ABSTRACT
Vancomycine serum levels were measured in 198 cancer patients with documented grampositive bacteremia and twenty two failed. Failures were analyzed for risk factors of therapy failure. Only 8 of 22 showed low serum peak or through vancomycin levels. One patient was treated less than 7 days, 9 had persisting and 4 catheter associated bacteremia. Bacteremias due to VAN resistant strains were excluded. In 14 out of 22 patients, multiple or one risk factor could be determined, but in 8 patients, no risk factor was found. Hence the, case control study was conducted to compare the group of failures in 22 patients with a group of patients with underlying disease and neutropenia treated successfully within the same period and same antibiotic policy at the same cancer center, by VAN for gram-positive bacteremia. Persisting, catheter associated and enterococcal bacteremias were the only statistical significant risk factors predicting a therapy failure in cancer patients. Neither Vancomycine serum peak nor through levels predicted the outcome: failure or cure of gram-positive bacteremia in cancer patients. (Tab. 1, Ref. 5.).
Subject(s)
Anti-Bacterial Agents/blood , Bacteremia/drug therapy , Gram-Positive Bacterial Infections/drug therapy , Neoplasms/complications , Neutropenia/complications , Vancomycin/blood , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Gram-Positive Bacterial Infections/complications , Humans , Retrospective Studies , Treatment Failure , Vancomycin/therapeutic useABSTRACT
High-performance liquid chromatography (HPLC) was applied for the determination of suramin levels in serum samples from cancer patients treated with this drug. Ion-pair chromatography in combination with the deproteination procedure extraction and hydrolysis of complex serum proteins-suramin were recommended. Extraction recoveries and linearity for wide concentration range were evaluated. Detection limit of suramin in serum samples was determined (0.5 micrograms/ml), and concentration curves as the dependences of suramin concentration levels and time have been illustrated. Chromatographic conditions were optimized for minimal analysis time (max. 10 min) and suitable chromatographic resolution (Rij greater than 1.25).
Subject(s)
Antineoplastic Agents/blood , Suramin/blood , Antineoplastic Agents/therapeutic use , Chemical Precipitation , Chromatography, High Pressure Liquid , Humans , Male , Prostatic Neoplasms/blood , Prostatic Neoplasms/drug therapy , Suramin/therapeutic useABSTRACT
Thirty eight patients with acute lymphoblastic leukemia were treated protocol 0171 (VCR, PRED, MTX, cyclophosphamide +/- +/- 6-MP) and protocol 0276/A (VRC, PRED, L-ASP, MTX, 6-MP, cyclophosphamide). Overall complete remission rate in both studies was 84--85%, and additional treatment in protocol 0171 resulted in complete remission rate of 92%. Median duration of complete remission in protocol 0171 was 23 months and median survival of all patients was 33 months. Six patients randomized to regimen "A" (without 6-MP in intensification) had median duration of complete remission 8 months and media survival was 13 months. Seventeen patients treated with regimen "B" (with 6-MP in intensification) had median duration of complete remission 25 months and median survival was 39 months. Median survival of patients allocated on protocol 0276/A in 21+ months and median duration of complete remission is 23 months at present. Twelve percent of patients treated with the best regimen have survived more than 66 months in continuous complete remission. The incidence of drug related death in complete responders was 6%. The relapses were most frequent during the first two years of remission. Extramedullary leukemia as the initial site of relapse was observed in 9% of patients.
