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Biomedical subjects

D Serraino

Publications and source records attributed to D Serraino.

At least 91 records · Page 5Linked to original sources
PubMed1996

Long-term survival of patients with HIV-related systemic non-Hodgkin's lymphomas.

BACKGROUND: the overall outcome of patients with HIV-related non-Hodgkin's lymphomas (HIV-NHL) is poor because of the adverse clinico-pathological features of HIV-NHL and the underlying HIV infection. However, the experience of physicians in the management of HIV-NHL has increased, in particular in the use of intensive chemotherapy regimens, leading to an improvement in the prognosis of some of these neoplasms. Because some patients with AIDS may survive up to 5 years, it is possible to evaluate the long-term efficacy of the treatment of patients with HIV-NHL. In the general population, aggressive NHL, that are those occurring in HIV patients, may be considered cured after 2 years of lasting complete remission (CR) after chemotherapy. PATIENTS AND METHODS: we reviewed our monoinstitutional case-series of 73 HIV-infected patients with systemic NHL, observed between April 1985 and February 1993. Two groups of patients were arbitrarily identified, the first one (group A) including patients with a CR lasting for at least 2 years (N = 13) and the other including all remaining patients (group B) (N = 60). RESULTS: the 13 patients of group A differed significantly from the other patients in terms of higher CD4+ cell count and performance status (PS) at the time of diagnosis of NHL. There was no significant difference in the histological subtypes of the HIV-NHLs. The overall survival of the 73 patients was 8 months. In a separate analysis on all patients, age less than 30 years, PS less or equal to 1, a CD4+ cell count equal to or higher than 100/mm3 and the absence of B symptoms were significantly associated with a longer survival. The median survival in patients of group A was 42 months, however none of these patients relapsed during a median observation time of 42 months (range, 24-90). CONCLUSIONS: long-term survival and possibly cure can be obtained in some patients with HIV-NHL, in particular in those with a better PS and a less advanced immune dysfunction. In fact some of these patients are alive without evidence of disease 4 to 7 years after therapy, and others died of causes related to underlying HIV infection, in particular opportunistic infections, rather than relapse of NHL.

Adult↗
PubMed1996

Kaposi's sarcoma and non-Hodgkin's lymphomas in children and adolescents with AIDS.

OBJECTIVE: To assess the proportion of, and the characteristics associated with, Kaposi's sarcoma (KS) and non-Hodgkin's lymphomas (NHL) in children (0-12 years) and adolescents (13-19 years) at AIDS diagnosis, in Europe and in the United States (US). DESIGN: Comparison of the proportions of KS and NHL at AIDS diagnosis, according to various characteristics, by means of the European Non-Aggregate AIDS Data Set (4400 children and 764 adolescents) and the US AIDS Public Information Data Set (4710 children and 1064 adolescents) updated to June 1993. METHODS: Comparison of data was made using odds ratios (OR) and corresponding 95% confidence intervals. RESULTS: Between 0 and 19 years, the proportion of KS at AIDS diagnosis (0.5% in Europe and 0.9% in the US) increased with age, particularly in Europe, and was higher in males than in females. It decreased with time in the US but not in Europe. In the US, black children showed a nearly threefold excess of KS as compared with white children. Adolescents who reported homosexual intercourse with other males had significantly elevated risks of KS, both in Europe (OR, 6.3) and in the US (OR, 21.1). NHL was diagnosed in 0.9% of children in Europe and in 1.5% in the US. The proportion of NHL significantly increased with age (3.1% among adolescents in Europe and 3.0% in the US), and was higher in males than in females. In the US, NHL tended to decline in proportion with all AIDS cases over time and showed a nearly twofold higher frequency in white children. No association emerged between NHL and HIV transmission category. CONCLUSIONS: In agreement with incidence rates in the general paediatric population, but at variance with AIDS in adults, NHL turned out to be more common than KS in children and adolescents with AIDS. A strong excess of KS was already present in adolescents who reported homosexual intercourse.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Entry and evaluation of elderly patients in European Organization for Research and Treatment of Cancer (EORTC) new-drug-development studies.

BACKGROUND: This study aimed to determine the extent to which elderly patients (> or = 65 years) currently are being entered in Phase II single-agent studies, and if advanced age is associated with increased toxicity. METHODS: This analysis was based on the age distribution of 2344 patients with various solid tumors entering 16 Phase II EORTC single-agent trials from January 1983 to February 1992. RESULTS: Of the study group, 22% were 65 years or older and 8% were 70 years or older. Delay in dose administration and dose reduction were significantly higher for elderly patients compared with younger patients (P < 0.05). When adjusting for previous chemotherapy pretreatment, no difference between elderly and nonelderly patients was noted in the frequency of grade 3 and 4 hematological toxicity, nausea, vomiting, and diarrhea. A significant higher frequency of episodes of severe oral toxicity (P < 0.05) and alopecia were observed for elderly patients, but a higher proportion (P < 0.05) of elderly patients received drugs for which stomatitis was an established side effect. No significant difference in the frequency of complete plus partial responses was observed between older and younger patients (9% versus 7%). Treatment discontinuation significantly increased with age, ranging from 24% for those younger than 50 years to 33% among elderly patients (x for trend = 12.83, P < 0.001). There was not evidence that excess toxicity was an obstacle to treatment continuation for elderly patients, whereas treatment discontinuation did occur for the older age group more frequently because of loss to follow-up and treatment refusal. CONCLUSION: Selected elderly patients can and should enter new-drug-development protocols without an increased risk of more severe or frequent side effects. A priori exclusion based on an arbitrary chronologic age limit no longer should occur.

Age Factors↗
PubMed1995

HIV transmission and Kaposi's sarcoma among European women.

OBJECTIVE: To assess the association between the presence of Kaposi's sarcoma (KS) as an AIDS-defining illness and HIV transmission categories among European women with AIDS. DESIGN: Comparison of the prevalence of KS as an AIDS-defining illness in different HIV transmission categories. METHODS: Odds ratios (OR) and 95% confidence intervals (CI) for KS were computed by means of unconditional multiple logistic regression equations. RESULTS: KS was reported in 344 (2.2%) out of 15,809 women diagnosed with AIDS. Women who reported HIV infection via heterosexual intercourse had a > twofold increase of KS risk than intravenous drug users (OR, 2.4; 95% CI, 1.9-3.0). Particularly elevated OR were observed among women originating from African or Caribbean countries (OR, 4.9; 95% CI, 3.7--6.5), and in partners of bisexual men (OR, 4.8; 95% CI, 2.8--8.2). Such risk patterns for KS were consistent in different countries, age groups and year of AIDS diagnosis. CONCLUSIONS: These results are in agreement with similar analyses from the United States, and support the existence of some putative KS agent(s) which can be acquired via sexual intercourse with bisexual men, or earlier in life in countries where non-AIDS-associated KS is frequent.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Hodgkin's disease and human immunodeficiency virus infection: clinicopathologic and virologic features of 114 patients from the Italian Cooperative Group on AIDS and Tumors.

PURPOSE: To describe virologic, clinicopathologic, and therapeutic features of a large series of Italian patients with Hodgkin's disease (HD) and human immunodeficiency virus (HIV) infection. PATIENTS AND METHODS: From November 1986 to March 1994, 114 cases were observed. The relationship between Epstein-Barr virus (EBV) and HD was determined by an in situ hybridization technique, immunostaining for EBV-encoded latent membrane protein-1 (LMP-1) expression, and Southern blotting. Twenty-six patients were included in a prospective study evaluating the combination of chemotherapy (CT) with zidovudine. RESULTS: Combined approach on EBV study revealed that 14 (78%) of 18 patients were EBV-associated. An almost equivalent distribution of EBV subtypes was observed in EBV-carrying cases, indicating that in the HIV setting, type 2 EBV also may be pathogenetically involved in HD development. In comparing these 114 patients with our single-institutional series of 104 HIV-negative patients with HD, we observed at presentation a younger median age (29 v 38 years); a prevalence of males (90% v 56%); and a higher percentage of stage IV disease (52% v 15%), presence of B symptoms (77% v 35%), and extranodal disease (63% v 29%). The complete remission (CR) rate (58%) and median survival (13 months) of patients treated prospectively were similar to that of patients treated with standard CT regimens. The statistically significant favorable prognostic factors for survival being the following: achievement of CR, CD4+ count greater than 250/microL, and no prior diagnosis of AIDS at onset of HD. CONCLUSION: Our virologic findings indicate that HIV-related HD is more closely associated with EBV than HD in the general population. The peculiar clinicopathologic findings, the role of some prognostic factors, and the possibility of cure of HIV-related HD have been demonstrated.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The classification of AIDS cases: concordance between two AIDS surveillance systems in Italy.

This study assessed the concordance between the transmission classification of 725 acquired immunodeficiency syndrome (AIDS) cases by the Italian AIDS Registry (the national surveillance system) and the classification of the same cases by the Italian Cooperative Group on AIDS-Related Tumors. A high degree of concordance emerged for intravenous drug users in both sexes (kappa = 0.88; 95% confidence interval [CI] = 0.84, 0.92), for homosexual men (kappa = 0.83; 95% CI = 0.79, 0.87), and for persons infected through contaminated blood or blood derivatives (kappa = 1.00). The concordance was lower among heterosexual men (kappa = 0.51; 95% CI = 0.37, 0.65) and especially among men whose risk group was not determined (kappa = 0.28; 95% CI = 0.12, 0.44). The discrepancies observed among heterosexual men indicate a need for continuing and accurate monitoring of AIDS reporting by transmission category.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Smoking habits and non-Hodgkin's lymphoma: a case-control study in northern Italy.

BACKGROUND: A potential relationship between non-Hodgkin's lymphoma and tobacco smoking has been reported. This was further considered in a case-control study conducted in northern Italy in the provinces of Milan and Pordenone. METHODS: A total of 429 cases of incident, histologically confirmed non-Hodgkin's lymphoma and 1,157 controls in hospital for acute, nonneoplastic, nonimmunological, non-tobacco-related diseases were interviewed during their hospital stay. Relative risk (RR) estimates and their 95% confidence intervals (CI), according to various measures of tobacco smoking, were derived from multiple logistic regression equations including terms for age, sex, study center, body mass index, and alcohol and coffee drinking. RESULTS: Compared with that for never smokers, the multivariate RR was 1.0 (95% CI, 0.8 to 1.4) for both current smokers and ex-smokers. No trend in risk emerged with the number of cigarettes smoked per day (RR = 0.9, 95% CI, 0.7 to 1.3 for less than 20 cigarettes/day, and RR = 1.2, 95% CI, 0.8 to 1.8, for 20 or more cigarettes/day), or tar yield (RR = 1.2 for less than 17 mg, 1.0 for 17-20 mg, and 0.9 for more than 20 mg). Similarly, no trend in risk was observed with duration of smoking (RR = 1.0 for less than 30 years, 1.0 for 30-39 years, and 1.1 for 40 or more years) or age at starting smoking (RR = 1.1 for less than 20 years, 1.0 for 20-29 years, and 1.1 for 30 years or over) and, for ex-smokers, with time since quitting (RR = 1.1 for less than 10 years and 1.0 for 10 or more years of smoking cessation). CONCLUSIONS: The present study found no association between various measures of tobacco smoking and non-Hodgkin's lymphoma.

Adolescent↗
PubMed1994

Hodgkin's disease in patients with HIV infection and in the general population: comparison of clinicopathological features and survival.

BACKGROUND: Hodgkin's disease (HD) has been described in patients with HIV infection in association with unfavourable prognostic factors. Similarly, HD in the older general population has a poorer prognosis than in younger patients. PATIENTS AND METHODS: With the aim of comparing the clinicopathological features and survival of HD in HIV-infected patients and in the general population, we analysed 176 patients with HD from 1986 to 1992. We divided the 84 HIV-negative patients into two groups: group A included patients less than 55 years old, group B patients of 55 years or older. This division was made in order to compare HD in HIV-infected patients with the less favourable group of patients with HD in the general population, i.e., older patients. RESULTS: Patients of the older group and HIV-infected patients had a significantly lower frequency (31% and 21%, respectively) of nodular sclerosis subtype compared to the younger group (85%). Mixed cellularity (MC) is significantly more frequent both in the older group and in HIV-infected patients. Lymphocyte predominance is more frequent (16%) in older patients than in the other two groups. HIV-infected patients are more likely to show advanced stages, B symptoms, and extranodal involvement. Chemotherapy (CT) alone has been the most widely used (83%) treatment in HIV-infected patients, while CT plus radiotherapy (RT) has been mostly employed in the general population. Twelve (14%) HIV-infected patients did not receive any treatment. Complete remission was achieved in 51% of the cases in the HIV-infected patients, and around 90% of the cases in the general population. The estimated 4-year survival rate in the HIV-infected patients is much lower (33%) than in the other two groups (100% in group A, and 88% in group B). CONCLUSION: While MC is the most common histological subtype both in HIV-infected patients and in the older general population, HD in HIV-infected patients has a worse prognosis than in the older general population, not only because of underlying HIV infection, but also because of the more unfavourable clinicopathological features at presentation.

Actuarial Analysis↗
PubMed1994

AIDS incidence rates in Europe and the United States.

OBJECTIVE: To facilitate the quantitative comparison of AIDS incidence statistics between countries and with other diseases using statistics based on age-standardized incidence rates instead of absolute number of cases. DESIGN: AIDS incidence rates for 19 countries belonging to the World Health Organization (WHO) European region, and for comparative purposes, the United States. METHODS: Incidence rates were standardized using the world standard population for all ages, from 1985 to 1992. The data were derived from the WHO European Non-Aggregate AIDS Dataset and the Centers for Disease Control and Prevention (CDC) AIDS Public Information Dataset, adjusted for reporting delays in each country. RESULTS: The AIDS incidence rate for men (81 in 1,000,000) in the United States was fourfold higher than the highest rate in a European country (Switzerland) in 1985; incidence rates in all other European countries, except France and Denmark, were below 10 in 1,000,000. Subsequently, AIDS incidence has increased more rapidly in southern Europe than in the rest of the continent. The estimated incidence rate for men in Spain (243 in 1,000,000) approached that in the United States (304 in 1,000,000) in 1992, and three additional countries (France, Switzerland and Italy) showed rates above 100 per million. The spread of the AIDS epidemic among women in some southern European countries was faster than in the United States. In Switzerland and Spain the standardized incidence rates in women were higher than in the United States by 1988 and 1992, respectively. CONCLUSIONS: Analysis trends in incidence rates avoids some weaknesses of AIDS statistics based on absolute numbers, and should become one of the standard tools for AIDS surveillance.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The aged patient with lung cancer. Management recommendations.

Elderly patients with lung cancer have not benefited from the therapeutic improvements obtained during the 1980s with younger adults. Potentially operable non-small-cell lung cancers are more common in elderly patients, who are more likely to have localized disease at diagnosis. Even so, elderly patients are rarely treated with surgery. Radiotherapy remains the most frequently adopted tool to treat non-small-cell lung cancer in this age group. Epipodophyllotoxin derivatives constitute the best option for chemotherapy of elderly patients with small-cell lung cancer. When used as single agent regimens, these drugs show the same overall response rate as combination chemotherapy, but with reduced toxicity. Haematopoietic growth factors are used to reduce bone marrow damage following cytotoxic chemotherapy, and may be a promising tool in elderly patients. Special attention should be given to increasing the number of elderly patients with small-cell lung cancer enrolled in phase I and II studies to investigate new agents for the treatment of this tumour.

Aged↗