis when evaluating different treatments

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01273.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract: We present 2 patients with Bernard‐Soulier syndrome from two different families. The parents of one of the patients were found to have had common ancestors in the 17th century. The platelet membrane content of glycoprotein (GP)Ib was measured in the patients and their first‐degree relatives with an ELISA technique based on monoclonal antibodies. Both patients had very low levels of GPIb. In one of the families the heterozygotes had reduced expression of GPIb but in the other the obligate heterozygotes had normal values, suggesting that the molecular pathology differs between the two families. In both patients, bleeding time was shortened by infusion of DDAVP (1‐deamino‐8‐D‐arginine vasopressin), although it was not completely normalised. DDAVP may be of some therapeutic value in cases of Bernard‐S

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1991.tb01274.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY