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Biomedical subjects

N Niitsu

Publications and source records attributed to N Niitsu.

At least 73 records · Page 4Linked to original sources
PubMed1995

COP-BLAM regimen combined with granulocyte colony-stimulating factor and high-grade non-Hodgkin's lymphoma.

The clinical efficacy of COP-BLAM chemotherapy combined with human recombinant granulocyte colony-stimulating factor (G-CSF) was evaluated in 104 previously untreated patients with non-Hodgkin's lymphoma (NHL). According to the method of Laurence et al., a modified COP-BLAM regimen was administered every 21 days. G-CSF was added when the granulocyte count fell below 1000 x 10(9)/l. Ninety-eight of 104 (94.2%) patients achieved a complete remission; the 4-year survival rate was 82.4% with a median duration of observation of 26 months. Survival was significantly longer in patients with low serum LDH levels, B-cell type or low CRP or in earlier clinical stages, than in patients with high serum LDH levels, T-cell type of higher CRP levels or in advanced clinical stages. The mean duration of administration of G-CSF was 5.4 days. Twelve patients developed infections during treatment. The adverse effects of G-CSF included interstitial pneumonia, bone pain and fever. Patients administered COP-BLAM combined with G-CSF achieved a high rate of remission and had a low incidence of infection. Nearly all the patients could be treated in 21-day cycles. The results suggest that G-CSF combined with COP-BLAM was effective in treating NHL, because the patients can tolerate a higher dose of the anticancer agents.

Adolescent↗
PubMed1995

[Evaluation of respiratory tract disease accompanying malignant lymphoma in the elderly].

We studied the usefulness of bronchoscopy in the diagnosis of pulmonary complications in elderly patients with non-Hodgkin's lymphoma (NHL). The subjects were 12 patients 65 or older with NHL. Two of these patients underwent transbronchial lung biopsies (TBLB), all of them underwent bronchiolavage (BAL) and 2 with tumors underwent transbronchial biopsies of the tumors. Diagnosis was obtained in 8 out of 12 patients (66.7%). Two patients showed infiltration of lymphoma cells, 2 had cytomegalovirus (CMV) infection, 1 had pneumocystosis (P. carinii), 2 had fungal infections and 1 had a bacterial infection. TBLB was performed in 2 patients with platelet counts of over 5 x 10(4)/microliters. Lymphoma cell infiltration was diagnosed in one of these patients and a fungal infection in the other. BAL was performed on all patients. CMV was detected in 2 cases by the PCR method, P. carinii was detected in 1 case and aspergillus in 1 case. Klebsiella pneumonia was diagnosed in 1 patient. Since respiratory tract complications are often serious in NHL and the prognosis depends on early diagnosis and treatment, it is important to perform bronchoscopy on elderly patients and obtain a definitive diagnosis.

Aged↗
PubMed1995

[Usefulness of COP-BLAM therapy with concomitant G-CSF in elderly patients with non-Hodgkin's lymphoma in comparison with patients not given G-CSF].

COP-BLAM therapy with concomitant G-CSF was performed in patients 65 years of age of older with non-Hodgkin's lymphoma (NHL) and the therapeutic effects and its adverse effects were compared with those in a group not given G-CSF concomitantly. The subjects were 64 patients with NHL, divided into 36 in the G-CSF group and 28 in the non-G-CSF group. In the G-CSF group, complete remission (CR) was achieved in 88.9% and the efficacy rate was 94.5%. In the non-G-CSF group, 89.3% achieved CR, and there was no significant difference between the G-CSF and non-G-CSF groups. The survival time and duration of remission also showed no significant differences between the G-CSF and non-G-CSF groups. The frequency of granulocytopenia as an adverse effects was significantly reduced in the G-CSF group, but the other adverse effects showed no intergroup differences. The occurrence rates of fever of at least 37.5 degrees C and documented infection were significantly less in the G-CSF group. These results indicate that COP-BLAM therapy with concomitant G-CSF achieved a high remission rate, showed few severe adverse effects, especially infections, and can be safely performed in elderly patients.

Aged↗
PubMed1995

[Usefulness of 123I-MIBG myocardial SPECT in patients with hematologic malignancies with chemotherapeutic agent-induced cardiomyopathy].

In 59 patients with hematologic malignancy undergoing chemotherapy regimens including adriamycin (ADR), myocardial imaging was performed by SPECT with 123I-metaiodobenzylguanidine (MIBG) to detect cardiac sympathetic nerve abnormalities. SPECT imaging was performed 20 min and 4 hr after intravenous injection of 123I-MIBG, and the washout rate (WR) for the entire left ventricle was calculated. Then the relationship of the WR to the total dose of ADR, the left ventricular ejection fraction, and the frequency of arrhythmias was evaluated. It was found that the WR was related to the total dose of ADR, suggesting that it is a useful parameter for cardiac sympathetic nerve damage. As the WR increased, the frequency of ventricular arrhythmias also increased. The WR was usually normalized 3-6 months after the discontinuation of ADR. In patients with a WR > or = 50%, however, prolonged follow-up was required. In conclusion, the WR on 123I-MIBG myocardial SPECT scans may be useful as a parameter for predicting cardiac toxicity requiring the discontinuation of ADR or dose reduction.

3-Iodobenzylguanidine↗
PubMed1995

[The effects of COP-BLAM regimen with G-CSF for intermediate and high grade non-Hodgkin's lymphoma].

G-CSF was used concomitantly with the COP-BLAM regimen, and its therapeutic results and adverse effects were evaluated. A total of 104 patients with untreated non-Hodgkin's lymphoma (NHL), including 22 in stage II, 52 in stage III and 30 in stage IV. Seventy five patients had diffuse large cell type, 18 diffuse medium cell type, and 11 diffuse mixed cell type. The treatment consisted of the COP-BLAM regimen based on the method of Laurence et al., was performed every 3 weeks. Complete remission was achieved in 98 out of 104 patients (94.2%), and the 4-year survival rate was 82.4%, while at the time of evaluation the median observation period was 26 months. The survival time was significantly prolonged in patients with low LDH values, B-cells, stage II or low CRP values. The COP-BLAM regimen with concomitant G-CSF administration achieved a high remission rate and reduced the frequency of infections. Almost all of the patients could be treated in 21-day cycle and this appeared to be effective for treatment with increased dose intensity.

Adolescent↗
PubMed1995

[Chemotherapy with concomitant IFN treatment in three HBV carriers (mutant strain) with malignant lymphoma].

Intensive multidrug chemotherapy with concomitant IFN was performed in three hepatitis B virus (HBV) carriers with malignant lymphomas. All of the patients were HBsAg+, HBsAb-, HBcAb+, HBeAg- and HBeAb+ (mutant strain+). HBV-DNA polymerase (DNA-P) was normal at the beginning of chemotherapy, and complete response was achieved with CO-BLAM chemotherapy (without PDN) in all cases. In case 1, a slight elevation of DNA-P and normal GOT and GPT was observed after IFN-alpha was started during the third course. IFN-alpha was administered twice a week. In case 2, elevation of DNA-P and normal GOT and GTP were noted at the end of the 5th course, then daily IFN-alpha was started. In case 3, daily IFN-alpha was started during the 3rd course because of elevation of DNA-P. It was possible to prevent severe liver damage by administering IFN immediately after the elevation of DNA-P, since DNA-P elevation is noted before GOT and GPT elevation. The detection of the HBV mutant strain could be helpful in the treatment of HBsAg+ and HBeAb+ patients. In all of three patients, DNA-P, serum GOT and GPT normalized quickly after the administration of IFN-alpha. Severe hepatitis did not develop.

Aged↗
PubMed1995

[Assessment of cardiac toxicity by 123I-MIBG myocardial SPECT in elderly non-Hodgkin lymphoma patients treated with COP-BLAM and G-CSF].

COP-BLAM chemotherapy with concomitant G-CSF was performed on patients 65 or older with non-Hodgkin's lymphoma (NHL), and cardiac sympathetic disorders due to the chemotherapeutic agents were studied using 123I-MIBG (metaiodobenzylguanidine) myocardial SPECT (single photon emission CT). The results showed no correlation between the ejection fraction due to echocardiography and the total dose of adriamycin (ADR). However, there was a positive correlation between the total dose of ADR and the washout rate, and the possibility of cardiac sympathetic disorders caused by ADR was suggested.

3-Iodobenzylguanidine↗
PubMed1994

[Therapy-related acute non-lymphocytic leukemia (M2) with 7;11 chromosome translocation induced into complete remission by low dose cytosine arabinoside and cytarabine ocfosfate therapy].

A case of therapy-related acute non-lymphocytic leukemia (t-ANLL) in a 70-year-old female patient is reported. An operation for lung cancer was performed in February 1991, and she was treated with etoposide (VP-16), a topoisomerase II inhibitor. Nineteen months after the start of chemotherapy, she complained of palpitations, and anemia and thrombocytopenia developed. The myelogram revealed 41.2% leukemic cells, and a diagnosis of t-ANLL induced by VP-16 was made. The karyotype of bone marrow cells showed 46, XX, t(7;11) (p13;p15), 16p+. She obtained complete remission (CR) by treatment with low dose cytosine arabinoside (Ara-C) and cytarabine ocfosfate (SPAC). Karyotype with t-ANLL induced by alkylate agents frequently shows unbalanced abnormalities. The difference of cytogenetic findings suggest the difference of mechanisms. Detailed chromosomal analysis make clear the oncogenesis of t-ANLL. It is reported that the prognosis of patients with t-ANLL treated by conventional chemotherapy is poor. Considering that elderly cases of acute leukemia have a lower probability of achieving CR than non-elderly cases, because of complications and side effects of chemotherapy such as bone marrow suppression, treatment with low dose Ara-C and SPAC is thought to be indicated in elderly patients with t-ANLL.

Aged↗
PubMed1994

[Evaluation of pulmonary function and bronchoalveolar lavage fluid in elderly non-Hodgkin's lymphoma before and after COP-BLAM III therapy].

We investigated pulmonary function and bronchoalveolar lavage fluid (BALF) before and after COP-BLAM III therapy in elderly patients with non-Hodgkin's lymphoma (NHL). The patients consisted of 8 men and 5 women, over 60 years of age, with previously untreated NHL. The PaO2 averaged 86.5 +/- 7.6 mmHg before treatment, and 69.3 +/- 9.2 mmHg after treatment. Six Patients showed a decrease in PaO2 to less than 20 mmHg. Percent (%) carbon monoxide diffusion capacity was 91.4 +/- 7.1% before treatment and 69.6 +/- 11.5% after-treatment, and 8 patients showed a decrease of at least 20%, whereas there were no definite changes in percent vital capacity or the percent of forced expiratory volume in one second. After BALF collection, the total cell count was slightly increased and the lymphocyte count was also increased after treatment, whereas there were no significant changes in neutrophil or eosinophil counts. There were no significant changes in T-cell or B-cell counts after treatment. The CD4/CD8 was 0.51 before treatment and 1.65 after treatment in patients without pulmonary complications, showing a tendency to increase, while the low ratio before treatment, 0.24, was nearly unchanged after treatment in those who developed pneumonia during their course. Considerable attention should be paid to pulmonary complications. As a result of chemotherapy, lymphocytic infiltration was observed subclinically in the lung, suggesting that changes in the local pulmonary immune system may be involved in the occurrence of pulmonary complications.

Aged↗
PubMed1994

[3 cases of elderly malignant lymphoma of the thyroid gland].

Chemotherapy and radiotherapy were performed on patients over 70 years of age with malignant lymphoma of the thyroid gland and complete remission (CR) was achieved in three patients who are reported here. Case 1: An 87-year-old woman who had been treated for Hashimoto's disease for 10 years as an outpatient was diagnosed as having a diffuse-small cell, B-cell type lymphoma by an aspiration biopsy of the tumor in the left thyroid. COP-BLAM chemotherapy followed by radiotherapy achieved CR. Case 2: A 71-year-old woman was referred to our department because of a right cervical tumor. A biopsy of the tumor revealed a diffuse medium-sized, B-cell type lymphoma. She also has been proved to have hypothyroidism. She entered CR after COP-BLAM chemotherapy combined with a radiotherapy. Case 3: A 76-year-old male patients with Hashimoto's disease who had been treated for 12 years at another outpatient clinic, presented with a right cervical tumor. Aspiration biopsy of the tumor yielded a diagnosis of B-cell lymphoma. COP-BLAM chemotherapy combined with radiotherapy achieved a CR. All three patients entered CR after chemotherapy combined with radiotherapy. Moreover, the microsome test and thyroid test also became negative after the combined modality therapy. In the future, there will probably be increases in the incidence of malignant lymphoma of the thyroid gland, due to the aging of society, and it will be necessary to establish methods of diagnosis and treatment for this disease.

Aged↗
PubMed1994

[VCAP chemotherapy combined with interferon-alpha (HLBI) for elderly multiple myeloma].

VCAP chemotherapy combined with natural interferon-alpha (HBLI) was performed on elderly patients over 65 year with multiple myeloma (MM), and its clinical effects were compared with those of VCAP chemotherapy without HLBI on elderly MM and also with those of HLBI-VCAP and VCAP combination therapy on non-elderly MM. Sixteen elderly and 21 non-elderly patients received HLBI-VCAP combination therapy, whereas 12 elderly and 21 non-elderly patients were treated with VCAP chemotherapy alone. The remission rate (CR+PR) was 81% for the elderly HLBI-VCAP group, 58% for the elderly VCAP group, 90% for the non-elderly HLBI-VCAP group, and 76% for the non-elderly VCAP group. While the median survival time was 54 months for the elderly HLBI-VCAP group and 13.5 months for the elderly VCAP group, it was 70 months for non-elderly HLBI-VCAP group and 34.5 months for the non-elderly VCAP group. The survival time in the elderly HLBI-VCAP group was significantly longer than that in the elderly VCAP group. Therefore, improvement of survival in cases treated by interferon was much better in the elderly group than in the non-elderly group. These results indicate that HLBI-VCAP combination therapy is beneficial for the treatment of elderly MM.

Aged↗
PubMed1994

Combination chemotherapy with COP-BLAM III for intermediate and high-grade non-Hodgkin's lymphoma.

The clinical effects of COP-BLAM III combination chemotherapy and recombinant human granulocyte colony-stimulating factor (rhG-CSF) were examined in 60 patients with intermediate or high-grade non-Hodgkin's lymphoma (NHL). The patients consisted of 37 men and 23 women with a median age of 53 years. The modified COP-BLAM III regimen based on the method of Boyd et al. consisted of six cycles of 6 weeks duration each. The complete remission rate for all patients was 83.3% (50 of 60 patients). With the median observation duration of 47.5 months, the overall median survival time for all patients was 86 months or more. The disease-free survival rate for the 50 CR patients was 88.2% at 86 months. The incidence of infections was significantly reduced by the concomitant use of rhG-CSF. The most common adverse effect was neutropenia (< or = 1000/microliters). The percent diffusing capacity for carbon monoxide in the lung (%DLCO) was reduced in 12 of the 60 patients (20.0%). We conclude that COP-BLAM III is a useful regimen for intermediate and high-grade NHL. However, caution is required since some elderly patients had reduced pulmonary function.

Adolescent↗
PubMed1994

[Type III procollagen N-terminal peptide and type IV collagen-7S level in the serum and BALF of patients with non-Hodgkin's lymphoma before and after chemotherapy].

Combination chemotherapy regimens using multiple agents have been reported to produce long term survival in patients with non-Hodgkin's lymphoma (NHL). However, the adverse effects of those regimens, particularly pulmonary complications, have resulted in fatalities. We measured P-III-P and type IV collagen-7S level in the serum and BALF of 23 previously untreated NHL patients who underwent COP-BLAM III chemotherapy in which a high dose of bleomycin (BLM) was used, and studied the relationship between those parameters and the pulmonary functions in those patients. The parameters and pulmonary function were measured before the first course and after the completion of the fourth course of chemotherapy. As for pulmonary function, chemotherapy produced an increment of %DLCO value but no change in PaO2, %VC, and %FEV1.0. While serum P-III-P levels remained unchanged, P-III-P levels in BALF slightly decreased after the chemotherapy. Type IV collagen-7S levels both in serum and BALF showed no change after the chemotherapy. Serum P-III-P levels after the chemotherapy were significantly correlated with both total cell counts and lymphocyte counts in the BALF. But there was no correlation between serum P-III-P levels and %DLCO. Mild and early-Stage fibrosis was observed in the lungs of the patients who were treated with COP-BLAM III. Pulmonary adverse effects are not likely to be associated with the total administered dose of BLM, but are associated with individual susceptibility to BLM toxicity. Our results suggest that the chemotherapy should be discontinued or the dose of BLM should be reduced if the P-III-P level in BALF increases.

Adolescent↗
PubMed1994

[Clinical usefulness of 123I-MIBG myocardial SPECT in patients with adriamycin-induced cardiomyopathy].

In 29 patients who had been administrated adriamycin (ADR) for the treatment of hematopoietic malignancies, myocardial SPECT was performed 20 minutes and 4 hours after an intravenous dose of 123I-metaiodobenzylguanidine (MIBG). Findings of the myocardial SPECT were compared with the total dose of ADR, ejection fraction (EF) and left ventricular wall motion, as assessed by ultrasound echocardiography. The mean total dose of ADR was 329.3 mg/m2 (range, 150-550 mg/m2). 1) Although the cardiac function was normal, the washout rate (WR) of MIBG was high in 75% of the patients whose MIBG myocardial SPECT showed abnormality on ADR, suggesting the presence of adrenergic nerve disorder. 2) The total dose of ADR was significantly correlated with WR of MIBG (p < 0.001). Consequently, WR of MIBG may be an index which reflects adrenergic nerve disorder in the myocardium earlier than EF. 3) It was suggested that adrenergic nerve disorder was involved in pathogenesis of myocardial complications associated with ADR administration. In summary, MIBG myocardial SPECT could be a useful test for determining a dosage regimen of ADR therapy of individual patients.

3-Iodobenzylguanidine↗
PubMed1994

[Studies on MRSA pneumonia as a complication of hematopoietic malignancies].

Recently, the progress of chemotherapy has improved the clinical outcome of chemotherapy for hematopoietic malignancies considerably. However, the incidence of MRSA infections has increased in patients with hematopoietic malignancies, since preventive, multi-drug administration of antibiotics is frequently used in these patients. Moreover, patients with hematopoietic malignancies complicated by MRSA pneumonia have a poor prognosis. We examined lymphocyte subpopulations in bronchoalveolar lavage fluid (BALF) in MRSA pneumonia-complicated patients with hematopoietic malignancies and studied their relationship with the clinical features. We also discuss the cause of their poor prognosis. Of 223 patients with hematopoietic malignancies, 18 (8.1%) were complicated by MRSA pneumonia. Many of those patients had lymphoid malignancies. MRSA pneumonia occurred when neutrophil count was decreased. Most patients had been treated with chemotherapy containing anticancer drugs or with corticosteroid therapy. They had also been treated with third generation cefem antibiotics. We studied lymphocyte subsets in BALF in MRSA pneumonia-complicated patients with non-Hodgkin's lymphoma (NHL) and observed the local changes of the pulmonary immunological system due to NHL itself and due to anti-lymphoma chemotherapy. Our findings suggest the possibility that these immunological changes may play a role in the susceptibility to MRSA pneumonia.

Adult↗
PubMed1994

[Lennert's lymphoma associated with the syndrome of inappropriate secretion of antidiuretic hormone and autoimmune hemolytic anemia].

We report a case of Lennert's lymphoma complicated by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and autoimmune hemolytic anemia (AIHA). A 76-year-old female patient was admitted to our hospital because of cervical lymph node swelling. A diagnosis of Lennert's lymphoma was made by histological examination of the biopsied lymph node. She was also diagnosed as SIADH and AIHA. After the patient was treated with COP-BLAM therapy, lymph-adenopathy, SIADH and AIHA improved. However, lymph node swelling and hyponatremia became exacerbated again after the third course of COP-BLAM therapy. Then she was treated with IMV-triple P therapy. Eventually, she died of aspergillus pneumonia. The etiology of her SIADH was suggested to be an abnormal feedback mechanism of ADH secretion due to the infiltration of lymphoma cells into the diencephalic-hypophysial system.

Aged↗