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)

Central nervous system (CNS) infections in immunocompromised hosts are often accompanied by subtle disorders because immunosuppression usually decreases the inflammatory response. CNS infections in immunocompromised patients are usually caused by organisms different from those found in the general population. The organism causing CNS infection in an immunocompromised host can often be predicted if the type of immune abnormality of the patient is known. The common causes of CNS infection in immunocompromised hosts are reviewed here. Meningitis in patients with neutropenia is usually due to enteric Gram negative bacilli that live in the patient's own digestive tract. Pseudomonas aeruginosa is most common and is followed by E. Coli, Klebsiella, Enterobacter and Proteus. A major risk in patients with abnormal immunoglobulins or splenectomy is infection with encapsulated bacteria, particularly Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. Meningitis caused by any of the encapsulated bacteria can be fulminant. Listeria monocytogenes is the most common cause of bacterial meningitis in patients with impaired cellular immunity. Nocardia asteroides is a leading cause of brain abscess in patients with hematologic malignancy. Most patients have evidence of concomitant pulmonary lesions. Fungi are among the most common organisms involving the CNS in immunocompromised hosts. Susceptible patients include those with lymphoma or leukemia and those who receive therapies aimed at suppressing delayed hypersensitivity. Cryptococcus neoformans is a common fungal cause of CNS infection in immunocompromised hosts. The primary site of infection is the lung. Spread to the CNS is via the blood stream. The clinical course is highly variable: meningitis, meningoencephalitis and focal mass lesions. Candida causes meningitis or meningoencephalitis characterized by multiple small abscesses in neutropenic hosts. Organisms reach the CNS via the blood stream usually from the digestive tract or infected intravenous catheters. Aspergillus causes brain abscess, cerebral infarction and focal meningitis in patients with neutropenia. The primary infection is in the lung. The parasites that infest the CNS of immunocompromised patients are usually those that exploit a T-lymphocyte, mononuclear phagocyte host defect. The most common are Toxoplasma gondii and Strongyloides stercoralis. There have been a few cases of amebiasis with dissemination to the brain in patients with hematologic malignancies. Toxoplasma gondii causes major CNS disease in immunocompromised hosts: meningoencephalitis or mass lesions.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Infections of the central nervous system in malignant hemopathies]. 372 88

A hematologic malignancy occurred simultaneously with a malignant mediastinal germ cell tumor in two men. In one instance the blood disorder was acute nonlymphocytic leukemia, and in the other, malignant histiocytosis. We subsequently identified nine additional patients, all male (age range 12-48 years), with a mediastinal germ cell tumor and either acute nonlymphocytic leukemia or malignant histiocytosis. Six of the 11 patients had not received either radiation or chemotherapy before development of the hematologic malignancy. One patient developed malignant histiocytosis and was found to have a malignant mediastinal germ cell tumor after having received steroid therapy for a renal allograft. The four remaining patients developed acute nonlymphocytic leukemia 5-32 months after initiation of irradiation or chemotherapy for a mediastinal germ cell tumor. In four patients with acute leukemia, karyotypic analysis established the clonal nature of the leukemic process. Although the leukemia may be therapy-related in four or possibly five patients, this explanation cannot be applied to the remaining six patients. These six patients, coupled with studies of in vitro growth characteristics of teratocarcinoma cells described previously, suggest that a previously unrecognized association between malignant mediastinal germ cell tumors and hematologic malignancies may exist in humans.
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PMID:Association between mediastinal germ cell tumors and hematologic malignancies. Report of two cases and review of the literature. 385 13

An instance of cerebral abscess presenting with episodes of palinopsia occurred in a patient suffering from acute myelogenous leukaemia. Palinopsia is a very uncommon symptom in cerebral disease. Review of hospital autopsy records for a decade revealed 280 other instances of haematological malignancy, in only one of which a cerebral abscess was also present.
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PMID:Cerebral abscess in leukaemia: an unusual presentation of a rare complication. 387 Apr 34

The use of supralethal chemoradiotherapy followed by marrow transplantation has progressed from being an experimental approach applied only to a limited number of end-stage patients to an important therapeutic option appropriate for many adults with a variety of hematologic malignancies. With the use of transplantation, 10% to 30% of patients with relapsed leukemia and approximately 50% of patients with acute nonlymphoblastic leukemia in first remission can be cured. Cures have also been seen in a variety of other hematologic malignancies, including chronic granulocytic leukemia, preleukemia, hairy cell leukemia, and malignant lymphoma. Transplantation is currently limited by the need for a suitable marrow donor; by the complications of the transplant procedure, including infection, graft-versus-host disease, and the toxicities of intensive chemoradiotherapy; and by the risk of recurrent disease. Some of these limitations will likely be overcome as a result of current research. The use of partially matched family members and matched unrelated donors will make transplantation available to more patients. Some forms of posttransplant infection, including those associated with herpes simplex and cytomegalovirus, can now be prevented or treated. Improved methods of controlling graft-versus-host disease including T-cell depletion of marrow and the use of more effective immunosuppressive agents, as well as a better understanding of the toxicities of the preparative regimens, are making the transplant procedure safer and more tolerable. Finally, the development of better preparative regimens and transplantation earlier in the patient's disease course will likely allow for a larger percentage of patients to be cured.
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PMID:Treatment of acute leukemia in adults with chemoradiotherapy and bone marrow transplantation. 388 38

Since 1971, 8,483 women with primary breast cancer participated in seven trials evaluating adjuvant chemotherapy. Leukemia occurred in only three of 2,068 patients treated by operation alone. The cumulative risk was 0.06% after 10 years in those free of metastases or a second primary tumor, and 0.27% in those with tumor. Thus, leukemia is not an important factor in the natural history of breast cancer. Five of 646 women receiving postoperative regional radiation developed leukemia, an overall risk of 1.39 +/- .49% at 10 years. Twenty-seven cases of leukemia (0.5%) and seven of myeloproliferative syndrome (0.1%) were recorded in 5,299 patients who received L-phenylalanine mustard (L-PAM)-containing regimens. The maximum cumulative risk of leukemia in chemotherapy recipients (leukemia of any type and myeloproliferative syndrome) was 1.68 +/- .33% at 10 years following operation. The risk excluding those with myeloproliferative syndrome was 1.29 +/- .28%. The risk of leukemia in patients free of metastases or a second primary was 1.11 +/- .30% at 10 years, and when combined with myeloproliferative syndrome, it was 1.54 +/- .36%; risks not significantly greater than observed following radiation (P = .58 and .29). No cases of leukemia were observed during the 2 years of chemotherapy and none have occurred after the seventh postoperative year. Comparisons with the surveillance, epidemiology, and end results tumor registries (SEER) data indicate an increased relative risk of acute myelogenous leukemia following postoperative regional radiation (P less than .01) and adjuvant chemotherapy (P less than .001). The findings indicate that hematologic disorders are side effects of both radiation and alkylating agents used in the adjuvant treatment of primary breast cancer. The risk of such events is lower than that reported following treatment of other solid tumors and hematologic malignancies by chemotherapy. The benefit from adjuvant chemotherapy for breast cancer exceeds the risk of leukemia. Since chemotherapy is not uniformly beneficial, efforts should be directed toward identifying responders so that only those who will benefit are exposed to the risk.
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PMID:Leukemia in breast cancer patients following adjuvant chemotherapy or postoperative radiation: the NSABP experience. 390 49

Combination chemotherapy consisting of etoposide and cytosine arabinoside (Ara-C) was given to 38 children with hematological malignancy. They included 18 patients with acute lymphocytic leukemia (ALL), two with non-Hodgkin's lymphoma (NHL), one with myeloproliferative disorder (MPD), and one with histiocytic medullary reticulosis (HMR), all of whom had relapsed or not responded to initial treatment. Sixteen patients with nonlymphocytic leukemia (ANLL), 13 in remission, two in relapse, and one in induction failure, were also studied. The drug combination was administered by intravenous infusion twice a week for two consecutive weeks at a dosage of 150 mg/m2 for each drug. Among the 18 patients with ALL, seven complete responses and three partial responses were achieved. Six of the seven complete responders relapsed at 0.5-3 months, and the remainder has been in remission for 2.5+ months. None of the patients with refractory ANLL, NHL, MPD or HMR achieved complete remission; however, two of three ANLL patients and one HMR patient demonstrated partial response. Among the 13 ANLL patients in remission, 9 patients have continued remission for more than 4 months with a median of 26+ months, ranging from 6+ months to 40+ months, while 4 relapsed within 4 months after the administration of this regimen. The toxic effects were tolerable. Results indicate that an etoposide and Ara-C combination is effective especially in refractory ALL in childhood.
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PMID:[Etoposide (VP 16/NK 171) and cytosine arabinoside combination chemotherapy in refractory childhood leukemia]. 396 59

Two hundred and thirty-six cases of multiple primary cancer associated with hematological malignancies, collected from 35 medical institutions in Japan, are reported. Based on the time interval between the first cancer and the second cancer, they were divided into three groups: synchronous cancer (94 cases), metachronous cancer subsequent to hematological malignancy (61 cases) and metachronous hematological malignancy subsequent to carcinoma (76 cases). The most common initial cancers were acute leukemia (including atypical leukemia and erythroleukemia), non-Hodgkin's lymphoma, multiple myeloma and chronic myelogenous leukemia of the hematological malignancies, and gastric cancer of the carcinomas. Patients with cancer of the uterus and breast in the metachronous cancer group metachronously developed hematological malignancies more frequently than those in the synchronous cancer group. Multiple primary cancer was observed more frequently in men than in women both in the synchronous cancer group and in the group with metachronous cancer subsequent to hematological malignancies. Acute leukemia was the most frequent disease type in incidence among the metachronous hematological malignancies. This secondary acute leukemia was characterized by a mostly granulocytic nature, poor response to chemotherapy and poor prognosis.
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PMID:Multiple primary cancers associated with hematological malignancies. 400 83

Pyoderma gangrenosum is a rare occurrence in patients with haematological malignancy. This characteristic but nonspecific inflammatory process with skin destruction occurred in 4 patients with myelodysplasia, in one with acute leukaemic transformation of myelofibrosis, and in de novo acute myeloblastic leukaemia in another. Clinically, the cutaneous lesion in these patients differed from that associated with inflammatory bowel disease, arthritis, or the idiopathic type of pyoderma gangrenosum by having the vesiculo-bullous borders. Histopathological differences were also evident since more superficial layers of the skin were involved in the ulceration than typically encountered in patients with non-malignant systemic disease. Despite the less penetrating nature of this variant, treatment of the pyoderma gangrenosum is unsatisfactory and in the absence of effective therapy for the underlying disease, healing occurred only in the patient with acute leukaemia who achieved complete remission in response to chemotherapy.
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PMID:Pyoderma gangrenosum in myelodysplasia and acute leukaemia. 403 58

Aneuploidy as an indication of abnormal cellular DNA content has recently been confirmed to be a reliable marker of malignant cells in human solid tumors and hematologic malignancies. Flow cytometry (FCM), measuring cellular DNA content in thousands of cells within seconds, is able to safely detect the "rare event cell," the rare aneuploid cell in a diploid cell population. This very fast and sensitive technique was combined with a newly developed cell separation technique. Cell separation prior to FCM enabled us to detect malignant cells at concentrations of 0.05% in blood, bone marrow, and lymph node cell suspensions of patients with leukemia. An illustration of this method is presented in conjunction with first clinical applications demonstrating that patients with minimal residual disease in clinically complete remission had significantly shorter survival times than patients in whom no minimal residual disease was detected with this new method.
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PMID:Aneuploidy as a marker of minimal residual disease in leukemia. 406 49

Many of the conceptual advances in the treatment of advanced cancer have resulted from studies of the hematologic malignancies: The signal importance of complete remission, the complete disappearance of evident disease, as the major contributor to significant palliation; the first studies of adjuvant therapy, that is chemotherapy given to patients free of disease, which demonstrated prolongation of disease-free periods; the first studies of intensification, including early, intermittent, and late; combination chemotherapy; and finally, the important observation that advanced metastatic malignancies can be cured were made in studies of these important diseases. Because of treatment advances that have occurred over the last 10 to 20 years, the majority of patients with adult hematologic malignancies that were once considered universally fatal can be either cured or have substantial palliation. Treatment for adult acute leukemia has advanced such that 15% to 20% of patients have prolonged disease and treatment-free survivorship; in Hodgkin's disease, over 70% of patients can be cured; and for the lymphomas, the majority or 50% to 60% of patients can be cured with available treatments. Major treatment advances in supportive treatment such as allogeneic transfusion and allogeneic and autologous bone marrow transplantation improve the perspective for control of the hematologic malignancies. In addition, the potential for biologic response modifiers or the biologic products of normal cells that are normally involved in the regulation of both proliferation and differentiation show enormous potential for the treatment of advanced disease. Studies of interferon have shown promising early results in chronic granulocytic leukemia and in hairy cell leukemia. A new class of drugs, the acridine analogs, of which AMSA (4'-[9-acridinylamino]methanesulfon-M-anisidide) is a member, has been introduced and has established activity against acute leukemia. VP-16 (etoposide) has just become commercially available and is an important drug both in leukemia and lymphoma. Finally, the discovery of new knowledge about the biochemical pharmacology of drugs such as arabinosyl cytosine has offered a major advance in salvage treatment and the potential for substantial further improvement in the frontline management of these diseases. The rapid advances in both palliative and curative treatment for the hematologic malignancies have generally found broad application to the management of advanced cancer arising from other organ systems.
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PMID:The hematologic malignancies. Leukemia, lymphoma, and myeloma. 620 91


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