Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023418 (leukemia)
 93,477 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Case mix and charges for chemotherapy treatment were examined by an analysis of the inpatient discharges for DRG 410 (chemotherapy) from eight teaching hospitals and of outpatient visits from two teaching hospitals. Discharges for ovarian cancer were the most common and the least expensive, costing $1,600 or half as much as the most costly, less common conditions (leukemia and testicle cancer). Diagnosis explained 13 percent of the inpatient charge variation; metastasis explained less than 1 percent. Outpatient chemotherapy overlapped with inpatient among only 3 of the 10 most common diagnoses. The implication is that the two settings are complementary with regard to chemotherapy administration.
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PMID:Case mix and charges for inpatient and outpatient chemotherapy. 1031 89

The number of allogeneic and autologous bone marrow transplants continues to grow worldwide. Bone marrow transplantation (BMT) has become standard therapy for many patients with leukemia, lymphoma, multiple myeloma and testicular cancer. Encouraging results of autologous BMT in treating patients with poor-risk breast cancer have led to this approach being tested in nationwide randomized trials. In order to increase availability and efficacy of BMT, other sources of hematopoietic cells are explored for transplantation, such as from HLA-matched unrelated volunteer donors, partially matched related donors, placental/umbilical cord blood and allogeneic peripheral blood. Relapse of original malignancy remains the main obstacle for the success of BMT. Recent clinical investigations have demonstrated that donor-derived peripheral blood leukocytes are effective in inducing remissions in patients with hematological malignancies who relapse after allogeneic BMT. BMT procedures are associated with significant complexity and should be carried out only in transplant units that meet adequate standards. In order to better define the role of BMT in treating cancer, more phase III clinical trials are needed. The future of BMT will depend on further improvements in its efficacy and economic constraints.
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PMID:Bone Marrow Transplantation for Cancer - An Update. 1038 82

I was deeply moved by David Sanford's Wall Street Journal article, which follows. As David's story recounts, he came to me in deep despair. He believed that there was little hope to escape what is commonly termed a "death sentence" from AIDS. With state-of-the-art treatment, he has regained considerable health, as his HIV viral load has fallen to undetectable levels and his helper T-cell number has increased. How long these changes will be sustained and what the future holds are still unclear. But it is clear that David is pursuing life with great vigor and his sense of optimism and commitment to survive have been restored. I believe the hematologist/oncologist is in a particularly unique position in the clinical care of people with AIDS. Our history of conquering diseases which were, like AIDS, regularly associated with decline and death, gives us a perspective that engenders hope. I recall a friend and classmate in the fifth grade in Public School 187 in Queens, New York, who died of childhood leukemia. In those days, mentioning the word "leukemia" was forbidden, so our teacher informed us that Eric had died of "blood poisoning." We children all sat confused, wondering how to protect ourselves from such insidious "poisons." Childhood leukemia is now curable in the majority of afflicted children; I suspect that Eric would have been saved had the current treatment regimens existed in the early 1950s. Similar triumphs against lymphoma and testicular cancer are held up as real examples of progress in the field of oncology. I point to such victories in counseling patients with AIDS facing currently incurable diseases. AIDS is a moving target. Important breakthroughs in rational drug design provided us with the protease inhibitors, and laid the foundation for combination therapy which might potentially control the replication of the virus for decades and thereby restore longevity. Prospects for a true cure (full eradication of the virus from the system) are still hotly debated, but no one can deny that the clinical gains made in the last two years have been significant. We have witnessed the first clinical remission of AIDS. David Sanford's individual story is a mirror to the larger world of people with HIV. His restoration of health is not unique, not an isolated antidote, but a prototype of what is being seen in controlled clinical trials. Moreover, the importance of access to medical care, particularly new drugs, is evident from his tale. The impact of these new therapies on a humanitarian plane is the greatest, but its economic impact, with reduction of hospitalization, and increase in individual productivity, is also apparent. I find myself, as a physician, being importantly instructed by people like David Sanford. Our greatest gratification comes from science changing clinical reality, and restoring productive lives that become filled with realistic hopes.
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PMID:AIDS: A Personal Perspective That Engenders Hope. 1038 38

Because routinely collected survival data for cancer patients in England and Wales do not typically specify cause of death, conventional estimates of survival in cancer patients based on such data are a measure of their mortality from all causes rather than their mortality due to cancer. As a result, trends in survival over time are difficult to interpret because changes in overall survival may well reflect changes in the risk of death from other causes, rather than from the cancer of interest. One way of overcoming this problem is to use some form of 'relative survival' defined as a measure of survival corrected for the effect of other independent causes of death. Since this concept was first introduced, various methods for calculating relative survival have been proposed and this had led to some confusion as to the most appropriate choice of estimate. This paper aims to provide an introduction to the concept of relative survival and reviews some of the suggested methods of estimation. In addition, a particularly simple, but robust approach, is highlighted based on expected and observed mortality. This method is illustrated using preliminary data from the Office for National Statistics on cancer survival in patients born after 1939 and diagnosed with cancer during 1972-84. The examples presented, although limited to analyses on a small number of selected sites, highlight some encouraging trends in survival in people aged under 35 diagnosed with leukaemia, Hodgkin's disease and testicular cancer during this period.
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PMID:Estimating relative survival among people registered with cancer in England and Wales. 1040 87

Since the advent of cisplatin-based chemotherapy in the 1970s, the majority of metastatic testicular cancer patients can be cured with chemotherapy followed by surgery. The high-curability of testicular cancer, along with young age of afflicted patients, can result in patients living for many years after the initial treatment. The development of second cancer represents one of the most severe long-term complications in these patients. Patients who have achieved a long-term disease-free status have an increased risk of developing germ-cell tumor in the contralateral testis. Late relapse (occurring more than 2 years after initial treatment) of germ-cell tumor at any site has also been found in approximately 3% of all patients. Patients receiving radiotherapy or chemotherapy for testicular cancer a have small, but clearly identifiable, risk of developing second malignancies. Radiotherapy is associated with a two- to threefold increased risk for second solid cancer. Chemotherapy, especially high-dose etoposide regimens, is associated with increased risk for second leukemia. Although the incidence of second malignancies is rather low, it is important to monitor the carcinogenic potential of therapy, and to develop a preventive approach for second cancer.
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PMID:[Treatment of testicular and second cancer]. 1058 66

Cisplatin appears to be the major cause for long-term toxicity in patients treated for testicular cancer. Long-term side effects consist mainly of nephrotoxicity, ototoxicity, and neurotoxicity as well as gonadal damage. Following standard-dose chemotherapy approximately 20% to 30% of patients will be affected by long-term side effects, although not all these side effects will cause an impaired quality of life. Several strategies have been or currently are being evaluated to reduce acute and long-term complications including the introduction of equally effective, but less toxic regimens, or the use of cytoprotective agents such as amifostine. Secondary acute myeloid leukemia and secondary myelodysplastic syndrome probably represent the worst possible long-term complications of cancer therapy in those patients who originally were cured of their primary testicular cancer. Therapy-related solid tumors are mainly associated with the use of radiation therapy and the risk for developing a therapy-related solid tumor is increased approximately two to three times compared to the general population. In contrast, therapy-related leukemias are predominantly associated with chemotherapy, particularly with the use of topoisomerase-II inhibitors and alkylating agents. In general, the cumulative incidence of therapy-related leukemia following treatment of germ cell cancer is low. It is approximately 0.5% and 2% at 5 years of median follow-up for patients receiving etoposide at cumulative doses< or = 2 g/m(2) and >2 g/m(2), respectively. The risk-benefit analysis in patients with testicular cancer clearly favors the use of current treatment regimens including high-dose chemotherapy. However, even the acceptably low number of therapy-related long-term complications should encourage the search for equally effective but less toxic therapies. This review will highlight important available data about therapy-related toxicity and particularly, therapy-related malignancies following cisplatin-etoposide-based chemotherapy.
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PMID:Late toxicity following curative treatment of testicular cancer. 1058 57

Given the young age at which testicular cancer is treated and the excellent prognosis for patients suffering from this disease, therapy-related malignancies represent a significant problem. Therapy-related solid tumors are associated mainly with the use of radiation therapy. The risk for developing a therapy-related solid tumor is approximately 2- to 3-fold increased compared with the general population. Therapy-related leukemias are associated predominantly with chemotherapy, particularly with the use of topoisomerase-II inhibitors and alkylating agents. In general, the cumulative incidence of therapy-related leukemia is low. It is approximately 0.5% and 2% at 5 years of median follow-up for patients receiving etoposide at cumulative doses < or = 2 g/m2 and > 2 g/m2, respectively. High cumulative doses of etoposide given over a short period of time appear to be less leukemogenic than a similar dose of etoposide given over a longer period of time. There might, additionally, be a synergistic effect of cisplatin and etoposide on the induction of therapy-related leukemia. For patients who receive high-dose chemotherapy with autologous stem-cell support, the risk of therapy-related myelodysplastic syndrome and leukemia appears to be substantially lower compared with that reported in non-Hodgkin's lymphoma patients undergoing high-dose chemotherapy. The transplantation procedure itself does not appear to add to the therapy-related leukemia risk. The risk-benefit analysis in patients with testicular cancer clearly favors the use of current treatment regimens including high-dose chemotherapy. However, even the acceptably low number of therapy-related leukemias should encourage the search for equally effective but less toxic therapies.
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PMID:Therapy-related malignancies following treatment of germ cell cancer. 1059 12

A systematic review of the literature was undertaken to assess what published evidence is currently available to support the increasing use of autologous stem cell transplantation (ASCT), and to evaluate the published data with regard to the comparative cost of high-dose and conventional therapy. The review aimed to identify all published, randomized controlled trials (RCTs) comparing high-dose therapy (HDT) with ASCT versus conventional chemotherapy (CC) in acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, and breast, lung, testicular and ovarian cancer. The review also aimed to identify all studies that had compared the cost of the two treatment strategies. Reports were identified by systematic searches of Cancerlit, Embase and Medline, and handsearching of several conference proceedings. Where possible, pooled odds ratios (ORs) were calculated according to the fixed-effect model. A total of 18 randomized trials were identified in acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, and breast, lung and testicular cancer. Trials were generally small and no disease site had sufficient information to determine reliably whether high-dose therapy with autologous transplant is more effective than CC. Five studies were identified that compared the cost of the two treatments. These found the cost of HDT to be between one and four times higher than that of CC. Further randomized trials are required. Where appropriate, these should include economic assessment and assessments of long-term toxicity.
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PMID:Autologous stem cell transplantation for malignancy: a systematic review of the literature. 1079 94

Down's syndrome is an inherited disorder caused by trisomy of chromosome 21. In patients with Down's syndrome, an increased risk of leukemia has been observed. Recently, the coincidence of testicular cancer with this syndrome has been also emphasized. We present a case of Down's syndrome associated with testicular seminoma. This is the 19th case of Down's syndrome associated with testicular tumor in Japan.
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PMID:[A case of Down's syndrome associated with testicular seminoma]. 1084 65

Modern techniques of banking sperm provide an effective way to preserve the option of future fertility for most teenagers and young men diagnosed with a variety of malignancies that will necessitate treatment with chemotherapy, pelvic surgery, or significant radiation doses to the testes. Results of cumulative data collected at the Cleveland Clinic Foundation from patients with testicular cancer, lymphoma, leukemia, sarcoma, carcinoma and other kinds of malignancy have revealed that: (1) pretreatment semen quality (pre-freeze and post-thaw) in patients with cancer is poorer compared with healthy donors; (2) the percentage decline in semen quality (from pre-freeze to post-thaw) in patients with cancer is similar to that of normal donors. This suggested that the effect of cryodamage on spermatozoa from patients with cancer is similar to that of normal donors. (3) The stage of cancer in patients with testicular cancer and Hodgkin's disease shows no relationship to their semen quality. Based on studies conducted at the Cleveland Clinic Foundation, we recommend that sperm cryopreservation be offered to all men of reproductive age who have malignancies. Cryopreservation is safe and inexpensive, and gives patients a chance to establish pregnancies in the future with an assisted reproductive technique.
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PMID:Semen banking in patients with cancer: 20-year experience. 1084 86


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