National Cancer Institute®
Last Modified: August 1, 2002
UI - 11721427
AU - Guo L
TI - [Management of childhood acute leukemia with standard protocol for increasing the long-time disease free survival rate]
SO - Zhonghua Xue Ye Xue Za Zhi 1999 Jul;20(7):341-2
UI - 11721433
AU - Li C; Han M; Feng S
TI - [Pure red cell aplasia after allogeneic peripheral blood stem cell transplantation: a case report and literature review]
SO - Zhonghua Xue Ye Xue Za Zhi 1999 Jul;20(7):359-61
AD - Institute of Hematology and Blood Diseases Hospital, CAMS, PUMC, Tianjin 300020.
OBJECTIVE: To report a case of post-allogeneic peripheral blood stem cell transplantation (allo-PBSCT) pure red cell aplasia(PRCA) and the treatment outcome. METHODS: A patient with acute non-lymphoblastic leukemia(M2a) was treated with allo-PBSCT. His post-PBSCT PRCA was treated with plasmapheresis(2-3 times weekly) and Epo(3,000 U/day, subcutaneously). RESULTS: Reticulocyte count (Ret) recovered to 0.01 at day +131 and hemoglobin reached 110 g/L at day +154. Erythroid cells in the bone marrow recovered to 0.25, and BFU-E and CFU-E within normal range. This normalized hematopoiesis remained for over 5 months after the cessation of Epo. CONCLUSION: Post allo-PBSCT PRCA can be successfully treated with plasma exchange and Epo.
UI - 11948108
AU - Saito T; Kanda Y; Kami M; Kato K; Shoji N; Kanai S; Ohnishi T; Kawano Y;
TI - Nakai K; Ogasawara T; Matsubara H; Makimoto A; Tanosaki R; Tobinai K; Wakasugi H; Takaue Y; Mineishi S Therapeutic potential of a reduced-intensity preparative regimen for allogeneic transplantation with cladribine, busulfan, and antithymocyte globulin against advanced/refractory acute leukemia/lymphoma.
SO - Clin Cancer Res 2002 Apr;8(4):1014-20
AD - Hematopoietic Stem Cell Transplantation and Hematology Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
PURPOSE: Cladribine (2-CdA) is a purine analogue that exhibits activity against a variety of hematological malignancies and has a potent immunosuppressive effect. We therefore performed a pilot study to evaluate the feasibility of a novel 2-CdA-based reduced-intensity stem cell transplantation (RIST) regimen. EXPERIMENTAL DESIGN: A total of 16 scheduled patients with hematological malignancies were enrolled for comparison of their data with conventional stem cell transplantation (n = 19). The regimen for RIST consisted of 2-CdA (0.11 mg/kg/day for 6 days), busulfan (4 mg/kg/day for 2 days), and rabbit antithymocyte globulin (2.5 mg/kg/day for 4, 2, or 0 days). The underlying diseases included acute myelogenous leukemia (n = 6), chronic myelogenous leukemia (n = 2), myelodysplastic syndrome (n = 6), and non-Hodgkin's lymphoma (n = 2). RESULTS: After RIST, four patients died before day 100 as a result of acute graft-versus-host disease (n = 1), bacteremia (n = 1), disseminated candidasis (n = 1) and congestive heart failure (n = 1). Another patient died of cerebral infarction on day 140. Thus, acute-phase regimen-related toxicities >grade III were observed in only one patient. Engraftment and complete donor chimerism were achieved by day 28 in 14 evaluable patients, and 6 of them (43%) experienced grade II-IV acute graft-versus-host disease. With a median follow-up of 328 days (range, 231-633 days), the actuarial 1-year overall and disease-free survival rates were 69% and 50%, respectively. Notably, among seven high-risk patients (five patients had been in complete remission two or more times and two not in complete remission with refractory disease at transplant), only two patients developed leukemia relapse after RIST. Although the recovery of CD4+ cells was significantly slower (P = 0.02) in RIST than in conventional stem cell transplantation, the incidence of clinically documented infections was not significantly different between the two groups. CONCLUSION: The results suggest that this novel regimen containing 2-CdA is well tolerated and induces early complete donor chimerism. The unexpected durable remission achieved in patients with advanced disease at transplant suggests the presence of an acceptable antileukemia/lymphoma effect, which would warrant a further clinical trial.
UI - 11911407
AU - Zhao WL; Chen SJ; Shen Y; Xu L; Cai X; Chen GQ; Shen ZX; Chen Z; Wang ZY
TI - Treatment of acute promyelocytic leukemia with arsenic trioxide: clinical and basic studies.
SO - Leuk Lymphoma 2001 Nov-Dec;42(6):1265-73
AD - Shanghai Institute of Hematology, Rui Jin Hospital affiliated to Shanghai Second Medical University, People's Republic of China.
Arsenic trioxide (As2O3) has recently been identified as an effective drug in the treatment of newly diagnosed and relapsed acute promyelocytic leukemia (APL) without cross-resistance to all-trans retinoic acid and achieved complete remission rates of 80-90% according to most reports. With intravenous infusion at a dose of 0.08-0.16 mg/kg daily, a course of 28-42 days is required to induce remission. As2O3 in combination with chemotherapy as postremission therapy results in longer survival than arsenic alone. In vitro, As2O3 exerts dose-dependent dual effect; triggering apoptosis at relatively high concentration (0.5-2.0 micromol/l), which is associated with the disruption of mitochondrial transmembrane potentials, while inducing partial differentiation at low concentration (0.1-0.5 micromol/l), which might be related to retinoic acid signaling pathway. Importantly, at both concentrations, As2O3 can degrade PML (promyelocytic leukemia) -RAR alpha (retinoic acid receptor), an oncoprotein that has a central role in leukemogenesis.
UI - 11911410
AU - Steinbach D; Hermann J; Littlewood T; Zintl F
TI - Risk group definition in children with acute myeloid leukemia by calculating individual risk factors on the basis of a multivariate stepwise Cox regression analysis.
SO - Leuk Lymphoma 2001 Nov-Dec;42(6):1289-95
AD - University Children 's Hospital, Jena, Germany. firstname.lastname@example.org
To define risk groups in children with acute myeloid leukaemia (AML), we conducted a multivariate stepwise Cox regression analysis of three consecutive multicentre studies in East Germany. The total number of patients was 240, but cytogenetics and remission status on day 15 were routinely investigated only in the most recent study, AML-III/93 (78 patients). We derived an equation to calculate individual risk factors, determined those risk factors for all patients of study AML-III/93 and divided them into three groups with 26 patients in each. The variables in the equation were: WBC, FAB-type, auer rods, cytogenetics and response status on day 15. The event-free survival was 80% in the low risk, 55% in the intermediate risk and 15% in the high risk group. Our results strongly suggest that calculating individual risk factors on the basis of a multivariate stepwise Cox regression analysis is a useful tool in defining risk groups.
UI - 12042043
AU - Olesen G; Tonder H; Hokland P
TI - Reduced total number of cobblestone area forming cells and in vitro stromal-cell growth in autografts from acute myeloid leukemia patients.
SO - Cytotherapy 2000;2(3):201-9
AD - Department of Hematology, Aarhus University Hospital, Opgang 4A, DK 8000 Aarhus C, Denmark.
BACKGROUND: It is well known that ABMT in acute myeloid leukemia (AML) often results in delayed hematopoietic engraftment, but the reason behind this has not been resolved. Previous studies have largely dealt with measurements of committed myeloid progenitors as surrogate markers for hematopoiesis. METHODS: Measurements of Week 5 cobblestone area forming cells (CAFC) and stromal-cell growth in BM autografts from 14 AML patients were compared with those from 10 NHL patients. RESULTS: Grafts achieved from the AML patients contained a significantly lower total number of CAFC than those from the NHL patients. The reason for this was a lower total amount of mononuclear cells (MNC) obtained during harvest procedure (mean 0.4 x 10(8)/kg for AML, versus 0.8 x 10(8)/kg for NHL). In contrast, the frequency of CAFC was comparable both between patient groups (mean 1.47, range 0.15-6.33 per 10(4) MNC for AML versus mean 1.47, range 0.53-3.57 per 10(4) MNC for NHL) and compared with that of eight normal donors (mean 1.12, range 0.73-1.73 per 10(4) MNC). An inverse relationship was observed between the total CAFC number in the grafts and the hematopoietic reconstitution of both granulocytes > or = 2.0 x 10(9)/L and thrombocytes > or = 50 x 10(9)/L, in which the level of 9.0 x 10(3) CAFC/kg implied a prompt engraftment for both patient groups. Whereas the stromal cell outgrowth in vitro from 8/10 NHL patients was similar to that of six normal donors, only a few stromal cells appeared in the majority of nine evaluable AML patients. DISCUSSION: A decreased total CAFC content, as well as an inferior stromal-cell function, may be critical elements for prolonged hematopoietic reconstitution in AML.
UI - 12113052
AU - Stanisic S; Kalaycio M
TI - Treatment of refractory and relapsed acute myelogenous leukemia.
SO - Expert Rev Anticancer Ther 2002 Jun;2(3):287-95
AD - Cleveland Clinic Foundation, Department of Hemotology and Medical Oncology, 9500 Euclid Ave. R-35, Cleveland, OH 44195, USA. Staniss@ccf.org
Refractory and relapsed disease occurs in most acute myelogenous leukemia patients. Salvage chemotherapy offers a 30-70% chance of a second complete remission. Unfortunately, this second remission is usually short lived and salvage chemotherapy is rarely curative. Allogeneic bone marrow transplant, either human leukocyte antigen (HLA)-sibling matched or matched unrelated donor, is the only treatment to offer long-term disease-free survival and possible cure. Many patients will be ineligible for allogeneic bone marrow transplant. A conjugated antiCD33 monoclonal antibody, gemtuzumab ozogamicin, has recently been approved for use in relapsed and refractory acute myelogenous leukemia patients. New and novel agents are also undergoing trials in an attempt to improve on the overall poor outcomes.
UI - 11728232
AU - Bruserud O; Wendelboe O
TI - Biological treatment in acute myelogenous leukaemia: how should T-cell targeting immunotherapy be combined with intensive chemotherapy?
SO - Expert Opin Biol Ther 2001 Nov;1(6):1005-16
AD - Division of Hematology, Department of Medicine, Haukeland University Hospital and the University of Bergen, Norway. email@example.com
T-cell targeting immunotherapy is now considered as a possible strategy in the treatment of acute myelogenous leukaemia (AML). Clinical importance of antileukaemic T-cell reactivity after allogeneic stem cell transplantation (SCT) is well established and the early experience from IL-2 therapy suggests that even autologous T-cells can mediate antileukaemic reactivity. The clinical experience also indicates that immunotherapy should begin when the leukaemia cell burden is minimal, and the detection of an operative cellular immune system, even in patients with chemotherapy-induced cytopenia, further suggests that it is possible to begin T-cell targeting therapy early after chemotherapy while patients are still cytopenic. However, adult patients in particular have a T-cell defect after chemotherapy that may last for several months. For this reason immunotherapy should probably be continued or repeated until a maximal effect is achieved when the patients no longer have a T-cell defect. This treatment approach may also be considered in combination with autologous SCT. T-cell targeting regimens should include, if possible, several therapeutic components. Firstly, native AML blasts can function as accessory cells during T-cell activation and in vivo therapy with T-cell growth factors (e.g., IL-2, IL-15) may then enhance antileukaemic reactivity or non-specific cytotoxicity against the AML cells; and secondly, a further enhancement of AML-specific reactivity may be achieved by vaccination with AML-specific peptides, immunisation with AML-blasts expressing a dendritic cell phenotype, or exposure to normal antigen-presenting cells (APC) pulsed with or expressing AML-specific peptide sequences.
UI - 12173711
AU - Hogan WJ; Letendre L; Litzow MR; Tefferi A; Hoagland HC; Pruthi RK;
TI - Kaufmann SH Neutropenic colitis after treatment of acute myelogenous leukemia with idarubicin and cytosine arabinoside.
SO - Mayo Clin Proc 2002 Aug;77(8):760-2
AD - Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
OBJECTIVE: To determine the gastrointestinal toxic effects of idarubicin and cytosine arabinoside combination therapy in patients with newly diagnosed acute myelogenous leukemia (AML). PATIENTS AND METHODS: We performed a single-institution retrospective analysis of the incidence of neutropenic colitis in patients with newly diagnosed AML receiving idarubicin and cytosine arabinoside combination therapy. Using pharmacy records, we identified 78 patients who received idarubicin during the review of their medical records. Patients with preexisting bowel conditions were excluded from this analysis. We used a strict definition of neutropenic colitis that included clinical findings (severe abdominal pain, diarrhea, hematochezia, and/or peritoneal signs) plus radiographic evidence of bowel inflammation in the absence of an identified bacterial pathogen. RESULTS: Of the 78 patients receiving idarubicin and cytosine arabinoside for treatment of AML, 65 were included in this study. We observed neutropenic colitis in 10 of these 65 AML patients. This complication was followed by sepsis in 3 patients and was the major cause of death in 4 of the 8 patients who died. CONCLUSION: This analysis suggests that neutropenic colitis is a frequent and serious complication of idarubicin and cytosine arabinoside treatment.
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