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Biomedical subjects

J W Linman

Publications and source records attributed to J W Linman.

At least 19 recordsLinked to original sources
PubMed1981

Effect of schedule on activity and toxicity of 5-azacytidine in acute leukemia: a Southwest Oncology Group Study.

One-hundred-fifty-four patients with acute leukemia and extensive prior chemotherapy were treated with 5-Azacytidine and evaluated according to five different schedules. One-hundred-twenty patients received adequate trials; 34 patients died within 14 days of onset of treatment. Nine patients achieved a complete remission (CR) and two achieved a partial remission. Although two of the treatments have a higher remission rate, the data were not statistically significant. The median time to CR was 48 days (range 21-173). The median duration of CR was 65 days (range 39-369). There was no difference in response rate according to cell type. The median age of responders was 31 years, and 39 years for nonresponders. Proportionately there were more women among responders (5M/6F) and more men (70M/39F) among nonresponders. At onset of therapy the median leukocyte counts were similar between responding (5.4 X 10(3)) and nonresponding (5.7 X 10(3)) patients, but the proportion of leukemic cells was significantly higher among nonresponding patients (46% vs. 7%). Toxicities included nausea, vomiting, diarrhea, skin rash, myalgias, prolonged myelosuppression, hypotension, and central nervous system stupor and/or coma. Lower dose continuous infusion schedules of five-, seven-, and ten-days duration appear effective and were associated with less toxicity.

Acute Disease↗
PubMed1981

Maintenance management of acute nonlymphocytic leukemia.

The necessity of intensive maintenance chemotherapy in enhancing the duration of life in patients with acute nonlymphocytic leukemia (ANLL) in remission has been evaluated. Twenty-four patients were managed with maintenance chemotherapy and 24 were not. In patients under 50, there was no evidence that maintenance prolonged survival. In patients over the age of 50, maintenance chemotherapy prolonged survival (p = 0.03). In both groups the duration of first remission appeared to be lengthened in patients on maintenance chemotherapy (p = 0.09). Since patients 50 and older were difficult to reinduce, it appears that the greatest prolongation of life for them is afforded by continuous maintenance chemotherapy which may forestall relapse. On the other hand, patients less than 50 years of age have a high likelihood of achieving a second complete remission; it is in this group that maintenance chemotherapy adds only to morbidity.

Acute Disease↗
PubMed1980

Glucocorticoid therapy in the preleukemic syndrome (hemopoietic dysplasia): identification of responsive patients using in-vitro techniques.

Bone marrow cells from 54 patients with the preleukemic syndrome were cultured in agar (granulocyte colony forming units) in the presence and absence of cortisol. Twenty-four patients were given trials of prednisone therapy after the initial culture was performed. Cortisol (in vitro) failed to enhance colony growth in 29 of these 34 cases, and none of the 29 patients responded to prednisone therapy. Cortisol enhanced colony growth in five patients and three of these responded favorably to prednisone therapy. The correlation of in-vivo with in-vitro events is significant (P less than 0.005). Glucocorticoid therapy is of value in the management of a small number of patients with the preleukemic syndrome but is hazardous in those who fail to respond. These preliminary observations suggest that bone marrow cell culture techniques may aid in the identification of those patients who will and those who will not respond favorably to such therapy.

Bone Marrow↗
PubMed1978

The preleukemic syndrome (hemopoietic dysplasia).

Retrospective analysis of patients with acute myelomonoblastic (or nonlymphocytic) leukemia has helped to clarify the early stages of the evolution of this disease, and a clinical picture has emerged that is sufficiently discriminating to permit prospective observations. The clinical and laboratory features of the hematologic disorder preceding overt, blast-cell leukemia (i.e., the "preleukemic syndrome" or "hemopoietic dysplasia") are described, and diagnostic criteria and approaches to management are considered. This hematologic syndrome appears to be a stage in a multiphasic panmyelopathy that involves all products of the marrow stem cell. Available data indicate that most of these patients develop acute leukemia within 24 months of the onset of the hematologic abnormalities, but longer courses are not uncommon. Prospective documentation in a large group of patients is needed before the natural course can be accurately defined; such studies are now being planned.

Adrenal Cortex Hormones↗
PubMed1978

Clonal evolution in atypical chronic granulocytic leukemia: a non-Philadelphia translocation.

Hemopoietic cells in chronic granulocytic leukemia (CGL) frequently contain a chromosome translocation involving chromosome 22 and another autosome, usually number 9. The translocated chromosome 22 is known as the Philadelphia (Ph) chromosome. The appearance of a second Ph chromosome is the most common cytogenetic abnormality in CGL signaling the blastic phase. For 6 yr we serially studied a man with atypical CGL whose marrow cells were marked by a translocation from chromosome 18 to chromosome 11 [46XY,t(11;18)(q23;q12)]. Three months prior to blast transformation there appeared an extra copy of the marker chromosome 18: 47XY,t(11;18)(q23;q12),+(18p11 leads to 18q12). This man presents a new cytogenetic pattern of clonal evolution in CGL. The pattern is analogous to that of the Ph chromosome and is characterized by a balanced chromosomal rearrangement and the subsequent acquisition of an extra copy of the small translocation chromosome immediately prior to blast transformation.

Adult↗
PubMed1978

Diagnosis and treatment of the preleukemic syndrome (hemopoietic dysplasia).

Retrospective and prospective observations have established the existence of a recognizable hematologic syndrome preceding the development of acute nonlymphocytic leukemia. This syndrome, which has been termed the "preleukemic syndrome" or "hemopoietic dysplasia", appears to be a stage in a multiphasic myeloproliferative disorder, rather than a separable disease with a propensity to develop leukemia. All products of the marrow stem cell are involved. The panmyelopathy begins as a red cell disease (eg, a refractory or sideroblastic anemia) and progresses to involve megakaryocytes and platelets and finally granulocytes or monocytes, or both; the terminal event is acute nonlymphocytic (myelomonoblastic) leukemia. Prospective documentation is needed in order to define the natural course of this marrow disease. Such studies are now in progress and should provide important information concerning the pathophysiology of acute nonlymphocytic leukemia.

Aged↗
PubMed1977

Randomized clinical trial of cystosine arabinoside and 6-thioguanine in remission induction and consolidation of adult nonlymphocytic acute leukemia.

One hundred and forty-seven adults with acute nonlymphocytic leukemia were randomized to one of two treatment regimens utilizing cytosine arabinoside and 6-thioguanine. In regimen A the drugs were administered every 12 hours until marrow cellularity was reduced by at least 50%. In regimen B the drugs were administered every 12 hours for 5 days with five to 7 days rest intervals between courses. Decisions to continue or reinstitute therapy were based solely on marrow cellularity and marrow ratings. The overall response in referee-verified cases in both groups was similar (41%); regimen B proved to be the easier protocol to administer but required greater support. Younger patients or those with an initial high hemoglobin count responded best to these drug regimens. Only 36% of our patients experienced severe marrow hypoplasia (i.e., a 75% or greater reduction in marrow cellularity) prior to complete remission, suggesting that cytosine arabinoside and 6-thioguanine in combination may selectively suppress leukemic cells while sparing normal hematopoietic elements.

Acute Disease↗
PubMed1977

Dyskeratosis congenita: hematologic evaluation of a sibship and review of the literature.

Dyskeratosis congenita is a rare genodermatosis whose hematologic complications include pancytopenia of variable time of onset, a propensity for opportunistic infections, and neoplasia. A family in which the disorder segregated in 3 generations and involved 9 members is reported, and the hematologic data of the 46 previously reported cases are reviewed.

Adult↗
PubMed1976

The preleukemic syndrome: clinical and laboratory features, natural course, and management.

The clinical and laboratory features of the stages in the evolution of acute nonlymphocytic leukemia are reviewed. Based on a retrospective analysis of 34 patients who died with an acute myelomonoblastic leukemia, the "preleukemic syndrome" has been shown to display a clinical picture sufficiently specific to permit its recognition prospectively (i.e., before the development of overt leukemia). The results to date of a variety of prospective studies are reviewed, and the approach(es) to the management of these cases is considered.

Adrenal Cortex Hormones↗
PubMed1975

Cobalt excretion test as index of iron absorption and diagnostic test for iron deficiency.

A cobalt excretion test was performed in 50 patients with various, mainly hematologic, disorders and was found to be an accurate and easily obtainable index of iron absorption. The test was found to be of very limited value in predicting iron stores. The cobalt excretion test may have some usefulness as a simple, apparently safe, noninvasive test for identification of persons with iron depletion resulting from uncomplicated blood loss. However, in more complex circumstances, it fails to differentiate iron deficiency anemia from anemia due to other causes.

Adult↗