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Biomedical subjects

B M Colls

Publications and source records attributed to B M Colls.

At least 37 records · Page 2Linked to original sources
PubMed1994

Second malignant neoplasms in patients with Hodgkin's disease.

AIM: To determine the incidence of second malignant neoplasms in patients treated for Hodgkin's disease. METHODS: The records were reviewed of all patients receiving primary treatment for Hodgkin's disease at the Oncology Service, Christchurch Hospital from 1969 to 1992. Second malignant neoplasms presenting at least six months after the diagnosis of Hodgkin's disease were noted and the cumulative risk estimated. RESULTS: Twenty-two second malignant neoplasms developed in 20 of the 209 patients. The risk was 5.6 +/- 3.8% (CI) at five years, 11.4 +/- 6.2% at ten years, and 21.7 +/- 11.2% at 15 years and continued to increase thereafter. Thirteen patients have died of their second malignancy, including two of a third malignancy, while four have been followed for less than one year. Three leukaemias (CML, 1; acute non lymphocytic leukaemia, 2), three lymphomas and 16 solid tumours developed. The risk was greater after six or more cycles of MOPP-like chemotherapy and after radiation doses exceeding 30 Gray. The risk was less after laparotomy and splenectomy (p = 0.0205). CONCLUSIONS: In view of the significant risk of a second neoplasm in survivors of Hodgkin's disease follow up should continue beyond ten years, after which time second malignancies were more likely than recurrence. Efforts should continue to minimise the carcinogenicity of therapy while preserving efficacy.

Adolescent↗
PubMed1992

Increased incidence of germ cell testicular cancer in New Zealand Maoris.

A higher incidence of germ cell testicular cancer was found in Maoris (6.84/100,000) compared with non-Maoris (5.26/100,000) in New Zealand from 1975 to 1986, especially in the 15-49 year age group (Maoris 12.30/100,000, non-Maoris 9.47/100,000; P = 0.04). Previous studies have shown Whites to have the highest incidence of this malignancy. Possible reasons for this and some other epidemiological features are discussed.

Adolescent↗
PubMed1992

Hodgkin's cells express a novel pattern of adhesion molecules.

Adhesion molecules play an important role in the functioning of the immune system, particularly with regard to cell-cell interactions and antigen presentation. Several adhesion molecules are expressed on Hodgkin's disease-derived cell lines and these are important in their molecular interactions as antigen presenting cells (APC). There are no data regarding the expression of many of these adhesion molecules on Reed-Sternberg cells and its mononuclear variant (Hodgkin's cells (HC)) present in pathological material. To obtain this information we undertook an immunohistological study on material from 18 cases of Hodgkin's disease using a panel of MoAbs to examine the expression of adhesion molecules on HC. The HC were shown to express the integrin beta 1 subfamily molecules, LFA-1 (CD11a) and p150,95 (CD11c) in high density but lacked CR3 (CD11b). All of the immunoglobulin gene superfamily adhesion molecules studied were present to some degree on HC, with ICAM-2, in particular, showing moderate to strong expression in most cases. The Hermes antigen CD44 was present in high density but leukosialin (CD43), another molecule present on diverse leucocyte types, was, in general, not detected on HC. These new data showing that ICAM-1, ICAM-2 and LFA-3 are, like LFA-1, expressed on HC emphasize the ability of HC to act as APC. The known adhesion molecule phenotype of the recently defined haematopoietic lineage of human dendritic cells (DC) is broadly similar to that of HC, perhaps supporting the hypothesis that some HC represent a malignancy of an APC (DC) lineage.

Antibodies, Monoclonal↗
PubMed1992

Results of the surveillance policy of stage I non-seminomatous germ cell testicular tumours.

A series of 115 patients with clinical Stage I non-seminomatous germ cell testicular tumours were managed with orchiectomy and close surveillance (median follow-up 36 months, range 3-119); 34 (29.5%) relapsed, 21 within 6 months, 29 within a year and the latest at 28 months. At relapse all patients were treated with platinum or analogue-based drug combinations, supplemented in 7 by retroperitoneal node dissection; 30 patients achieved durable remissions and 2 have had further relapses successfully treated. Two died; both had malignant teratoma intermediate with primary stage T1 and vascular and/or lymphatic invasion of primary tumour. At a median follow-up time of 36 months, the survivors (98.3%) demonstrate no evidence of disease, these results matching the outcome of other methods of management. Vascular and/or lymphatic invasion was associated with an enhanced relapse rate but specific histology, T stage of the primary and pre-orchiectomy serum alpha-fetoprotein status did not appear to favour relapse. The first sign of relapse was tumour marker alone in 10 patients, radiological features alone in 12, or both in 10 patients. However, in 2 cases the relapse was first detected clinically. Furthermore, pre-orchiectomy and relapse marker status did not correlate well. These points emphasise the importance of all aspects of follow-up, none of which can be safely omitted.

Adolescent↗
PubMed1992

Fasting plasma lipid measurements following cisplatin chemotherapy in patients with germ cell tumors.

PURPOSE: Elevated total serum cholesterol levels have been reported recently in a group of patients with metastatic testicular cancer after treatment with cisplatin combination chemotherapy. We have studied the lipid profile of a similar group of patients in an attempt to confirm this observation. PATIENTS AND METHODS: Fasting plasma lipid concentrations were measured in 47 patients with advanced germ cell tumors who were previously treated with a cisplatin combination chemotherapy. The values obtained for mean total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, apolipoprotein A1, and apolipoprotein B concentrations were compared with those obtained from a control group of 59 patients with germ cell tumors who were not treated with chemotherapy and with data from the New Zealand male population. Median time from the completion of chemotherapy to lipid measurement in the treated group was 50 months (range, 2 to 138 months). The median total dose of cisplatin given was 720 mg (range, 300 to 1,625 mg). RESULTS: Mean total plasma cholesterol concentrations in the cisplatin group (5.87 mol/L) and the control group (5.70 mmol/L) did not differ significantly (P > .4). There was no significant difference for any of the variables between the chemotherapy and control groups and those of the New Zealand male population. There was a trend toward higher mean triglyceride concentrations in the chemotherapy group, but this did not reach significance. CONCLUSIONS: We have not demonstrated an elevation in total plasma cholesterol after cisplatin chemotherapy as has been reported by previous investigators. Our results suggest that in these patients, cisplatin-containing combination chemotherapy is not associated with a significant adverse effect on plasma lipid profile.

Adult↗
PubMed1991

The management of small cell lung cancer in Christchurch 1979-89.

The management of 215 consecutive patients with small cell lung cancer referred to the oncology service at Christchurch Hospital, 1979-89, was reviewed. After staging, 118 patients were treated with combination chemotherapy (cyclophosphamide, vincristine and doxorubicin), with (87) or without (31) thoracic irradiation. Patients with other medical problems were treated with alternative chemotherapy (34) or irradiation alone (54). Nine received symptomatic care alone. Eighty-five (40%) had limited disease, with no extrathoracic metastases beyond supraclavicular nodes. The response rate to treatment was 66%. Median survival for the whole group was 33 weeks, 51 weeks for those with limited and 26 weeks for extensive disease. The cumulative risk of developing cerebral metastases was 40% at one year. Patients surviving 26 weeks spent one third of their time as hospital inpatients or outpatients. Twenty-two patients survive, five progression free for 4-8 years, including two who had initial surgical resection. The study supports the policy of reserving intensive staging for fit patients who appear to have limited disease and for those entered into clinical trials. Fit patients with limited disease warrant treatment with combination chemotherapy and thoracic irradiation.

Aged↗
PubMed1990

Carboplatin is ototoxic.

For assessment of the ototoxic potential of carboplatin [cis-diammine-1,1-cyclobutane dicarboxylate platinum(II); CBDCA], pure-tone audiograms were evaluated in 27 patients receiving a total of 119 doses of carboplatin in the range of 300-400 mg/m2. Pure-tone audiometry (PTA) was done immediately prior to and 4 weeks after the administration of 80 doses (67%). Defining carboplatin ototoxicity as an increase of greater than or equal to 30 dB in auditory thresholds that was unexplainable by other causes, we identified 5 examples (19%). Hearing loss tended to be cumulative with increasing dose and was always maximal at 8,000 Hz. Two patients had an increase in auditory thresholds at 1,000 Hz, but this only amounted to 10 dB in each case. Patients developing ototoxicity tended to be older. Sex, the pre-treatment creatinine clearance, the pretreatment audiogram, the number of doses, and the cumulative dose did not emerge as being reliable predictors of subsequent ototoxicity. We conclude that although carboplatin is ototoxic, clinically significant deafness does not occur with conventional dosing and routine audiometric monitoring is therefore unnecessary. However, we suggest that caution should be exercised when carboplatin is given either at higher doses or for longer periods when there is concomitant use of other potentially ototoxic agents or when there is significant pre-existing auditory impairment.

Audiometry, Pure-Tone↗
PubMed1990

Comparison of methods of assessment of renal function in patients with cancer treated with cisplatin, carboplatin or methotrexate.

In patients with cancer treated with cisplatin, carboplatin or methotrexate creatinine clearance calculated using the Cockcroft-Gault formula was compared with measured clearance and with the glomerular filtration rate. In 106 patients the average squared difference for calculated and 24 hour urine creatinine clearance was 0.288, n = 606; and for calculated creatinine clearance and glomerular filtration rate (measured using diethylenetriaminepenta-acetic acid, DTPA), 0.212, n = 34. On 35 of 606 occasions (6%) in 18 patients (17%), the calculated clearance overestimated the 24-hour urine creatinine clearance when it was less than 1 mL/s. In all but one patient, this was explained by factors leading to renal impairment (seven patients) or overestimation of clearance (ascites in two patients) or by an isolated low value of 24-hour urine creatinine clearance (eight patients). Declining renal function with increasing total dose of cisplatin was detected by both calculated and 24-hour urine creatinine clearance in patients with germ cell tumours. Derivation of an equation to predict creatinine clearance showed a linear association with plasma creatinine concentration, patient age, weight and gender. Variability in cancer patients was similar to that in the original Cockcroft-Gault study. Calculation of creatinine clearance can be used in cancer patients to monitor treatment with renally-eliminated chemotherapy agents.

Adult↗
PubMed1989

Sequential half-body irradiation in lymphomatoid granulomatosis. Report of a case and an immunohistologic study.

A case is presented of a man with ulcerating skin nodules who was diagnosed by histologic and immunohistologic analysis of skin biopsy specimens as having lymphomatoid granulomatosis (LYG). Phenotypic studies showed the majority of the infiltrating cells to be activated CD4+ T-lymphocytes. The disease followed a rapidly progressive course and did not respond to treatment with cytotoxic chemotherapy. The patient developed life-threatening systemic symptoms and involvement of both upper and lower respiratory tracts. After treatment with sequential half-body irradiation he has been in complete remission for 3.5 years.

Adult↗
PubMed1989

Circadian pharmacokinetics of methotrexate.

Six patients with intermediate- and high-grade non-Hodgkin's lymphoma were treated with 400 mg/m2 i.v. methotrexate (MTX) at 0600 and 1800 hours. Despite evidence of circadian rhythms in renal function, the pharmacokinetics of total and free serum MTX showed no significant difference between these two times. The marked two-fold circadian variation in MTX pharmacokinetics previously reported in rats was not observed in these patients.

Aged↗
PubMed1989

Nodular sclerosing, mixed cellularity and lymphocyte-depleted variants of Hodgkin's disease are probable dendritic cell malignancies.

The normal counterpart of the Reed-Sternberg cell and its mononuclear variant, collectively referred to as Hodgkin's cells (HC), remains controversial. The possibility that HC are malignant dendritic cells was tested by using a panel of 38 monoclonal antibodies to phenotype the cells from 16 cases of Hodgkin's disease (HD), excluding lymphocyte-predominant HD, and the Hodgkin's cell line L428. The results were then compared with the known phenotype of human dendritic cells. HC stained strongly for HLA Class I and Class II antigens. The leucocyte common antigen was weakly expressed in most cases. Expression of T and B cell markers was unusual, with the exception of the CD40 antigen which was found on a majority of HC. HC commonly expressed the CD11a, CR4 (CD11c), CD15, CD18 and a number of activation antigens but did not stain with a variety of macrophage-specific antibodies. The antigenic phenotype of L428 and the HC of case material were similar. This immunocytological analysis failed to support a lymphocyte or macrophage origin for HC. Instead the antigenic phenotype of the Reed-Sternberg cell and its mononuclear variant more closely resembles that of dendritic cells than of any other haemopoietic cell normally resident in lymph nodes.

Antibodies, Monoclonal↗
PubMed1988

High grade nonHodgkin's lymphoma: management with moderate dose combination chemotherapy.

We have reviewed the management of high grade nonHodgkin's lymphoma in a regional cancer centre over an eight year period. Forty-seven patients were referred with diffuse histiocytic, diffuse undifferentiated and lymphoblastic lymphomas or true histiocytic neoplasms. Twenty-six were treated with doxorubicin, cyclophosphamide, vincristine and prednisone (ACOP). The overall complete remission rate was 73%, 83% for stage I and II disease and 62% for stages III and IV. Kaplan-Meier analysis shows 49% surviving at a median follow up time of 23 months (range 1-108 months) with 11 of the 13 survivors continuously disease free. Toxicity was not severe except for one treatment-related death. Most were treated as outpatients. Patients 70 years of age or older were treated less intensively and only 3 of 14 survive. We conclude that treatment with ACOP is simple and effective in the management of high grade nonHodgkin's lymphoma. Currently our protocol includes the same agents, but at higher dosage, with the addition of methotrexate; we believe this should be tested against the recent more intensive, multiagent alternating regimens in a prospective, randomised clinical trial.

Aged↗
PubMed1987

Amelioration of cytotoxic-induced emesis with high-dose metoclopramide, dexamethasone and lorazepam.

A double-blind randomised controlled trial comparing the antiemetic effects of sublingual lorazepam combined with high-dose, short course metoclopramide (3 mg/kg) infused twice 3 h apart with or without i.v. dexamethasone is reported. Sixty patients receiving a total of 209 cycles of potentially severely emetic cytotoxic chemotherapy were randomised to receive one or other antiemetic regimen. In those receiving platinum-based chemotherapy the addition of dexamethasone was associated with an improvement in freedom from nausea (P less than 0.01) and freedom from vomiting (P less than 0.05). In the non-platinum-based chemotherapy group the addition of dexamethasone led to a reduction in the duration and severity of nausea, and duration of vomiting (P less than 0.05 in each case). Both antiemetic regimens were well tolerated with a low incidence of adverse effects and could be administered easily in an outpatient setting.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Possible mechanism for mianserin induced neutropenia associated with saturable elimination kinetics.

Two cases of mianserin induced neutropenia associated with prolonged elimination of the drug were studied. In each case the pharmacokinetic profile suggested saturable elimination kinetics, and the temporal relation of mianserin concentrations and the neutrophil count suggested a direct toxic effect of mianserin on the bone marrow. Until further studies are carried out the plasma mianserin concentration and neutrophil count should be measured in any patient who develops an infection while taking this drug.

Aged↗