ABSTRACT
The paper presents a retrospective analysis of long-term follow-ups (from 1959 to 2000) of 86 patients with acute pro-myelocytic leukemia, a rare type of hemoblastoses. The specific features of this form of leukemia is that blast cells of the bone marrow and peripheral blood have a specific granularity that plays a decisive role in the development of the severe hemorrhagic syndrome leading to patients' death. The morphological, cytochemical, cytogenetic, electron microscopic, and biochemical features of blast cells in this disease and its pathogenesis, clinical presentation, and treatment are considered. An extract from the records of a female patient who has had a complete clinical and hematological remission for 22 years is given. The follow-up of such a prolonged remission has not been covered in the Russian literature.
Subject(s)
Granulocyte Precursor Cells , Leukemia, Promyelocytic, Acute/pathology , Leukemia, Promyelocytic, Acute/therapy , Adult , Biochemical Phenomena , Biochemistry , Blood Coagulation Tests , Cytogenetics , Female , Follow-Up Studies , Granulocyte Precursor Cells/cytology , Granulocyte Precursor Cells/enzymology , Granulocyte Precursor Cells/pathology , Hemorrhagic Disorders/etiology , Histocytochemistry , Humans , Leukemia, Promyelocytic, Acute/blood , Leukemia, Promyelocytic, Acute/diagnosis , Leukemia, Promyelocytic, Acute/genetics , Leukemia, Promyelocytic, Acute/mortality , Male , Microscopy, Electron , Middle Aged , Remission Induction , Retrospective Studies , Time FactorsABSTRACT
AIM: To study efficacy of maintenance therapy of patients with acute promyelocytic leukemia (APL) in the APL treatment Russian multicenter trial. MATERIAL AND METHODS: The trial was made with participation of 18 hematological departments of clinics in Russia. A total of 68 APL patients entered the trial. The maintenance therapy consisted of 5-day courses of cytostatic drugs which alternated or did not alternate with 5-day courses of ATRA. Cytogenetic tests were made in 31 patients, t(15;17) was detected in 26 of them. Molecular examination conducted in 28 patients discovered chimeric transcript PML/RARa in 26 of them. Of 20 patients examined in Hematological Research Center, 7 (35%) had a bcr 1/2 variant of the transcript PML/RARa, 13 (65%)--bcr 3 variant. RESULTS: 65 patients were eligible for assessment. A complete remission was achieved in 90% cases. No resistance was observed. In follow-up within 30 months the recurrence rate was similar on both treatments. The results of the induction therapy and survival in patients with different variants of the transcripts were also similar. Overall 2.5 year survival for all the patients was 77%, recurrence-free--80%. The survival analysis in patients with leukocytosis higher and lower 10 x 10(9)/l found no statistical differences by the survival. Patients with hyperleukocytosis had higher early lethality than patients with leukocytes under 10 x 10(9)/l (25% vs 5.3%, p = 0.03). CONCLUSION: The APL 06.01 protocol showed high efficacy of the relevant maintenance which provides a complete molecular remission in the majority of patients with probable recurrence-free 2.5 year survival 80%.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/genetics , Leukemia, Promyelocytic, Acute/drug therapy , Adolescent , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cytarabine/administration & dosage , Cytarabine/therapeutic use , Daunorubicin/administration & dosage , Daunorubicin/therapeutic use , Disease-Free Survival , Drug Administration Schedule , Female , Humans , Leukemia, Promyelocytic, Acute/genetics , Leukemia, Promyelocytic, Acute/mortality , Male , Middle Aged , Neoplasm Proteins/genetics , Oncogene Proteins, Fusion/genetics , Protein-Tyrosine Kinases/genetics , Proto-Oncogene Proteins/genetics , Proto-Oncogene Proteins c-bcr , Remission Induction , Transcription, Genetic , Tretinoin/administration & dosage , Tretinoin/therapeutic useABSTRACT
AIM: To evaluate the efficiency of combination of interferon-alpha (INF) and all trans-retinoic acid (ATRA) as a treatment for maintaining remission in high risk group patients with acute myeloid leukemia (AML). MATERIALS AND METHODS: Three-day INF + ATRA course was administered every 3 months to 22 patients with AML from high risk group (impossibility of drug therapy during the first complete remission, resistant forms of AML, relapses, secondary AML, acute promyelocytic leukemia after attaining molecular remission). RESULTS: INF + ATRA during remission maintained a long first complete remission (median 18 months) in patients with primary AML after small-volume drug therapy, led to long first and second complete remissions (median 12 months) in patients with resistant AML, and induced and maintained molecular remissions in patients with acute promyelocytic leukemia.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Interferon-alpha/administration & dosage , Leukemia, Myeloid/drug therapy , Tretinoin/administration & dosage , Acute Disease , Adolescent , Adult , Drug Therapy, Combination , Female , Humans , Leukemia, Promyelocytic, Acute/drug therapy , Male , Middle Aged , Recurrence , Remission Induction , Risk Factors , Time FactorsABSTRACT
The authors share their experiences with examination and surgical treatment of 163 patients with various neoplasms of the mediastinum. The first place among the neoplasms is occupied by tumors of the lymphatic apparatus (33%), the second--by tumors of the thymus (21%). The video-thoracoscopic technique was used in 17 of 131 operations performed. Complications after the operations took place in 6 patients (4.5%), two patients died (1.5%). A conclusion is made that the patients of this category must be treated not only by thoracic surgeons but also by hematologists, neurologists, neurosurgeons and specialists in radiation therapy.
