Biomedical subjects
Publications and source records attributed to E Krykowski.
This study is a presentation of a case of a 43 year old woman suffering from thrombotic thrombocytopenic purpura, the clinical course of which was complicated and in which no improvement was observed after fresh frozen plasma transfusions and treatment with steroids. The complete clinical and haematological remission was obtained only after intensive plasma exchange by therapeutical plasmapheresis.
The application of granulocyte-macrophage and granulocyte colony stimulation factors (GM-CSF and G-CSF) has been progressively increased in the treatment of patients with agranulocytosis. The aim of our study was to compare the time of neutrophil recovery in patients with severe agranulocytosis treated with G-CSF or GM-CSF and the historical control group. We have studied 6 patients with agranulocytosis treated with stimulating factors and 7 patients in historical control group. Most of the patients have been exposed to thiamazole or non-steroid antiinflammatory drugs. Our results demonstrate that patients receiving colony stimulating factor have a significantly shorter period of recovery (the mean time 8.7 +/- 1.98 days) than the historical control group (the mean time 11.0 +/- 2.24 days). We observed also a shorter time of antibiotico-therapy and hospitalization in the group of patients treated with colony stimulating factor.
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This study attempts to characterize the response of patients with chronic lymphocytic leukemia (CLL) to the purine analog 2-chlorodeoxyadenosine (2-CdA). We have treated 10 patients with 2-CdA, at a dose 0.05-0.1 mg/kg/daily, for 7 days as a 2-hour infusion. Mean age was 54.6 years (range, 34-68 years). Mean time from diagnosis to treatment with 2-CdA was 37.0 months (range, 8-84 months). All the studied patients had received preliminary therapy consisting of other than 2-CdA chemotherapeutic regimens. Eight out of 10 patients had Rai stage III-IV disease. Four patients had Coombs positive hemolytic anemia before 2-CdA treatment. Seven patients responded to 2-CdA. Two complete remission (CR) and 5 partial remission (PR) were achieved. All patients but one with Coombs positive autoimmune positive hemolytic anemia achieve complete resolution of hemolysis. Severe neutropenia was frequent, and serious infections were noted in 20%, 43% and 50% of cases during the first, second and third course of 2-CdA, respectively. We conclude that 2-CdA is an effective agent in relapsed CLL patients, particularly in cases complicated by autoimmune hemolytic anemia.
Six patients with hairy cell leukemia have been treated with 2-chloro-2'-deoxyadenosine in a dose 0.05 mg/kg/daily in 2 h intravenous infusions during 7 consecutive days. Two patients underwent splenectomy with no clinical or hematologic improvement. Complete remission has been achieved in 4 patients and partial remission in one. 2-CdA was not effective in a patient with HCL-variant. The longest unmaintained CR lasted 11 months. The drug was well tolerated. Only slight side effects were observed. The drug exerted, however, myelosuppressive action resulting in cytopenias in the peripheral blood. Clinical consequences of this activity require further investigation. 2-CdA seems to be a drug of choice in the management of HCL.
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Thrombocytopenia is the most frequent cause of acquired hemorrhagic diathesis. In addition to disorders that may cause thrombocytopenia in nonpregnant women, pregnant patients are at risk for the development of thrombocytopenia caused by syndromes such as preeclampsia, which are unique to pregnancy. In this review we discuss the major causes of thrombocytopenia that occur during pregnancy. These include the immune thrombocytopenic purpura, so called "gestational" thrombocytopenia, preeclampsia-associated thrombocytopenia, HELLP syndrome, thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome.
We report on our experience with the application of recombinant human granulocyte colony-stimulating factor (G-CSF, Neupogen, Hoffmann La Roche) in patients with various types of hematological malignancies, who had chemotherapy-induced myelosuppression, and in patients with idiopathic aplastic anemia. The administration of G-CSF was associated with marked increase in white blood cells counts (WBC) in twelve out of 14 treated patients. In one patient with aplastic anemia the WBC decreased rapidly to the initial value after the cessation of cytokine therapy. Significant increase of platelet number was observed in 6 patients. No toxicity was encountered with the hematopoietic growth factor therapy. Our study points to the fact that G-CSF have a stimulating effect on the regeneration of hematopoiesis, particularly within the granulopoietic compartment. The effect can be obtained both in a case of idiopathic- and cytostatic-dependent marrow aplasia.
Granulocyte--colony stimulating factor (G-CSF, filgrastim) is a glycoprotein hormone of the hematopoietin family that primarily influences the proliferation and differentiation of neutrophilic granulocytic precursors. As with all glyco-protein hormones, G-CSF interacts with target cells by binding to specific cell-surface receptors. It stimulates proliferation, differentiation and activation of cells of the neutrophil--granulocyte lineage and has been investigated as therapy for patients with various neutropenic conditions. A major use for recombinant G-CSF therapy will be in ameliorating the neutropenia which follows cytoreductive chemotherapy. The increase in neutrophils produced by this factor render it a useful treatment for conditions such as congenital, acquired and cyclic neutropenias. It may be an effective therapy in myelodysplasia and aplastic anaemia. G-CSF is also useful in accelerating the recovery of transplanted bone marrow in patients with leukaemia, lymphoma and solid tumors. G-CSF is well tolerated. The most frequently reported adverse effect is mild to moderate bone pain.
Fifteen patients with various myeloid and lymphoid neoplasias after receiving highly myelotoxic chemotherapy were treated with a single daily dose of 5 micrograms/kg of GM-CSF. G-CSF at a daily dose of 5-8 micrograms/kg was used in four patients with severe pancytopenia in the course of acute or chronic lymphoid leukemia treated with cytotoxic agents, and in two patients with idiopathic aplastic anemia. The administration of cytokines was provided for 4-10 days GM-CSF increased the WBC in twelve out of fifteen patients, mainly because of an increase in the number of neutrophils. Six patients receiving GM-CSF demonstrated rapid platelet recoveries. The rapid increase of the WBC was observed in all G-CSF treated patients. In one patient with aplastic anemia the WBC/ANC decreased rapidly to the initial values after the cessation of the G-CSF therapy. Fast platelet recovery was seen in three patients treated with G-CSF.
We have observed two cases of aplastic anaemia diagnosed during the second trimester of pregnancy. In both patients a cesarean section was performed (in 32 and 37 week of gestation). During the course of pregnancy the patients received transfusions of erythrocytes and platelets. In one case high doses of methylprednisolone were administered. The same patient was given immunoglobulins IV prior to the delivery and the number of platelets increased to 100 x 10(9)/L. One baby had respiratory distress syndrome and died 3 months after birth. The second baby is 9 months old now and is in good health. Haematological improvement did not occur post partum and immunosuppressive treatment with antithymocyte globulin and cyclosporine was performed in both patients. Despite of that remissions did not occur and one patient died 7 months after delivery. The second patient still has haematological problems and is red cell and platelet transfusion dependent. We discuss the pathogenetic aspects of aplastic anaemia occurring during pregnancy, as well as the therapeutic problems before and after delivery.
Among 90,128 patients with malignancies in the years 1976-1989 acute non lymphoblastic leukaemia (ANLL) was diagnosed in 351 patients (0.4%) and in 15 (4.3%) of them ANLL was secondary neoplasm. Secondary ANLL occurred in 10% of all the 148 secondary malignancies observed at that period of time and constituted 6.7% of secondary malignancy in patients with solid tumours and 43% in patients with myeloproliferative syndromes as a first malignant neoplasm. In the treatment of first malignancy radiotherapy was applied in 11 persons, in combination with chemotherapy in 7 of them and chemotherapy alone was given to 4 patients. The appearance of the secondary ANLL was usually preceded by the myelodysplastic syndrome. Morphologically, secondary ANLL belonged mostly to M6 and M4 (8 patients) according to FAB classification. The course of ANLL was fulminant and the disease was completely resistant to the treatment.
We have studied the efficacy of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) in stimulating haematopoiesis of patients with chemotherapy-induced myelosuppression. Ten patients with various myeloid and lymphoid neoplasias were treated daily with a single subcutaneous dose of rhGM-CSF (5 micrograms/kg/day), for a period of 5-10 days, after receiving highly myelotoxic chemotherapy. The treatment increased the white blood cell count (WBC) in nine of ten patients, primarily because of an increase in the number of neutrophils. Increase in bone marrow myeloid precursor cells, and myeloid to erythroid cell rations accompanied the white-cell response. In spite of this, five patients demonstrated rapid platelet recoveries, and in two patients erythrocyte levels increased after GM-CSF treatment. No toxicity was encountered with the cytokine therapy. Although rhGM-CSF was shown to stimulate haematopoiesis in patients with chemotherapy-induced myelosuppression, additional studies are needed to assess whether the use of GM-CSF will reduce chemotherapy-associated morbidity and improve response rates and survival among patients with neoplasias.
We investigated the influence of recombinant human tumor necrosis factor alfa (rh-TNF alpha) on the clonal growth of CFU-GM from 14 normal individuals and clonogenic blasts (CFU-L) from 16 patients with acute myeloid leukaemia (AML) in semi-solid cultures in vitro. Recombinant human TNF was produced by the Center of Molecular and Macromolecular Studies of the Polish Academy of Sciences (Lódź, Poland) as a lyophylized powder. This factor was added to the culture medium at the concentrations of 10, 100, 1000 U/ml. A dose-dependent growth inhibition of CFU-GM and AML CFU-L was observed. The inhibitory effect of rh-TNF alpha was significantly greater on CFU-L than CFU-GM.
Eosinophilia may be associated with various pathologic states such as malignant disorders, atopic and parasitic diseases, certain infections, as well as drug reactions. We describe a case of a 48-year-old patient who was submitted to a single-course therapy with 2-chlorodeoxyadenosine because of hairy-cell leukaemia and previously did not respond to splenectomy. After the treatment marked transient eosinophilia appeared which preceded the achievement of complete remission. It is supposed that eosinophilia might have been caused by the release of cytokines from damaged leukaemic cells.
The results of the treatment with MOPP/COPP program for 114 patients with advanced Hodgkin's disease are presented. Complete remission has been achieved in 74 patients (65%). Thirty four of them (30%) are still remaining in first remission. The relapse of disease was observed in 37 patients, in 16 of them during first 24 months of follow-up. Three patients were lost of observation. The analysis of these unsatisfactory long-term results suggests that more effective management policies for patients with advanced Hodgkin's disease are needed.
The paper presented a case of a patient with type III by FAB myelodysplastic syndrome, in whom during a low dose cytarabine therapy ventricular fibrillation occurred. Authors discussed roles of anemia, ischemic heart disease and hypokalemia as factors which could increase circulatory system sensitivity on cytarabine action.