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Biomedical subjects

R J Haas

Publications and source records attributed to R J Haas.

At least 37 records · Page 2Linked to original sources
PubMed1989

Bone marrow transplantation in childhood leukaemia--experience and strategies in the Federal Republic of Germany.

BMT has gained its place in the treatment of childhood leukaemia. Nevertheless, there are still many questions open. In acute lymphoblastic leukaemia children should normally be grafted in 2nd remission (CR). Some high risk cases, however, should probably be grafted in 1st CR. It is not clear whether children with late relapses benefit more from BMT than from renewed chemotherapy. Children with a relapse during maintenance therapy, however, have a better survival rate with BMT. In acute nonlymphoblastic leukaemia certain high risk patients should be grafted in 1st CR but it has still to be shown that BMT is superior to chemotherapy in such cases. It is not clear whether children with a relapse following intensive chemotherapy (such as the BFM-protocols) will benefit from BMT at all. In chronic myelocytic leukaemia, BMT in chronic phase should be performed. Thus, for the first time cure has become possible for this disease. Waiting for acceleration or even the occurrence of a blast crisis decreases the chance of survival after BMT dramatically. Since complications of BMT such as graft-versus-host reaction or severe infections are less frequent in children, relapses remain the main problem after BMT in childhood leukaemia.

Bone Marrow Transplantation↗
PubMed1989

Bone marrow transplantation for the treatment of leukaemia-results of the Munich Cooperative Group.

This report summarizes the results of marrow transplantation from HLA-identical siblings and syngeneic twins for treatment of acute myelogenous leukaemia, chronic myelogenous leukaemia, acute lymphoblastic and undifferentiated leukaemia from 1975 until December 1986. Three conditioning regimens and treatment of the marrow graft in vitro with absorbed antithymocyte globulin or the monoclonal antibody "Campath 1" for prophylaxis of graft-versus-host disease (GVHD) have been studied and analyzed retrospectively. The regimen of total body irradiation in large fractions of 4 Gy and of cyclosphosphamide (200 mg/kg) has achieved the most favorable results. Inactivation of T-cells by treatment of the marrow "in vitro" has decreased the severity of GVHD without improving survival. The antileukaemic effect of the graft may be important for control of the disease and may be improved by better immunosuppression of the recipient.

Adolescent↗
PubMed1989

Improved survival following HLA-incompatible bone marrow transplantation. Munich Cooperative Group of Bone Marrow Transplantation.

In most centers allogeneic bone marrow transplantation is restricted to patients with HLA-identical siblings as donors. We have transplanted 16 patients with marrow of donors other than HLA-identical siblings. Seven patients were grafted in the years 1978 until 1984. Six died of transplant complications and one of recurrent leukemia. More recently 9 patients were transplanted following an improved immunosuppressive conditioning treatment derived from experimental studies in dogs. Four are alive and in continuous remission between more than 2 months and 2 years. 5 patients died, 3 from fungal infections, one from recurrent leukaemia and one early from endothelial leakage syndrome. Our results indicate that intensified immunosuppressive conditioning may improve the results of marrow transplantation from HLA-haploidentical donors.

Adolescent↗
PubMed1988

[Primary liver tumors in childhood: an analysis of 19 cases].

Nineteen patients were operated on for primary liver tumors at our hospital from 1970 to March 1987. Among malignancies, hepatoblastomas and hepatocellular carcinomas were equally often seen (7 cases each), among benign tumors, there were 3 hemangioendotheliomas and 2 hemangiomas. In 6 of the 14 children with malignant tumors, only a biopsy could be performed due to primary inoperability, tumor excision was possible in 8 cases. Following chemo-embolisation, tumor excision could be carried out in a second-look operation in one case. Six patients with hepatoblastoma died within 6 months following diagnosis, 2 of them, however, succumbed to therapeutical side effects. Four of the seven patients with hepatocellular carcinoma were alive after a mean follow-up of 6.4 years (2-15 years).

Adolescent↗
PubMed1986

Acquired immune haemolysis by anti A 1 antibody following bone marrow transplantation.

In ABO mismatched organ or bone marrow transplants recently some cases of acquired immune hemolysis have been reported. It was felt that these life threatening complications were due to immunosuppressive treatment with cyclosporin-A. A case of severe hemolysis following mismatched BMT is reported. Here no cyclosporin-A treatment was given since the bone marrow was T-cell deprived by an E-rosetting technique. Apparently T-cell purging can under these conditions become dangerous.

ABO Blood-Group System↗
PubMed1985

[Therapeutic experiences with high-dose ARA-C and L-ASP].

Five patients, 4 with ALL, 1 with AML received 8 cycles of HD-ARA-C (Capizzi protocol). One complete remission was achieved, 2 patients died shortly after cycle 1 and could not be evaluated. Two patients responded partially. Toxicity was considerable.

Adolescent↗
PubMed1985

Active immunization against varicella of children with acute leukaemia or other malignancies on maintenance chemotherapy.

Twenty-six patients with acute leukaemia and other malignancies susceptible to varicella were vaccinated with the Oka-strain live attenuated varicella vaccine during maintenance chemotherapy. All recipients showed no adverse clinical reactions. There was no spread of vaccine virus. Seroconversion was 94% in seronegative patients. Among those having low antibody titres before vaccination, a booster effect was demonstrable in 56%. None of the seroconverted recipients contracted varicella despite documented contact exposure. No case of herpes zoster occurred. The results suggest that, in immunocompromised children, live varicella vaccination has a protective effect against varicella infection which may result in a mortality rate of up to 7% in these patients.

Acute Disease↗
PubMed1984

In vivo production of childhood acute lymphoblastic leukemia cells in relation to ploidy and immunological subtype.

Eighteen pretreatment cases of acute lymphoblastic leukemia (ALL) in children were investigated by quantitative autoradiography in order to determine the labeling index (LI) as well as the DNA synthesis time (ts). The ploidy of the leukemic blasts was evaluated by Feulgen-microphotometry. The group consisted of 12 cases expressing the common ALL (CALL) antigen only, while 6 showed varying degrees of development along the T-cell axis. The latter subgroup was taken together and termed T-ALL for the sake of simplicity. By dividing LI by ts the fractional birth rate (FBR) was derived representing the percentage of the total leukemic cell mass newly formed per unit of time. The present study confirms a previous investigation in which a higher LI was detected in association with hyperdiploidy. It shows that ts is simultaneously prolonged, while the DNA synthesis rate remains unchanged. This proves that in hyperdiploid cases the longer ts is caused by a larger amount of DNA to be synthesized. The FBR is the same for eu- and hyperdiploid, as well as for CALL and T-ALL cases, and there is no correlation between the FBR and the white blood cell count. So far, ALL is the only type of leukemia in which a prolongation of ts has been demonstrated in comparison to normal human lymphatic cells. This prolongation is not caused primarily by differences in ploidy. The type of growth is accumulative, since the relative rate of cell production is lower than normal. As a finding of practical importance, the labeling index is shown to correlate quite closely with the FBR. In this cell system the LI can thus be used as a parameter reflecting the rate of relative cell production.

Adolescent↗
PubMed1984

Prolonged methotrexate infusions in children with acute leukemia in relapse and in remission and with medulloblastoma. Pharmacokinetics, toxicity and clinical results.

In 86 children with acute lymphocytic leukemia (ALL) and in 6 children with medulloblastoma 253 24-hour methotrexate (MTX) infusions with 150, 500, and 700 mg/m2 were performed. MTX concentrations in plasma and cerebrospinal fluid (CSF) were measured with a specific radioimmunoassay. In 131 infusions with 500 mg/m2 given to patients with ALL in remission, the MTX plasma concentration 24 h after the end of infusion did not exceed 7 X 10(-7) mol/1. Mild hematologic toxicity occurred in 22% of the treatment cycles. In contrast 8/45 infusions given to patients with ALL in relapse were associated with delayed MTX elimination followed by severe toxicity. The CSF: plasma ratio of MTX measured during 58 infusions did not exceed 11% in patients with ALL in remission, but was above this value in 13/34 infusions in patients with leukemia of the central nervous system (CNS). 24-hour MTX infusions with 500 mg/m2 were as hepatotoxic as 4- to 6-hour infusions with 3-8.5 g/m2. With MTX as single agent no remissions were achieved in 8 patients with ALL in relapse. The addition of asparaginase in 10 patients resulted in 3 complete and 2 partial remissions. In patients with ALL in first remission clinical results confirmed the value of intensive MTX therapy for disease-free survival.

Actuarial Analysis↗