Neoadjuvant intravenous cisplatin for T2-4NxMo bladder cancer.
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Biomedical subjects
Publications and source records attributed to P Duval.
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Two murine monoclonal antibodies, FMC-8 and WM-21, reactive with the human leucocyte differentiation antigens CD-9 (p-24) and CD-10 (CALLA), respectively, have been used for purging leukemic cells from remission bone marrow. Nine patients with the common variant of acute lymphoblastic leukemia (c-ALL) in second or subsequent remission underwent bone marrow harvesting. Bone marrow mononuclear cells underwent lytic incubation in vitro with antibodies FMC-8 and WM-21, and rabbit serum as a source of complement, and were then cryopreserved. A mean of 0.90 +/- 0.50 x 10(8) nucleated cells per kilogram of recipient body weight remained after treatment, with 0.38 +/- 0.24 x 10(8) nucleated cells and 8.3 +/- 10.3 x 10(4) CFUGM per kg being recovered on thawing. Seven patients subsequently received marrow-ablative treatment with high dose cyclophosphamide (120 mg/kg) and fractionated total body irradiation (12 Gy), followed by infusion of antibody-purged autologous bone marrow. Three deaths due to sepsis occurred within the first 35 days, compounded in one patient by poor marrow engraftment. All other patients engrafted promptly, and four remain in continuous complete remission at 2, 6, 9, and 28 months after transplantation. The procedure carries a substantial risk of early toxicity, but offers a significant chance of prolonged unmaintained remission to selected patients with poor prognosis acute lymphoblastic leukemia.
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Long-term disease-free survival (78 + and 31 + months) has been achieved in two of four patients treated for brain metastases from non-seminomatous germ cell tumours between 1980 and 1984. The incidence of cerebral metastases among 101 patients seen over the 5-year period was 4%. The encouraging results from the use of combined modality treatment, incorporating cisplatin-based chemotherapy, whole brain irradiation and surgery, are reviewed.
Between August 1981 and December 1983, 50 patients with invasive high risk bladder cancer were treated initially with 100 mg. per m.2 cis-platinum intravenously in 2 doses with a 3-week interval, which was followed by definitive treatment (radiotherapy and/or cystectomy). High risk disease was defined on the basis of at least 2 of the following: invasion into or beyond the muscle (stages B2 to D1), grade III histology, large tumors and ureteral obstruction. Major symptomatic improvement was noted in 38 patients (76 per cent) after 1 to 2 doses of cis-platinum and 30 (60 per cent) had an objective response to cis-platinum. An objective response (complete or partial remission) was noted in 43 patients (86 per cent) after cis-platinum plus definitive treatment. The 12-month actuarial survival was 86 per cent and the 2-year actuarial survival was 80 per cent (although only 14 patients were entered in the study more than 2 years ago). The protocol was well tolerated, with nausea and vomiting being the most common side effects. There were no deaths related to treatment. Ten patients (20 per cent) died of cancer. The relevance of initial cis-platinum therapy in this management program is now being evaluated in a multicenter randomized trial.
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We report an epidemic of acute pulmonary histoplasmosis which occurred in February 1994 among a group of 24 persons after they had once or twice visited a cave in New Caledonia. This study describes the physical and laboratory findings, which lead to the diagnosis of histoplasmosis. Each test was evaluated. All members of the group had a physical examination, early and late serological tests, pulmonary X-rays (including CT) and some had mycological examination of bronchoalveolar washes. Mycological investigations were made on samples collected from the cave. Histoplasmic skin testing was not possible. We defined a case as a person who visited the cave in January 1994, had evocative radiological features and at least four symptoms among the following: weakness, fever, headache, arthralgia, thoracic pains, dyspnea, cough and nausea. Of the 24 exposed persons, 7 cases were considered as severe, 8 cases as moderate, and 6 cases as mild, for a total of 21 cases and an attack rate of 87.5%. There was no progression towards disseminated histoplasmosis and no recorded death. The incubation period lasted from 5 to 17 days. The symptoms were divided into three groups. In the first group, the symptoms of fever, headache and arthralgia were common and nonspecific. In the second group, the symptoms of chest pain, cough, and dyspnea which often occurred later, were less common and more specific. In the third group, the symptoms of vomiting, diarrhea and dizziness were less common. The chest X-ray showed abnormalities in 100% of the cases, and in 11 of the 21 cases the characteristic finding was a miliary.(ABSTRACT TRUNCATED AT 250 WORDS)