Summary:We have initiated a long-term prospective study of sexual function using the Derogatis Interview for Sexual Functioning (DISF) for males and females. 8 This self-adminisPatients undergoing high-dose chemotherapy and bone marrow transplantation (BMT) may experience a vartered questionnaire has a number of advantages. It is widely used, easy to administer and well validated in cancer iety of abnormalities of psychological and physical function including sexual dysfunction. However, no study patients. 9 It evaluates fantasy, arousal, experience, orgasm and desire in addition to giving an overall score of sexual has prospectively evaluated whether there is an association between sexual dysfunction and BMT. In a prefunction. In our initial study, we evaluated 30 patients pre-BMT and found that sexual dysfunction was commonly vious study in which we analyzed the sexual function of 30 patients immediately before transplant, we found seen. 10 Since then the sample size has been increased to 50 and we have prospectively resurveyed these patients at 3 that nearly half of all patients had sexual dysfunction using the Derogatis Interview for Sexual Functioning months, and in some cases, 12 months post-BMT. We also attempted to correlate these results with possible demofor males and females. The findings of the pilot study led us to hypothesize that the incidence of sexual dysgraphic risk factors for sexual dysfunction, as well as with the medical complications of the transplant. function would not be significantly altered by BMT; we performed a prospective study designed to test this hypothesis. In this study a further 20 patients about to undergo BMT were surveyed, making a total of 50.Patients and methods Thirty-one of 38 survivors were reanalyzed 3-6 months after transplant. The major finding of the study is thatPatients and definitions the incidence of sexual dysfunction is unchanged 3 months after transplant (48 vs 36%, P = NS). The mean All patients between the ages of 16 and 65 years undergoing bone marrow transplantation between July 1994 and total score on the DISF was decreased by 7.5 points but this was also not significant. A preliminary analysis of November 1995 at Hahnemann University Hospital were approached to participate in a prospective study of sexual 16 patients surveyed at 12 months post-BMT suggests little change in sexual function between 3 and 12 months function. The sexual function of the first 30 patients pre-BMT has been reported in detail. 10 The majority of patients post-BMT. We conclude that in the first 12 months after high-dose chemotherapy and BMT the pretreatment received regimens containing busulfan and cyclophosphamide. Patients with breast cancer received cisplatinum and difficulties remain.
Previous studies have indicated that p53 gene mutations were an uncommon event in acute lymphoblastic leukemia (ALL) in children. In one series of 330 patients, p53 mutations were seen in fewer than 3%. We analyzed bone marrow mononuclear cells derived from 10 children with ALL at diagnosis who subsequently failed to achieve a complete remission or who developed relapse within 6 months of attaining complete remission for p53 gene mutations and mdm-2 overexpression. We found that three children had p53 gene mutations, and four overexpressed mdm-2. Also, experiments comparing relative levels of mdm- 2 RNA and protein in these patients demonstrated that mdm-2 overexpression can occur at the transcriptional and posttranscriptional level in primary leukemic cells. Although we were unable to link Waf-1 RNA expression with p53 status in childhood ALL, our data show potential p53 inactivation by multiple mechanisms in a large percentage of these patients and demonstrate that these alterations can be detected at diagnosis. Inactivation of the p53 pathway may, therefore, be important in children with ALL who fail to respond to treatment and may be useful for the early identification of children requiring alternative therapies.
References1 Takeda S, Ito K, Sakura T et al. Three AML patients with existing or pre-existing intracerebral granulocytic sarcomas who were successfully treated with allogeneic bone marrow transplantation. Bone Marrow Transplant 1999; 23: 731-734. 2 Oehmichen M, Domasch D, Wietholter H. Origin, proliferation, and fate of cerebrospinal fluid cells. A review on cerebrospinal fluid cell kinetics. J Neurol 1982; 227: 145-150. 3 Coriat AM, Muller U, Harry JL et al. PCR amplification of SRY-related gene sequences reveals evolutionary conservation of the SRY-box motif. PCR Meth Appl 1993; 2: 218-222.
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