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V Koza

Publications and source records attributed to V Koza.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Treatment of multiple myeloma with high-dose chemotherapy and transplantation of autologous hematopoietic stem cells and subsequent maintenance therapy with interferon alfa-2b or interferon alfa 2b and dexamethasone. Report of the ongoing study of the "4W" Czech Myeloma Group].

We report our results with high-dose chemotherapy in previously untreated multiple myeloma patients (4 courses of VAD chemotherapy, collection of PBSC after priming with cyclophosphamide, 5 g/m2, high-dose chemotherapy with melphalan, 200 mg/m2). Second transplantation was indicated only for patients who did not achieve remission after the first high-dose therapy (paraprotein lower than 25% of the pretreatment value). For the second transplantation melphalan (200 mg/m2) with methylprednisolone (1.5 g for 5 days) were used as conditioning regimen. After high-dose therapy all patients were randomized into two arms of maintenance therapy: interferon alpha-2b or sequential maintenance therapy (interferon alpha-2b for 3 months followed after 4 week pause by 40 mg of dexamethasone days 1-4, 10-13 and 20-23. The administration of interferon alpha was resumed four weeks after the last dexamethasone for next three months. The maintenance therapy continued for 48 months or until the progression. Fifty-five patients were enrolled in the study from January 1996 to August 1997. Thirty-five patients have undergone the first transplantation and 57% of them reached complete remission. There were 10% of non-responders after the first high-dose regimen. The mean time to reach white blood cell count above 1 x 10(9)/L after the application of high dose melphalan and platelets more than 50 x 10(9)/L were 12.2 (range 6-16 days) and 12.4 (range 0-25 days), respectively. Grade 4 mucositis according to SWOG classification requiring total parenteral nutrition was presented in 40% of the patients. The mean number of 1 unit of platelets and 2 units of packed red blood cells transfusions were given within the posttransplant period. Early transplant related mortality was 3%. This paper describes the response and tolerance of each particular step of therapy. The follow-up has been too short to evaluate event-free and overall survivals.

Adolescent↗
PubMed1998

[Monitoring cytomegalovirus infection using the 2-step nested polymerase chain reaction in patients with allogenic bone marrow transplantation].

Cytomegalovirus infections and their sequelae are the most serious complications in patients after allogenic bone marrow transplantations. Therefore in recent years quite rightly attention is paid to new diagnostic methods which make earlier and more sensitive detection of incipient CMV infection possible. The method of the two-stage polymerase chain reaction (PCR) was used for early detection of CMV infection and its possible further monitoring in 38 recipients of allogenic bone marrow. A positive result was recorded in 15 (39%) patients whereby in 10 (13%) repeated positivity was involved. In three in this group of patients (8%) CMV disease developed, always preceded by PCR positivity. Sensitivity, specificity, positive and negative predictive CMV PCR values were 100, 66, 20 and 100%. Concomitant comparison with serological examination (antibody titre class IgM/seroconversion) revealed the small contribution of serology (corresponding values are 67, 54, 11 and 95%) in patients after bone marrow transplantations. The presented results provide evidence of the contribution of PCR in the diagnosis of CMV in those patients where due to their high sensitivity and excellent predictive value it is possible to avoid the toxicity of unnecessary antiviral treatment.

Adolescent↗
PubMed1997

Donor work-up and transport of bone marrow--recommendations and requirements for a standardized practice throughout the world from the Donor Registries and Quality Assurance Working Groups of the World Marrow Donor Association (WMDA).

In October 1995 the World Marrow Donor Association (WMDA) was restructured in order to facilitate its primary function of establishing guidelines in relation to international bone marrow and blood stem cell transplants -- transplants in which the donor is in one country and the patient is in another country. Five new working groups were established -- Donor Registries, Ethics, Quality Assurance, Finances, and Stem Cells. This paper, prepared by members of the Donor Registries Working Group, in consultation with the Quality Assurance Working Group, provides recommendations for the 'donor work-up'. This term covers events that start when the definitive donor has been identified, includes the harvesting (collection) and transportation of the stem cell product and ends when the product reaches the transplant centre. The paper includes examples of the documentation intended to ensure compliance with the recommendations at all key points in the sequence.

Bone Marrow Transplantation↗
PubMed1997

Individual criteria could be optimal for starting G-CSF application after autologous stem cell transplantation.

The optimal time for starting G-CSF application after autologous peripheral stem cell transplantation (APSCT) still remains undetermined. All previous studies used 'fixed' days (0 or +1 vs +5 or +7 post-transplant) for this purpose. As many other drugs have individual, patient-dependent criteria (eg antibiotics, blood products, etc), and the discontinuation of G-CSF also has strict patient-dependent criteria (surprisingly absent when starting the drug) we suppose that attempts to find general criteria suitable for every patient may not be successful. In order to also take the patients' individual predispositions into account we designed a randomized clinical trial to compare 'immediate' administration of G-CSF (day +1: group A) vs 'delayed, patient-dependent' (first day when absolute neutrophil count (ANC) was below 0.5 x 10[9]/1: group B) therapy with G-CSF (both groups received 10 microg/kg/day i.v.). A total of 70 patients after APSCT suffering from non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) conditioned with BEAM, or from multiple myeloma (MM) after melphalan (L-PAM: 200 mg/m2) were enrolled in this study (35 in each group). Both groups were comparable with regard to age, sex, disease stage and previous therapy as well as the number of CD34+ cells transplanted. In group B, G-CSF administration began on day +4 post-transplant (+2 - +5). There were no detectable differences seen in the hematopoietic recovery (time to reach ANC more than 0.5 x 10(9)/l: 12 days vs 13 days; time to platelet recovery, more than 50 x 10(9)/l: 24 days in both groups), use of blood products or antibiotics, infections, or days of hospitalization. Delayed G-CSF application led to significant cost saving in terms of APSCT (approximately US$1341 for each patient). We suggest that 'patient-dependent' criteria for starting G-CSF are reasonable especially in patients conditioned with protocols only slowly inducing neutropenia: eg NHL and HD patients after BEAM, MM after L-PAM or patients after busulphan and cyclophosphamide (BUCY2).

Adult↗
PubMed1994

The influence of induction chemotherapy and remission status on haemostasis in patients treated for acute myeloid leukaemia.

Haemostatic parameters were studied in 31 adult patients treated for acute myeloid leukaemia (AML) using the 3 + 7 regimen. Lower values of antithrombin III (AT-III), alpha 2-antiplasmin (alpha 2AP) and plasminogen were observed on days 8 and 14 (P < 0.05). Fibrinopeptide A (FpA) levels were higher at diagnosis (P < 0.05), increased again during chemotherapy on days 4 and 8 and eventually returned to the normal range. Tissue plasminogen activator, plasminogen activator inhibitor, protein C and fibrin(ogen) degradation products were normal throughout the period of observation. Complete remission (CR) was achieved in 19 of 31 patients (61%). In order to compare haemostatic changes in CR patients with those in refractory cases, patients were divided into two groups. In patients with refractory AML (n = 12) AT-III, plasminogen and alpha 2 AP were significantly lower than in those in CR. FpA levels were increased in all patients at diagnosis. This elevation progressed in both groups during chemotherapy (on days 4 and 8) and then normalized only in patients in CR. However, in resistant patients, higher FpA values persisted or even increased further on day 14. The fact that none of our patients suffered from clinically manifest thrombotic complications suggested that haemostasis was well compensated and the observed changes were of no clinical importance, even if they were significant statistically.

Antithrombin III↗
PubMed1994

[Hemostasis in patients with acute leukemia treated with high doses of cytosine-arabinoside: the effect of chemotherapy and infectious complications on hemostasis].

Haemostatic parameters were studied in 12 adult patients with acute myeloid leukaemia and acute lymphoblastic leukaemia in complete remission using high-dose cytosine arabinoside regiments together with with other drugs. Increased tissue plasminogen activator (t-PA:Ag) antigen 4 hours after AraC application (p < 0.05) as well as increased levels of plasminogen activator inhibitor activity (PAI) (p < 0.05) and fibrinopeptide A (FPA) antigen (p < 0.05) were observed on day 2. All patients during bone marrow aplasia suffered from infectious complications (7 from sepsis and 5 from fever of undetermined origin). During that period of infection the increased levels of FPA on day 21 (p < 0.05), PAI on days 15 and 21 (p < 0.05) and fibrinogen on day 21 (p < 0.05) as well as decreased values of antithrombin III (p < 0.05) on day 21 and protein C on day 15 (p < 0.05) were measured. t-PA:Ag, plasminogen, alpha 2 antiplasmin and fibrin(ogen) degradation products were within normal throughout infectious complications. None of the patients experienced clinically manifest thrombotic complication. Though the results demonstrate that changes found were not clinically important (even if they were statistically significant), and that haemostasis was compensated as well as that thrombosis was not serious problem, authors recommend routine haemostasis monitoring in acute leukaemia patients, especially at diagnosis, in association with chemotherapy and during infectious complications.

Acute Disease↗
PubMed1994

Spindle cell tumor of lymph node of probable reticulum cell origin associated with multiclonal gammopathy.

We describe a case of a 48 year old man who presented repeatedly with a neck lymph node tumor. The tumor grew insidiously over 11 years and the patient died at the age of 58 with the generalization of the tumor into the right cervical, paratracheal lymph nodes and spleen. The tumor was composed of spindle shaped cells with occasional intranuclear cytoplasmic pseudoinclusion. At the ultrastructural level the tumor revealed membrane bound crystalline inclusions, which were locally in direct contact with both the nuclear envelope and confronting cisternae of the endoplasmic reticulum. The tumor was associated with multiclonal gammopathy composed of two subsets of IgG/lambda and one subset of IgA/lambda positive paraprotein produced by lymphoid cells surrounding the tumor. We diagnosed the tumor as "spindle cell tumor of lymph node of probable reticulum cell origin associated with multiclonal gammopathy" and consider the lymphoid tissue producing the paraprotein to be reactive.

Autopsy↗
PubMed1994

[The central registry of bone marrow donors and the program for bone marrow transplantation from unrelated donors--20 months' experience].

The authors describe their 20 months' experience with the establishment of a bone marrow register in the Czech Republic and its practical association with the programme of bone marrow transplantations from non-related subjects. During the 20 months of activity 5455 voluntary bone marrow donors were examined and at present more than 500 new voluntary donors are examined every month. For 21 patients a HLA identical unrelated donor is sought. For four patients a HLA compatible donor was found. The first bone marrow transplantation from a unrelated donor was performed and another patient is prepared for transplantation within the next few days. The authors discuss professional, organizational, moral and ethical problems associated with the elaboration of this medical programme.

Adult↗
PubMed1993

Littoral cell angioma of the spleen. A case report with ultrastructural and immunohistochemical observations.

We describe histological, immunohistochemical and ultrastructural findings in a case of littoral cell angioma of the spleen in a 44 year old man. Beside phagocytosis and heavy haemosiderin deposits in the cytoplasm, a very characteristic and hitherto undescribed feature of the littoral cells was focal accumulations of eosinophilic globules 0.5-2 microns in size, which often entirely filled the cytoplasm of the tumour cells. Ultrastructurally the globules were composed of abundant cytoplasmic deposits of lysosomes and residual bodies. The globules most probably originate from the phagocytized red blood cells, lymphocytes and plasma cells. Immunohistochemically the tumour cells reacted positively with antibodies against factor VIII-related antigen, KiM1P, KP1 and lysozyme and negatively with antibodies against cytokeratins AE1-AE3, EMA and S-100 protein. Ultrastructurally the tumour cells often formed long cytoplasmic processes without external lamina and pinocytic vesicles. Scarce and poorly formed junctions between the tumour cells were seen. Very rarely cytoplasmic rod-shaped microtubulated bodies, often difficult to distinguish from heavy accumulations of lysosomes were observed.

Adult↗
PubMed1993

[The significance of plasminogen activator inhibitor 2 in patients with hematologic malignancies].

The authors investigated the incidence of the plasminogen activator inhibitor-2 (PAI-2) in 88 patients with haematological tumours. In four patients (4.5%) an elevated PAI-2 level was found: in patient (no. 1) with non-differentiated leukaemia which developed as a result of transformation of myelodysplastic syndrome, in a female patient (no. 2) with non-differentiated blastic crisis of chronic myeloid leukaemia, in a female patient (no. 3) with acute monocytic leukaemia (M5) and in a pregnant female (patient no. 4) with a malignant lymphogranuloma. In none of the other patients with another type of acute myeloid leukaemia or other haematological tumours PAI-2 was detected. High PAI-2 levels after successful cytostatic treatment and attainment of complete remission reached normal levels, during a relapse high PAI-2 levels were recorded again. The authors assume that the presence of PAI-2 may suggest a monocytic origin of the cells which produce it. They conclude also that its value may reflect the activity of the disease with high levels during presentation or relapse of the disease and a drop or disappearance of PAI-2 after successful treatment and achieved remission.

Female↗
PubMed1992

Myoid differentiation in vascular transformation of lymph node sinuses due to venous obstruction. Immunohistochemical and ultrastructural studies.

Five cases of vascular transformation of lymph node sinuses due to venous obstruction are described in this paper. Evidence was found in four cases to actin immunoreactivity, and involvement of myofibroblasts was electronmicroscopically observed in one case. Differential diagnosis of vascular transformation of lymph node sinuses is discussed. The lesion is similar to KAPOSI's sarcoma-like subcutaneous processes and to chemodectoma-like bodies in the lung.

Adult↗
PubMed1991

[Diagnostic use of neutrophil segments negative for peroxidase, chloroacetate esterase and sudanophilia in peripheral blood in leukemia].

The paper contains the results of three cytochemical reactions used for detection of myeloid differentiation (peroxidase, sudanophilia, chloroacetate esterase) in neutrophil segments of the peripheral blood stream in 107 patients with acute myeloid or lymphatic leukaemia. Enzymatically deficient segments were detected in 23 (34.8%) patients with acute myeloid leukaemia. They were not found in any patients lymphatic leukaemia not in healthy subjects. The concurrent deficit of all three reactions was found in 69% of the cases with defective neutrophil segments. However, also isolated affection of any of these reactions was found. In acute leukaemias, not differentiated from the cytochemical and immunophenotypical aspect, we may consider simple evidence of the presence of the mentioned abnormal neutrophil segments in peripheral blood as a highly probable sign of myeloid differentiation of acute leukaemia.

Acute Disease↗
PubMed1991

[Development of therapy of acute myeloid leukemia at the First Internal Medicine Clinic in Plzen].

The authors summarize the development of diagnosis and treatment of acute myeloid leukaemias (AML) at the First Medical Clinic in Plzen in a (group) of 102 patients treated during 1966-1990. On their own results they demonstrate the importance of intensive post-remission treatment with large doses of cytosine arabinoside (ara-c) which makes possible long survival or complete recovery of some patients, and at the same time the necessity and pretentious character of comprehensive supportive treatment is emphasized.

Acute Disease↗
PubMed1991

[Injections of mitoxantrone, VUFB Praha, in the treatment of acute myeloid leukemia and non-Hodgkin's lymphoma].

Mitoxantrone injections (Mx), VUFB Prague, were administered to 24 patients with acute myeloid leukaemia (AML) and non-Hodgkin lymphoma (NHL). Patients with NHL were treated by monotherapy with Mx or by polychemotherapy in combination with CMOP (cyclophosphamide, mitoxantrone, vincristine, prednisone). To patients with AML Mx was administered 1x during induction treatment as monotherapy, in the remaining nine patients as post-remission treatment or re-induction treatment in combination with medium doses of cytosine arabinoside (IDAC + Mx). A positive therapeutic effect was observed in NHL with a high or medium degree of malignity during primary as well as during secondary treatment. Very good therapeutic results with Mx were achieved in AML in induction, post-remission and even re-induction treatment with a minimal haematological and non-haematological toxicity.

Acute Disease↗
PubMed1990

[The effect of HLA alloimmunization and other factors on the effectiveness of thrombocyte concentrates].

Sixteen patients with severe thrombocytopenia and secondary bone marrow inhibition were given 81 thrombocyte concentrates. In 55.6% platelet transfusions led to an adequate posttransfusion rise of platelets, in 44.4% of thrombocyte transfusions the increase of platelets was not satisfactory. The cause of the inadequate posttransfusion rise of platelets in 19.4% were antibodies against HLA antigens. In addition to other known factors which influence the rise of platelets a significant relationship was revealed between administration of Amphotericin B, broad spectrum bactericide antibiotics and the body temperature. To improve substitution of thrombopenic patients by platelet concentrates the authors recommend to create a national register of HLA typed donors.

Adult↗
PubMed1990

[Pure red cell aplasia in chronic lymphatic leukemia. Successful treatment using immunosuppression].

The authors describe two cases of chronic lympocytic leukaemia complicated by pure red cell aplasia of autoimmune origin. The first patient achieved complete recovery of erythropoiesis after short-term immunosuppression by means of cyclophosphamide and prednisone. The second patient did not respond to the same combination of immunosuppressive drugs and remission was achieved by administration of antithymocyte globulin. In the discussion the authors deal with contemporary knowledge of the pathogenesis of autoimmune erythroblastopenia and mechanismus of action of antithymocyte globulin.

Aged↗