Biomedical subjects

W H Macey

Publications and source records attributed to W H Macey.

9 recordsLinked to original sources

PubMed2000

A primary care approach to cutaneous T-cell lymphoma.

Approximately 1,000 new cases of cutaneous T-cell lymphoma are definitively diagnosed each year. Mycosis fungoides and Sézary syndrome are the primary lymphomas in this group. Mycosis fungoides can begin in the patch, plaque, or tumor stage or in a combination. Less commonly, its initial presentation is erythrodermic. Because the initial appearance of cutaneous T-cell lymphoma can be subtle and the histopathologic evidence nonspecific, the disease is commonly misdiagnosed as a common dermatologic condition such as chronic eczema. Misdiagnosis can severely affect treatment and prognosis. Clinicians must be able to recognize this disease and know when to include it in the differential diagnosis. This article provides an overview of cutaneous T-cell lymphoma, discusses differential diagnoses, and outlines management considerations.

Aged↗

PubMed1999

Photopheresis: clinical applications and mechanism of action.

Photopheresis is a leukapheresis-based therapy that utilizes 8-methoxypsoralen and ultraviolet A irradiation. Photopheresis is currently available at approximately 150 medical centers worldwide. Recent evidence suggests that this therapy used as a single agent may significantly prolong life, as well as induce a 50%-75% response rate among individuals with advanced cutaneous T cell lymphoma (CTCL). Furthermore, a 20%-25% complete response rate with photopheresis alone, or in combination with other biologic response modifiers, has been obtained at our institution among patients with Sezary syndrome. These complete responses have been characterized by the complete disappearance of morphologically atypical cells from the skin and blood. The use of sensitive molecular techniques has also confirmed the sustained disappearance of the malignant T cell clone from the blood of patients with complete responses. In addition to the treatment of CTCL, numerous reports indicate that photopheresis is a potent agent in the therapy of acute allograft rejection among cardiac, lung, and renal transplant recipients. Chronic graft versus host disease also appears to be quite responsive to photopheresis therapy. Likewise, there may also be a potential role for photopheresis in the therapy of certain autoimmune diseases that are poorly responsive to conventional therapy. The immunologic basis for the responses of patients with these conditions is likely due to the induction of anticlonotypic immunity directed against pathogenic clones of T lymphocytes. Treatment-induced apoptotic death of pathogenic T cells and activation of antigen presenting cells are postulated to have important effects in this therapeutic process.

Animals↗

PubMed1997

Dermatology and the World Wide Web.

The internet is a global network of computer databases. Over the last decade the fastest growing area of the internet has been the World Wide Web. The World Wide Web now offers a vast array of dermatologic resources that can be used to support the delivery of patient care. The purpose of this article is to provide a brief explanation of the World Wide Web, and to list some of the dermatologic resources that are available there.

Computer Communication Networks↗

PubMed1996

Treatment of cutaneous T-cell lymphoma with extracorporeal photopheresis monotherapy and in combination with recombinant interferon alfa: a 10-year experience at a single institution.

BACKGROUND: Extracorporeal photopheresis is a pheresis-based therapy that permits the direct targeting of psoralen-mediated photochemotherapy to circulating pathogenic T cells. Although photopheresis is currently used to treat cutaneous T-cell lymphoma (CTCL), limited data are available regarding overall response rates and durability of responses among patients with advanced disease. Furthermore, little is known about the effectiveness and tolerability of combined regimens employing other biologic response modifiers including interferon alfa. OBJECTIVE: Our purpose was to determine the efficacy of photopheresis among 41 patients with the clinical and laboratory diagnosis of CTCL; the majority of patients had stage III or IV disease with the presence of circulating malignant T cells. METHODS: A retrospective chart review during a 10-year period at a single university hospital was performed for all patients receiving either photopheresis monotherapy on two consecutive days every 4 weeks (one cycle) and for an additional 12 patients who also received interferon alfa 1.5 to 5 million U subcutaneously three to five times weekly. RESULTS: Thirty-one of 41 patients (76%) were treated for six or more cycles. The remaining 10 were treated with less than six cycles because of rapidly progressing disease (n = 6), death unrelated to CTCL (n = 2), or withdrawal from treatment (n = 1); one of the 10 patients had only received five cycles of treatment but is still receiving therapy. Twenty-eight of the 31 patients treated for six or more cycles received photopheresis alone. Among the 28, seven patients (25%) had a complete remission, 13 (46%) had a partial remission defined as more than 50% clearing of skin disease, and eight (29%) did not respond to treatment. The presence of Sézary cells in the peripheral blood was associated with a favorable response. Median time to treatment failure was 18 months, whereas median survival from initiation of therapy was 77 months and from the time of diagnosis exceeded 100 months. Nine of these 28 patients went on to receive combination therapy with interferon alfa and, in some cases, other agents. Among these nine patients, five had an enhanced clinical response to the combination therapy compared with treatment with photopheresis monotherapy. The combined regimen was well tolerated. CONCLUSION: These results indicate that patients with advanced CTCL can achieve a high response rate for an extended period with photopheresis and that interferon alfa combined with photopheresis is a well-tolerated regimen that appears to produce higher response rates than photopheresis alone.

Adult↗

PubMed1996

Interferon: an overview for dermatology nurses.

Interferons are glycoproteins that have numerous immunologic effects. Over the last decade the use of interferon has grown dramatically. Interferon preparations are now commonly used in many dermatologic conditions. The types of interferon that are commercially available, their therapeutic applications, and the nursing care of patients who receive interferon are reviewed.

Drug Monitoring↗

PubMed1995

Photopheresis and the role of the nurse.

Extracorporeal photochemotherapy (ECP, photopheresis) is a form of pheresis therapy approved by the federal Food and Drug Administration for treating the systemic manifestations of cutaneous T-cell lymphoma. Increasing evidence suggests that it may also be useful in treating many immune-related diseases, as well as in preventing and treating organ transplant rejection. Because the precise mechanism of action for photopheresis has not been clearly defined, research to determine future applications for this treatment is needed. It is important for dermatology nurses to understand photopheresis, to whom it is given, the nursing care for patients receiving photopheresis, and the current research and potential applications of this therapy.

Decision Trees↗

PubMed1994

Use of extracorporeal photochemotherapy in heart transplant recipients during acute rejection: a case study.

Despite the growing availability of improved immunosuppressive agents, acute and chronic rejection episodes remain a major complication in heart transplant recipients. The rejection of allografts is a normal part of the body's response to foreign antigens. The key to controlling this response is to administer a regimen of multiple immunosuppressive drugs. Evidence indicates that by adding extracorporeal photochemotherapy to a standard immunomodulatory regimen, the rejection process can be reversed without significantly increasing patient risk. In this case study we examine extracorporeal photochemotherapy and the care of patients receiving this therapy.

Graft Rejection↗

PubMed1994

Cutaneous T-cell lymphoma: a case study, treatment, and nursing implications.

In this case study, the course and treatment of fatal cutaneous T-cell lymphoma (CTCL) in an adult male is presented. Following diagnosis, the patient received multiple therapeutic regimens, including extracorporeal photochemotherapy, also known as photopheresis. The different treatments for CTCL are described. Photopheresis is useful in the care of CTCL patients, and nurses will play a large part in their care.

Algorithms↗

PubMed1989

Extracorporeal photochemotherapy in the treatment of cutaneous T cell lymphoma and autoimmune disorders affecting the skin.

Extracorporeal photochemotherapy (ECPCT) is a new form of chemoimmunotherapy which involves the ex vivo exposure of malignant peripheral blood cells to 8-methoxypsoralen (8-MOP) and ultraviolet A (UVA) radiation followed by reinfusion of the treated cells. This treatment has resulted in an unprecedented number of prolonged remissions in patients with therapeutically resistant forms of cutaneous T cell lymphoma (CTCL) characterized by the systemic dissemination of a clonal population of malignant helper T lymphocytes. Although the mechanism of the beneficial effect is uncertain, an immune reaction to the reinfused modified T cells probably results in tumour regression. Because the T cell antigen receptor (TCR) is an immunogenic structure and because an identical TCR is present on the entire clonal population of malignant T cells in each individual with CTCL, modification of this structure represents the most likely target for the effects of 8-MOP and UVA. Understanding of the precise events leading to tumour regression in CTCL during treatment with ECPCT may lead to the expanded use of this therapy for other lethal haemopoietic malignancies.

Autoimmune Diseases↗