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Biomedical subjects

B Paule

Publications and source records attributed to B Paule.

At least 37 records · Page 2Linked to original sources
PubMed1997

Retinoids and metastatic renal cell carcinoma.

The treatment of metastatic renal cell carcinoma remains unsatisfactory. Several therapeutic trials with retinoids and r interferon alpha (r IFN alpha) suggest a synergic antiproliferative effect between retinoid acid and r IFN alpha. Pharmacokinetic data and the mechanism of antiproliferative effects of retinoids are discussed. The induction of growth arrest is related to the expression of specific retinoid receptors. Further investigations are required in order to target the patient population which requires this therapy.

Antineoplastic Agents↗
PubMed1997

[Prognostic factors of multiple myeloma].

Multiple myeloma is a heterogeneous disease with survival ranging from a few months to many years. Several clinical parameters (S beta 2-M) are a direct expression of the tumor burden and have been shown by univariate analysis to be related to patient survival. Durie and Salmon developed a myeloma staging system that analyzed the presenting clinical features, response to treatment and survival duration. But this classification is not related to the intrinsic malignancy (labeling index). Many new parameters (genetic alterations, plasma cell evaluation; serum marqueurs, immune dysregulation) related to patient response to chemotherapy and survival duration have been identified. However, they have not yet been included in standard staging and compared with the recognized prognostic parameters in multivariate analysis. There is a need to create a new international myeloma staging system based on biological features of the disease.

Humans↗
PubMed1996

[Non-cancer uses of methotrexate].

Methotrexate, used for nearly 40 years as an antimetabolite for cancer therapy, also has indications in dermatology, rheumatology and pneumology. When given at low dosage, it has an antiinflammatory effect although the mechanism is not totally understood. Numerous therapeutic trials have been performed in chronic inflammatory diseases such as rheumatoid arthritis in the adult, juvenile polyarthritis and corticosteroid-dependent asthma. Methotrexate is effective in severe resistant forms of rheumatoid arthritis and is used either alone or in combination with other drugs as first intention therapy because of the good tolerance, patient compliance and ease of use. The beneficial effect in severe corticosteroid-dependent asthma remains to be demonstrated. It has also been used in severe forms of psoriasis and may be useful in other diseases with an autoimmune component. Other less common indications including Crohn's disease, ectopic pregnancy and pregnancy termination require confirmation. Tolerance and compliance are generally good, even for prolonged treatments and undesirable effects are almost always reversible at withdrawal.

Adult↗
PubMed1991

Right atrial extension of an embryonal carcinoma of the testis.

A case of embryonal carcinoma of the testis extending into the inferior vena cava and the right atrium is presented. Tumor extension was demonstrated preoperatively by computed axial tomography. Successful resection of the intravascular and right atrial extension was achieved using extracorporeal circulation. It is concluded that intravascular and right atrial extension is not a contraindication to radical surgery. This type of metastasis raises the same therapeutic and prognostic problems as those raised by tumor masses in the lungs or lymph nodes found after chemotherapy for malignant nonseminomatous germ cell tumor of the testis.

Adult↗
PubMed1990

Comparison of the 5-hydroxytryptamine3 (serotonin) antagonist ondansetron (GR 38032F) with high-dose metoclopramide in the control of cisplatin-induced emesis.

To compare ondansetron (GR 38032F), a 5-hydroxytryptamine3-receptor antagonist, with metoclopramide in the prophylaxis of acute cisplatin-induced emesis, we conducted a double-blind crossover study in 97 patients scheduled to receive cisplatin (80 to 100 mg per square meter of body-surface area) for treatment of cancer. None had received chemotherapy before this trial. Among the 76 patients who satisfactorily completed both parts of the study, complete or nearly complete control of emesis (i.e., no episodes of emesis occurred, or only one or two) was achieved in 57 of 76 treatments (75 percent) with ondansetron and in 32 of 76 treatments (42 percent) with metoclopramide (P less than 0.001). Ondansetron was also more effective in controlling acute nausea, as assessed with a visual-analogue scale (P = 0.019) or a graded scale (P = 0.024). There was a significant preference among patients for ondansetron (55 vs. 26 percent; P = 0.006). Dystonic reactions were observed during three treatments with metoclopramide; both agents were otherwise well tolerated. We conclude that ondansetron is more effective than metoclopramide in the control of cisplatin-induced nausea and vomiting, and that this suggests that serotonin is an important mediator of this side effect.

Adult↗
PubMed1989

GR38032F, a 5HT3 receptor antagonist, in the prophylaxis of acute cisplatin-induced nausea and vomiting.

A total of 28 patients receiving cancer chemotherapy with cisplatin-containing regimens (70-120 mg/m2) participated in an evaluation of the efficacy and safety of GR38032F for the prevention of acute nausea and vomiting. GR38032F, a 5HT3 receptor antagonist, was given 30 min prior to cisplatin as an 8-mg loading dose by i.v. infusion over 15 min, followed by continuous infusion at a rate of 1 mg/h for 24 h. Efficacy was assessed by measurement of the number of episodes of retching and vomiting occurring in the 24 h after cisplatin administration and by an assessment of nausea during the same period. In all, 26 patients were evaluable for efficacy: overall, complete control was achieved in 12 patients (46%), major control (1-2 emetic episodes), in 6 (23%); minor control (3-5 episodes), in 1 (4%); control could not be achieved (failure; greater than 5 episodes) in 7 patients (27%). GR3832F was the tolerated, with no significant drug-related adverse events. These encouraging results should be confirmed in comparative trials.

Adult↗
PubMed1989

Morphologic heterogeneity and plasmablastic transformation in advanced plasmacytic/plasmablastic myeloma: a study of 35 serial bone marrow biopsies in 9 patients.

Thirty-five bone marrow biopsies were performed in 9 patients with plasmacytic/plasmablastic myeloma stage IIIA of the Durie and Salmon classification. The cytologic and/or histologic transformation observed in the serial bone marrow biopsy specimens of 3 patients reflected an aggravation of the disease, and was expressed as an increase of bone marrow plasmablasts associated with a gradual decrease or even disappearance of the plasmacytic component. Beyond 50% of bone marrow plasmablasts, the plasmablastic myeloma represented a more aggressive phase in the course of the disease. In 2 patients this transformation was manifested by the development of extramedullary lesions. The possibility of chemotherapy influencing the progression of the plasmablastic clone by destroying the initial plasmacytic clone cannot be ruled out. These results are not devoid of therapeutic implications. They also emphasize the need for serial bone marrow biopsies for better detection of transformation into a less favorable cytologic and/or histologic type of myeloma.

Blast Crisis↗
PubMed1989

Remission of autoimmune hemolytic anemia associated with chronic lymphocytic leukemia following splenic irradiation.

A 56-year old woman with chronic lymphocytic leukemia associated with corticosteroid-resistant autoimmune hemolytic anemia was successfully treated with splenic irradiation. Cobalt 60 in the dose of 8 Gy was delivered to the spleen, considered sufficient for therapy of B lymphocyte CALLA-phenotype. There has been no recurrence of autoimmune hemolytic anemia over a follow-up period of 28 months. The mechanism of action of splenic irradiation is discussed. This treatment might offer a simple and effective alternative to splenectomy in patients with steroid-resistant hemolytic anemia when surgical operation is contraindicated or refused.

Anemia, Hemolytic, Autoimmune↗
PubMed1988

Prognostic significance of plasma cell morphology in multiple myeloma.

The effect of bone marrow plasma cell morphology at diagnosis on survival time was evaluated in 66 patients with multiple myeloma. According to the morphologic classification multiple myeloma was categorized as plasmacytic, plasmacytic/plasmablastic, or plasmablastic. The plasmablastic myeloma had an estimated median survival of 9 months compared with 42 months for plasmacytic/plasmablastic myeloma. Median survival of plasmacytic myeloma has not yet been attained. Plasma cell morphology at diagnosis is an important predictor of survival duration in patients with multiple myeloma. These parameters provide information required for decisions on treatment modalities.

Aged↗
PubMed1988

[The percentage of bone marrow plasmacytes and prognosis in multiple myeloma].

The degree of medullary infiltration by plasmocytes has a prognostic value which completes the clinical classifications proposed in multiple myeloma. Beyond a 50 p. cent medullary infiltration, the mean survival of the patients is significantly shorter (p less than 0.02) than survival of patients presenting less than 50 p. cent medullary infiltration. The degree of medullary infiltration is unrelated to the stage of Durie and Salmon classification, but is correlated to the degree of differentiation of the plasmocytes.

Aged↗
PubMed1988

[Prognostic and therapeutic significance of bone marrow biopsy in multiple myeloma. Analysis of 31 stage II A and III A patients].

The prognostic value of bone marrow biopsy was established in 31 patients suffering from stage IIA and IIIA myeloma (Durie and Salmon classification). Data obtained from quantitative marrow cytology permit to differentiate 3 sub-groups of cells: plasmocytes, plasmoblasts, plasmocytes/plasmoblasts of which the incidence on the prognosis and the response to treatment was studied. There is a correlation between the response to MP and the nature of various cells populations and, on the other hand, the type of infiltration. A sub-group of patients, resisting to MP, was identified: diffuse plasmoblastic myelomas of poor prognosis. Induction poly-chemotherapy seems far superior over the MP combination, which was always a controverted issue.

Aged↗
PubMed1987

[Heterogenicity of the response to chemotherapy in plasmablastic myeloma].

Several recent studies have identified in multiple myeloma a plasmablastic subgroup characterized by its very sombre prognostic. We report the results of treatment in 10 high risk patients with plasmablastic myeloma stage IIIA in the Durie and Salmon classification, stage III in the Bartl classification (tumoral mass greater than 50%). The median survival of the 10 patients was 8 months. These patients, who were resistant to melphalan-prednisone (M-P) or to VMCP in conventional doses, fell into 2 categories: those who responded to chemotherapy with adriamycin, and those who resisted all types of chemotherapy from the start. The finding of such heterogeneous responses to chemotherapy in the plasmablastic subgroup of multiple myeloma and the usefulness of CALLA+ antigen determination make it necessary to study cell differentiation antigens, which would in the long term alter the therapeutic approach in these patients.

Adult↗
PubMed1986

[Therapeutic application of sequential bone marrow biopsy in myeloma: analysis of 13 medullary biopsies].

The therapeutic applications of sequential bone marrow biopsy were investigated in 6 patients with myeloma. Our results showed that the response to chemotherapy is modified by data from quantitative bone marrow cytology which separate subgroups of patients (plasmocytes or plasmoblasts) with different prognosis. The selective disappearance of certain bone marrow components (plasmoblasts and/or diffuse infiltration) after chemotherapy results in tumoral growth retardation which is reflected in a higher objective response rate. These preliminary results emphasize the need for pretreatment bone marrow biopsy in order to select the most appropriate drugs. A prospective study involving a large number of patients is in progress; its purpose is to find out whether adding to the already known clinical classifications a classification based on the type of bone marrow infiltration and on the degree of cell differentiation is therapeutically useful.

Adult↗