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Biomedical subjects

J Reiffers

Publications and source records attributed to J Reiffers.

At least 235 records · Page 13Linked to original sources
PubMed1991

Role of splenectomy in incidence and severity of acute graft-versus-host disease: a multicenter study of 157 patients.

Allogeneic bone marrow transplantation is a therapeutic option for many hematological malignancies. Graft-versus-host disease (GVHD) remains one of the major complications and has a high mortality rate. The pathophysiological mechanisms involved are poorly understood and GVHD prevention regimens still give disappointing results. This study concerned 157 patients with diverse diagnoses from Bordeaux, Grenoble and Marseille who had undergone an HLA-matched transplantation without T cell depletion. Thirty-one patients (20%) had been splenectomized before transplantation. The role of splenectomy in the incidence and severity of acute GVHD was investigated using a univariate and multivariate analysis of 11 risk factors including splenectomy. Univariate analysis found three significant risk factors linked with GVHD incidence: splenectomy, age of recipient and GVHD prevention by monotherapy versus a combination of methotrexate plus cyclosporin. Multivariate analysis retained only the effects of age and GVHD prevention on GVHD incidence and showed that splenectomy was the most important factor in GVHD severity. One explanation for the role of splenectomy could be the spleen's possible function as a filter of activated T lymphocytes from the transplant. We therefore concluded that it would be preferable to abstain from splenectomizing patients before transplantation although splenectomy is still advisable in certain malignancies after transplantation.

Acute Disease↗
PubMed1991

The TAM regimen prior to allogeneic and autologous bone marrow transplantation for high-risk acute lymphoblastic leukemias: a cooperative study of 62 patients.

A total of 62 patients with high-risk acute lymphoblastic leukemia (ALL) were treated with fractionated total body irradiation, high-dose cytosine arabinoside and melphalan followed by bone marrow transplantation (BMT). Thirty-six patients received allogeneic and 26 autologous BMT. Eight patients were treated in CR1, 36 in CR2 (first relapse occurring on therapy for 32), seven in further CR, 10 in relapse (five early first relapse, four second relapse and one fourth relapse) and one with refractory ALL. Severe toxicity occurred in 26 of the 62 patients (42%) and 14 died (22.5%) from non-leukemic causes. The actuarial event-free survival at 3.6 years was 28% after autologous BMT and 52% after allogeneic BMT with actuarial relapse rates of 62% and 35%, respectively. The results of this pilot study seem promising for this group of poor risk ALL, but the relapse rate remains high after autologous BMT and needs to be improved.

Adolescent↗
PubMed1990

Peripheral neuropathies and lymphoma without monoclonal gammopathy: a new classification.

Recent progress in immunopathological studies of peripheral nerve and lymph node fragments together with 16 personal cases and numerous clinicopathological reports have suggested a new classification of peripheral neuropathies (PN) and lymphomas. These are: (1) PN due to local infiltrations by a T-cell lymphoma: (2) acute polyradiculoneuritis due to active demyelination and associated with infiltrates of a T-cell lymphoma in the epineurium, resembling Marek's disease (which is a T-cell lymphoma); (3) B-cell lymphoma proliferation which may be restricted to or predominate in the peripheral nervous system, with a large clinicopathological heterogeneity ranging from localized forms to ascending polyradiculoneuropathies; (4) angiotropic lymphoma, which is a B-cell lymphoma and may present as an acute mononeuropathy; (5) patients with acquired immunodeficiency syndrome due to lymphomatous infiltrates in the endoneurium, of which 2 cases of PN have been reported; (6) PN associated with organomegaly, endocrinopathy, M-component and skin lesions, certain cases being associated with a plasmocytoma and sometimes Castleman's disease but without any monoclonal gammopathy: (7) classic Guillain-Barré syndrome, prone to develop in patients with extraneural lymphoma but without any lymphomatous infiltrates in the peripheral nervous system; (8) certain cases (4 out of 16 in our series) where there is no clear relationship between PN and lymphoma, and there are mainly features of axonal degeneration. Inflammatory perivascular infiltrates were sometimes present in the epineurium.

Aged↗
PubMed1990

A prospective study comparing vancomycin and teicoplanin as second-line empiric therapy for infection in neutropenic patients.

In recent years, the most common cause of infection in neutropenic patients has shifted from Gram-negative to Gram-positive bacteria. To compare the efficacy and toxicity of teicoplanin and vancomycin in neutropenic patients, we conducted a prospective study of 151 adult leukaemic patients hospitalized for intensive chemotherapy. After chemotherapy, the median duration of granulocytopenia (less than 500/mm3) was 25 d (range 13-49). When the patients became febrile, they received ceftazidime (CTZ) alone (2 g every 12 h, intravenously). If fever persisted more than 48-72 h after administration of CTZ, the patients were randomly assigned to receive CTZ combined with either vancomycin (vanco) (30 mg/kg/d) or teicoplanin (teico) (6 mg/kg every 12 h on day 1, then daily). When fever persisted further, an aminoglycoside antibiotic and/or amphotericin B were usually added to the previous combination. Of the 151 patients, 116 patients became febrile during the period of aplasia. Fifty-nine patients had persistent (or recurrent) fever despite administration of CTZ and received either vanco (n = 35) or teico (n = 24). Sixteen of these latter 59 patients had septicaemia (vanco n = 9; teico n = 7) due to Candida sp. (n = 2), Gram-negative (n = 2) or Gram-positive (n = 12) bacteria. The main characteristics of patients and infection were similar in both arms. The treatment was considered as a success (disappearance of fever within 48 h) in 21/35 patients of the vanco group (60%) compared to 13/24 patients of the teico group (54%; P not significant). The percentage of failures for infection due to Gram-positive bacteria was 2/11 for vanco versus 2/7 for teico (P not significant). Two patients in each group died from infection. The main cause of failure was retrospectively attributed to fungal pathogens. No major toxic effects were found in either group. These preliminary results do not show any difference between vanco and teico as second-line antibiotic therapy in leukaemic patients with severe and prolonged granulocytopenia.

Adolescent↗
PubMed1990

In vitro activities of vancomycin and teicoplanin against coagulase-negative staphylococci isolated from neutropenic patients.

This study reports the in vitro activities of vancomycin and teicoplanin against 185 coagulase-negative staphylococcal strains isolated from 80 neutropenic patients who received different antibiotic treatments. All strains were susceptible to vancomycin: MICs for 50 and 90% of strains tested were 2 and 4 mg/liter, respectively. Teicoplanin was less active, and MICs displayed a wider range. For only teicoplanin was there a correlation between resistance and previous treatment. At the 4- and 32-mg/liter breakpoint levels, only 20% of the strains isolated from patients without glycopeptide treatment were intermediate or resistant, whereas 49.2% of the strains from patients who had received vancomycin or teicoplanin or both were intermediate or resistant.

Agranulocytosis↗
PubMed1990

Autologous bone marrow or blood stem cell transplantation in chronic myeloid leukemia. France Auto Greffe Group.

Forty-seven patients with Ph1-positive chronic myeloid leukemia in transformation (CML) underwent autologous transplantation of peripheral blood stem cells (ABSCT) collected at the original diagnosis before any treatment. They were treated according to 3 consecutive strategies: single transplant (Group I = 17 patients), double transplant (Group II = 13 patients), double transplant followed by recombinant alpha interferon (IFN) (Group III = 17 patients). The actuarial median duration of second chronic phase was 3 months, 10 months and 18 months for Group I, Group II and Group III patients (p less than 0.0001). The encouraging results observed for Group III patients prompted us to propose ABSCT for patients in chronic phase with initial prognostic factors (high-risk CML) suggesting that IFN will not be effective if administered as front-line therapy. To date, 13 patients with high-risk CML underwent ABSCT followed by IFN therapy. Ten patients achieved a complete hematological response following transplantation. Two of 6 evaluable patients had a cytogenetical response 6 months after ABSCT. A longer follow-up is needed to see if the duration of chronic phase may be prolonged.

Adult↗
PubMed1990

Long-term follow-up after bone marrow transplantation for chronic myelogenous leukemia: factors associated with relapse.

Data on 281 patients with chronic myelogenous leukemia who received bone marrow transplants were analysed. The median follow-up time was 40 months; 170 patients were in first chronic phase, 14 were in second chronic phase, 73 were in accelerated phase and 24 were in blastic crisis. The overall actuarial survival was 50% at 5 years. In multivariate analyses, the probability of relapse correlated with the phase of the disease, the method of total body irradiation, the T cell depletion of the marrow and the occurrence of a chronic graft-versus-host disease (GVHD). The probability of survival was better for patients with grade 0-1 GVHD than for patients with grade 2-4 GVHD. In contrast, the probability of disease-free survival was significantly better for patients who received a non-T cell-depleted marrow than for recipients of T cell-depleted marrow. Interval between diagnosis and transplant, splenectomy before transplant, patient age and donor recipient sex match were not significantly associated with outcome. Bone marrow transplantation in first chronic phase with an HLA identical non-T cell depleted marrow offers the better chance of prolonged leukemia-free survival.

Adult↗
PubMed1990

Treatment of acute myeloid leukemia in elderly patients: the influence of maintenance therapy (BGM 84 protocol).

Ninety-two elderly patients (ages 50-70) with "de novo" acute myeloid leukemia were given induction chemotherapy consisting of aclacinomycin-A (ACLA) (100 mg/m2/day x 3) and cytosine arabinoside (ARA-C) (100 mg/m2 day, continuous infusion, 7 days). Fifty-one patients (55%) achieved complete remission (CR), 8 patients exhibited drug resistance and 33 patients died during chemotherapy or aplasia. Three patients had severe cardiac toxicity. The only prognostic factor significantly affecting CR was the initial leukocyte count. After consolidation using ACLA (80 mg/m2/day x 2) and ARA-C (100 mg/m2/day x 5), 47 CR patients were randomly assigned to 2 different treatment arms: 23 patients (Group A) received intensive sequential chemotherapy consisting of 4 monthly courses of 8 different drugs while 24 other patients (Group B) were given ACLA and ARA-C at regular intervals, associated with continuous chemotherapy consisting of 6-mercaptopurine, methotrexate and androgens. The probability of disease-free survival at 2 years was significantly higher (33 +/- 22%) for Group B patients than for Group A (13 +/- 16%) (P less than 0.05). We conclude that continuous maintenance chemotherapy may be useful in increasing the number of long-term survivors, at least in the elderly who have not received very intense consolidation chemotherapy following CR.

Aclarubicin↗
PubMed1990

Bone marrow transplantation for chronic myelogenous leukemia. Results of the French Cooperative Group (GEGMO).

Data on 281 patients with chronic myelogenous leukemia who received bone marrow transplants were analyzed. The median follow-up time was 48 months. One hundred and seventy patients were in 1st chronic phase, 111 were in more advanced disease. The overall actuarial survival was 50% at 5 years. In multivariate analyses, the probability of relapse was correlated with the phase of the disease, the method of total body irradiation, the T cell depletion of the marrow and the occurrence of a chronic GVHD. The probability of disease free survival was significantly better for the patients who received a non T cell depleted marrow than for recipients of T cell depleted marrow. Bone marrow transplantion in first chronic phase with an HLA identical non T cell depleted marrow offers the better chance of prolonged leukemia free survival.

Acute Disease↗