Rapid response to recombinant interferon alpha 2B and high-dose prednisone in multiple drug-resistant multiple myeloma.
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Aged↗
Biomedical subjects
A Wahlin
Publications and source records attributed to A Wahlin.
Effects of plasmapheresis on the plasma concentration of proteins used to monitor the disease process in multiple myeloma.
We studied the influence of plasmapheresis on the plasma concentrations of proteins (IgG, IgA, beta 2-microglobulin) used for estimation of tumour cell mass in patients with multiple myeloma. Simultaneously, the effects of plasmapheresis on plasma concentrations of proteins (CRP, alpha 1-antitrypsin, haptoglobin) used for the assessment of inflammatory processes were studied. Also, changes in the plasma concentration of protein HC, a recently described protein occurring both as a free protein and as an IgA complex, were studied. The influence of plasmapheresis varied for the different proteins. The plasma levels of IgG, IgA, CRP, alpha 1-antitrypsin, and haptoglobin decreased during plasmapheresis. The simultaneous reduction of the level of protein HC was smaller than that of IgG, IgA and haptoglobin. The plasma concentration of beta 2-microglobulin did not decrease during plasmapheresis. The recovery rates of the proteins were found to be approximately inversely related to their molecular weights.
Alpha-Globulins↗
Management of polycythaemia vera, essential thrombocythaemia and myelofibrosis with hydroxyurea.
A total of 59 symptomatic patients with myeloproliferative disorders (polycythaemia vera 24 pats., essential thrombocythaemia 25 pats., myelofibrosis 10 pats.) and elevated platelet counts were studied during 1653 months of continuous treatment with hydroxyurea. Reduction of the platelet level to less than 500 x 10(9)/l was achieved within 8 weeks in 86% of polycythaemia pats., 80% of thrombocythaemia pats., 60% of myelofibrosis pats. Control of disease-related symptoms was achieved within 1 year in 78% of the patients. There was no instance of severe bone marrow toxicity. Side-effects of hydroxyurea were modest. Survival was excellent, with 86% probability of survival after 5 yr of therapy. We consider hydroxyurea a first-choice alternative in the treatment of patients with polycythaemia vera, essential thrombocythaemia and mylofibrosis with thrombocytosis.
Drug Evaluation↗
Multiple myeloma--transformation to high-grade malignant lymphoma.
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Antineoplastic Combined Chemotherapy Protocols↗
Improved survival in multiple myeloma with renal failure.
Forty-four myeloma patients with large tumour cell mass and impairment of renal function (S-creatinine greater than 2 mg/dl, stage III B) were studied. Seven patients, who received no active treatment, neither cytostatics nor plasmapheresis, survived for less than 1 month (median). Twenty-one patients who were treated with chemotherapy combination (M-2 protocol: melphalan, vincristine, BCNU, cyclophosphamide, prednisone) plus plasma exchanges for three days at the start of each 5-week cycle survived longer (median 17 months, p less than 0.01) than 16 patients who were treated with melphalan-prednisolone alone (median 2 months). However, better supportive care, dialysis, and improved antibiotic treatment may also have contributed to the improved results. It is concluded that intensive chemotherapy in full dosage, plasmapheresis, and active uremia treatment including dialysis should be considered in patients with advanced myeloma and renal failure.
Adult↗
Plasma fibronectin levels during daily plasmapheresis.
Plasma fibronectin concentrations were studied in 10 patients with multiple myeloma. After plasma exchange for 3 d (2.5-3 l plasma daily) the plasma fibronectin decreased to about 50% of the initial level. Resynthesis of fibronectin seemed to increase during 3 d of plasmapheresis, and was sufficient to normalize plasma fibronectin concentration. The plasma fibronectin concentration reached the initial level within 2 d after interrupting plasmapheresis in spite of concurrent cytotoxic treatment. The patients studied showed no signs of infection.
Fibronectins↗
Hydroxyurea treatment of myeloproliferative disorders. Macro-megaloblastic blood and bone marrow changes.
Blood and bone marrow changes induced by continuous low-dose hydroxyurea treatment are described. A linear increase in mean red cell volume was observed after onset of therapy. The entire normocyte population was replaced by abnormally large erythrocytes within 150 days. The bone marrow morphology changed in megaloblastic direction. Bone marrow iron stores and number of sideroblasts increased, findings compatible with ineffective erythropoiesis. Serum folate and cobalamin levels remained normal. These morphologic changes might cause confusion when examining blood or bone marrow samples from patients treated with hydroxyurea.
Bone Marrow↗
Chronic monocytic leukemia terminating in blastic transformation.
Chronic monocytic leukemia (CMoL) is a rare disorder, closely related to malignant histiocytosis, but a separate entity. The clinical course of the patient described in this case report was characterized by persistent monocytosis without response to cytotoxic therapy, and a large number of infections. On two occasions a clone of cells containing an extra chromosome 20 was observed. The disease terminated in a phase with rapidly increasing numbers of immature monocytoid cells, corresponding to blastic transformation.
Cell Transformation, Neoplastic↗
The significance of handmirror cells in acute myelocytic leukaemia type M1 and M2 after weak cytostatic treatment.
The handmirror shape is a cell configuration assumed by mononuclear leucocytes and leucocyte precursors during locomotion. A fraction of fixed tumour cells in bone-marrow smears from patients with acute leukaemia have this handmirror shape. The incidence of handmirror cells has been reported to correlate positively with length of patient survival in some previous studies, but not in others. This controversy was elucidated by examination of bone-marrow smears of a retrospective material, consisting of smears from 32 patients with acute myelocytic leukaemia of the M1 and M2 type from 1971-1974. During this period, cytostatic treatment of acute myelocytic leukaemia was so weak that it can be considered almost negligible for the patient group studied. There was a positive but statistically non-significant correlation between incidence of handmirror cells and length of patient survival (Rs = +0.28, p = 0.11). It is reasonable to assume that incidence of handmirror cells is a minor prognostic sign, the effect of which is not detectable in all materials.
Adult↗
T-cell subsets in multiple myeloma. Impact of cytostatic treatment.
Blood leukocyte and lymphocyte counts, absolute and relative numbers of T-lymphocytes and T-cell subsets were studied in 45 patients with multiple myeloma and 18 healthy controls. No differences were found between untreated patients and controls. In the group of untreated patients similar results were obtained in patients with low-intermediate tumour cell mass as in patients with large tumour cell mass. In patients with large tumour cell mass studied during cytostatic therapy, leukocyte and lymphocyte counts, T-cells, OKT4+ cells and OKT4/OKT8 ratios were significantly lower than in untreated patients. Patients studied at varying intervals (2-28 mo.) after cessation of therapy still exhibited abnormal leukocyte and lymphocyte counts, numbers of T-cells, OKT4+ cells and OKT4/OKT8 ratios.
Aged↗
Staging of idiopathic myelofibrosis. Significance of haemoglobin value and reticulocyte count.
A retrospective analysis of 18 patients with idiopathic myelofibrosis (IMF) suggested that IMF is adequately staged by combining haemoglobin value and reticulocyte count. Four stages were recognized. All deaths occurred in late stage. The stages appeared to reflect a sequential course of the disease. The present staging system adequately identified patients at high risk. However, the rate of disease progress varied greatly. It is therefore suggested that the rate of disease progress should also be considered when an individual patient is evaluated.
Aged↗
Nonfamilial polycystic kidneys without enlargement.
7 middle-aged males with bilateral, polycystic, nonfamilial kidneys without enlargement are described. The histological examination revealed multiple cysts of varying sizes and changes such as in interstitial nephritis. 6 of the patients had hematuria and/or calculi in the urinary tract. The etiology of the cysts is not clear. The picture does not conform to that of congenital cystic kidney. The cysts might possibly be a final phenomenon in contracted kidneys, so-called acquired cystic disease, but it should be noted that in 4 of the 7 cases the cystic degeneration was demonstrated log before the uremia appeared. Another possibility is that the cystic transformation described here might be attributed to a specific type of interstitial nephritis.
Adolescent↗
ECG changes during lithium therapy. A prospective study.
The influence of long-term lithium treatment on the ECG was investigated in 53 consecutive patients. An ECG was recorded prior to and 4 and 12 months after institution of lithium therapy. The most frequently observed change during treatment was flattening or inversion of the T wave. Heart rate decreased and P-Q interval increased slightly during therapy. There was no change in the S-T segment or the Q-T interval corrected for heart rate. Our data indicate that well monitored lithium treatment of patients with serum lithium concentrations of about 0.6 mmol/l does not cause serious ECG abnormalities. In the absence of symptoms or signs of heart disease, routine monitoring of ECG is not necessary during lithium treatment.
Adult↗
Myeloma-associated cardiac amyloidosis. A case report.
A patient with Bence-Jones myeloma and amyloidosis was treated with cytotoxic drugs and plasmapheresis, resulting in rapid improvement of myeloma-associated symptoms and signs. However, amyloidosis-associated symptoms, especially hypotension, grew worse. Echocardiographic examination demonstrated hypertrophy and a hyperrefractile appearance of the myocardium, thought to be pathognomonic of amyloid heart disease. A permanent pacemaker was inserted for treatment of Adams-Stokes attacks caused by sick sinus syndrome and atrioventricular conduction disturbances. Postmortem examination of the heart demonstrated abundant amyloid deposits corresponding to the altered acoustic qualities of the myocardium. Echocardiographic examination is a valuable non-invasive method for demonstration of amyloid deposits in the heart in multiple myeloma.
Aged↗
Treatment of advanced bone marrow neoplasms with ifosfamide combinations.
Ifosfamide, in combination with other cytostatics, was given to 15 patients with advanced neoplasia derived from bone marrow cells. A response to therapy was obtained in 8 patients. It is suggested that ifosfamide, in combination with other drugs, deserves larger trials in the treatment of advanced bone marrow neoplasia.
Adolescent↗
Staging and survival in multiple myeloma.
The records of 91 patients with multiple myeloma were reviewed and staging was performed according to Durie & Salmon (1). Patients with progressive disease were re-staged. Patients first diagnosed in stage I were younger than patients first diagnosed in stage III and survived longer than patients in stages II or III. The duration of stage I was longer than the duration of stages II and III. When patients in stage I-II progressed into stage III, their age and remaining survival time were similar to the age and survival of patients first diagnosed in stage III. These findings are compatible with the hypothesis that myeloma stage I precedes myeloma stage III and is often diagnosed by chance. It is suggested that patients with myeloma stage I should be omitted from comparisons between different myeloma populations.
Adult↗
Long-term lithium treatment and renal functions. A prospective study.
Renal functions were examined in 53 patients before the start of long-term lithium treatment (I) and then after 4 months (II) and 12 months (III) on lithium treatment. The tubular function was studied by means of the DDAVP (Minirin) test and the glomerular filtration rate was measured by creatinine clearance. The mean maximum urine osmolality (+/- SE) on the first occasion (I) was 800 +/- 20 mosm/kg H2O, 702 +/- 20 on the second (II), and on the third (III) 723 +/- 17 mosm/kg H2O. The mean creatinine clearance before the start of lithium treatment (I) was 128 +/- 5 ml/min, after 4 months (II) 106 +/- 4 and after 12 months (III) 114 +/- 5 ml/min. The results of the present study suggest that lithium treatment with serum levels of approximately 0.6 mmol/l causes a decrease in renal concentrating ability and the glomerular filtration rate in the early stages after the start of therapy. This decrease in the renal functions does not seem to progress during the first year of lithium treatment.
Adult↗
Lithium therapy and thyroid function tests. A prospective study.
Thyroid function tests including thyroxine (T4), T3 test, thyroid-stimulating hormone (TSH), free T4 index and antithyroid antibodies were studied in 51 patients before the start of long-term lithium therapy and after 4 and 12 months on lithium. After 4 months on lithium, changes occurred in all laboratory parameters - T4 and T3 test levels decreased and TSH increased. After 12 months T4 and T3 test increased to pretreatment levels and TSH remained higher than before the start of lithium. During 1 year of lithium treatment only 1 patient developed clinical signs of hypothyroidism and started levo-thyroxine substitution therapy.
Adult↗