Biomedical subjects

N Steckel

Publications and source records attributed to N Steckel.

4 recordsLinked to original sources

PubMed2005

Caspofungin as second-line therapy for fever of unknown origin or invasive fungal infection following allogeneic stem cell transplantation.

Caspofungin (CAS) is the first of a new class of antifungal agents, the echinocandins, that interfere with fungal cell wall synthesis by inhibition of glucan synthesis. Here, we report the results of 31 patients treated with CAS following allogeneic SCT. CAS was administered as a second-line agent to patients with invasive fungal infection (IFI) (n=15) or fever of unknown origin (n=16) who were recalcitrant to or intolerant of prior antifungal therapy. Unsuccessful first-line regimes included amphotericin B (n=17), liposomal amphotericin B (n=5), fluconazole (n=3), itraconazole (n=1), and voriconazole (n=2). All patients received concomitant immunosuppressive therapy for graft-versus-host disease. In 23 patients, cyclosporin A (CSA) and CAS were administered concurrently without any major side effects detected. Observed increases in GPT were not clinically significant. Normalization of serum creatinine and significant reductions in C-reactive protein were observed in response to CAS. Favorable outcome to CAS were documented in eight of 15 patients with IFI and in 15 of 16 patients with fever of unknown origin. CAS is a promising alternative in patients with IFI and fever of unknown origin in the setting of allogeneic SCT.

Adolescent↗

PubMed2001

A comparison of chimerism and minimal residual disease between four different allogeneic transplantation methods in patients with chronic myelogenous leukemia in first chronic phase.

The detection of chimerism, residual molecular and cytogenetic disease following transplantation of peripheral blood stem cells (PBSCT) with a nonmyeloablative conditioning (n = 9) and the transplantation of highly purified CD34(+) stem cells (CD34(+) PBSCT) (n = 16) were compared to unmanipulated bone marrow transplantation (BMT) (n = 69) and unmanipulated PBSCT (n = 50) after myeloablative conditioning in patients with first chronic phase of chronic myelogenous leukemia (CML) (n = 137), second chronic phase of CML (n = 4), acute lymphoblastic leukemia (n = 2) and acute myeloid leukemia (n = 1). A molecular relapse (MR) as defined by two consecutive positive polymerase chain reaction assays for the detection of M-bcr-abl transcripts (n = 141) and cbfbeta-myh11 transcripts (n = 1) in a 4-week interval was found in 10 of 16 patients (63%) after CD34(+) PBSCT, and in 27 of 69 patients (39%) after BMT, whereas only three of 50 patients (6%) after PBSCT (P < 0.001) and one of eight patients (13%) after PBSCT with reduced conditioning suffered from a MR. A cytogenetic relapse occurred in five of 16 patients (31%) after CD34(+)PBSCT and 21 of 69 patients (30%) after BMT (NS) compared to two of 50 patients (4%) after PBSCT and none of the eight patients after PBSCT with reduced conditioning (P < 0.05). The lowest treatment-related mortality was seen in the 16 patients after CD34(+) PBSCT, who are all currently alive with a median follow-up of 15 months, whereas the survival rate for BMT, PBSCT and PBSCT with reduced conditioning were 65%, 63% and 58%, respectively. Multivariate analysis including all potential influential factors of post-transplant residual disease recurrence showed that patients after CD34(+) PBSCT had a significantly higher risk (two times) to develop a MR than patients after BMT (P < 0.03), whereas patients after unmanipulated PBSCT had a significant lower risk (eight times) for the occurrence of a MR post transplant (P < 0.001). Patients after BMT and CD34(+) PBSCT had the lowest rates of complete chimerism (CC) at 3 months after transplant. Only five of nine patients (55%) after CD34(+) PBSCT and 19 of 33 patients (58%) after BMT achieved CC compared to 19 of 22 (86%) patients after PBSCT and seven of eight (88%) patients after PBSCT with reduced conditioning (P < 0.05).

Actuarial Analysis↗

PubMedDate not supplied

Ependymomas: a clinical and pathologic study. Part I. Biologic features.

A series of 102 Oxford ependymomas was analyzed by comparing certain clinical data with pathologic data obtained by a review of the histologic slides of the tumors. All the data analysis was performed by computer, thus permitting a rapid search of many parameters for relationships of statistical significance. Age and site were found to be associated with the duration of pre-operative symptoms, mitotic index, tumor cell number, and some specific histologic features.

Adolescent↗

PubMedDate not supplied

Ependymomas: a clinical and pathologic study. Part II. Survival features.

A survival analysis of cases of ependymoma was performed. Patients with ependymomas of the infratentorium were found to have shorter disease-free intervals and to live for a shorter time after treatment than those with tumors of the cauda equina. Children with infratentorial tumors did not have a recurrence if they survived 3 or more years after operation, whereas adults with infratentorial tumors could have a first recurrence even 5 or more years after surgery. Younger patients did not survive as long as older patients in the group of infratentorial ependymomas. In contrast, age did not influence survival in patients with cauda equina ependymomas. Patients with ependymomas of the infratentorium and the cauda equina having long histories had a better prognosis than those with short histories. Changes in mitotic index and tumor cell number could not be correlated with the length of survival. In the infratentorial group, patients with rosette-bearing tumors had a poor prognosis, whereas patients with subependymal areas in their tumor had a better prognosis. Total surgical removal with no further treatment appeared to be as effective as subtotal removal followed by radiotherapy for the cauda equina tumors.

Adolescent↗