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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 3 (1997), S. S55 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Multiple immunsuppressive Bedingungen wie neoplastische Grunderkrankungen selbst, immunsuppressive Behandlung mit zytotoxischen Substanzen und Kortikosteroiden, aber auch die schwere und irreversible, erworbene Immunsuppression bei AIDS machen den Menschen signifikant empfänglicher für ein breites Spektrum viraler Infektionen und erhöhen deren Morbidität und Mortalität. Sowohl T- als auch B-Zell-Abnormalitäten und -Defizienzen können für die Erhöhung dieser Suszeptibilität verantwortlich sein. Einige Virusinfektionen führen eher zu schweren Krankheitsverläufen unter einer zellvermittelten Immunsuppression, andere nehmen durch eine beeinträchtigte humorale Immunität des Wirts protrahierte und schwere Verläufe. Virusinfektionen hingegen, denen eine Immunpathogenese zugrunde liegt, d. h. deren zytopathogenen Effektormechanismen vom Immunsystem des Wirts stammen, verlaufen unter einer ausgeprägten Immunsuppression eher klinisch stumm. Unter diesen Bedingungen fehlen allerdings die Mechanismen, die zu einer Eliminierung der Virusinfektion führen. In vielen Fällen kommt es so zur Persistenz des Erregers unter Immunsuppression und zur klinischen Manifestation der Infektion in der Phase der immunologischen Rekonstitution, z. B. einige Wochen nach Absetzen oder Reduktion der immunsuppressiven Therapie. Eine herausragende Bedeutung bezüglich der Morbidität und Mortalität von Virusinfektionen beim immunkompetenten Patienten kommt den Viren der Herpesgruppe zu. Bei hoher Durchseuchungsquote der Bevölkerung und der Eigenschaft der Viren, latent im Organismus zu verbleiben, führen Reaktivierung und Primärinfektionen bei immunsupprimierten Patienten zu lebensbedrohlichen Situationen.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Der Internist 38 (1997), S. 1045-1049 
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Hochdosistherapie ; Leukämie-Therapie ; Stammzelltransplantation ; Tumor-Therapie ; Malignom-Therapie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zum Thema Die Hochdosistherapie ist in der Regel nur in Kombination mit einer Stammzelltransplantation möglich. Insbesondere bei Malignomen der Hämatopoese, hier wiederum vorwiegend bei Leukämien, ist dieses Verfahren etabliert. Zunehmend wird die Hochdosistherapie aber auch bei soliden Tumoren mit ermutigenden Ergebnissen evaluiert. Das Konzept dieser Behandlung und die Methodik wird in dieser Arbeit auch dem Nichtspezialisten verständlich aufgezeigt. Da auch eine Hochdosistherapie nicht sämtliche Tumorzellen zu zerstören vermag, werden zusätzliche Behandlungsoptionen bei minimal residueller Tumorerkrankung erläutert.
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  • 3
    ISSN: 1569-8041
    Keywords: chemotherapy ; hematopoietic growth-factor support ; high-dose chemotherapy ; peripheral blood stem cell transplantation ; small-cell lung cancer ; treatment toxicity and mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: We conducted a phase I/II trial to assess the feasibilityand activity of VIP-E chemotherapy in small-cell lung cancer. End-points weretreatment-related morbidity and mortality, response to treatment, duration ofresponse, and survival. Patients and methods: Two cycles of combination chemotherapy followedby granulocyte colony-stimulating factor (G-CSF) were given at a dose ofetoposide (500 mg/m2), ifosfamide (4000mg/m2), cisplatin (50 mg/m2), and epirubicin(50 mg/m2) to 100 consecutive patients with SCLC. Thirtypatients (19 with LD, and 11 with ED SCLC) proceeded to VIC-E high-dosechemotherapy with autologous peripheral blood stem cell transplantation(PBSCT) at a cumulative dose of etoposide 1500 mg/m2,ifosfamide 12,000 mg/m2, carboplatin 750 mg/m2and epirubicin 150 mg/m2 (VIC-E). Surgical resection ofprimary tumor was attempted at the earliest feasible point. Thoracicirradiation was given after completion of chemotherapy. Results of conventional-dose VIP-E: 97 patients were evaluable forresponse. Objective response rate was 81% in LD-SCLC (33% CR,48% PR; excluding patients in surgical CR) and 77% in ED-SCLC(18% CR, 58% PR). Treatment mortality was 2%. Mediansurvival was 19 months in LD-SCLC and 6 months in ED-SCLC. Two-year survivalwas 36% in LD and 0% in ED SCLC. Results of high-dose VIC-E: All 30 patients improved on or maintainedprior responses. Four patients (13%) died of treatment-relatedcomplications. Median survival was 26 months in LD-SCLC and 8 months inED-SCLC. Two-year survival was 53% in LD and 9% in ED SCLC. Conclusion: VIP-E chemotherapy is an effective induction therapy forSCLC. Compared with traditional protocols such as ACO orcarboplatin/etoposide, response rates are slightly improved, while survivalis not different. In the LD SCLC subgroup, high-dose chemotherapy improvedresponse rates and survival, especially for patients in surgical CR prior tohigh-dose therapy. In ED SCLC, however, higher response-rates did nottranslate into improved survival. Selected LD-SCLC patients with good partialor complete remissions after prior therapy may benefit from HDC and PBSCT.
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  • 4
    ISSN: 1569-8041
    Keywords: chemotherapy ; hematopoietic growth-factor support ; high-dose chemotherapy ; non-small-cell lung cancer ; peripheral blood stem cell transplantation ; treatment toxicity and mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: We conducted a phase I/II trial to assess the feasibilityand activity of combination chemotherapy with etoposide, ifosfamide,cisplatin, and epirubicin in limited-stage (LS, stage I–IIIB) andextensive-stage (ES, stage IV) non-small-cell lung cancer (NSCLC). End-pointswere treatment-related morbidity and mortality, response rate, duration ofresponse, and survival. Patients and methods: Chemotherapy followed by granulocytecolony-stimulating factor was given at a dose of etoposide (500mg/m2), ifosfamide (4000 mg/m2), cisplatin (50mg/m2), and epirubicin (50 mg/m2) (VIP-E) to107 patients with NSCLC. Twenty-five patients with qualifying responsesproceeded to high-dose chemotherapy with autologous peripheral blood stem celltransplantation after etoposide (1500 mg/m2), ifosfamide(12,000 mg/m2), carboplatin (750 mg/m2) andepirubicin (150 mg/m2) (VIC-E) conditioning. Results of conventional-dose VIP-E: 35 of 102 (34%) evaluablepatients responded (2 CR's, 33 PR's), 33/102 patients (33%) showed nochange (NC); the remainder of patients progressed with therapy (PD). Objectiveresponse rate was 68% (4% CR, 64% PR) in LS-NSCLC and23% (1.4% CR, 21.4% PR) in ES-NSCLC. Median duration ofsurvival was 13 months in LS-NSCLC and 5.5 months in ES-NSCLC. Two-yearsurvival was 26% in LS and 2% in ES-NSCLC. Results of high-dose VIC-E: 23 of 24 evaluable patients improved ormaintained prior responses (92%), 1 patient showed NC. Treatmentmortality was 4%. Median duration of survival was 17 months in LS-NSCLCand 10 months in ES-NSCLC. Two-year survival was 30% in LS and8% in ES-NSCLC. Conclusion: Response-rates and survival after conventional-dose VIP-Echemotherapy are comparable to other published trials of combinationchemotherapy in NSCLC. Toxicity and mortality is acceptable in limited stage,but unacceptably high in extensive stage NSCLC. Although better response-rateswere achieved in the high-dose arm, they did not translate into improvedsurvival. Most stage IV NSCLC-patients will neither benefit from VIP-Econventional dose, nor from VIC-E high dose chemotherapy. Whether selectedLS-patients with partial or complete responses to VIP-E induction chemotherapycould benefit from dose intensification in an adjuvant or neo-adjuvant settingremains to be determined.
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