ABSTRACT
Erlotinib, an orally active epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), is indicated for EGFR mutation-positive patients with poor performance status. Erlotinib is also used as a second-line agent in patients who show disease progression after failure of first-line therapy. Warfarin is administered in patients with advanced cancer for the prevention or treatment of venous thromboembolism. Both erlotinib and warfarin are metabolized in the human liver primarily by the CYP3A4 enzyme system. Thus, erlotinib may inhibit the metabolism of warfarin and clinicians should pay attention to the possible interaction between the two drugs when they are administered concurrently. We report the case of a 50-year-old man who showed changes in the prothrombin time-international normalized ratio (PT-INR) after coadministration of erlotinib and warfarin.
Subject(s)
Humans , Middle Aged , Carcinoma, Non-Small-Cell Lung , Disease Progression , Liver , Protein-Tyrosine Kinases , Prothrombin , Prothrombin Time , Quinazolines , ErbB Receptors , Venous Thromboembolism , Warfarin , Erlotinib HydrochlorideABSTRACT
To our knowledge, this is the first report of case of high-grade endometrial stromal sarcoma metastasized to the stomach. Endometrial stromal sarcoma is very rare, accounting for 0.2% of female genital tract malignancies. High-grade endometrial stromal sarcoma demonstrates more frequent infiltration into the muscle layer of the uterus or metastasis to other organs, having a poorer prognosis than low grade disease. During its clinical course, endometrial stromal sarcoma may involve ovary, fallopian tube and pelvic cavity. Distant metastasis to lung, liver, bladder, breast, heart, brain and bones have been reported. However, to the best of our knowledge, high-grade endometrial stromal sarcoma presenting with gastric metastasis has never been reported. We now report a case of a 52-year-old woman with previously diagnosed lung metastasis having stomach metastasis from endometrial stromal sarcoma of the uterus.
Subject(s)
Female , Humans , Middle Aged , Accounting , Brain , Breast , Endometrium , Fallopian Tubes , Heart , Liver , Lung , Muscles , Neoplasm Metastasis , Ovary , Prognosis , Sarcoma , Sarcoma, Endometrial Stromal , Stomach , Urinary Bladder , UterusABSTRACT
Cutaneous T-cell lymphoma(CTCL) is a rare cutaneous malignant disease and is typically a disease of older adults. There is no optimal treatment for CTCL, which ranges from topical steroid to systemic chemotherapy. Hence until curative therapy is found, therapies that keep CTCL in check and prevent progression to more advanced lymphoma may be desirable alternatives and may presetve quality of life. Herein we report our experience in treating a stage 11B CTCL patient with triple combination of interferon alfa, oral retinoid, and psoralen plus WA(PWA) therapy.
Subject(s)
Adult , Humans , Drug Therapy , Ficusin , Interferon-alpha , Interferons , Lymphoma , Lymphoma, T-Cell, Cutaneous , Photochemotherapy , Quality of Life , T-LymphocytesABSTRACT
BACKGROUND: Clinical and biologic characteristics of elderly patients with acute myeloid leukemia (AML) have not been well defined yet and there is no consensus on the appropriate treatment approach. We analyzed the outcome of these patients in terms of complete remission (CR) and the long-term life expectancy. METHODS: Twenty patients received mitoxantrone at the dose range of 4~8 mg/m2/ day for 3 days according to the patients' condition based on age and performance status, low-dose cytosine arabinoside 10mg/m2 subcutaneously at every 12 hours for 10~14 days, and etoposide 100mg/day per os for 10~14 days. Most of patients achieving CR received at least 1~3 more courses of post-remission therapy with same initial regimen. Nine out of 17 patients receiving more than two courses of post-remission chemotherapy received their cryopreserved peripheral bloods stem cells after the second or third consolidation chemotherapy. RESULTS: Overall, CR was achieved in 16 (80%) out of 20 patients and the median CR duration was 6 months (range 2~17 months). The most frequent complication during the induction chemotherapy was pneumonia (55%). CONCLUSION: The induction chemotherapy regimen including mitoxantrone, cytosine arabinoside, and etoposide seems to be promising in elderly AML patients in terms of CR rate, while its duration was short. Hopefully, it is necessary to develop a new post-remission therapy to maintain long-term disease-free survival in elderly AML patients.
Subject(s)
Aged , Humans , Consensus , Consolidation Chemotherapy , Cytarabine , Disease-Free Survival , Drug Therapy , Etoposide , Induction Chemotherapy , Leukemia, Myeloid, Acute , Life Expectancy , Mitoxantrone , Pneumonia , Population Characteristics , Stem CellsABSTRACT
We report the first case of anti-LebH antibody concurrent Leb antigen supression during pregnency. A 32-year-old woman was diagnosed as idiopathic thrombocytopenic purpura at the 20th week of gestation. She was administrated intravenous immunoglobulin and transfused packed red cells due to thrombocytopenia and anemia. Before an elective cesarean section at 38th week of gestation, her red cells were typed B, Rh(D) positive and her serum had anti-A and her Lewis phenotype was Le(a-b-). The antibody screeening test was positive and anti-Leb which was identified in the antibody identification test. However, it revealed stronger reaction against O, Le(a-b+) red cells than B, Le(a-b+) red cells and we concluded that it was anti-LebH. About 1 year after delivery, the anti-LebH was detected as low titer (about 1:4) but Lewis phenotype was converted to original phenotype as Le(a-b+).
Subject(s)
Adult , Female , Humans , Pregnancy , Anemia , Cesarean Section , Immunoglobulins , Phenotype , Purpura, Thrombocytopenic, Idiopathic , ThrombocytopeniaABSTRACT
PURPOSE: We assessed the three-alkylator combination of busulfan, melphalan and thiotepa or TBI, melphalan and thiotepa conditioning for allogeneic stem cell transplantation in 7 adult patients with refractory or relapsed acute leukemias. MATERIALS AND METHODS: Six patients were transplanted for acute myeloid leukemia, one for acute lymphoblastic leukemia and included 5 of relapsed refractory, 2 of relapsed after first-BMT. All but 1 cases received G-CSF stimulated CD34+ allogeneic peripheral blood progenitor cells (PBPCs) in addition to stimulated allogeneic marrow. RESULTS: All patients except one engrafted (median time to ANC >0.5 10 (9)/L=11days, to platelets >30 X 10 (9)/L=14 days) successfully and complete remission was obtained in 6 patients. Grade I-II acute GVHD and controllable regimen-related toxicity especially oral mucositis (grade II-III) developed in all cases, but 2 patients including one second- allogeneic BMT patient expired early by transplant-related toxicity of hepatic or multiorgan failure along the course of sepsis. CONCLUSION: Although the observation period on these cases are limited, the data presented show that the combination of busulfan, melphalan and thiotepa is tolerable as a preparative regimen for allogeneic marrow transplantation in high-risk leukemic patients. We think that these encouraging results need to be confirmed in prospective studies in the future.
Subject(s)
Adult , Humans , Bone Marrow Transplantation , Bone Marrow , Busulfan , Drug Therapy , Granulocyte Colony-Stimulating Factor , Leukemia , Leukemia, Myeloid, Acute , Melphalan , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Sepsis , Stem Cell Transplantation , Stem Cells , Stomatitis , ThiotepaABSTRACT
BACKGROUND: By development of monoclonal antibodies (MoABs) directed against hematopoietic cells, flow cytometric analysis of bone marrow has become commonplace in clinical hematology laboratories and has a major role in evaluation of lymphohematopoietic malignancies. However, little information about antigen expressions and distribution of normal human bone marrow cells has been published. Therefore, we analysed the immunophenotype of the normal human bone marrow cells to get a normal baseline data for flow cytometric analysis. METHODS: The bone marrow aspirates of 20 healthy donors of allogeneic bone marrow transplantation were analysed using flow cytometry (Becton-Dickinson Co, USA). Seven gated region (R) were set using the forward vs. right angle light scatter (FSC/SSC) cytogram and the percentages of positive cells against 17 monoclonal antibodies were identified in these gated regions by dual parameter flow cytometry. RESULTS: The proportion of total CD45+ cells was 87.57+/-12.82% (mean+/-1SD, n=20) and CD45- (nucleated erythrocytes) cells was 12.43+/-12.82% of all nucleated bone marrow cells. T cells were more numerous than B cells in total gates (P=.0001). T helper/inducer cells (Th) to T suppressor/cytotoxic cells (Ts) ratio was 1.38+/-0.53 and CD4+ cells were distributed in larger size and higher SSC fractions in FSC/SSC cytogram than CD8+ cells (P=.0001). While CD4+, 8+ cells were rarely existed, CD10+ cells were 17.63+/-11.43% of all nucleated bone marrow cells and they mainly distributed in granulocytic fractions. Lymphocytes represent 60% of all lymphogate cells and T cells were mostly mature cells. CD10+ cells and CD34+ cells in the R1 (lymphogate) were 4.37+/-3.07% and 1.78+/-1.25%, respectively. The total CD34+ cells represent 0.88+/-0.5% of all nucleated bone marrow cells and 65% of them were CD34+CD33+ cells. CONCLUSION: These results indicate each subpopulation of normal bone marrow reveals different regional expression from morphological estimation and these normal expressions should be considered in flow cytometric analysis of hematologic disorders.
Subject(s)
Humans , Antibodies, Monoclonal , B-Lymphocytes , Bone Marrow Cells , Bone Marrow Transplantation , Bone Marrow , Flow Cytometry , Hematology , Immunophenotyping , Lymphocytes , T-Lymphocytes , Tissue DonorsABSTRACT
Twenty-six primary hip prostheses were implanted in nineteen patients with a diagnosis of aplastic anemia between January 1990 and December 1992. The preoperative diagnosis were osteonecrosis of the femoral head in twenty-five hips and femoral neck fracture in one. The duration of follow-up was minimum of fours years. Preoperatively, the average Harris hip score was 56. At four years postoperatively, the average score reached 87. At this time, twelve hips were rated excellent, eleven good, two fair, and one poor. One patient who received a bipolar arthroplasty showed an intrapelvic protrusion of the acetabular component. Another bipolar fixed with Boneloc cement was performed due to femoral neck fracture. There was no migration of component, subsidence, radiolucency or osteolysis in three hips with hybrid fixation. No sign of migration of acetabular component was seen with uncemented prosthesis. Two hips with HA coated acetabular components showed a progressive radiolucent line. Progressive retroacetabular osteolysis was found in one hip at zone I and II. There were neither cases of infection nor hemorrhage complications. Two patients died of pneumonia and sepsis, respectively, at fifty-three and fifty-seven months postoperatively. It appears that fatty marrow conversion of proximal femur and pelvis does not affect the survival of cemented and uncemented fixation, but long-term follow-up is needed to validate our view. We have demonstrated that the hip arthroplasty in most patients with aplastic anemia can be successful despite the fact that hematologic characteristics of aplastic anemia seem to indicated a high risk for hemorrhagic complication and infection. In conclusion, we strongly recommend hip arthro-plasty if the patients has a painful hip joint, regardless of severity of aplastic anemia whose prognosis may be disappointing.
Subject(s)
Humans , Acetabulum , Anemia, Aplastic , Arthroplasty , Bone Marrow , Diagnosis , Femoral Neck Fractures , Femur , Follow-Up Studies , Head , Hemorrhage , Hip Joint , Hip Prosthesis , Hip , Osteolysis , Osteonecrosis , Pelvis , Pneumonia , Prognosis , Prostheses and Implants , SepsisABSTRACT
No abstract available.
Subject(s)
Drug Therapy , Leukemia, Myelogenous, Chronic, BCR-ABL PositiveABSTRACT
No abstract available.
Subject(s)
Humans , Cytarabine , Cytosine , Idarubicin , Induction Chemotherapy , Leukemia, Myeloid, AcuteABSTRACT
Carcinosarcoma of the esophagus is regarded as a rare malignant neoplasm composed of both carcinomatous and sarcomatous elements. Esophageal carcinosarcoma classified into 3 subgroups, pseudosarcoma, so called carcinosarcoma, and true carcinosarcoma. we report a case of large polypoid tumor consist of squamous cell carcinoma, undifferentiatred small cell and spindle cell proliferation. The patient was 47 year-old man who had suffered from dysphasia and substernal chest pain for 2 months. A protruded tumor in size of 8x4x3.5 cm with stalk was found in midesophagus at the level of 28 cm from the incisor. The tumor was round with smooth surface stained with Lugol solution. There were multiple erosions at the stalk of the tumor, Partial esophagectomy and esophagogastrostomy was done, Undifferentiated small cell was confirmed by immunoreactivity to neuron specific enolase and electron microscopic findings.