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)

Fifteen patients with acute leukemia resistant to standard chemotherapy were treated by bone marrow transplantation from HLA-matched siblings after conditioning with a new combination chemotherapy/radiation therapy regimen--SCARI. SCARI consists of 5 days of high-dose cytosine arabinoside and 6-thioguanine followed by 3 days of daunorubicin. After a rest period, cyclophosphamide and total-body irradiation are given sequentially. This regimen had acceptable morbidity. Median survival was 169 days. Overall survival and disease-free survival was 27% at over 11 months. Relapse rate was 13% of the entire group and 30% by actuarial projection. Relapses were late and initially extramedullary. Deaths from causes other than leukemia occurred early secondary to fungal infection and late secondary to interstitial pneumonia (frequently cytomegalovirus). Graft-versus-host disease and graft rejection were not causes of mortality. In these patients conditioned with SCARI, leukemic recurrences were infrequent but infectious complications were a major hazard.
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PMID:Bone marrow transplantation with intensive combination chemotherapy/radiation therapy (SCARI) in acute leukemia. 1 96

One hundred patients, 54 with acute myelogenous leukemia (AML) and 46 with acute lymphoblastic leukemia (ALL), considered to be in the end stages of their disease, after combination chemotherapy were treated by marrow transplantation. All patients were given a marrow graft from an HLA-identical sibling after receiving 1000-rad total body irradiation (TBI). One group of 43 patients was given cyclophosphamide (CY), 60 mg/kg on each of 2 days, 5 and 4 days before TBI. In a second group of 31 patients, additional chemotherapy was given before CY and TBI. In a third group of 19 patients, BCNU was given before CY and TBI. A fourth group of 7 patients received other chemotherapy regimens before TBI. Six patients died 3-17 days after marrow infusion without evidence of engraftment. Ninety-four patients were engrafted and only one patient rejected the graft. Thirteen patients are alive with a marrow graft, on no maintenance antileukemic therapy, and without recurrent leukemia 1-4 1/2 yr after transplantation. Three have chronic graft-versus-host disease (GVHD). Four patients are alive 1 1/2 - 3 1/2 yr after grafting but have had a relapse of their leukemia. Of 93 evaluable patients, 19 did not develop GVHD and 24 developed very mild GVHD. Fifty patients developed moderate to severe GVHD, and 40 of these were treated with antithymocyte globulin. Interstitial pneumonia occurred in 54 patients and was the primary cause of death in 34. Interstitial pneumonia often occurred in association with GVHD and the most common etiologic agent was cytomegalovirus. A total of 31 patients have had a relapse of leukemia. There was no definite correlation between relapse of leukemia and the presence or absence of GVHD. The relapse rate appeared to be relatively constant over the first 2 yr and was extremely low after that time. Neither survival nor leukemic relapse appeared to be influenced by the type of leukemia nor by the preparative chemotherapy regimen given before TBI. Patients in fair clinical condition at the time of transplantation showed significantly longer survival times than patients in poor condition (p = 0.001). This observation, coupled with the observation that some patients may be cured of their disease, indicates that marrow transplantation should now be undertaken earlier in the management of patients with acute leukemia who have an HLA-matched sibling marrow donor.
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PMID:One hundred patients with acute leukemia treated by chemotherapy, total body irradiation, and allogeneic marrow transplantation. 1 51

A prospective study of 80 bone marrow transplant recipients with acute leukemia and aplastic anemia employed serial viral cultures, determination of complement-fixing antibody to cytomegalovirus (CMV), and study of material obtained from open lung biopsy and autopsy. There were 43 episodes of interstitial pneumonia, 28 of which were fatal. About 40% of the cases were idiopathic. CMV was the most common candidate pathogen, present in 47% of affected lungs. By a median of 53 days following transplantation, 46% of the recipients were shedding CMV from some site. This event was three times more frequent among recipients who had positive titers of antibody to CMV before transplantation than among seronegative recipients. Failure to respond werologically to CMV infection markedly increased the hazard of dying of interstitial pneumonia. Graft-vs-host disease significantly increased the incidence and lethality of interstitial pneumonia. The presence of leukemia (rather than aplastic anemia) and/or certain factors in the technique of preparation for engraftment may have been significant.
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PMID:A prospective analysis interstitial pneumonia and opportunistic viral infection among recipients of allogeneic bone marrow grafts. 2 31

Laminar air flow isolation and decontamination procedures were evaluated in a prospective randomized study in patients with aplastic anemia or acute leukemia undergoing marrow transplantation from HLA-matched siblings. Patients transplanted in the laminar air flow group had significantly less septicemia and major local infections than did patients in the control group. Nineteen of 46 laminar air flow patients and six of 44 control patients are alive at present. In patients with aplastic anemia the survival was 13 of 17 in the laminar air flow group compared with four of 17 in the control group. In patients with acute leukemia the survival was six of 29 in the laminar air flow group versus two of 27 in the control group. These differences were not statistically significant. Death in both the laminar air flow and control groups was predominantly due to interstitial pneumonitis or recurrent leukemia, which were unaffected by isolation and decontamination.
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PMID:Protective environment for marrow transplant recipients: a prospective study. 3 Nov 23

A bone marrow transplantation from an HLA-identical, MLC nonreactive paternal donor has been performed in a patient with acute lymphoblastic leukemia resistant to drug treatment. Prompt engraftment was documented; however, the patient died of interstitial pneumonitis due to cytomegalovirus 65 days after transplant. Clinical manifestation of graft-versus-host reaction was mild. Recurrence or persistence of leukemia was found at the time of death using cytogenetic markers and determination of the leukemic marker enzyme terminal deoxynucleotidyl transferase.
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PMID:Bone marrow transplantation for acute leukemia using a histocompatible paternal donor. 3 19

Much progress has been made in allogeneic bone marrow transplantation for severe aplastic anemia (SAA) and acute leukemia (AL). In SAA it was shown that hemopoietic chimerism and apparently permanent cures can be achieved in the majority of patients by conditioning with cyclophosphamide followed by bone marrow transplantation (BMT) from an HLA-identical sibling. The previous transfusion history is crucial for failure or success: untransfused patients do very well while graft rejection is an enormous problem in most polytransfused ones. We have shown that most patients without HLA-identical sibling donors can be adequately helped as well. After conditioning with ALG followed by transfusion of haploidentical marrow and low dose androgens there is partial to complete autologous hemopoietic reconstitution in virtually all patients. This points to the fact that most of these patients have pluripotent hemopoietic stem cells that are intact, but apparently unable to differentiate to mature cells, because they are inhibited by autoimmune mechanisms. The results of BMT in patients with endstage leukemia are modest. New pilotstudies with early marrow grafts, i.e. for ANLL in first remission and for ALL in second remission indicate that with this type of approach potentially over 50% of all patients with HLA-identical siblings can be cured. We recommend that HLA-typing should be performed early in families with SAA and AL and that the possibility of a marrow graft should be seriously considered before the patients have endstage disease. Marrow grafts are technically simple but they may pose enormous problems such as graft versus host reaction (GvH), interstitial pneumonia, graft rejection and leukemic recurrence. Therefore, the procedure should only be performed in highly specialized centers with much knowledge and experience in the immunobiology of bone marrow transplantation.
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PMID:[Bone marrow transplantation in severe aplastic anemia and acute leukemia]. 4 65

Bone marrow transplantation is an experimental approach to the treatment of patients with acute leukemia, aplastic anemia, and other neoplastic and genetic diseases. To date, long-term disease-free survival has been achieved in a small proportion of carefully selected patients with resistant acute leukemia. While results are not optimal, they are acceptable in late stage patients where there are no effective alterates. Major problems in marrow transplantation for leukemia include tumor resistance and a spectrum of immunologic complications including GVHD, immunodeficiency, and interstitial pneumonitis. Potential approaches to these problems have been suggested. Progress in any one area would have a substantial impact on improving survival and extending the applicability of marrow transplantation to patients at an earlier stage of their disease.
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PMID:Bone marrow transplantation in acute leukemia: current status and future directions. 4 7

530 children with acute lymphoblastic leukaemia were diagnosed between 1. 1. 1971 and 31. 12. 1974, and treated at 35 German hospitals according to the Memphis study VII or VIII2 and subsequently followed until 31. 12. 1976. At diagnosis 17.2% of the patients had a WBC count of over 50,000/mm3, 8.9% had mediastinal enlargement, 2.1% CNS leukaemia and 1.7% Down's syndrome. After being treated for two and a half years and being observed for a maximum of six years (minimum two years) 262 children (49.4%) were living, 203 (38.8%) in continued complete remission, most of them one to three years after end of treatment. Primary bone marrow relapse occurred in 39.6%, but CNS relapse in only 8.7%. Cranial irradiation at a dose of 1800 rad in 70 patients produced a CNS relapse of only 7.1%. Forty-one of these 530 children (7.7%) died in continued complete remission, the main causes being interstitial pneumonia and varicella. There was no difference in initial features and treatment results between six centres which had many and 29 with rather fewer patients. The five-years-survival rate (life-table method) was 41 +/- 3.5% for all 530 children and 10 +/- 3.7% for the 92 children with initial leucocyte counts of over 50.000/mm3.
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PMID:[Combination chemotherapy and cranial irradiation in 530 children with acute lymphoblastic leukaemia (author's transl)]. 14 70

659 children with acute lymphoblastic leukemia from 42 German hospitals were diagnosed from January 1, 1971 until December 31, 1974, treated according to Memphis study VII or VIII2, and observed until December 31, 1976. At diagnosis 16,1% of the patients had a leukocyte count over 50 000/mm3, 8,5% a mediastinal enlargement, 2,0% a CNS-leukemia and 1,8% a Down-syndrome. After a treatment time of 2 1/2 years and an observation time of maximal 6, minimal 2 years 329 children (= 50,0%) were living, 257 (= 39,1%) in continuous complete remission, most of these 1-3 years after cessation of therapy. A primary relapse in the bone marrow occured in 36,3%, in the CNS in 10,0% of the patients. A cranial irradiation dose of 1800 rad in 120 patients yielded a CNS-relapse rate of 7,5%. 49 of the 659 children (= 7,4%) died in continuous complete remission, the main causes being interstitial pneumonia and varicella. No difference in initial features and treatment results was found between 7 centres with many patients and 35 hospitals with fewer patients.
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PMID:[Results of Memphis-study VII ("Pinkel-Therapy") in 659 children with acute lymphoblastic leukemia. Cooperative therapeutic study of the German working group on childhood leukemia with participation of 42 hospitals]. 27 15

Acute leukemias in infants, including the congenital and neonatal leukemia, present a number of unfavourable features. Age of the infant, hyperleukocytosis, outstanding organomegaly, early onset of the CNS leukemia are some of the factors causing this group of acute leukemias of childhood to be those with highest risk. The poor prognosis of the illness is further worsened by frequent rejection of cytotoxic therapy, often failure in inducing remission and its shortness. Two patients with acute lymphoblastic leukemia, aged 4 months, are presented. Clinical the hematologic remission was achieved in both by the application of the current therapeutic methods. Recurrence and CNS leukemia appearing 5 months after the remission resulted in death of one patient. The second patient also developed CNS leukemia 5 months after remission. It was treated and another remission was achieved, but the child died due to interstitial pneumonia.
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PMID:[Acute leukemia in infants]. 29 3


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