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  • 1
    Electronic Resource
    Electronic Resource
    Wandel der Therapieergebnisse bei akuter Leukämie unter Anwendung verschiedener Behandlungsschemata, mit besonderer Berücksichtigung spezieller gnotobiotischer Maßnahmen (1983)
    Springer
    Journal of molecular medicine 61 (1983), S. 329-338 
    Details
    ISSN: 1432-1440
    Keywords: Acute leukemia ; Reverse isolation ; Remission rates ; Survival ; Age differences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 202 patients with acute leukemia (156 myeloid-AML, 46 lymphatic and undifferentiated-ALL/AUL) were studied retrospectively for the efficiency of different treatment schedules. Other variables we analysed were the influence of infection prevention with reverse isolation in laminar air flow units and of the age as a prognostic factor. 34% of all AML-patients achieved complete remission. Therapy with Adriamycin, Cytosine-Arabinoside and Vincristine resulted in 25 complete remissions in 51 patients (49%). The median duration of remission was 8 months and the median survival 19 months. The remission rate was improved by treatment with Cytosine-Arabinoside, 6-Thioguanine and Daunomycin (11 of 17 patients). Remission rate was significantly higher in patients up to 30 years of age than in patients older than 50 years (p〈0.008). Survival and remission duration were not different in respect to the age. Reverse isolation with total enteral and topical decontamination resulted in a higher remission rate (p=0.06 not significant) in AML-patients, compared with the control-group. Survival lasted longer with infection prevention. In ALL/AUL-patients the rate of complete remissions was 16 of 34 patients (47%), with a median survival of 17 months. Patients up to the age of 30 had a higher remission rate than those older than 50 years (p=0.017). Patients with ALL/AUL younger than 31 years had a median duration of remission of 16 months and a survival probability of 0.66 after 43 months.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01485023
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  • 2
    Electronic Resource
    Electronic Resource
    Knochenmarktransplantation bei Patienten mit Leukämien (1982)
    Springer
    Journal of molecular medicine 60 (1982), S. 1279-1287 
    Details
    ISSN: 1432-1440
    Keywords: Bone marrow transplantation ; Acute leukemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Between October 1979 and March 1982, bone marrow transplantations were performed by the Tübingen Group for BMT on 19 patients with acute leukemia in remission and on one patient with chronic myelocytic leukemia in chronic phase. The conditioning regimen consisted of 2×60 mg cyclophosphamide/kg and 10 Gy whole-body irradiation with the linear accelerator. The lung dose was limited by shielding to 8 Gy. In 15 patients, the bone marrow cell suspension of the donor was preincubated with antihuman T-cell globulin (AHTCG) for prophylaxis of graft-versus-host disease (GVHD). All patients showed prompt engraftment of donor cells with good hemopoietic function and complete chimerism. Under reverse isolation in sterile units, no severe bacterial or fungal infections were seen in the phase of bone marrow aplasia. Twelve in twenty patients survived between 25 and 900 days. A severe GVHD was seen only in two patients — one after preincubation with AHTCG. One patient died from relapse of his leukemia, another patient had a testicular relapse which was treated with local radiotherapy. Major problems were seen with chronic GVHD (six patients) and infectious complications, most importantly interstitial pneumonia, in the late post-transplant period.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01727484
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  • 3
    Electronic Resource
    Electronic Resource
    Bone marrow transplantation for acute leukemia in second or subsequent remission (1984)
    Springer
    Journal of molecular medicine 62 (1984), S. 1081-1085 
    Details
    ISSN: 1432-1440
    Keywords: Bone marrow transplantation ; Acute leukemia ; Recurrent leukemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twenty-one patients with acute leukemia in second to fifth remission were treated with bone marrow transplantation: 19 patients with transplants from HLA-matched siblings and two with transplants from identical twins. Twelve patients survived from 15 to 1,625 days after transplantation: six of 11 in the ALL group and six of 10 in the AML group. Recurrence of leukemia after marrow transplantation occurred in five patients. The cause of death in five patients was infection, in two patients combined with graft-versushost disease. Long-term disease-free survival can probably be achieved in 30%–35% of all patients with acute leukemia who receive a marrow transplant in second or subsequent remission.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01711377
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  • 4
    Electronic Resource
    Electronic Resource
    High-dose cytosine arabinoside and daunorubicin postremission therapy in adults with de novo acute myeloid leukemia Long-term follow-up of a prospective multicenter trial (1995)
    Springer
    Annals of hematology 71 (1995), S. 219-225 
    Details
    ISSN: 1432-0584
    Keywords: Key words De novo AML ; Adults ; HD-Ara-C/DNR consolidation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A total of 149 consecutive de novo AML patients aged 50 years or less (median age = 37 years) were enrolled in this prospective multicenter trial initiated in May 1985. All patients received the same induction and early consolidation therapy with daunorubicin (DNR), cytosine arabinoside (Ara-C), and etoposide (DAV). High-dose Ara-C/DNR therapy included Ara-C at 3 g/m2, in 12 doses (HD-Ara-C/DNR I) and eight doses (HD-Ara-C/DNR II), followed by DNR 30 mg/m2 for 3 days. A complete remission (CR) was achieved in 104 (70%) patients; 61 complete responders received at least one cycle with HD-Ara-C/DNR. If those patients who were transplanted in first CR (n = 26), were not considered, the median relapse-free-survival (MRFS) of the remaining 78 patients was 15 months, with a probability of relapse-free survival (RFS) at 116 months of 30% (95% CI, 20–40%) after a median follow-up of 95 months. The MRFS of the HD-Ara-C/DNR consolidated patients was 25 months, with a probability of RFS at 116 months of 37% (95% CI, 24–50%). If all patients who were transplanted (n = 44) were not considered, the median survival time (MST) was 18 months with a probability of being alive at 118 months of 24% (95% CI, 16–33%). MST of the HD-Ara-C/DNR consolidated patients was 58 months with a survival probability of 46% (95% CI, 31–60%) at 118 months. Prognostic factor analysis did not reveal any significant influence of age, sex, FAB subtype, white blood cell count, hemoglobin level, thrombocyte count, LDH, or response to the first induction course on RFS of the HD-Ara-C/DNR consolidated patients. In summary, HD-Ara-C/DNR consolidation can improve the long-term outcome of a subgroup of de novo AML patients. Further improvement of the outcome seems to depend on the identification of patients with an inferior outcome under that strategy who might benefit from alternative treatment strategies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01744371
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  • 5
    Electronic Resource
    Electronic Resource
    Interventional antimicrobial therapy in febrile neutropenic patients (1994)
    Springer
    Annals of hematology 69 (1994), S. 231-243 
    Details
    ISSN: 1432-0584
    Keywords: Fever ; Neutropenia ; Infection Pneumonia ; Antimicrobial therapy ; Antifungals Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In this prospective multicenter trial, treatment strategies for 1573 patients with neutropenia 〈1000/μl and fever ≥38.5° C after cytotoxic chemotherapy were compared. Patients with unexplained fever were randomized to a three-phase sequential study for different established drug regimens. If an infection could be defined microbiologically or clinically, treatment modifications were determined. In phase I, treatment for all patients consisted of acylaminopenicillin (PEN) plus aminoglycoside (AMG); or third-generation cephalosporin (CEPH) plus AMG; or PEN plus CEPH. In 800 patients with unexplained fever the response rates were: PEN/AMG (n=258): 74.4%, CEPH/AMG (n=252): 73.4%; PEN/CEPH (n=290): 70.0%. Total response rate was 72.5%. In phase II, patients not responding after 3 days received PEN/CEPH/vancomycin (n=70) or PEN/CEPH/AMG (n=74). The respective response rates were 52.9% and 55.4%, total 54.2%. If fever did not resolve, the patients received either PEN/CEPH (n=40) or imipenem/cilastatin (n=59) both in combination with amphotericin-B/5-flucytosin/ rifampin. The response rates were 62.5% and 79.7%, respectively (p=0.07), total 72.7%. No significant differences between the treatment modalities compared were found. Analyzing all three phases together, 91.3% of patients with unexplained fever were cured. The response rate was also analyzed according to patients with gram-positive bacteremia (n=183), response rate =82.5%; gram-negative organisms (n=145) 78.6%; fungemia (n=51) 43.1% (p〈0.001); lung infiltrates (n=269) 61.3% (p〈 0.001); clinically documented infections (n=198) 84.4%; and clinically and microbiologically documented infections (n=84) 82.1%. If infections were diagnosed after at least 5 febrile days, more lung infiltrates and fungal infections occurredp〈0.001). Leukocytes rising above 500/μ during the infection predicted better response rates (p〈0.001): in unexplained fever 97.8% vs 86.5% and lower death rates 1.5% vs 8.5%. In documented infections the response rates were then 89.9% vs 62.3% and the death rates 7.0% vs 20.5%. Therapy of neutropenic fever and infections must be adapted according to risk factors and should include early empiric antifungal therapy. The therapeutic and prophylactic use of hematopoietic growth factors to overcome neutropenia should be evaluated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700277
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  • 6
    Electronic Resource
    Electronic Resource
    High-dose cytosine arabinoside and daunorubicin postremission therapy in adults with de novo acute myeloid leukemia (1995)
    Springer
    Annals of hematology 71 (1995), S. 219-225 
    Details
    ISSN: 1432-0584
    Keywords: De novo AML ; Adults ; HD-Ara-C/DNR consolidation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A total of 149 consecutive de novo AML patients aged 50 years or less (median age = 37 years) were enrolled in this prospective multicenter trial initiated in May 1985. All patients received the same induction and early consolidation therapy with daunorubicin (DNR), cytosine arabinoside (Ara-C), and etoposide (DAV). High-dose Ara-C/DNR therapy included Ara-C at 3 g/m2, in 12 doses (HD-Ara-C/DNR I) and eight doses (HD-Ara-C/DNR II), followed by DNR 30 mg/m2 for 3 days. A complete remission (CR) was achieved in 104 (70%) patients; 61 complete responders received at least one cycle with HD-Ara-C/DNR. If those patients who were transplanted in first CR (n=26), were not considered, the median relapsefree-survival (MRFS) of the remaining 78 patients was 15 months, with a probability of relapse-free survival (RFS) at 116 months of 30% (95% CI, 20–40%) after a median follow-up of 95 months. The MRFS of the HD-Ara-C/DNR consolidated patients was 25 months, with a probability of RFS at 116 months of 37% (95% CI, 24–50%). If all patients who were transplanted (n=44) were not considered, the median survival time (MST) was 18 months with a probability of being alive at 118 months of 24% (95% CI, 16–33%). MST of the HD-Ara-C/DNR consolidated patients was 58 months with a survival probability of 46% (95% CI, 31–60%) at 118 months. Prognostic factor analysis did not reveal any significant influence of age, sex, FAB subtype, white blood cell count, hemoglobin level, thrombocyte count, LDH, or response to the first induction course on RFS of the HD-Ara-C/DNR consolidated patients. In summary, HD-Ara-C/DNR consolidation can improve the long-term outcome of a subgroup of de novo AML patients. Further improvement of the outcome seems to depend on the identification of patients with an inferior outcome under that strategy who might benefit from alternative treatment strategies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01744371
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  • 7
    Electronic Resource
    Electronic Resource
    Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients (1995)
    Springer
    Annals of hematology 71 (1995), S. 287-291 
    Details
    ISSN: 1432-0584
    Keywords: Key words Aspergillosis ; Amphotericin B ; Inhalation ; Neutropenia ; Prophylaxis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To determine the value of aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis (IPA), we initiated a prospective randomized multicenter trial. The scheduled intent-to-treat interim analysis included 115 patients (30%) with prolonged neutropenia after chemotherapy for acute myeloid leukemia, acute lymphoblastic leukemia/high-grade non-Hodgkin's lymphoma, or solid tumors undergoing autologous stem cell transplantation. Sixty-five patients had been randomized to receive prophylactic aerosol amphotericin B inhalations at a dose of 10 mg twice daily (group A); for the remaining 50 patients no aerosol amphotericin B prophylaxis was used (group B). No serious side effects from amphotericin B inhalations occurred, but coughing (54%), bad taste (51%), and nausea (37%) caused early cessation of aerosol amphotericin B prophylaxis in 23% (15/65) of courses. In group A, the incidence of proven, probable, or possible IPA was 5% (3/65) as compared with 12% (6/50) in group B (p〉0.05). Microbiologically documented bacterial pneumonias were observed in 5/65 (8%) patients in group A and in 1/50 (2%) patients in group B (p〉0.05). Thus, no reduction in incidence of IPA from use of prophylactic aerosol amphotericin B inhalations was found in this interim analysis. As there were no serious side effects from aerosol amphotericin B prophylaxis, accrual in the study will continue for a total of 380 patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01697981
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  • 8
    Electronic Resource
    Electronic Resource
    Meropenem monotherapy versus combination therapy with ceftazidime and amikacin for empirical treatment of febrile neutropenic patients (1998)
    Springer
    Annals of hematology 76 (1998), S. 73-80 
    Details
    ISSN: 1432-0584
    Keywords: Key words Leukemia ; Neutropenia ; Infection ; Antibiotics ; Meropenem
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Infections remain the major cause of morbidity and mortality among neutropenic cancer patients. The current study addresses the question whether monotherapy with the new broad-spectrum carbapenem meropenem exhibits efficacy comparable to that of the standard combination therapy with ceftazidime and amikacin for empirical treatment of febrile neutropenic patients. Seventy-one patients with hematological malignancies (55%) or solid tumors (45%), neutropenia 〈500/μl, and fever 〈38.5  °C were randomly assigned to either meropenem (1 g every 8 h) or ceftazidime (2 g every 8 h) and amikacin (15 mg/kg/day) intravenously. Meropenem (n=34) and ceftazidime/amikacin (n=37) were equivalent with respect to the clinical response at 72 h (62% versus 68%) (p〈0.05) and at the end of unmodified therapy (59% versus 62%). Gram-positive bacteremia responded poorly in the meropenem and ceftazidime/amikacin group (29% versus 25%), whereas all gram-negative bacteremias responded except for one in the meropenem group caused by Pseudomonas aeruginosa. All patients survived to 72 h. One patient in each group died of gram-positive sepsis resistant to study medication. No significant side effects occurred in any regimen. This study suggests that meropenem monotherapy might be as effective as combination therapy with ceftazidime and amikacin for the empirical treatment of febrile neutropenic patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050366
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  • 9
    Electronic Resource
    Electronic Resource
    Knochenmarktransplantation bei akuter Leukämie: Prophylaktische Antiserumbehandlung des Knochenmarks zur Unterdrückung einer Transplantat-gegen-Wirt-Reaktion (1981)
    Springer
    Annals of hematology 43 (1981), S. 113-118 
    Details
    ISSN: 1432-0584
    Keywords: Acute leukemia ; Bone marrow transplantation ; Anti-T-cell-globulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Anti-human-thymocyte globulin (AHTZG) was applied to prevent GvHD in clinical bone marrow transplantation. AHTZG produced by absorption with several cell preparations reacted specifically with T-lymphocyte populations and was no longer inhibitory to human CFUc and bone marrow growth in diffusion chambers. Marrow grafts of 14 patients with ALL were incubated in vitro with AHTZG and transferred to the recipients conditioned with antileukemic chemotherapy and total body irradiation of 1000 rad. Ten patients were transplanted after relaps, four patients during remission. The patients tolerated the marrow without side effects and a hemopoietic engraftment was seen in 12 cases. Three patients showed signs of GvHD on the skin, two of them showed later on also manifestations in the liver. In the other cases no GvHD could be detected. Five out of 14 patients are still alive between 144 and 964 days post transplantation in remission.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00320471
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  • 10
    Electronic Resource
    Electronic Resource
    Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients (1995)
    Springer
    Annals of hematology 71 (1995), S. 287-291 
    Details
    ISSN: 1432-0584
    Keywords: Aspergillosis ; Amphotericin B Inhalation ; Neutropenia ; Prophylaxis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine the value of aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis (IPA), we initiated a prospective randomized multicenter trial. The scheduled intent-to-treat interim analysis included 115 patients (30%) with prolonged neutropenia after chemotherapy for acute myeloid leukemia, acute lymphoblastic leukemia/high-grade non-Hodgkin's lymphoma, or solid tumors undergoing autologous stem cell transplantation. Sixty-five patients had been randomized to receive prophylactic aerosol amphotericin B inhalations at a dose of 10 mg twice daily (group A); for the remaining 50 patients no aerosol amphotericin B prophylaxis was used (group B). No serious side effects from amphotericin B inhalations occurred, but coughing (54%), bad taste (51%), and nausea (37%) caused early cessation of aerosol amphotericin B prophylaxis in 23% (15/65) of courses. In group A, the incidence of proven, probable, or possible IPA was 5% (3/65) as compared with 12% (6/50) in group B (p〉0.05). Microbiologically documented bacterial pneumonias were observed in 5/65 (8%) patients in group A and in 1/50 (2%) patients in group B (p〉0.05). Thus, no reduction in incidence of IPA from use of prophylactic aerosol amphotericin B inhalations was found in this interim analysis. As there were no serious side effects from aerosol amphotericin B prophylaxis, accrual in the study will continue for a total of 380 patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01697981
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