Biomedical subjects

M N Silverstein

Publications and source records attributed to M N Silverstein.

At least 55 records · Page 3Linked to original sources

PubMed1980

Moderate versus intensive chemotherapy of prognostically favorable non-Hodgkin's lymphoma: a progress report.

Two hundred and fifty-two patients with advanced stages of favorable non-Hodgkin's lymphoma (NHL) subtypes (nodular histiocytic (NH), and diffuse well-differentiated lymphocytic (DLWD)) were analyzed for response and survival to moderate (cyclophosphamide-prednisone (CP)) vs. intensive (BCVP or COPP) chemotherapy regimens. The overall complete response (CR) rate was 57%. The median duration of remission for the entire group was 88 weeks and 65% of complete responders were in remission at one year. Survival rates at one year were 87% for BCVP, 86% for COPP, and 91% for CP. The response rate, response duration, and survival rate differences between the groups were not significant. Severe and life threatening hematologic toxicity rates were significantly higher with BCVP and COPP as compared to CP (P less than 0.001). The highest CR rate was obtained in NM (74%) and CP gave the highest CR rate in DLWD (60%). Survival rates at one year for NM (97%) and NLPD (90%) were comparable whereas the one-year survival rate for DLWD was significantly lower (75%) than that for NLPD (P less than 0.005) or NM (P less than 0.001). We conclude that in favorable NHL subtypes, cyclophosphamide-prednisone combination is an effective regimen with minimal toxicity.

Cyclophosphamide↗

PubMed1980

Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group.

The prognostic effect of weight loss prior to chemotherapy was analyzed using data from 3,047 patients enrolled in 12 chemotherapy protocols of the Eastern Cooperative Oncology Group. The frequency of weight loss ranged from 31 percent for favorable non-Hodgkin's lymphoma to 87 percent in gastric cancer. Median survival was significantly shorter in nine protocols for the patients with weight loss compared to the patients with no weight loss. Chemotherapy response rates were lower in the patients with weight loss, but only in patients with breast cancer was this difference significant. Decreasing weight was correlated with decreasing performance status except for patients with pancreatic and gastric cancer. Within performance status categories, weight loss was associated with decreased median survival. The frequency of weight loss increased with increasing number of anatomic sites involved with metastases, but within categories of anatomic involvement, weight loss was associated with decreased median survival. These observations emphasize the prognostic effect of weight loss, especially in patients with a favorable performance status or a limited anatomic involvement with tumor.

Activities of Daily Living↗

PubMed1980

Randomized clinical trial comparing two dose regimens of ICRF-159 in refractory malignant lymphomas.

A clinical trial of ICRF-159 was done in patients with Hodgkin's disease and non-Hodgkin's lymphomas whose tumors had become resistant to conventional chemotherapy. Antitumor effect and toxicity were compared in patients who were randomly assigned to receive either a loading course or a weekly regimen. Among 82 evaluable cases, five of 39 (13%) treated with the loading course schedule and six of 43 (14%) treated with the weekly schedule experienced objective tumor regressions. Response duration tended to be brief (median, 7 weeks). Life-threatening myelosuppression was more frequent in patients receiving the loading course regimen. Survival was somewhat longer among patients receiving the weekly schedule (median survival, 24 versus 12 weeks; P = 0.04). ICRF-159 demonstrated definite but limited therapeutic activity in this population of patients with advanced malignant lymphomas. The weekly schedule was associated with fewer episodes of life-threatening toxicity and longer patient survival.

Adult↗

PubMed1979

Splenectomy in myeloid metaplasia.

Between 1960 and 1977, 50 patients with agnogenic myeloid metaplasia were splenectomized. Twenty-five of 26 patients with painful splenomegaly, 4 of 9 patients with refractory hemolytic anemia, 4 of 10 patients with refractory thrombocytopenia, and 4 of 4 patients with portal hypertension showed significant benefit from the procedure. There were five immediate postoperative deaths. Four of these deaths occurred early in our series of splectomies for myeloid metaplasia before 1970. Only one death has occurred in the last 21 patients operated on. Survival following splenectomy averaged 25.5 mo.

Female↗

PubMed1978

Agnogenic myeloid metaplasia with ear involvement.

A 52-year-old man with agnogenic myeloid metaplasia had a sudden onset of pain and bleeding from the left ear and an associated decrease in hearing acuity on that side. Examination revealed a friable mass that filled the middle ear and protruded through a perforated tympanic membrane. Special staining of a tissue specimen of the mass revealed myeloid metaplasia. Otorhinolaryngologists should be aware of the fact that the ear can be involved in hematopoietic disorders.

Ear Diseases↗

PubMed1978

Primary thrombocythemia in the young patient.

Primary thrombocythemia is typically a disease of older patients and frequently is associated with thrombosis and hemorrhage. Seven female and two male patients younger than 30 years were evaluated because of platelet counts exceeding 1 million/mm3. No hemorrhagic or thrombotic problems existed before diagnosis or developed during the follow-up period of 14 months to 10 years. Platelet function studies done in six of the nine patients showed absent aggregation with epinephrine and variable aggregation with adenosine diphosphate, as are seen in other chronic myeloproliferative states. One patient had spontaneous aggregation. Secondary causes of thrombocytosis were excluded. Only one patient received specific chemotherapy, which was given before 1973. Thus, thrombocythemia without a secondary cause appears to be much more benign in the young patient than in the older, and aggressive chemotherapy to lower the platelet count is not necessarily justified unless serious complications develop.

Adenosine Diphosphate↗

PubMed1977

Myeloproliferative diseases.

The various myeloproliferative diseases have different symptoms, therapeutic problems, and prognoses. The most common of these disorders appears to be agnogenic myeloid metaplasia, which primarily affects older persons. The five-year survival rate at the Mayo Clinic for these patients is 58%, and the prognosis depends on the presence of symptoms, anemia, and thrombocytopenia and on the size of the liver. Androgen therapy is often necessary to control anemia, and splenectomy may be indicated.

Adult↗

PubMed1977

Managing chronic leukemias.

Chronic lymphocytic leukemia and chronic granulocytic leukemia vary considerably in their clinical features, laboratory findings, and therapy, but both generally have an ominous prognosis. Chemotherapy remains the mainstay of treatment in both disorders, with adjunctive measures to control complications such as anemia and splenomegaly. Immunotherapy for granulocytic leukemia is still under study but appears promising.

Adult↗

PubMed1977

Sea-blue histiocyte syndrome in Thai siblings.

We report two cases of sea-blue histiocyte syndrome in Thai siblings. The abnormal histiocytes were found in the bone marrow and liver of both patients, but none was found in the other members of the family. Cirrhosis and absence of axillary hair were present in both patients. One patient also had elephantiasis of the legs and Klinefelter's syndrome. Our studies support an autosomal recessive inheritance.

Bone Marrow↗

PubMed1977

Effect of splenectomy on teardrop-shaped erythrocytes in agnogenic myeloid metaplasia.

Teardrop-shaped erythrocytes (TD) are frequently observed in the peripheral blood of patients with agnogenic myeloid metaplasia (AMM). These deformed cells may result from the myelofibrosis or the extramedullary hematopoiesis in the spleen. To determine the influence of the spleen on TD formation, we reviewed the presplenectomy (pre-S) and postsplenectomy (post-S) peripheral blood smears from 13 patients with AMM. The splenectomy was performed for a variety of reasons, including symptomatic hypersplenism or splenomegaly. The average number of TDs per 1,000 RBCs in the pre-S smears was 42 (range, 15 to 112 TDs), compared with 11 TDs in the post-S smears (range, 6 to 20 TDs)(P = less than .001). Only one of the 13 patients failed to exhibit this decrease in TDs post-S. There was no definite correlation between the number of TDs and the weight of the spleen removed at surgery, the interval since surgery, or age and sex of the patient. Based on this fourfold decrease in the number of TDs post-S, we conclude that the spleen in AMM play an important role in TD formation.

Aged↗

PubMed1976

The evolution into and the treatment of late stage polycythemia vera.

The onset of postpolycythemic myeoloid metaplasia or spent polycythemia has been recognized for many years. As the result of many different series, the development of postpolycythemic myeolid metaplasia might be expected in from 15%-20% of patients with postpolycythemia vera. It appears that an etiologic role for sodium phosphate 32P may exist in this evolutionary pattern. About 70% of patients with PPMM will have symptoms with the onset of the syndrome. The major mechanisms producing symptoms result from (1) anemia, (2) pressure from massive splenomegaly, and (3) bleeding problems. Iron deficiency is a frequent cause of anemia in patients with PPMM. The major mechanism of anemia in these patients, however, relates to ineffective erythropoiesis and shortened red cell survival. Androgen trials for ineffective erythropoiesis seem worthwhile, although data on this point is too limited to draw any firm conclusions. A steroid trial for those patients with major hemolytic episodes is indicated. In those patients in whom adrenal steroid therapy fails to control major hemolysis, a consideration for splenectomy exists. Pressure-related manifestations secondary to massive splenomegaly have been treated with radiation therapy and oral alkylators. Although there is data to document amelioration of painful symptoms with associated shrinking of the spleen, long-term control of this problem has not been forthcoming. Again, patients who are medical failures in control of pressure-related manifestations may be considered for splenectomy. Bleeding problems may arise with PPMM secondary to thrombocytopenia, thrombocythemia, or qualitative platelet dysfunction. Adrenal steroids have met with some success in improving platelet counts in patients with life-threatening thrombocytopenia. Those patients who are medical failures with adrenal steroids in terms of thrombocytopenia might be candidates for splenectomy. Control of thrombocythemia has been observed with oral alkylator therapy and chlorambucil may have a special role in managing this complication. Qualitative platelet defects leading to severe bleeding are best managed with fresh platelet transfusions. Patients with PPMM in contrast to patients with agnogenic myeoloid metaplasia have a more lethal syndrome and shortened survivorship. Causes of death in patients with PPMM include cardiac problems, transition to acute leukemia, hemorrhage, and infection.

Anemia↗

PubMed1974