ABSTRACT
An in vitro synergism between different inducers of AML cell differentiation has been previously observed. Therefore, we treated 53 myelodysplastic (MDS) patients with a low dose combination of cis-retinoic acid (cRA, 20-40 mg/day) and 1,25 alpha (OH)2 cholecalciferol [(OH)2D3, 1-1.5 micrograms/day] +/- intermittent 6-thioguanine (30 mg/m2/day). The latter was reserved for patients with bone marrow (BM) blast excess (> or = 5%). The treatment was well tolerated, without major toxicity. Among 25 patients with BM blasts less than 5%, we observed one complete, eight partial and four minor responses (response rate 52%) with a median response duration of 8 months (2 +/- 24). Median survival, which did not correlate with response, is projected at 76 months. Thirty-one patients with BM blast excess (> or = 5%), including three of the previous group who progressed to refractory anemia with excess of blasts (RAEB), were treated with the three-drug protocol. One complete, 12 partial and six minor responses were obtained (response rate 61%) with a median response duration of 6 months (2-29+). A significant difference in survival (P < 0.005) was observed between the 19 responders (median 25 months) and the 12 non-responders (median 9 months). A reduction in the transfusion need was observed in 41% of the transfusion-dependent patients with blast excess and in 53% of those without blast excess. Therefore, combined differentiating therapy seems more effective than previously reported single agent treatments and should be considered for a larger randomized study to assess its actual impact on survival of MDS patients.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Myelodysplastic Syndromes/drug therapy , Aged , Aged, 80 and over , Blast Crisis , Blood Transfusion , Bone Marrow Transplantation , Cholecalciferol/administration & dosage , Female , Humans , Male , Middle Aged , Myelodysplastic Syndromes/blood , Remission Induction , Survival Analysis , Thioguanine/administration & dosage , Tretinoin/administration & dosageABSTRACT
The authors analyse the results obtained in a study of 28 cancer patients managed with total parenteral nutrition (TPN) for a period variant from 5 to 19 days. The results fully justify the usefulness of the TPN in cancer patients before the treatment against the cancer.
Subject(s)
Digestive System Neoplasms/therapy , Parenteral Nutrition, Total , Aged , Aged, 80 and over , Digestive System Neoplasms/mortality , Female , Genital Neoplasms, Female/therapy , Humans , Male , Middle Aged , Parenteral Nutrition, Total/adverse effects , PrognosisABSTRACT
The Authors analyse the problem about O2 transportation throughout the tissues and report the P50 values based upon two homogenous groups of shocked patients; the first polytransfused, the second hemodilutioned. An increased P50 among hemodilutioned patients appears to be significant.
