Physical performance and psychosocial status in lung cancer patients: results from a pilot study.

BACKGROUND: The aim of this study was to assess the physical performance and psychosocial status of lung cancer patients. PATIENTS AND METHODS: Patients with predominantly advanced-stage non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) were recruited. Muscle strength was assessed via hand-held dynamometry (HHD) and endurance capacity via the 6-minute walk test (6MWT), and results were compared to healthy reference values. Psychosocial status, lung cancer-specific symptoms, and quality of life (QoL) outcomes were evaluated. RESULTS: 39 patients (NSCLC n = 22, SCLC n = 17) with predominantly advanced-stage disease and a median age of 62 years (range 44-83 years) were enrolled. Compared to a healthy reference population, mean muscle strength values of upper (elbow flexion -28.2% (±17.5), elbow extension -12.4% (±11.1)) and lower (knee extension -47.6% (±19.3), hip abduction -44.9% (±14.9), hip flexion -13% (±24.2)) extremities, and 6MWT were lower (male/female: 434/411 m vs. 597/514 m). Lung cancer-specific symptoms and QoL were comparable to published data. CONCLUSION: Our results indicate that lung cancer patients experience muscular weakness, lower endurance performance, and decreased QoL compared to a healthy reference population. The feasibility and benefit of a structured exercise intervention in this specific population need to be evaluated, in particular its effect on psychosocial well-being.

Complementary and alternative medicine in patients with chronic lymphocytic leukemia.

BACKGROUND: Despite the widespread use of complementary and alternative medicine (CAM) in the general population for the treatment of chronic diseases, only few data have been published for patients with leukemia. The aim of this survey was to study systematically the use of CAM in patients with chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS: A structured questionnaire was sent to 247 CLL patients of all clinical stages and disease durations, treated and untreated. The questionnaire was returned anonymously by 87 patients (35%). RESULTS: Thirty-nine patients (44%) had used alternative treatments. No correlation was seen with educational level, gender, or previous or current chemotherapy. The most common alternative or complementary treatment modality was vitamin supplementation (26%), followed by mineral (18%), homeopathic (14%), and mistletoe therapy (9.2%). Some 21% of patients considered their alternative treatment as being successful. Most patients reported that they decided to use CAM after conducting a personal investigation and based on the information they found, without outside recommendations (59%). The majority of the patients used patient brochures about CLL as an important source of information (54%), followed by specific lectures (34%) or the internet (32%). CONCLUSION: Our data show that patients with CLL use a wide range of CAM, among them potentially harmful methods. Rational, evidence-based medical information about the effects and risks of CAM use should be made available through patient brochures distributed by patient organizations, through information events with lectures, or via the internet.

High rate of centrosome aberrations and correlation with proliferative activity in patients with untreated B-cell chronic lymphocytic leukemia.

B-cell chronic lymphocytic leukemia (CLL) is characterized by a high rate of clonal genomic alterations and a low proliferative activity with cell cycle arrest in G(0)/G(1) phase. Recently, centrosome aberrations have been described as a possible cause of chromosomal instability and aneuploidy in many human malignancies. To investigate whether centrosome aberrations do occur in CLL and whether they correlate with common prognostic factors and disease activity, we examined peripheral blood mononuclear cells (PBMC) from 70 patients with previously untreated CLL using an antibody to gamma-tubulin. All 70 CLL samples displayed significantly more cells with centrosome aberrations (median: 26.0%, range 11.0-41.5%) as compared to peripheral blood B lymphocytes from 20 age-matched, healthy individuals (median: 2.0%, range 0-6%; p < 0.001). The extent of centrosome aberrations correlated with the proliferative activity of the CLL cases as measured by lymphocyte doubling time (p = 0.02) as well as with time to first treatment (p = 0.05). Accordingly, more centrosome aberrations were found in PHA-stimulated T lymphocytes from healthy individuals as well as in B cells from surgically removed tonsil tissue of patients with acute tonsillitis as compared to the peripheral blood B lymphocytes from the control group. In contrast, no correlation was observed between centrosome aberrations and immunoglobulin VH gene mutation status or cytogenetically defined risk groups. These findings suggest that, despite the common observation of most CLL cells remaining in G(0)/G(1) phase, their centrosome replication process is deregulated and correlates to the proliferative activity of CLL cells.

Autologous bone marrow transplantation in adult patients with acute lymphoblastic leukemia.

Autologous bone marrow transplantation (ABMT) was introduced as a treatment for terminal leukemic relapse more than 40 years ago. For childhood acute lymphoblastic leukemia (ALL) the role of ABMT is well defined. Some studies suggest that it is also beneficial for adult patients with high-risk factors or with relapse. However, these inferences are based on a relatively small number of patients with short follow-up. Nevertheless patients with high-risk ALL are candidates for ABMT if no histocompatible sibling is available. Similarly patients in second or later complete remission (CR) in the absence of a histocompatible donor may derive benefit from ABMT. The different conditioning regimens used by the treatment centers are associated with different toxicities but none has been proven to be superior than others. In the majority of studies the marrow has been purged of leukemic cells, but this maneuver has never been evaluated in a randomized comparative trial. Transplant related mortality rate of ABMT is low compared to allogeneic transplantation. The GvL effect, which is important to eliminate malignant cells in acute and chronic myelocytic leukemia, has not been definitively demonstrated in ALL. The tyrosine-kinase inhibitor STI 571 offers new perspectives for patients with the Phl/bcr/abl translocation. It may be especially useful for treating minimal residual disease (MRD) before and/or after ABMT.