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Biomedical subjects

B Coiffier

Publications and source records attributed to B Coiffier.

At least 217 records · Page 12Linked to original sources
PubMed1988

Treatment of acute myeloid leukemia in elderly patients. A retrospective study.

In an attempt to rationalize the use of therapy in acute myeloblastic leukemia (AML) in elderly patients, 69 cases of primary AML in patients older than 60 years of age were reviewed retrospectively. Therapy was empirical and 12 patients received supportive care (SC) only, 35 received aggressive chemotherapy (AC), and 22 received low-dose cytosine arabinoside (LD-araC). Patients receiving SC only often had a poor Karnofski index and their median survival was 17 days. Aggressive chemotherapy yielded complete remissions (CR) in 48% of the patients, whereas 23% of the patients had resistant disease (RD) and 29% had other failures (OF). Low-dose araC, which was administered to patients significantly older than those receiving AC, yielded 23% CR, 68% RD, and 9% OF, with important hematologic toxicity in most patients. Median survival was 211 days in patients receiving AC and 235 days in patients treated with LD-araC. Survival beyond 2 years from diagnosis was noted in the AC group only. A low Karnofski index was the strongest factor in poor prognosis, while age was not a prognostic factor. The initial characteristics of the patients did not allow us to define groups of patients who should be treated by either AC or LD-araC. We concluded that the decision to treat patients actively should rely more on the patient's general condition and socio-economical criteria than on age.

Aged↗
PubMed1988

Acute leukaemia following high-dose chemoradiotherapy with bone marrow rescue for ovarian teratoma.

A case of acute leukaemia following intensive chemo- and radiotherapy for solid tumour is reported. A 15-year-old girl received four courses of chemotherapy with adriamycin, cyclophosphamide and cisplatinum after the surgical diagnosis of ovarian immature teratoma. An intensification treatment was performed with cyclophosphamide and total body irradiation, followed by marrow rescue. The diagnosis of myelomonocytic acute leukaemia was performed 8 months later. The patient died after a transient improvement following a treatment by hydroxyurea. The roles of the primary tumour, of the chemotherapy and of the marrow transplantation in the occurrence of leukaemia are discussed.

Acute Disease↗
PubMed1988

T-cell lymphomas: immunologic, histologic, clinical, and therapeutic analysis of 63 cases.

Sixty-three patients with T-cell lymphoma (TCL) were analyzed to correlate morphological and immunological features with clinical presentation, response to therapy, and survival. Clinical presentation was severe, with 59% of patients having stage IV disease, 60% B symptoms, 35% poor performance status, 44% large tumoral mass, and 40% a high number of extranodal localizations. Morphological subtypes were small-cell in four cases, diffuse-mixed in 29 cases, monomorphic medium-sized in two cases, immunoblastic in 21 cases, anaplastic large-cell in four cases, and unclassified in three cases. Immunological phenotypes were immature T in 11 cases, CD4 in 26 cases, CD8 in 13 cases, and undefined (CD4 + CD8) in ten cases. Response to therapy was poor except for the 39 patients treated by an intensive and sequential regimen (non-Hodgkin's lymphoma [LNH]-80 or LNH-84) that gave a 77% complete remission (CR) rate with a 23% relapse rate. Median survival was 35 months. No correlation was found between morphological subtypes and other variables. Helper (CD4) phenotype seemed to have a better prognosis than other phenotypes. Variables associated with long survival for all the patients were localized disease and absence of large tumoral mass and for the subgroup of patients treated by the LNH regimens CD4 phenotype, absence of B symptoms, absence of a large tumoral mass, and less than two extranodal sites of disease.

Adolescent↗
PubMed1988

[Perspectives for an epidemiological study of hairy cell leukemia].

A strong male predominance (4/1) has been noticed in all series of hairy cell leukemia (HCL) and we wonder whether there could be a link between male predominance and occupation. From a series of 161 patients observed by two different groups, the repartition of profession suggest an aetiological link between HCL and occupational exposure, particularly radiation, benzene and other solvents, since it appears that the proportion of medical workers (6%), mechanic divers (22%), printers and painters (10%) and farmers (11%) represent a high proportion of patients. Aware of the relative rarity of the disease we suggested to set up a national registry of the cases of HCL, the precise incidence of which remains unknown, and to start a classical case-referent study.

Female↗
PubMed1987

Myelodysplastic syndromes. A multiparametric study of prognostic factors in 336 patients.

Two groups of patients with a myelodysplastic syndrome (MDS) were analyzed by univariate (log-rank test) and multivariate (logistic regression) analyses to detect the most important prognostic factors. By stepwise analysis, the variables found to have prognostic significance for death were as follows: age, percentage of marrow blasts, presence of circulating blasts, and number of platelets. The variables found significant for predicting progression to acute leukemia (AL) were as follows: hemoglobin level, percentage of marrow blasts, and presence of circulating blasts. The first group of 193 patients was used to build a prognostic index which reflected the probability of a given patient dying or progressing to AL within 6, 9, or 12 months. The application of this prognostic index to a test group of 143 patients was used to determine the expected error rate and the validity of the prediction rule.

Age Factors↗
PubMed1987

Prognostic factors in angioimmunoblastic lymphadenopathy.

In order to identify prognostic factors in angioimmunoblastic lymphadenopathy (AIL), 30 directly diagnosed patients were prospectively followed for more than 42 months. Age and sex distribution, clinical and laboratory findings and evolution were not different from previously reported series. Median duration of survival was 24 months. Parameters associated with a longer survival in our series were localized adenopathies (P = 0.01) and the achievement of a remission (P less than 0.0001). Features associated with a shorter survival included drug exposure in relation to the onset of the disease (P = 0.02), rash (P less than 0.0001), lymph node eosinophilia (P = 0.03) and elevated serum lactic dehydrogenase (P = 0.03). Drug exposure and rash were, however, significantly dependent (P = 0.02). In addition, lymphopenia, the presence of circulating immune complexes, and the absence of polyclonal hypergammaglobulinemia may indicate a poor prognosis, although the significance level is not achieved in this short series. None of the parameters tested was significantly related to the lymphomatous transformation of AIL, which occurred in four cases. It is concluded that multicentric prospective studies of AIL are necessary in order to better define this disorder, to find prognostic factors, and to optimize therapy.

Adult↗
PubMed1987

Angioimmunoblastic lymphadenopathy with malignant transformation during long-term remission of ocular melanoma.

A 52-year-old woman presented with angioimmunoblastic lymphadenopathy five years after undergoing enucleation for ocular melanoma. She was first treated by corticotherapy and azathioprine and had two successive remissions over an 18-month period. Lymph node biopsy performed when lymphadenopathy relapsed for the second time showed focal malignant transformation of angioimmunoblastic lymphadenopathy. Intensive polychemotherapy induced a complete remission. Three months after completion of chemotherapy, the patient presented with hepatic metastases from her melanoma and died shortly thereafter. This is believed to be the first documented association between angioimmunoblastic lymphadenopathy and melanoma. Issues regarding the relationship between angioimmunoblastic lymphadenopathy and nonlymphoid malignancies are raised.

Biopsy↗
PubMed1987

Gastrointestinal lymphomas. Immunohistologic study of 23 cases.

Twenty-three primary gastrointestinal lymphomas were studied morphologically and immunologically on fresh frozen tissue, and on cell suspension for 16 of them. Polyclonal antibodies reactive with immunoglobulin chains and a panel of 16 monoclonal antibodies reactive with B- and T-cells, histiocytes, and epithelial cells were used. According to the Working Formulation, 5 cases were low grade, 12 intermediate grade, and 5 high grade; 1 case was an extramedullary plasmocytoma. Forty-seven percent were large cell lymphomas and 13% follicular lymphomas. There were 20 (86%) B-cell lymphomas and 2 T-cell lymphomas; one case lacked detectable markers for B-, T-, or histiocytic cells. Monoclonality was demonstrated in 13 out of the 20 B-cell lymphomas, whereas the other 7 expressed pan-B antigens. It is concluded that immunologic studies on frozen surgical material are of precise diagnostic value in gastrointestinal lymphomas, whereas fixed endoscopic biopsies only permit the distinction between lymphomas and undifferentiated carcinomas.

Adolescent↗
PubMed1987

[Contribution of anthracyclines in treatment of lymphoproliferative disorders].

Adriamycin is the most successful anthracycline in malignant lymphomas. Epirubicine is too new to be fully appreciated. Others anthracyclines have no real efficacy in nonleukemic lymphoid malignancies. The prognosis of malignant lymphomas has been transformed since the introduction of this drug in the chemotherapeutic protocols: the level of complete remission increased from 25% with CVP protocols to 50% with CHOP-types protocols, and to more than 70% with intensive chemotherapy protocols (m-BACOD, LNH-80). The number of live patients at 2 years grew in the same proportions. The efficacy of adriamycin in follicular lymphomas is of less value. In Hodgkin's disease the efficacy of adriamycin pull it to first line protocols (ABVD) with identical results to those obtained with MOPP chemotherapy. This drug has its place in the treatment of myeloma patients and in chronic lymphocytic leukemia patients with stage C.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Low-grade non-Hodgkin's lymphoma in the adult: new therapeutic approaches].

Treatment of disseminated low grade non-Hodgkin's lymphomas (NHL) remains unsolved. Despite an initial high remission rate (50%-70%) with chemotherapy, relapses occur and only 20 to 40% of patients are expected to be free of disease after 10 years. From 1981 to 1984, 113 low grade NHL were studied in order to determine factors influencing survival without progression. In a randomized trial, patients received either PCOP combination or PACOP for 6 months followed by chlorambucil or CVP for 12 months. Histological distribution was: follicular small cleaved cells 70 patients, follicular mixed 31 patients, small cells CLL type 12 patients. Stage distribution was: stage IV 88 patients with 74 bone marrow involvement, stage III 17 patients, stage II with bulky masses 8 patients. Complete response (CR) was observed in 49 patients at the end of treatment. Among the ten variables studied, only stage and the number of sites involved had a significant effect on the probability of achieving CR. Only CR significantly affected the freedom from progression (P less than 0.01). Median survival after progression was 21 months. Recently, alpha recombinant interferon has been proposed as treatment for low grade NHL. Cumulative results from the literature give a response rate of 42% on 139 patients. The response rate was higher in follicular NHL than in the CLL type, and response did not clearly correlate with dose. The CR rate was low (less than 20%) and relapses occurred after stopping therapy. Combined use of interferon and chemotherapy is proposed for future clinical trials.

Adult↗
PubMed1987

Intensive chemotherapy in aggressive lymphomas: updated results of LNH-80 protocol and prognostic factors affecting response and survival.

One hundred patients with aggressive malignant lymphomas treated with the LNH-80 regimen were evaluated for long-term survival and pretreatment characteristics predictive of response and survival. LNH-80 consists of three intensive courses of adriamycin cyclophosphamide vindesine bleomycin (ACVB) followed by sequential consolidation and final intensification. Eighty-four patients went into complete remission (CR), eight had a partial response (PR), three failed to respond, and five died during induction. Twenty-three patients (27%) relapsed, in two of whom a prolonged second remission was obtained. Sixty-three patients are currently alive, two of them with disease. Four patients died in CR. Median survival and median freedom from relapse survival were not reached with a median follow-up of 4 1/2 years. Characteristics negatively associated with response in multivariate analysis were: poor performance status, bone marrow involvement, and two or more extranodal sites of disease. Duration of CR was associated with splenic involvement. Three characteristics were negatively associated with survival in multivariate analysis: age, high grade subtypes, and bone marrow involvement.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Totally implantable venous-access systems: apropos of experiences of 30 patients].

Thirty-one totally implantable venous access system were investigated in patients who required intravenous administration of chemotherapy, drugs, nutrients solutions, blood products and blood sampling. Mean duration of venous access was 179 days (ranged from 9 to 429 days). Eight complications were observed, five benign without consequence on port system use, three severe (infections) requiring its removal. No death occurred during implantation and port system use. Patient acceptance was better than with other methods for repeated vascular access. In patients requiring prolonged chemotherapy, totally implantable venous access systems represent a new technique of long term venous access, with easy implantation and lack of restriction of daily activities. Review of literature show that complications are most frequently local and easy to manage. Four types of complications may have severe consequences for patient and/or port system use: catheter occlusion, venous thrombosis, local and/or general infection, and skin necrosis subsequent or not to extravasation. They represent the major cause of port system removal, but this is seldom necessary. Acquired experience allow to justify an earlier implantation of totally implantable venous access systems before chemotherapy and destruction of available surface vessels.

Adult↗
PubMed1986

Intensive and sequential combination chemotherapy for aggressive malignant lymphomas (protocol LNH-80).

Ninety-seven patients with aggressive malignant lymphoma (ML) were treated with an intensive and sequential chemotherapy (protocol LNH-80). There were 42 patients with intermediate grade ML, 53 patients with high-grade ML, and two patients with true histiocytic ML. Most of the patients were in advanced stage: 21 stage III and 61 stage IV. The LNH-80 protocol schedule comprised three phases: (1) induction with three courses of an intensified CHOP-Bleo (cyclophosphamide, doxorubicin, vindesine, methylprednisolone, and bleomycin); (2) consolidation with cytarabine, followed by high-dose methotrexate and folinic acid rescue, then asparaginase; and (3) final intensification with two courses of CVAP-Bleo (cyclophosphamide, teniposide, cytarabine, methylprednisolone, and bleomycin). CNS prophylaxis included one injection of methotrexate during each induction course and the drugs of the consolidation phase. In cases of initial CNS localization, cranial radiotherapy was added. Eighty-four patients (87%) went into complete remission (CR), 18 (21%) of whom relapsed, usually during the phase of treatment or within 6 months of completing chemotherapy. Sixty-three patients are alive with an overall median follow-up of 24 months. The median survival time and the median disease-free survival have not been reached, and the survival curve seems to have plateaued at above 60%. There was no statistical difference between intermediate-grade ML (CR 90%, relapse 18%) and high-grade ML (CR 84%, relapse 24%). The toxicity of this treatment is mainly encountered during the induction phase: almost all patients had short-term neutropenia, less than 0.500 g/L in 57, with a documented infection in 25. Overall treatment-related mortality was 6%, with four patients dying during the induction phase.

Adolescent↗
PubMed1986

Intensive timed chemotherapy protocol for 37 resistant or relapsing acute myeloid leukemias.

Thirty-seven patients with acute myeloid leukemia in relapse or at initial diagnosis but resistant to conventional induction regimen have been treated by single-cycle timed sequential chemotherapy, including continuous infusion of cytarabine over 72 hours on Days 1-3 and 8-10 and short injections of daunorubicin on Days 1-3. There were 21 complete remissions (56%), 11 failures, and five early deaths. For responders, median durations of complete remission and survival were 7 and 12 months, respectively.

Adult↗
PubMed1985

[Histological transformation of low malignancy lymphoproliferative syndromes. Clinical and developmental study of 32 cases].

Fourteen out of 283 patients with chronic lymphoid leukaemia, 2 out of 47 with Waldenström's disease and 16 out of 136 with low malignancy lymphoma (follicular with predominant small cleaved cells, mixed follicular with small and large cells, or diffuse lymphocytic) underwent histological transformation of their disease into a highly malignant lymphoma (immunoblastic in 14 of the 32 cases). There are no clinical or biological signs that predict these changes which seem to occur haphazardly in time. Seven patients died within one month of the diagnosis. The classical treatments failed. Complete remission was obtained in 5 cases with the intensive and sequential chemotherapy used for initially aggressive lymphomas.

Antineoplastic Combined Chemotherapy Protocols↗