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Biomedical subjects

H J Weinstein

Publications and source records attributed to H J Weinstein.

89 records · Page 5Linked to original sources
PubMed1980

Treatment of acute myelogenous leukemia in children and adults.

We designed a protocol to address the problem of relapse from complete remission in acute myelogenous leukemia. Patients in remission were treated for 14 months; early and later intensification of chemotherapy, sequential drug combinations, and high-dose continuous infusions of cytarabine were included. Eighty-three consecutive patients under 50 years of age were entered into this study from February 1976 to October 1979. The rate of complete remission is 70 per cent. A Kaplan-Meier analysis predicts that 49 +/- 17 per cent of patients (mean +/- 2 S.D.) who entered complete remission will remain free of disease at two years. Durations of complete remission for patients in the 0 to 17-year and 18 to 50-year age groups are comparable.

Adolescent↗
PubMed1980

Management of acute lymphoblastic and acute myeloblastic leukemia in childhood.

"Plus ça change, plus c'est la même chose." So it is murmured by skeptics who hear the blasts of premature trumpeting heralding early therapeutic triumphs, and then, years later, strain to hear the nearly inaudible notes of guarded optimism that report long-term evaluations. But life has changed, dramatically, for the child with leukemia. In the past untreated patients with acute lymphoblastic leukemia (ALL) or acute myeloblastic leukemia (AML) had a median survival of 1-3 months from the time of diagnosis. The most common causes of death were hemorrhage and infection. Today, the majority of properly treated children with ALL and AML remain continuously disease-free for over 5 and over 1 year, respectively. More than a third of children with ALL may be curable (1). The successful long-term management of children with leukemia often depends on appropriate decisions by the physicians who first encounter these patients. This review is intended to assist them.

Antineoplastic Agents↗
PubMed1980

Heterogeneity of T-cell lymphoblastic malignancies.

To determine the T-cell lineage of the malignant lymphoblast in lymphoblastic lymphoma, tumor cells from nine patients were phenotyped employing a T-cell subset specific heteroantisera, TH2. The normal human peripheral blood T-cell compartment is composed of 80% TH2-negative and 20% TH2-positive T cells, as defined by reactivity with subset specific heteroantisera. Human suppressor cells are TH2 reactive, whereas helper cells are TH2 unreactive. Tumor cells from the majority of patients with lymphoblastic lymphoma were TH2 reactive in contrast to the lack of reactivity previously described in the majority of patients with T-cell acute lymphoblastic leukemia. Comparative clinical studies, including disease presentation and course, were correlated with the presence of the TH2 antigen on the tumor cell. These results provide evidence to support the notion of heterogeneity in the T-lymphoblastic malignancies and suggest that lymphoblastic lymphoma and T-cell acute lymphoblastic leukemia are probably not a single disease process.

Adult↗
PubMed1979

Improved prognosis for patients with mediastinal lymphoblastic lymphoma.

Patients with diffuse lymphoblastic lymphoma (which includes convoluted lymphocytic lymphoma) with mediastinal involvement have predictable progression of disease to a leukemic phase that is cytologically indistinguishable from acute lymphoblastic leukemia (ALL). Therefore we treated 12 patients with diffuse lymphoblastic lymphoma involving the mediastinum with therapy that is effective in ALL. Treatment consisted of intermittent combination chemotherapy with adriamycin and preventive central nervous system therapy (craniocervical irradiation and intrathecal methotrexate). Mediastinal irradiation was given either for initial respiratory distress or to patients who had incomplete regression of disease following induction chemotherapy. Eleven patients achieve complete remission. With a median follow-up of 41 mo, and using life table analysis, 86% of these patients have remained in continuous complete remission. The results of this study demonstrate the efficacy of treating diffuse lymphoblastic lymphoma with mediastinal presentation as a disseminated lymphoid malignancy.

Adolescent↗
PubMed1978

Impaired antibody response to pneumococcal vaccine after treatment for Hodgkin's disease.

To determine if a normal antibody response can develop after therapy for Hodgkin's disease, we immunized 53 patients and 10 normal controls with dodecavalent pneumococcal vaccine. Antibody concentrations three weeks after immunization (geometric mean of 11 serotypes) were 1566 ng of protein nitrogen per milliliter in controls, 963 ng per milliliter after subtotal radiation (P less than 0.05 compared to controls), 658 ng per milliliter after chemotherapy (P less than 0.05), 377 ng per milliliter after subtotal radiation plus chemotherapy (P less than 0.01) and 283 ng per milliliter after total nodal radiation plus chemotherapy (P less 0.001). Low levels of antibody before immunization correlated with a poor response (r = +0.73, P less than 0.001). The ability to respond to immunization improved significantly but did not return to normal as long as four years after combined therapy. The antibody response to pneumococcal vaccine is profoundly impaired in patients who have received intensive treatment for Hodgkin's disease: the ability of this vaccine to protect them from overwhelming postsplenectomy infections remains in doubt.

Adolescent↗
PubMed1978

The role of radiation therapy in the treatment of pediatric non-Hodgkin's lymphomas.

Between 1971 and 1976, 64 patients less than 18 years of age with non-Hodgkin's lymphoma were treated at Boston's Children's Hospital Medical Center-Joint Center for Radiation Therapy. A multimodality approach was used, consisting of radiation therapy (3500--4500 rad), surgery, and chemotherapy. Since 1973, all patients have received a regimen initially comprising Adriamycin, Prednisone, 6-Mercaptopurine, Vincristine, and L-Asparaginase. Methotrexate was substituted for Adriamycin following a cumulative total dose of 450 mg/m2. The 5-year actuarial survival for all patients was 61% while relapse-free survival was 54%. The actuarial and relapse-free survival for patients presenting with localized disease was 75% and 72%, respectively. Median follow-up was 40 months and all relapses occurred within 24 months of initial therapy. A multidisicplinary approach, such as the current regimen, offers a good prognosis for this disease.

Adolescent↗
PubMed1978

Congenital leukaemia and the neonatal myeloproliferative disorders associated with Down's syndrome.

Congenital leukaemia is a rare disease with approximately 100 cases reported in the literature. It is most often diagnosed as acute myelogenous leukaemia (AML). Leukaemic skin nodules and hepatosplenomegaly are the most frequent clinical findings noted. The laboratory manifestations include a markedly elevated white count with a large percentage of blasts, and a bone marrow aspirate that is cellular with a monotonous population of immature cells. Neonatal leukaemoid and leucoerythroblastic reactions may cause diagnostic confusion. In particular, the neonate with Down's syndrome can manifest either AML or a profound transient myeloproliferative syndrome that is clinically and haematologically indistinguishable from congenital AML. In contrast to congenital leukaemia, however, this myeloproliferative syndrome is transient and resolves spontaneously without anti-leukaemia therapy. On the other hand, untreated congenital leukaemia is a fatal disease. For this reason it is important to establish early diagnosis of congenital leukaemia and institute therapy. Treatment programmes should be modelled after established childhood programmes for acute lymphocytic leukaemia and acute myelogenous leukaemia.

Diagnosis, Differential↗
PubMed1977

Contamination of a fiberoptic bronchoscope with Proteus species.

We have traced an episode of contamination of a fiberoptic bronchoscope with a Proteus species to an index patient. Bacterial cultures obtained by aspiration through the fiberoptic bronchoscope from 11 of 12 subsequent bronchoscopies in 8 additional patients grew a Proteus species with sensitivities similar to those of the initial isolate. Culture of the fiberoptic bronchoscopic specimen yielded an identical organism. There were no definitive ill effects in the patients. These findings necessitated a change in our fiberoptic bronchoscope disinfection protocol as well as development of culture surveillance mechanism to detect breaks in the cleaning procedure. The importance of this and avoiding potential outbreaks of fiberoptic bronchoscope-related infeciton is emphasized.

Bronchoscopes↗
PubMed1977

Pulmonary lavage in patients treated with mechanical ventilation.

Mucous plugs and secretions in smaller bronchi may be responsible for impaired exchange of gases and abnormal compliance. Conventional therapy is often insufficient for removal of these plugs and secretions, especially in patients treated with mechanical ventilation. Therefore, pulmonary lavage with 237 +/- 6 ml of physiologic saline solution infused through the flexible fiberoptic bronchoscope in patients with respiratory failure was accomplished on 43 occasions to evaluate the therapeutic benefit of this procedure on oxygenation and compliance. Eighty-one percent (35) of the 43 lavages were associated with a significant increase of the ratio of arterial to alveolar oxygen pressures (PaO2/PAO2) (11 +/- 1) hours after lavage; 63% (27) of the 43 lavages were associated with a significant increase in effective static compliance (Cst) at 8 (+/- 1) hours after lavage. There were no persistent complications other than transient decreases in PaO2/PAO2 and effective Cst soon after lavage. The results suggest that this procedure is a useful therapeutic method in selected patients with respiratory failure.

Blood Gas Analysis↗
PubMedDate not supplied

Gene therapy with B7.1 and GM-CSF vaccines in a murine AML model.

PURPOSE: Characterization of B7.1 and GM-CSF vaccines on the induction of anti-tumor immunity in a murine AML model. MATERIALS AND METHODS: Primary AML cells were retrovirally transduced with the murine costimulatory molecule B7.1, a natural ligand for the T-cell receptors CD28 and CTLA-4, or the cytokine GM-CSF. Mice were vaccinated with irradiated AML cells expressing B7.1 or GM-CSF before or after inoculation of wild type AML cells. RESULTS: Intravenous injection of irradiated B7.1 or GM-CSF expressing AML cells can provide long lasting systemic immunity against a subsequent challenge of wild type AML cells. Vaccination with irradiated B7.1 or GM-CSF expressing AML cells results in rejection of established leukemia when the vaccination occurs in the early stages of the disease. However, when the vaccines are administered > 2 weeks after leukemic inoculation, only mice which receive the GM-CSF vaccine are cured of leukemia. CONCLUSIONS: These results suggest that tumor burden and vaccine efficiency are most likely to be the limiting factors in the curative potential of tumor vaccines. Novel approaches such as this experiment could provide improved therapeutic outcomes in patients with AML and other cancers.

Animals↗
PubMedDate not supplied

Late events in pediatric patients with Ewing sarcoma/primitive neuroectodermal tumor of bone: the Dana-Farber Cancer Institute/Children's Hospital experience.

The outcome for 82 pediatric patients with Ewing sarcoma (ES) and primitive neuroectodermal tumor (PNET) of bone is reported; the patients were treated at the Dana-Farber Cancer Institute (DFCI) and Children's Hospital (CH) in Boston, MA (USA) from 1971-1988. The charts of all patients with ES/PNET of bone treated during this period were reviewed for disease status, therapy, sites of relapse, information on second malignancies, and survival status. Eighty-two patients with ES/PNET of bone treated at DFCI/CH were identified. The 10-year event-free survival (EFS) rates were 12% (95% confidence interval [CI] 0, 27%) and 38% (95% CI 26, 51%) for patients with and without metastases, respectively (P = 0.002); the overall survival (OS) rates were 17% (95% CI 1, 33%) and 48% (95% CI 35, 61%) for patients with and without metastases (P = 0.001). Median follow-up for surviving patients is 10.2 years. Primary site in the pelvis also was associated with a poor outcome for patients with no metastatic disease (P = 0.006 OS, P = 0.03 EFS). Thirty-one patients survived in first remission at least 5 years from diagnosis, and of these, five experienced relapse of original disease, and five experienced secondary malignancies. Pediatric patients treated for ES/PNET of bone remain at risk for life-threatening events into the second decade of follow-up. After 5 years, the risk of second malignant neoplasm is at least as high as the risk of late relapse. Prolonged follow-up of patients with ES and PNET of bone is indicated.

Adolescent↗