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  • 1
    Electronic Resource
    Electronic Resource
    Incidence and outcome of critical illness amongst hospitalised patients with haematological malignancy: a prospective observational study of ward and intensive care unit based care (2005)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 60 (2005), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To determine the incidence and outcome of critical illness amongst the total population of hospital patients with haematological malignancy (including patients treated on the ward as well as those admitted to the intensive care unit), consecutive patients with haematological malignancy were prospectively studied. One hundred and one of the 1437 haemato-oncology admissions (7%) in 2001 were complicated by critical illness (26% of all new referrals). Fifty-four (53%) of these critically ill patients survived to leave hospital and 33 (34%) were still alive after 6 months. The majority (77/101) were not admitted to the intensive care unit but were managed on the ward, often with the assistance of the intensive care team. Independent risk factors for dying in hospital included hepatic failure (odds ratio 5.3, 95% confidence intervals 1.3–21.2) and central nervous system failure (odds ratio 14.5, 95% confidence intervals 1.7–120.5). No patient with four or more organ failures or a Simplified Acute Physiology Score II ≥ 65 survived to leave hospital. There was close agreement between actual and predicted mortality with increasing Simplified Acute Physiology Score II for all patients, including those not admitted to intensive care.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2005.04139.x
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  • 2
    Electronic Resource
    Electronic Resource
    A phase I study of human lymphoblastoid interferon administered by continuous intravenous infusion (1982)
    Springer
    Cancer chemotherapy and pharmacology 9 (1982), S. 97-102 
    Details
    ISSN: 1432-0843
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A phase I study of human lymphoblastoid interferon (IFN-α) was undertaken in patients with acute leukaemia and other malignancies. The pharmacokinetics of intravenous IFN-α were also investigated. IFN-α was administered to two patients by intravenous (IV) bolus injection at a dose of 5×106 U/m2; and to a further 37 patients (40 cycles) by continuous intravenous infusion (IVI) for 5, 7, or 10 days at doses ranging from 5 to 200×106 U/m2/day. Pyrexia, general malaise, anorexia, and rigors were observed at all dose levels; three patients became hypotensive. Myelosuppression occurred in all patients, including seven without bone marrow infiltration. Transient rises in alkaline phosphatase and transaminases (SGOT) were observed in patients receiving daily doses greater than 30×106 U/m2. Dose-limiting central nervous system toxicity, hyperkalaemia, and hypocalcaemia were encountered at 200×106 U/m2. In six patients with acute leukaemia there was a fall in the number of circulating leukaemic blasts and in one patient with acute myelogenous leukaemia (AML) the degree of bone marrow infiltration decreased from 99% to less than 5% with cellularity returning to normal. Serum levels of IFN above 1,000 U/ml were achieved with daily doses above 30×106 U/m2 given by IVI. The maximum safely tolerated daily dose, 100×106 U/m2 administered for 7 days, is appreciably higher than that used in most previous studies, although even at this level consideralbe toxicity may be encountered.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00265387
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  • 3
    Electronic Resource
    Electronic Resource
    Generation of cytotoxic T lymphocytes from peripheral blood of leukaemic patients (1993)
    Springer
    Cancer immunology immunotherapy 37 (1993), S. 47-53 
    Details
    ISSN: 1432-0851
    Keywords: Leukaemia ; IL-2 ; TIL ; LAK
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Peripheral blood mononuclear cells from 13 patients with acute leukaemia were used to establish long-term interleukin-2-dependent cytotoxic T lymphocytes. Cells were grown in RPMI medium containing interleukin-2 (IL-2, 100 U/ml) and 2.5% conditioned medium prepared by activating normal lymphocytes with phytohaemagglutinin. Proliferation of IL-2-dependent CD3-positive lymphocytes was seen in 1 of 2 acute lymphocytic leukaemia cases (ALL), 1 of 4 acute myelogeneous leukaemia cases (AML) (M1) and 8 of 8 more differentiated AML. In 2 cases with detectable leukaemic cell markers (1 ALL and 1 AML) passageable cells were developed, that expressed normal T cell phenotypes (namely CD3, CD4, and CD8) at the expense of leukaemic cells. In 1 of 2 cases, long-term IL-2-cultured cells showed specific cytotoxic activity against autologous leukemic cells. The percentage killing against autologous and two allogeneic target cell lines at a 50/1 effector/target (E/T) ratio was 42%, 9% and 19% respectively. Similarly the cytotoxic activity of IL-2 activated from 4 different individuals against conventional tumour targets K562 and Daudi at a ratio of 50/1 was 29%–68% (median=55%) and 34%–78% (median=61%) respectively. It was also found that this killing potential of the activated cells was maintained for as long as culture was continued (median 23 days, range 17–75 days). The mechanism(s) of T cell proliferation at the expense of leukaemic blast cells in the case of a minority of leukaemic patients and the possible clinical therapeutic potential of these cells following in vitro IL-2 activation deserve further investigation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01516941
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  • 4
    Electronic Resource
    Electronic Resource
    CT appearances of mucosa-associated lymphoid tissue (MALT) lymphoma (1999)
    Springer
    European radiology 9 (1999), S. 693-696 
    Details
    ISSN: 1432-1084
    Keywords: Key words: MALT lymphoma ; Stomach ; Computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade lymphoma that differs from high-grade non-Hodgkin lymphoma both clinically and histologically. The CT appearances of MALT lymphoma are described. Of 40 patients referred with biopsy-proven MALT lymphoma, only seven had not had gastrectomy or chemotherapy prior to CT examination. The CT scans of these seven cases were analysed for the degree and extent of gastric wall thickening, enlargement of abdominal and extra-abdominal lymph nodes, and presence of extranodal disease. In all patients the stomach was distended with oral contrast medium and scans performed at narrow collimation, after intravenous administration of 20 mg hyoscine butylbromide. In six patients focal thickening of the gastric wall was 1 cm or less. One patient had thickening of over 4 cm. There was no enlargement of abdominal or extra-abdominal lymph nodes or extension to adjacent organs. Thus on CT, at presentation, MALT lymphoma results in minimal gastric wall thickening, unlike high-grade non-Hodgkin lymphoma, which typically causes bulky gastric disease, nodal enlargement and extension into adjacent organs. CT is therefore of limited value in monitoring response to treatment. With disease greater than minimal thickening, transformation to a higher grade should be considered.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050734
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  • 5
    Electronic Resource
    Electronic Resource
    Acute promyelocytic leukaemia: a retrospective analysis of patients treated at St. Bartholomew's Hospital 1969–1995 (1999)
    Springer
    Annals of hematology 78 (1999), S. 131-137 
    Details
    ISSN: 1432-0584
    Keywords: Key words APML ; Survival ; Remission ; Recurrence ; Cytogenetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Seventy-two patients with acute promyelocytic leukemia (APML) were treated at St.Bartholomew's Hospital (SBH) over a 25-year period. Improvements in supportive care and the use of more intensive chemotherapy have led to an increase in the complete remission rate from 14 to 58%. Similarly, the median survival has increased from 3 weeks to 2 years; the median duration of remission, which was 7 months in 1974, has not yet been reached. There was also a significant difference in survival from first recurrence, compared with that of patients with other subtypes of acute myeloid leukemia. RT-PCR analysis on bone marrow samples from 14 patients confirmed the presence of the PML/RARA fusion; 13 of the 14 patients achieved 'molecular remission' after therapy. The one patient who remained persistently positive experienced recurrence within 4 months. In seven of the eight patients in whom the disease recurred, the translocation was identified by RT-PCR at the time of relapse, whilst in one patient it was noted 4 months prior to morphological recurrence. These results illustrate the improvement in prognosis that occurred over a 25-year period in patients with APML treated at a single centre.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050489
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  • 6
    Electronic Resource
    Electronic Resource
    Mitoxantrone and cytosine arabinoside as treatment for acute myeloblastic leukemia in older patients (1995)
    Springer
    Annals of hematology 71 (1995), S. 35-39 
    Details
    ISSN: 1432-0584
    Keywords: Acute myeloid leukemia ; Cytosine arabinoside ; Elderly ; Mitoxantrone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The majority of patients with acute myeloid leukemia (AML) are elderly, and their response to chemotherapy is poorer than that of younger patients. The combination of mitoxantrone (MTN) and cytosine arabinoside (Ara-C) is a possible alternative to an anthracycline/Ara-C combination for the treatment of AML in these patients. Of 52 older patients (〉 59 years) referred over a 3.5-year period, 33 patients (age range 60–78 years, median 67 years) received MTN and Ara-C as therapy for newly diagnosed AML. MTN was administered at a dose of 12 mg/m2/day, intravenously, for 3 days (23 patients), or 10 mg/m2/day for 5 days (10 patients), and Ara-C at a dose of 100 mg/m2 twice daily, intravenously, for 7 days. Complete remission (CR) was achieved in 16/33 patients (48%). The median remission duration was 6 months (range 1–37 months). The median survival was 14 months for those who achieved CR compared with 9 months for those with resistant disease. Two patients remain in first CR after 13 and 37 months, but three patients died whilst receiving consolidation therapy. In selected elderly patients with AML, the combination of MTN and Ara-C provides an acceptable alternative to an anthracycline/ Ara-C regimen, with a higher CR rate than historical controls. However, the CR rate and remission duration remain low compared with those of younger patients, supporting the need to investigate new approaches to treatment in this population.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01696230
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  • 7
    Electronic Resource
    Electronic Resource
    Mitoxantrone and cytosine arabinoside as treatment for acute myeloblastic leukemia in older patients (1995)
    Springer
    Annals of hematology 71 (1995), S. 35-39 
    Details
    ISSN: 1432-0584
    Keywords: Key words Acute myeloid leukemia ; Cytosine arabinoside ; Elderly ; Mitoxantrone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The majority of patients with acute myeloid leukemia (AML) are elderly, and their response to chemotherapy is poorer than that of younger patients. The combination of mitoxantrone (MTN) and cytosine arabinoside (Ara-C) is a possible alternative to an anthracycline/Ara-C combination for the treatment of AML in these patients. Of 52 older patients (〉59 years) referred over a 3.5-year period, 33 patients (age range 60–78 years, median 67 years) received MTN and Ara-C as therapy for newly diagnosed AML. MTN was administered at a dose of 12 mg/m2/day, intravenously, for 3 days (23 patients), or 10 mg/m2/day for 5 days (10 patients), and Ara-C at a dose of 100 mg/m2 twice daily, intravenously, for 7 days. Complete remission (CR) was achieved in 16/33 patients (48%). The median remission duration was 6 months (range 1–37 months). The median survival was 14 months for those who achieved CR compared with 9 months for those with resistant disease. Two patients remain in first CR after 13 and 37 months, but three patients died whilst receiving consolidation therapy. In selected elderly patients with AML, the combination of MTN and Ara-C provides an acceptable alternative to an anthracycline/ Ara-C regimen, with a higher CR rate than historical controls. However, the CR rate and remission duration remain low compared with those of younger patients, supporting the need to investigate new approaches to treatment in this population.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01696230
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  • 8
    Electronic Resource
    Electronic Resource
    Intensive chemotherapy for adult acute lymphoblastic leukaemia given with or without granulocyte-macrophage colony stimulating factor (1996)
    Springer
    Annals of hematology 73 (1996), S. 259-263 
    Details
    ISSN: 1432-0584
    Keywords: Key words ALL ; Intensive chemotherapy ; GM-CSF
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Twenty-six patients with newly diagnosed ALL (age range 15–49 years, median 32 years) received treatment comprising: cycles 1 and 2: adriamycin 30 mg/m2 days 1–3, vincristine: 2 mg days 1, 8, and 15, with prednisolone 40 mg daily, given until complete remission (CR). l-asparaginase 10000 units/m2, days 1–14, was given only with the first cycle. Cycle 3 consisted of 100 mg/m2 etoposide orally, days 1–5, and 1 gm/m2 bd cytosine arabinoside (ara-C) days 1–5. Cycles 1–3 were then repeated. Intrathecal methotrexate (MTX) 12.5 mg was given on day 1 of each treatment cycle. The first 12 consecutive patients received this chemotherapy alone, the subsequent 14 received, in addition, 3 μg/kg GM-CSF subcutaneously, from day 4 of cycles 1, 2, 4, and 5 (and from day 6 of cycles 3 and 6) until the absolute neutrophil count had reached 0.5×109/l. All patients in whom CR was achieved then received prophylactic cranial irradiation. With the exception of those with T-ALL, this was followed by oral maintenance therapy consisting of 6-mercaptopurine, MTX, and cyclophosphamide for 3 years. Patients receiving GM-CSF did not have shorter intercycle times or a lower incidence of documented infections than those who did not receive it. The CR rate was 89% overall - uninfluenced by GM-CSF, but higher than that achieved previously at St Bartholomew's Hospital in an equivalent age-group.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050238
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  • 9
    Electronic Resource
    Electronic Resource
    High-dose treatment with autologous bone marrow support as consolidation of first remission in younger patients with acute myelogenous leukaemia (2000)
    Springer
    Annals of oncology 11 (2000), S. 1007-1015 
    Details
    ISSN: 1569-8041
    Keywords: ABMT ; AML ; high-dose treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Debate and controversy remain as to the optimalpost-remission therapy for younger patients with acute myelogenous leukaemia(AML). The aim of this study was to evaluate high-dose treatment (HDT) withautologous bone marrow support (ABMS) as consolidation of first completeremission (CR). Patients and methods:One hundred forty-four patients (AML-M3excluded, median age 38 years, range 15–49 years) received remissioninduction therapy comprising: adriamycin 25 mg/m2, days 1–3,cytosine arabinoside (ara-C) and 6-thioguanine, both at 100 mg/m2bid, days 1–7. Patients in whom CR was achieved received two furthercycles of the same treatment prior to bone marrow being harvested andcryopreserved. HDT comprised ara-C: 1 g/m2 b.i.d. × six daysand total body irradiation (TBI): 200 cGy b.i.d. for three days. Thawedautologous marrow was then re-infused. Results:Complete remission was achieved in 106 of 144 patients(73%) who were thus eligible to receive ara-C + TBI + ABMS; 61 actuallyreceived it. Following HDT, the median time to neutrophil recovery (〉0.5× 109/l) was 25 days (range 11–72 days) and to plateletrecovery (〉20 × 109/l), 42 days (range 15–159 days).There were eight treatment-related deaths. Analysis by `intention to treat'shows both remission duration (log-rank, P= 0.001) and survival(log-rank, P= 0.004) to be significantly longer for the 106 patientseligible to receive HDT than for a historical control group (n= 133)who received identical remission induction and consolidation therapy butwithout ara-C + TBI + ABMS. With a median follow-up of 5.5 years, 39 of 106patients remain in CR (37%) and 54 (51% of those in whom CR wasachieved) remain alive, with a predicted actuarial survival of 52% at5 years. Conclusions:The addition of ara-C + TBI + ABMS to conventionalconsolidation therapy significantly improved remission duration and survivalover those of a historical control group of patients with AML (aged 〈50,AML-M3 excluded). HDT was, however, associated with significanttreatment-related mortality and slow blood count recovery. The use of ara-C+ TBI supported by peripheral blood progenitor cells should make the treatmentsafer and more widely applicable in AML.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008333903220
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  • 10
    Electronic Resource
    Electronic Resource
    High-dose therapy with autologous haematopoietic support in patients with transformed follicular lymphoma: A study of 27 patients from a single centre (1998)
    Springer
    Annals of oncology 9 (1998), S. 865-869 
    Details
    ISSN: 1569-8041
    Keywords: autologous bone marrow transplantation ; transformed follicular lymphoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The prognosis of patients with transformed follicular lymphoma (FL-t) is poor. The use of high-dose therapy (HDT) with autologous haematopoietic support was therefore evaluated as consolidation of remission. Patients and methods: Twenty-seven patients received high-dose cyclophosphamide and total body irradiation (cyclo + TBI) with autologous bone marrow (BM; n = 24) or peripheral blood progenitor cell support (PBPC; n = 3). BM was treated in vitro with anti-B cell antibodies and complement. Nineteen of 27 patients were treated in first stable remission following transformation. Eight other patients with a history of transformation were treated following a subsequent recurrence of follicular lymphoma (FL). Results: With a median follow-up of 2.4 years, 14 of 27 patients remain alive and in remission; five are alive and free of disease at more than four years. The median survival is 8.5 years. There were two ‘early’ treatment-related deaths of respiratory failure, and two ‘late’ deaths of myelodysplastic syndrome (MDS) in remission of lymphoma at 2.8 and 8.5 years. Seven of nine patients having had a recurrence underwent re-biopsy. In two, histology revealed FL, in five, transformed follicular lymphoma. One of the patients with recurrent FL is alive without further therapy, and two of five patients with recurrent FL-t are alive and in remission after further chemotherapy. Conclusions: It is appropriate to consider HDT for younger patients with FL-t in remission. Repeat biopsy should be considered for patients with recurrent disease. There is a risk of late MDS in patients undergoing this treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008349427337
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