Like other tAMLs with a karyotype specific of de novo AML [balanced 11q23 rearrangement or t(15;17)], tAMLs with t(8;21), inv(16), or t(8;16) are usually characterized by a short latent period, previous treatment often combining a drug that directly reacts with DNA and an ATTop, and absence of preleukemic phase. Hematologic characteristics and response to treatment are also identical to those of de novo AML with the same karyotypes.
High-dose chemotherapy or chemoradiotherapy followed by autologous PBPC support in MM is feasible and efficient. Further studies are needed to confirm these encouraging, although preliminary, results and to compare this technique with other therapeutic strategies.
Summary:Fifty-six patients with chemosensitive NHL were studied to assess factors affecting mobilization and peripheral blood stem cell (PBSC) collection: all were mobilized with high-dose cyclophosphamide and etoposide and G-CSF 5 g/kg/day. None of them had bone marrow involvement at the time of mobilization or a history of extended field irradiation. Previous chemotherapy regimens were divided into two groups: moderately myelotoxic chemotherapy (MMC) and highly myelotoxic chemotherapy (HMC). The adequacy of the PBSC harvest was not associated with age, gender, a past history of bone marrow involvement or disease status. In contrast, the number of MMC cycles (n (MMC) ) and the number of HMC cycles (n (HMC) ) were both significant (P = 0.009 and P = 0.0004, respectively) and were used to compute a score predictive of a successful PBSC harvest: SCORE = n (MMC) + 4 n (HMC) . The estimated successful PBSC collection rate was greater than 80% in patients with a score ranging from 0 to 15 and dropped rapidly to below 20% in patients with a score exceeding 25. This scoring system may help to determine the timing of PBSC mobilization in patients with a score below 15 and suggests that new PBSC mobilization procedures should be investigated in other patients. Bone Marrow Transplantation (2000) 25, 495-499. Keywords: lymphoma; scoring system; peripheral blood stem cell Some patients with poor prognosis lymphoma can now be cured with high-dose chemotherapy followed by hematological stem cell support 1,2 and peripheral blood stem cells (PBSC) accelerate hematological recovery at a faster rate than bone marrow stem cells. 3 Consequently, the surgical bone marrow harvest procedure has progressively been replaced by peripheral blood collection obtained by leukapheresis. Although PBSC mobilization and collection techniques have improved, the yield is still suboptimal in a subset of patients. In particular, heavily pretreated
Summary:Forty-two patients with refractory (15 patients) or relapsed (27 patients) Hodgkin's disease (HD) were included in a prospective single center study evaluating the efficacy of a regimen VIP combining etoposide 75 mg/m 2 /day days 1-5, ifosfamide 1.2 g/m 2 /day days 1-5 and cisplatinum 20 mg/m 2 /day days 1-5, one course every 4 weeks as salvage therapy in patients with refractory or relapsed Hodgkin's disease, potentially eligible for high-dose chemotherapy with reinjection of hematopoietic stem cells (HSC). If patients were considered chemosensitive after two courses of VIP, high-dose chemotherapy followed by the reinjection of HSC was planned. After two courses of VIP, 67% achieved an objective response including 38% complete responses. Overall, 28 patients went on to high-dose therapy with reinjection of HSC, and 46% of grafted patients are in a sustained complete remission. When the overall patient population is considered, 33% are in complete remission (CR) with a median follow-up of 37 months. A CR of less than 12 months and refractory disease were associated with a poor survival. These results showed that the VIP regimen is effective in relapsed or refractory HD and allows high-dose therapy to be given in the case of most responding patients. However, results in patients with refractory disease or a first complete remission of less than 12 months need to be further improved. Keywords: Hodgkin's disease; salvage therapy; VIP; etoposide; ifosfamide; cisplatinumThe prognosis for patients with Hodgkin's disease (HD) has dramatically improved with the use of modern extended-field radiotherapy and/or chemotherapy. With first-line chemotherapy, up to 80% of patients with advanced Hodgkin's disease achieve a complete remission (CR). 1-5 Despite optimal initial treatment, 20-50% of patients fail to enter remission or will relapse after achieving a complete response. [1][2][3][4][5][6][7] It has long been stated that patients who relapse after a first remission can be divided into two groups according to the length of their first remission. When patients relapse more than 1 year after the end of their first-line therapy, as many as 85% of them achieve a second complete remission when the same drug combination is used. 8-10 However, recent reports have shown that long-term disease-free survival at 15 years is achieved in only 20% of these favorable relapses. 8 Conversely, when patients relapse less than 12 months after their first CR or when they do not achieve a first CR, the results of conventional salvage therapy are worse and few long-term survivors are expected. 7,8,[11][12][13][14] High-dose chemotherapy followed by autologous hematopoietic rescue was considered a viable option because of good results achieved in a series of phase II trials. In refractory patients pooled with complete responders (Ͻ12 months), high-dose chemotherapy with reinfusion of HSC yielded CR rates of 40-80% with approximately 40% of patients free of disease at 3 years. [15][16][17][18][19][20][21][22][23][24][25] High-dose chemo...
Vaginal bleeding during aplasia can induce transfusion support, infection and discomfort. Oral and intramuscular hormonotherapy can be toxic and/or difficult to manage (mucositis). This single-center pilot study evaluated the efficacy and safety of leuprorelin (L) in preventing heavy vaginal bleeding in 20 nonmenopausal women with leukemia, lymphoma or myeloma and foreseable therapy-induced thrombocytopenia. Until platelet recovery, patients received subcutaneous injections of L, with concomitant nomegestrol acetate (NA) during the first 35 days to prevent flare-up. Median age was 33 years (18-48). Platelet nadir was < 20 x 10(9)/l in 17 patients; 103 L injections were performed (median per patient: 4 [1-14]). No moderate or severe adverse event was related to hormonal therapy. Seventeen patients did not experience any clinically or therapeutically relevant bleeding. Eleven spottings and 8 metrorrhagias (mean duration: 3 days) occurred in 11 patients, requiring enhanced NA in 3 cases (baseline platelet count was < 20 x 10(9)/l in 1 pt, premature termination of NA [the single platelet transfusion for metrorrhagia] in 1 pt, and endometrial hyperplasia (EH) in the third). In patients without EH, only 5 spottings were observed after the third injection, without neither clinical nor therapeutic impact (63 injections). In conclusion, leuprorelin administration is safe and effective in preventing vaginal bleeding. The sustained-release form and subcutaneous administration offer quality of life advantages.
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