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P Carlier

Publications and source records attributed to P Carlier.

At least 19 recordsLinked to original sources
PubMed1992

Autologous and allogeneic bone marrow transplantation in acute myeloid leukemia in first complete remission: an update of the Genoa experience with 159 patients.

In the attempt to evaluate the role of Autologous and Allogeneic Bone Marrow Transplantation, we have retrospectively analyzed 159 patients with Acute Myeloid Leukemia in first complete remission treated in our Unit, most of whom were referred from other Institutions. High-dose therapy was uniform and consisted of cyclophosphamide 60 mg/kg/d on two consecutive days and TBI in a single dose (10 Gy) for ABMT patients and in fractionated doses (3.3 Gy x 3 days) for BMT patients. Eight years actuarial survival was similar in two groups (52% for BMT and 49% for ABMT). The actuarial risk of relapse for BMT and ABMT was 29% and 43%, respectively. Considering that none of ABMT patients was "purged" with in vitro technique, this review seems to confirm the importance of "in vivo" purging with postremission intensification, immediately before the harvesting. Of course, more patients and a longer follow-up are needed to draw final conclusions.

Adolescent↗
PubMed1992

Intensive conventional chemotherapy can lead to a precocious overshoot of cytogenetically normal blood stem cells (BSC) in chronic myeloid leukemia and acute lymphoblastic leukemia.

Forty patients with Ph-positive blastic phase (BP) (28 patients) or chronic phase (CP)-CML (3 patients) and relapsed adult acute lymphoblastic leukemia (ALL) (9 patients) with cytogenetical translocations [t(8;14):2 patients; t(4;8):2 patients; t(4;11):3 patients; t(9;22):2 patients], received an intensive conventional chemotherapy. During early recovery from marrow aplasia, when WBC reached 0.3-1.5 x 10--9/L, peripheral blood stem cells (BSC) were collected by 4-8 leukapheresis consecutively. BSC collected from the 2/3 patients with CP-CML resulted Ph-negative and PCR negative. In 8 out of 26 BP-CML patients, BSC resulted Ph-negative and in two cases PCR negative. Of the nine ALL patients, 6 patients lost the cytogenetic translocations, one patient died during aplasia, two patients did not have cytogenetic modifications and died in few weeks of leukemia and one patient out of six responding patients relapsed before transplant. After complete recovery, 15 patients (BP-CML:8 patients; CP-CML:2 patients; ALL:5 patients) were subsequently given high-dose therapy (VP-16 +/- Cy+TBI in single dose) followed by reinfusion of "normal" BSC. Both the patients in CP-CML and 5/5 patients with ALL maintain clinical and cytogenetic remission; all the patients transplanted in BP-CML relapsed 5-18 months post-transplant. It is concluded that intensive conventional chemotherapy employed in CML and ALL can lead to a precocious overshoot of cytogenetically normal BSC.

Adolescent↗
PubMed1991

Cyclosporine-induced graft-versus-host disease after autologous bone marrow transplantation in hematological malignancies.

In the attempt to induce graft-vs-host disease (GVHD) in patients undergoing autologous bone marrow transplantation (ABMT) or blood stem cell transplantation (BSCT), 12 consecutive patients received cyclosporin A (CyA) post transplant. CyA was given at a dose of 1.5 mg/kg/day intravenously for 28 days, starting on the day of transplant. Histologically proven acute GVHD of the skin occurred in seven patients 9-14 days after ABMT and lasted 7-11 days. CyA-induced GVHD after ABMT resembles mild GVHD after allogeneic bone marrow transplantation (BMT). Although the preliminary data reported here show that it is possible to induce GVHD in patients undergoing ABMT, it is not yet known whether GVHD after ABMT will have an antitumor activity.

Adult↗
PubMed1991

Lung fluid dynamics and supply dependency of oxygen uptake during experimental endotoxic shock and volume resuscitation.

BACKGROUND AND METHODS: We studied the effect of volume resuscitation on lung fluid balance and systemic oxygen extraction during septic shock in eight anesthetized dogs. Sepsis was induced using a 2-hr continuous infusion of Escherichia coli endotoxin at 0.25 micrograms/min.kg. Relationships between oxygen uptake (VO2) and oxygen supply (DO2) were performed acutely during stepwise controlled decrements in cardiac output by progressive inflation of an intracardiac balloon. At each stage, DO2 and corresponding VO2 were measured independently and the individual critical DO2 level was referred to as the point below which the relationship held. The slope of such a constructed relationship was defined as the maximal oxygen extraction ratio. Lung fluid balance was assessed by measurements of extravascular lung water. All values were studied at baseline, after endotoxin insult, and after reversing hypotension by a 10% dextran infusion. RESULTS: Endotoxin infusion led to a shock state that associated hypotension (from 135 to 63 mm Hg) with increases in blood lactate (from 0.53 to 3.9 mmol/L). The mean critical DO2 and maximal oxygen extraction ratio were significantly altered from 7.9 to 17.8 mL/min.kg and from 0.81 to 0.38, respectively. After reversing hypotension by 28 mL/kg colloid infusion, the critical DO2 (11.4 mL/min.kg) and maximal oxygen extraction ratio (0.48) were significantly improved. However, restoration of normal values required a state of fluid overload by further dextran infusion (8 mL/kg). At the end of the fluid challenge, extravascular lung water significantly increased from 6.4 to 17.4 mL/kg. CONCLUSIONS: These data suggest that volume loading may reverse endotoxin-induced peripheral perfusion abnormalities. However, substantial pulmonary edema may occur, possibly jeopardizing the beneficial effects of fluid expansion.

Animals↗
PubMed1991

Therapy of acute phase chronic myelogenous leukemia with intensive chemotherapy, blood cell autotransplant and cyclosporine A.

The expansion of the Philadelphia (Ph) chromosome positive clone in chronic myeloid leukemia (CML) may depend on its capacity to suppress the proliferation of Ph-negative stem cells, but this proliferative advantage might, in certain circumstances, be reversible. Various lines of evidence suggest that Ph-negative cells, albeit in a suppressed state, must still be present. As recently suggested, the expansion of 'putative' normal Ph-negative hemopoietic stem cells might have, in certain circumstances, a proliferative advantage over the Ph clone in CML. This suggests that the treatment of CML with intensive chemotherapy might allow the collection of Ph-negative hemopoietic cells in the early phase of recovery. Eight patients with acute phase chronic myelogenous leukemia (AP-CML) were treated with idarubicin, intermediate dose cytarabine and etoposide. During recovery from bone marrow aplasia, when the white blood cell count reached 0.3-1 x 10(-9), blood cells were collected with 2-5 (median 3) consecutive leukapheresis. In 5/8 patients, these peripheral cells were Ph-negative at the cytogenetic analysis. Moreover, in one case the polymerase chain reaction analysis performed to detect the presence of minimal residual disease in the cells collected by leukapheresis was negative, further confirming that this approach may induce a very high degree of suppression of the Ph-positive clones. After complete recovery, these five patients were subsequently treated with high-dose etoposide, cyclophosphamide and total body radiation (10 Gy, single dose) followed by reinfusion of Ph-negative peripheral blood stem cells. All these patients received cyclosporine A post-autotransplant in an attempt to induce acute graft-versus-host-disease. Three of 5 patients remain in clinical and cytogenetic remission 5-15 months post-transplant. It is concluded that Ph-negative peripheral blood stem cells can be recovered from patients with AP-CML and used successfully to restore Ph-negative hemopoiesis after high dose therapy.

Adult↗
PubMed1991

Autologous bone marrow transplantation as adjuvant treatment for high-risk Hodgkin's disease in first complete remission after MOPP/ABVD protocol.

Fifteen patients with very poor prognosis Hodgkin's disease in remission after MOPP/ABVD regimen, were treated with high-dose chemotherapy (HDC) and autologous marrow transplantation (ABMT) immediately after achieving complete remission (CR). Thirteen patients (86.6%) remain alive in unmaintained CR at a median time of 36 months (range 10-64 months) post-transplant. In the other two patients reasons for failure included relapse of Hodgkin's disease (one patient) and death due to interstitial pneumonitis secondary to carmustine therapy. These patients were compared with a historical control group consisting of 24 patients with the same poor prognostic factors, who achieved CR with MOPP/ABVD and did not receive other treatment. Eight out of 24 patients (33%) remain alive and well in unmaintained CR at a median time of 42 months (range 19-83 months). The administration of MOPP/ABVD combined with HDC and ABMT was not associated with an increased incidence of major toxicity. The results achieved support the early sequential treatment of a highly effective drug combination followed by HDC/ABMT that can substantially improve the likelihood of cure in these advanced stage very poor prognosis Hodgkin's disease patients.

Adolescent↗
PubMed1991

Sympatholytic drugs and cardiac remodelling in human and experimental arterial hypertension.

Perfusion of isoprenaline in the dog may induce left ventricular hypertrophy (LVH), and this effect is suppressed by propranolol. Cultured foetal cardiomyocytes exposed to catecholamines show an increase in protein synthesis and RNA turnover. In spontaneously hypertensive rats (SHR), and perhaps in man, sympatholytic agents appear to be more effective in preventing or reversing LVH than some other antihypertensive drugs. These data suggest that, if increased load remains the main trigger mechanism for cardiac remodelling in arterial hypertension, the sympathetic nerve activity may modulate the response of the cardiac cells.

Animals↗
PubMed1991

Nine years' experience with ABMT in 128 patients with Hodgkin's disease: an Italian study group report.

One-hundred, twenty-eight patients with Hodgkin's disease in remission or who had failed a mechlorethamine, vincristine, procarbazine and prednisone (MOPP), a doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) and/or lomustine, etoposide and prednimustine (CEP) regimens have been treated with a high-dose therapy (HDT) containing cyclophosphamide, etoposide, carmustine (CVB) and autologous bone marrow transplantation (ABMT). Forty patients were treated while they were in resistant or progressive disease states using alternating MOPP/ABVD protocol; 15 patients received ABMT in first relapse; 51 patients had a complete remission (CR) with first-line therapy but later relapsed and then received conventional salvage therapy; 16 achieved no response or progression ("resistant relapse" patients) and 35 responded partially or completely ("sensitive-relapse" patients). The other 22 patients received ABMT in remission. Following HDT, 56 patients (52.8%) achieved CR and 23 patients (21.6%) achieved a partial remission for an overall response rate of 74.4%. Sixteen patients failed to respond and died in progressive disease 1 to 10 months (median 6 months) after ABMT. High-dose therapy produced severe toxicity including vomiting (100%), mucositis (75%) and liver enzymes and alkaline phosphatase elevations (51%). There were 10 treatment-related deaths. A multivariate analysis identified poor performance status and resistant-relapse patients as very important adverse risk factors for survival immediately after ABMT. These results, while validating this procedure for inducing remissions in advanced highly-treated patients, at the same time confirm the need of employing this approach in first relapse or in second complete remission after standard therapy and before ABMT or, in first complete remission in very high risk Hodgkin's disease patients. Our experience in 15 very poor prognosis Hodgkin's disease patients transplanted in first CR demonstrated to be much significant.

Adult↗
PubMed1990

Clinical use of GM-CSF in autologous bone marrow transplantation.

Over the last decade, the key role of specific glycoproteins (hematopoietic growth factors) in the proliferation and maturation of hematopoietic cells (in conjunction with some of their particular functional activities) has been demonstrated through in vitro and in vivo studies. These glycoproteins have been evaluated for their potential application in reducing the duration of myelosuppression following conventional chemotherapy and autologous bone marrow transplantation. Preliminary results using granulocyte-macrophage colony-stimulating factor to restore neutrophil competence seem to be encouraging.

Agranulocytosis↗
PubMed1990

[Effect of long-term administration of vasodilators and "antitrophic" agents on the structure and function of the heart in hypertensive rats].

In this study, we determined whether the persistency of cardiac hypertrophy after chronic vasodilation therapy with minoxidil (minox) was associated with functional or metabolic alterations in hypertensive rat hearts before, during and after an ischemic insult. In addition, we investigated the effects of the simultaneous administration of difluoromethylornithine (dfmo), a substance that could block hypertrophy by a direct inhibition of protein synthesis. Four groups of male Wistar rats were prepared: 1) normotensive controls (n = 8), 2) untreated renovascular hypertensive rats (HT, n = 15), 3) hypertensives treated with minox (8 mg/kg, n = 19), 4) hypertensives treated with minox and dfmo (1.7 g/kg, n = 20). After 21 days of treatment, the animals were sacrificed. In a small number of hearts, ornithine decarboxylase (ODC) activity was assayed in order to verify that dfmo, which is a suicide inhibitor of ODC, had effectively interrupted the polyamines pathway. The other hearts were prepared for retrograde perfusion at 35 degrees C and at constant flow (10 ml/min x g). Cardiac function was monitored via the balloon inserted in the left ventricle (LV) and the following protocol was applied: a) baseline period (24 min), b) ischemia (24 min), c) recovery (36 min). Finally, the hearts were weighed and LV wall thickness and inner radius were measured. Blood pressure was maintained near normotension in the two treated groups. Mean systolic pressure (in mmHg) was 145 +/- 4 with minox and 144 +/- 3 with minox + dfmo versus 181 +/- 4 in the HT group (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[Radiologic abnormalities of the sinuses in juvenile allergic asthma. Comparison with a control population].

X-ray features of sinuses have have been studied in 50 young adult allergic asthmatic patients and compared with 55 non allergic, non asthmatic, young subjects. The aim of the study was to determine the frequency of abnormalities of sinuses and to look for own abnormalities to asthmatic patients. 60% of the asthmatic patients showed sinuses abnormalities, and 40% among non asthmatic subjects (p less than 0.05). Nevertheless, there were non significant differences in mucosal thickening of maxillary sinuses among asthmatic patients and non asthmatic subjects. So, this feature cannot be useful as a diagnostic symptom of allergic asthma. In this study, asthmatic patients with X-ray sinuses abnormalities were not more severe than those without abnormalities.

Adult↗