ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In recent years new developments in cytogenetics, immunophenotyping, and molecular biology have dramatically advanced our understanding of leukemia. Unfortunately, traditional morphologic evaluation of acute myeloblastic leukemia using the French-American-British classification correlates poorly with most of this new information and does not predict response to therapy. In this review we concentrate on applications of molecular biologic techniques to the diagnosis of leukemias, and discuss use of this technology to detect minimal residual disease. We then present a revised classification for acute myeloblastic leukemia according to whether myelodysplasia-like features are present or lacking. Cases may then be further classified using French-American-British morphology and other parameters. This classification appears to correlate better with new biologic data and with therapeutic response.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Cytogenetic and molecular studies have assumed an increasing role in the evaluation and management of patients with leukemia. Many cytogenetic findings have become well established as important independent indicators of prognosis in the acute leukemias. There has been a recent explosion of knowledge about the genes involved in leukemogenesis and the manner in which their structure or expression is altered by chromosomal translocations or point mutations. Application of newer techniques such as the polymerase chain reaction and in situ hybridization has begun to allow quantitation of residual leukemia cells after therapy. Cytogenetic and molecular findings should allow us to use more individualized therapy in treating leukemia, as well as therapy targeting leukemia-specific abnormal gene products.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Hematopoietic growth factors, particularly granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor, can be used as supportive agents to enhance bone marrow recovery after the administration of myelosuppressive chemotherapy given for nonmyeloid neoplasms. The use of these agents in the treatment of acute myeloid leukemia and myelodysplastic syndrome poses novel opportunities and challenges due to their direct effects on the neoplastic cells, which represent the transformed counterparts of normal hematopoietic stem cells. The interaction between hematopoietic growth factors and leukemic progenitor cells bearing a specific receptor for a given agent would be expected to result in proliferation, although maturation induction could occur. Hematopoietic growth factors have been employed as primary differentiating agents in myelodysplastic syndrome and as supportive agents after chemotherapy in acute myeloid leukemia. In either case, close monitoring for evidence of leukemic stimulation is required. Alternatively, pretreatment with colony-stimulating factors could induce cell cycling, thereby making the leukemic cells more susceptible to S-phase-specific chemotherapeutic agents, such as cytarabine.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Acute promyelocytic leukemia is a clonal expansion of malignant cells blocked at a specific stage of myeloid differentiation. The disease is associated with a specific translocation between chromosome 17 and chromosome 15 (t(15;17)] and with a bleeding diathesis previously attributed to disseminated intravascular coagulation, which has recently also been related to primary fibrinolysis. The high percentage of early deaths, about 20%, experienced by acute promyelocytic leukemia patients, is generally due to the hemorrhagic syndrome. A new finding is the high effectiveness of treatment with all-transretinoic acid, a vitamin A derivative, for inducing complete remission. The induction of cellular maturation by this agent represents the first model of differentiation therapy. Furthermore, recent molecular studies revealed that the breakpoints of the t(15;17) translocation are clustered in the gene of retinoic acid receptor-α, generating a hybrid gene product. Gene transfection experiments disclosed the impairment of gene transactivation due to the hybrid gene products, opening new concepts for understanding leukemogenesis. Understanding the mechanisms of action of retinoic acid could extend differentiation therapy to other malignancies with aberrant gene transcription.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The goal of therapy for young adults with de novo acute myeloid leukemia is cure. Seventy percent or more of young adults achieve initial remission, and 30% to 40% of adults receiving postremission chemotherapy appear to remain in remission. High-dose cytarabine consolidation therapy appears particularly effective. However, with current approaches, only 20% of young adults are cured. New approaches are needed to increase the cure rate substantially, and autologous bone marrow transplantation appears to be the most promising treatment modality in acute myeloid leukemia. Improved preparative regimens and purging techniques may be critical factors in determining the effectiveness of autologous bone marrow transplantation. In adult acute lymphoblastic leukemia, very high remission rates are now being reported with intensive multiagent induction therapy, and approximately one third of young adults with this disease are cured with current intensive chemotherapy approaches. The role and optimal methods of bone marrow transplantation for acute lymphoblastic leukemia are under investigation.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Chronic myeloid leukemia is an enigma in origin and a source of frustration in treatment because until recently no real progress had been made in altering its natural history. Nevertheless, recent advances in cell biology and molecular genetics, and a plethora of morphologic, biochemical, and cytogenetic data of potential clinical relevance have yielded new data regarding this disease. The use of marrow transplantation and recombinant interferon have been of significant clinical importance, although their roles in the overall treatment of the disease remain to be determined.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Multiple myeloma remains a fatal disease. However, in the last few months new biologic and clinical information has been provided about this disease. In particular, the immunophenotype of myeloma cells seems to indicate, at least in some patients, the possibility of a stem cell involvement in the pathogenesis of myeloma. Moreover, the recent progress in understanding the complex cytokine network has revealed the possibility that myelomatous proliferation is highly influenced by some cytokines such as interleukin-6, interleukin-3, interleukin-2, and granulocyte-macrophage colony-stimulating factor. Furthermore, it has been shown that the mechanism responsible for the resistance of myeloma cells to chemotherapy may be partially overcome by the use of calcium antagonists associated with quinine. Finally, new insights into the pathogenesis and biology of the disease have been provided by studies of molecular biology and flow cytometry undertaken in multiple myeloma patients. The best conventional induction treatment remains to be defined. However, the increased use, as new therapeutic modalities, of interferon-α and transplantation procedures in multiple myeloma opens new hopes of a cure. In the future, a better comprehension of the multiple myeloma biology associated with a wider use of new and more effective therapeutic approaches will certainly improve the natural course of the disease.

ISSN:1040-8746    

出版商:OVID    

年代:1992

数据来源: OVID