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Biomedical subjects

M Baccarani

Publications and source records attributed to M Baccarani.

At least 163 records · Page 9Linked to original sources
PubMed1989

Prognostic variables and clinical staging in multiple myeloma.

To evaluate the most important factors in the prognosis and staging of multiple myeloma (MM), the presenting clinical features of 163 previously untreated patients with MM were correlated with survival duration using univariate and multivariate regression analyses. The univariate proportional hazard analysis ranked the parameters in the following order of importance: platelet count, hemoglobin level (Hb), tumor cell mass stage, lytic bone lesions, creatinine, and age. When the individual contribution of each variable was assessed by multivariate regression analysis, platelet count was confirmed to be the dominant feature for prognosis and clinical stage provided additional information. The introduction of platelet count could then be used to improve the reliability of the Durie and Salmon staging, by allowing to separate the high-risk group (stages II and III) into a smaller subgroup (22%) of thrombocytopenic patients (less than 150 x 10(9) platelets/L) whose risk of death was actually very high (median survival, 9 months) and a larger subgroup (46%) of patients with normal platelet count and intermediate or standard risk (median survival, 48 months). This simple change in the prognostic system gave rise to markedly different survival curves also after the exclusion of patients with renal failure and applied successfully to both old and young patients (greater than and less than 50 years, respectively). Finally, platelet count, Hb, and lytic bone lesions could be combined simply to stratify patients with normal renal function into three risk groups: (1) low (39% of cases; median survival, 79 months), (2) intermediate (53% of cases; median survival, 48 months), and (3) high (8% of cases; median survival, 19 months).

Bone Marrow↗
PubMed1988

Prognostic significance of additional cytogenetic abnormalities at diagnosis of Philadelphia chromosome-positive chronic granulocytic leukemia.

Of 661 patients with Philadelphia chromosome (Ph)-positive, nonblastic chronic granulocytic leukemia, 58 had cytogenetic abnormalities in addition to the Ph at the time of diagnosis. Twenty patients had reduplication of the Ph in one or more metaphases. Twenty-one patients with a single Ph exhibited hyperdiploidy in one or more metaphases. Eleven patients had two or more hypodiploid metaphases as their only numerical abnormality. The remaining six patients had a variety of abnormalities. Many patients had more than one type of abnormality. Survival of patients in the different subgroups was similar, but these 58 patients had a shorter course than the 603 patients without additional cytogenetic abnormalities (P less than .02). Survival curves for the two populations did not diverge until the 2-year point, after which the annual death rate among patients with additional cytogenetic abnormalities was approximately 40% higher than that of patients without such abnormalities. The two populations had similar relative risk values according to a hazard ratio formula previously described by the International CGL Prognosis Study Group. Thus, they would have been expected to have essentially identical survival curves. We conclude that the presence of additional cytogenetic abnormalities at the time of diagnosis constitutes an independently significant prognostic feature with an unusually delayed influence on survival.

Adolescent↗
PubMed1987

In vitro exposure of leukemic cells to low concentration Arabinosyl Cytosine: no evidence of differentiation inducing activity.

Low dose Arabinosyl Cytosine (LD ARA-C) is widely used for treatment of acute non-lymphocytic leukemia (ANLL) and myelodysplastic syndrome (MDS) in the elderly, based on a favorable response rate and on the hypothesis that LD ARA-C can induce differentiation or maturation of leukemic cells. We investigated the effect of low concentration of ARA-C on the growth of marrow cells that were obtained from 6 cases of MDS and from 11 cases of ANLL by using the in vitro culture system for normal granulo-monocyte precursors (CFU-GM). At ARA-C concentrations equal to or higher than 1 ng/ml cell growth was inhibited in a dose-dependent manner. At ARA-C concentration of 0.1 ng/ml cell growth was slightly affected, but colony number and colony cell composition were identical to control cultures. This experiment did not support the hypothesis that ARA-C can induce leukemic cells to recover any normal growth patterns but confirmed that even very low ARA-C concentrations can inhibit or slow down leukemic cell proliferation.

Acute Disease↗
PubMed1987

Cytogenetic analyses in 89 patients with secondary hematologic disorders--results of a cooperative study.

Eighty-nine patients who developed a secondary hematologic disorder and were studied with chromosome analysis were collected from nine institutions. The results of the study confirmed previous findings, in particular, -5/5q-, -7/7q-, -17, and +21 were the most frequently encountered aberrations. Moreover, a t(1;7)(p11;p11) was reported in four cases and consistent chromosome abnormalities were observed in a small group of patients who had been treated only with surgery, but not with chemo- or radiotherapy for a previous tumor.

Acute Disease↗
PubMed1987

Cell kinetic effect of low dose arabinosyl cytosine.

Low dose arabinosyl cytosine (ARA-C) is effective for treatment of acute non-lymphocytic leukaemia (ANLL). The mechanism of action is not clearly understood and it was suggested that low doses of the drug could induce leukaemic cells to differentiate. We investigated the effect of low dose ARA-C (20 mg/m2/d, divided into two doses s.c. at 12 h intervals, x 20 d) on the cell cycle distribution of leukaemic cells in four cases of ANLL. By comparison, four other cases of ANLL were studied during treatment with standard dose ARA-C (200 mg/m2/d as a continuous i.v. infusion x 7 d). Both treatments induced an accumulation of leukaemic cells in post G1 phases, at a variable extent and rate. During treatment by low dose ARA-C, the mitotic index (MI) fell slowly to zero in two patients who achieved a complete remission (CR), while it fell but recovered during treatment in the patients who did not achieve a CR. The MI fell rapidly to zero in the four cases treated by standard dose, who achieved a CR. These data are consistent with the known cytotoxic activity of ARA-C, via inhibition and slowing of DNA synthesis leading to defective cell proliferation and to cell death.

Acute Disease↗
PubMed1987

Relationship of serum lactate dehydrogenase level with first remission length in adult acute lymphocytic leukaemia.

Several features have a prognostic value in adults with acute lymphocytic leukaemia (ALL). However, in about two-thirds of all cases prognosis remains quite variable, with a substantial number of early relapses. This study shows in 118 adult patients who attained complete remission (CR) between 1978 and 1984 that pretreatment serum total lactate dehydrogenase (LDH) activity was inversely correlated with first CR length. The prognostic value of LDH was higher than that of any other features both in univariable and in multivariable analysis. The value was significant in the whole series as well as in patients who lacked other high risk features. Among non-high risk and low-WBC count cases, patients with LDH less than or equal to 500 U/l had a median first CR duration of 27 months, and a projected 5-year relapse free survival of 36%, versus 9 months and 12% of patients with LDH greater than 500 U/l. These results fit well with the results of a study of ALL in children, and suggest that pretreatment serum total LDH activity is an important risk determinant in adult ALL.

Adolescent↗
PubMed1986

Normal T-lymphocyte function in patients with Hodgkin's disease in long-lasting remission.

In 18 patients with Hodgkin's disease (HD) in long-lasting remission (more than 5 years), the distribution of circulating T-lymphocytes was analyzed using a series of monoclonal antibodies (OKT3, T4, T8, Leu-7, Leu-11 and T10) and correlated with cell function (helper capacity in a pokeweed mitogen system and natural killer (NK) activity). A reduced proportion of OKT4 (helper/inducer)-positive cells associated with a normal absolute number was consistently accompanied by a significant increase (p less than 0.005) in the proportion and absolute number of OKT8 (suppressor/cytotoxic)-positive cells. The OKT4-positive cells, despite their moderate percentage reduction, showed normal helper activity. A more extensive characterization of the lymphoid population in these patients documented a preserved cytotoxic function in a 51Cr release assay and increased proportion of cells expressing NK-associated antigens (Leu-7, Leu-11, OKT10) with a high number of cells coexpressing OKT8 and Leu-7. It is suggested that in patients with Hodgkin's disease in long-lasting remission no laboratory (or clinical) evidence of cellular immunodeficiency can be documented.

Adult↗
PubMed1986

Lymphoblastic lymphoma in adolescents and adults. Clinical, pathological and prognostic evaluation.

Sixty-four adult patients with lymphoblasts lymphoma (LB) identified according to Kiel Classification were analyzed retrospectively. Three distinct clinical presentations were identified: prevalent abdominal disease (29 pts = 45.3%), prevalent mediastinal disease (14 pts = 21.9%) and prevalent superficial node involvement (21 pts = 32.8%). On histological grounds, the patients with abdominal disease were mainly associated to "Burkitt like" cell lymphoma (55%); patients with mediastinal disease to convoluted cell type (58%); and those with superficial node disease to unclassified cell type (48%). Immunological studies showed a significant correlation between mediastinal disease and T phenotype (P = 0.0011), abdominal disease and B phenotype (P = 0.00042), and between superficial node disease and non-B non-T phenotype (P = 0.00024). Survival was independent of the type of clinical presentation and protocol employed but was correlated with the stage (P less than 0.0005), symptoms (P less than 0.025), bulky disease (P less than 0.025) and bone marrow involvement (P less than 0.025). Furthermore the response to therapy was strongly correlated with prognosis (P less than 0.0001) with 34.5 months median survival for complete responders, 9 months for partial responders, and 3 months for non-responders. Four patients underwent bone marrow transplantation (three autologous and one allogeneic BMT in a patient in leukemic phase); three of them are still in CR (18, 22, and 27 months from the transplant) while one patient had an early relapse and died 3 months later.

Adolescent↗
PubMed1986

Hodgkin's disease (HD): a historical perspective.

Five hundred and seven patients with Hodgkin's lymphoma (HL), forming the basis of our 18 years experience, are retrospectively analyzed. Four therapeutic periods are recognizable: The 1966-1970 period was characterized by the absence of treatment and management policy. The 55 patients entered in this period experienced 70 and 56% survival at 5 and 10 yr, respectively, from diagnosis. The 1971-1974 period was characterized by the increasing knowledge of staging relevance and therapeutic approaches. The 153 patients who were treated in this period experienced 72 and 60% survival at 5 and 10 yr, respectively. The 1975-1980 period was characterized by a large combination of MOPP and radiotherapy. The 216 patients who entered this period observed 80 and 72.5% survival at 5 and 10 yr, respectively. The last therapeutic period (1980 to present time) is characterized by the increasing relevance of prognostic factors and alternating use of MOPP and ABVD as non-cross resistant regimen. The 83 patients who entered this period showed 90% survival at 5 yr. Both survival and disease-free survival were positively influenced by the change of therapeutic strategies during the four periods (P less than 0.005). Although better results have been recorded moving from one to the next therapeutic period, the present policy has been also based on the recognition of a high number of late complications due to the therapy. Preliminary results about the present therapeutic experience seem to indicate both a good remission rate and low incidence of complications.

Adult↗
PubMed1986

Hodgkin's disease occurring in a Warthin's tumor: first case report.

The case of a Warthin's tumor whose lymphoid component was totally replaced by a malignant lymphoma, Hodgkin's type, is reported. The disease was characterized by a rapid downhill course, with repeated medullary relapses and subsequent episodes of bone marrow failure. Death occurred 13 months after the initial diagnosis and was due to severe visceral involvement by Hodgkin's lymphoma, as confirmed at post mortem examination.

Adenolymphoma↗
PubMed1986

Bone marrow transplantation in multiple myeloma.

We report 3 cases of allogeneic bone marrow transplantation in multiple myeloma that we have recently performed. Following conditioning treatment with i.v. cyclophosphamide (60 mg/kg/d, for 2 d), oral melphalan (1.0 mg/kg/d, for 5 d), i.v. BCNU (5.5 mg/kg, in a single dose) and total body irradiation (10 Gy in a single fraction) we observed in all 3 cases the disappearance both of serum M component and of monoclonal bone marrow plasma cells. 1 patient died of acute GVH disease, grade IV, at 2 months, while the other 2 patients are in good health and in unmaintained complete remission at 4 and 20 months, respectively. The usefulness of allogeneic bone marrow transplantation in the management of multiple myeloma is emphasized.

Adult↗
PubMed1986

Meningitis and septicaemia in adults splenectomized for Hodgkin's disease.

Splenectomized and asplenic persons are at risk of developing sudden episodes of meningitis and/or septicaemia, frequently due to Streptococcus pneumoniae (overwhelming postsplenectomy infection, or OPSI). The application of staging splenectomy to patients with Hodgkin's disease (HD) generated a new population at risk for OPSI. We reviewed the cases of sudden meningitis and/or septicaemia in a series of 491 consecutive adults with HD. No case was recorded among 149 non-splenectomized patients. 6 episodes of OPSI were observed in 5 of 342 splenectomized patients (crude frequency 1.75%, actuarial frequency at 10 yr 3.87%). The infecting organisms were Streptococcus pneumoniae (5 cases) and Salmonella enteritidis (1 case). 2 episodes (1 fatal) occurred during first complete remission (CR), 15 and 120 months, respectively, after splenectomy, 4 episodes (2 fatal) occurred after first relapse. For splenectomized patients in continuous CR, the cumulative risk of OPSI was 2.30% (95% CL 0-6.10%), and it was 15.25% (95% CL 0-35.37%) for splenectomized patients who had relapsed. These data suggest that, in adults with HD, the risk of OPSI should not limit the indication to staging splenectomy and does not warrant systematic prophylaxis. However, in splenectomized relapsed patients, OPSI can be a troublesome complication and appropriate prophylaxis could be useful.

Adolescent↗
PubMed1986

High-dose therapy followed by autologous bone marrow transplantation (ABMT) in previously untreated non-Hodgkin's lymphoma.

13 previously untreated patients with poor prognosis non-Hodgkin's lymphoma (NHL) underwent high-dose therapy followed by autologous bone marrow transplantation (ABMT). All patients experienced a great cytoreductive effect and 9 of them reached a complete remission (mean duration 32 months). The best results were observed in patients with more limited disease and in those without symptoms. 7 patients still remain in complete unmantained remission 15-46 months from the transplant. The probability of survival is 74% at 46 months. No therapy-related deaths were recorded. In differentiating our preliminary approach, we propose high dose therapy followed by ABMT as induction phase in patients with stage II and as consolidation after first line therapy in patients with stages III-IV. Further studies are warranted to determine which type of lymphoma may benefit more and which conditioning regimens may improve the remission rate.

Adolescent↗