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D Reece

Publications and source records attributed to D Reece.

15 recordsLinked to original sources
PubMed2004

Autologous stem cell transplantation in primary systemic amyloidosis: the impact of selection criteria on outcome.

Autologous stem cell transplantation (ASCT) for primary systemic amyloidosis (AL) produces high hematologic and organ responses. However, treatment-related mortality remains high and reported series are subject to selection bias. In all, 48 of 80 amyloid patients referred to our center had AL in the absence of myeloma, 26 of these 48 were deemed transplant candidates and 20 actually underwent ASCT. Transplant-related mortality has fallen from 50 to 20% since January 1999 due to better patient selection and prophylactic measures. Intent-to-treat organ responses were renal (46%), cardiac (25%) and liver (50%). Organ responses in patients who survived transplantation were renal (75%), cardiac (40%) and liver (100%). The 3-year OS post-ASCT was 56% with improved outcome predicted by a better performance status (P=0.08), normal ALP (P=0.08), nephrotic syndrome (P=0.01) and the absence of severe hypotension (P=0.01). The 3-year OS for all referred patients was 44% and this was not significantly better for transplant candidates. Patients with significant hypotension (systolic blood pressure < or =90 mmHg) or poor performance status (ECOG >2) have an exceedingly high treatment-related mortality and should not be transplanted. For those undergoing ASCT, organ response rates appear promising, but conclusive evidence of improved survival for this select group of patients is still lacking and will require randomized trials.

Adult↗
PubMed2003

Intermediate dose thalidomide (200 mg daily) has comparable efficacy and less toxicity than higher doses in relapsed multiple myeloma.

Thalidomide at doses >200 mg has 100% grade 1-2 and 25% grade 3-4 toxicities requiring discontinuation. We report a retrospective study of relapsed myeloma patients treated with thalidomide 200 mg with no dose escalation. Thirty patients were identified; 43% of patients responded with paraprotein decline >75% -- 2 (6%), 50-75% -- 7 (23%), 25-50% -- 4 (14%) and 2 (6%) were stable. All five patients with 13q deletion responded. Only 54% reported grade 1-2 toxicities (none reporting > grade 2) with 5 (17%) discontinuing treatment due to toxicity. Thalidomide 200 mg daily with no dose escalation appears as effective and better tolerated than escalated doses for relapsed myeloma patients.

Adult↗
PubMed2000

Into 2000: the journal of pathology on the web

The Journal of Pathology is now available to institutional and member subscribers in both PDF and HTML formats. The use of HTML offers the possibility of various enhancements to the Journal's content, including the creation of hot links to cited articles, which will greatly ease the access to relevant literature. Articles will shortly be made available online before the print issues, allowing for early dissemination. The Journal will also soon be able to publish supplementary material in electronic format only. A personalized e-mail alerting service could be provided to subscribers with defined areas of special interest. Authors and readers are encouraged to express their views on these and other potential developments, by communicating with the Editor-in-Chief (e-mail: j.pathology@qub.ac.uk). Copyright 2000 John Wiley & Sons, Ltd.

Journal Article↗
PubMed2000

The journal of pathology publishes faster on EarlyView

Original papers accepted by The Journal of Pathology are now published online via EarlyView once proofs have been approved by authors. Readers can therefore view papers before they are compiled into a print issue. Authors can cite the EarlyView version of the paper as published online and by using the paper's DOI (digital object identifier). Papers can therefore be read and cited in a shorter time frame, enabling faster publication for authors and a faster response to published work. Copyright 2000 John Wiley & Sons, Ltd.

Journal Article↗
PubMed1997

A randomized phase II study of BB-10010: a variant of human macrophage inflammatory protein-1alpha for patients receiving high-dose etoposide and cyclophosphamide for malignant lymphoma and breast cancer.

Macrophage inflammatory protein-1alpha (MIP-1alpha) is a chemokine that can inhibit the cell cycle progression of both primitive haemopoietic and epidermal progenitor cells. This property could potentially be exploited to attenuate both the myelosuppressive effects of chemotherapy as well as mucositis. We evaluated both the biological and clinical effects of BB-10010, a genetically engineered variant of MIP-1alpha, in patients with malignant lymphoma or breast cancer receiving high-dose etoposide (VP 3.6 g/m2) and cyclophosphamide (Cy 200 mg/kg). 52 patients were randomized to one of three cohorts. Cohort A received no BB-10010; cohorts B and C received 10 microg/kg and 100 microg/kg of BB-10010, respectively. All patients received post-chemotherapy G-CSE BB-10010 was well tolerated. There were no significant differences between groups in recovery to an ANC > 0.5 x 10(9)/l, 1 x 10(9)/l or 1.5 x 10(9)/l, the number of days with an ANC < 0.5 x 10(9)/l, days to a platelet count > 50 x 10(9)/l or 100 x 10(9)/l, or the incidence and severity of mucositis. There was no evidence of any effect of BB-10010 on colony-forming cell (CFC) or long-term culture-initiating cell (LTC-IC) mobilization, cycling activity in the marrow or on chemotherapy-induced changes in CFC or LTC-IC number both of which were in the normal range by 22 d after completion of the chemotherapy. To our knowledge this is the first report of a myelointensive regimen having no apparent long-term effect on the LTC-IC compartment. In summary, BB-10010 is safe when used in patients receiving high-dose therapy but has no effect on reducing the toxicity of such therapy.

Adolescent↗
PubMed1996

Acyclovir prophylaxis of oral herpes virus during bone marrow transplantation.

Oropharyngeal shedding of herpes viruses (herpes simplex, cytomegalovirus) was assessed in patients on standard acyclovir prophylaxis during bone marrow transplantation (BMT) to determine the frequency of viral shedding and to assess possible oropharyngeal complications that may be associated with viral reactivation in these patients. We conducted a prospective assessment of 83 patients receiving BMT. Patients were evaluated weekly and oral surveillance cultures were completed. Shedding of herpes simplex virus (HSV) was detected in the oropharynx of 2.9% of seropositive patients on prophylactic acyclovir, and only one case of clinical oral herpetic infection was seen. Cytomegalovirus (CMV) was cultured from the oropharynx in 13.3% of CMV seropositive patients provided with prophylactic acyclovir, but no oropharyngeal lesions were attributed to CMV reactivation. No correlation was seen between HSV and CMV pretransplant serology and severity of oral mucositis and acute graft versus host disease. No effect on time to engraftment was detected. This study supports the continuing use of acyclovir prophylaxis in HSV seropositive patients receiving BMT. Acyclovir prophylaxis was effective in preventing viral shedding in all but 2.9% of patients, and only one case of clinical infection was diagnosed. The frequency of CMV shedding was approximately four times that of HSV; however, no oral lesions were attributed to CMV.

Acyclovir↗
PubMed1996

Prophylaxis of candidiasis in patients with leukemia and bone marrow transplants.

OBJECTIVES: The increased risk for systemic fungal infection and the potential fatal consequences of disseminated candidiasis in bone marrow transplant patients has prompted study of prophylaxis and early treatment of candida colonization and infection. STUDY DESIGN: Patients with leukemia who received fluconazole prophylaxis were compared with a concurrent group of patients not given prophylaxis for fungal organisms. RESULTS: A trend to reduction of oropharyngeal colonization by Candida albicans was seen (p = 0.07) although no significant differences in systemic candidiasis were seen. In patients with documented systemic candidiasis, oral colonization was present and systemic infection was identified after the development of ulcerative oral mucositis. CONCLUSIONS: Our results support the potential of fluconazole to reduce oropharyngeal colonization by Candida albicans, however, we did not show prophylaxis of oral candidiasis or systemic candidiasis. These findings and reports of fluconazole-resistant candidal species and a rising number of cases of infection as a result of Candida krusei indicate the need for further studies of prophylaxis of candidal infection in patients who are anticipated to develop profound neutropenia.

Adolescent↗
PubMed1995

Should high risk patients with Hodgkin's disease be singled out for heavier therapeutic regimens while low risk patients are spared such therapies?

In order to optimize the use of intensive therapy and autologous transplantation in patients with progressive Hodgkin's disease, we have examined the outcome of our initial 100 patients entered into autograft studies between 1985 and 1992. At a median follow-up of 3.6 (range 1.6-8.2) years, the actuarial progression free survival (PFS) was 46% (95% confidence intervals 33%-57%). The most significant determinant of PFS was the disease status at the time of protocol entry. Patients entered into transplant studies at the time of first untested relapse had a PFS of 61% compared with 38% in those who had failed induction chemotherapy, 25% in patients treated in > or = second untested relapse and 0% in those in a chemoresistant relapse. The reasons for failure differed, however, in that a high non-relapse mortality was seen in the > or = second untested relapse and resistant relapse groups while a high probability of relapse was observed in the induction failures and resistant relapse group. The most obvious group to target with more intensive therapeutic regimens consists of patients who have failed induction chemotherapy.

Adolescent↗
PubMed1995

Early autologous bone marrow transplantation (ABMT) in the treatment of Hodgkin's disease.

The use of ABMT "early" in Hodgkin's disease (HD) could refer to its to its application at diagnosis, as part of primary therapy or even at the first evidence of disease progression after primary therapy. We have recommended intensive therapy and ABMT to HD patients at the time of first relapse after a complete remission induced by primary chemotherapy. Among the 58 patients entering transplant protocols at the time of first relapse, the majority first received several cycles of conventional chemotherapy and/or local radiotherapy prior to hospitalization for conditioning and autotransplantation. However, all 58 were subsequently conditioned with high-dose cyclophosphamide, BCNU and VP 16-213 +/- cisplatin (CBV +/- P) and autologous transplantation. The progression free survival (PFS) after transplantation was 61% (95% confidence intervals [C.I.] 43%-74%) at a median follow-up of 3.6 (range 1.6-8.2) years. Two patients died of toxicity within the first 5 months of ABMT, while 3 late deaths occurred > 1 year post-transplant. The probability of progression was 28% (95% C.I. 17%-43%). Multivariate analysis identified 3 adverse risk factors for PFS-B symptoms at relapse, initial remission duration < 1 year and extranodal disease at relapse. PFS was significantly correlated with the number of adverse factors. Patients with 2 or 3 risk factors are candidates for more intensive or innovative measures due to the high relapse rate seen in these subgroups. Patients with 0 or 1 risk factors have a < 15% probability of relapse post-transplant, and are arguably candidates for less aggressive regimens.

Adolescent↗
PubMed1992

Structural rearrangement of the Y chromosome in a case of acute myeloid leukemia M2.

Involvement of the Y chromosome in numerical changes associated with acute nonlymphocytic leukemia is quite common, whereas acquired structural rearrangements of the Y chromosome are much rarer, there being only four such cases documented in the literature [1]. We identified a case of acute myeloid leukemia (AML M2) with rearrangements of chromosomes 1, 10, and Y; at remission, all analyzed metaphases were normal, confirming the acquired nature of the Y chromosome abnormality.

Adult↗
PubMed1992

Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation.

The goal of reducing oral complications during chemotherapy and bone marrow transplantation has received attention at several centers. The current randomized study of 86 adults with leukemia treated with chemotherapy or bone marrow transplantation assessed the potential role of chlorhexidine, nystatin, and saline solution rinses to reduce the findings of oral mucositis, gingivitis, and oral infection. The results of this study did not show a reduction in mucositis with the use of these rinses. However, potential bacterial and fungal pathogens were identified less frequently in the patients using chlorhexidine rinse.

Adolescent↗
PubMed1991

Outcome of treatment of first relapse of Hodgkin's disease after primary chemotherapy: identification of risk factors from the British Columbia experience 1970 to 1988.

The outcome of treatment for a first relapse of Hodgkin's disease after primary chemotherapy was analyzed in 80 patients. They were divided into four groups: group 1 (n = 24) had initially been treated with three cycles of (mechlorethamine, vincristine, prednisone, and procarbazine [MOPP]) and wide-field irradiation therapy; group 2 (n = 25) had six cycles of MOPP; group 3 (n = 15) and group 4 (n = 16) both initially received MOPP/ABVD (MOPP plus doxorubicin, bleomycin, vinblastine, and dacarbazine) or MOPP/ABV hybrid, but group 3 received conventional salvage regimens whereas group 4 was treated with high-dose chemotherapy and autologous bone marrow transplantation as salvage therapy (n = 16). Freedom from second failure (FF2F) was used as the major endpoint. Actuarial FF2F for all patients was 38% after a median follow-up of 75 months for patients who were alive. Risk factor analysis was performed on the 71 patients who had been treated with curative intent. The presence or absence of any one of three risk factors had a strong negative impact on outcome: stage IV disease at primary diagnosis, B symptoms at relapse, or a time from primary treatment to relapse of less than 1 year. Actuarial FF2F at 5 years was 17% in the group of patients with one or more of these three factors present (n = 49). If none of these factors was present, FF2F was 82% (n = 22) (P less than .001). Even high-dose chemotherapy and autologous bone marrow transplantation were not able to overcome the negative impact of one or more risk factors (FF2F = 19%, n = 12). The outcome of salvage treatments depends most on the presence or absence of these three risk factors and less on the type of salvage treatment. Patients with none of these risk factors present have an excellent outcome if they are treated with non-cross-resistant chemotherapy, or radiotherapy, or both. Novel approaches are needed for patients with one or more of these factors present. Reports on salvage treatments for Hodgkin's disease in first relapse after primary chemotherapy should include data on the proportion of patients having stage IV disease at diagnosis, B symptoms at relapse, and a time from primary treatment to relapse of less than 1 year.

Adolescent↗
PubMed1987

Neuromedin N: presence and chromatographic characterization in the rat.

The distribution of neuromedin N and its structurally related peptide, neurotensin, was investigated in the rat and found to be remarkably similar with highest concentrations in the ileum. However, neuromedin N but not neurotensin was found in the kidney. Chromatographic analysis of immunoreactive neuromedin N demonstrated a single peak of immunoreactivity which was distinguishable from the single peak of immunoreactive neurotensin. Neuromedin N is likely to be a naturally occurring peptide and is distinct from neurotensin in rat peripheral tissues.

Animals↗