Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Management of complications in patients with chronic myelogenous leukemia(CML) were reviewed. In chronic phase, the complications due to the increased WBC are not common. Currently, most patients are treated with interferon and/or hydroxyurea. Although the clinical benefit of interferon therapy has been proven with randomized trials, side effects with interferon are significantly higher than hydroxyurea. Common side effects are fatigue, weight loss, insomnia, depression and neurotoxicity. The complications following stem cell transplantation are classified into three categories: 1) regimen related toxicities of heart, lung and liver, 2) acute complications related to hematoimmune disturbance including acute and chronic graft-versus-host disease and infectious complications, 3) long term consequences of stem cell transplantation. During blastic phase, management of infectious complications is important.
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PMID:[Management of complications in patients with chronic myelogenous leukemia]. 1176 48

Infusions of donor bone marrow derived cells (DBMC) continue to be tested in clinical protocols intended to induce specific immunologic tolerance of solid organ transplants based on the observations that donor-specific tolerance is induced this way in animal models. We studied the immunological effects of human DBMC infusions in renal transplantation using modifications in lymphoproliferation (MLR) and cytotoxicity (CML) assays. The salient observations and tentative conclusions are summarized in this review. Among many types of organs transplanted using DBMC at this center, it was found that the cadaver renal recipients (CAD) had significantly decreased chronic rejection and higher graft survival when compared to equivalent non-infused controls. DBMC infusion was also associated with a marginal and non-specific immune depression. It was also observed that the number of chimeric donor cells gradually increased in the iliac crest bone marrow compartment with a concomitant decrease in the peripheral blood and that the increase was more rapid in living-related donor (LRD)-kidney/DBMC recipients in spite of a lower number of DBMC infused (<25%) than in the CAD-kidney/DBMC group. In the LRD recipients with residual anti-donor responses, purified chimeric cells of either donor or recipient inhibited recipient immune responses to the donor significantly more strongly than the freshly obtained bone marrow from the specific donor or volunteer suggesting an active regulatory role for chimeric cells. A number of (non-chimeric) subpopulations of bone marrow cells including CD34(+) stem cells and the CD34(-) early progeny like CD38(+), CD2(+), CD5(+) and CD1(+) lymphoid cells as well as CD33(+) (but CD15(-)) myeloid cells down-regulated the MLR and CML responses of allogeneic PBMC stimulated with (autologous) donor spleen cells. These regulatory effects appeared to be refractory to the action of commonly used immunosuppressive drugs and occurred during the early phase of the immune response through cell-cell interactions. Most of these DBMC sub-populations had stimulatory capabilities, albeit markedly lower than donor spleen cells, but only through the indirect antigen presentation pathway. When co-cultured with allogeneic stimulators, purified CD34(+) cells were found to give rise both to CD3(-) TCRalphabeta(+), as well as CD3(+) TCRalphabeta(+) cells and, thereby, responded in MLR to allogeneic stimulation (but did not generate cytotoxic effector cells). Also, a number of DBMC subpopulations inhibited the CML and to a lesser extent the MLR, of autologous post-thymic responding T cells stimulated with allogeneic irradiated cells, mediated through soluble factors. Finally, non-chimeric DBMC also inhibited the proliferative and cytotoxic responses of autologous T cells to EBV antigens, inducing T suppressor cells, which in turn could inhibit autologous anti-EBV CTL generation and B cell anti-CMV antibody production. These studies all suggested a strong inhibitory property of a number of DBMC sub-populations in vitro and in vivo with the notion that they promote unresponsiveness.
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PMID:Immune responses and their regulation by donor bone marrow cells in clinical organ transplantation. 1296 84

(1) For many years the reference first-line treatment for patients with chronic myeloid leukaemia who do not qualify for bone marrow transplantation was interferon alfa-2, possibly combined with cytarabine. (2) Imatinib, a tyrosine kinase inhibitor, was initially approved for second-line treatment of adults with chronic myeloid leukaemia and in the accelerated phase or blast crisis. This indication has now been extended to cover first-line treatment and children. (3) An unblinded trial in 1106 adults compared imatinib (400 mg/day by mouth) as a first-line treatment with the combination of interferon (5 MIU/m2/day) and cytarabine (20 mg/m2/day, 10 days a month) subcutaneously. After 18 months, imatinib significantly increased progression-free survival rate (92.1% versus 73.5%) and quality of survival, but not overall survival. (4) In the paediatric setting, there are follow-up data from only 17 children who received imatinib as a first- or second-line treatment. The results were similar to those obtained in adults. (5) In the only available trial in adults, the number of treatment withdrawals for adverse events was lower among patients taking imatinib. Fatigue and depression were the two serious adverse events reported more commonly by people taking interferon + cytarabine. (6) Imatinib is given by mouth, which is more convenient than subcutaneous route required for interferon + cytarabine. (7) In practice, pending a second comparative trial and further follow-up, imatinib seems a therapeutic advance in the first-line treatment of chronic myeloid leukaemia.
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PMID:Imatinib: new indication. Chronic myeloid leukaemia, first-line option: favourable findings to be confirmed. 1498 92

Trials with interferon-alpha (IFN-alpha) have provided contradictory findings regarding the presence of cognitive side effects. The development of depression in some patients also raises questions about whether cognitive dysfunction might be secondary to an organic, interferon-induced mood disorder. Thirty patients with chronic myelogenous leukemia were examined before and during treatment with IFN-alpha alone or IFN-alpha and chemotherapy. Increased depressive symptoms and declines in information processing and executive functions were observed, but depression alone could not account for cognitive dysfunction. There was some evidence suggesting that exposure to chemotherapy and higher cumulative IFN-alpha dose may contribute to cognitive impairment.
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PMID:Cognitive dysfunction and depression during treatment with interferon-alpha and chemotherapy. 1526 Mar 70

The purpose of this prospective cohort study was to identify pretransplant and transplant predictors of 1-year survival after allogeneic hematopoietic stem cell transplantation (HSCT) for chronic myelogenous leukemia. Psychosocial and behavioral variables such as alcohol abuse and cigarette smoking were systematically assessed at the time of HSCT with structured diagnostic instruments. A total of 114 patients participated, with an overall 1-year survival rate of 66%. Lifetime alcohol and other substance use, cigarette smoking, depression, and quality of life prior to transplant were not found to affect 1-year survival. However, other clinical variables prior to transplant and once transplant occurred were found to predict survival.
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PMID:Predictors of 1-year survival assessed at the time of bone marrow transplantation. 1534 82

We report long-term outcome in 102 patients with cCML transplanted from an HLA-identical sibling donor from 1982 to 1998. The conditioning regimen was based on cyclophosphamide associated with either total body irradiation (TBI) (37 patients) or with busulfan (63 patients). Graft-versus-host disease (GvHD) prophylaxis consisted of cyclosporin and methotrexate in the majority of the patients. Fifteen year overall survival was estimated at 53% (95% confidence interval (CI), 44-65) with a plateau after 2.5 years. Long-term survival was adversely affected by: longer time from chronic myeloid leukemia (CML) diagnosis to transplantation, older age at time of transplantation and GvHD (acute grade III-IV or chronic extensive). The main cause of death was infection, related to GvHD in 69% of patients. Splenectomy also significantly increased the risk of bacterial infection. 15-year relapse was estimated at 8% (95% CI, 0.1-14). Late malignancies occurred in seven patients, four of whom had an invasive cancer. Other frequent late complications included cataracts, psychological depression, osteonecrosis and hypothyroidism. These complications were more frequent following splenectomy, TBI and in patients with chronic extensive GvHD. We conclude that allogeneic transplantation with a related donor can cure more than half of CML patients in chronic phase, although physicians should be alert to long-term complications.
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PMID:A 10-year median follow-up study after allogeneic stem cell transplantation for chronic myeloid leukemia in chronic phase from HLA-identical sibling donors. 1599 Aug 68

Hepatitis C viral infection is a global health problem that affects approximately 4 million people in the United States. Combination treatment with pegylated interferon (IFN)-alpha plus ribavirin has been shown to be most effective in treating patients with chronic hepatitis C (CHC). Despite its efficacy, one of the most common side effects of this regimen is depression. Whereas IFN-alpha has been found to induce depression in chronic myelogenous leukemia, melanoma, and renal cell carcinoma, CHC patients may be especially prone to develop IFN-induced depression. This review includes a summary of differences between IFN-alpha and IFN-beta and addresses whether pegylation of IFN (versus nonpegylated IFN) gives rise to a treatment with reduced potential to induce depressive symptoms. Consideration is also given to evidence showing that treatment with ribavirin may contribute to IFN-induced depression. Thyroid disorders and anemia (as well as other medical conditions) have also been associated with IFN exposure and may account for some incidences of depression in CHC patients. Evidence is reviewed indicating that prior psychiatric and mood disorders (especially previous episodes of major depressive disorder), just prior to IFN treatment, contribute to the propensity to develop depression during treatment. In addition, a brief description is provided of potential biological mechanisms of IFN-induced depression (ie, monoamines, hypothalamic-pituitary-adrenocortical [HPA] axis, proinflammatory cytokines, peptidases, intercellular adhesion molecule-1, and nitric oxide). Finally, a discussion is provided on the use of antidepressants as a preventative versus restorative treatment, including a commentary on risks of using antidepressants in this patient population.
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PMID:Interferon-induced depression in chronic hepatitis C: a review of its prevalence, risk factors, biology, and treatment approaches. 1741 17

The aim of this study was to investigate the apoptosis-inducing effect of anti-CD44 monoclonal antibody IM7 on chronic myeloid leukemia (CML) stem/progenitor cells in vitro and to explore its possible mechanism. Leukemic stem/progenitor cells (LSPCs) expressing CD34(+), CD38(-) and CD123(+) were isolated from bone marrow (BM) cells of 20 patients with newly-diagnosed chronic myeloid leukemia by using EasySep(TM) magnetic beads. The percentage of apoptotic CML-LSPCs was assayed by Annexin-V/PI staining; the expression changes of c-myc and NF-kappaB mRNA were detected by real-time quantitative PCR (RQ-PCR) and RT-PCR; the NF-kappaB activity was detected by NF-kappaB Activation Nuclear Translocation Assay Kit; the BCL-2 protein expression was determined in the Western blot method. The results showed that the IM7 effectively induced apoptosis of CML-LSPCs; the mean percentage of early apoptotic cells significantly increased, as compared with the untreated control CML-LSPCs cells 12.58 +/- 2.84% vs 5.42 +/- 1.84% (p < 0.05). The c-myc, NF-kappaB mRNA expressions were down-regulated as compared with the control group (0.65 +/- 0.10 vs 1.00, 0.42 +/- 0.21 vs 1.00, respectively) (p < 0.01) by RQ-PCR and (0.49 +/- 0.09 vs 0.60 +/- 0.12, 0.47 +/- 0.11 vs 0.67 +/- 0.08, respectively)(p < 0.01) by RT-PCR. The BCL-2 protein level in CML-LSPCs treated with IM7 also decreased as compared with the control group (p < 0.01). In addition, the depression of NF-kappaB activity was observed through fluorescence microscope. It is concluded that the anti-CD44 monoclonal antibody IM7 effectively induces apoptosis of CML-LSPCs through down-regulating c-myc and bcl-2 mRNA expression, and decreasing NF-kappaB activity in CML-LSPCs.
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PMID:[Apoptosis of chronic myeloid leukemia stem/progenitor cells induced by anti-CD44 monoclonal antibody IM7 in vitro]. 2056 10

Sixty nine patients with various types of haematological malignancies were studied. Chronic myeloid leukaemia (n =32) was the commonest diagnosis. The patients were assessed on Hamilton Rating Scale for Depression, PGI-N(2) Health Questionnaire and Presumptive Stressful Life Events Scale and those who had scores above the cut off points for Hamilton Rating Scale and/or PGI-N(2) Health Questionnaire were assessed on Present State Examination. The patients were followed up at 3 and 6 months interval. At 3 months 51 patients were re-assessed whilst at 6 months only 26 could be re-evaluated. There were no significant changes in scores of Hamilton Rating scale and PGI-N(2) Health Questionnaire at intake and subsequent follow-up assessments. No significant correlations between stressful life experience and severity of illness emerged. Twenty nine patients were interviewed on Present State Examination and of these 20 had diagnosable depressive neuroses- From consultation liaison psychiatric point of view, provision of psychiatric help to these patients is discussed.
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PMID:Psychological aspects of haematological malignancies. 2192 72

Adherence to imatinib(IM) is of utmost importance in patients with chronic myeloid leukemia (CML) to maximise treatment effectiveness. The main objective is to measure adherence to IM by evaluating individual patient characteristics, personal behaviour and, treatment related psychological factors influencing adherence behaviour. Hundred patients receiving IM were analysed for adherence behaviour using 9 item Morisky Medication Adherence Scale (9-MMAS). Various factors were assessed for their impact on adherence behaviour. These factors were age, gender, duration of treatment, frequency and dosing of treatment, use of tobacco and alcohol, educational qualification, employment status, monthly income, side effects, financial assistance in treatment, social support, knowledge about medicine and disease, concomitant drug burden, polypharmacy, physician patient interaction, patient educational sessions and prevalence of depression. Seventy five percent of patients were found to be adherent. On univariate analysis, prevalence of depression (p<0.000001), moderate severe depression (p<0.000001), concomitant drug burden (p=0.036) and monthly income (p=0.015) were found to be significantly influencing adherence. The final multivariate model retained prevalence of depression with OR= 10.367 (95% CI, 3.112-34.538) as independent predictor of adherence to therapy. This study suggests that identification and treatment of depression among CML patients may further enhance adherence to IM therapy.
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PMID:Factors influencing adherence to imatinib in Indian chronic myeloid leukemia patients: a cross-sectional study. 2574 40


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