Search PubMed⌕ Search

Biomedical subjects

C D Bloomfield

Publications and source records attributed to C D Bloomfield.

At least 199 records · Page 11Linked to original sources
PubMed1982

Chemotherapy and combined modality therapy for Hodgkin's disease: a progress report on Cancer and Leukemia Group B studies.

Between 1974 and 1977, the Cancer and Leukemia Group B (CALGB) initiated four studies which address current major questions in the therapy for Hodgkin's disease. The efficacy of chemotherapy alone as compared with combined modality therapy in patients with poor-prognostic stages I and II is evaluated in CALGB 7751. Currently, both therapies produce very high complete remission rates in asymptomatic patients; the remission rate is better with combined modality therapy in symptomatic patients. Single and combined modality therapies are compared for stage III patients in CALGB 7451. Complete remission rates have been similar, but relapse-free survival is superior for patients treated with local nodal radiotherapy followed by chemotherapy (P = 0.04). In particular, stage IIIA patients with nodular sclerosis seem to benefit from the inclusion of radiotherapy in their initial treatment. In CALGB 7551, the efficacy of chemotherapy alone versus chemotherapy plus radiotherapy to areas of bulky disease is under study in patients with stages IIIB and IV. Currently, a relapse rate of less than 10% has been seen among sites irradiated, and survival is best for patients treated with radiotherapy bracketed by chemotherapy. Finally, the role of two alternating non-cross-resistant combination chemotherapy programs is being studied in CALGB 7552. Relapse-free and overall survival is better with the doxorubicin-containing regimen than with either the alternating or alternate chemotherapy program. At present, the median followup for each of these studies is less than 5 years. Further observation is required to answer the critical questions relating to prolonged disease-free survival and cure.

Adult↗
PubMed1982

Translocation 4; 11 in acute lymphoblastic leukemia: clinical characteristics and prognostic significance.

Banded bone marrow chromosome analyses have been done on 83 unselected patients with acute lymphoblastic leukemia (ALL). Seven patients, all with non-T, non-B ALL, had a translocation involving the long arms of chromosomes 4 and 11. Five of these patients, 4 children and 1 adult, were first studied at diagnosis, and the t(4;11) (q21;q23) was the only karyotypic abnormality. All 5 presented with a marked leukocytosis (greater than 150 X 10(9)/liter). Four of these 5 patients achieved a complete remission following the same intensive treatment regimen; however, remission duration and survival were very short (medians 2.5 and 8 mo, respectively). The fifth patient is currently receiving induction chemotherapy. The remaining 2 patients, both adults, were studied in relapse only, and had other karyotypic abnormalities in addition to the t(4;11). One of these relapse patients was a female whose clinical presentation and course were similar to those above. The last patient was a male who presented with a leukocyte count of 7 X 10(9)/liter and maintained an initial complete remission for 37 mo. Our data suggest that patients who have a t(4;11) (q21;q23) at the time of diagnosis of ALL have a poor prognosis with conventional therapy and require a new therapeutic approach.

Adolescent↗
PubMed1982

Effect of age on therapeutic response and survival in advanced Hodgkin's disease.

Although age is a recognized prognostic factor in advanced Hodgkin's disease, there are few data concerning the use of combination chemotherapy in patients greater than 60 years. In two phase III trials of the Cancer and Leukemia Group B, 385 previously untreated patients with stage III or IV Hodgkin's disease received multidrug chemotherapy. All patients received a combination of either mechlorethamine or a nitrosourea, as well as a vinca alkaloid, procarbazine, and prednisone. Two hundred and five patients were less than 40 years of age, 107 were 40-59 years, and 73 were greater than or equal to 60 years. The overall response rates in these three age groups were 70%, 66%, and 40%, respectively. Age at the time of diagnosis was the predominant factor affecting response, and the response rate was not significantly higher in those older patients who received full doses of chemotherapy. Age was also associated with an increased frequency of serious leukopenia and thrombocytopenia. The group of patients greater than or equal to 60 years of age experienced the shortest median time to recurrence, 33 months. The intermediate age group also had a shorter time to recurrence (median, 44 months) than patients less than 40 years (median not yet reached). The low complete response rate and the short duration of response in the patients greater than or equal to 60 years of age resulted in a median survival time of 18 months. Even when the analysis of restricted to just the older patients who received greater than or equal to 90% of the projected drug doses, the complete remission rate, the median time to recurrence (20 months), and the duration of survival (27 months) are still much shorter than in younger patients.

Adult↗
PubMed1982

Results of lung irradiation for Hodgkin's disease patient with large mediastinal masses and/or hilar disease.

From 1970 to 1979, 130 patients with Hodgkin's disease were seen at the University of Minnesota and were treated with curative radiotherapy following surgical staging. Thirty-nine of the 130 patients had large mediastinal masses. Twenty patients with large mediastinal masses treated before 1975 received regular mantle-field irradiation. Our treatment technique was modified in 1975 because of frequent recurrences in the intrathoracic region in these patients. Between 1975 and 1979, patients with large mediastinal masses were treated with low-dose lung irradiation as an initial part of the mantle field treatment. Nineteen patients were treated in this manner, and 16 of these 19 have been followed for greater than 24 months. Only one of the 16 patients has had a recurrence in the lung. We have not seen any serious acute of subacute pulmonary or cardiac complications after low-dose lung irradiation. The followup period is still too brief for the study of late complications. Analysis of four results with lung irradiation reveals excellent control of large mediastinal masses and significantly improved recurrence-free survival.

Adolescent↗
PubMed1982

Evaluation of leukemic cell chromosomes as a guide to therapy.

Recent improvements in methodology permit a clonal chromosome abnormality to be identified in most cases of acute leukemia. As a consequence, leukemic cell chromosome evaluation is finding increased usefulness for diagnosis, prognosis and therapy. In this paper we review examples of the clinical utility of leukemic cell karyotype analysis drawn primarily from a recent study at the University of Minnesota for acute nonlymphoblastic leukemia and from the Third International Workshop on Chromosomes in Leukemia for acute lymphoblastic leukemia.

Acute Disease↗
PubMed1981

A controlled trial of prophylactic granulocyte transfusions during initial induction chemotherapy for acute myelogenous leukemia.

To evaluate the role of prophylactic granulocyte transfusions during remission-induction chemotherapy for acute myelogenous leukemia (AML) we randomized 102 infected patients either to receive daily granulocyte transfusions when blood granulocytes fell below 0.5 x 10(9) per liter (54 patients) or not to receive them (48). Although the percentage of patients acquiring any infection was similar in the transfusion and control groups (46 and 42 per cent, respectively), granulocyte transfusions decreased the proportion of patients with bacterial septicemia (9 per cent of those with transfusions vs. 27 per cent of the controls; P = 0.01). Granulocyte transfusions did not reduce the incidence of other infections or improve bone-marrow recovery, remission rate and duration, or survival. Seventy-two per cent of the patients given transfusions had transfusion reactions. Pulmonary infiltrates were more common in the transfusion group than in the control group (57 per cent vs. 27 per cent; P = 0.002). Thirty-five per cent of the patients with pulmonary filtrates died, as compared with 5 per cent of those without filtrates. We conclude that prophylactic granulocyte transfusions should not be used during remission-induction chemotherapy in AML because the risks outweigh the benefits.

Bacterial Infections↗
PubMed1981

All patients with acute nonlymphocytic leukemia may have a chromosomal defect.

Previous studies of banded marrow chromosomes suggest that half the patients with acute nonlymphocytic leukemia (ANLL) have normal karyotypes. To determine whether high-resolution chromosome analysis could detect additional abnormalities, we studied marrow from 26 patients with ANLL, using methotrexate cell synchronization as well as a direct technique. In 24 patients, including 18 who were untreated, adequate mitoses were obtained. All demonstrated clonal chromosomal abnormalities, which involved a balanced translocation in 11 cases, a complete or partial monosomy in 10, and a trisomy in six. Previously reported recurring defects in ANLL were identified, including t(15;17) in two cases, -7 in two cases, and +8 in three cases. In addition, a new specific abnormality involving band 11q23 was noted in one patient with acute monocytic leukemia and in two with myelomonocytic leukemia. Our results suggest that most, if not all, patients with ANLL have chromosomal changes, and that our new technique may allow more precise identification of subtypes of ANLL with characteristic clinical and hematologic features.

Adolescent↗
PubMed1981

VP 16-213 and cyclophosphamide in the treatment of refractory acute nonlymphocytic leukemia with monocytic features.

The treatment of refractory acute nonlymphocytic leukemia remains a major clinical problem in leukemia therapy. VP 16-213 is an investigational agent that may have specificity for monocytic blasts, and the combination of VP 16-213 and cyclophosphamide is synergistic in experimental leukemia. Seven patients with highly refractory acute nonlymphocytic leukemia, which demonstrated monocytic features, were treated with a combination of VP 16-213 and cyclophosphamide after they had failed to respond to multiple courses of intensive induction regimens. Three complete remissions and one partial remission were achieved. The times to complete remission were 21, 23, and 34 days. The durations of complete remission were 5, 9, and 12+ months. Myelosuppression was the most common side effect; one patient experienced nausea and stomatitis. There were no documented infections or hemorrhage, and no one died as a result of therapy. This combination is both well tolerated and effective in the treatment of refractory leukemia with monocytic features.

Adult↗
PubMed1981

5-Azacytidine and renal tubular dysfunction.

During initial trials of 5-azacytidine in adults with advanced acute leukemia, we unexpectedly observed acid-base, fluid, and electrolyte abnormalities that contributed directly to the deaths of two early patients. To evaluate this toxicity further, we studied 22 patients who received a total of 33 courses of combination chemotherapy that included 5-azacytidine. During 29 courses (88%) of treatment, polyuria, glucosuria, and/or transient changes in the serum concentrations of bicarbonate or phosphorus were detected. Spontaneous polyuria with demonstrable salt wasting and orthostatic hypotension occurred during seven courses (21%) of treatment. Inappropriate glucosuria was observed in nine courses (27%). In 24 courses (73%) the serum bicarbonate fell below the normal range. The urine became alkaline during 12 of these instances; the anion gap was not increased during the acidosis. Hypophosphatemia with serum phosphorus concentrations as low as 0.3 mg/dl occurred in 21 of 32 evaluable courses (66%). In the three patients studied the tubular reabsorption of phosphorus was 10%-18%. The renal abnormalities that were observed suggest both proximal and distal tubular damage from 5-azacytidine. Patients receiving 5-azacytidine should be monitored closely for manifestations of renal toxicity.

Acute Disease↗
PubMed1981

Long-term disease-free survival in acute nonlymphocytic leukemia.

Twenty-six of 45 adults (58%) with acute nonlymphocytic leukemia who were treated with intensive induction chemotherapy over 5 yr ago entered complete remission. All patients entering remission were placed on weekly maintenance chemotherapy consisting of cytosine arabinoside and 6-thioguanine. The median duration of complete remission was 17 mo and 7 patients (27%) remained in their initial remission for 62 + to 102 + mo. All but one of the patients in complete remission over 5 yr have had treatment discontinued. Only 1 of 7 patients in remission for more than 5 yr has relapsed. Median survival is 26.5 mo, and 8 patients (31%) currently remain alive without evidence of leukemia 63--105 mo from diagnosis. It is possible to achieve long-term disease-free survival with chemotherapy alone in acute nonlymphocytic leukemia.

Acute Disease↗
PubMed1981

Use of monoclonal antibodies, morphology, and cytochemistry to probe the cellular heterogeneity of acute leukemia and lymphoma.

A combined immunological, morphological, and cytochemical approach to the study of malignant cells in patients with acute leukemia and lymphoma is presented. Newly produced monoclonal antibodies that bind to antigens of human mononuclear cells (TA-1), or B-lymphocytes (BA-1) were used to study malignant cells from patients with acute lymphoblastic leukemia (ALL). acute myelocytic leukemia, acute myelomonocytic leukemia, and chronic lymphocytic leukemia. Results in lymphoid leukemia-lymphoma patients were compared with other immunological markers and indicate that the major groups of ALL and childhood non-Hodgkin's lymphoma are T-ALL, pre-T-ALL, pre-B-ALL, B-ALL, and non-T, non-B-ALL. In addition, each major group had multiple phenotypes when analyzed with seven immunological markers including the erythrocyte rosette receptor, surface immunoglobulin, cytoplasmic immunoglobulin M, the early lymphocyte-acute lymphoblastic leukemia antigen, monoclonal antibody TA-1, monoclonal antibody BA-1, and a monoclonal antibody against HLA-DR. While immunological heterogeneity was demonstrable within each group, distinct biological behavior was observed, with T-ALL and B-ALL generally presenting as "lymphomas" and the others presenting as "leukemias." Morphological analysis using the French-American-British classification provided independent information in the definition of groups with differing clinical behavior. Cytochemical analyses demonstrated focal paranuclear staining of leukemia cells with acid phosphatase in 73% of T-ALLs and 6% of non-T, non-B-ALLs.

Acute Disease↗
PubMed1981

Glucocorticoid receptors in adult acute lymphoblastic leukemia.

Glucocorticoid receptors were studied in leukemic cells from 14 newly diagnosed adults with acute lymphoblastic leukemia. Receptors were found in all cases; total receptor levels ranged from 1,348 to 18,697 sites per cel (median, 7,553). To determine the utility of glucocorticoid receptor levels for predicting response to glucocorticoid therapy, lymphoblasts were studied for receptors on nine occasions, and the patients were then treated with dexamethasone as a single agent. Response to glucocorticoid therapy appeared to correlate with lymphoblast receptor level. Five of six patients with greater than 4,500 total receptor sites per cell responded; all three patients with less than 4,500 receptors failed to respond. Glucocorticoid receptor level did not correlate with response to combination chemotherapy, duration of remission, or survival. Glucocorticoid receptors were studied at the initial presentation and following relapse in five patients. In two patients, the receptor level did not change following therapy; both patients at diagnosis had leukemias resistant to glucocorticoids. Three patients at relapse developed leukemias with lower receptor levels; these patients had leukemias sensitive to glucocorticoids at diagnosis. Our data suggest that the glucocorticoid receptor levels of lymphoblasts may be useful in predicting response to glucocorticoid therapy in adult acute lymphoblastic leukemia. They also suggest that, following relapse, cases initially sensitive to glucocorticoid may develop resistance by selection of cells with fewer receptors.

Acute Disease↗
PubMed1981

The effects of glucocorticoid therapy on glucocorticoid receptors in leukemia and lymphoma.

Measurement of glucocorticoid receptors appears to be useful for selecting which patients with leukemia and lymphoma should receive glucocorticoid therapy. To determine the effect of recent or concurrent glucocorticoid therapy on the number of measured tumor glucocorticoid receptor sites, 18 patients with leukemia and lymphoma were studied. Baseline determinations of numbers of glucocorticoid receptors were performed on the malignant cells circulating in the patients' peripheral blood. Glucocorticoid therapy was then instituted consisting of dexamethasone 4 mg p.o. every 6 hr. Repeat determinations of the number of glucocorticoid receptor sites were performed within 24 hr and at various subsequent times from the start of therapy. When compared to baseline receptor numbers, 16 of 18 patients demonstrated a decrease in receptor number (median decrease 1651 sites/cell) after the start of glucocorticoid therapy. The magnitude of the change in receptor number was independent on the initial number of receptors. Our results suggest that in order accurately interpret glucocorticoid receptor numbers in patients with leukemia and lymphoma, glucocorticoid should not be administered for 3 wk prior to determinations of receptor levels.

Adult↗