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G Todeschini

Publications and source records attributed to G Todeschini.

66 records · Page 4Linked to original sources
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Ceftazidime and amikacin as empiric antibiotic therapy of febrile granulocytopenic patients with hematological malignancies. Report of 171 consecutive episodes.

One hundred and seventy-one consecutive febrile episodes occurring in 130 neutropenic adult patients with hematological malignancies (mainly acute leukemia) were empirically treated with a combination antibiotic therapy consisting of ceftazidime (100 mg/kg/day) + amikacin (15 mg/kg/day). Of these, 161 were evaluable. In the majority of episodes (75 per cent) documented infections were identified as a cause of fever. There were 73 bacteremias (34 Gram-negative, 29 Gram-positive, 10 polymicrobial). One third of patients had pneumonia. Cure without change of the initial regimen was achieved in 45/73 (62 per cent) bacteremic episodes and in 12/13 episodes of microbiologically documented infections without bacteremia. There were 35 clinically documented infections and 26 (74 per cent) of these were cured. Of the 40 patients presenting with possible infections 26 (65 per cent) were cured. Overall, cure without modification of the initial antibiotic combination was achieved in 109/161 episodes (68 per cent). In spite of the frequent occurrence of persistent neutropenia (82 per cent), the infectious mortality was low (8.6 per cent), and often due to superinfection. The deaths due to primary infections were 6/161 (3.7 per cent). Side effects were mild and rare. In our experience ceftazidime + amikacin was an effective and safe empirical regimen for this population of hematologic patients with persistent neutropenia and severe documented infections.

Agranulocytosis↗
PubMedDate not supplied

Improved prognosis of Pseudomonas aeruginosa bacteremia in 127 consecutive neutropenic patients with hematologic malignancies.

OBJECTIVES: Although decreasing in frequency, Pseudomonas aeruginosa bacteremia is still a major challenge for neutropenic cancer patients. In patients with hematologic malignancies, the prognosis of P. aeruginosa bacteremia is particularly poor due to the prolonged and severe neutropenia, mucosal damage, and other defects in immunity related both to the underlying disease and to the cytotoxic therapy. METHODS: To verify the outcome of P. aeruginosa bacteremia and to try to define possible prognostic factors, the authors reviewed the medical records of 127 consecutive episodes of P. aeruginosa bacteremia observed in the hematologic unit of the Verona University School of Medicine. RESULTS: Presence of pneumonia and septic shock, persistence and severity of neutropenia, delayed and inappropriate antibiotic therapy, and unresponsive underlying disease had negative impact on clinical outcome of P. aeruginosa bacteremia. CONCLUSIONS: With recognition of the risk factors and more careful management, the prognosis of P. aeruginosa bacteremia in neutropenic patients with hematologic malignancies has improved in recent years.

Adolescent↗
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Stage II large B-cell lymphoma with sclerosis treated with MACOP-B.

In a series of 193 patients with advanced stage diffuse large-cell lymphoma (DLCL) treated with MACOP-B, 18 (11%) were defined as having a stage II large B-cell lymphoma with sclerosis of the mediastinum. This type of lymphoma has been reported to have a highly aggressive behaviour and special histological and clinical features. In our series young women were more commonly affected and the most striking clinical feature was the presence of a bulky mediastinal mass in 81%. A comparison was made between stage II patients with DLCL with and without sclerosis. The group of patients with sclerosis had prognostic parameters significantly worse than those of the patients without sclerosis, namely, elevated LDH level and bulky disease. The complete remission rates (89% vs 76%) were similar in the two groups and, with a median follow-up of 23 months, survival and disease-free survival rates were also superimposable. MACOP-B chemotherapy has been proven effective in this subgroup of lymphoma patients with sclerosis that had thus far been reported to have a poor prognosis.

Antineoplastic Combined Chemotherapy Protocols↗
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[Surgery and chemotherapy in the treatment of primary gastric lymphomas: case review].

Fifty-seven patients with primary gastric non-Hodgkin's lymphoma are here reported. All our patients were treated with surgery as first step procedure. Thirty-six were treated in addition with chemotherapy (four of them with radiotherapy also). Thirty-eight were stage IE and nineteen IIE. According to the Working Formulation, 12 cases were classified as low, 25 intermediate and 20 high malignancy. 55 patients achieved a complete remission (96%) and only 6 relapsed (11%). The 10-year disease-related survival is 89%. Patients treated with combined surgery and chemotherapy were mainly a high risk group (high grade histologic subtype, stage IIE, incomplete resection). Nevertheless the survival of this group was similar to the group initially treated with surgery alone (p = 0.17) in which such unfavorable prognostic factors were not present. Stage, presence of residual tumor after surgery, sex and age did not statistically correlate with survival. Furthermore, there was not statistical difference among the various histological subgroups (p = 0.16). We stress the importance of cooperation among surgeons and oncologists in order to plan an appropriate treatment.

Adult↗
PubMedDate not supplied

Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) salvage of mechlorethamine, vincristine, prednisone, and procarbazine (MOPP)-resistant advanced Hodgkin's disease.

Thirty-nine patients with advanced Hodgkin's disease were treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Thirty-one of these patients had previously failed to respond to MOPP (mechlorethamine, vincristine, prednisone, and procarbazine) treatment (29 patients) or to CCVPP (lomustine, cyclophosphamide, vincristine, procarbazine, and prednisone) treatment (two patients). Twenty-seven patients were considered evaluable: eight (30%) achieved complete remission (CR), two (7%) achieved partial remission (PR), and 17 (63%) had no response. All of the complete responders are still in continuous unmaintained CR, while 14 of the 19 partial responders and nonresponders have died. The overall median survival was 21 months; it was 16 months for partial responders and nonresponders. The remaining eight patients had ABVD substituted to MOPP early in treatment, because of allergy to procarbazine: six patients achieved CR and two achieved PR. Our results are in keeping with the literature data and confirm the effectiveness of ABVD as primary and salvage treatment in advanced Hodgkin's disease.

Adult↗
PubMedDate not supplied

Idarubicin in patients with diffuse large cell lymphomas: a randomized trial comparing VACOP-B (A = doxorubicin) vs VICOP-B (I = idarubicin).

BACKGROUND AND OBJECTIVE: Idarubicin is an effective drug in acute leukemia but its use in non-Hodgkin lymphomas (NHLs) is not yet well established. We evaluated its efficacy in patients with diffuse large cell lymphoma (DLCL) by means of a randomized trial comparing two 12-week regimens (VACOP-B and VICOP-B) which differed only in the anthracycline drug used (doxorubicin vs idarubicin). METHODS: From January 1992 to December 1994, 104 patients aged less than 65 years with de novo advanced stage DLCL were enrolled. Fifty-two patients were treated with VACOP-B (doxorubicin 50 mg/sqm) and 52 with VICOP-B (idarubicin initially 8 mg/sqm and thereafter 10 mg/sqm). RESULTS: Clinical characteristics of the two groups were not significantly different. One HBsAg+ patient died of hepatic necrosis in the VICOP-B arm, and severe (WHO grade > 2) toxicities occurred in 7 patients treated with VACOP-B and in 5 treated with VICOP-B; the only significant difference was for mucositis (p = 0.02). Complete remission (CR) was obtained in 79% of patients receiving VACOP-B and in 56% (idarubicin 8 mg/sqm) and 75% (idarubicin 10 mg/sqm) of those in the VICOP-B group (p = n.s.). Prognostic factors that negatively affected CR were advanced stage in VACOP, bone marrow infiltration in both schedules. At a median follow-up of two years, overall survival (67% VACOP and 61% VICOP) and disease-free survival (65% and 67%, respectively) were not significantly different. INTERPRETATION AND CONCLUSIONS: Idarubicin is slightly less toxic than doxorubicin; at a dose of 10 mg/sqm the former is easily tolerated and shows the same efficacy as doxorubicin in the treatment of DLCL.

Adolescent↗
PubMedDate not supplied

Combination of chemotherapy and radiotherapy improves the cure rate in primary extranodal lymphomas of the head and neck (PLHN).

BACKGROUND: Since PLHN are rare, prognostic factors and the therapeutic strategy have not yet been clearly assessed. PATIENTS AND METHODS: Seventy-one patients with PLHN (44 stage I, 27 stage II; 54 with high-grade histology) received the following treatments: 5 radical surgery, 21 radiotherapy, 43 combined treatment (mainly chemotherapy plus radiotherapy) [CT] and 1 was not treated. RESULTS: Disease-related survival (DRS) and disease-free survival (DFS) were 84% and 69% at 5 years and 70% and 56% at 10 years. CT provided significantly better DRS and DFS than radiotherapy alone (92% and 81% vs 70% and 43% respectively), though the group receiving the CT included most of the patients with high-grade histology (37) and stage II (20). Outcome was not influenced by stage and site of involvement (Waldeyer's ring vs non-Waldeyer's ring). Multivariate analysis showed that favourable prognostic factors were age for DRS, high-grade histology and CT for DFS. CONCLUSIONS: Patients receiving the CT fared significantly better, though most of them had high-grade histology and stage II.

Adult↗