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)

Treatment of chronic myeloid leukaemia (CML) with IFN-alpha (IFN) is known to confer significant survival benefit, but the drug's impact on quality of life (QoL) in CML is unclear. We describe a cross-sectional comparison of QoL in patients randomised to long-term treatment with IFN versus no IFN within the UK MRC CML 3 trial, assessing the long-term consequences and psychosocial side effects of IFN therapy. Patients completed the EORTC QoL QLQ-C30, an in-house leukaemia/IFN questionnaire, a brief assessment of sexual functioning and demographic details. In total, 163 eligible patients completed questionnaires (85% response). Patients receiving IFN reported significantly worse QoL for emotional, cognitive and social functioning, pain and dyspnoea (P<0.01), and marginally worse fatigue, nausea and vomiting (P<0.05). As expected from other IFN use, those on IFN experienced more flu-like and febrile symptoms and skin problems than those not on IFN. In all, 35% of patients stopped IFN before questionnaire completion. This made no material difference to the results, except that those continuing on IFN had slightly better self-assessed Global health/QoL than those who had stopped (P<0.03). IFN treatment adversely affected sexual health after allowing for age and gender. In conclusion, IFN treatment has a significant adverse impact on QoL. Patient awareness of the survival benefits and these QoL effects should enable better-informed decision-making. The impact on QoL of IFN dose, and of imatinib therapy versus IFN in early CP CML, are being investigated. QoL will need evaluating in future studies of combination treatment (IFN+imatinib).
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PMID:Treatment of CML using IFN-alpha: impact on quality of life. 1287 50

Antiphospholipid syndrome is characterized by venous and arterial thrombosis, recurrent pregnancy loss and the presence of the lupus anticoagulant, anticardiolipin antibodies or both. Antiphospholipid syndrome may occur as a primary disease or in patients with systemic lupus erythematosus or other autoimmune, infectious or neoplastic disorders. In this paper we report a 29-year-old Saudi female, a known case of antiphospholipid syndrome, presented with complaints of fever, breathlessness and generalized fatigue. Further investigations confirmed her as a case of myeloblastic leukemia (M1, French-American-British classification). Acute myeloblastic leukemia is not described to be associated with primary antiphospholipid syndrome in the literature to date. This is the first case report of such association.
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PMID:Acute myeloblastic leukemia in a patient with primary antiphospholipid syndrome. 1297 90

The purpose of this qualitative descriptive study was to allow childhood leukemia patients to describe their quality of life (QoL) in their own words. These personal accounts provide an opportunity for health care personnel to understand the impact that leukemia has on these children. A total of 13 children in three focus group interviews participated. They ranged in age from 5 to 9 years and were either off therapy or had completed at least 6 months of treatment. Four semistructured interview questions were used to guide the interviews. Each question related to a domain identified in previous research as having an effect on QoL. Thus, the areas explored in this study were (a) physical well-being and symptoms, (b) psychological well-being, (c) social well-being, and (d) spiritual well-being. Five themes were identified: (a) fatigue, (b) the effect on activities, (c) medication and treatment effects, (d) relationship changes, and (e) hair loss.
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PMID:Quality of life among childhood leukemia patients. 1456 66

Fatigue is a major complaint among advanced cancer patients. Several instruments are available for measuring fatigue. The EORTC QLQ-C30 is one of the most frequently used health-related quality of life (HRQOL) instruments, and it includes a three-item fatigue subscale. Limited knowledge exists about the validity, performance and sensitivity of EORTC QLQ-C30 fatigue scale as compared with a fatigue-specific instrument. The aim of the present study was to validate the EORTC QLQ-C30 fatigue scale (FA) against the Fatigue Questionnaire (FQ). The FQ is frequently used and was developed to measure fatigue in both cancer and noncancer populations. The FQ measures physical (PF, seven items) and mental fatigue (MF, four items). The study population included two different cohorts: A) patients with advanced metastatic cancer included in a prospective randomized study of palliative radiotherapy (n = 238); B) patients with leukaemia and malignant lymphoma curatively treated with stem-cell transplantation and high-dose chemotherapy (n = 128). The analysis demonstrated that the FA correlated higher with the PF scale (r = 0.67-0.75) as compared with the MF scale (r = 0.49-0.61). The item scale correlations between FA items and the PF scale were consistently higher than between FA items and the MF scale. A factor analysis including all the items within the FA and the FQ identified two factors. All FA items loaded on a PF factor (0.70-0.85). A floor/ ceiling effect, indicating a high number of respondents with lowest, respectively, highest scores was observed more frequently in the FA as compared with the FQ. The PF discriminated better between diagnostic groups with different levels of fatigue than the FA did. In conclusion, the EORTC QLQ-C30 fatigue scale is measuring physical fatigue. A floor/ ceiling effect seems to appear for the EORTC QLQ-C30 fatigue scale. The validity of the EORTC QLQ-C30 fatigue scale is to be questioned for use in palliative care patients. In studies with fatigue as a defined end point, a domain-specific instrument should, therefore, be added.
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PMID:The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors. 1648 51

We evaluate the efficacy of the oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) in 71 refractory/relapsed multiple myeloma patients, including a prognostic analysis to predict both response and survival. Patients received thalidomide at escalating doses (200-800 mg/day), daily cyclophosphamide (50 mg/day) and pulsed dexamethasone (40 mg/day, 4 days every 3 weeks). On an intention-to-treat basis and using the EBMT response criteria, 2% patients reached complete response (CR), 55% partial response (PR) and 26% minor response (MR) yielding a total response (CR+PR+MR) rate of 83% after 3 months of therapy. After 6 months of therapy, responses were maintained including a 10% CR. The 2-year progression free and overall survival were 57 and 66%, respectively. A favorable response was associated with beta2 microglobulin < or =4 mg/dl, platelets >80 x 10(9)/l and nonrefractory disease. Regarding survival, low beta2 microglobulin (< or =4 mg/dl), age (< or =65 years) and absence of extramedullary myelomatous lesion were associated with a longer survival. Major adverse effects included constipation (24%), somnolence (18%), fatigue (17%) and infection (13%). Only 7% of patients developed a thrombo-embolic event. ThaCyDex is an oral regimen that induces a high response rate and long remissions, particularly in relapsing patients with beta2 microglobulin < or =4 mg/dl and < or =65 years.
Leukemia 2004 Apr
PMID:The oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) is effective in relapsed/refractory multiple myeloma. 1497 8

The cure and management of patients with cancer are constantly evolving. The rapid translation of scientific findings into clinical therapeutics has resulted in a variety of efficacious cancer agents. Results from recently completed and ongoing clinical trials continue to demonstrate the efficacy and tolerability of many of these new cancer therapies. This supplement aims to provide the oncology nurse with a better understanding of the pathophysiology and management of a variety of cancers. Each article provides practical information to the nurse treating cancer in clinical practice. At the conclusion of this educational activity, the participant should be able to discuss the most recent advances in the medical management of leukemia as well as lung, breast, and ovarian cancer; to describe the role and report the results of new molecular-targeted therapies in treating malignancies; to review new therapies for managing chemotherapy-related hematologic toxicities, cognitive impairment, fatigue, and pain; and to recognize the need and discuss the measures used to improve symptom control and supportive care in the palliative setting.
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PMID:Advances in cancer research and practice. 1502 5

The purpose of this literature review was to identify and summarize published studies describing the epidemiology and management of chronic lymphocytic leukaemia (CLL). Chronic lymphocytic leukaemia represents 22-30% of all leukaemia cases with a worldwide incidence projected to be between < 1 and 5.5 per 100,000 people. Australia, the USA, Ireland and Italy have the highest CLL incidence rates. Chronic lymphocytic leukaemia presents in adults, at higher rates in males than in females and in whites than in blacks. Median age at diagnosis is 64-70 years. Five-year survival rate in the USA is 83% for those < 65 years old and 68% for those 65 + years old. Hereditary and genetic links have been noted. Persons with close relatives who have CLL have an increased risk of developing it themselves. No single environmental risk factor has been found to be predictive for CLL. Patients are usually diagnosed at routine health care visits because of elevated lymphocyte counts. The most common presenting symptom of CLL is lymphadenopathy, while difficulty exercising and fatigue are common complaints. Most patients do not receive treatment after initial diagnosis unless presenting with clear pathologic conditions. Pharmacological therapy may consist of monotherapy or combination therapy involving glucocorticoids, alkylating agents, and purine analogs. Fludarabine may be the most effective single drug treatment currently available. Combination therapy protocols have not been shown to be more effective than fludarabine alone. As no cure is yet available, a strong unmet medical need exists for innovative new therapies. Experimental treatments under development include allogeneic stem cell transplant, mini-allogeneic transplants, and monoclonal antibodies (e.g. alemtuzumab against CD52; rituximab against CD20).
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PMID:The clinical and epidemiological burden of chronic lymphocytic leukaemia. 1519 32

A 63-year-old woman presented to the internist with fatigue, cough, low-grade fever, splenomegaly and leucocytosis up to 130 x 10(9)/l. Although a diagnosis of chronic myelogenous leukaemia was initially entertained, she turned out to have a metastasised melanoma. The differential diagnosis and workup is discussed, as well as potential mechanisms by which the tumour could have induced the leucocytosis, such as the production of G-CSF or similar mediators, and the prognostic significance of this phenomenon.
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PMID:Extreme leucocytosis and splenomegaly in metastasised melanoma. 1536 1

A 44-year-old man was referred to Hakodate Chuo Hospital because of progressive fatigue in April 2001, and was diagnosed as having adult T-cell leukemia (ATL; acute type). Complete remission was not obtained even with the application of multiple anti-leukemic agents including CHOP-V-MMV. The patient received an allogeneic bone marrow transplant from his HLA-identical, HTLV-I antibody-negative sibling donor in June 2002. The conditioning regimen consisted of cyclophosphamide, etoposide and total body irradiation. Cyclosporine A and a short course of methotrexate were given as prophylaxis for graft-versus-host disease (GVHD). Engraftment was achieved on day 16, while ATL cells were detected in the peripheral blood throughout the transplantation. ATL cells were also detected in bone marrow on day 20. Withdrawal of the immunosuppressant induced the eradication of the residual ATL cells in the peripheral blood on day 24 and in the bone marrow on day 40. Grade III of acute GVHD developed in the bowel on day 40, which lasted for over 5 months and was gradually resolved by administration of prednisolone and tacrolimus. The patient remains in complete remission 23 months after the transplantation. The clinical consequence of our case clearly shows that a graft-versus-leukemia (GVL) effect combined with graft-versus-host disease (GVHD) plays a curative role even in an early phase after bone marrow transplantation for patients with adult T-cell leukemia.
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PMID:[Eradication of adult T-cell leukemia cells and maintenance of remission by the graft-versus-leukemia effect after allogeneic bone marrow transplantation]. 1551 Aug 33

(1) Acute promyelocytic leukaemia is a rare disease. There is a high remission rate after combination treatment with tretinoin and anthracycline, but there is no established treatment for refractory or relapsed disease. Further treatment with tretinoin, combined with intensive cytotoxic chemotherapy, seems to give the best results in patients who qualify for this treatment, but assessment is limited. (2) Arsenic trioxide has now been approved for induction of remission and consolidation in patients with refractory or relapsed acute promyelocytic leukaemia. (3) The clinical evaluation dossier that supported the application contains data from two non comparative trials including 12 and 40 patients. A complete haematological response was obtained in 45 (87%) of the 52 patients, and the survival rate among patients in first relapse was 77% after a median follow-up of two years. These results are similar to those previously obtained with tretinoin plus intensive cytotoxic chemotherapy. (4) All the patients treated with arsenic trioxide experienced adverse events. This was to be expected given the acute and chronic toxicity of arsenicals. Most events included fatigue, gastrointestinal disturbances, peripheral neuropathies, prolongation of the QT interval; and biochemical disturbances (hypokalaemia, hyperglycaemia, elevated transaminase activity). (5) Like tretinoin, arsenic trioxide can provoke a potentially severe leukocyte activation syndrome. (6) In practice, these encouraging data justify further assessment of arsenic trioxide. This drug is already an option for patients with refractory or relapsed disease who cannot receive tretinoin plus intensive chemotherapy.
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PMID:Arsenic trioxide: new preparation. Acute promyelocytic leukaemia: encouraging results but persistent doubts. 1553 37


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