Feasibility and recent improvement of autologous stem cell transplantation for acute myelocytic leukaemia in patients over 60 years of age: importance of the source of stem cells.

A total of 193 patients with acute myelocytic leukaemia (AML) [147 in first complete remission (CR1)], ranging from 60 years to 75 years of age (median 63 years), were autografted between January 1984 and December 1998. The source of stem cells was peripheral blood (PB) in 128 patients, bone marrow in 51 patients and a combination of both in 14 patients. Total body irradiation (TBI) was used in 34 cases. Ninety-seven per cent of patients had successful engraftment of neutrophils on day 15 (range days 7-71) and of platelets on day 30 (range days 9-894). In patients autografted in CR1, the transplant-related mortality (TRM) was 15 +/- 4%, the relapse incidence (RI) was 58 +/- 5%, the leukaemia-free survival (LFS) was 36 +/- 5% and the overall survival was 47 +/- 5% at 3 years. The source and dose of stem cells were studied in particular; in patients transplanted in CR1, the RI was 44 +/- 11% in those receiving marrow compared with 63 +/- 6% in those receiving PB (P = 0.04). Patients autografted in CR1 who received higher granulocyte-macrophage colony-forming units (CFU-GM) doses (above the median) had a lower RI (47 +/- 11% vs. 79 +/- 9%, P = 0.009). There was a significant improvement in patients transplanted after March 1996; for those in CR1, the RI was 41 +/- 8% vs. 65 +/- 6% (P = 0.01), the LFS was 53 +/- 8% vs. 28 +/- 5% (P = 0.01) and the overall survival was 72 +/- 7% vs. 36 +/- 6% (P = 0.02). By multivariate analyses, significant factors for the outcome were the date of transplant with recent improvement and the source of stem cells, with a lower RI for marrow. Autologous stem cell transplantation (ASCT) is a potential therapeutic approach in patients with AML over 60 years of age; results have improved recently.

In vitro and in vivo digestibility and metabolic effects of 3 wheat-flour products (white bread, french toast (rusk) and french toast bran-enriched) in normal subjects.

We devised to study the effects of two technological processings of industrial bread (degree of cooking and enrichment with bran) on in vitro digestibility and repercussions on carbohydrate metabolism in healthy subjects. 3 products were tested in vitro and in vivo: white bread (WB), french toast obtained from the same white bread (FT) and french toast enriched with bran (BFT). In vitro, the percentage of starch hydrolysed was significantly lower for the bran-enriched toast than for WB and FT (p less than 0.001). In vivo, the 3 products and an oral glucose load were given at 08.00 h, after an overnight fast, to 12 healthy volunteers (8 F; 4 M); (age = 24 +/- 1 years; BMI = 21.9 +/- 0.9; mean +/- SEM) on four consecutive days and in random order (latin squares 3 x 4). Each meal contained 35 g carbohydrate and 125 ml water and, for the wheat products, about 190 Kcal. The mean results of the glycemic indexes were: WB = 115 +/- 17%; FT = 99 +/- 21%; BFT = 87 +/- 21% (NS) with the corresponding insulin indexes at 81 +/- 8%, 79 +/- 9% and 90 +/- 8% respectively (NS). The mean plasma glucose and insulin values at 30 minutes did not differ between the three tested foods but were all significantly lower than that observed with glucose (p less than 0.01). Plasma glucose transiently descended below baseline values in all subjects for glucose and BFT. Neither the toasting process nor the presence of wheat bran had any major effect upon hyperglycemia and insulin secretion in the healthy subjects studied.