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Biomedical subjects

C Gisselbrecht

Publications and source records attributed to C Gisselbrecht.

At least 145 records · Page 8Linked to original sources
PubMed1991

Treatment of relapsed and refractory Hodgkin's disease with high dose chemotherapy and autologous bone marrow transplantation.

Despite combination of chemotherapy and radiotherapy, some patients with refractory or relapsed Hodgkin's disease (HD) have a bad prognosis. We performed high dose chemotherapy (HDCT) (BCV regimen) with autologous bone marrow transplantation (ABMT) in 26 patients with advanced HD. 11 patients were considered refractory after at least two non cross-resistant chemotherapy regimens and radiotherapy in 8 cases. 15 patients had a poor prognosis relapse (in visceral or irradiated site) after complete remission and they received chemotherapy before ABMT. At the time of transplantation 4 patients had progressive disease with B symptoms and did not respond to HDCT; they all died 3 to 12 months post-transplantation from persistent HD. For the remaining 22 patients, 3 months after HDCT 19 patients (73%) were in complete remission, 2 (8%) in partial remission and one patient died from toxicity. After complete remission 4 patients relapsed at 12 to 18 months and 15 patients are in persistent remission 24 to 46 months after transplantation. These results are encouraging in patients with bad prognostic factors but able to respond to chemotherapy.

Adolescent↗
PubMed1991

Autoimmune hemolytic anemia disclosing Hodgkin's disease associated with Castleman's disease.

A man was admitted for severe autoimmune hemolytic anemia with a mediastinal mass. He required corticosteroid treatment, which altered the first histological examination. Laparosplenectomy was performed and all histological sections were negative, but the hemolytic anemia was not improved. Finally, thoracotomy was performed when the mediastinal mass increased after reducing the corticosteroid treatment. Pathological examination revealed Hodgkin's disease associated with Castleman's disease. After chemotherapy and radiotherapy, the patient remains in complete remission.

Adult↗
PubMed1990

[Non-Hodgkin's lymphoma in HIV infection. A multicenter retrospective study of 21 cases].

The incidence of non-Hodgkin's malignant lymphoma is known to be increased in patients who are seropositive for the human immunodeficiency virus (HIV). We report here a multicentre retrospective study of 21 HIV-positive patients with non-Hodgkin's lymphoma seen between 1985 and 1987. All phenotype B lymphomas of intermediate or high malignancy grade according to the Working Formulation are difficult to classify histologically. Because of this problem, reexamination of the specimens by several pathologists and perhaps also the use of other morphological prognostic criteria, such as mitotic index, seem to be desirable. In more than one-third of our patients the presence of a lymphoma led to the finding of HIV seropositivity in subjects who were all issued from populations at risk. Median age was 39 years. Spread evaluation showed stage III or IV in most cases with, in 4 out of 5 patients, extranodal sites, notably the neuromeningeal system, liver, gastrointestinal tract and bone marrow. The median overall survival was 5 months, but in April 1989 2 patients had survived for more than 30 months. Obtaining complete remission (11/21 cases) was imperative for a 10 months' survival. Eight of the 11 patients in whom complete remission was obtained had received the heavy induction chemotherapy required by the degree of malignancy, but no death due to drug toxicity was recorded. 17 patients died, with active lymphoma (12 cases) and/or infection (8 cases) being documented at the time of death. The finding of more than 500/sq. mm CD4 lymphocytes in peripheral blood in 10 cases while the lymphoma was developing, and the heterogeneity of the Epstein-Barr virus (EBV) profile in serum raise the question of the role played by T-cell immunodeficiency and by EBV infection in the physiopathogenesis of these lymphomas.

Adult↗
PubMed1990

Successful treatment of adult acute lymphoblastic leukemia after relapse with prednisone, intermediate-dose cytarabine, mitoxantrone, and etoposide (PAME) chemotherapy.

Thirty-nine patients with relapsed acute lymphoblastic leukemia (ALL) and four with primarily refractory ALL were treated with a regimen that included cytarabine 1 gm/m2 (2-hour infusion) twice daily days 1 to 5, mitoxantrone 12mg/m2 daily days 1 to 5, prednisone 0.5 mg/kg daily days 1 to 5, and etoposide 200 mg/m2/day daily days 6 to 8. Of the 43 patients, 30 achieved a complete remission (CR), 28 out of the 39 relapsed patients and two among the four with refractory disease. Five patients died in aplasia. Eight patients were nonresponders. Nonhematologic side effects consisted predominantly of nausea, vomiting, and mucositis. One patient had transient cerebellar dysfunction. Recovery of blood counts occurred at a median of 24 days. The median time to CR was 38 days. As this regimen is highly effective in relapsed or refractory ALL, its use during earlier stage of the disease is warranted.

Adolescent↗
PubMed1990

[Adult T-cell leukemia and non-malignant adenopathies associated with HTLV I virus. Apropos of 17 patients born in the Caribbean region and Africa].

Adult T-cell leukaemia is the first blood disease caused by a retrovirus: HTLV-1. The authors report the first French series of 15 patients, of whom 9 came from the classical endemic areas--the Antilles and outer Caribbean Islands--and 6 from Africa where the serological prevalence of HTLV-1 is high but few cases of adult T-cell leukaemia have been reported. Emphasis is laid on the importance of immunodeficiency (refractory strongyloidiasis, Pneumocystis carinii pneumonia, polyclonal B lymphoproliferative syndrome) and of other pathologies associated with the retrovirus (polyarthritis, lymphocytic interstitial pneumonia). The authors also describe the presence of adenopathy in healthy carriers: either adenitis suggestive of retroviral infection, or Castelman's disease adenopathy. These clinical presentations are similar to those described in lymphadenopathy syndromes due to the human immunodeficiency viruses. Aggressive lymphomas require chemotherapy, but sooner or later resistance develops, and the prognosis is very poor. The indications for allogeneic bone marrow transplantation are still to be determined. The diagnosis of adult T-cell leukaemia must be considered in all patients with blood disease coming from the endemic areas.

Adult↗
PubMed1990

Cutaneous type of adult T cell leukemia/lymphoma in a French West Indian woman. Clonal rearrangement of T-cell receptor beta and gamma genes and monoclonal integration of HTLV-I proviral DNA in the skin infiltrate.

A 45-year-old woman, a native of the French West Indies who had lived in France since 1973, developed multiple cutaneous plaques and nodules in 1987. Histopathologic studies revealed dermal infiltration with mature activated T cells (CD4+, CD25+, DR+) with nuclear convolutions and epidermatotropisim. High titers of specific human T lymphotropic virus (HTLV)-I antibodies were detected in the serum. Molecular analysis of DNA extracted from the skin tumor biopsy specimen showed a clonal integration of an HTLV-I provirus and a T-cell clonal population as demonstrated by T-cell receptor beta and gamma gene rearrangement studies. Neither HTLV-I provirus nor T-cell receptor rearrangements were detected in peripheral blood mononuclear cells DNA despite the presence of rare adult T cell leukemia cells (less than 1%) and a small excess of DR-expressing cells, and detection of HTLV-I Pol and Px sequences by in vitro gene amplification. In this case only gene analysis of the skin lesions made possible an early diagnosis of a cutaneous adult T cell leukemia. This illustrates the need for such molecular studies to differentiate, in HTLV-I seropositive patients from endemic areas, a HTLV-I-induced T cell lymphoma from HTLV-I-nonrelated cutaneous T cell lymphomas.

Antigens, CD↗
PubMed1990

Peripheral T-cell lymphomas have a worse prognosis than B-cell lymphomas: a prospective study of 361 immunophenotyped patients treated with the LNH-84 regimen. The GELA (Groupe d'Etude des Lymphomes Agressives).

The prognostic significance of phenotype in malignant lymphomas (ML) is a matter of controversy. Here we analyze the clinical presentation, response to treatment, and survival of the 361 phenotyped patients with ML who were treated by the LNH-84 regimen. Histologic subtypes were diffuse-small cell in 10 patients, diffuse mixed in 69, diffuse large-cell in 177, immunoblastic in 94, and anaplastic large-cell in 11. One hundred and eight patients (30%) had a peripheral T-cell ML and 253 (70%) a B-cell ML. Most of B-cell MLs were of diffuse large-cell type, and the T-cell MLs were distributed among diffuse mixed and immunoblastic subtypes. T-cell MLs had an aggressive presentation with more patients having advanced stage (21% versus 41% stage II, 53% versus 45% stage IV, p = .0002), and B symptoms (58% versus 42%, p less than .01). The only significant difference in clinical manifestations were the higher frequency of gastrointestinal involvement in B-cell MLs (20% versus 2%, p less than .0001) and the more frequent spleen (39% versus 21%, p = .0005) and skin (19% versus 3%, p less than .0001) involvement in T-cell MLs. There was no difference in response to the LNH-84 regiment between the two subgroups, but T-cell ML patients relapsed at a higher rate (43% versus 29%, p less than .001). T-cell ML patients have a significantly shorter freedom-from-relapse (FFR) survival (median: 34 months versus not reached, logrank test: p = .002) and a non-significant shorter overall survival (median: 42 versus 50 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Acute non-lymphocytic leukemia following FAM combination adjuvant chemotherapy for gastric and lung adenocarcinoma.

We report 2 cases of acute non-lymphocytic leukemia with distinct clinical and karyotypic features shared by therapy-related acute non-lymphocytic leukemia occurring after adjuvant chemotherapy including 5-fluorouracil, doxorubicin and mitomycin C. Our observation suggests a causal relationship between exposure to mitomycin C and the occurrence of acute non-lymphocytic leukemia.

Adenocarcinoma↗
PubMed1990

Autologous bone marrow transplantation in Hodgkin's disease.

The outcome of advanced Hodgkin's disease has improved since the use of MOPP and ABVD. However 50% of these patients will relapse. Conventional salvage therapy can yield a complete response rate of 50%. However, only 5 to 30 percent can expect to be cured. Autologous bone marrow (ABMT) in reported publications can reach 50 to 80% remission rate in refractory patients with a disease free survival of 40 to 80%. Adverse prognostic factors are: tumor burden, number of prior chemotherapies, response to latest therapy and performance status. At the present time, ABMT is discussed in relapse of poor prognosis with initially stage I to IIIA. Twenty-six patients underwent ABMT at Saint-Louis Hospital. Fifteen were sensitive relapses of poor prognosis, 11 initially refractory disease. After ABMT, 19 were in complete remission including 14 relapses. Disease free survival was 80% for relapsing patients, again 50% for refractory patients (P = 0.001). ABMT should be a tool for refractory patients and relapses of poor prognosis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Interleukin-2 after autologous bone marrow transplantation as consolidative immunotherapy against minimal residual disease.

Recipients of autologous BMT demonstrate clinically significant immune deficiency, particularly involving the T lymphocytes. While quantitatively the immune system generally returns to normal during the first 3 months, there is a prolonged delay in the recovery of qualitative immune functions. T cell proliferation is impaired immediately after transplantation and slowly recovers over a period of more than 1 year. In addition, a defect has been documented in IL-2 producing cells and may be of major importance in the pathophysiology of this immunodeficiency. However, post-ABMT, PHA-stimulated T cells are TAC+ and are able to respond to exogenous IL-2 in vitro. Very early after ABMT, NK and LAK activities of PBMC normalize but are significantly increased in vitro by IL-2. On this basis, a clinical assessment of rIL-2 administration on the immunological reconstitution of ABMT patients and as consolidation immunotherapy against minimal disease has been initiated in a phase I/II study.

Bone Marrow Transplantation↗
PubMed1990

Aggressive non Hodgkin lymphoma in the elderly. A retrospective study of 72 patients with clinical features and treatment.

Aggressive non Hodgkin lymphoma (NHL) occurs frequently in the elderly and because of drug related toxicity treatment remains controversial. Seventy-two patients over 65 years (68-83 y, median 73 y) with intermediate and high grade NHL were retrospectively studied. We found 22 cases of high grade NHL and diffuse large cell the most frequent type encountered (54%). Seven patients had stage I, 8 stage II, 14 stage III, and 43 stage IV disease. Treatment for localized disease was radiotherapy or chlorambucil, and disseminated stage patients were treated by three different chemotherapy regimens, group I: classic dose chemotherapy without Adriamycin (15 pts), group II: same type of regimen with Adriamycin (45 mg/m2) (42 pts), group III: high dose chemotherapy with Adriamycin (75 mg/m2) (8 pts). Overall complete response (CR) rate was 53% without significant differences between treatment groups. Median duration of survival was 38 months and estimated 5 year survival at 40%. Following complete remission, 15 patients (40%) relapsed. Thirty-seven patients have died, 6 from toxic deaths (5 toxic deaths in group II and III), 28 from NHL, and 3 from other diseases. Toxicity was greater among patients treated with Adriamycin. In a multivariate analysis, the attainment of complete remission was the only factor influencing survival. Our data shows that classical dose chemotherapy leads to the same CR rate and survival as more intensive regimens.

Age Factors↗
PubMed1989

Immune reconstitution after bone-marrow transplantation.

Recipients of both allogeneic and autologous BMT demonstrate clinically significant immune deficiency involving T and B lymphocytes. While quantitative aspects of the immune system generally return to normal in the first 3 to 4 months, there is a prolonged delay in the recovery of qualitative immune functions. T-cell proliferation is impaired immediately after transplantation and recovers after more than 1 year. There is a documented defect in IL-2 producing cells post-BMT, but PHA-stimulated T cells are TAC+. Therefore, addition of IL-2 in vitro may normalize the T-cell proliferation defect. NK and LAK activities normalize very early post-BMT. In the light of these data, the clinical assessment of rIL-2 administration on the immunological reconstitution of ABMT patients and as consolidative immunotherapy is being investigated.

Antibody Formation↗
PubMed1989

LNH-84 regimen: a multicenter study of intensive chemotherapy in 737 patients with aggressive malignant lymphoma.

From July 1984 to September 1987, 737 patients with aggressive malignant lymphoma (ML) were treated by an intensive regimen (LNH-84) comprising three or four courses of doxorubicin, 75 mg/m2; cyclophosphamide, 1,200 mg/m2; vindesine, 2 mg/m2 x 2; bleomycin, 10 mg x 2; and prednisolone, 60 mg/m2 x 5 (ACVB), consolidation with high-dose methotrexate, ifosfamide, etoposide, asparaginase, and cytarabine, and a randomized late intensification with two courses of cytarabine, cyclophosphamide, teniposide, bleomycin, and prednisone (AraCVmB). Four hundred forty-two patients had intermediate-grade ML, 221 highgrade ML, and 74 unclassified ML. Most of the patients had advanced disease: stage IIE (23%), III (13%), or IV (47%); 38% disseminated nodes; 38% two or more extranodal sites; and 41% a tumoral mass greater than 10 cm. Five hundred fifty-three patients (75%) went into complete remission (CR), 63 (9%) into partial remission, 62 (8%) failed to respond, and 59 (8%) died during ACVB courses, 17 of them from progression of the disease. With a median follow-up of 23 months, the estimated 2-year overall survival time to failure (TTF), and time to relapse (TTR) survival are 67%, 56%, and 67%, respectively. Patients receiving a late intensification had the same relapse rate as the other patients. A persistent fibronecrotic mass was found in 150 patients (20%) and did not influence the relapse rate. Toxicity was mainly neutropenia and infection during the ACVB courses, with 40 patients (5%) dying from septic complications while responding to treatment. Fifty-three percent of the patients had a neutropenia less than 0.500 x 10(9)/L, 58% fever (6% grade 4), and 49% a documented infection (8% grade 4). These results obtained with the LNH-84 regimen demonstrate that this therapeutic scheme is an effective treatment for aggressive ML.

Adolescent↗
PubMed1989

[Lymphoma and AIDS].

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Acquired Immunodeficiency Syndrome↗
PubMed1989

[Cancer of the breast: intensive treatment with bone marrow autografts].

High dose chemotherapy with autologous bone marrow transplantation has been proposed in metastatic and inflammatory breast cancer. Data in the literature reported an improvement of the quality and of the rate of response. However, the impact on survival remains to be demonstrated. Since 1985, a pilot study in inflammatory and directly metastatic breast cancer has been started in order to determine the impact of high dose chemo-radiotherapy. Patients were treated with an induction regimen consisting of cyclophosphamide 1,200 mg/m2 and 4'epi-adriamycin 75 mg/m2 every 15 days x 4. Mastectomy was performed associated for patients younger than 50 years with bone marrow collection and cryoconservation. In this group, late intensification with cyclophosphamide 2.2 g/m2 day 1 and 2, TBI and autologous bone marrow transplantation was performed. Fourteen patients have been treated: 9 inflammatory breast cancers T4 b N1 M0, 5 metastatic cancers at presentation including 3 with inflammatory breast cancer T4 b N1 M1 and 2 metastatic T2 N1 M1. Relapses had occurred in 7 patients, of them 4 were metastatic. Five patients died from their disease, and one from CMV interstitial pneumonitis. Six patients are alive free of disease but only one was metastatic. On this limited number of patients, survival of metastatic breast cancers does not seem to benefit from this regimen.

Adult↗
PubMed1989

MHC related genetic susceptibility to Hodgkin's disease.

The present report describes 4 Caucasoid families, HLA genotyped, with at least 2 affected siblings suffering from Hodgkin's disease. The affected sibling pairs were identical (2 shared haplotypes) in 2 families and haploidentical (1 shared haplotype) in the 2 others. These results together with the data already published provide evidence for a distortion of the segregation of HLA haplotypes: from a total of 43 pairs of siblings reported, the observed repartition is 22, 15, 6 (2, 1, 0 shared haplotypes respectively) instead of 10.75, 21.5, 10.75 (mendelian repartition). The excess of identical siblings pairs (51% instead of 25%) (p less than 10(-5) confirms the existence of a genetic linkage between the chromosomal HLA region and the susceptibility to the disease.

Adolescent↗