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  • 1
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0584
    Keywords: Acute nonlymphocytic leukemia ; Intensified induction therapy ; Toxicity ; Response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Sixty patients with ANLL were given intensified remission induction therapy consisting of thioguanine, cytosine arabinoside and daunorubicin (TAD). The mean age of patients was 47.6 years (range 18 to 74 years). Basing on leukemic cell kinetic data time sequencing of drugs was different from the original TAD protocol. Complete remission (CR) was achieved in 43/60 patients (72%) with 10 CR in 15 patients over 60 years of age. Seventy-nine percent of the CR were induced by one cycle vs. thirty percent reported from the original TAD regimen. The major cause of induction failure — in ten of the 60 patients — was thrombocytopenia refractory to platelet transfusions. Persisting leukemia after two induction cycles was documented in only two patients. Median remission duration by life table analysis is 10 months with 17 patients in continuous CR for 1+ to 22+ months.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Annals of hematology 24 (1972), S. 252-253 
    ISSN: 1432-0584
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-0584
    Keywords: Akute nichtlymphoblastische Leukämie ; intensivierte Induktionstherapie ; Toxizität ; prognostische Faktoren ; Acute nonlymphocytic leukemia ; Intensified induction therapy ; Toxicity ; Prognostic factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Cytosine arabinoside (ARA-C) and daunorubicin (DNR) (7+3 regimen) produced complete remission (C.R.) in 16 of 31 adult patients with ANLL (regimen A). Addition of vincristine (VCR) and ifosfamide (IF) revealed C.R. in 5 of 11 patients (regimen B). Dosage escalation for ARA-C and DNR and additional thioguanine (T.A.D. regimen) produced C.R. in 5 of 9 patients when ARA-C was given by continuous infusion (regimen D) and in 8 of 10 patients when given by bolus injections (regimen F). Clearance of blasts from the bone marrow by the first course was achieved in 11 of 14 patients by the T.A.D. regimens D and F vs. 15 of 38 patients by regimens A and B (p〈0.05). Time to recovery of neutrophils and platelets after one course of D or F was not prolonged as compared to A and B provided that clearance of bone marrow blasts was adequate. Increased dose of ARA-C by continuous infusion (D) instead of bolus injections (F) induced unacceptable gastrointestinal toxicity. In (only evaluable) regimen A median remission duration was 11.5 (1-31+) months. In patients with adequate blast clearance by the first course median remission duration was 19 (5-31+) months vs. 2.5 (1–6) months in the delayed blast clearance group (p〈0.001). In patients under 60 years of age in regimens D and F 11 of 11 achieved C.R. vs. 18 of 34 in A and B (p〈0.025). In patients receiving chemotherapy at original dosage 12 of 14 in regimens D and F achieved C.R. vs. 13 of 26 in A and B (p〈0.1).
    Notes: Zusammenfassung Cytosin-Arabinosid (ARA-C) und Daunorubicin (DNR) (7+3-Schema) führten bei 16 von 31 erwachsenen Patienten mit ANLL zu einer kompletten Remission (C.R.) (Regime A). Das identische Schema erweitert durch Vincristin (VCR) und Ifosfamid (IF) ergab eine C.R. bei 5 von 11 Patienten (Regime B). Dosissteigerung für ARA-C und DNR sowie Ergänzungen durch Thioguanin (TG) (T.A.D.-Schema) ergab C.R. bei 5 von 9 Patienten, wenn ARA-C kontinuierlich infundiert wurde (Regime D) und bei 8 von 10 Patienten wenn ARA-C als Bolus-Injektionen gegeben wurde (Regime F). Eine adäquate Blastenreduktion im Knochenmark bereits nach dem ersten Kurs zeigten bei den T.A.D.-Schemata D und F 11 von 14 Patienten gegenüber 15/38 bei A und B (p〈0,05). Die Erholungszeit der Neutrophilen und Thrombozyten war nach einem D- oder F-Kurs nicht länger als nach einem A- oder B-Kurs, sofern eine adäquate Blastenreduktion erzielt wurde. Erhöhte Dosis von ARA-C als Dauerinfusion (D) statt Bolusinjektion (F) verursachte inakzeptable gastro-intestinale Nebenwirkungen. Nach dem am längsten verfolgten Regime A betrug die mediane Remissionsdauer 11,5 (1-31+) Monate, und zwar bei Patienten mit adäquater Blastenreduktion durch den ersten Kurs 19 (5-31+) Monate vs. 2,5 (1–6) Monate bei Patienten mit verzögerter Blastenreduktion (p〈0,001). Bei Patienten unter 60 Jahren erreichten 11/11 bei den Regimen D und F eine C.R. gegenüber 18/34 in A und B (p〈0,025). Bei den Patienten ohne Dosisreduktion erreichten 12/14 bei den Regimen D und F und 13/36 bei A und B eine C.R. (p〈0,1).
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  • 5
    ISSN: 1432-0584
    Keywords: Chronic lymphocytic leukemia ; Fludarabine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a clinical phase-II study fludarabine phosphate was given to 20 patients with advanced chronic lymphocytic leukemia who had failed on prior conventional therapy. Fludarabine was administered at a dose of 25 mg/m2/d for 5 days. Treatment cycles were repeated every 4 weeks until maximal response, followed by two cycles for consolidation. Four of the 20 patients achieved complete remission and seven patients partial remission, resulting in an overall response rate of 55% (11/20). Fludarabine therapy was well tolerated, with mild myelosuppression and secondary infections comprising the predominant side effects. These data warrant further confirmation and a randomized comparison of fludarabine with established regimens, which is currently underway.
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  • 6
    ISSN: 1432-0584
    Keywords: Acute myelocytic leukaemia ; Multidrug therapy ; Clinical results ; Cell kinetic data ; Regimen modification
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 31 adult patients (study A) with acute myelocytic leukaemia were treated for remission induction with cytosine arabinoside (ARA-C, 100 mg/ m2/day) by a 7 (5) day continuous infusion. 3 (2) doses of daunorubicin (DNR, 45 mg/m2 i.v.) were added at daily intervals. For maintenance 5 day ARA-C was given monthly in sequential combination with DNR, thioguanine (TG), or ifosfamide (IFOS). 16 (52%) patients achieved complete remission (C.R.) after 1.8 (1–23) courses and 6.7 (3–10) weeks from treatment start. The median survival for responders and non-responders was 11.5 months, early death rate within 6 weeks was 3 (10%). Median remission duration was 13.5 months. Among 11 patients surviving for 7–22 months 7 patients are in first remission for 5.5–20.5 months. DNR, IFOS and TG were not given before the 3rd day of ARA-C infusion. In a previous group of 34 leukaemic patients and in 44 therapy courses DNA histograms of bone marrow cells using pulse cytophotometry showed marked accumulation in S-phase for 75% of courses. Also (G2 + M)-cells in the DNA distribution and thymidine pulse labelling indices were markedly increased in most cases, whereas thymidine uptake by scintillation counter was diminished and mitotic indices had not changed significantly. In now 15 patients (study B) the induction regimen was intensified by adding vincristine (VCR, 2 mg i.v.) and 3 doses of IFOS (600 mg/m2 i.V.). Preliminary results are 50% C.R. after 1,7 (1–2) courses and 6.8 (5–10) weeks from initiation of therapy. 2 patients died in the first 6 weeks. Modification and intensification of established drug combinations for AML on the basis described appear reasonable and possible.
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  • 7
    ISSN: 1432-0584
    Keywords: Hepatosplenic candidiasis ; Clinical picture ; Therapy ; Radiology ; Histology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Systemic candidiasis with Candida-induced abscesses, predominantly in the liver and the spleen, was diagnosed in 27 patients with haematologic malignancies after intensive cytostatic therapy. Specific features included septic fever unresponsive to antimicrobial therapy, hepatosplenomegaly with multiple lesions in the liver and spleen (diameter up to 2 cm) as detected by computed tomography (CT) or ultrasound, and an elevation in liver enzymes. During treatment, induced neutropenia, hepatic and splenic foci were poorly defined histologically and were not identified by imaging procedures. After granulocyte recovery these foci showed characteristic histological patterns. Ultrasound and/or CT investigations of the abdomen now revealed characteristic lesions in the liver and the spleen. Gamma-GT and alkaline phosphatase were early indicators of hepatic involvement in Candida septicaemia and were often already elevated in aplasia.
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  • 8
    ISSN: 1432-0584
    Keywords: Key words Candida pneumonia ; Aspergillosis ; Bronchoscopy ; High resolution CT scan
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In a retrospective study of 56 patients with hematological malignancies and fungal pneumonia we have analyzed the value of different diagnostic procedures. In all patients (Candida n = 29, Aspergillus n = 23, mixed fungal infection n = 4) bronchoscopy and/or high-resolution computed tomography of the lungs was performed. Cultural detection of fungi in bronchoalveolar lavage was successful in 23/32 Candida and 11/23 Aspergillus pneumonias. Other relevant pathogens were identified by bronchoscopy in 21 cases. Thorax CT scans showed diagnostic evidence of fungal pneumonia in 10/13 Candida and in 16/18 Aspergillus infections. Blood cultures were positive in 9/33 Candida pneumonias and in none of aspergillosis cases. Serological testing and surveillance cultures had only limited value for the early diagnosis of pulmonary mycosis. Our data suggest that bronchoscopy and high resolution CT scans are mutually complementary diagnostic tools with high sensitivity in patients with hematological malignancies and new pulmonary infiltrates. These procedures facilitate the early and reliable recognition of invasive fungal disease which may have a bearing on the initiation, length, and differential therapy of antimycotic drugs.
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Annals of hematology 55 (1987), S. 172-172 
    ISSN: 1432-0584
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-0584
    Keywords: Multiple myeloma ; Refractoriness ; Chemotherapy ; VAD regimen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Seventeen patients with advanced refractory multiple myeloma were treated with a 4-day continuous infusion of vincristine and adriamycin in combination with 4-day intermittent high-dose dexamethasone (VAD). Ten patients entered a partial remission (59%). Complete remission was not achieved in any patients. The median response duration was 11 months and the median survival of the responding patients was 18 months versus 5 months for non-responders. Major complications during VAD treatment were infections probably due to a combination of myelosuppression and intensive corticosteroid therapy. The VAD regimen offers a useful chemotherapy that produces an overall high response rate even in intensively pretreated patients resistant to first line therapy. The treatment results in a clear tendency to longer survival in responding patients.
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