ABSTRACT
60 adult patients with acute leukemia (AL) previously untreated or in relapse received induction chemotherapy with different types of supportive care. Group A was decontaminated by nonabsorbable antibiotics in strict reverse isolation, group B was isolated only and group C was treated under routine hospital conditions. There were less infections in group A and B compared with group C. 76% of patients in group A achieved remission, in contrast to 57% in group B and 59% in group C. Late evaluation three years after termination of the study showed that all patients were dead except four patients being in first remission after discontinuation of maintenance treatment. Three patients were treated in group A, one patient in group C. However, the differences of survival and remission rates were not significant. Failure to demonstrate significant advantage of isolation and decontamination in treatment of AL was caused by insufficient suppression of microbes by the applied antimicrobial measures. Thus, it is suggested to investigate better antimicrobial treatment before gnotobiotic care is accepted as routine supportive treatment in AL.
Subject(s)
Germ-Free Life , Leukemia/therapy , Patient Isolation/methods , Acute Disease , Adolescent , Adult , Antineoplastic Agents/administration & dosage , Child , Child, Preschool , Drug Therapy, Combination , Evaluation Studies as Topic , Humans , Leukemia/mortality , Leukemia, Lymphoid/therapy , Leukemia, Myeloid, Acute/therapy , Middle Aged , Prospective Studies , Random AllocationABSTRACT
An exact account of previous drug intake was obtained in 42 patients with acute agranulocytosis. Because of the multiplicity of administered drugs, often in the form of multiple-drug preparations, it was possible in only a minority of cases to ascribe with any degree of certainty a causative role to any particular drug. But outstanding as possible causes were thyrostatic drugs and pyrazolone. But no conclusion could be drawn as to the incidence of agranulocytosis with regard to these drugs because of the absence of data on the frequency that they are prescribed and the unknown number of fatal cases of agranulocytosis. The results indicate that multiple drug treatment and in particular the unnecessary prescribing of multiple-drug preparations makes it difficult to ascertain side-effects of drugs. They once again point to the need of frequent checks of white cell count in the drug treatment of pyrexial diseases.
Subject(s)
Agranulocytosis/chemically induced , Drug-Related Side Effects and Adverse Reactions , Acute Disease , Adolescent , Adult , Aged , Analgesics/adverse effects , Antithyroid Agents/adverse effects , Child , Child, Preschool , Female , Humans , Male , Middle AgedSubject(s)
Anemia, Aplastic/therapy , Bone Marrow Transplantation , Adult , Child , Child, Preschool , Female , Graft Rejection , Graft Survival , Humans , Male , Transplantation, IsogeneicABSTRACT
Thirty patients with severe drug-induced agranulocytosis were admitted to the Ulm University Hospital between January, 1968 and October, 1976. All of 13 already infected patients treated with antimicrobial decontamination in a plastic isolation bed system survived. But nine of 17 patients treated in the open ward died. The cases were not randomised and there was a difference in age between the two groups, but nevertheless the results suggest that antimicrobial decontamination and isolation is superior to treatment in an open ward.
Subject(s)
Agranulocytosis/therapy , Patient Isolators , Adolescent , Adult , Aged , Agranulocytosis/chemically induced , Agranulocytosis/complications , Bacterial Infections/drug therapy , Blood Transfusion , Carbenicillin/therapeutic use , Child , Child, Preschool , Drug-Related Side Effects and Adverse Reactions , Female , Gentamicins/therapeutic use , Germany, West , Granulocytes/transplantation , Humans , Male , Middle Aged , Retrospective StudiesSubject(s)
Anemia, Aplastic/therapy , Bone Marrow Cells , Bone Marrow Transplantation , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Prognosis , Transplantation, HomologousABSTRACT
Bone-marrow transplantation (BMT) from an unrelated, HL-A-phenotype-identical, MLC-negative donor was performed in a 31 year old woman with severe longlasting aplastic anemia. In vitro assays failed to demonstrate humoral or cellular sensitization of the recipient against donor-type antigens. Following conditioning with cyclophosphamide, prompt but only transient engraftment of the transplant occurred accompanied by signs of mild graft-versus-host-disease (GVHD) of the liver. The results of a second bone marrow transplantation from the same donor cannot be evaluated due to early death of the recipient. It is concluded that bone marrow from unrelated, HL-A and MLC-identical donors may engraft without severe GVHD. Rejection of the graft in our patient may have been related to greater antigenic differences that can be expected to exist between HL-A and MLC-identical unrelated individuals than between HL-A and MLC-identical siblings. However, insufficient preparative immunosuppression with cyclophosphamide due to severe hepatic hemosiderosis appears equally likely as the cause of graft rejection. The possibly increased risk of graft rejection or severe GVHD should not preclude the use of unrelated HL-A and MLC-identical marrow donors, when histocompatible sibling donors are not available; but more potent immunosuppressive regimens than the cyclophosphamide protocol may be necessary to ensure permanent engraftment.
