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Biomedical subjects

J M Whitehouse

Publications and source records attributed to J M Whitehouse.

At least 19 recordsLinked to original sources
PubMed1992

Adult lymphoblastic lymphoma: high incidence of central nervous system relapse in patients treated with the Stanford University protocol.

Twelve adult patients with non-leukaemic lymphoblastic lymphoma were treated with combination chemotherapy and central nervous system prophylaxis according to the protocol developed at Stanford University. Despite strict adherence to the Stanford protocol, 4 of 12 patients relapsed in the CNS, all with meningeal disease. Only four of the 12 patients are in continuing complete remission 6 to 88 months from the completion of induction therapy. These results are inferior to those previously reported for this regimen, and fail to confirm the high rate of control of CNS disease.

Adolescent↗
PubMed1979

Cancer trials.

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed1979

Measurement of antibodies to tubulin by radioimmunoassay.

A solid-phase double antibody radioimmunoassay capable of measuring antibody to tubulin, the principal component of microtubules, is described. This assay is simple, combining sensitivity with specificity and also allowing determination of antibody subclasses.

Animals↗
PubMed1978

MVPP chemotherapy regimen for advanced Hodgkin's disease.

During January 1968 to December 1972, 133 patients with advanced Hodgkin's disease (HD) were admitted to hospital for combination chemotherapy with mustine, vinblastine, procarbazine, and prednisolone (MVPP regimen). Remission rates were 76% among 49 untreated patients and 90% among 42 patients who had relapsed after radiotherapy. The corresponding five-year survival rates were 65% and 86% respectively. Provided the observed yearly mortality (6%) remains unchanged 75% of patients who had previously received no treatment or irradiation and achieved remission are expected to continue in first remission after five years. Forty-two patients had received prior chemotherapy. They had lower remission and five-year survival rates (40% and 33% respectively), and fewer than half of those achieving remission were still in first remission after five years. There were several reasons for the poor prognosis in this group, including advanced-stage disease (stage IVB), age over 40, and achievement of remission.Chemotherapy was administered on an outpatient basis. Haematological toxicity and immediate drug-related side effects were similar to those of other regimens but there was no appreciable neurotoxicity. Most deaths were due to either HD itself or complications of advanced disease. Five malignancies other than HD occurred in patients who had received both single-agent chemotherapy and radiotherapy before MVPP chemotherapy. Two patients developed osteonecrosis of the femoral heads.Combination chemotherapy has a profound effect on the prognosis of advanced HD. The MVPP regimen yields results comparable to those of other regimens but with perhaps less toxicity.

Adolescent↗
PubMed1978

Comparison of combined and single-agent chemotherapy in non-Hodgkin's lymphoma of favourable histological type.

Sixty-six untreated patients with advanced non-Hodgkin's lymphoma of favourable histological type were allocated alternately to initial treatment with cyclophosphamide, vincristine, and prednisolone or with chlorambucil. The complete remission rate was higher in the group receiving combination chemotherapy, but the overall response rate was the same for both groups. The mean duration of complete remission was the same as that of good partial remission, and was the same for both treatments. The duration of remission was influenced by histological type and extent of disease at presentation, but not age. Those who responded to the initial treatment (whether with complete or with good partial remission) survived significantly longer than did non-responders. It is concluded that neither treatment is satisfactory and that new treatment programmes are needed for patients with a favourable prognosis, especially young patients with extensive disease.

Adult↗
PubMed1978

Combination chemotherapy for acute lymphoblastic leukaemia in adults.

Fifty-one adults with acute lymphoblastic leukaemia were entered into a trial of intense initial chemotherapy and early "prophylaxis" of the central nervous system (CNS). Initial treatment with OPAL (Oncovin (vincristine), prednisolone, adriamycin (doxorubicin), and L-asparaginase (colaspase)) followed by craniospinal or cranial irradiation and intrathecal methotrexate produced remission in 36 patients (71%). Seventeen of these patients relapsed three to 18 months after the start of remission; the remainder had been in remission for 12 to 52 months by the end of the study. The predicted median duration of complete remission was 18.5 months. None of the four patients who initially had clinical evidence of CNS disease, three of whom also had leukaemic cells identical to those found in Burkitt's lymphoma, achieved remission. Those patients who initially had hepatomegaly or splenomegaly had a shorter remission than those without. The predicted median survival was 27 months in those who achieved complete remission, one month in those who did not, and 21 months overall. The addition of colaspase and doxorubicin to vincristine and prednisolone and the use of early CNS treatment clearly improved the remission rate among adults with acute lymphoblastic leukaemia, though the presence and length of remission was affected by the extent of disease at presentation. Burkitt-like leukaemia, which had a poor prognosis, is probably a separate disease and may benefit from a different therapeutic approach.

Adolescent↗
PubMed1978

Combination chemotherapy for advanced non-Hodgkin's lymphoma of unfavourable histology.

Thirty previously untreated adults with diffuse histiocytic and diffuse undifferentiated lymphoma were treated with a combination of adriamycin, vincristine, prednisolone, and L-asparaginase. Complete remission was achieved in 11 out of 12 cases with stage III and 7 out of 18 cases with stage IV disease (P less than 0.005). Bone marrow infiltration, clinical central nervous system involvement, and massive intra-abdominal disease all influenced the prognosis adversely. Complete remission was followed by cranial irradiation and intrathecal methotrexate, and maintained with weekly cyclophosphamide and methotrexate and daily 6-mercaptopurine. The duration of remission was significantly longer for patients with stage III disease (the median of which has not been reached), than for patients with stage IV disease (P = 0.007). Survival was significantly longer for patients in whom complete remission was achieved than for those in whom it was not (P = 0.001), and also for patients with stage III than for those with stage IV disease (P = 0.02).

Adolescent↗
PubMed1978

Pure red cell aplasia.

Complete or near complete remission of acquired pure red cell aplasia, not associated with thymoma, occurred in response to prednisone (six occasions), prednisone and cyclophosphamide (twice), cyclophosphamide alone (once) and splenectomy (once). These results were observed in four patients and confirm the value of cyclophosphamide and possibly splenectomy in patients resistant to prednisone in acquired red cell aplasia. In two of these patients, bone marrow progression from a state of ineffective erythropoiesis with many red cell precursors to that of red cell aplasia was observed. This indicates that some acquired refractory anaemias characterized by ineffective erythropoiesis may have the same pathogenesis as acquired red cell aplasia. The absence of demonstrable antibodies active against erythroblasts may merely reflect the insensitivity of currently available techniques. However it is possible that non-humoral immune mechanisms may be involved in the production of some forms of acquired red cell aplasia responsive to immunosuppressive drugs.

Adult↗
PubMed1977

Hodgkin's disease occurring during acute leukaemia in remission.

Three patients with acute lymphoblastic leukaemia are reported in whom Hodgkin's disease developed during chemotherapy-maintained remission. This association has been reported only once before. The pathogenesis of the Hodgkin's disease in these patients is discussed, including the possible role of anti-leukaemic therapy.

Adolescent↗
PubMed1977

Oral anticandidal prophylaxis in patients undergoing chemotherapy for acut- leukemia.

Fifty-six untreated patients with acute leukemia (38 acute myelogenous leukemia, 16 acute lymphoblastic leukemia, and 2 blast crisis of chronic granulocytic leukemia) were randomized on admission to one of three groups--one to receive oral anticandidal prophylaxis through the period of remission induction chemotherapy with nystatin, another to receive natamycin, and the third to receive no anticandidal prophylaxis. Neither of the first two groups show any advantage over the last and it is concluded that provided gut sterilization regimes are not employed, prophylactic oral anticandidal treatment is of no value in these patients and should be reserved until there is clinical evidence of infection.

Administration, Oral↗
PubMed1977

Immunotherapy for acute myelogenous leukaemia: a controlled clinical study 2 1/2 years after entry of the last patient.

One hundred and thirty-nine untreated patients with acute myelogenous leukaemia (AML) were admitted between August 1970 and December 1973 and allocated into two remission treatment regimens: one to receive chemotherapy alone and the other chemotherapy with immunotherapy. Of the patients who attained remission. 22 were in the chemotherapy group and in September 1975 2 remained alive, the median survival time being 270 days and after relapse 75 days. Twenty-eight patients received immunotherapy during remission, and 5 remained alive; the median survival time of the group being 510 days and after relapse 165 days. Ongoing acturial analysis precisely predicted early in the study the median survival of the two groups, but it took a 2-year follow-up after entry of the last patient before it became clear that there were very few long-term survivors. The increase in survival time produced by the immunotherapy is apparently made up of two components: prolongation of the first remission and length of survival after the first relapse. It must be notted that the chemotherapy for this study was devised 6 years ago and the results of the control arm (chemotherapy alone) may be poorer than those obtained in contemporary studies.

Adolescent↗
PubMed1977

Early central nervous system involvement in adults with acute non-myelogenous leukaemia.

Of 47 consecutive patients aged 15-60 years with acute non-myelogenous leukaemia (ANML) (40 acute lymphoblastic leukaemia (ALL); 5 acute Burkitt-like leukaemia (ABLL), 2 acute undifferentiated leukaemia (AUL) treated with a standard chemotherapy protocol (OPAL), 31 achieved complete remission (28/40(70%) of patients with ALL). CNS leukaemia occurred in 4/16 non-remitters, and in 6 patients who achieved complete remission (CR). CNS leukaemia occurred in all 5 patients with acute Burkitt-like leukaemia. 4/28 patients with ALL achieving CR had evidence of CSF involvement on cytocentrifuge examination shortly after CR. The apparent risk of early CNS disease suggests that prophylactic CNS therapy should be given early in the treatment of acute non-myelogenous leukaemia.

Adolescent↗
PubMed1977

Burkitt's lymphoma in British adults: clinical features and response to chemotherapy.

Eight British adults with tumours histologically and cytochemically identical to African Burkitt's lymphoma are described. In each case there was an acute clinical onset and similar tumour distribution, with involvement of the intra-abdominal organs, bone marrow and central nervous system. Jaw tumours were only present in 3 cases, and were never gross. Four patients presented as acute leukaemia. Combination chemotherapy and cranial irradiation were used to eradicate disease, but complete remissions were obtained in only 3 patients, and survival of over 1 year in only 2. The remainder died with disease present, less than 5 months from diagnosis.

Adolescent↗
PubMed1977

Long-term haematological complications of thorotrast.

Six cases representing the spectrum of haematological complications due to systemic administration of Thorotrast are reposted. Two patients suffered from acute leukaemia, one patient had marrow failure and three patients presented with haematological features of hyposplenism; two of these also had solid tumours. The literature is reviewed.

Acute Disease↗
PubMed1976

Intensive investigation in management of Hodgkin's disease.

Ninety-eight patients with clinically localised Hodgkin's disease underwent laparotomy and splenectomy to determine the extent of microscopic spread. In 68 patients the procedure was carried out for untreated disease apparently confined above the diaphragm. Abdominal disease cannot be confidently excluded on the basis of non-invasive investigation at presentation. Clinical assessment of splenic disease was unreliable unless gross splenomegaly was present. Pedal lymphography was accurate in assessing para-aortic and iliac disease but of no value in assessing other intra-abdominal lymph node involvement, including that of the mesenteric lymph node. Trephine bone marrow biopsy findings were normal in all patients before surgery, and only one patient was found to have diseased bone marrow by Stryker-saw biopsy at operation. Liver disease was identified at operation in nine patients, some of whom were asymptomatic with clinically undetectable splenic and nodal disease. Detailed clinical staging failed to detect disease in one-third of patients who underwent laparotomy. These studies show that if radiotherapy is to remain the treatment of choice for disease truly localised to lymph nodes a detailed staging procedure, including laparotomy and splenectomy, remains essential. The value of this potentially curative treatment is considerably diminished in the patient who has been inadequately staged.

Hodgkin Disease↗