Sequential intermediate high-dose therapy with etoposide, ifosfamide and cisplatin for patients with germ cell tumors.

Intermediate high dose VIP (etoposide, ifosfamide, cisplatin) achieved comparable efficacy and improved tolerance in comparison with high-dose chemotherapy plus PBSC in poor risk germ cell tumors. The aim of this study was to confirm the effectivity and tolerance of this regimen in clinical practice. Twenty-five consecutive patients, 9 previously untreated with poor prognosis and 16 relapsed, were treated with 1.6 VIP or 1.9 VIP+PBSC. A relative dose intensity of 1.6 VIP was used in 14 patients and 11 patients received the intensity of 1.9 VIP. Clinical response was achieved in 56% of patients. Fifty-eight percent of patients have survived more than 1 year and 44% more than 2 years. No significant difference was noted between previously treated and untreated patients, as well as between the patients on 1.6 VIP and 1.9 VIP, with the exception of improved 1-year survival of patients on 1.9 VIP. One of four cisplatin-refractory patients achieved durable partial remission with a normal level of tumor markers. Serious non-hematological toxicity was rare. Myelotoxicity of 1.9 VIP was less serious in comparison with 1.6 VIP regimen, but the difference was not significant. Sequential intermediate high-dose therapy is an effective and tolerable regimen for patients with poor risk germ cell tumor as well as for relapsed patients.

Fungal pathogens in etiology of septic shock in neutropenic patients with cancer (short communication).

During the 3 years from 1989 to 1991, we evaluated the etiology of septic shock cases and infection-associated mortality. A total number of 38 patients was included in the study, according to the criteria for septic shock (SS), (Intensive Care Medicine Society, 1989). In 1989, P. aeruginosa and Enterobacteriaceae among the pathogens prevailed. In 1990 and 1991, S. aureus, enterococci and fungi were most frequent. From 8 patients with SS in 1990, the shock was due to Candida albicans in 1 and to mucoraceae in 3 patients. In 10 patients examined in 1991, 8 cases of SS were due to Candida albicans, Aspergillus niger, Fusarium solani and Acremonium strictum. The decrease of the incidence of shocks and increase of fungal etiology were found to be associated with the use of quinolones in prophylaxis and cephalosporines, aminoglycosides and vancomycine in empiric therapy in febrile neutropenic patients.

Ceftriaxone versus ceftazidime plus aminoglycoside therapy for infections in patients with neutropenia after cytotoxic chemotherapy. Short communication.

One hundred and one patients undergoing anticancer chemotherapy due to hematologic malignancy were retrospectively divided into two groups: 67 patients were treated with ceftriaxone plus amikacin, receiving once daily (od) 2-4 g ceftriaxone, 1-1.5 g amikacin (those without a peripheral or central venous catheter) and 34 patients with central or peripheral venous catheter (CPVC) receiving ceftizidime 2 g three times daily (tid) plus amikacin 0.5 g tid i.v. Both groups were similar as to their isolated pathogens, localization of infection, and basic diagnoses of hematologic malignancies. There was no significant difference in efficacy between ceftriaxone plus amikacin versus ceftazidime plus amikacin, but the toxicity was lower in once daily ceftriaxone plus amikacin group.

Candidosis, aspergillosis and zygomycosis in an oncology department.

The incidence, aetiology and treatment of fungal infections in a 60-bed department of clinical oncology over 2 years is reported. During the second year, after the moving of the department from an old to a new building with an improved epidemiologic regimen, the incidence decreased rapidly, although the mortality due to systemic disseminated mycosis did not change.

Ciprofloxacin plus vancomycin versus ceftazidime plus gentamicin in the treatment of pneumonia in granulocytopenic patients with or without venous catheters. Short communication.

58 granulocytopenic patients with confirmed bronchopneumonia were divided retrospectively into two groups for this pilot study: group 1 included neutropenic patients with venous catheters who were treated with ciprofloxacin (CIP; 200-300 mg, i.v. b.i.d.) + vancomycin (VAN; 0.5-1 g, i.v. b.i.d.), and group 2, which included patients without venous catheters treated with ceftazidime (2 g, i.v. t.i.d.) + gentamicin (1 mg/kg, i.v. t.i.d.). Pneumonia was diagnosed clinically and radiologically in all patients; 92.3% in group 1 and 46.8% in group 2 were also microbially confirmed. Mixed infections were present in most patients. 3 of 26 patients (11.5%) in group 1 and 9 of 32 (20.1%) in group 2 did not recover while 88.5% in group 1 and 71.9% in group 2 recovered. CIP + VAN seems to be more effective in treating pneumonia in neutropenic patients, with only 1 patient in the group suffering an adverse effect compared with 5 in group 2.

Netilmicin plus ceftriaxone versus amikacin plus ceftriaxone in the treatment of infections in granulocytopenic patients.

For the treatment of febrile episodes in granulocytopenic cancer patients, a combination of bactericidal and intravenously administered broad spectrum agents is recommended. An aminoglycoside plus a beta-lactame (piperacillin, azlocillin or IIIrd generation cephalosporins) are the drugs of first choice in an empiric approach. Because of frequent parenteral interventions (e.g. catheters, cannulations) in thrombopenic patients with multifactorial immunosuppression, we consider the application of once daily drugs, such as ceftriaxone, netilmicin or amikacin. For single dose treatment (1st day two applications), we used ceftriaxone in combination with netilmicin or amikacin as the first approach and retrospectively evaluated 47 patients for efficacy and safety.

Intensive combination chemotherapy (TTL-I protocol) of large cell and immunoblastic lymphomas--long-term observation.

Fifty patients with advanced (Stage III and IV) large cell and immunoblastic lymphoma were treated with eight 4-week courses of chemotherapy. The first two identical A courses were composed of high dose cyclophosphamide, vincristine, 5-day administration of bleomycin, 2-week prednisone, and methotrexate with calcium leucovorin. The next two "B" courses were composed of vincristine, 3-day administration of doxorubicin together with bleomycin, and prednisone. The next two "C" courses were composed of cyclophosphamide, vincristine, bleomycin, prednisone, methotrexate, and calcium leucovorin. The last two "D" courses were the same as "B" courses. CNS prophylaxis was done with intrathecal methotrexate. Fourty-two patients (84%) achieved complete remission, 7 patients entered partial remission, and 1 patient failed to respond. The median survival of all groups was 80 + months (range 2-181 + months). Nine patients relapsed (21%), and seven patients died in complete remission, three of them died of toxicity. The most frequent toxicity was myelosuppression, mostly leukopenia, frequently followed by infection, sometimes severe. Neurotoxicity and stomatitis were frequent, but usually not severe. Two patients developed secondary malignancies. Most of the patients (54%) are alive without evidence of disease at present.

[Various antibiotics in the monotherapy and combined therapy of infections in cancer patients. Retrospective study of 290 patients]. / Rôzne antibiotiká v monoterapii i kombinovanej terapii infekcií u onkologických pacientov. Retrospektívna stúdia u 290 pacientov.

The authors present in a retrospective study the results of treatment of infections in 290 immunodeficient patients, mostly with haematological malignancies. As compared with classical empirical combined treatment (aminoglycoside + IIIrd generation cephalosporins), combinations of quinolones and amoxycillin, amoxycillin clavulanate or vancomycin proved more satisfactory.

Fluconazole in the treatment of mycotic oropharyngeal stomatitis and esophagitis in neutropenic cancer patients.

The efficacy and safety of fluconazole, a new triazole antifungal agent, was evaluated in 24 patients with neutropenia due to cytotoxic anticancer chemotherapy with polyfactorial immunodepression. Twenty of 23 patients benefited from treatment, and except for 1 patient with mild abdominal discomfort the drug was well tolerated. Mycological eradication appeared in 17 from 23 evaluable patients, superinfection in 1 case and persistence could be evaluated in 5 cases. Candida albicans, C. crusei and C. pseudotropicalis together with Torulopsis sp. were the most frequently isolated organisms from pharyngeal and esophageal mucosa in treated patients with oropharyngeal and esophageal mycosis.

Nephrotoxicity of aminoglycosides, polypeptides and cephalosporins in cancer patients.

The nephrotoxicity of various combinations of antibiotics--aminoglycosides, cephalosporins, vancomycin, amphotericin B--in 171 oncologic patients is described. The most nephrotoxic combination seems to be cefotaxime plus gentamicin, ceftriaxone plus amikacin and amphotericin B with cephalosporin, vancomycin or aminoglycoside. Less toxic was netilmicin with penicillin or cephalosporin, and vancomycin.

Comparison of two non-cross-resistant combinations (ABVP/LOPP) with COPP plus bleomycin in the treatment of advanced Hodgkin's disease.

Eighty patients with advanced Hodgkin's disease were randomized either to treatment with combination of doxorubicin, bleomycin, vinblastine, and prednisone (ABVP), alternating with lomustine, vincristine, procarbazine, and prednisone (LOPP)--Group A, or to combination of cyclophosphamide, vincristine, procarbazine, prednisone, and low dose of bleomycin (COPP-Bleo)--Group B. Thirty-nine out of 41 patients (95%) in Group A achieved complete remission (CR) as compared to 25 CR in 39 patients (64%) in Group B. Patients with systemic symptoms, bulky disease, and nodular sclerosis achieved significantly more CR after treatment with ABVP/LOPP regimen than with COPP-Bleo regimen. Ninety percent of patients are alive in Group A (median observation time 97+ months) as compared to 58% in Group B (median observation time 97+ months). Ninety-two percent of complete responders are in CR in Group A as compared to 53% of complete responders in Group B. These differences between both groups are significant. More serious (WHO grade III and IV) myelosuppression as well as stomatitis and alopecia were observed in Group A. Gastrointestinal toxicity and neurotoxicity was more frequent in Group A. No patient died due to toxicity in Group A as compared to one patient in Group B. Non-cross-resistant alternating regimen ABVP/LOPP was more effective in the treatment of advanced Hodgkin's disease than the COPP-Bleo regimen, especially for patients with advanced Stage IVB Hodgkin's disease.

[Peroral ciprofloxacin in the therapy of infections in oncology patients]. / Perorálny ciprofloxacín v liecbe infekcií u onkologických pacientov.

The authors give an account of their initial experience with oral ciprofloxacin (Ciprinol) in the treatment of various infections in 28 immunosuppressed oncological patients. A favourable effect--cure and improvement--were recorded in 72% of all treated patients. Unfavourable side-effects were observed in 4 of 28 patients, in two they were the reason for discontinuation of treatment.