ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Allogeneic bone marrow transplantation is an accepted therapy for acute leukemia, with an increased rate of long-term survival and possible cure. Unfortunately, it can be given only when an HLA-identical donor is found. For this reason, large international registries containing normal HLA-typed volunteer marrow donors have been established. Although preliminary, results are encouraging. Approaches using stem cell purification and expansion, fetal and neonatal cells, and new immunosuppressive agents are currently under investigation.

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Chronic myelogenous leukemia is a lethal disease of the hematopoietic stem cell. Marrow transplant from an HLA-matched sibling donor can cure some patients with chronic myelogenous leukemia. Best results are observed when patients receive transplants early in chronic phase. The advantages of delaying marrow transplantation for a trial of interferon-α are questionable if a suitable matched related donor is available. The high incidence of relapse following T-lymphocyte-depleted marrow transplantation for chronic myelogenous leukemia emphasizes the existence of dormant, malignant clones that persist after ablative therapy. The presence of very small numbers ofbcr-abl-positive hematopoietic cells after marrow transplantation can be detected by sensitive molecular genetic techniques and does not always predict hematologic relapse. Successful treatment of hematologic relapse after marrow transplantation can result from treatment with interferon-α, donor buffy coat cells, or second transplantation. HLA phenotypically matched and, in some cases, class 1 HLA antigen mismatched unrelated donors can be used successfully for marrow transplantation. Complications include an increased incidence of graft failure and graft-versus-host disease. Younger patients undergoing transplantation early in the disease course fare best. Preliminary results suggest that autologous marrow transplantation can induce complete hematologic and cytogenetic remission and may prolong survival in some cases. Strategies are being developed to obtain benign primitive progenitors suitable for autologous marrow transplantation by positive selection and to develop further posttransplantation antileukemic cell therapy to be used as an adjunct to autologous marrow transplantation for chronic myelogenous leukemia.

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Very high-dose cytotoxic therapy requiring bone marrow transplantation is the most active treatment for most hematologic malignancies and appears to be the treatment of choice for most patients with these diseases at relapse. Autologous bone marrow transplantation and allogeneic bone marrow transplantation can generally be expected to yield similar results in patients with lymphoma or acute leukemia; autologous bone marrow transplantation offers the advantage of greater availability and less toxicity but with a higher rate of tumor recurrence. Novel approaches that can increase the antitumor activity of autologous bone marrow transplantation without increasing the toxicity are being investigated. Dose intensification followed by autologous marrow rescue is also very active against responsive solid tumors, eg, breast cancer, ovarian cancer, testicular cancer, and pediatric solid tumors. However, it is difficult to demonstrate that autologous bone marrow transplantation has yet to lead to an improvement in disease-free survival for patients with solid tumors. Therefore, the exact role autologous bone marrow transplantation should play in the treatment of solid tumors remains to be established.

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Acute graft-versus-host disease is a two-step process. First, allorecognition of histocompatibility antigen activates T lymphocytes, which releases several cytokines, including interleukin-1 and tumor necrosis factor. Understanding of this activity resulted in new therapeutic approaches. Chronic graft-versus-host disease remains a very frequent and difficult problem to treat. Thalidomide was introduced as therapy for chronic graft-versus-host disease. Although basic research reported this year had no common theme, progress was made in many areas.

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Animal models have been a mainstay for the preclinical evaluation of the principles of bone marrow transplantation. In addition to evaluation of the therapeutic effectiveness of bone marrow transplantation in oncologic, hematologic, immunologic, and genetic diseases, experimental animal models provide insights into the immunobiology of bone marrow transplantation, including engraftment kinetics, tolerance, immune reconstitution, and graft-versus-host and graft-versus-tumor reactions. Many recent developments in experimental bone marrow transplantation resulted from not only the discovery of new spontaneously occurring models of human diseases but also the induction of neoplastic diseases,eg, chronic myelogenous leukemia, by transplantation of syngeneic marrow cells into which foreign genes were introduced and expressed. Murine bone marrow transplantation systems are an exemplary format for the study of clinically relevant basic aspects of hematopoiesis, including identification and elucidation of the biology of hematopoietic stem cells. Finally, the application of molecular biologic techniques in animal bone marrow transplantation models provides the preclinical foundations of gene-insertion therapy by transplantation of syngeneic or autologous marrow-derived stem cells into which functional genes were inserted.

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

New treatments of lung cancer are likely to develop from a greater understanding of the biology of lung tumors and the mechanisms of carcinogenesis and tumor progression. It is clear that numerous molecular genetic changes are present in lung cancer. Some of these changes,eg, mutated oncogenes, are found in other tumors. They provide clues about the carcinogenesis and pathogenesis of lung cancer. The relationship between these genetic changes and prognosis is becoming clearer. Study of membrane receptors for growth signaling and interaction of cells with their environment has identified factors relevant to prognosis and possible targets for therapy. Model systems to interfere with growth signaling have been developed.

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Lung cancer continues to be a leading cause of preventable death, with an estimated 123,000 of the 143,000 lung cancer deaths in the United States in 1991 directly attributable to tobacco smoking. Given that mortality from this disease has not changed appreciably in the past two decades and despite continuing advances in cancer treatment, a new emphasis is being placed on prevention and early detection research through the identification of high-risk individuals and the definition of useful biomarkers. This review summarizes the status of these efforts over the past year.

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Lung cancer has now displaced coronary heart disease as the single leading cause of excess mortality among smokers in the United States. Because screening by chest radiography and sputum cytology did not result in a reduction in lung cancer mortality, current research is directed at identifying earlier markers of malignancy. Molecular genetic and immunohistochemical techniques may now be applied to sputum cytology, and it may be possible to use such tests to screen certain subpopulations who are at extremely high risk for the development of lung cancer. Computed tomography scanning remains the most sensitive imaging technique for the evaluation and staging of patients with both small cell and non-small cell lung cancer. Several prospective trials have now shown that the specificity and sensitivity of computed tomography in the assessment of mediastinal nodes are still too low to eliminate the need for mediastinoscopy. Patients should not be denied thoracotomy on the basis of enlarged lymph nodes detected by computed tomography scan alone, and histologic verification of tumor involvement is essential, especially for patients who have obstructive pneumonitis. For extrathoracic staging, the diagnostic sensitivity and specificity of computed tomography and ultrasound are similar for the detection of liver metastases, but computed tomography is a more sensitive tool for detecting extrahepatic abdominal metastases. Monoclonal antibody imaging techniques currently do not seem to be either sensitive or specific enough to replace any of the current staging procedures more commonly in use.

ISSN:1040-8746    

出版商:OVID    

年代:1993

数据来源: OVID