At the instance of 174 patients with leukemia is demonstrated that the development to a more aggressive cytoreductive chemotherapy during the last 15 years achieved success without increasing the risk of treatment. A decisive improvement of prognosis for the acute leukemia of adult age is, however, to be expected only from new methods.

Acute Disease↗

PubMed1983

[Discontinuous plasma exchange with the conventional hemodialysis technic and blood cell centrifugation].

A conventional haemodialysis system, to which the patient is connected as for acute dialysis, forms the basis of the plasma substitution method. At each session around 2 litres of plasma were exchanges within 3 hours. Freshly frozen donor plasma was mainly used as the substitution solution. A total of 20 substitutions were carried out in 5 patients in a period of 7 months. The indications were: 3 x major mismatch in the ABO system before bone marrow transplantation, myasthenic crisis, violent attacks connected with lupus erythematosus with rapid development of renal insufficiency. The therapeutic goal of quickly eliminating immunopathogenetic proteins was achieved in all cases. It was possible to reduce the level of isoagglutinins, haemolysins, autoantibodies (myasthenia gravis) and immunity complexes (LE) effectively. The clinical course confirmed the excellent effectivity. There were no serious complications despite the serious primary diseases. Volume imbalances, changes of body temperature, precipitations of cryoglobulins, electrolyte disturbances or citrate intoxications were always well controllable thanks to the combination of plasma substitution and dialysis.

ABO Blood-Group System↗

PubMed1983

[Adenosine deaminase activity in hemoblastoses].

The activity of adenosine deaminase was determined in lymphocytes, erythrocytes and blood plasma of 73 patients with different haematological malignancies and also in healthy control subjects. The enzyme activities were measured using adenosine as substrate and by analysis of released ammonia. Statistically significant decreased enzyme levels in lymphocytes and partial also in erythrocytes were observed in chronic lymphocytic leukaemia, Hodgkin's disease and multiple myeloma. The lower activities of ADA of these patients may be related to the impaired immunological function. In contrast in myeloid leukaemia, blast crisis of myeloid leukaemia and in acute leukaemias significant increased ADA levels in lymphocytes or blast cells were observed. Between the content of blast cells in peripheral blood and ADA activity of the mononuclear cell fraction exists a positive correlation. The increased ADA values of blast cells are a sign of an elevated purine metabolism.

Adenosine Deaminase↗

PubMed1982

[Prognostic significance of histobiopsy findings in bone marrow of malignant lymphomas in adults].

Issuing from the fact that the histobiopsy of the bone marrow is the most sufficient method for the proof of infiltrates of malignant lymphomas in the marrow, in 41 patients with Hodgkin's disease and 89 patients with malignant non-Hodgkin-lymphomas was tested whether already may be rendered prognostic conclusions from the histologic findings of the marrow. In these cases could be shown by the different course in patients with Hodgkin's disease in stage IV with and without affection of the marrow that a specific infiltration of the marrow is accompanied by a significant deterioration of the prognosis, which should be taken into consideration in the therapy planning. In the malignant non-Hodgkin-lymphomas those with a high degree of malignity showed a significantly worse prognosis than those with a low degree of malignity. Thus in the individual case the coordination of a lymphoma to one of these groups of malignity which is possible at the histobiopsy of the iliac crest may already be of prognostic significance also without consideration of the type of lymphoma. The prognostic significance of the type of lymphoma itself could be confirmed by the different course of the survival curves in the histologic subtypes of the immunocytoma. Since finally patients with a lymphoplasmocytic immunocytoma in diffuse affection of the marrow show a significantly worse prognosis than in the focal affection may be concluded that apart from the degree of malignity and the type of lymphoma also the type of affection of the marrow which is to be established histologically seems to have a decisive prognostic significance from which the necessity of a different therapeutic approach may be derived. Further examinations on larger numbers of patients including multivariant analyses will yield still more evident results.

Adult↗

PubMed1982

[Indication for prophylactic and therapeutic thrombocyte substitution].

The substitution of thrombocytes is on principle indicated only when a disturbance of the formation is present. The prophylactic application, i.e. before the occurrence of a haemorrhage, which is sometimes life-limiting, is to be preferred, however, on account of the danger of sensitization it is bound to particular conditions: temporarily limited need of substitution, decreased immune reagibility of the recipient (basic disease, therapy), medico-therapeutically induced thrombocytopenia (cytostatic drugs); example: haemoblastoses. Prerequisites are subtile control of clinical effectiveness and formation of antibodies. In planned bone marrow transplantation only preparation of individual donors (not related!) with HLA-A/B match are to be used. The same is applied to already alloimmunized patients, in which case a negative lymphocytotox cross test must still be present. Patients without option to transplantation or without HLA-antibodies may receive also random preparations of individual donors or mixed preparations. AB0-minor-incompatibilities are without significance, AB0-major-incompatibilities are not permissible. The introduction of thrombocyte-specific testings is urgently to be aspired to.--Exclusively therapeutic substitution of thrombocytes, i.e. in manifest haemorrhage, is performed in a primarily not limited period of substitution, in a completely immune competent recipient with regularly low values of thrombocytes without cytoreductive therapy (example: aplastic anaemia). In these cases on account of high danger of sensitization only preparations of individual donors with HLA-A/B-match should be used. In cases of exception in thrombocytopenic, life-threatening haemorrhages on account of metabolic disturbances (immune thrombocytopenia, massive transfusions) the substitution with thrombocytic mixed concentrates is satisfied.--The substitution of thrombocytes is a common task of clinic and blood donation service, which opens new possibilities of therapy (e.g. transplantation of bone marrow).

Anemia, Aplastic↗

PubMed1982

[Central venous long-term catheter in the treatment of acute leukemia: implantation of a modified Hickman technic].

Central venous catheters are an essential prerequisite for the supportive ascertainment of highly aggressive cytoreductive therapy programmes in patients with acute leukaemia. From the indications (parenteral nutrition, transfusions, blood taking a. o.) and the particular conditions of the patient with acute leukaemia (granulo- and thrombocytopenia) results the superiority of a subcutaneously tunnelled central venous catheter with a particular occlusion of the place of entry into the skin in contrast to usual techniques.

Catheters, Indwelling↗

PubMed1982

[Thrombocyte substitution in acute leukemia. Effect of histocompatibility on the clinical efficacy].

Thrombocyte substitution is an essential prerequisite for intensive cytoreductive therapy in acute leukemia. Evaluating 228 thrombocyte transfusions in 17 patients shows that the clinical effectiveness of thrombocyte concentrates can be increased by making the coordination of HLA antigens of donor and receiver as good as possible. When measured in the corrected increment (CI) 24 hours after transfusion, the effectiveness of A3/B1 match preparations (CI = 7.0 +/- 1.6) is significantly higher than that of random preparations (CI = 3.0 +/- 0.5). With the presence of HLA antibodies an effective substitution (CI24 greater than or equal to 4.5) can only be achieved by A3/B1 match thrombocytes. This can only be realized by applying the fourfold thrombapheresis of single donors.

Adolescent↗

PubMed1981

[Monitoring cytostatic therapy in acute leukemia with reference to the agar-colony technic].

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Bone Marrow↗

PubMed1980

[Comparative treatment of acute leukemia in adults].

13 full remissions and 8 partial remissions were achieved in 32 first treatments of acute leukaemia. The average duration of full remissions amounted to 225 days, that of partial remissions was 140 days. The average survival time of responders amounted to 410 days, that of non-responders was 52 days. The results of 18 recidive treatments were distinctly worse. Allowing for alexane permanent infusion, the findings and complications of different therapeutical schemes were compared. Improvements of the results seem to be only possible, if cytostatic treatment is supplemented by taking initial and progress evaluating, prognostic relevant parameters into consideration (e.g. stem cell cultures), and by escalating supportive measures including histocompatible blood cell substitution and reverse isolation as well as transplantation of human bone-marrow.

Adolescent↗

PubMed1979

[Unusual skin manifestation in undifferentiated cell leukemia].

In undifferentiated cell leukoses of adults cutaneous manifestations are relatively rare. Therefore the casuistics of a 20-year-old patient with a subleukaemic undifferentiated cell paraleukoblast leukosis is described which is characterized by a cutaneous manifestation in form of cherry-stone-sized papules, the leukotic genesis of which could be histologically ascertained. An initial cytostatic polychemotherapy with Vincristin, Alexan and Daunoblastin did not show any effect concerning the marrow conditions as well as the skin changes which still increased in size. An associated combination therapy with Methotrexat and Daunoblastin led to a diminution and paling of the skin infiltrations, which by a subsequent Methotrexat-monotherapy fully disappeared, apart from pigmented residual spots. In the bone marrow took place a full remission of the acute leukosis as certained by biopsy of the iliac crest.

Adult↗

PubMed1979

[Valuation of autologous bone marrow transplantation in radio- and chemotherapy of malignant tumours (author's transl)].

This paper discusses the prerequisites of bone marrow autotransplantation performed as part of cancer therapy, the emphasis being on the condition of the patient, the facilities available to the institution for the treatment of cancer patients, the biology of the tumour, and the present possibilities of carrying out what is called superdose cancer therapy. The practical performance of a bone marrow autograft is based upon the withdrawal of bone marrow with indefinite vital stem cell preservation by deep cooling at a time when the tumour has not yet led to bone marrow metastasizing. The conserved bone marrow is used, in subsequent radiological and/or cytostatic superdose therapy, as a reserve in the case of extreme damage to hematopoiesis. The discussion of the current status of this method and the prospects for its general use reflects the whole spectrum of the problems associated with the most favorable procedure to be used, the type of superdose therapy to be employed, the time of regrafting, and the accurate assessment of the results obtained.

Bone Marrow Transplantation↗