摘要:

High-dose cytotoxic therapy with stem cell rescue (ie, bone marrow transplantation or BMT) is curative, and frequently the treatment of choice, for many patients with malignancies and nonmalignant diseases that affect blood cells. Major advances in our basic understanding of the biology of normal and abnormal hematopoiesis are rapidly being translated to the clinic, and have resulted in both improved supportive care and disease control for BMT patients. With the success of BMT, new challenges have emerged but many old issues remain. Alternative sources of stem cells for transplantation are being explored, and in the case of mobilized peripheral blood, have become “standard-of-care” at some centers. In addition, the increasing number of patients surviving BMT has focused attention on issues related to quality of life and late side-effects.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Severe aplastic anemia (SAA) is a life-threatening bone marrow failure disorder characterized by pancytopenia and a hypocellular marrow. Drugs, chemical exposure, radiation, and viruses are implicated as etiologic agents, although the majority of community-acquired SAA is idiopathic. Regardless of the inciting event, most cases of SAA result from immune-mediated destruction of bone marrow progenitor cells, which spares pluripotent hematopoietic stem cells. SAA is treated by either allogeneic bone marrow transplantation (BMT) or immunosuppressive therapy. BMT restores normal hematopoiesis and cures the disease in 60% to 80% cases, with the major causes of failure being graft rejection and graft-versus-host disease. Most patients treated with immunosuppressive therapy recover hematopoiesis sufficiently to not require transfusions and are free of infection, although in many, recovery is incomplete. Moreover, up to 50% of SAA patients successfully treated with immunosuppressive therapy relapse or develop a secondary clonal disorder, such as paroxysmal nocturnal hemoglobmuria, myelodysplastic syndrome, or leukemia. High-dose cyclophosphamide without BMT is capable of restoring normal hematopoiesis with little or no risk of relapse or secondary clonal disorders. A number of effective treatment options for the treatment of SAA are now available. The optimal approach for definitive management of SAA continues to evolve.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Chronic myelogenous leukemia (CML) is a hematologie malignancy characterized by an initial chronic phase of expanded clonal myelopoiesis followed by inevitable progression to accelerated phase and finally to fatal blast crisis. Although interferon therapy results in hematologic control of disease in most patients and major cytogenetic responses in 30% to 35%, resulting in better survival than with conventional therapy with hydroxyurea or busulfan, most patients have residual disease detectable by molecular methods. Allogeneic bone marrow transplantation may cure selected patients with CML and should be considered early in the course of disease. Newer approaches to therapy include autografting using mobilized peripheral blood stem cells. Selection and expansion of nonleukemic progenitors may improve outcome following autologous transplantation. Advances in understanding of mechanisms of action of antisense oligonucleotides, ribozymes, and tyrosine kinase inhibitors and the immunologic responses to CML cells are also likely to lead to novel approaches to therapy.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Quality of life (QOL) studies in bone marrow transplantation (BMT) recipients are increasingly regarded as one of the ways to evaluate the outcome of BMT. Recent reports continue to detail acute and late psychosocial problems in BMT recipients. More and more longitudinal studies of QOL and comparisons of QOL outcomes after BMT or alternative nontransplant treatments are appearing in the literature. Several interventions that may promote positive effects on psychosocial adjustment are suggested: attention to patients' coping styles by the healthcare team, encouragement of aerobic exercise, attempts to lessen patients' levels of anxiety, and the presence of at least one staff member identified by the patient as an important source of support over time-all may have positive influences on QOL.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Peripheral blood stem cell transplantation is being used more frequently in both the autologous and allogeneic setting. The use of cytokines either alone or in conjunction with chemotherapy priming has made peripheral procurement of the stem cells through apheresis possible. Differences exist both in the composition of the graft and in subsequent posttransplantation immune reconstitution between peripheral blood stem cells and bone marrow. Reliable estimates of the comparative incidence of acute and chronic graft-versus-host disease following blood or marrow allogeneic transplantation are not yet available.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

From the perspective of an annual review of the contemporary literature on thoracic malignancies, there are several patterns that characterize the literature, including: 1) important advances with immediate clinical application; 2) important advances with future application; 3) things that might be important if we understood them better; and 4) my eyes glaze over.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Lung cancer chemoprevention continued to make progress in 1997. The incidence of tobacco abuse continues to slowly fall in the United States, and paralleling it, lung cancer incidence. Biomarkers of carcinogenesis and susceptibility continue to be an important area in identifying high-risk patients. The analyses of two major lung cancer prevention trials, β-Carotene and Retinol Efficacy Trial (CARET) and Alpha-Tocopherol Beta-Carotene (ATBC), were also published this past year. Both found an increased incidence of lung cancer in individuals receiving beta-carotene. In both trials, heavy smokers seem to be the most adversely affected group. The mechanism of this increased incidence of cancer and total deaths still eludes investigators.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Considerable evidence has accumulated that cancer has a genetic origin based on the development of somatic mutations in families of genes responsible for critical functions of cellular DNA repair, growth control, and division. Restoration of the function of a single pivotal gene product appears sufficient to mediate antitumor effects that are potentially clinically significant. For example, restoration of wild-type p53 function in the cancer cell by gene transfer is sufficient to cause either cell-cycle arrest or apoptosis. This effect is not restricted to p53 but has been observed for oncogenes and other tumor suppressor genes as well. Genes can be delivered with sufficient efficiency by direct intratumoral injection to mediate tumor regression as shown in preclinical studies and phase I clinical trials in non-small cell lung cancer. Although clinical trials of gene replacement are in the earliest stages, this treatment offers a unique mechanism of action with a potentially high therapeutic index.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article reviews the most important recent clinical trials on the treatment of small cell lung cancer (SCLC). Two randomized studies addressing the timing of thoracic radiotherapy in limited stage SCLC are discussed. In the smaller of the two studies (n= 103), a survival benefit was associated with initial versus delayed radiotherapy. No survival differences in the larger study of the two studies were detected, which compared alternating with sequential delivery of radiotherapy (n= 335). The optimal way to deliver radiotherapy still must be defined. Two small, randomized studies on dose intensity with the use of growth factor support in patients with extensive disease reached conflicting results. Two randomized trials including patients with poor prognosis were discontinued prematurely, owing to interim analyses reporting a significant disadvantage in survival associated with oral single-agent etoposide compared with intravenous multiagent treatment. Thus, oral etoposide has a very limited role as single-agent treatment in the palliative setting. Convincing data have emerged regarding the camptothecins. Randomized studies of both the camptothecins and the taxanes in combination with established drugs are awaited with interest. Unfortunately, too many studies still lack sufficient statistical power, and large randomized studies are needed.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Radiation therapy plays an important role in the treatment of patients with unresectable non-small cell lung cancer. Local control rates with past radiation therapy techniques have been poor, in the range of 10% to 15%. Recent advances in dose planning and delivery, as well as radiation biology, offer the promise of improved control and better protection of dose limiting normal tissues.

ISSN:1040-8746    

出版商:OVID    

年代:1998

数据来源: OVID