Biomedical subjects
Publications and source records attributed to F Pein.
Thanks to the recent progress made concerning the biology of neuroblastoma, we can now define with greater accuracy the progression and prognosis of these tumours. Several biologic profiles distinguish the neuroblastoma at stage IV-S, the prognosis of which is usually good, thus providing it with a true biological identity.
Sixteen children with non-Hodgkin's lymphoma (NHL) who had relapsed were treated with high-dose chemotherapy with BCNU, cyclophosphamide, cytarabine, 6-thioguanine (high-dose chemotherapy [HDC]) and autologous bone marrow transplantation (ABMT). Eleven complete responses were obtained and five patients remain in prolonged complete unmaintained remission 77+ to 152+ weeks after treatment. The best results were obtained in patients with CNS involvement and when this regimen was used after complete remission or partial response was obtained by other means. The results appear to be better in B-cell than in T-cell lymphomas, but the numbers are too small for statistical assessment. The use of ABMT rendered the pancytopenic period short and safe, despite the use of drug doses higher than those previously described for this HDC. The frequency of interstitial pneumonitis, possibly related to pulmonary toxicity of chemotherapy, remains a major concern. These results show that this regimen can help to cure some patients but its toxicity prohibits its use in primary therapy.
Within 13 years (1969-1981) 1 339 monoclonal gammopathies were recognized and fully investigated. The following were remarked: the high frequency of "double gammopathies": 6,2 p. 100 (83 cases); the high frequency of the association of (G + M): 52,4 p. 100 of double gammopathies of different classes (63 cases); both of these probably in relation of the abnormal frequency of the IgM-gammopathies (35,4 p. 100 in the Anjou province). Clinical correlation of double gammopathies do not appear to be different from those noticed in monoclonal gammopathies. In the 62 cases of obvious diagnosis, chronic lymphoproliferative diseases are the more frequent: 32,3 p. 100, followed by 17,7 p. 100 of multiple myelomas, 14,5 p. 100 of carcinoma, 4,9 p. 100 of other malignant diseases, 22,6 p. 100 of benign disorders and 8 p. 100 of idiopathic cases. In all the cases of multiple myeloma and Waldenström's macroglobulinemia, a reciprocal correlation is remarked between predominant monoclonal immunoglobulin and the diagnosis. In all the other diseases (except for 3 cases) one of the two monoclonal components is an IgM.
BACKGROUND: Present treatment for Wilms' tumour is very successful. Now, efforts are aimed at reducing toxicity and burden of treatment by shortening schedules without loss of effectiveness. The objective of this randomised trial was to assess whether postoperative chemotherapy for patients with stage I intermediate-risk and anaplastic Wilms' tumour could be shortened to only 4 weeks from the standard 18 weeks, while maintaining equivalent event-free survival. METHODS: Between June, 1993, and June, 2000, 410 patients were randomly assigned after four doses of vincristine plus one course of dactinomycin postoperatively either to stop further adjuvant chemotherapy (no further chemotherapy group, n=200), or to receive a further two courses of the same chemotherapy (standard group, n=210). Previous treatment consisted of chemotherapy before nephrectomy of four doses of vincristine and two courses of dactinomycin followed by surgical resection of the tumour. Eligible patients were at least 6 months old and had stage I tumours with either intermediate-risk histology or anaplasia. The primary endpoint of this equivalence trial was 2-year event-free survival. Both per-protocol and intention-to-treat analyses were done. FINDINGS: By 2 years, 18 recurrences were reported in the standard group, and 22 in the no further chemotherapy group. Event-free survival was 91.4% (95% CI 87.5-95.2) for the no further chemotherapy group and 88.8% (84.3-93.2) for the standard group (difference=2.6%, upper 97.5% confidence limit 8.4%). The null hypothesis, that experimental treatment is less effective than standard treatment, could be rejected (p=0.008). CONCLUSIONS: Shortening duration of chemotherapy could reduce acute and late side-effects and inconvenience for patient and parents while maintaining effectiveness, and could be beneficial in terms of health costs.
Three-quarters of breast carcinomas at an advanced stage display metastases, usually of the osteolytic type. Osteolysis results from a predominant increase of osteoclastic activity stimulated by humoral or local factors secreted by cancerous cells. Bisphosphonates interfere with osteoclasts and therefore can reduce the osteolysis. These compounds act through three main mechanisms: physico-chemical inhibition of bone crystal, cytostatic effect on osteoclasts, and in the case of pamidronate, direct or indirect action on the mononucleate precursors of osteoclasts. Three bisphosphonates are now available: etidronate, clodronate and pamidronate. Ten published studies report on their use in breast carcinoma with osteolytic metastases, and without hypercalceamia. Four studies concern clodronate in 54 patients, and six studies concern pamidronate in 128 patients. Intravenous pamidronate seems to be the more effective of the two, with densification of the lytic areas in 25% of the cases. All studies mention a decrease of pain, risk of fracture, hypercalcaemia and new metastatic locations. Side-effects are minimal. Controlled studies are needed to confirm the position of bisphosphonates in the management of malignant osteolysis.
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