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E Archimbaud

Publications and source records attributed to E Archimbaud.

At least 55 records · Page 3Linked to original sources
PubMed1996

HLA-identical sibling bone marrow transplantation in younger patients with chronic lymphocytic leukemia. European Group for Blood and Marrow Transplantation and the International Bone Marrow Transplant Registry.

OBJECTIVE: To characterize in detail the outcomes of HLA-identical sibling bone marrow transplantation for chronic lymphocytic leukemia (CLL) in patients younger than 60 years of age. DESIGN: Retrospective cohort study. SETTING: 30 centers for bone marrow transplantation worldwide, which reported data on outcome of HLA-identical sibling bone marrow transplantation for CLL to the European Group for Blood and Marrow Transplantation or the International Bone Marrow Transplant Registry between 1984 and 1992. PATIENTS: 54 patients diagnosed with CLL (median age, 41 years; range, 21 to 58 years). The median interval from diagnosis to transplantation was 37 months (range, 5 to 130 months). At the time of transplantation, 3 patients were at Rai stage 0; 10 were at stage 1; 10 were at stage 2; 7 were at stage 3; and 22 were at stage 4. INTERVENTION: Transplant regimens varied. Most patients received high-dose cyclophosphamide and total body irradiation, followed by infusion of bone marrow from an HLA-identical sibling. After transplantation, immune suppression with cyclosporine or methotrexate or both was generally used to prevent graft-versus-host disease. MEASUREMENTS: The primary outcome was survival. We also studied hematologic remission, defined as normalization of the leukocyte count, hemoglobin level, and platelet count, and absence of lymphadenopathy and splenomegaly. RESULTS: 38 patients (70%) achieved hematologic remission. Twenty-four (44%) remain alive a median of 27 months (range, 5 to 80 months) after transplantation. Three-year survival probability was 46% (95% CI, 32% to 60%). Three patients who received transplants at Rai stage 0 remain alive 21, 32, and 45 months after transplantation. Three-year survival probabilities were as follows: 68% (CI, 38% to 98%) in 10 patients who received transplants at Rai stage 1, 30% (CI, 2% to 58%) in 10 patients who received transplants at Rai stage 2, 57% (CI, 21% to 93%) in 7 patients who received transplants at Rai stage 3, and 34% (CI, 12% to 56%) in 22 patients who received transplants at Rai stage 4 CLL. Five patients (9%) died of progressive leukemia and 25 (46%) of treatment-related complications. CONCLUSIONS: Bone marrow transplants from HLA-identical siblings can result in hematologic remission and survival in persons with CLL, but it is uncertain how these results compare with those of conventional therapies.

Adult↗
PubMed1996

Occurrence of T-cell lymphoma in a patient with acute myelogenous leukemia.

We describe a patient with AML with a monocytic component who developed a T-lymphoblastic lymphoma. Lymphoma was diagnosed 9 months following AML diagnosis. To our knowledge, this is the first report of phenotypically documented T-cell lymphoma following AML. The questions relating to the pathogenesis of the two malignancies are discussed.

Adult↗
PubMed1996

Timed sequential chemotherapy for advanced acute myeloid leukemia.

Timed sequential chemotherapy (TSC) combining mitoxantrone on days 1-3, etoposide on days 8-10 and cytarabine on days 1-3 and 8-10, was administered to 240 patients with advanced acute myelogenous leukemia (AML). Sixty one percent of patients, with a 95% confidence interval (CI) ranging from 54 to 67%, achieved complete remission (CR), including 47% (CI: 38-55%) of refractory patients and 78% (CI: 70-86%) of late first relapse patients (p < 0.0001). Thirty percent of patients did not respond to therapy and 9% died from toxicity. Median duration of neutropenia was 32 days and of thrombocytopenia 29 days. Severe non hematologic toxicity included sepsis in 45% of patients and mucositis in 27%. Post-remission therapy varied but included maintenance chemotherapy in most patients, a second course of TSC in 27, autologous stem cell transplantation in 17 and allogeneic transplantation in 20. Median survival of patients who were not transplanted was 7 months with 13% (CI: 7-19%) survival at 5 years. Median disease-free survival (DFS) was 9 months with 13% (CI: 6-20%) DFS at 5 years. Previous refractoriness was the main factor associated with poor prognosis for achieving CR, DFS and survival in a multivariate analysis. There was no difference in DFS between patients receiving the different modalities of intensive post-remission therapy. These results confirm initial reports on TSC and show that some patients with first relapse off therapy can enjoy prolonged DFS using chemotherapy only.

Acute Disease↗
PubMed1995

Timed sequential chemotherapy for previously treated patients with acute myeloid leukemia: long-term follow-up of the etoposide, mitoxantrone, and cytarabine-86 trial.

PURPOSE: To confirm and extend encouraging preliminary results of timed sequential chemotherapy (TSC) in patients with previously treated acute myelogenous leukemia (AML). PATIENTS AND METHODS: We report the results of the regimen of mitoxantrone on days 1 to 3, etoposide on days 8 to 10, and cytarabine on days 1 to 3 and 8 to 10 (EMA) in 133 patients, with a median follow-up of 40 months. RESULTS: Sixty percent of patients, with a 95% confidence interval (CI) ranging from 51% to 68%, achieved complete remission (CR), including 44% (CI, 32% to 57%) of refractory patients and 76% (CI, 64% to 86%) of late first-relapse patients (P = .0002). Twenty-nine percent of patients did not respond to therapy, and 11% died from toxicity. Median duration of neutropenia and thrombocytopenia was 31 days and 29 days, respectively. Severe nonhematologic toxicity included sepsis in 54% of patients and mucositis in 23%. Postinduction therapy included a second course of EMA in 27 patients, maintenance in 10, autologous bone marrow transplantation (BMT) in 12, and allogeneic BMT in 13. Median survival of patients who did not have transplantation performed is 7 months, with 11% (CI, 4% to 18%) survival at 5 years. Median disease-free survival (DFS) is 8 months with 20% (CI, 8% to 32%) DFS at 5 years. Twenty-eight percent (CI, 15% to 44%) of nontransplanted patients who achieved CR had an inversion of CR duration. Previous refractoriness was the main factor associated with poor prognosis for CR achievement, DFS, and survival. CONCLUSION: These results confirm initial reports on TSC and show that approximately 20% of patients with first relapse after therapy can enjoy prolonged DFS using chemotherapy only.

Acute Disease↗
PubMed1995

Expression of N-CAM (CD56) on acute leukemia cells: relationship with disease characteristics and outcome.

Expression of CD56 was analyzed by indirect immunofluorescence method on bone marrow samples from 94 newly diagnosed patients with acute leukemia (AL), including 59 acute myelogenous leukemias (AML) and 35 acute lymphoblastic leukemias (ALL). CD56 was expressed on 17 +/- 18% (range: 0-72%) of AML cells and 24 +/- 24% (range: 0-98%) of ALL cells, without significant differences between FAB subtypes in AML, nor immunologic subtypes in ALL. Expression of CD56 was not associated with any clinical or biological characteristic at diagnosis, nor with prognosis in AML or ALL. We do not confirm previously described relationships between CD56 expression and initial characteristics and evolution of acute leukemia.

Acute Disease↗
PubMed1995

CD34 expression is associated with major adverse prognostic factors in adult acute lymphoblastic leukemia.

Seventy-five adult patients with newly diagnosed acute lymphoblastic leukemia (ALL) were analyzed for CD34 expression on leukemic cells. CD34 was significantly associated with B-cell lineage ALL (p = 0.0002). In B-lineage ALL, CD34 positivity was significantly associated with expressions of CD9 (p = 0.001), CD19 (p = 0.00001) and CD22 (p = 0.002). CD34 was more expressed in B-ALLs with higher WBC cell count (p = 0.04), and higher percentage of peripheral blood leukemic cells (p = 0.005), total or partial monosomy of chromosome 7 (p = 0.0001) or Ph+ chromosome (p = 0.01); and less expressed in cases with hyperdiploidy (> or = 50 chromosomes) (p = 0.03). CD34 was more expressed in poor risk B-ALLs patients, defined according to Hoelzer criteria (p = 0.01). In T-lineage ALL, CD34 positivity was inversely correlated with the expression of CD10 (p = 0.05). After intensive induction therapy, 58 of 73 evaluable patients (79%) achieved a complete remission (CR). CD34 positivity was correlated with the persistence of blast cells in day 15 bone marrow aspirates (p = 0.001) and after one course of induction chemotherapy (p = 0.01). With a median follow-up of 11 months, no statistical differences were seen in leukemia-free survival and overall survival between CD34 positive and negative cases, even when stratifying by immunophenotype. We conclude that CD34 expression is associated with features of poor prognosis in adult ALL. Its study might therefore become useful in the design of future prognostic models.

Adolescent↗
PubMed1995

Recombinant alpha-interferon as treatment for chronic myelogenous leukemia in relapse after allogeneic bone marrow transplantation: a report from the Société Française de Greffe de Moelle.

Thirty three patients with Philadelphia chromosome positive (Ph+) chronic myelogenous leukemia (CML) in relapse after allogenic bone marrow transplantation (BMT) were treated with recombinant alpha-interferon (IFN). Ten patients received IFN for cytogenetic relapse (group I) and 23 (group II) for hematologic relapse. The starting dose of IFN varied from 1.7 to 6 million units/m2/day (median 3 x 10(6) U/m2/day). Among the 10 group I patients, 3 subsequently developed hematologic relapse. Of the other 7, a cytogenetic response was observed in 6 (complete 4, minor 2). Three of these responders are alive in complete cytogenetic remission. Of the 23 group II patients, 3 did not respond to IFN but 20 achieved a complete (CHR) (n = 14) or a partial hematologic response (PHR) (n = 6). Thirteen of the 14 CHR patients subsequently achieved a cytogenetic response (complete 7, minor 6). Seven of the latter 13 patients are still alive in complete cytogenetic remission (CCR). Thus, for the entire group of 33 patients, IFN was followed by CCR in 11 cases (33%); all these patients are still alive and the median follow-up in CCR is now 60.7 months (range 35.3-72.5 months). The BCR-ABL rearrangement was not detected by RT-PCR in 5 of the 10 patients analyzed. Eleven other patients developed either blast crisis or acceleration. The 3-year probability of survival from the start of IFN therapy probability of survival from the start of IFN therapy was 70 +/- 16% (95% CI) and was statistically higher for patients who achieved CCR than for the others.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Allogeneic bone marrow transplantation remains an efficient consolidation for adults with acute myeloid leukemia even when performed very soon after diagnosis (< 100 days). The SFGM (Société Française de Greffe de Moelle.

Allogeneic BMT is presently recognized as one of the reference anti-leukemic treatments for AML patients. It could be a very useful therapy in CR1 AML if it is efficient as an early form of consolidation after induction therapy. Later procedures may be of lesser importance since they concern a population which may have already been cured by chemotherapy. Alternatively it is not solved if very early BMT gives patients sufficient therapy and provides lower toxicity. To answer this question we analyzed data from the Société Française de Greffe de Moelle (SFGM) on a sub-group of patients according to the following criteria: (1) Allogeneic BMT carried out on patients with AML in CR1; (2) after January 1985; (3) conditioning with CyTBI; (4) GVHD prophylaxis with MTX-CsA; (5) interval between diagnosis and BMT < 100 days. Forty-two fulfilled all criteria. Age was 31 +/- 8 years and M/F ratio was 19/23. WBC at diagnosis were 36 +/- 49 x 10(9)/l and four patients needed two induction courses to achieve CR1. Median follow-up is now 51 (24-116) months. Twenty-two patients developed a grade > or = 2 acute GVHD. Early transplant mortality at 1 year is no higher than 14%. Two patients died of secondary malignancies at 3.5 and 6.5 years after BMT. Finally 5-year (and 7-year) probabilities for relapse, survival, leukemia and event-free survival are respectively 17% (17%), 71% (62%), and 71% (71%) and 68% (59%). These data indicate the feasibility of such an approach with low mortality and low relapse rates providing a good long-term outcome. This should prompt an invitation to initiate the search for an HLA-identical sibling when AML is diagnosed in a young patient eligible for allo-BMT.

Adult↗
PubMed1995

Post-transplant obstructive lung disease ("bronchiolitis obliterans"): a clinical comparative study of bone marrow and lung transplant patients.

Patients at a single pulmonary centre who developed obstructive lung disease after bone marrow transplantation (BMT) and lung transplantation (LT) were studied, in order to compare the clinical expression of post-transplant obstructive lung disease (PTOLD) (bronchiolitis obliterans) in these two conditions, which have so far been studied separately. Nine out of 179 patients surviving more than 100 days after BMT (5%) and 9 out of 44 patients surviving more than 100 days after LT (20%) developed post-transplant obstructive lung disease. This was defined by an irreversible airflow obstruction, as characterized by a forced expiratory volume in one second divided by forced vital capacity (FEV1/FVC) of less than 70%, and a FEV1 of less than 70% of predicted value. The mean interval between transplantation and the diagnosis of post-transplant obstructive lung disease was 262 days and 217 days for BMT and LT patients, respectively. In all cases, pulmonary symptoms consisted of dyspnoea and progressively productive cough. Bronchial dilatation on high-resolution computed tomography scans was the main imaging feature present in both groups of patients at the onset of post-transplant obstructive lung disease. The mean FEV1/FVC ratio was 51 and 54% for BMT and LT patients, respectively. All BMT and LT patients had normal transfer coefficient. Clinical chronic graft-versus-host disease was present in all BMT patients before or concurrent with the onset of post-transplant obstructive lung disease, and all LT patients had presented at least one episode of acute lung rejection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Expression of VLA molecules on acute leukemia cells: relationship with disease characteristics.

VLA molecules are involved in the adhesion of hematopoietic cells to the bone marrow stroma and play a role in the mediation of cellular interactions and migrations that are potentially important in the biology of acute leukemia (AL). We studied the expression of VLA-2 (CD49b), VLA-4 (CD49d), and VLA-5 (CD49e) by indirect immunofluorescence on leukemic cells from 67 patients with acute myelogenous leukemia (AML) and 40 patients with acute lymphoblastic leukemia (ALL). VLA-2, VLA-4, and VLA-5 were expressed, respectively, on 13 +/- 17%, 33 +/- 29%, and 36 +/- 30% of AML cells with 20, 54 and 61% positive cases and on 22 +/- 27%, 40 +/- 30%, and 39 +/- 29% of ALL cells with 29, 60, and 61% positive cases. Significant difference was neither noted between French-American-British (FAB) subtypes in AML or ALL nor between immunologic subtypes in ALL. There were highly significant correlations between the expression of the three beta 1-integrins tested in both AML and ALL. In AML, expression of both VLA-4 and VLA-5 was associated with that of CD14 (p = 0.003 and p = 0.01, respectively) and CD19 (p = 0.006 and p = 0.009, respectively). Expression of VLA-5 was correlated with that of CD15 (p = 0.004). Expression of VLA-4 was associated with both a high initial blast cell count (p = 0.01) and high percentage of bone marrow blast cell involvement (p = 0.003). In ALL, expression of VLA molecules was correlated neither with differentiation antigen nor with hematologic features. In AML, as in ALL, no significant correlation was noted between expression of VLA molecules and evolution of the disease.

Adult↗
PubMed1995

[Bases for intravenous administration of cytosine arabinoside in the treatment of adult acute myeloid leukemia].

Cytosine arabinoside (Ara-C) is one of the most active drugs in the treatment of adult acute myeloid leukemia and is widely applied at all phases of therapy. In spite of its extensive clinical use, controversies exist about the most appropriate way and dose of intravenous administration: continuous or bolus infusion and standard-, intermediate- or high-dose. The present review focuses on the role and place of each modality of administration of Ara-C and on the potential interest on hematopoietic growth factors recently given concomitantly to Ara-C therapy. Based on available clinical and experimental data, the following conclusions can be drawn: conventional continuous infusion Ara-C-based regimens remain the standard therapy regarding first remission induction. The use of high-dose Ara-C has been followed by improved results in patients with slow initial cytoreduction after a first course of treatment and is an interesting approach for consolidation protocols. In relapsed and refractory adult acute myeloid leukemia, higher than conventional doses undoubtedly enhance the efficacy of Ara-C salvage therapy. Encouraging results emerge from the association of hematopoietic growth factors administered concomitantly to Ara-C based regimens, which need confirmation in prospective randomized placebo controlled comparative trials.

Adult↗
PubMed1994

Rearrangement of CCND1 (BCL1/PRAD1) 3' untranslated region in mantle-cell lymphomas and t(11q13)-associated leukemias.

Rearrangement and overexpression of CCND1 (BCL1/PRAD1), a member of the cyclin G1 gene family, are consistent features of t(11q13)-bearing B-lymphoid tumors (particularly mantle-cell lymphoma [MCL]). Its deregulation is thought to perturb the G1-S transition of the cell cycle and thereby to contribute to tumor development. As suggested by previously published studies, rearrangement of the 3' untranslated region (3' UTR) of CCND1 may contribute to its activation in some lymphoid tumors. To define further the prevalence of such rearrangements, we report here the result of the molecular study of 34 MCL and six t(11q13)-associated leukemias using a set of probes specific to the different parts of the CCND1 transcript. We also sequenced the entire cDNA of the overexpressed CCND1 transcripts in a t(11q13)-associated leukemia. DNA from four of these 40 patients showed rearrangement of the 3' UTR of CCND1 coexisting with major translocation cluster (MTC) rearrangement. Southern blot and sequence analyses showed that, as a result of these rearrangements, the 3' AU-rich region containing sequences involved in mRNA stability and in translational control is eliminated. Moreover, the finding that the CCND1 mRNA half-life was greater than 3 hours (normal tissues, 0.5 hours) in three t(11q13)-associated cell lines stresses the importance of posttranscriptional derangement in the activation of CCND1. Finally, we did not observe any mutation in the coding frame of the CCND1 cDNA analyzed.

Amino Acid Sequence↗
PubMed1994

Prospective genetically randomized comparison between intensive postinduction chemotherapy and bone marrow transplantation in adults with newly diagnosed acute myeloid leukemia.

PURPOSE: To compare intensive chemotherapy and HLA-identical allogeneic bone marrow transplantation (BMT) as postinduction therapy in young adults with acute myeloid leukemia (AML). PATIENTS AND METHODS: Seventy-eight consecutive AML patients younger than 40 years of age were treated according to a prospective protocol in which every patient in complete remission (CR) with an HLA-identical sibling was scheduled to receive BMT rather than intensive chemotherapy consolidation. To minimize comparison biases, the availability or not of an HLA-identical sibling donor was considered to be the equivalent of genetic randomization to the BMT or chemotherapy arm, respectively. RESULTS: Fifty-eight patients (74%) achieved a CR. A donor was found for 27 patients (BMT arm), and 20 of these patients were actually transplanted in first CR. The 31 patients without a donor were allocated to the chemotherapy arm. Patients in the two arms had similar disease characteristics at diagnosis and previous responses to induction therapy. The cumulative risk of relapse was 43% +/- 24% in the BMT arm and 67% +/- 19% in the chemotherapy arm (P = .01). The 7-year leukemia-free survival (LFS) rate was 41% +/- 20% in the BMT arm and 27% +/- 16% in the chemotherapy arm, a difference that is not statistically significant between the two arms. The overall survival rates were 41% +/- 20% and 46% +/- 19%, respectively. CONCLUSION: In this study, the availability of an HLA-identical sibling donor was not associated with a better survival rate because of both the impossibility of some patients with a donor to receive BMT and the more efficient salvage treatment of patients who relapsed after intensive consolidation chemotherapy than of patients who relapsed after BMT.

Acute Disease↗
PubMed1994

Treatment of acute respiratory failure with non-invasive intermittent positive pressure ventilation in haematological patients.

OBJECTIVE: The aim of this study was to assess whether non-invasive positive pressure ventilation delivered intermittently (Ni-IPPV) by means of a facial or nasal mask is beneficial in haematological patients suffering from acute respiratory failure. DESIGN: Prospective, open, non-randomised study. SETTING: University Hospital, medical intensive care unit. PATIENTS AND METHOD: Eighteen haematological patients with acute respiratory failure which occurred before, during or just after therapeutic aplasia were ventilated with Ni-IPPV delivered via an individual nasal mask or a standard facial mask. Non-invasive ventilation was achieved until weaning (success (S)) or intubation (failure (F)). RESULTS: Twelve patients were ultimately intubated and died (F group). Seven needed intubation within 3 hours following admission because of the inability of Ni-IPPV to provide adequate ventilation in six patients and after cardiac arrest, probably related to cardiac aspergillosis in one patient. Six patients were not intubated and were discharged alive (S group). Of 11 patients who received Ni-IPPV for more than 3 hours, the respiratory rate decreased significantly (p < 0.05) from 33 +/- 7 breaths/min to 24 +/- 5 breaths/min with Ni-IPPV and the PaO2 increased significantly from 6.6 +/- 1.7 kPa upon admission to 17.7 +/- 5.5 kPa during Ni-IPPV. Mean daily ventilation was 12 +/- 7 hours for a mean duration of 5.5 +/- 4.4 days. Pressure support was used in nine patients and appeared the most efficient ventilation mode of non-invasive ventilation. The duration per day of Ni-IPPV was shorter and PaCO2 values during Ni-IPPV were lower in the S group than in the F group. CONCLUSIONS: This technique is able to provide adequate ventilatory support for many haematological patients and allows avoidance of ventilation in some.

Acute Disease↗