[Chemotherapy of multiple myeloma. Review of the recent trials].
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Antineoplastic Agents↗
Biomedical subjects
W Arcese
Publications and source records attributed to W Arcese.
ACTH 1-17 effects in acute myeloid leukemia.
We conducted a double blind randomized clinical study with 100 micrograms i.v. ACTH 1-17 versus placebo in 40 consecutive acute myelocytic leukemia patients (AML). The same regimen 3 + 7 schedule, employing daunorubicin (DNR) associated with cytosine-arabinoside (ARA-C), was applied as remission induction therapy to all patients. Prednisone therapy was performed as necessary. Twenty patients, receiving ACTH 1-17, were compared with 20 other patients receiving placebo in regard to remission rate, hemorrhagic and infective complications, remission duration and survival. No significant difference was observed between the 2 groups for all parameters taken into consideration. The two year actuarial curves of remission duration and survival showed a trend in favour of the ACTH 1-17 group. It needs a longer follow-up to evaluate if ACTH 1-17 will represent an effective adjuvant of the induction chemotherapy for the long-term control of the acute myelocytic leukemia.
Adolescent↗
Cryptosporidiosis in patients with hematologic malignancies.
The clinical features of cryptosporidial infection in 20 patients with hematologic malignancies were assessed. Five patients had severe diarrhea, 10 had moderate diarrhea, and five were asymptomatic carriers of Cryptosporidium. Extraintestinal cryptosporidiosis with pulmonary involvement was observed in one case and relapse of cryptosporidiosis in four. All but one patient recovered from cryptosporidiosis whether or not spiramycin was administered. Cryptosporidiosis in T cell-depleted recipients of allogeneic bone marrow transplants did not appear more severe than that in patients undergoing autologous bone marrow transplantation or conventional chemotherapy.
Adolescent↗
Gastrointestinal surgical emergencies in patients treated for hemathological malignancies.
BACKGROUND: Upper and lower gastrointestinal symptoms are major and serious complications in patients who undergo chemotherapy for hematological malignancies. Their most frequent causes are acute intestinal graft-versus-host disease (GVHD) after bone marrow transplant, infections, toxicity or preexisting gastrointestinal diseases. Mortality can reach 30-60% of cases. PATIENTS AND METHODS: We report 15 cases operated on for abdominal emergencies: 3 severe gastrointestinal bleeding and 12 acute abdomen. RESULTS: We performed 10 bowel resections, one cholecystectomy, one splenectomy, two laparotomy with pancreatic debridement and peritoneal lavage, and one suture of perforated peptic ulcer. Operative mortality was 33.3% (5/15). Deaths have been reported only in the group of patients with acute abdomen. In all cases death was correlated to generalized sepsis related to immunosuppression. CONCLUSIONS: We believe that an aggressive approach, consisting of close monitoring and early laparotomy combined with vigorous supportive therapy, should be used when dealing with suspected gastrointestinal complications in patients with hematological malignancies.
Adolescent↗
Ganciclovir and standard high-dose immunoglobulins for the treatment of cytomegalovirus interstitial pneumonia in a bone marrow recipient.
A 47-year-old woman received an allogeneic bone marrow infusion because of chronic myeloid leukemia. Two months after the transplant she developed an interstitial pneumonia: bronchoalveolar lavage yielded cytomegalic cells with intranuclear bodies, and cytomegalovirus DNA was detected by in situ hybridization techniques. Ganciclovir and standard high-dose immunoglobulins were administered to the patient with resolution of the pneumonia. No relapse of pneumonia was observed after a 4-month follow-up. It seems that the favorable outcome of the potentially fatal pneumonia observed in this patient might be related to early diagnosis, and prompt administration of ganciclovir and standard high-dose immunoglobulins.
Bone Marrow Transplantation↗
Long-term remission of T-lymphoid extramedullary blast crisis of chronic myelogenous leukemia following allogeneic bone marrow transplantation.
Extramedullary blast crisis (EBC) with T-lymphoid phenotype has been reported rarely and generally associated with extremely poor prognosis. We describe a case of T-lymphoid EBC in which long-lasting remission was observed following intensive chemotherapy and allogeneic bone marrow transplantation (BMT). Characterization of bone marrow (BM) and lymph node (LN) cells was performed by means of morpho-cytochemical, cytogenetic, immunophenotypic and molecular analyses. These showed, together with a marrow picture consistent with typical Ph'+ chronic myelogenous leukemia, the expansion of an early T-lymphoid (CD7+/TdT+) LN cell population exhibiting the same bcr rearranged pattern and an additional Ph' chromosome. At the present time, 33 months after BMT, the patient is alive and well, with persistent clinical, hematological, cytogenetic and molecular evidence of complete remission.
Adult↗
Hemolysis in Rh-negative female recipient after Rh-incompatible bone marrow transplantation for chronic myeloid leukemia.
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Adult↗
Cyclosporine-associated bilateral deltoid paralysis after allogeneic bone marrow transplantation for chronic myelogenous leukemia.
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Adult↗
Allogeneic transplants of rhG-CSF-mobilized peripheral blood stem cells (PBSC) from normal donors. GITMO. Gruppo Italiano Trapianto di Midollo Osseo.
There is a growing interest in the use of peripheral blood stem cells (PBSC) for allogeneic transplantation. This is due in part to the idea that, as with autologous transplantation, increasing the number of allogeneic hemopoietic progenitors infused may lead to reduced complications. However, introducing the PBSC technique into allogeneic transplants implies theoretical as well as ethical problems involving both patient and donor. We are still uncertain whether the PBSC technique will result in an increase of GVHD or (better) of GVL. G-CSF, necessary for effective PBSC mobilization, is safe but its use in normal subjects should be regarded with caution. For this reason, a Study Committee promoted by the GITMO (Gruppo Italiano Trapianto di Midollo Osseo) evaluated the key aspects of allogeneic PBSC collection and transplantation. The present paper summarizes the scientific data and suggests some guidelines for the introduction of allogeneic PBSC transplantation into clinical practice. The procedure should be considered experimental and the Committee strongly recommends the use of allogeneic PBSC in experienced centers, initially in patients with advanced disease. The donor should be given a complete explanation of the advantages and risks of G-CSF therapy, leukapheresis and general anesthesia. A careful monitoring of both patient and donor should also be included to watch for short-term and long-term side effects.
Granulocyte Colony-Stimulating Factor↗
Thrombotic thrombocytopenic purpura: a rare late complication of allogeneic bone marrow transplantation.
Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) usually occurs in a setting of systemic infection or graft-versus-host reaction during the first weeks following transplant. We report a case of fatal TTP that developed eight months after allogeneic bone marrow transplantation (BMT) without any evident association with other transplantation-related complications. Conditioning chemotherapy could have induced the disorder by causing damage to the vascular endothelium. The removal of immunosuppression, including cessation of cyclosporin A (CyA), may have precipitated the disease.
Adult↗
Biochemical indices may not accurately reflect changes in nutritional status after allogeneic bone marrow transplantation.
The validity of biochemical indices routinely used for nutritional assessment was evaluated in patients undergoing allogeneic bone marrow transplantation for hematologic malignancies. Sixteen patients received total parenteral nutrition (TPN) for 15 days (35 kcal kg.body wt-1.day-1; 1.4 g amino acid.kg body wt-1.day-1) starting 1 day after transplantation. Nutritional status was evaluated before and after the TPN period by determining anthropometric (body weight, triceps skinfold thickness, and midarm circumference) and biochemical (transferrin, prealbumin, ceruloplasmin, and C3c) indices. Anthropometric indices, which were within the normal range before TPN, were not changed on day 15; transferrin and prealbumin concentrations significantly (p = 0.03) decreased whereas ceruloplasmin and C3c significantly (p = 0.03) increased. The levels of acute-phase proteins (alpha-1-acid glycoprotein, alpha-1-antitrypsin, and C-reactive protein), determined in 8 of the 16 patients at the same time intervals, were increased after 15 days of TPN and were significantly inversely correlated with transferrin and prealbumin. On the basis of these data, it appears that biochemical indices are not sufficiently reliable in the nutritional assessment of bone marrow transplantation patients because the levels of these substances are markedly affected by the acute-phase response secondary to febrile episodes and graft-versus-host disease, which frequently complicate transplantation.
Acute-Phase Proteins↗
Peripheral blood stem cells for allogeneic transplantation. Recommendations from the GITMO 1996. Gruppo Italiano Trapianti di Midollo Osseo.
Allogeneic transplants with PBSC are rapidly expanding, but a number of problems concerning both donors and recipients are still unsolved. GITMO (Italian Bone Marrow Transplant Group) has established a committee for allogeneic PBSC transplants. We present here an analysis of the main aspects of this evolving area and suggest revised guidelines for the use of allogeneic PBSC transplantation.
Hematopoietic Stem Cell Transplantation↗
A single high dose of idarubicin combined with high-dose ABA-C (MSKCC ALL-3 protocol) in adult and pediatric patients with acute lymphoblastic leukemia. Experience at the University La Sapienza of Rome.
BACKGROUND AND OBJECTIVE: The anthracycline analogue idarubicin, either alone or in combination with other antineoplastic drugs, has shown antileukemic activity in relapsed and refractory acute lymphoblastic leukemia (ALL). In an attempt to minimize the non-hematologic toxicity and obtain a potent antileukemic effect, MSKCC activated a pilot study in previously treated adult ALL, using HD-ARA-C combined with idarubicin administered as a single high-dose infusion. We herein report our experience with a series of pediatric and adult high risk ALL and NHL patients treated with the protocol above, which confirms its feasibility, response rate and individual compliance. METHODS: In a clinical phase II study the combination of a single high dose (HD) idarubicin and HD cytosine-arabinoside (ARA-C), as designed at the Memorial Sloan Kettering Cancer Center, was applied to 70 adults and children with refractory or early relapse acute lymphoblastic leukemia (ALL) and T-cell lymphoblastic non-Hodgkin's lymphoma (NHL). Therapy consisted of HD-ARA-C 3 g/m2/d on days 1-5, idarubicin 40 mg/m2 on day 3, prophylactic intrathecal methotrexate on days 1 and 4, and G-CSF 5 mg/kg/d s.c. from day 7 to hematopoietic reconstitution (PMN > 0.5 x 10(9)/L). RESULTS: Fifty-five of the 70 patients (78%) achieved complete remission (CR), four died in aplasia due to infection and 11 were non-responders. Recovery of blood counts occurred at a median of 21 days from the start of treatment. Non-hematologic side effects were extremely limited and consisted predominantly of infections. INTERPRETATION AND CONCLUSIONS: In view of the highly unfavorable series of patients selected, this study confirms the feasibility and antileukemic activity of the HD-idarubicin + HD- ARA-C combination in patients with refractory and early relapse ALL and NHL. The excellent tolerance to this regimen does not preclude bone marrow transplantation as post-remission treatment.
Adolescent↗
A single high dose of idarubicin combined with high-dose ARA-C (MSKCC ALL-3 protocol) in adult and pediatric patients with acute lymphoblastic leukemia. Experience at the University "La Sapienza" of Rome.
BACKGROUND AND OBJECTIVE: The anthracycline analogue idarubicin, either alone or in combination with other antineoplastic drugs, has shown antileukemic activity in relapsed and refractory acute lymphoblastic leukemia (ALL). In an attempt to minimize the non-hematologic toxicity and obtain a potent antileukemic effect, MSKCC activated a pilot study in previously treated adult ALL, using HD-ARA-C combined with idarubicin administered as a single high-dose infusion. We herein report our experience with a series of pediatric and adult high risk ALL and NHL patients treated with the protocol above, which confirms its feasibility, response rate and individual compliance. METHODS: In a clinical phase II study, the combination of a single high dose (HD) of idarubicin and HD cytosine-arabinoside (ARA-C), as designed at the Memorial Sloan Kettering Cancer Center, was applied to 70 adults and children with refractory or early relapse acute lymphoblastic leukemia (ALL) and T-cell lymphoblastic non-Hodgkin's lymphoma (NHL). Therapy consisted of HD-ARA-C 3 g/m2/d on days 1-5, idarubicin 40 mg/m2 on day 3, prophylactic intrathecal methotrexate on days 1 and 4, and G-CSF 5 mg/kg/d s.c. from day 7 to hematopoietic reconstitution (PMN > 0.5 x 10(9)/L). RESULTS: Fifty-five of the 70 patients (78%) achieved complete remission (CR), four died in aplasia due to infection and 11 were non-responders. Recovery of blood counts occurred at a median of 21 days from the start of treatment. Non-hematologic side effects were extremely limited and consisted predominantly of infections. INTERPRETATION AND CONCLUSIONS: In view of the highly unfavorable series of patients selected, this study confirms the feasibility and antileukemic activity of the HD-idarubicin + HD-ARA-C combination in patients with refractory and early relapse ALL and NHL. The excellent tolerance to this regimen does not preclude bone marrow transplantation as post-remission treatment.
Adolescent↗