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G B Zulian

Publications and source records attributed to G B Zulian.

At least 19 recordsLinked to original sources
PubMed2004

[Sensible anticancer treatment in the very old].

Significant numerical increase of elderly people augments in parallel the number of geriatric oncological situations. It is thus necessary to bridge between two apparently divergent worlds. This will allow to look at and evaluate the elderly cancer person with the accuracy of the specialist while remaining at the appropriate distance ordered by the geriatrician eye. It becomes then possible to undertake diagnostic and therapeutic manoeuvres in the respect of everybody's individuality. This contributes to maintain the best quality of life possible until the end. Pater(mater)nalism is to be abandoned and knowledge is to be shared. Daily interdisciplinarity, humanitarian spirit and ethical sensibility are essentials tools to make this enterprise a success.

Age Factors↗
PubMed1999

Cladribine with cyclophosphamide and prednisone in the management of low-grade lymphoproliferative malignancies.

The feasibility of combining cladribine with cyclophosphamide and prednisone in the management of indolent lymphoid malignancies was determined. Nineteen patients [nine chronic lymphocytic leukaemia (CLL), seven non-Hodgkin's lymphoma (NHL) and three macroglobulinaemia (M))] received cladribine 0.1 mg kg(-1) per day as a subcutaneous bolus injection on days 1-3 (up to 5 injections) with intravenous cyclophosphamide 500 mg m(-2) on day 1 and oral prednisone 40 mg (m-2) on days 1-5 at 4-weekly intervals up to a maximum of six courses. A total of 80 courses were given. Overall response rate was 88%, with four patients achieving a complete clinical and haematological response and 12 achieving a partial response. Neutropenia WHO grade 4 in two patients and WHO grade 3 infection in one patient were the limiting toxicities on treatment. During the follow-up, WHO grade >3 haematological complications occurred in five patients and WHO grade >3 non-haematological complications in five patients. There were no treatment-related deaths. This study demonstrates the feasibility of the cladribine/cyclophosphamide/prednisone (CCP) combination that appears highly active and safe in the management of indolent lymphoid malignancies.

Aged↗
PubMed1998

Multiple myeloma.

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Age Factors↗
PubMed1998

Fewer infections, but maintained antitumor activity with lower-dose versus standard-dose cladribine in pretreated low-grade non-Hodgkin's lymphoma.

PURPOSE: To study the efficacy and the safety of cladribine (2-chlorodeoxyadenosine [2-CDA]) administered at two different dosages. PATIENTS AND METHODS: In this two-cohort study, patients with low-grade refractory/relapsing non-Hodgkin's lymphoma (NHL) received 2-CDA at a dose of 0.7 mg/kg per cycle as a continuous intravenous (i.v.) infusion (group 1, n = 44) or at a reduced dose of 0.5 mg/kg per cycle as a subcutaneous (s.c.) bolus injection (group 2, n = 60). Three 2-CDA cycles at > or = 4-week intervals were planned, then treatment could be pursued until six cycles. RESULTS: A total of 300 cycles were administered (group 1, 114 cycles; group 2, 186). Patient characteristics in both groups were comparable. The median dose-intensities were 0.17 mg/kg/wk and 0.13 mg/kg/wk for groups 1 and 2, respectively (P < or = .0001). The overall response rate for all 104 patients was 54% (95% confidence interval [CI], 45% to 66%; 15% complete response [CR] and 39% partial response [PR]). Response was similar in both patient groups (57% in group 1 and 53% in group 2; P = .72), and no association between 2-CDA dose-intensity and response rate was found (P = .35). Median remission duration was 7 and 12 months in groups 1 and 2, respectively (P = .21). Toxicity, in particular opportunistic infections (> or = grade 2, 30% in group 1 v 7% in group 2; P = .003) and myelosuppression (> or = grade 3 neutropenia, 33% v 8% of 2-CDA cycles, P < .0001), were more frequent in group 1. Multiple logistic regression analysis showed that the infection risk (grade > or = 2) was decreased by 81% with 2-CDA dose reduction in group 2 after adjusting for number of pretreatment regimens and time since diagnosis (P = .01). CONCLUSION: When administered as a s.c. bolus injection, 2-CDA at 0.5 mg/kg per cycle is safe and this dose level should not be exceeded in this patient population.

Adult↗
PubMed1997

Feasibility, toxicity, and activity of LNH84-derived chemotherapy in the management of aggressive lymphomas.

The results of chemotherapy remain unsatisfactory for many patients with advanced lymphomas. Both standard and more aggressive chemotherapy regimens might have their respective role in the management of theses diseases. We have tested the feasibility and assessed the toxicity and activity of a LNH84-derived chemotherapy for aggressive non-Hodgkin's lymphoma in two general hospitals. Thirty-three untreated patients were included over a period of 4 years. Median age was 39 years, 21 were male. International Working Formulation was F for 2 patients, G for 17, H for 8, I for 1, J for 4, one unclassified. Seventeen patients had B symptoms, 15 stage IV, 8 bulky disease, 21 abnormal LDH, 5 performance status > or =2. The overall response rate was 93%. The single treatment related death resulted from bleomycin acute pneumonitis. Neutropenia WHO grade 4 occurred in all patients, resulting in infections grade 3 in 12 and thrombocytopenia grade 4 in 3. In the induction phase, courses could never be repeated day 14. The dose intensity of the four drugs contained in this phase is thus calculated between 64.5 and 81.5%. At 3 years, overall survival is 80% and event-free survival is 62%. This LNH84-derived regimen is effective. However, the induction phase is toxic and a 3-weekly interval appears more appropriate. Such intensive treatment might benefit patients with very aggressive lymphomas and this should be studied in randomized comparison against standard CHOP.

Adolescent↗
PubMed1997

Myelodysplastic syndrome with biclonal monosomy 7 and trisomy 8 after treatment with cladribine (2-chloro-2-deoxyadenosine) and involved field radiation therapy.

Therapy-related myelodysplastic syndrome (t-MDS) and acute nonlymphocytic leukemia (t-ANLL) are dramatic complications of cancer chemotherapy. Drugs like plant alkaloids or antimetabolites have not been reported to cause either t-MDS or t-ANLL. Monosomy 7(-7) and trisomy 8(+8) are among the most common abnormalities in myelodysplastic syndromes. Both abnormalities in two different clones of the same patient are very rarely reported. Such a myelodysplastic syndrome occurring shortly after treatment with an antimetabolite, the adenosine analogue cladribine (1-chlorodeoxadenosine), and involved field radiotherapy is reported here.

Adult↗
PubMed1997

Multiple myeloma: clinical evaluation of plasma cell lymphoproliferative disorders and initial management.

After many years of nosologic errance, plasma cell lymphoproliferative disorders are now firmly classified as belonging to the lymphoma family. Their characteristic biological and clinical course starts from the localized form of plasmacytoma, progressing to the more diffuse benign gammopathy, then the premalignant conditions like indolent (IM) or smouldering (SM) myeloma, and ending at the multiple myeloma (MM) stage. During and before this multistep development, genetic and environmental factors appear to be involved and spontaneous regressions may even occur. However, when MM is diagnosed, the outcome is invariably fatal despite conventional radiotherapy and chemotherapy. Prognostic factors like G-reactive protein, the plasma cell labeling index, and beta 2-microglobulin are extremely useful not only for determining the aggressivity of the abnormal clone but also for predicting the transformation from a benign state to a definitive malignant condition. Standard single-agent chemotherapy with melphalan and multidrug combinations can significantly prolong survival, but no cure has yet been achieved. High-dose chemotherapy with stem cell support can decrease tumor burden to an undetectable level and, compared with conventional approaches, has recently proved to increase response rates, the symptom-free interval, and survival. Moreover, interferon alfa is also able to prolong the responding interval, but this has yet to be translated into a survival advantage. These new more aggressive therapies are reminiscent of the early days of leukemia treatment and should now be offered to patients in controlled trials on the basis of comorbidities rather than age or some discriminating economic factors.

Combined Modality Therapy↗
PubMed1996

[Treatment of aggressive non Hodgkin's lymphoma: the experience of a general hospital].

PURPOSE: The LNH84 regimen for aggressive non Hodgkin's lymphoma consists in an intensive induction phase followed by a consolidation phase. The objectives of this study are to evaluate the feasability and activity of a modified induction phase of this regimen in an oncologic department of a general university hospital. PATIENTS: Twenty-eight consecutive patients receive three or four induction courses of CDBVP corresponding to intravenous cyclophosphamide (C), doxorubicin (D), bleomycin (B), vincristine (V) and oral prednisone (P), for a total of 89 courses. Median age is 42 years and 18 patients are male. IWF is F to J. Fourteen have B symptoms, five a bulky disease, 18 abnormal LDH and nine bone marrow involvement. RESULTS: After the induction phase, 12 patients achieve CR and 11 PR for an overall response rate of 92%. Toxicity consists in severe myelosuppression with a neutropenia WHO grade 4 in all patients. The interval between courses is lengthened for each period, with a median interval of 18.5 days between cycle 1 and 2, 19.5 days between cycle 2 and 3 and 22 days between cycle 3 and 4. Eight patients present an infection WHO grade 3 and one patient died of a treatment related pulmonary complication. At 3 years the overall survival and event free survival is 78% and 57% respectively. CONCLUSIONS: In our experience, the CDBVP protocole is a toxic regimen difficult to administer in a general hospital. Its administration out of a protocole can not be recommanded for good prognosis patients. Its interest for poor prognosis patients should be evaluated with clinical studies.

Adolescent↗