ABSTRACT
AIMS: Colorectal carcinoma in patients under 40 years of age usually has a poor prognosis. Controversies still exist regarding the features and the prognosis of colorectal cancer in young patients. METHODS: The records of 45 patients with histologically confirmed colorectal carcinoma treated between 1992 and 2002 at the Division of Oncology at Taipei Veterans General Hospital were reviewed. The relevance of sex, duration of symptoms, tumor site, histological type, lymph node involvement, Karnofsky performance status (KPS), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) levels at the diagnosis and tumor stage to overall survival (OS) were determined by univariate analysis, and their independent significance were tested by multivariate analysis. RESULTS: Most patients presented with an advanced tumor stage (24% Dukes' C and 66% Dukes' D). Colon carcinoma constituted 76% of the colorectal tumors. Family history was present in two patients and did not affect the OS. Two patients were found to have colon carcinoma during pregnancy. The 5-year survival rate in patients with Stage B, C, and D were 25, 16 and 0%, respectively. With aggressive treatment, patients with early stage carcinoma achieved longer survival. Eleven patients received resection of metastatic carcinoma of the liver, lung and ovary. Adjuvant chemotherapy with irinotecan/5-fluorouracil-based chemotherapy seemed to improve the OS in such patients, though the OS was still poorer than in patients with early stage tumors. In univariate analysis, KPS (P = 0.0001), lymph node involvement (P = 0.0024), CEA (P = 0.0423) and LDH levels (P = 0.0126) at the diagnosis and tumor stage (P = 0.0122) proved to be significant predictors of overall survival. Multivariate analyses revealed that KPS > or =70% (P = 0.007) and normal LDH levels at diagnosis (P = 0.004) were predictive of overall survival in this population. CONCLUSIONS: The present study shows that performance status and preoperative LDH levels were the major determinants for survival in patients with colorectal carcinoma under 40 years of age and the present series also suggests that surgical resection of metastatic colorectal carcinoma followed by adjuvant chemotherapy might be beneficial in certain patients. The data also suggests that current treatment modalities for young patients with advanced colorectal cancer might not be effective and more effective therapeutic regimens might be needed. Thus, it is important for surgeons to recognize the potential for colorectal cancer in young patients and to take an aggressive approach to the diagnosis and early treatment of the disease.
Subject(s)
Adenocarcinoma/mortality , Colorectal Neoplasms/mortality , Adenocarcinoma/blood , Adenocarcinoma/pathology , Adolescent , Age Factors , Carcinoembryonic Antigen/blood , Child , Colorectal Neoplasms/blood , Colorectal Neoplasms/pathology , Female , Follow-Up Studies , Humans , Male , Neoplasm Staging , Pregnancy , Pregnancy Complications, Neoplastic/blood , Pregnancy Complications, Neoplastic/mortality , Pregnancy Complications, Neoplastic/pathology , Prognosis , Retrospective Studies , Risk Factors , Sex Factors , Survival Rate/trends , Taiwan/epidemiologyABSTRACT
We describe a case of pulmonary nocardiosis in a female patient with graft-versus-host disease (GVHD) underwent therapy with imatinib mesylate for a relapse of chronic myeloid leukemia (CML) after allogeneic bone marrow transplantation (BMT). The patient developed chronic GVHD 8 months after the use of imatinib and was on corticosteroid therapy. Three months after the development of chronic GVHD, she acquired pulmonary nocardiosis and a computed tomography (CT) scan of the chest showed multiple nodular lesions with cavitations over both lungs. She was successfully treated with single-agent trimethoprim-sulfamethoxazole (TMP/SMX) and the infection did not recur. Our case indicated that pulmonary nocardiosis could occur in patients with GVHD undergoing imatinib and corticosteroid therapy and might be treated by single-agent TMP/SMX.
Subject(s)
Bone Marrow Transplantation , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Nocardia Infections/etiology , Nocardia asteroides/isolation & purification , Piperazines/therapeutic use , Pneumonia, Bacterial/etiology , Pyrimidines/therapeutic use , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Benzamides , Bronchiolitis Obliterans/etiology , Female , Graft vs Host Disease/complications , Humans , Imatinib Mesylate , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Lung/diagnostic imaging , Nocardia Infections/diagnostic imaging , Nocardia Infections/drug therapy , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Bacterial/drug therapy , Tomography, X-Ray Computed , Transplantation, Homologous , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
The effect of all-trans retinoid acid (ATRA) on the expression of Notch1 gene by real-time reverse transcriptase polymerase chain reaction (RT-PCR) in acute promyelocytic leukemia cells (APL), NB4, and HL-60 lacking t(15;17) was studied. The cells were treated with ATRA 0.5 microM for up to 96 hours. The increased transcript level of Notch1 was in concert with that of CD11b in NB4 cells, but not in HL-60 cells. The expression of Notch1 gene might be specific for APL cells. As Notch1 gene is involved in the differentiation and leukemogenesis in lymphoid neoplasm, observations suggest that Notch1 is involved in ATRA-modulated differentiation process in APL.
Subject(s)
Genetic Predisposition to Disease , Leukemia, Promyelocytic, Acute/genetics , Receptors, Cell Surface/genetics , Transcription Factors , Tretinoin/pharmacology , Base Sequence , Cell Division/drug effects , Cell Division/physiology , Female , Gene Expression Regulation, Neoplastic , HL-60 Cells/drug effects , HL-60 Cells/physiology , Humans , Male , Molecular Sequence Data , Neoplasm Proteins/genetics , Receptor, Notch1 , Reverse Transcriptase Polymerase Chain Reaction/methods , Sensitivity and SpecificityABSTRACT
We describe a case of Chryseobacterium indologenes bacteremia in a leukemia patient with chronic graft-versus-host disease (GVHD) 6 months after allogeneic bone marrow transplantation. Blood cultures from a vein and via Hickman catheter grew C. indologenes. The patient was successfully treated with piperacillin/tazobactam and the infection did not recur. Our case indicates that C. indologenes infection can occur in patients with GVHD after allogeneic BMT and might be treated with a single agent, piperacillin/tazobactam without the removal of intravascular catheter.