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Biomedical subjects

H Bonner

Publications and source records attributed to H Bonner.

At least 19 recordsLinked to original sources

Effect of highly active antiretroviral therapy on the natural history of anal squamous intraepithelial lesions and anal human papillomavirus infection.

The effect of highly active antiretroviral therapy (HAART) on the natural history of anal squamous intraepithelial lesions (ASIL)-the likely anal cancer precursor-and anal human papillomavirus (HPV) infection is unknown. ASIL severity and level of anal HPV DNA were evaluated among HIV-positive men who have sex with men (MSM) for at least 6 months before initiation of HAART. The results were compared with those from a 6-month period after initiation of HAART. Anal swabs for cytology and HPV studies were obtained, followed by high-resolution anoscopy and biopsy. Among men whose most severe pre-HAART diagnosis was atypical squamous cells of undetermined significance or low-grade ASIL, 18% (confidence interval [CI], 6-31%, 7 of 38) progressed and 21% (CI, 8-34%, 8 of 38) regressed 6 months after starting HAART. Seventeen percent (CI, 0-38%, 2 of 12) of study subjects who began with a normal diagnosis developed ASIL. Only 4% (CI, 0-10%, 1 of 28) of study subjects with high-grade ASIL regressed to normal. There was no reduction in the proportion of study subjects who tested positive for HPV DNA or HPV DNA levels after HAART initiation. The ASIL and HPV data were similar to those of the pre-HAART comparison period. These results indicate that HAART has little effect on either ASIL or HPV in the first 6 months after HAART initiation.

Adult↗

Concurrent diagnosis of chronic lymphocytic leukemia and myelodysplastic syndrome.

An elderly patient is described with concurrent presentation of chronic lymphocytic leukemia and myelodysplastic syndrome, documented by clinical and hematological findings, flow cytometry and cytogenetics. The chromosome data suggested that these disorders developed as separate clones from two different hematopoietic precursor cells in this patient.

Aged↗

Pharmacokinetic profile of amifostine.

This article reviews the chemistry, measurement, metabolism, and pharmacokinetics of the cytoprotective agent amifostine. Validated analytic methodology to measure parent drug and pharmacologically active metabolites and pharmacokinetic studies are essential to the efficient performance and analysis of clinical studies. Well-validated analytic methods developed in the authors' laboratory were used to characterize this agent. Amifostine [s-2-(3-aminopropylamino)ethyl-phosphorothioate] is the phosphorylated pro-drug form of the active free thiol drug WR-1065 [2-(3-aminopropylamino)ethanethiol]. Observations described here support the hypothesis that amifostine is dephosphorylated rapidly by alkaline phosphatase present on the plasma membranes of the arteriolar endothelium of various normal tissues and on the plasma membranes of the kidneys' proximal tubular epithelium to its active thiol metabolite WR-1065, which in turn immediately enters normal tissues. Other metabolites that have been identified are WR-33278, the symmetrical disulfide of WR-1065; the mixed disulfides WR-1065-cysteine and WR-1065-glutathione; and cysteamine. Amifostine was recently approved by the US Food and Drug Administration for use as a cytoprotector in cancer patients receiving chemotherapy. Current pharmacokinetic studies in cancer patients are focusing on establishing a population model as a basis for developing limited sampling strategies for future investigations of the pharmacokinetic-pharmacodynamic behavior of amifostine.

Amifostine↗

Non-Hodgkin's lymphoma of the brain: can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315.

Between 1983 and 1987 the Radiation Therapy Oncology Group conducted a prospective phase II study to evaluate survival in primary non-Hodgkin's lymphoma of the brain treated with whole brain irradiation to 40 Gy and a 20 Gy boost to tumor plus a 2 cm margin. Forty-one patients are reported. Full follow-up is available on 35/41 who have died. Six are alive at 8.8-67.2 months from start of radiation therapy with a median followup of 53.9 months. Overall median survival was 11.6 months from start of radiation therapy and 12.2 months from diagnosis, with 48% surviving 1 year and 28% surviving 2 years. Karnofsky Performance Status and age were significant prognostic factors. Patients with a Karnofsky Performance Status of 70-100 had a median survival of 21.1 months compared to 5.6 months for patients with a status of 40-60 (p less than .001). Fourteen patients less than 60 years of age had a median survival of 23.1 months, while 27 patients greater than or equal to 60 years of age had a median survival of 7.6 months (log-rank p = .001). Disease recurred in the brain in 25/41 (61%) of the patients, (21/41 in the brain only and 4/41 in the brain plus distant metastases). Despite high dose and large volume irradiation, primary Central Nervous System lymphoma still exhibits excessive mortality, especially in older patients. This paradox of the relative radioresistance of primary Central Nervous System lymphoma remains unresolved.

Adult↗

Comparison of chlorambucil and prednisone versus cyclophosphamide, vincristine, and prednisone as initial treatment for chronic lymphocytic leukemia: long-term follow-up of an Eastern Cooperative Oncology Group randomized clinical trial.

The Eastern Cooperative Oncology Group (ECOG) conducted a study in which patients with advanced chronic lymphocytic leukemia (CLL) were randomized between a regimen consisting of chlorambucil (30 mg/m2 orally day 1) and prednisone (80 mg orally days 1 to 5) (C + P) administered every 2 weeks and a more intensive regimen of cyclosphosphamide (300 mg/m2 orally days 1 to 5), vincristine (1.4 mg/m2 intravenously [IV] day 1), and prednisone (100 mg/m2 orally days 1 to 5) (CVP) given every 3 weeks. Treatment was continued for up to 18 months to maximal response. Of the 122 eligible patients, 60 received C + P, while 62 received CVP. With a median follow-up of 7 years, there were no significant differences in survival (4.8 v 3.9 years, P = .12), complete remission (CR) rate (25% v 23%; P = .83), or duration of response (2.0 v 1.9 years; P = .78) between C + P and CVP. Toxicity was modest despite the prolonged treatment. The long median survival of 4.1 years for stage III and IV patients is superior to that usually reported. This could stem from continuing treatment to maximal response rather than an increase in intensity of therapy. These results are comparable to those reported with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy by other investigators. The data suggest that intermittent C + P administered to maximal response continues to be the standard treatment approach for advanced CLL.

Adult↗

Endotracheal diazepam: absorption and pulmonary pathologic effects.

We conducted a study to evaluate the absorption of endotracheally administered diazepam and the pulmonary pathologic changes induced by its administration. Six cats received diazepam and five cats received saline endotracheally. Serial blood gases and serum diazepam levels were drawn at intervals for 90 minutes after the administration of diazepam. The cats were sacrificed after two days and their lungs were examined by a pathologist. Mean diazepam levels reached a peak two minutes after the administration of diazepam and remained elevated above therapeutic levels for 90 minutes. There was no significant change in pH, PO2, or PCO2 for either group. Histologic examination of the lungs showed a significantly increased incidence of pneumonitis in the diazepam group as compared to the saline group. This study demonstrates that although diazepam is well absorbed when administered endotracheally, it has adverse effects on the lungs that may preclude endotracheal use in the currently available commercial form.

Absorption↗

Hydrolysis of S-2-(3-aminopropylamino)ethylphosphorothioate (WR-2721).

The hydrolysis reaction of S-2-(3-aminopropylamino)ethylphosphorothioate (WR-2721), a radioprotective agent currently undergoing clinical trials, was studied under a variety of experimental conditions in order to provide more complete data and to reconcile significant differences found between two previous studies. 31P NMR spectroscopy was primarily used to follow the reaction, but comparable results were also obtained in parallel studies using a spectrophotometric technique and a technique involving liquid chromatography with electrochemical detection, in which the free sulfhydryl product, 2-(3-aminopropylamino)ethanethiol (WR-1065), was measured. Upon hydrolysis, inorganic phosphate and the free sulfhydryl group were formed by cleavage of the P-S bond. The reaction rate versus pH profile at 30 degrees in 42.5 mM buffer, mu = 127.5 mM, showed primarily hydrolysis of the monoanion, with an acid-catalyzed reaction below pH 1.5 to 2.0 involving the neutral species of the ester. The energy of activation at pH 4.0 in 42.5 mM acetate buffer was 25.7 kcal/mole (23.1 kcal/mole by liquid chromatography with electrochemical detection). The entropy of activation at pH 4.0, 36 degrees was positive, and there was a deuterium isotope effect on the reaction. A small buffer effect on the rate of the reaction at pH 4.0 and pH 5.0 was found to include contributions from both general acid and general base catalysis. These data are consistent with a mechanism for hydrolysis of the monoanion involving a partially rate-determining proton transfer to the sulfur atom and the formation of metaphosphate ion, which is rapidly hydrolyzed to inorganic phosphate.

Amifostine↗

Leu M1 and S100 in Hodgkin's disease and non-Hodgkin's lymphomas.

Leu M1 positivity of Reed-Sternberg (RS) cells has been reported. The authors studied the specificity and sensitivity of Leu M1 in Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Within NHL, they particularly selected cases that were confused with HD. The authors also studied S100 antigen to determine the pattern of staining in HD and NHL. Paraffin-embedded sections of 23 HD cases (3 lymphocyte predominate, 10 nodular sclerosing, 10 mixed cellularity) and 22 NHL cases (13 diffuse large cell, 5 diffuse mixed small and large cell, 4 others) were studied using an ABC technic. In 20 of 23 HD cases, RS cells and variants were Leu M1+; most cases contained prominent paranuclear positivity; some had diffuse cytoplasmic staining; and some had apparent staining of the cell surface. Neutrophils were intensely positive for Leu M1 and occasional histiocytes also were labeled. In two of the three negative cases (MC), the neutrophils were only weakly positive, thus suggesting a problem with tissue preparation. Of 22 NHL cases, 15 were totally Leu M1 negative. In six cases, rare or occasional tumor cells contained Leu M1 positivity in either a weak punctate, granular, or surface pattern. In an additional case, extensive pleomorphic cell staining was seen indistinguishable from that observed in RS cells; this case was the fourth recurrence of a primary skin NHL which began two years earlier as a pure small cleaved cell NHL. A total of three cases had positive pleomorphic cells. Some carcinomas were also Leu M1 positive. Concerning S100 antigen, the authors found scattered non-neoplastic cells throughout both HD and NHL samples; no tumor cells stained with this antigen. The negative S100 reaction of RS cells fails to support the argument for a dendritic cell origin. In properly prepared tissue, Leu M1 staining is quite sensitive for RS cells and variants, displaying a characteristic pattern. However, occasional Leu M1 positivity identified in NHL raises doubt as to its complete specificity.

Aged↗

Identification of early relapsing patients with adult acute nonlymphocytic leukemia by bone marrow biopsy after initial induction chemotherapy.

Bone marrow biopsies obtained from 69 adult patients with acute nonlymphocytic leukemia (ANLL) six to 10 days after initial induction chemotherapy were reviewed blindly to detect the presence of residual leukemia. Discrimination between the presence or absence of leukemic cells was provided by assessment of the numbers, clustering, and nuclear morphology of blasts and promyelocytes. Twenty-six patients had frank leukemia, 25 had no apparent leukemic cells, and 18 had focal residual leukemia. Of 25 patients whose bone marrow contained no detectable residual leukemic cells, 21 gained complete remission without further chemotherapy. These patients had a median duration of remission of 278 days, with five patients still remaining in remission for 578-882 days. Similarly, all of the 18 patients who had focal residual leukemia achieved complete remission without additional chemotherapy; however, all have relapsed with a median duration of remission of 163 days. This study indicates that patients with foci of residual leukemia in their one-week posttreatment bone marrow samples readily achieve remission, but carry a substantial leukemic burden that increases the likelihood of early relapse.

Acute Disease↗

Full dose versus attenuated dose daunorubicin, cytosine arabinoside, and 6-thioguanine in the treatment of acute nonlymphocytic leukemia in the elderly.

Between July 1, 1981 and November 1, 1982, 45 patients with acute nonlymphocytic leukemia (age, greater than or equal to 70 years) were randomly assigned to receive induction chemotherapy using either daunorubicin, cytosine arabinoside, and 6-thioguanine in full dosage (F DAT) or an attenuated schedule of the same drugs (At DAT) as part of an Eastern Cooperative Oncology Group controlled trial. Forty patients were deemed evaluable, 20 on each arm. The overall complete remission (CR) rate for all patients in both arms was 28% (11/40). There was no significant difference in CR rates between the two arms. There were 12 early deaths (less than 60 days) in the F DAT arm compared with only five early deaths on the At DAT arm (P = .05). Due primarily to this early death rate, the median survival for the F DAT group was 29 days v 159 days for the At DAT groups (P = .02). The range of survival of the patients in CR for the At DAT group given either one or two cycles of induction therapy was 121 to 414 days, while the survival range for the F DAT CR patients was 121-186 + days. The median survival for those not achieving CR was 14 days for the F DAT group v 80 days for the At DAT (P less than .02). Fifty-nine percent of the At DAT patients spent greater than 100 days out of the hospital v 12% for the F DAT group. Attenuated chemotherapy with lower doses of DAT is the preferred induction regimen for elderly patients with acute nonlymphocytic leukemia since it causes fewer early deaths, allows a better quality of life, and yields survival times as durable as intensive therapy.

Acute Disease↗

Immunoregulatory cell subsets in Goodpasture's syndrome: evidence for selective T suppressor-cell depletion during active autoimmune disease.

In a patient with documented untreated Goodpasture's syndrome, serial determination of T-cell subsets using monoclonal antibodies and flow cytometry revealed a persistent but variable deficiency of T-suppressor cells during the period of active disease. As the percentage of OKT8+ cells (suppressor/cytotoxic T cells) returned to normal levels, anti-basement membrane autoantibody production decreased and finally disappeared. Possible pathogenetic implications of immunoregulatory cell imbalance specifically in reference to Goodpasture's syndrome are discussed.

Adult↗

Extremely high levels of natural killer cells in angioimmunoblastic lymphadenopathy.

Analysis of peripheral blood leukocytes from a patient with angioimmunoblastic lymphadenopathy using monoclonal antibodies and the fluorescence-activated cell sorter showed an unusually high proportion of cells that were OKT10+OKM1+63D3-. Since a large proportion of the large granular lymphocytes associated with natural killing in humans bears this surface phenotype, both blood and lymph node cells were subsequently tested for cell-mediated cytotoxicity in natural killer (NK)-cell assays. Following chemotherapy, both cells bearing the NK surface phenotype and the NK cytotoxicity disappeared and a population of cells, bearing none of the typical lymphocyte or monocyte markers, became dominant. At this point the patient was diagnosed as having immunoblastic sarcoma and shortly thereafter succumbed to his disease. In the few cases where extremely high levels of NK activity have been reported, the tumor cells themselves have been responsible for cell-mediated cytotoxicity. In this case, the final tumor population had no NK activity. Thus either a subpopulation of cytotoxic tumor cells was destroyed by chemotherapy or the patient had expanded numbers of NK cells reacting against his tumor prior to therapy.

Antibodies, Monoclonal↗

Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases.

Granulocytic sarcoma is an uncommon tumor composed of granulocytic precursor cells. Because it occurs in a variety of clinical settings and because the tumor cells are primitive it is frequently unrecognized during life. This presentation details the authors' experience with 61 biopsy-proven granulocytic sarcomas. The patient age range was from 2 to 81 years (mean 48 years). In eight patients the tumors were multiple. Most common sites of involvement were bone, periosteum, soft tissue, lymph node and skin. Twenty-two tumors occurred in 15 patients with no known disease, 26 occurred in 24 patients with a known myeloproliferative disorder, and 13 occurred in 11 patients with proven acute myeloid leukemia. Thirteen of the 15 patients with no known disease developed acute leukemia in from one to 49 months after the biopsy of their tumors (mean 10 months). Most tumors occurring in patients with a known myeloproliferative disorder were associated with blast crisis. The authors' cases displayed a morphologic range from well-differentiated to those tumors that displayed virtually no evidence of differentiation by conventional microscopy. It was therefore not surprising that most tumors were originally diagnosed as lymphoma. Chloro-acetate esterase (CAE) stains were performed on 56 tumors and 47 were studied with antilysozyme immunoperoxidase technique. Fifty-six of the 57 specimens studied by either technique were positive. Antilysozyme immunoperoxidase stains were particularly useful in confirming the diagnosis.

Acetates↗

The role of complement in Ascaris suum induced histopathology.

The role of complement in the histopathology of primary and challenge re-infection by Ascaris suum was assessed. Guinea-pigs deficient in C4 or depleted of the terminal components C3 to C9 by cobra venom factor (CVF) were employed. Pathological changes in the livers of complement-deficient guinea-pigs differed slightly from controls. The most striking findings were in the lungs of CVF-treated infected animals, where marked eosinophilic abscesses were observed following either a primary or repeat infection with Ascaris suum. Additionally, greater numbers of larvae were harvested from the lungs of both CVF-treated and C4-deficient infected guinea-pigs as compared with controls. Serum C4 levels varied over the first 7 days after primary infection, declining in several of the normal and CVF-treated animals, but remaining stable in others. The C4 levels remained unchanged in re-infected animals. The C3 to C9 levels remained within the normal range in both primary and re-infected guinea-pigs. The data suggests that complement is involved in the host responses to infection with Ascaris suum. In the absence of complement (C3 to C9), enhanced pulmonary eosinophilic infiltration and eosinophilic granuloma formation occur in both primary and re-infected animals.

Animals↗