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Biomedical subjects

J P Gockerman

Publications and source records attributed to J P Gockerman.

At least 37 records · Page 2Linked to original sources
PubMed1990

Improved survival in advanced Hodgkin's disease with the use of combined modality therapy.

To compare the effectiveness of combined modality therapy and chemotherapy alone for the treatment of advanced Hodgkin's disease (Stages IIB-IV), records of 154 patients who achieved a complete or partial response to induction combination chemotherapy were analyzed. Sixty-seven patients received consolidation radiotherapy and 87 patients received no further treatment. Thirty of 154 patients participated in a prospective randomized trial of the Southeastern Cancer Study Group (SEG). Ten-year actuarial survival (Hodgkin's disease deaths only) was 93% for the combined modality therapy patients compared with 59% for the chemotherapy alone patients (p less than 0.0005). Combined modality therapy patients had an 87% 10-year actuarial freedom from relapse as opposed to 56% for the chemotherapy alone patients (p less than 0.0005). Relapse occurred in 33 of the chemotherapy alone patients, 28 (85%) being in sites involved at initial diagnosis. Seven combined modality therapy patients recurred with only two true in-field failures. Multi-variate analysis demonstrated treatment (combined modality) as the only variable affecting outcome. Patients prospectively treated with combined modality therapy in the Southeastern Cancer Study Group trial also showed a statistically significant improvement in both survival and freedom from relapse compared with patients receiving chemotherapy only. There was no apparent increase in toxicity from using combined modality therapy compared with chemotherapy. Three chemotherapy patients and one combined modality therapy patients developed acute leukemia.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Clinicopathologic and cytogenic features of CD34 (My 10)-positive acute nonlymphocytic leukemia.

The authors performed membrane antigen phenotyping on 75 patients with acute nonlymphocytic leukemia with a panel of myeloid-associated monoclonal antibodies. The 34 patients (45%) with CD34-positive leukemia were not significantly different from the 41 with CD34-negative leukemia with respect to age, hemoglobin, white blood cell count, or platelet count at presentation, but their blasts were more likely to lack the CD15 or CD33 antigens and to have FAB M1 or M2 morphologic characteristics. CD34-positive leukemia was more likely to arise after chemotherapy. Patients with CD34-positive leukemia were less likely to enter a complete remission even when analysis was limited to those patients receiving a high-dose induction-type chemotherapy regimen. Giemsa-banding karyotyping studies were obtained in 55 of the cases. In 30 of these cases (56%) clonal karyotypic abnormalities were demonstrated. Although the karyotypic abnormalities and phenotypes were varied, there was a high degree of association between the karyotypic abnormalities monosomy 7/del (7q) and the CD34-positive phenotype; this antigen was expressed on blasts from eight of the nine patients displaying this abnormality. Monoclonal antibody phenotyping of myeloid leukemia with reagents such as anti-CD34 may help to define biologically interesting subsets of ANLL with distinct clinicopathologic expression.

Antigens, Differentiation↗
PubMed1988

Evidence for a selective antileukemic effect of cytosine arabinoside in chronic granulocytic leukemia.

On the basis of in-vitro studies indicating that low concentrations of cytosine arabinoside exert preferential inhibition of granulocyte-macrophage colony-forming cells from patients with chronic granulocytic leukemia vs normal subjects, we treated two outpatients with low doses of this agent, administered by subcutaneous infusion for 12-31 days. Both patients continued their usual activities, including employment, during these infusions. They exhibited only Ph-positive metaphases at entry into the protocol but in both cases, Ph-positive cells were reduced to approx. 10% of marrow metaphases, after 2-3 successive infusions. Both patients exhibited significant increases in Ph-positive cells, to 46 and 72% of marrow metaphases, during subsequent chemotherapy with hydroxyurea, in dosage sufficient to maintain granulocytopenia and a normal serum B12 level. After additional cytosine arabinoside, both patients again showed decreases in Ph-positive cells, to 7% (p less than 0.01) and 19% (p less than 0.0001), respectively. This clinical experience is consistent with the conclusion that cytosine arabinoside (but not, hydroxyurea) exerts a selective antileukemic effect in some patients with CGL.

Adult↗
PubMed1988

Altered immunologic reconstitution after standard-dose chemotherapy or high-dose chemotherapy with autologous bone marrow support.

Altered immunologic reconstitution is observed in patients treated with high-dose chemotherapy consisting of cyclophosphamide, cisplatin, and carmustine, melphalan, or etoposide with autologous bone marrow support, and it is similar to that seen in patients treated with high-dose chemoradiotherapy and allogeneic bone marrow transplantation. A decrease in the absolute number and percentage of B cell and CD4 antigen-positive cells and an increase in the absolute number and percentage of CD8 and Ia antigen-positive cells occur along with a decrease in the CD4/CD8 ratio that persists for 6-12 months after high-dose chemotherapy and autologous bone marrow support. These changes have been associated with four serious infectious episodes usually seen only in immunocompromised patients. The above changes were not seen in patients treated with high-dose busulfan, a drug that has relatively specific effects on granulocytes. It is postulated that these alterations result from effects of chemotherapy on the residual lymphocytes or on the environment of repopulating lymphocytes. Functional studies of lymphocyte populations during immunologic reconstitution after standard-dose combination chemotherapy and high-dose chemotherapy with autologous bone marrow support are needed.

Antibodies, Viral↗
PubMed1988

High-dose combination alkylating agents with bone marrow support as initial treatment for metastatic breast cancer.

To evaluate the effect of high-dose chemotherapy in the treatment of metastatic breast cancer, we performed a phase II trial of a single treatment with high-dose cyclophosphamide (5,625 mg/m2), cisplatin (165 mg/m2), and carmustine (600 mg/m2), or melphalan (40 mg/m2) and bone marrow support as the initial chemotherapy for metastatic breast cancer. Twenty-two premenopausal patients with estrogen receptor negative, measurable metastatic disease were treated. Twelve of 22 patients (54%) obtained a complete response at a median 18 days. The overall response rate is 73% (complete and partial response). Median duration of response in the patients achieving complete response was 9.0 months with a median duration of survival for complete responders that is currently undefined. Relapse occurred predominantly at sites of pretreatment bulk disease or within areas of previous radiation therapy. Toxicity was frequent and five patients died of therapy-related complications. The results indicate that a single treatment with intensive combination alkylating agents with bone marrow support can produce more rapid and frequent complete responses than conventional chemotherapy when used as initial chemotherapy for metastatic breast cancer, although median disease-free and overall survival is not improved. Three patients (14%) remain in unmaintained remission beyond 16 months.

Adult↗
PubMed1986

Cytomegalovirus glomerulopathy: a controversial lesion.

Seven autopsies performed on immunosuppressed bone marrow transplant recipients who died with documented herpes virus infection were reviewed. The kidneys were studied by light and electron microscopy and revealed no pathological findings, specifically no glomerulopathy or tubular interstitial nephritis. Seven renal biopsies performed on kidney transplant recipients in whom a diagnosis of cytomegalovirus glomerulopathy was entertained were also studied. These patients exhibited clinical parameters suggestive of cytomegalovirus infection. Three patients had subsequent nephrectomies and two showed severe acute vascular rejection. The one kidney without demonstrable acute vascular rejection was negative for cytomegalovirus on culture. Three additional patients improved or stabilized their renal function under therapy for rejection. Light, electron microscopic and immunofluorescent studies, although confirmatory of endothelial cell damage, did not substantiate active cytomegalovirus renal infection in these patients. An additional group of fifteen children with disseminated cytomegalovirus infection revealed no evidence of glomerulopathy. Finally, two kidney transplant recipients with proven cytomegalovirus infection (one with associated tubular interstitial nephritis) also showed no glomerular alterations. It is the author's opinion that the entity that has been considered as cytomegalovirus glomerulopathy probably represents rejection, either a peculiar anti-endothelial type of rejection or a protracted, early, or partially resolved acute vascular rejection without residual or identifiable acute vascular rejection changes in the tissue sampled.

Adolescent↗
PubMed1986

Gastrointestinal involvement and multiple lymphomatous polyposis in mantle-zone lymphoma.

The clinical, histologic, and immunologic features of three cases of lymphoma presenting with gastrointestinal symptoms and involving the gastrointestinal tract were studied. Two of the cases had involvement of long segments of the bowel with polypoid lesions, a rare presentation of gastrointestinal lymphoma referred to as multiple lymphomatous polyposis (MLP). All cases were classified as mantle-zone lymphoma (MZL), a follicular variant of intermediate lymphocytic lymphoma (ILL) characterized by the proliferation of small atypical lymphoid cells as wide mantles surrounding benign-appearing germinal centers. The patients were typical of other patients with MZL in that they were male, middle age or older, and their clinical courses were not aggressive despite the presence of disease at an advanced stage. Our review of the literature suggests that there is an inordinate number of cases of MZL with gastrointestinal involvement. We also note that most reports of cases of MLP have described histologic lesions remarkably similar to what we have observed. We conclude that MZL may have predilection for involvement of the gastrointestinal tract, that this involvement is often in the manner of MLP, and that most cases of MLP probably have MZL or ILL.

Aged↗
PubMed1986

Randomized comparison of tamoxifen versus diethylstilbestrol in estrogen receptor-positive or -unknown metastatic breast cancer: a Southeastern Cancer Study Group trial.

In a randomized study 115 postmenopausal women with advanced breast cancer who were estrogen receptor-unknown or -positive were treated initially with tamoxifen or diethylstilbestrol (DES). Their pretreatment characteristics showed no significant difference. The frequency of response was identical with tamoxifen and DES, showing a complete response rate of 2% versus 2% and a partial response rate of 4% versus 8%, respectively; stable disease was present in 78% versus 73% of the patients, respectively. The median time to disease progression (5 vs 6 months) and median survival depending on initial hormone therapy (34 vs 35 months) were identical for tamoxifen and DES, respectively. Gastrointestinal toxicity was more frequent and more severe with DES than tamoxifen. Responses were seen with withdrawal of each agent and on crossover to the alternative agent. Our conclusions are that: DES and tamoxifen are equally effective in treating metastatic breast cancer in the postmenopausal patient who is estrogen receptor-positive or -unknown; withdrawal and crossover responses are seen with both agents; side effects are minimal but more frequent with DES; and on the basis of cost-effectiveness DES is the preferable agent.

Adult↗
PubMed1984

Oral candidiasis in cancer patients.

Oral candidiasis in cancer patients is an infection for which inconsistent diagnostic and therapeutic strategies currently prevail. Recent studies have shown its potential importance in the development of systemic candidiasis. A clinical and cytologic study was undertaken on 52 consecutive cancer patients admitted to our institution. Although the incidence of clinical candidiasis was low (8%), 27% of patients harbored evidence of subclinical colonization by Candida. In addition, a significant correlation was found between candidal colonization and low absolute lymphocyte counts. The significance of these findings in relation to systemic candidiasis and rationale for therapy are discussed.

Candida↗
PubMed1984

Pneumonia in bone marrow transplant patients.

The radiographic, pathologic, and clinical features of 22 episodes of pneumonia in 18 bone marrow transplant recipients were analyzed retrospectively. These pneumonias could be divided into three diagnostic categories: (1) a transient form of nonspecific interstitial pneumonia resembling pulmonary edema in radiographic appearance occurred in five patients during the first 2 weeks after transplantation; (2) a fatal, progressive form of interstitial pneumonia began from 2 weeks to several months after bone marrow transplantation in seven patients; and (3) airspace pneumonias occurred in nine patients within 2 months of transplantation and were uniformly fatal. While the temporal and radiographic presentation of transient early interstitial pneumonia is often characteristic and may not require biopsy for diagnosis, the airspace and progressive interstitial pneumonias affecting bone marrow transplant recipients present variable patterns that are often radiographically indistinguishable. The direct pulmonary toxicity of high-dose total-body irradiation and chemotherapy may be contributory in producing both the early transient and later progressive forms of nonspecific interstitial pneumonia.

Bone Marrow Transplantation↗
PubMed1983

Oral manifestations of the chronic graft-v-host reaction.

The graft-v-host reaction (GVHR), a major complication of bone marrow transplantation, is a complex immunologic phenomenon with a diverse and often confounding presentation. After reviewing major systemic manifestations, this report details the clinical and pathological oral findings of chronic GVHR. The reaction is characterized clinically by a mucosal lichenoid keratosis. Pathological findings resemble mucosal lichen planus, and minor salivary gland show lesions similar to those of Sjögren's syndrome. These oral findings are potentially valuable in the early recognition and follow-up of chronic GVHR. The differential diagnosis includes viral infections and chemotherapeutic drug toxicity, but these can usually be eliminated from consideration by viral cultures and temporal correlation of symptoms, respectively.

Adult↗
PubMed1982

Hereditary thrombotic thrombocytopenic purpura: microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency occurring in consecutive generations.

Microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency occurred in a mother an daughter when each was in her third decade. The mother had prominent neurological findings, fever, and expired from renal insufficiency. Her daughter's only major symptom was renal insufficiency. The similarity of the mother's illness to thrombotic thrombocytopenic purpura and of the daughter's to adult hemolytic uremic syndrome suggests that these diseases are variants of a single clinical disorder, while their occurrence in direct descendents strengthens the postulate that in selected instances a genetic predisposition to these disorders may be important.

Adult↗
PubMed1982

Drug-induced interstitial lung diseases.

Any discussion of drug-induced interstitial lung disease is fraught with the problem of having a syndrome in which information is composed predominantly of case reports. When the information is taken as a whole, however, the picture becomes clearer: (1) Some drugs can produce significant pulmonary toxicity; (2) the clinical history, physical examination, and chest roentgenogram are not unique or specific for drug-induced interstitial lung disease; and (3) the lung reacts in limited ways to various insults, producing pathologic changes that are not unique for drug-induced interstitial lung disease. The work of Crystal et al. has shed new light on interstitial lung disease. Their concept that the alveolitis is the key initiating step in interstitial lung disease fits with the pathologic findings in many situations of drug-induced interstitial lung disease. Furthermore, as they proposed, if the primary alveolitis has not progressed to derangement of alveolar structures, then the process can be reversed. This may explain the variable response seen with drug withdrawal and the use of corticosteroids. These concepts have not been extensively studied in drug-induced interstitial lung disease and this needs to be done to fully evaluate their ideas. A keen awareness of the potential for any drug to cause drug-induced interstitial lung disease can be of immense benefit to the patient, for early discontinuation of the agent is likely to increase the chance of reversing the pulmonary toxicity.

Anti-Bacterial Agents↗