PubMed Health⌕ Search

Biomedical subjects

M Michallet

Publications and source records attributed to M Michallet.

At least 109 records · Page 6Linked to original sources
PubMed1990

Treatment of acute myeloid leukemia in elderly patients: the influence of maintenance therapy (BGM 84 protocol).

Ninety-two elderly patients (ages 50-70) with "de novo" acute myeloid leukemia were given induction chemotherapy consisting of aclacinomycin-A (ACLA) (100 mg/m2/day x 3) and cytosine arabinoside (ARA-C) (100 mg/m2 day, continuous infusion, 7 days). Fifty-one patients (55%) achieved complete remission (CR), 8 patients exhibited drug resistance and 33 patients died during chemotherapy or aplasia. Three patients had severe cardiac toxicity. The only prognostic factor significantly affecting CR was the initial leukocyte count. After consolidation using ACLA (80 mg/m2/day x 2) and ARA-C (100 mg/m2/day x 5), 47 CR patients were randomly assigned to 2 different treatment arms: 23 patients (Group A) received intensive sequential chemotherapy consisting of 4 monthly courses of 8 different drugs while 24 other patients (Group B) were given ACLA and ARA-C at regular intervals, associated with continuous chemotherapy consisting of 6-mercaptopurine, methotrexate and androgens. The probability of disease-free survival at 2 years was significantly higher (33 +/- 22%) for Group B patients than for Group A (13 +/- 16%) (P less than 0.05). We conclude that continuous maintenance chemotherapy may be useful in increasing the number of long-term survivors, at least in the elderly who have not received very intense consolidation chemotherapy following CR.

Aclarubicin↗
PubMed1990

Bone marrow transplantation for chronic myelogenous leukemia. Results of the French Cooperative Group (GEGMO).

Data on 281 patients with chronic myelogenous leukemia who received bone marrow transplants were analyzed. The median follow-up time was 48 months. One hundred and seventy patients were in 1st chronic phase, 111 were in more advanced disease. The overall actuarial survival was 50% at 5 years. In multivariate analyses, the probability of relapse was correlated with the phase of the disease, the method of total body irradiation, the T cell depletion of the marrow and the occurrence of a chronic GVHD. The probability of disease free survival was significantly better for the patients who received a non T cell depleted marrow than for recipients of T cell depleted marrow. Bone marrow transplantion in first chronic phase with an HLA identical non T cell depleted marrow offers the better chance of prolonged leukemia free survival.

Acute Disease↗
PubMed1989

Comparison of allogeneic or autologous bone marrow transplantation and chemotherapy in patients with acute myeloid leukaemia in first remission: a prospective controlled trial.

Eighty-five adult patients under the age of 50 years with acute myeloid leukaemia (AML) were entered into a prospective controlled study conducted to compare the effectiveness of allogeneic or autologous bone marrow transplantation and intensive chemotherapy for patients in first complete remission. Sixty-one patients (72%) achieved complete remission then received a consolidation treatment. After consolidation, 58 patients who were still in remission were assigned to three different therapeutic modalities. Fifty-two patients were evaluable: 20 patients who had an HLA-identical sibling donor underwent allogeneic bone marrow transplantation within 3 months after achievement of complete remission; the other 32 patients were randomized to receive autologous bone marrow transplantation or intensive sequential chemotherapy. The actuarial risk of relapse at 3 years was 18% for the allogeneic patients, 50% for the autologous patients and 83% in the chemotherapy group. The difference was highly significant (P less than 0.0002). The disease-free survival was respectively 66% (95% confidence interval 41-85%), 41% (95% confidence interval 16-66%) and 16% (95% confidence interval 0-31%) (P less than 0.004). We conclude that allogeneic bone marrow transplantation is presently the best therapeutic approach for patients with AML in first complete remission.

Actuarial Analysis↗
PubMed1988

[Prospective and comparative study of 2 antibiotic therapy protocols in 66 febrile neutropenic patients. Ceftazidime-vancomycin versus ticarcillin-vancomycin-amikacin].

Out of 66 febrile neutropenic patients, 33 were treated with a ceftazidime-vancomycin combination (group A) and 33 with a ticarcillin-vancomycin-amikacin combination (group B). There was no significant difference in satisfactory results between the two groups (group A 79 per cent, group B 88 per cent), and both regimens were equally active in all febrile episodes. Reversible side-effects (renal and cutaneous toxicity) were observed in 15 per cent of the cases. Two cases of superinfection and one case of resistance occurring during treatment were noted in group B patients. At a time when Gram-positive infections are increasingly frequent among febrile neutropenic patients, the ceftazidime-vancomycin combination seems to be as effective as the ticarcillin-vancomycin-amikacin triple drug combination.

Adolescent↗
PubMed1988

Allogeneic bone marrow transplantation in chronic lymphocytic leukemia: report from the European Cooperative Group for bone marrow transplantation (8 cases).

Allogenic bone marrow transplantation (BMT) was performed in 8 patients with B chronic lymphocytic leukemia (CLL): 6 males and 2 females with a median age of 41 years (37 to 46). Seven patients were resistant to previous therapy and were grafted in the evolutive phase. Only 1 patient was grafted without any previous treatment. At the time of BMT 5 patients were classified according to the Rai classification in stage IV, 1 in stage III and 2 in stage 1. The delay between diagnosis and BMT was 47 months (5 to 68). Graft versus host disease (GVHD) prophylaxis was methotrexate (1 patient), cyclosporine (2 patients), methotrexate + cyclosporine (3 patients), cyclosporine + physical removal of T cells (2 patients). The conditioning regimen was standard for 5 patients, reinforced for 3 patients with Chlorambucil (1 patient) and etoposide (2 patients). A successful engraftment was obtained in all cases. The lymphocytosis decreased slowly and disappeared from day 0 to day 28. All patients developed an acute GVHD 5 of which resolved. Three patients died: 2 of acute GVHD and 1 of intracerebral hemorrhage. Five patients are alive in persistent complete remission without clinical symptoms and with normal peripheral blood and normal bone marrow. The median follow-up is 27 months (13-53). This small series suggests that allogeneic BMT should be investigated in selected patients as possible curative treatment of CLL.

Acute Disease↗
PubMed1987

Impact of T-cell depletion on outcome of allogeneic bone-marrow transplantation for standard-risk leukaemias.

71 leukaemic patients having HLA-matched bone-marrow transplants (BMT) were randomised to receive whole marrow (group A) or marrow depleted of T cells by treatment with monoclonal antibodies (anti CD4-CD5-CD8, group B; anti CD2-CD5-CD7, group C) plus complement. All patients received cyclophosphamide and total body irradiation before transplantation and cyclosporin after BMT. Marrow treatment removed 97% of T cells (median) in group B and 99% in group C. Although both serious and mild graft-versus-host disease (GVHD) were reduced in T-cell depleted patients, graft failure and relapse were increased. Graft failure was caused by GVHD and transplant complications in the controls and by rejection and relapse in the T-cell depleted groups; relapse-free survival did not differ between the groups. Without better control of host immunity and of the residual leukaemia T-cell depletion of the marrow, BMT should not be pursued in standard-risk patients.

Adolescent↗
PubMed1987

Splenectomy during chronic lymphocytic leukemia.

The combination of discontinuous high-dose chlorambucil therapy with splenectomy greatly increased the prognosis of aggressive forms of chronic lymphocytic leukemia (CLL). The median survival for 43 patients was 84 months from diagnosis and 48 months from splenectomy. For 15 stages O, according to Rai classification, obtained after splenectomy, duration ranged from 3 to 105 months. The median survival of a group of patients showing "nodular splenic infiltration" was 104 months and superior to that of a group of patients showing "diffuse splenic infiltration" (72 months). In four of 15 cases studied, the peripheral blood lymphocytic clone disappeared after splenectomy.

Adult↗
PubMed1987

[Deep candidiasis in agranulocytic patients: mycological and serological surveillance in 91 febrile episodes and management of an antifungal and antibacterial protocol].

This study took place between February 1984 and February 1985 in 76 febrile neutropenic patients. We evaluated the whole mycological and serological results, in 91 febrile episodes. We separated two groups: group I (acute leukemia, chronic myeloïd leukemia, medullar aplasia, lymphomas) and group II (chronic lymphoïd leukemia, Hodgkin disease, myelomas, solid tumors). Patients were included in this study if they developed a temperature of 38.5 degrees C or greater and if they had less than five hundred neutrophils per mm3. They were treated with mono or bi-antibiotherapy. If the patient remained febrile more than 72 hours, an antifungal therapy was added (Amphotericin B IV). Through these weekly results, we conclude: the high frequency of digestive tract candidiasis in such patients; disseminated candidiasis occurs only in the first group patients with fungal digestive colonization; the overall response rate in this study was 77 per cent. This underlines the interest of empiric treatment with amphotericin B IV.

Agranulocytosis↗
PubMed1987

Bone marrow transplantation in multiple myeloma: report from the European Cooperative Group for Bone Marrow Transplantation.

Of 14 patients who received an allogeneic bone marrow graft from HLA-compatible sibling donors, 10 have survived for 6 to 34 months posttransplantation (median, 12 months). Four patients have died, two of relapse at extramedullary sites, one of severe acute GVHD, and one from GI bleeding and pericardial effusion. One patient is alive in relapse and four patients have signs of minimal persistent disease. Five patients are well without signs of active disease. Minor improvement in osteolytic lesions on X-ray were seen in three patients, but the X-ray bone structure was mainly unchanged in most patients. Bone marrow transplantation appears promising for treatment of certain patients with multiple myeloma.

Adult↗
PubMed1986

A prospective randomized study comparing the efficacy of Timentin alone or in combination with amikacin in the treatment of febrile neutropenic patients.

One hundred febrile episodes in neutropenic (PMN less than 500/mm3) patients were treated with Timentin alone or in combination with amikacin. The overall response rate in 87 episodes was 82.9% with Timentin alone and 84.5% with the combination. Eleven out of 15 patients with septicaemia were cured by Timentin alone and 12 out of 13 by the combination, a response rate of 73.3% and 92.4% respectively (not-statistically significant P = 1.307). The rates of superinfection were low. Few side effects occurred. Timentin is a useful antibiotic in the treatment of febrile neutropenic patients and was, in this study, as effective alone as in combination with an aminoglycoside in the initial therapy.

Adolescent↗
PubMed1986

Autografting for chronic granulocytic leukemia in transformation.

Forty-five patients were treated for chronic granulocytic leukemia (CGL) in transformation by intensive chemotherapy (23 patients) or radiochemotherapy (22 patients) followed by autologous transplantation of bone marrow (17 patients) or blood-derived hematopoietic stem cells (28 patients). Hematopoiesis was reestablished in most evaluable patients and was significantly more rapid in previously splenectomized patients or in those receiving more than 10 X 10(8) nucleated cells/kg. However, partial or complete failure of engraftment was observed in 11 patients, in most cases after autografting with marrow cells. The median survival of all patients was 4.5 months. The major cause of death was the rapid recurrence of the blast cells not eradicated by the conditioning regimen. However, 4 of the 11 patients treated during the accelerated phase are still alive in the chronic phase, 17, 23, 35, and 54 months after autografting. These results and the restoration of hematopoiesis without the Philadelphia chromosome in 5 patients suggest that autografting could be used in CGL before the onset of the blast crisis.

Adult↗
PubMed1982

[Non-gonadic complications of chemoradiotherapy in Hodgkin's disease. A study of eighty-three patients (author's transl)].

Eighty-three patients with Hodgkin's disease were treated with a combination of chemotherapy and radiotherapy. 43 were included in protocol 1 (from january 1970 to january 1974) and 40 in protocol 2 (february 1974 to december 1977). In protocol 1, staging laparotomy was not systematically performed (20 cases). Treatment consisted of 2 intravenous injections in Vinblastine and total nodal irradiation. In protocol 2, laparotomy was systematic in patients over 50 (35 cases). Patients with stages 1 and II treated as mentioned above. Patients with stage III received two Mopp courses followed by total nodal irradiation. Patients older than 50 with stages I and II and poor prognosis factors received chemotherapy only. Laparotomy was associated with a 0% mortality rate and a 3,6% morbidity rate. No myelitis or pericarditis were observed. Herpes zoster occurred in 24% of the patients, pulmonary apex fibrosis in 6%, hypothyroiditis in 2,4%, and leucopenia in 3,6%. Two late infectious complications were fatal. No solid tumor was apparent. Acute leukemia and non-Hodgkin malignant lymphoma developed in two patients. Good tolerance, shortness of treatment, and remission rate, warrant the pursuit of protocol 2 in which systematic laparotomy for patients under 50 allows total nodal irradiation and therefore reduction of chemotherapy.

Adolescent↗
PubMed1982

Non-Hodgkin's malignant lymphomas: a cytologic classification based on statistical analysis and correlated with prognosis.

On the basis of cytologic studies of 144 patients with non-Hodgkin's malignant lymphomas (NHML), a cytologic classification was established that was composed of three groups (1, 2 and 3) containing nine classes (1A, 1B, 1C; 2A, 2B, 2C; 3A, 3B, 3C). Statistical analyses were carried out using 52 well-defined elementary cytologic characteristics. All the results given by the data-gathering procedures (hierarchical and dynamic clustering methods), by the descriptive analyses (multifactorial and canonical analysis) and by the stepwise discriminant analysis were in agreement with the proposed cytologic classification system. The most discriminating cytologic characteristics of the classes were the cell size, the nuclear-cytoplasmic ratio, the degree of cytoplasmic basophilia, the homogeneity of the cytoplasm and the number of mitoses. The use of these properties renders this classification system reproducible and applicable to clinical practice. A comparison was made between the cytologic classes and the NHML patients as grouped according to their clinical courses. Of the patients in classes 2A, 2B and and 2C, 94% showed acute leukemic characteristics. Of those contained in classes 3A, 3B and 3C, 78% showed poor prognosis or metastatic patterns. Of those contained in classes 1A, 1B and 1C, 76% showed a good prognosis pattern.

Adolescent↗
PubMed1982

Purification and cryopreservation of granulomonocytic colony forming cells (GM-CFC) from the blood of patients with chronic granulocytic leukemia (CGL) for autologous transplantation.

A simple density-cut separation technique is described for obtaining GM-CFC concentrates from the peripheral blood of patients with chronic granulocytic leukemia (CGL) for autografting at the acute blastic phase of the disease. Large numbers of granulomonocytic colony forming cells (GM-CFC) were recovered from a single procedure (68.4 X 10(6) GM-CFC). The cryopreservation of these concentrates in liquid nitrogen allowed the recovery of 46.6 +/- 33.8% viable GM-CFC. An improved yield of GM-CFC was obtained by avoiding washing the cells (65.2 +/- 41.1%). The separation technique resulted in a concentrated suspension of progenitors in a small volume of medium (mean = 15 ml) allowing a great reduction in the amount of the cryoprotective agent injected into the patient at autografting. Preliminary data obtained in 4 patients transfused in blastic crisis after chemotherapy, with or without TBI, indicated the capacity of stored concentrates to repopulate these patients.

Adult↗