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Biomedical subjects

M Lazzarino

Publications and source records attributed to M Lazzarino.

At least 145 records · Page 8Linked to original sources
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Chronic myelomonocytic leukemia: clinical features, cytogenetics, and prognosis in 30 consecutive cases.

A retrospective analysis of 30 patients with chronic myelomonocytic leukemia (CrMML) was performed to define the natural history of the disease and the risk of acute transformation. Our patients fulfilled the following criteria of diagnosis: blood monocytosis over 1 X 10(9)/l, blast cell percentage in bone marrow up to 30, and in peripheral blood less than 5. The most common presenting feature was anemia; seven patients had fever; three patients complained of purpura and bleeding. Anysopoikilocytosis and macrocytosis were frequent. Abnormal granulocyte morphology, defective granulation and abnormal leukocyte alkaline phosphatase were often observed. Blast cells in peripheral blood smears were found in 14 patients. Serum and urine lysozyme levels were increased in 82 per cent and 93 per cent, respectively. Dysplastic changes involving erythroid, granulocytic and megakaryocytic lineages were constant features in all cases. Agranulated blasts above 5 per cent of marrow nucleated cells were seen in 13 patients (43 per cent). Seven of the 20 patients showed non-specific chromosomal abnormalities at diagnosis. Median survival from diagnosis was 18 months (range, 3-112). Evolution into acute myeloid leukemia occurred in 11 patients. No difference in survival was found between patients who developed acute leukemia and patients who did not. A shorter survival has correlated to the following parameters: leukocytes greater than 10 X 10(9)/l, the presence of blasts in peripheral blood and agranulated blasts in the marrow above 5 per cent.

Adult↗
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Residual mediastinal widening following therapy in Hodgkin's disease.

The chest radiograms (CXR) of 102 patients with Hodgkin's disease presenting with mediastinal involvement at diagnosis were reviewed to assess the incidence and relevance of residual mediastinal abnormalities after therapy. All patients had completed planned treatment and had no evidence of persisting extramediastinum disease at restaging. Thirty-nine cases (38 per cent) showed residual mediastinal widening at the end of therapy (minimal changes in nine and measurable changes in 30 cases). Neither presenting features nor treatment modality correlated with residual mediastinal mass on chest X-ray. The isolated intrathoracic relapse rate was 11 per cent for patients with normal mediastinum following therapy, as compared with 20.5 per cent for those with residual widening; this difference did not reach statistical significance (p = 0.3). The persistence of mediastinal abnormalities was associated with a trend towards a higher risk of intrathoracic relapse for patients with initial bulky disease (p less than 0.05) and for those with B symptoms (p = 0.07). Using thoracic CT scan for restaging (56 patients), the residual mediastinum rate rose to 70 per cent; the predictability of local relapse with this procedure was not greater than with conventional X-ray study.

Adult↗
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Treatment of terminal-phase chronic myelogenous leukemia with intermediate-dose cytarabine and hydroxyurea.

We used intermediate doses of Ara-C (IDAra-C) in the treatment of 15 patients with chronic myelogenous leukemia (CML) in blast crisis and, combined with hydroxyurea, in 20 CML patients in accelerated phase. Patients with blastic CML received intensive 5-day courses of IDAra-C 600 mg/m2 every 12 h as a 2-h infusion. Of 15 patients, three achieved complete response (CR) and three partial response (PR), for an overall response rate of 40 per cent. All patients developed severe leukopenia and thrombocytopenia, and two died in hypoplasia. Except nausea and vomiting requiring medication, other nonhematologic toxicities were uncommon. Median response duration was 4 months (range 1 to 7 months). Survival was 5 months for responders and 1.5 months for nonresponders. Patients with CML in accelerated phase were treated with two-day courses of IDAra-C 600 mg/m2 every 12 h by 2-h infusion, every two-three weeks. Daily hydroxyurea 1-1.5 g/day was administered between courses. Of 20 patients, 15 (75 per cent) achieved a good PR with rapid improvement of the symptoms of disease acceleration. The median duration of response was 11 months (range 3 to 38 months); duration was over 24 months in five patients. The median survival from the start of IDAra-C was 13 months for responders and 3.5 months for nonresponders. We conclude that IDAra-C is an effective approach for CML in terminal phase. Its use in 5-day induction courses for blast crisis CML has a response rate comparable to that achieved with high-dose Ara-C. In patients in accelerated phase, the combination of short courses of IDAra-C with hydroxyurea is a well-tolerated treatment able to improve substantially the clinical and hematologic symptoms of disease progression.

Adult↗
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CAV chemotherapy (CCNU, melphalan, etoposide) as salvage treatment for relapsing or resistant Hodgkin's disease.

Twenty-five adult patients with resistant or early relapsing Hodgkin's disease have been treated with CAV combination chemotherapy (CCNU, melphalan and etoposide). All patients had previously received both MOPP and ABVD regimens (23 patients as primary therapy and two as first salvage). High-energy radiotherapy had been administered in one case. The CAV chemotherapy was used as first salvage therapy in 15 cases (60%); the remaining patients had been heavily pretreated with different regimens including alkylating agents, vinblastine, and/or nitrosourea derivatives before CAV for multiple relapses or progressive disease. At the initiation of CAV chemotherapy, 64% of patients had extranodal disease (20% with more than one site), and bone marrow was involved in 16% of total cases. Thirty-two percent of CAV patients had progressed during primary therapy, while only 20% of cases had relapsed after complete remission (CR). The CR rate after CAV therapy was 17% (4 of 24); partial responses were observed in 33% of patients, giving an overall response rate of 50%. The response was influenced by the presence of nodal disease and by a prior response to chemotherapy. Considering the 15 patients who received CAV therapy as first salvage, the CR rate was 37%. The median survival from the initiation of CAV therapy was 23 months for the whole group of patients, and was not reached at 2 years for those who received CAV as first salvage therapy. Toxicity consisted of nausea (100% of cases), vomiting (63%), reversible alopecia (83%), mild to moderate leukopenia and thrombocytopenia (54% and 21%, respectively). No therapy-related deaths were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
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Non-Hodgkin's lymphoma in the elderly: the impact of advanced age on therapeutic options and clinical results.

BACKGROUND: Treatment of older patients with non-Hodgkin's lymphoma (NHL) is difficult and conflicting. Lower responsiveness to therapy has been reported; however, the high risk of treatment morbidity, drug-dose reduction, and the occurrence of unrelated deaths might account for the poor outcome of NHL in the elderly. METHODS: We retrospectively analyzed the therapeutic approach and the outcome in 90 NHL patients aged 65 years or older. Histologic classification was according to the Working Formulation. RESULTS: Twenty-nine patients with low-grade NHL have been managed conventionally: complete response (CR) rate was 34.5% and median overall survival was 35 months. Sixty-one patients with intermediate-grade (IG, 36 cases) or high-grade (HG, 25 cases) NHL were treated as follows: 5 stage I-IE cases underwent radiation therapy; of 56 stage II-IV patients, 14 had conservative single-agent therapy and 32 received an attenuated CVP regimen. Only 10 patients were considered suitable for attenuated CHOP or CHOP-like programs. Overall CR rate was 50% for IG and 32% for HG NHL: Median survival was 33 months and 10 months (p less than or equal to 0.05), respectively. For IG and HG patients, the attainment of CR influenced survival significantly. Treatment morbidity was observed in 41% of patients. Resistant lymphoma was the major cause of death (31/36) during the first six months of therapy. CONCLUSIONS: In our experience, the outcome of elderly NHL patients treated with conservative therapeutic approaches is poor. Intensive chemotherapy regimens tailored to individual patients are needed to improve clinical results.

Age Factors↗
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Spontaneous splenic rupture during induction chemotherapy for acute promyelocytic leukemia successfully treated with splenectomy.

We report a case of acute promyelocytic leukemia who suffered spontaneous splenic rupture with massive hemoperitoneum while receiving intensive induction chemotherapy. Emergency computed tomography of the abdomen helped in the diagnosis of intra-abdominal bleeding. The patient was successfully treated with immediate splenectomy and made an uneventful postoperative recovery. Ten days after surgery chemotherapy could be resumed and complete remission was achieved. Although spontaneous splenic rupture is a rare complication of hematologic malignancies, this diagnosis should be considered in all patients with leukemia who develop acute abdominal pain with hypotension, even in the absence of splenomegaly.

Adult↗
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Extramedullary disease in Ph'-positive chronic myelogenous leukemia: frequency, clinical features and prognostic significance.

Of 349 consecutive patients with Philadelphia-positive chronic myelogenous leukemia (Ph' + CML), 14 (4%) developed extramedullary disease (EMD) during their illness. The sites of EMD were: bone (57%), lymph nodes (29%), skin and soft tissues (21%), central nervous system (14%). The median time from diagnosis of CML to the occurrence of EMD was 48 months. At the time of diagnosis of EMD, 7 patients were hematologically in chronic phase, while 7 showed features of accelerated or blastic CML. For patients lacking medullary blastic transformation criteria, the median time from diagnosis of EMD to blast crisis was 4 months. The overall median survival from development of EMD was 5 months. In conclusion, EMD may occur during the course of CML either in the context of a frank blastic transformation, or as an isolated tumoral infiltrate which heralds an impending blast crisis. Its recognition requires a prompt change to acute-phase chemotherapy.

Adult↗
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Combination chemotherapy with alternating MOPP-ABVD in advanced Hodgkin's disease.

Fifty untreated adult patients with advanced Hodgkin's disease (HD) were given alternating MOPP-ABVD chemotherapy in a prospective eight-cycle program. This series included 33 patients with stage II-III disease and bulky lymphoma and/or B symptoms, and 17 patients with stage IV disease. Nodular sclerosis amounted to 52%, and systemic symptoms were present in 70% of patients. The median follow-up was 50 months from the initiation of therapy (range: 36-78 months). The complete remission rate was 80%, with no differences according to the main patient characteristics before therapy, except for bulky (65%) versus non bulky (88%) disease (p = 0.05). The actuarial 4-year overall (OS) and relapse-free survival were 78% and 71%, respectively. No clear-cut pretreatment characteristics showed an influence on survival, although there was a trend favoring non bulky versus bulky disease (p = 0.08). The actuarial 4-year OS of complete responders was 92%; all 13 patients who died had evidence of HD; the cause of death was disease progression and organ failure in 11 cases, acute myelomonocytic and opportunistic infections with AIDS in the other two cases, respectively. No severe pancytopenia episodes or life-threatening complications occurred during therapy; gastrointestinal and neurological toxicity were mild and no patient refused to complete the treatment. Menstruating women were given estrogen-progesterone combinations, and all continued to have regular menses throughout chemotherapy and afterwards; a young woman had a normal pregnancy resulting in a normal live birth. Only one case of stable amenorrhea was observed. Oligospermia after chemotherapy was seen in seven of 10 tested males, and azoospermia in one case.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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Hemorrhagic and thrombotic complications in polycythemia vera. A clinical study.

This study reviewed the clinical and hematologic characteristics of 161 patients with polycythemia vera treated with myelosuppressive agents, with or without antiaggregating platelet therapy, in order to determine the features associated with a risk of hemorrhagic or thrombotic complications. At presentation, 7 patients (4.3%) showed hemorrhages and 36 (22%) complained of thrombotic events. None of the evaluated clinical and hematologic parameters was significantly related to hemorrhagic or thrombotic presentation. During the clinical course, four of 107 patients (3.7%) experienced hemorrhagic complications and 34/107 patients (28%) complained of occlusive events, which accounted for 30% of total deaths. Among the clinical and hematologic presenting features, only age over 60 yrs could be identified as an unfavorable prognostic factor for the occurrence of thromboembolic episodes. Marked thrombocytosis, a high packed cell volume (PCV) and the thrombotic onset were not significantly related to the thrombotic risk. Platelet count and PCV at the time of the occlusive episode did not correlate with the clinical event; however, inadequate control of the proliferative disease seemed to increase the thrombotic tendency. Antiaggregating drugs, although unable to avoid thrombosis in our experience, might be safely associated with the myelosuppressive therapy, particularly in selected patients.

Adult↗