PubMed Health⌕ Search

Biomedical subjects

M Rahal

Publications and source records attributed to M Rahal.

17 recordsLinked to original sources
PubMed2006

ESHAP + fixed dose G-CSF as autologous peripheral blood stem cell mobilization regimen in patients with relapsed or refractory diffuse large cell and Hodgkin's lymphoma: a single institution result of 127 patients.

From 1996 to November 2004, 131 consecutive patients with relapsed or refractory diffuse large cell lymphoma (DLCL) and Hodgkin's lymphoma (HD) received ESHAP as mobilization chemotherapy before autologous peripheral blood stem cell transplant (ASCT). Patients received fixed dose G-CSF 300 microg SC bid starting 24-36 h after finishing mobilizing ESHAP. In all, four patients failed mobilization and are excluded. Characteristics of 127 patients: 68 males: 59 females. DLCL 49: HD 78. Initial stage I:II:III:IV:unknown was 15:34:33:42:3. Median age at ASCT 26 years. Median prior chemotherapy cycles were six [<6 (17 patients), 6-8 (90 patients), >8 (20 patients)]. Median ESHAP cycle used as mobilizer was third. Patients required 1, 2, 3, 4 apheresis were 93:25:8:1. Median total CD34+ cells/kg collected were 6.9 x 10(6) (DLCL 5.17 x 10(6) and HD 7.6 x 10(6)), patients weighing < or = 70 kg (93 patients) 6.54 x 10(6) and >70 kg (34 patients) 7.44 x 10(6) (P = 0.59), one apheresis (93 patients) 8.6 x 10(6)/kg and >1 apheresis (34 patients) 4.5 x 10(6) (P = 0.001). We conclude that ESHAP and G-CSF 300 microg SC bid is an effective mobilizing regimen even in patients >70 kg and most patients require only 1-2 apheresis.

Adult↗
PubMed2000

Adding high-dose tamoxifen to CHOP does not influence response or survival in aggressive non-Hodgkin's lymphoma: an interim analysis of a randomized phase III trial.

PURPOSE: CHOP is the standard regimen currently used in the management of the majority of patients with aggressive non-Hodgkin's lymphoma (NHL). However, CHOP only produces 30-35% long-term survival. We hypothesized that adding high-dose tamoxifen, which is known to have multiple drug resistance-modulatory effects, to the CHOP regimen could increase the response rate, and consequently enhance the survival of patients with NHL. PATIENTS AND METHODS: In a prospective, controlled, and randomized study, eligible adult patients with aggressive NHL were randomized between CHOP only (Group I), or CHOP plus high-dose tamoxifen (Group II). The primary aim was to assess the effect of tamoxifen on complete response (CR) rate, with the secondary evaluation of tamoxifen potential impact on survival. The interim analysis of this study is presented. RESULTS: Fifty-one and forty-seven evaluable patients were randomized to Group I and Group II, respectively. The median age of all patients was 53 y (range 18-78 y). The two groups had comparable distributions of the pretreatment prognostic variables. The CR for patients in Group I was 80% (41 patients) as compared with 74% (35 patients) in Group II (P=0.48). Likewise, there was no apparent difference in the partial remission rates between the two groups (6% vs 15%, respectively). Of patients who initially attained CR, 15 (37%) and 10 (29%) subsequently relapsed in Groups II and I respectively (P = 0.45). The NHL International Prognostic Index (IPI) was the only factor that predicted attaining CR. At the time of this interim analysis, the actuarial-estimated overall survival (OS) probability (+/-S.E.) for the entire population at 5 y was 58% (+/-6) with no survival difference between the two groups (P=0.51). Only attaining CR and the IPI predicted OS probability. The probability of remaining event-free at 5 y (+/-SE) for those achieving CR was 72% (+/-9), and there was no significant difference between the two treatment groups (P=0.68). Toxicity profile was similar in the two groups. CONCLUSION: Based on this interim analysis, combining high-dose tamoxifen, as used in this study, with the CHOP regimen has failed to have any favorable effect on the outcome of patients with aggressive NHL, and therefore cannot be recommended for future trials.

Adolescent↗
PubMed2000

The effect of nerve cuff geometry on interference reduction: a study by computer modeling.

The effect of nonlinearity in the extrafascicular field in tripolar electrode cuffs on interference pick-up was investigated. It was concluded that the interference is sensitive to electrode separation, especially in short cuffs. This suggests that significant improvements can be obtained by placing the end electrodes a few mm from the cuff ends.

Computer Simulation↗
PubMed2000

An improved configuration for the reduction of EMG in electrode cuff recordings: a theoretical approach.

A theoretical investigation of different electroneurogram recording techniques using electrode cuffs is presented. A new screened tripole arrangement is proposed with a higher inherent signal to interference ratio than the true tripole, which also allows the nulling of the residual electromyogram signal. The reduction in interference is small because the electrode impedance is large compared to the source resistance.

Biomedical Engineering↗
PubMed1997

A phase II trial of circadian-timed paclitaxel and cisplatin therapy in metastatic breast cancer.

PURPOSE: In a phase II study with combination paclitaxel and cisplatin in metastatic breast cancer using circadian timing, we attempted to maximise response and minimise toxicity. MATERIALS AND METHODS: Forty-one patients with histologically-proven metastatic breast cancer with or without previous chemotherapy were treated with Paclitaxel 135 mg/m2 administered as a three-hour infusion at 06.00 hours followed by cisplatin 75 mg/m2 as a one-hour infusion at 18.00 hours utilising circadian timing. Six cycles were planned once every 21 days. Response assessment was performed every two cycles, and toxicity was measured using WHO criteria. RESULTS: All patients were evaluable for response and toxicity. There were nine (22%) complete responses (CR), and 24 (59%) partial responses (PR), for an overall response rate of 80% (95% confidence interval (CI) 69-92). Responses were seen in patients previously treated with anthracyclines (75%) (95% CI 57-92), and in patients who had had no prior chemotherapy (90%) (95% CI 71-100). Responses were seen in all metastatic sites: liver 80%, lung 76%, bone 69%, and soft tissues 71%. The overall median response duration was seven months (range 3-26, 95% CI 5.0-9.8), and 14 of the responses (42%), (95% CI 28-62) were durable. A total of 212 cycles of chemotherapy were given. There were 15 episodes (7%) of grade 3-4 neutropenia, seven (3.2%) of grade 3-4 neurologic toxicity, and three (1.4%) of grade 3-4 nephrotoxicity. There were no toxic deaths. CONCLUSION: The combination of paclitaxel and cisplatin is very effective in metastatic breast cancer, and with application of circadian timing, toxicity has been acceptable. This combination is being tested as primary therapy in locally-advanced breast cancer at our institution.

Adult↗
PubMed1997

Primary pancreatic non-Hodgkin's lymphoma in a renal transplant recipient.

Primary pancreatic non-Hodgkin's lymphoma (NHL) is rare and accounts for less than 1% of all lymphomas. The development of NHL following transplant is well recognized. However, there are no previous reports on localized lymphomatous pancreatic involvement in a transplant patient. We report on the first case of primary pancreatic NHL developing in a renal transplant recipient. The patient was treated without reducing immunosuppression and received combination chemotherapy and radiation. The patient is in complete remission at 10-month follow-up.

Biopsy, Needle↗
PubMed1996

Primary pancreatic non-Hodgkin's lymphomas.

Primary pancreatic lymphomas are rare. We reviewed our experience at King Faisal Specialist Hospital and Research Center; the hospital tumor registry identified five patients with primary pancreatic lymphoma among the 1,212 adult non-Hodgkin's (NHL) cases referred to this institute during 1987-1994. The histology was diffuse large cell in all cases. According to the Ann Arbor classification, four patients had stage IE and one patient stage IIE disease. The diagnosis was established by laparotomy in three and ultrasound or CT-guided biopsy in two patients. All patients received chemotherapy. Radiotherapy was used in two cases; in one patient the pancreatic bed was irradiated, whereas in the other radiation was given for obstructive jaundice. Four patients are alive with no evidence of disease at 84, 26, 24, and 21 months follow-up. One patient relapsed at 12 months following chemotherapy and is alive with disease at 23 months follow-up. The clinical and radiological findings in primary pancreatic NHL are not pathognomonic, and the diagnosis is only established on histopathological examination. The management should be nonsurgical as the response to chemotherapy and radiation appears to be no different from NHL at other sites.

Adult↗
PubMed1992

Alternating chemo-radiotherapy with cisplatin and 5-fluorouracil plus bleomycin by continuous infusion for locally advanced undifferentiated carcinoma nasopharyngeal type.

UNLABELLED: More than 80% of undifferentiated carcinoma nasopharyngeal type patients with N3 disease (AJC-UICC 1987) will die with or from distant metastases within 3 years after the first symptom. From February 1986 to November 1987 30 consecutive patients with very advanced local disease were entered in a programme with chemotherapy-radiotherapy (CT-RT) alternation after a thorough work-up to eliminate the possibility of distant metastases. PROTOCOL: two cycles of cisplatin 100 mg/m2 day 1, bleomycin 15 mg intravenously day 1 and 16 mg/m2 per day by continuous infusion days 1-5; 5-fluorouracil (5-FU) 650 mg/m2 per day by continuous infusion days 1-5 4 weeks apart. This was followed by two series of high-energy radiotherapy, 35 Gy/3.5 weeks, with a third chemotherapy cycle in between. 27 men and 3 women were treated, the median age was 37 years (range 17-71) and the mean WHO performance status was 1 (range 0-3). TNM classification: 15 T4, 9 T3, 6 T2, 28 N3 and 2 N2c. 18 patients had nodes larger than 8 cm and 24 had bulky bilateral cervical nodes. Toxicity for this protocol was moderate, nausea and vomiting being the main side-effects. Results after two CT cycles were 3 complete responses (CR; 10%), 22 partial responses (PR; 73%), 2 disease stabilizations, 2 progressions, and 1 patient inevaluable. Of the 30 patients, 27 patients completed the CT-RT protocol, 2 patients died before radiotherapy and 1 refused treatment after 2 days on protocol. 25 patients were in CR 3 months after the end of radiotherapy. As of August 1991, with a median follow-up of 55 months (range 43-63), there are 17 patients alive, 2 of them with active disease and 15 are NED (2 after salvage therapy).

Adolescent↗
PubMed1990

Treatment of advanced squamous cell carcinoma of the skin with cisplatin, 5-fluorouracil, and bleomycin.

The authors treated 14 patients with advanced squamous cell carcinoma (SCC) of the skin or lip with one to four cycles of combination chemotherapy consisting of cisplatin by bolus injection, and 5-fluorouracil (5-FU) and bleomycin by continuous 5-day infusion. Objective responses were seen in 11 of the 13 evaluable patients (84%). Four patients had a complete remission (30%) and seven patients, a partial remission (54%). Local control after definitive complementary radiation and/or surgical treatment was achieved in seven patients. Toxic side effects was acceptable; they consisted of nausea and vomiting in all patients, transient skin changes, hematologic (Grade 3/4) abnormalities in four patients, and pulmonary fibrosis in one elderly patient. These results show that this chemotherapy combination could play a role in reducing the tumor mass and in facilitating definitive treatment to obtain better functional and cosmetic results in advanced SCC of the skin.

Adult↗
PubMed1990

High complete response in advanced nasopharyngeal carcinoma with bleomycin, epirubicin, and cisplatin before radiotherapy.

Undifferentiated carcinoma of nasopharyngeal type (UCNT) is a geographically endemic, Epstein-Barr virus-related carcinoma of epidermoid origin with reported 5-year survival rates of 15%-40% when treated with radiotherapy alone. Although UCNT can be well controlled locally by radiation therapy, in advanced nodal stage N3 [International Union Against Cancer-American Joint Committee on Cancer (UICC-AJCC, 1987)] the survival rate is below 20%, primarily because of metastatic spread in 80% of the fatalities. We report a pilot study of 41 patients with nonmetastatic, locoregionally advanced disease (85% of the patients had a nodal status greater than or equal to N2C-N3; 43% had T4 primaries), during which we used a combination of 100 mg of cisplatin/m2 on day 1, 15 mg of bleomycin by intravenous push and 12 mg/m2 by continuous infusion on days 1-5, and 70 mg of epirubicin/m2 on day 1 every 21 days for three cycles before definitive radiation therapy with 70 Gy for 7 weeks. Twenty-seven of 41 patients (66%; 95% confidence interval = 52.5%-80.5%) achieved a clinical complete response, and 40 of 41 (98%) had a major objective response after chemotherapy. Two deaths were treatment related, but side effects were moderate, and the overall treatment sequence was feasible. At the end of radiation therapy, all 39 assessable patients were in complete response, with a median follow-up of 21+ months (greater than 10-greater than 31); 33 (80%) patients had no evidence of disease. We believe that such a complete response rate in a high-volume disease with the use of combined modality treatment indicates a therapeutic gain in UCNT. Researchers performing a multicenter international controlled trial will test this hypothesis and compare local control, disease-free, and overall survival of the therapeutic sequence presented here with radiotherapy alone.

Adolescent↗
PubMed1987

[Non-Hodgkin's malignant lymphomas of the nasopharynx. Apropos of 24 cases treated at the Institut Gustave-Roussy].

Twenty-four patients with non Hodgkin's lymphoma of nasopharynx were treated in the Institut Gustave-Roussy, France, between 1976 and 1983. Mean age of patients was 53 years and the male/female sex ratio was 2. Symptomatology was immediately suggestive of a lesion in the nasopharynx in 21 of the 24 patients, and histology gave an unfavorable prognosis (diffuse large cell tumors) in 71% of cases. Complete investigations showed the lymphoma to be relatively limited in extent in the majority of cases (68% of stages I and II). These findings are in agreement with published reports. The 4 patient with stage I disease were treated by irradiation alone and are all alive without recurrence after 43 months. The 11 patients with stage II lesions received combined chemo-radiotherapy, and at 42-month follow up 8 were alive without recurrence (1 patient died of intercurrent illness). Results of conventional chemotherapy (CHVmP) in patients with stages III and IV were disappointing, however: only one patient survived for 60 months (after a cerebral recurrence treated by irradiation). Although current therapy is effective for stage I and II lesions, patients with stages III and IV require more aggressive therapy recently developed: heavy multiple chemotherapy, and even intensive chemotherapy-total body irradiation and bone marrow graft.

Adult↗
PubMed1976

[Effects of arginine and growth hormone, administered in vivo and in vitro, on the oxygen consumption of rat liver hemogenates].

Effects of arginine aspartate, arginine chlorhydrate, potassium aspartate, with equal arginine base and aspartate ion available for all there compounds, growth hormone, and association of these different substances, are studied on rat hepatic homogenates oxygen consumption during 7 to 12 h, after injection to rats 1 h before sacrifice (A.A.: 0.50 g, C.A.: 0.34 g, A.K.: 0.22 g, STH: 2 U.I.), or "in vitro" adjunction to the preparation (A.A.: 0.125 g, C.A.: 0.085 g. A.K.: 0.055 g. STH: 0.5 U.I./0.25 g of liver). 1) "In vivo", arginine (endogenous STH secretion stimulation) is active: A.A. (+23% to +96% from 1 h to 8 h, p is less than 0.01), C.A. (+49% from 5 h to 8 h, p is less than 0.01), whereas potassium aspartate is inactive. "In vitro", aspartate is active: A.K. (+24% to +147% from 4 h to 12 h, (p is less than 0.01), A.A. (+56% to +53% from 7 h to 12 h, p is less than 0.01), whereas arginine without aspartate: C.A. is inactive. 2) Exogenous STH is active "in vivo" (+111% from 5 h to 8 h, p is less than 0.01) and "in vitro" (+31% from 4 h to 7 h, p is less than 0.01). 3) Association A.A. + STH (endogenous STH + exogenous STH) when given "in vivo", dose not produce any additive effect the tissue Vo2 release (+91% from 5 h to 8 h, p is less than 0.01) does not differ from STH and A.A. Aspartate added to STH "in vitro" enhances STH effects: (A.A. + STH: + 44% to +114% from 4 h to 12 h, p is less than 0.01, A.K. + STH: 73% to + 152% from 4 h to 12 h, p is less than 0.01).

Animals↗
PubMed1975

[The effects of arginine and growth hormone on the nitrogen balance of rats].

Intramuscular administration effects of arginine aspartate (AA : 0,50 g a day for 4 days), arginine chlorhydrate (CA : 0.34 g a day for 4 days), potassium aspartate (AK : 0.22 g a day for 4 days) with equal arginine base and aspartate ion supply for all products, bovine growth hormone (STH : 2 U.I. a day for 4 days), and the association of these substances, are studied on 6 rats, during a 74 days nitrogen balance period. Arginine (endogenous STH secretion stimulation) produces a greater nitrogen retention with AA (+ 184%, p less than 0.01) than CA (+ 71% p less than 0.10). A.K. had no effect. With exogenous STH, effect is important (+ 248%, p less than 0.01) but does not significantly differ from AA. STH + A.A. and STH + C.A. associations (exogenous and endogenous STH) produce a very marked nitrogen retention (+ 282% and + 252%, p less than 0.01) which, however, does not significantly differ from STH when given alone.

Animals↗
PubMedDate not supplied

Final report of a phase II study of chemotherapy with bleomycin, epirubicin, and cisplatin for locally advanced and metastatic/recurrent undifferentiated carcinoma of the nasopharyngeal type.

PURPOSE: This article presents an assessment of the combination of bleomycin, epirubicin, and cisplatin as induction chemotherapy before radiotherapy in the treatment of undifferentiated carcinoma of the nasopharyngeal type in patients with recurrent/metastatic disease (group A), and in previously untreated patients with locoregionally advanced disease (UICC-AJCC 87, N2-3, M0) (group B) in terms of toxicity, antitumoral activity, and therapeutic efficacy. PATIENTS AND METHODS: From January 1987 to September 1990, 111 consecutive patients with histologically proven UCNT were treated with six cycles of intravenous cisplatin (100 mg/m2 day 1) epirubicin (80 mg/m2 day 1), and bleomycin (15 mg bolus day 1), followed by 16 mg/m2/day continuous infusion for 5 days, repeated every 21 days for three cycles. Three further cycles without bleomycin were given to 44 patients in group A. In group B (67 patients), only three cycles of the same protocol were given, with a slightly lower dose of epirubicin (70 mg/m2), followed by conventional radiotherapy (70 Gy/7 weeks). RESULTS: Of 44 patients entered in group A, 38 were evaluable for response. We observed 9 (20%) complete responses and 11 (25%) partial responses, for a 45% overall response rate. In 12 patients not previously given chemotherapy, there were 4 complete responses, compared to 5 complete responses in 32 patients previously treated with chemotherapy. Four patients are alive with no evidence of disease after 53+, 60+, 61+, and 72+ months. In group B the overall response rate to chemotherapy was 98% with 42 complete (62%) and 24 partial responses (36%). Three months after the end of radiotherapy, the overall complete response rate was 94% (63 patients). After a median follow-up time of 77 months (range, 53-94), the 4-year overall survival and disease-free survival rates for this group are 66% and 60%, respectively. The median disease-free survival has not been reached at 90 months. CONCLUSION: The results of the BEC combination trial are very encouraging in metastatic and recurrrent UCNT, with durable remissions in this poor-prognosis population. The results in patients with locally advanced disease have motivated prospective phase III testing of the neoadjuvant chemotherapy approach to evaluate its impact on locoregionally advanced disease (> or =N2MO UICC-AJCC 87).

Adolescent↗