Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:2.1.1.69 (BMT)
 2,655 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In acute lymphoblastic leukaemia (ALL) substantial progress has been achieved within the last few years. Complete remission rates up to 95% can now be achieved in children and 70-85% in adults; disease free survival rates are 70 and 30% respectively. To improve results further high dose treatment has been included, particularly to overcome drug resistance and to reach cytostatic levels in the sanctuary sites, such as the central nervous system. High dose cytarabine in combination with other cytostatic drugs, preferentially anthracyclines, seems to be of benefit for high risk adult ALL patients. High dose methotrexate, mostly explored in childhood ALL, is now also included in a variety of combinations in the treatment of adult ALL, but its effectiveness remains to be established. Substantial progress has been achieved in adult T-ALL and B-ALL with survival rates of 40-50%. The optimal form and duration of maintenance therapy in adult ALL is not yet clear but general omission of maintenance leaves patients with an inferior outcome. Which subgroups of adult ALL require maintenance and in what form still requires investigation. In recent adult ALL trials with intensive chemotherapy similar prognostic factors for disease free survival have emerged. Of adverse influence are delayed time to reach CR (more than 4/5 weeks), a high initial white blood cell count, higher age (above 50 or 60 years), and probably the immunological subtypes pre-T-ALL, pre-B-ALL, My(+)-ALL; of very adverse influence in elderly patients is the karyotype t(9;22) or the corresponding BCR/ABL gene rearrangement. High risk adult ALL patients with one or more of these adverse factors are candidates for allogeneic or autologous bone marrow transplantation in first remission. Whether all adult ALL patients are candidates for BMT in first CR is currently being explored in large prospective randomized trials.
 ...
PMID:Therapy and prognostic factors in adult acute lymphoblastic leukaemia. 780 3

Among patients included in the multicentric trial ALL87, 95 patients were randomly allocated to purged ABMT arm for post-remission therapy. Immunological phenotyping performed in patients at diagnosis allowed to assigned 51 patients (54%) to the B lineage and 34 patients (36%) to the T lineage. Only 64 patients (67%) actually received ABMT mainly because of early relapses. Fifty-two patients were depleted according to the protocol: 25 B-ALL were depleted with CD10+CD19 mAbs, 19 T-ALL with CD2+CD5+CD7 mAbs and 8 patients received an Asta-Z purged BMT. Among the 12 remaining patients, 4 received Asta-Z purged BMT and 8 an unpurged one. Using an intention to treat analysis, overall survival and event free survival were similar to results observed in chemotherapy group. This study emphasizes the importance of a precise phenotyping at ALL diagnosis which allows specific immunologic bone marrow purging for ABMT.
 ...
PMID:Autologous BMT for post-remission therapy in adult ALL: an immunological approach. For The French Group of Therapy of Adult ALL. 807 89

Current progressive chemotherapy and transplantation induce not only remission but complete cure. By this reason, the detecting system for MRD must be established in complete remission phase. In this study, we showed the detecting for MRD by molecular biology techniques in the patients with non-Hodgkin's lymphoma, CML, B-ALL and AML. 1) Malignant cells could be detected in peripheral blood or bone marrow cells by Southern blot analysis in 15 of 30 patients with non-Hodgkin's lymphoma. 2) In CML patients, BCR/ABL fusion gene was positive by RT-PCR for 6 months after BMT, 4 patients became undetectable for 7 months after BMT. 3) Rearrangement of Ig H has been disappeared in 12 months after achieved complete remission the patients with B-ALL. In conclusion, the detection for MRD remain an important goal for therapy including chemotherapy and bone marrow transplantation in hematopoetic malignancy.
 ...
PMID:[Detection of residual malignant cells in patients with hematopoietic malignancy]. 831 24

Results for adult ALL have improved, with CR rates of 68% to 91% and a cure rate of 25% to 41%. The outcome for patients with T-ALL has especially improved, and the major drugs responsible are C and ara-C. Outcome for B-ALL has improved by using short intensive cycles including, among other drugs, C and high-dose MTX. The inferior outcome of adult ALL compared with childhood ALL seems related to the high proportion of Ph1/BCR-ABL positive ALL patients, which constitute about 30% in adults versus less than 5% in children. The major prognostic factors for survival in adult ALL are age, time to achieve CR, cytogenetic abnormalities, immunologic subtype, and WBC; these may serve as a guide for BMT in first CR. New approaches in the treatment of adult ALL include the use of HGFs, the use of biologic response modifiers, and the detection of MRD to tailor treatment decisions.
 ...
PMID:Therapy of the newly diagnosed adult with acute lymphoblastic leukemia. 844 56

Hematopoetic stem cell transplantation (SCT) often represents a unique opportunity for curing children with leukemia. Nevertheless, selecting the patient who could really benefit from this procedure remains a controversial issue. The current consensus is as follows: About 20% of children with ALL can be defined as high-risk patients by criteria such as t(9;22), t(4;11), no complete remission at day 42, poor prednisone response, and T-immunophenotype or pre-pre B-ALL, myeloid markers or more than 100,000 white blood cells/microliter. This high-risk group is eligible for alloBMT in first remission, provided a family-matched donor is available. At relapse the majority of patients will benefit from alloBMT, and alternative donor sources can be considered in high-risk patients. Only early alloBMT relapses (up to 6 months after end of initial therapy) are sure candidates, whereas late relapses, especially extramedullary sites, may equally benefit from an intensive conventional relapse treatment. However, any alloBMT relapse beyond second remission should be transplanted with allogeneic stem cells (bone marrow or peripheral stem cells). In particular, family mismatched donors or matched unrelated donors may be acceptable in high-risk cases beyond first remission. In contrast, ASCR in ALL seems not to be superior to conventional therapy. In AML the standard-risk patient, defined by criteria such as FAB M1/M2-Auer rods positive, all FAB M3, and FAB M4, is not a candidate for SCT in first remission. Patients presenting other criteria or more than 5% of blasts in the bone marrow at day 15 are at high risk in first remission and should be considered for allo BMT if a family matched donor is available. ASCR in first remission AML remains a controversial issue. In contrast, in second remission alloBMT as well as ASCR are superior to conventional chemotherapy.
 ...
PMID:The present role of bone marrow and stem cell transplantation in the therapy of children with acute leukemia. 938 54

Precursor B-ALL blasts may be positive for CD20 in up to 50% of cases. There are few reports on the use of the anti CD20 monoclonal antibody, rituximab, in children with B-ALL. We report on two adult patients with precursor B-ALL who developed significant hepatic toxicity during induction chemotherapy. Single agent rituximab was given until recovery of liver enzymes was established. Both patients were able to continue further chemotherapy, underwent an Allo BMT and are now 10-12 months after diagnosis in a continuous CR.
 ...
PMID:Rituximab monotherapy as interim therapy in precursor B-ALL adults during periods of hepatic toxicity: report of two cases. 1701 90

A 12-year-old male with pre-B-cell acute lymphoblastic leukemia with cryptic BCR/ABL rearrangement underwent sex-mismatched allogeneic bone marrow transplantation (allo-BMT). Contradictory results were provided by various chimerism analyses 3 months later. Y-chromosome-specific quantitative polymerase chain reaction and sex chromosome-specific interphase fluorescence in situ hybridization (i-FISH) showed complete donor chimerism. Analysis of autosomal short tandem repeats (A-STR), BCR/ABL i-FISH test, and X-STR haplotype indicated relapse. Metaphase-FISH and combined BCR/ABL and sex chromosome-specific i-FISH patterns revealed loss of the Y-chromosome and duplication of the X-chromosome in the host cells. Sex chromosome changes after allo-BMT can cause significant difficulties in chimerism analysis.
 ...
PMID:Sex chromosome changes after sex-mismatched allogeneic bone marrow transplantation can mislead the chimerism analysis. 2097 81