Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0023467 (acute myeloid leukemia)
 35,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 54-year-old male was admitted because of dyspnea on exercise. His peripheral blood revealed pancytopenia with severely hypoplastic bone marrow. Bone marrow aspiration showed a marked hypocellular marrow with 62.4% of blast cells. Cytochemical studies showed that peroxidase activity, alpha-nephtyl buthylate esterase activity and PAS reaction were negative, and that only ASD-chroloacetate esterase activity was positive. Surface marker analysis of blast cells showed positive result for CD5, 7, 33 and 34 antigens. The T-cell receptor beta gene was rearranged, but the immunoglobulin H chain gene showed a germ line configuration. Terminal Deoxynucleotydyl Transferase (TdT) was positive, but cellular surface and cytoplasmic immunoglobulin were not recognized. A diagnosis of hypoplastic mixed lineage leukemia was made and treated with low dose cytosine arabinoside, he resulted in complete remission. The relation between hypoplastic leukemia, AML-M0 and mixed lineage leukemia was also discussed.
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PMID:[Hypoplastic mixed lineage leukemia successfully treated with low-dose cytosine arabinoside]. 872 48

A retrospective study of 37 patients with haematological malignancy (21 acute myeloid leukaemia, 11 acute lymphoid leukaemia, two lymphoma, two hairy cell leukaemia, one Hodgkin's disease) and histologically documented mucormycosis was conducted to evaluate the clinical characteristics and ascertain the factors which influenced the outcome from mycotic infection. Patients were admitted to 18 haematology divisions in tertiary care or university hospitals in Italy between 1987 and 1995. Fever, thoracic pain, dyspnoea and cough were the most frequent presenting symptoms. At the onset, 89% patients were neutropenic (neutrophil counts < 0.5 x 10(9)/l) with a median duration of previous neutropenia of 14 d (range 6-60). The most frequent sites of infection were lungs (81%), CNS (27%), sinus (16%), liver (16%) and orbital space (10%). Only three patients were asymptomatic. A correct in vivo diagnosis was made in only 13 (35%) patients. When performed, thoracic and cranial CT scan were the most useful diagnostic investigations. Despite the fact that 26 febrile patients were treated with empirical antifungal treatment, 28 of the 37 patients (76%) died from fungal infection at a median time of 17 d from the onset of clinical symptoms. Nine patients were cured by antifungal therapy plus, in five cases, radical surgery procedures. An analysis of factors influencing outcome demonstrated that the resolution of chemotherapy-induced neutropenia and prolonged treatment with amphotericin B and, if feasible, radical surgical debridement treatment, were significantly correlated with recovery from infection. Mucormycosis, a rare filamentous fungal infection that occurs most frequently in neutropenic acute leukaemia patients, is characterized by a high mortality rate. Extensive and aggressive diagnostic and therapeutic procedures are essential to improve the prognosis in these patients.
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PMID:Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. GIMEMA Infection Program (Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto). 937 50

GM-CSF may induce pulmonary complications, such as dyspnea with temporary decreases in oxygen saturation described as first dose effect for higher dosages of intravenous rhGM-CSF. This study investigated possible pulmonary disturbances in adult de novo AML patients receiving yeast rhGM-CSF 24 h prior to chemotherapy under phase II/III conditions. Eighteen patients were monitored for 22 treatment episodes. GM-CSF was given s.c. 1 q.d., 2 q.d. or continuously i.v. at 250 micrograms/m2/d 24 h prior to induction chemotherapy (TAD9, n = 18) and consolidation (TAD9, n = 4). Spirometry, bodyplethysmography, single breath-diffusion capacity (DLCO) and arterial blood gas analyses were obtained prior to GM-CSF, and repeated after 24 h. Pulse oxymetric oxygen saturation (saO2) was registered continuously for the first 16 h within day 1 of rhGM-CSF treatment. Patients were aged 21-75 years. The saO2 monitoring did not reveal any first dose effect. PaO2 values decreased from 78.9 mmHg before GM-CSF to 72.8 mmHg after 24 h (p < 0.01, maximum shift 15 mmHg). PaO2 shifts occurred mainly with pre-existing lowered paO2, but otherwise were independent of age, the route of GM-CSF administration, leukocyte levels, or increase of leukocytes with GM-CSF. Increases in AaDO2 reflected the paO2 shifts (p < 0.05). No dyspnea corresponded to these changes. DLCO values did not decrease significantly after 24 h. Summarily, contemporary dosage of yeast rhGM-CSF avoids short-term oxygen desaturations, but leads to clinically benign impairment in oxygen tension, based on ventilation/perfusion mismatches. This should be taken into account for patients starting at subnormal paO2.
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PMID:Decrease in arterial oxygen partial pressure within the first 24 h of rhGM-CSF administration in AML patients. 941 40

A 27-year-old male with acute myelogenous leukemia received an allogeneic bone marrow transplantation (allo-BMT). Pneumocystis carinii pneumonia developed on day 65 after the allo-BMT. The patient was intravenously treated with pentamidine. This resulted in a prompt improvement of his dyspnea and fever, but hyperkalemia occurred during the pentamidine therapy. Treatment with pentamidine was stopped and emergent treatment was started. Nevertheless, the serum potassium level rose to 7.7 mEq/l. Urgent dialysis was performed and the serum potassium level fell to 5.0 mEq/l after treatment. Careful monitoring of the serum potassium level is recommended during intravenous therapy with pentamidine.
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PMID:[Acute myelogenous leukemia with hyperkalemia induced by pentamidine administration]. 963 92

Several reports have showed an increased risk of secondary malignancies after bone marrow transplantation (BMT), especially after total body irradiation (TBI). We report on a 39-year-old female who underwent BMT with a matched unrelated donor because of acute myeloid leukemia in second complete remission. Previously, the patient received chemotherapy for induction, consolidation, maintenance and reinduction after diagnosis of relapse. Conditioning regimen consisted of cyclophosphamide and TBI. MTX and CSA was administered for GvHD prophylaxis. Engraftment was confirmed on day 28. Within 6 months following BMT, no complication occurred. Continuous complete remission was demonstrated by repeated bone marrow smears. On day 300 the patient complained of chest pain and dyspnea. X-ray and CT-scan showed thickening of the pleura and pleural effusion. A pleuracarcinosis was diagnosed by cytologic examination of a pleural aspirate. By an open thoracotomy a disseminated inoperable disease became apparent. Diagnosis of an adenocarcinoma was confirmed by histologic examination. The patient died 2 months later due to disseminated tumour in complete remission of AML. Solid tumours are rare as secondary malignancies after BMT. Usually the neoplasmas are late events occurring more than 10 years after BMT. In this case predisposing factors such as genetic disposition, long-term smoking, intensive pretransplant chemotherapy, TBI and immunosuppression may have lead to the early secondary malignancy.
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PMID:Early occurrence of an adenocarcinoma after allogeneic bone marrow transplantation in a patient with AML. 1037 70

We aimed to perform a prospective analysis of the main characteristics of deaths occurring in the oncohaematology department of a general hospital. From November 1995 to February 1997, a total of 81 patients died in our unit, 50 of whom (61.7%) were male. Their mean age was 67.8 (range 19-96) years. Underlying diseases were: multiple myeloma (9 cases), acute myeloid leukaemia (22), lymphoma (14), chronic lymphocytic leukaemia (6), acute lymphoblastic leukaemia (4), myelodysplastic syndromes (3), solid tumours (11), and other (12). The previous disease duration ranged from 5 days to 276 months (mean 31.9 months). The duration of the last hospital stay varied between 0 (death on arrival or on way to hospital) and 40 days (mean 9.3 days). Two patients died in the emergency unit just before entering our department (1 suicide). Only 15 patients had been admitted for the first time. In 70% of these cases death appeared predictable, as the consequence of refractory or end-stage disease. In these cases, all the "do not resuscitate" orders were in place at least 48 h before death. About half the patients died without any relative present. The frequencies of the clinical complaints evaluated were the following: pain necessitating opiates 27%; infection- or disease-related fever 40%; dyspnoea 44%; haemorrhage 20%; CNS disturbances 25%. The percentages of use of therapy tools chosen as indicators were: benzodiazepines 80%; chemotherapy 46%; anti-infectious agents 47%; transfusions 42%; major analgesics 27%; and steroids 40%. The circumstances and quality of patient deaths must be regularly evaluated so that palliative care in the final stages of life can be improved.
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PMID:Characteristics of deaths in a department of oncohaematology within a general hospital. A study of 81 cases. 1092 70

Gemtuzumab ozogamicin is a humanised monoclonal IgG4 antibody, linked to a cytotoxic calicheamicin derivative. It effects cell necrosis by specifically targeting the CD33 antigen which is expressed on the surface of leukaemic cell blasts in more than 90% of patients with acute myeloid leukaemia (AML), but is not present on normal stem cells. Therapy with gemtuzumab ozogamicin (2 doses of 9 mg/m2) in 3 noncomparative studies produced complete remission in 16% of adult patients with AML in first relapse, and complete remission with incomplete platelet recovery in an additional 13% of patients. Rates of remission did not differ between those aged less than 60 years and older than 60 years. Many patients were able to receive both doses of gemtuzumab ozogamicin therapy as outpatients. Survival duration was similar between those treated as outpatients and those requiring hospitalisation. About one-third of 11 children and adolescents treated with 2 doses of 9 mg/m2 gemtuzumab ozogamicin in a phase I study showed <5% bone marrow blasts after completion of therapy. The most commonly encountered adverse events in clinical trials with gemtuzumab ozogamicin were myelosuppression, increased levels of hepatic enzymes, infection, fever, bleeding, chills, nausea and vomiting and dyspnoea. No treatment-related renal failure or alopecia was reported.
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PMID:Gemtuzumab ozogamicin. 1151 Oct 25

In a 64-year-old man suffering from hypoblastic myelodysplastic syndrome a secondary acute myeloid leukaemia developed. After induction chemotherapy with resulting partial remission he received an allogenic (related) peripheral blood stem cell transplantation conditioned with 2 Gy total body irradiation. After haematopoietic reconstitution chest pain and dyspnoea appeared. Computer tomography revealed diffuse bilateral infiltrates which were considered to be suspicious for an invasive pulmonary aspergillosis of the left upper lobe. Respiratory and circulatory insufficiency occurred. In bronchoalveolar lavage fluid Aspergillus antigen was detected. In addition, Aspergillus flavus was isolated on Sabouraud-dextrose agar. Ambisome (liposomal encapsulated amphotericin B) was applied in high dosages. On the skin of the sides and the back five livid red stained nodular lesions with haemorrhagic infarctions appeared. Pathohistologically, both in PAS (periodate acid Schiff) and Grocott-Gomori staining conglomerates of septated hyphae were detected in corium and subcutis. In addition, Aspergillus flavus grew from skin tissue. Despite antifungal treatment the patient died from Aspergillus pneumonia and generalized aspergillosis with dissemination to heart, brain, and skin.
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PMID:Secondary cutaneous aspergillosis due to Aspergillus flavus in an acute myeloid leukaemia patient following stem cell transplantation. 1260 97

A retrospective survey was conducted over a 10-year period (1990-99) among 52 haematology divisions in order to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating haematological diseases. The study included 55 patients (18 with non-Hodgkin's lymphoma, 10 with acute lymphoblastic leukaemia, eight with acute myeloid leukaemia, five with chronic myeloid leukaemia, four with chronic lymphocytic leukaemia, four with multiple myeloma, three with myelodysplastic syndrome, two with myelofibrosis and one with thalassemia) who developed PCP. Among these, 18 (33%) underwent stem cell transplantation; only two received an oral prophylaxis with trimethroprim/sulphamethoxazole. Twelve patients (22%) developed PCP despite protective isolation in a laminar airflow room. The most frequent symptoms were: fever (86%), dyspnoea (78%), non-productive cough (71%), thoracic pain (14%) and chills (5%); a severe hypoxaemia was present in 39 patients (71%). Chest radiography or computerized tomography showed interstitial infiltrates in 34 patients (62%), alveolar infiltrates in 12 patients (22%), and alveolar-interstitial infiltrates in nine patients (16%). Bronchoalveolar lavage was diagnostic in 47/48 patients, induced sputum in 9/18 patients and lung biopsy in 3/8 patients. The diagnosis was made in two patients at autopsy. All patients except one started a specific treatment (52 patients trimethroprim/sulphamethoxazole, one pentamidine and one dapsone). Sixteen patients (29%) died of PCP within 30 d of diagnosis. Multivariate analysis showed that prolonged steroid treatment (P < 0.006) and a radiological picture of diffuse lung involvement (P < 0.003) were negative diagnostic factors.
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PMID:Pneumocystis carinii pneumonia in patients with malignant haematological diseases: 10 years' experience of infection in GIMEMA centres. 1197 21

We encountered 15 patients with rounded atelectasis induced by exposure to asbestos from 1992 to 1999. All patients were men whose ages ranged from 42 to 85 years, with a mean age of 64.2 +/- 11.5 years. Rounded atelectasis was present only in the right lung and two patients had 2 rounded atelectasis in the right lung. In eight cases, the rounded atelectasis was found in segment 10, while in the others, it was found in segments 4, 5, 6, 8, and 9. Although evidence of symptoms was absent, rounded atelectasis was detected in six patients through medical examinations. Others complained of chest pain and dyspnea. Thirteen patients displayed pleural plaques and only 2 patients revealed asbestosis. Malignant complications were discovered in 4 patients, of whom 3 showed primary lung cancer and 1 suffered acute myelocytic leukemia. In their occupational histories, 7 patients had been exposed to asbestos in the shipyards and 5 in the construction field. The mean period of the exposure was 25.1 +/- 12.7 years, and the latency period from the first asbestos exposure to the detection of atelectasis was 35.1 +/- 8.8 years. Five autopsied patients had more than 10,000 asbestos bodies in the lung, which indicated heavy exposure to asbestos. These results suggest that rounded atelectasis may appear after high-dose exposure to asbestos.
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PMID:[Clinical evaluation of rounded atelectasis induced by exposure to asbestos]. 1197 76


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