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1.
Leukemia ; 19(12): 2304-12, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16193083

ABSTRACT

Results of reduced intensity conditioning regimen (RIC) in the HLA identical haematopoietic stem cell transplantation (HSCT) setting have not been compared to those after myeloablative (MA) regimen HSCT in patients with acute myeloblastic leukaemia (AML) over 50 years of age. With this aim, outcomes of 315 RIC were compared with 407 MA HSCT recipients. The majority of RIC was fludarabine-based regimen associated to busulphan (BU) (53%) or low-dose total body irradiation (24%). Multivariate analyses of outcomes were used adjusting for differences between both groups. The median follow-up was 13 months. Cytogenetics, FAB classification, WBC count at diagnosis and status of the disease at transplant were not statistically different between the two groups. However, RIC patients were older, transplanted more recently, and more frequently with peripheral blood allogeneic stem cells as compared to MA recipients. In multivariate analysis, acute GVHD (II-IV) and transplant-related mortality were significantly decreased (P=0.01 and P<10(-4), respectively) and relapse incidence was significantly higher (P=0.003) after RIC transplantation. Leukaemia-free survival was not statistically different between the two groups. These results may set the grounds for prospective trials comparing RIC with other strategies of treatment in elderly AML.


Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Leukemia, Myeloid, Acute/therapy , Transplantation Conditioning/methods , Aged , Cause of Death , Dose-Response Relationship, Drug , Dose-Response Relationship, Radiation , Female , Graft vs Host Disease/etiology , Hematopoietic Stem Cell Transplantation/mortality , Histocompatibility Testing , Humans , Male , Middle Aged , Multivariate Analysis , Recurrence , Registries , Retrospective Studies , Siblings , Survival Analysis , Transplantation, Homologous , Treatment Outcome
3.
Bone Marrow Transplant ; 27(10): 1045-52, 2001 May.
Article in English | MEDLINE | ID: mdl-11438819

ABSTRACT

A hundred and eight patients less than 60 years old with de novo acute myeloid leukemia were treated between 1982 and 1994 by protocols including final intensification with a transplant using autologous bone marrow purged by mafosfamide in first remission in the absence of an HLA-matched sibling donor available for allograft. From 1989, we attempted to improve tumor control by using high-dose anthracyclines in induction, by increasing from one to two the number of consolidation courses pre-transplant and by introducing intermediate doses of cytarabine in the first consolidation course. The CR rate was 77% (33/43) before 1989 and 90% (59/65) after 1989 (P = 0.06). Forty-five out of the 59 patients (76%) who achieved CR after 1989 could undergo bone marrow grafting in CR1 vs 16/33 (48%) before 1989 (P = 0.01). In spite of the higher proportion of patients above 50 years after 1989 (32%) toxicity was mild and an adequate graft was obtained more frequently after one collection. The principal factor relating to improvement in graft feasibility was the post-1989 modification of induction and consolidation regimens. This improvement in graft feasibility was associated with a better disease-free survival (DFS) (48 +/- 7% vs 32 +/- 8%, P = 0.04) and overall survival (OS) (53 +/- 6% vs 30 +/- 7%, P = 0.007) at 5 years. By multivariate analysis four factors were associated with overall survival (OS): karyotype, white blood cell count at diagnosis, treatment regimen and bone marrow grafting in CR1. This global approach should be prospectively compared with intensive chemotherapy.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Bone Marrow Transplantation/standards , Leukemia, Myeloid/therapy , Acute Disease , Adolescent , Adult , Amsacrine/administration & dosage , Amsacrine/toxicity , Antineoplastic Combined Chemotherapy Protocols/toxicity , Bone Marrow Transplantation/mortality , Cytarabine/administration & dosage , Cytarabine/toxicity , Etoposide/administration & dosage , Etoposide/toxicity , Female , Humans , Leukemia, Myeloid/complications , Leukemia, Myeloid/mortality , Male , Middle Aged , Remission Induction , Retrospective Studies , Survival Rate , Transplantation, Autologous/mortality , Transplantation, Autologous/standards , Treatment Outcome
4.
Eur J Surg Oncol ; 25(6): 635-6, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10556014

ABSTRACT

Laparoscopic surgery has gained wide acceptance. However, there is still debate as to its role in assessment and staging of gastrointestinal malignancies(1)since it may promote dissemination of cancer cells.(2)We report the first case of a low-grade mesenteric nodal lymphoma for laparoscopic hernia repair, complicated by distant implants both on the peritoneum and wall mesh.


Subject(s)
Hernia, Inguinal/surgery , Laparoscopy/adverse effects , Lymphoma/pathology , Mesentery , Peritoneal Neoplasms/secondary , Aged , Humans , Male
5.
Bone Marrow Transplant ; 23(4): 401-3, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10100586

ABSTRACT

Progressive multifocal leucoencephalopathy is an opportunistic JC virus-related pathology occurring in immunocompromised patients. We report a case of severe cellular immunodeficiency in a patient who underwent autologous bone marrow transplantation for acute myeloblastic leukemia, and who subsequently developed progressive multifocal leucoencephalopathy, an unusual pathology in this context. Progressive multifocal leucoencephalopathy was preceded by a peripheral demyelinating neuropathy. We discuss the possible link between these two neuropathies, the possible aggravation or activation from CMV infection, as well as the possible contribution of bone marrow purging in the resultant cellular immunodeficiency.


Subject(s)
Bone Marrow Transplantation/adverse effects , Leukemia, Myeloid, Acute/therapy , Leukoencephalopathy, Progressive Multifocal/etiology , Peripheral Nervous System/physiopathology , Adult , Female , Humans , Leukoencephalopathy, Progressive Multifocal/pathology , Leukoencephalopathy, Progressive Multifocal/physiopathology , Peripheral Nervous System/pathology , Transplantation, Autologous
6.
J Clin Oncol ; 16(8): 2803-16, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9704733

ABSTRACT

PURPOSE: To analyze retrospectively survival and prognostic factors of patients with non-Hodgkin's lymphoma (NHL) autografted from 1979 to 1995 in a single institution. PATIENTS AND METHODS: A total of 120 patients, 64 with aggressive and 56 with low-grade NHL, were autografted. The carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) regimen was used in 104. The autograft was marrow in 101 patients. Marrow was purged in vitro by mafosfamide for 63 patients (adjusted dose [AD] in 32; unique dose [UD] in 31); 27 patients received a CD34+-selected graft. Following intensification, 45 patients received additional radiotherapy on previous sites of involvement. RESULTS: Outcome at 5 years for patients transplanted with low-grade NHL in first complete remission (CR1), in first partial remission (PR1), and in second complete remission (CR2) or beyond showed an event-free survival (EFS) of 75% +/- 12%, 46% +/- 18%, and 57% +/- 24%, a relapse incidence (RI) of 21% +/- 12%, 49% +/- 19%, and 43% +/- 25%, and a transplant-related mortality (TRM) of 5% +/- 5%, 10% +/- 7%, and 0%, respectively. For patients with aggressive NHL transplanted in CR1, in PR1, in CR2 or beyond, and in resistant relapse or in primary refractory disease, the EFS was of 73% +/- 9%, 58% +/- 19%, 29% +/- 16%, and 10% +/- 9%, the RI 22% +/- 9%, 14% +/- 9%, 77% +/- 18%, and 66% +/- 20%, and the TRM 6% +/- 6%, 32% +/- 21%, 11% +/- 10%, and 71% +/- 22%, respectively. In patients autografted upfront in first remission, additional radiotherapy was associated with a higher EFS, in univariate (P = .03) and multivariate analysis (P = .02, relative risk [RR] = .021). The role of graft purging with mafosfamide on the outcome reflected by the dose of colony-forming unit-granulocyte-macrophage (CFU-GM) per kilogram infused postpurging was assessed by univariate analysis: patients in first remission who received lower doses of CFU-GM had a lower RI and a higher EFS. CONCLUSION: This retrospective analysis suggests that marrow purging and posttransplant radiotherapy improve the outcome of patients with NHL autografted in first remission.


Subject(s)
Bone Marrow Purging , Hematopoietic Stem Cell Transplantation , Lymphoma, Non-Hodgkin/therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carmustine/administration & dosage , Combined Modality Therapy , Cyclophosphamide/analogs & derivatives , Cytarabine/administration & dosage , Disease-Free Survival , Etoposide/administration & dosage , Female , Humans , Lymphoma, Non-Hodgkin/pathology , Lymphoma, Non-Hodgkin/radiotherapy , Male , Melphalan/administration & dosage , Middle Aged , Prognosis , Recurrence , Remission Induction , Retrospective Studies
7.
Exp Hematol ; 20(2): 251-5, 1992 Feb.
Article in English | MEDLINE | ID: mdl-1544396

ABSTRACT

The tetrapeptide acetyl-N-Ser-Asp-Lys-Pro (AcSDKP) inhibits the entry into DNA synthesis of murine spleen colony-forming units (CFU-S) and protects these cells during chemotherapy. This synthetic peptide also inhibits the growth of normal human marrow progenitors granulocyte-macrophage colony-forming units (CFU-GM) and erythroid burst-forming units (BFU-E) and decreases their percentage in DNA synthesis at nanomolar concentration. In view of its clinical application as a marrow protector, we have investigated its effects on malignant cells. Studies were carried out on HL-60 cells and on fresh leukemic cells from patients with either chronic myeloid leukemia (CML) or acute myeloid leukemia (AML). Results showed that AcSDKP, whatever the doses used, did not modify the proliferation of both HL-60 cells and AML cells even when enhanced by stimulating factors such as interleukin 3 or granulocyte-macrophage colony-stimulating factor (GM-CSF). In addition, no change in the number and the percentage in S-phase of both HL-60 clonogenic cells and CML progenitors was observed. Our data clearly demonstrate that the tetrapeptide AcSDKP was ineffective on leukemic cells and therefore by acting selectively on normal progenitors represents a potent therapeutical agent for the protection of normal bone marrow progenitors during chemotherapy.


Subject(s)
Hematopoietic Stem Cells/cytology , Leukemia, Myeloid/pathology , Oligopeptides/pharmacology , Adult , Aged , Cell Cycle/drug effects , Cell Division/drug effects , Cells, Cultured , DNA/metabolism , Dose-Response Relationship, Drug , Female , Granulocyte-Macrophage Colony-Stimulating Factor/pharmacology , Hematopoietic Stem Cells/drug effects , Hematopoietic Stem Cells/metabolism , Humans , Interleukin-3/pharmacology , Male , Middle Aged , S Phase , Tumor Cells, Cultured/drug effects , Tumor Cells, Cultured/metabolism , Tumor Cells, Cultured/pathology
8.
Bone Marrow Transplant ; 9(2): 97-100, 1992 Feb.
Article in English | MEDLINE | ID: mdl-1571714

ABSTRACT

Three patients with acute leukemia who underwent autologous bone marrow transplantation (BMT) in complete remission, developed a severe respiratory syncytial virus (RSV) pneumonia, which was fatal in two. Identification of RSV was made on the products of bronchoalveolar lavage by direct immunofluorescence. As already described by others, the initial course of RSV infection varies, depending on whether it occurs sooner or later after BMT with a better prognosis in the latter situation. Treatment consists of aerosolized ribavirin. Infection by RSV is caused by manual contact with infected persons and contaminated surfaces. The severity of lung RSV infection in the course of BMT suggests the need for prophylactic measures in addition to standard isolation precautions.


Subject(s)
Bone Marrow Transplantation , Pneumonia, Viral/microbiology , Respiratory Syncytial Viruses , Respirovirus Infections , Acute Disease , Adult , Cross Infection/microbiology , Cross Infection/transmission , Female , Humans , Immunocompromised Host , Leukemia/therapy , Leukemia, Myeloid, Acute/therapy , Male , Patient Isolation , Pneumonia, Viral/transmission , Remission Induction , Respirovirus Infections/transmission , Transplantation, Autologous
9.
Presse Med ; 21(3): 119-23, 1992 Jan 25.
Article in French | MEDLINE | ID: mdl-1532059

ABSTRACT

Three patients developed severe respiratory syncytial virus pneumonia after bone marrow autograft for acute leukaemia. Clinically, the disease presents as interstitial or bilateral alveolo-interstitial pneumonia with hypoxaemia. Signs of ENT infection (otitis media, sinusitis) are present in 30 percent of the cases. In all 3 patients, the syncytial virus was isolated by direct immunofluorescence in bronchoalveolar lavage fluid. In 2 patients the infection began soon after the autograft, in deeply aplastic subjects, and required intubation and assisted ventilation. These 2 patients died despite inhalation of aerosolized ribavirin combined, in one of them, with ribavirin injections. In the third patient the infection began some time after the autograft and responded well to ribavirin in aerosols. In these three cases the viral infection occurred in an epidemic and nosocomial context. The respiratory syncytial virus is usually transmitted by the hands. Owing to the severity of this infection with lung involvement in immunodepressed patients, specific prophylactic measures should be taken side by side with the conventional measures.


Subject(s)
Bone Marrow Transplantation , Immunosuppression Therapy/adverse effects , Pneumonia, Viral/etiology , Respiratory Syncytial Viruses , Respirovirus Infections/etiology , Administration, Inhalation , Adult , Bronchoalveolar Lavage Fluid/microbiology , Female , Humans , Leukemia/therapy , Male , Pneumonia, Viral/drug therapy , Respirovirus Infections/drug therapy , Ribavirin/therapeutic use , Transplantation, Autologous
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