Search PubMed⌕ Search

Biomedical subjects

R Pearce

Publications and source records attributed to R Pearce.

At least 37 records · Page 2Linked to original sources
PubMed1997

Role of a second transplant in the management of poor-prognosis lymphomas: a report from the European Blood and Bone Marrow Registry.

PURPOSE: Treatment of selected patients with poor-prognosis lymphomas with high-dose chemotherapy and marrow or peripheral stem-cell rescue improves prognosis. A second course of myeloablative chemotherapy has been given to some patients, but few data are available on the indications, morbidity, and overall survival associated with this approach. This study was undertaken to evaluate morbidity and identify subgroups of patients who may benefit from a second transplant. PATIENTS AND METHODS: Thirty-four patients with lymphoma given two cycles of myeloablative chemotherapy and entered onto the European Blood and Bone Marrow Transplant (EBMT) registry between 1982 and 1995 were included in this study: Hodgkin's disease (HD), n = 12; intermediate/high-grade non-Hodgkin's lymphoma (HG-NHL), n = 17; and low-grade non-Hodgkin's lymphoma (LG-NHL), n = 5. The reason for second transplant, status at transplant, conditioning regimen, morbidity, and both progression-free survival (PFS) and overall survival (OS) were assessed. RESULTS: The second procedure was performed for the following reasons: (1) elective double procedure in four patients, (2) relapse after first transplant in 20, (3) partial remission (PR) after first transplant in eight, and (4) refractory disease after first transplant in two. The OS rate at 2 years for patients who underwent two transplants (estimated from the date of second transplant) was 49%, with a median follow-up time of 44 months. The OS rate at 2 years by histologic subtype was as follows; HD, 50%; HG-NHL, 60%; and LG-NHL, 0%. Seven of 15 patients with HD or HG-NHL who relapsed after they had achieved a posttransplant complete remission (CR) remain in CR 13 to 36 months after the second transplant, compared with two of 10 patients in CR (at 6 and 19 months after second transplant) who achieved a PR or had refractory disease after the first transplant. There were eight deaths (24%) before 3 months, of which three (9%) were transplant-related and the remainder due to persistent disease. Three late toxic deaths occurred: two of cardiovascular disease and one of secondary leukemia. CONCLUSION: Selected patients with HD and HG-NHL whose disease recurs after one transplant may benefit from a second transplant. Patients with refractory disease and LG-NHL did not benefit from a second transplant.

Adolescent↗
PubMed1996

Illness behavior and somatization in general practice.

In the primary care setting, the early recognition that a patient has psychological problems is frequently hindered by the deceptive mode of presentation known as somatization. In a cross-sectional survey of patients attending suburban General Practitioners in a large metropolitan city, the General Health Questionnaire-30 (GHQ-30) and the Illness Behavior Questionnaire (IBQ) were completed by 201 patients. A comparison was made between somatizing and nonsomatizing patients with new inceptions of illness in terms of the risk of the presence of a mild nonpsychotic psychiatric illness and aspects of illness behavior. For the group as a whole, somatizing patients were more likely to be older and female. Male somatizers differed from male nonsomatizers by showing greater disease conviction and affective disturbance and more readiness to acknowledge difficulties in their lives other than health problems. No differences were found between female somatizing and nonsomatizing patients. We conclude that, while male patients who somatize psychological distress may be distinguished from male nonsomatizers early in their illness, in terms of their illness behavior, these differences are not seen as early distinguishing characteristics in female patients who present to their General Practitioners with physical problems for which no organic cause can be established.

Adult↗
PubMed1996

Studies on the conversion of haloperidol and its tetrahydropyridine dehydration product to potentially neurotoxic pyridinium metabolites by human liver microsomes.

The neuroleptic agent haloperidol (HP) and its tetrahydropyridine dehydration product HPTP are biotransformed to the potentially neurotoxic HP pyridinium species HPP+ and the reduced HP pyridinium species RHPP+ in humans and rodents. The studies reported here were designed to identify the specific form(s) of human cytochrome P450 that catalyze(s) these transformations. Fifteen human liver microsomal preparations all catalyzed the oxidation of HP and HPTP to HPP+ and HPTP to RHPP+. Values for kcat/KM averaged 6.71 and 1.24 min-1 mM-1 for HPP+ and RHPP+ formation, respectively. The rates of conversion of HP and HPTP to HPP+ correlated well with testosterone 6 beta-hydroxylase activity, a marker of P450 3A activity. Microsomes prepared from a human lymphoblastoid cell line co-expressing human P450 3A4 and cytochrome P450 reductase also catalyzed the formation of HPP+ from HP and HPTP. Troleandomycin and ketoconazole, potent P450 3A inhibitors, and antibodies against P450 3A were effective inhibitors of HPP+ formation. We conclude that the conversions of HP and HPTP to potentially neurotoxic pyridinium metabolite HPP+ are catalyzed selectively by P450 3A4 in human liver microsomes.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed1996

Adult Burkitt's and Burkitt-like non-Hodgkin's lymphoma--outcome for patients treated with high-dose therapy and autologous stem-cell transplantation in first remission or at relapse: results from the European Group for Blood and Marrow Transplantation.

PURPOSE: To investigate the results of treatment for adult patients with Burkitt's and Burkitt-like non-Hodgkin's lymphoma (NHL) undergoing high-dose therapy and autologous stem-cell transplantation (ASCT), and to determine prognostic factors for this group. PATIENTS AND METHODS: A retrospective analysis of 117 adult patients reported to the lymphoma registry of the European Group for Blood and Marrow Transplantation (EBMT) between June 1984 and November 1994. Seventy of these patients received high-dose therapy and stem-cell transplantation in first complete remission (CR). Data on all patients were reviewed, and prognostic factors were determined by univariate and multivariate analysis. RESULTS: The actuarial overall survival (OS) rate for the entire group was 53% at 3 years. The major factor predicting for outcome after transplantation was disease status: the 3-year actuarial OS rate was 72% for patients transplanted in first CR, compared with 37% for patients in chemosensitive relapse, and 7% for chemoresistant patients. For patients transplanted in first CR, disease bulk at the time of ASCT was the only factor predictive of progression-free survival (PFS) and OS. CONCLUSION: The results of high-dose therapy and ASCT for patients with relapsed disease, particularly chemosensitive relapse, are superior to those reported for conventional-dose salvage regimens. The results for patients transplanted in first CR require comparison with modern dose-intensive regimens.

Adolescent↗
PubMed1996

Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain-Barré syndrome.

We compared intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) in the treatment of 50 patients with Guillain-Barré syndrome (GBS). Standard outcome measures did not differ for the two groups. Sixty-one percent of the PLEX-treated group and 69% of the IVIG-treated group improved by one disability grade at 1 month. The complication rate was higher in the PLEX-treated group. We conclude that the efficacy of IVIG in the treatment of GBS is comparable with that of PLEX and that it can be used safely, although we had a small number of patients. We did not observe a higher relapse rate with IVIG. The usefulness of combination therapy is unknown at this time.

Adolescent↗
PubMed1995

Decreased sensitivity to nerve growth factor of dorsal root ganglion neurons cultured from mouse trisomy 16, a model of Down's syndrome.

The effect of NGF was studied on the adhesion of mouse dorsal root ganglion (DRG) neurons to a laminin-coated surface and on their subsequent survival in primary culture. DRG neurons were obtained both from normal diploid mice and trisomy 16 mice. The latter are considered a model of human trisomy 21, Down's syndrome. Whereas both diploid and trisomy DRG neurons depended on NGF for adhesion, the sensitivity of trisomy 16 neurons to NGF was significantly reduced (P < 0.05). This suggests that excess expression of genes on mouse chromosome 16 alters NGF-regulated adhesion to laminin. Survival of neurons that had attached to laminin in culture did not appear dependent on NGF for either diploid or trisomy 16 neurons.

Animals↗
PubMed1995

Cloning and analysis of gene clusters for production of the Escherichia coli K10 and K54 antigens: identification of a new group of serA-linked capsule gene clusters.

The polysaccharide capsules of Escherichia coli have been classified into three groups: I, II, and I/II. The third group, I/II, has been poorly studied and possesses characteristics of both group I and group II capsules. In this report, we describe the cloning of the K10 and K54 capsule gene clusters, two representatives of group I/II capsules. Probes taken from DNA flanking regions 1 and 3 of the group II capsule clusters hybridized to these group I/II clones, confirming that the group I/II capsule genes are flanked by the same DNA and are therefore located in the same serA-linked region of the chromosome as group II capsule gene clusters. Southern blotting showed that homologous sequences were present in both the K10 and K54 capsule gene clusters and in other group I/II strains. No homology was detected between these sequences and the chromosomal DNA of either a group I or a group II strain. Likewise, no homology was detected to the chromosomal DNA of either a K11 or K19 strain, both of which had previously been classified as group I/II strains. In the K10 and K54 capsule gene clusters, these conserved sequences flanked a serotype-specific region in a manner analogous to group II capsule gene organization. Complementation of mutations in the kpsE, kpsD, and kpsC genes in region 1 of the K5 capsule gene cluster by subclones of the K10 and K54 capsule gene clusters indicated that certain stages in the export of group II and I/II capsules may be conserved. In the light of the findings presented here, we suggest that the group I/II capsule gene clusters are sufficiently different from group II capsule gene clusters to justify their renaming as group III.

Antigens, Bacterial↗
PubMed1995

BEAM chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-Hodgkin's lymphoma.

PURPOSE: To evaluate the outcome of patients with relapsed or resistant non-Hodgkin's lymphoma (NHL) undergoing high-dose chemotherapy and autologous bone marrow transplantation (ABMT) and to determine the main prognostic factors. PATIENTS AND METHODS: One hundred seven patients with relapsed or resistant intermediate-/high-grade NHL underwent high-dose carmustine, etoposide, cytarabine, and melphalan (BEAM) chemotherapy and ABMT at University College Hospitals between September 1981 and February 1993. The minimum follow-up duration of all patients is 6 months. RESULTS: At 3 months, the overall response rate to BEAM and ABMT was 73% (41% complete response and 32% partial response). The 5-year actuarial overall survival and progression-free survival rates were 41% and 35%, respectively. The early procedure-related mortality rate was 7% (eight of 107 patients). On multivariate analysis, the main prognostic factor was disease status at the time of ABMT. Patients with chemosensitive disease had an actuarial 5-year survival rate of 49% at 5 years compared with 13% for those with chemoresistant disease (P < .001). For patients considered to have chemosensitive disease at the time of transplantation, there is a significant difference in the actuarial progression-free survival rates for those who received high-dose therapy after attaining a partial response to first-line therapy (69% at 5 years) as compared with those with sensitive but relapsed disease (32% at 5 years) (P = .003). CONCLUSION: Patients with chemosensitive disease benefit most from high-dose chemotherapy, and those who receive such therapy early after achieving a partial response to first-line therapy have a high rate of cure.

Adolescent↗
PubMed1995

A randomized study of MOD versus VAD in the treatment of relapsed and resistant multiple myeloma.

67 patients with relapsed or resistant multiple myeloma were randomized to receive either VAD (vincristine, doxorubicin, dexamethasone) or MOD (mitozantrone, vincristine, dexamethasone). 12/30 (40%) patients receiving VAD and 15/37 (41%) patients receiving MOD achieved plateaux. The median duration of plateaux was significantly longer on VAD (15 months) than on MOD (8 months). No significant difference in overall survival was seen between the two treatment arms. The only toxicity which was severe in more than 5% of treatment cycles on either treatment arm was myelosuppression. No toxicity was significantly more severe on MOD than VAD. However, hair loss was significantly more severe on VAD than MOD. The frequencies of thrombocytopenia, haematuria and cutaneous toxicity were significantly greater on VAD than on MOD. Raised serum direct bilirubin levels were seen significantly more often on MOD than VAD. MOD and VAD have similar efficacy in relapsed/resistant multiple myeloma. MOD is the less toxic of the two regimens.

Aged↗
PubMed1995

Induction of liver microsomal cytochrome P450 in cynomolgus monkeys.

The aim of this study was to determine whether treatment of cynomolgus monkeys (Macaca fasicularis) with phenobarbital, beta-naphthoflavone, or dexamethasone causes an induction of microsomal crytochrome P450 (CYP) enzymes that are structurally and functionally related to rat enzymes belonging to the CYP1A, CYP2B, and CYP3A gene families. Oral treatment of male and female monkeys with phenobarbital resulted in a marked induction of a protein recognized by antibody against rat CYP2B1, as determined by Western immunoblotting. This protein, presumably a CYP2B enzyme, was not detectable in untreated monkeys, and was modestly inducible by dexamethasone but not beta-naphthoflavone. Induction of this CYP2B enzyme by phenobarbital was associated with a relatively large increase (up to 5-fold) in the rate of testosterone 16 beta-hydroxylation. Antibody, against rat CYP2B1 markedly inhibited this reaction in liver microsomes from phenobarbital-treated monkeys, but not from control monkeys. Consequently, the antibody-inhibitable rate of testosterone 16 beta-hydroxylation increased 17-fold after treatment of monkeys with phenobarbital, which is comparable with the situation in rats. In contrast to the rat CYP2B enzymes, the monkey CYP2B enzyme had little or no capacity to convert testosterone to 16 alpha-hydroxytestosterone or androstenedione, and had negligible capacity to O-dealkylate 7-pentoxyresorufin and 7-benzyloxyresorufin. Oral treatment of male and female monkeys with beta-naphthoflavone resulted in a marked induction of a protein recognized by polyclonal and monoclonal antibodies against rat CYP1A1 or against both CYP1A1 and CYP1A2. This protein was apparently a mixture of CYP1A1 and CYP1A2, neither of which was readily detectable in liver microsomes from control monkeys or monkeys treated with phenobarbital or dexamethasone. Induction of monkey CYP1A1/2 was associated with a marked increase in the O-dealkylation of 7-methoxyresorufin (up to 65-fold), the O-dealkylation of 7-ethoxyresorufin (up to 30-fold), and the N3-demethylation of caffeine (up to 17-fold), but only a 2-fold increase in benzo[a]pyrene 3-hydroxylation. Polyclonal antibodies against CYP1A1 markedly inhibited the N3-demethylation of caffeine and the O-dealkylation of 7-methoxy- and 7-ethoxyresorufin by liver microsomes from beta-naphthoflavone-treated monkeys, and partially inhibited the 3-hydroxylation of benzo[a]pyrene, indicating that monkey CYP1A1 and/or CYP1A2, like the corresponding rat enzymes, can catalyze all four reactions. Treatment of monkeys with phenobarbital resulted in a 2- to 3-fold induction of a protein recognized by antibody against rat CYP3A1. This protein (CYP3A8 or an immunochemically related enzyme) was constitutively expressed in untreated monkeys of both sexes.(ABSTRACT TRUNCATED AT 400 WORDS)

Alkylation↗
PubMed1994

Comparison of peripheral blood stem-cell and autologous bone marrow transplantation for lymphoma patients: a case-controlled analysis of the EBMT Registry data. Lymphoma Working Party of the EBMT.

A case-controlled analysis was performed to assess the effect of stem-cell source on autograft in a group of patients with malignant lymphoma reported to the European Bone Marrow Transplant Group (EBMT). The study was performed matching 83 patients autografted with peripheral blood stem cells (PBSC) with 83 autologous bone marrow transplantation (ABMT) patients. The case-matching was carried out following selection of the main prognostic factors for progression-free survival by multivariate analysis. The progression-free survival was similar in both types of transplants (38.5% PBSCT vs. 36.4% ABMT). The overall relapse and progression rate for the PBSCT was 51.2% compared with 50.1% for the ABMT patients. The differences were not significant statistically. The transplant-related mortality was 6% for both groups. The neutrophil and leucocyte recovery occurred faster in the peripheral blood stem-cell transplantation (PBSCT); the platelet recovery was not significant. A higher number of interstitial pneumonitis and fungal infection episodes were observed in the ABMT group. In conclusion, in these closely matched groups, there is no difference in PFS between patients undergoing PBSCT and those undergoing ABMT. However, the patients autografted with PBSC have a more rapid engraftment and a lower toxicity.

Adolescent↗
PubMed1994

High-dose therapy and autologous bone marrow transplantation in first complete remission for adult patients with high-grade non-Hodgkin's lymphoma: the EBMT experience. Lymphoma Working Party of the European Group for Bone Marrow Transplantation.

One hundred and eighteen patients presenting with high-grade non-Hodgkin's lymphoma, undergoing autologous bone marrow transplantation (ABMT) in first complete remission (CR), have been reported to the European Group for Bone Marrow Transplantation (EBMT). Of these, 102 were eligible for inclusion in this study following review of registration forms. Patients with lymphoblastic lymphoma were excluded. Remission induction and high-dose regimens varied between contributing centres. A maintained CR was observed in 90% of patients. Early relapse was observed in 6%, and 4% suffered toxic deaths. With a median follow-up of 45 months (3-112 months), the 5-year actuarial overall and progression-free survivals are both 70%. Nineteen (18%) patients relapsed at a median of 3.5 months (0.25-52 months) after ABMT, only 1 achieving a further durable CR. The only factor with prognostic significance was histological subtype, with diffuse small noncleaved-cell lymphoma having a significantly worse outcome. High-dose therapy and ABMT has produced effective consolidation of first remission in this group of patients, even in those with poor prognostic features at presentation.

Adolescent↗
PubMed1994

Involvement of cytochrome P4503A in catalysis of tamoxifen activation and covalent binding to rat and human liver microsomes.

Tamoxifen is the major therapeutic agent for the treatment of hormone-dependent breast cancer. Tamoxifen treatment appears to be associated with an increased incidence of endometrial carcinoma in humans and hepatocellular carcinoma in rats. These carcinogenic effects of tamoxifen might be induced by the formation of a tamoxifen reactive intermediate that binds covalently to macromolecules. Liver microsomal cytochrome P450s (CYPs) catalyze the metabolism of tamoxifen, forming a reactive intermediate that binds irreversibly to microsomal proteins, primarily to a 54 kDa protein (Mani, C. and Kupfer, D., Cancer Res., 51, 6052-6058, 1991). The current study identifies the P450 enzymes that catalyze the activation of tamoxifen to a reactive intermediate in rats and humans. Among the species examined, rats, chickens and humans demonstrate low tamoxifen binding activity, ranging from 0.1 to 0.4 nmol bound/mg protein/h. In contrast, hamsters and mice exhibit high binding, 1.2 and 1.6 nmol/mg protein/h respectively. Treatment of male rats with phenobarbital or pregnenolone-16 alpha-carbonitrile (PCN) markedly elevated the binding of tamoxifen to liver microsomal proteins. Methylcholanthrene treatment had no effect on binding. These findings suggested the involvement of CYP3A in catalysis of the covalent binding. Alternate substrates of CYP3A, cortisol and erythromycin, inhibited tamoxifen binding in liver microsomes from PCN- and phenobarbital-treated rats. Treatment of rats with troleandomycin (TAO), an inducer of CYP3A, followed by the dissociation of the TAO-CYP3A complex, elevated the covalent binding to liver microsomes approximately 3-fold. Antibodies against rat CYP3A1 strongly inhibited tamoxifen binding to liver microsomes from PCN- and phenobarbital-treated rats, whereas the antibodies anti-CYP2B1/2B2 did not inhibit binding. In humans, tamoxifen binding was inhibited by the anti-rat CYP3A1 IgG and also by alternate substrates of CYP3A. These results indicate that the activation of tamoxifen to a reactive intermediate by rat and human liver microsomes is principally catalyzed by CYP3A enzymes.

Animals↗
PubMed1994

Autologous bone marrow transplantation for patients with non-Hodgkin's lymphoma and CNS involvement: those transplanted with active CNS disease have a poor outcome--a report by the European Bone Marrow Transplant Lymphoma Registry.

PURPOSE: CNS involvement of non-Hodgkin's lymphoma (NHL) has always been considered a poor prognostic factor in relation to survival with conventional therapy. However, its effect on the outcome of autologous bone marrow transplantation (ABMT) has not been assessed. We examined this using data from the European Bone Marrow Transplant (EBMT) Lymphoma Registry. PATIENTS AND METHODS: One thousand four hundred sixty-four patients with NHL have been reported to the EBMT registry, of whom 62 had CNS involvement. Patients were divided into those who were clear of CNS disease at the time of ABMT and those who were not. Response, complications, and outcome to ABMT were analyzed, as were details of CNS diagnosis, treatment, and prophylaxis. RESULTS: Status at transplant was the only factor that significantly affected outcome of ABMT on univariate analysis (P = .03). The progression-free survival (PFS) rate of the group that had no CNS involvement at ABMT was 42% at 5 years, compared with 27% in a group of stage IV NHL patients without CNS disease (matched for status at transplant and histology). There were four of 45 (8.9%) toxic deaths. The PFS rate of the group that had CNS involvement at ABMT was 9% at a median follow-up time of 71 months, which was significantly different (P = .001) from that of the other group. There were five of 17 (29.4%) toxic deaths (P = .043). Patients who had CNS involvement at diagnosis, as compared with relapse, and those treated with both intrathecal chemotherapy and irradiation had a better outcome. CONCLUSION: The presence of CNS disease before ABMT but not present at transplant does not adversely affect the outcome of ABMT. In contrast, patients with CNS involvement at the time of ABMT have a poor prognosis, although a small number survive in complete remission (CR).

Adolescent↗
PubMed1994

High-dose therapy and autologous bone marrow transplantation for adult patients with lymphoblastic lymphoma: results of the European Group for Bone Marrow Transplantation.

PURPOSE: To investigate the results of treatment and factors that affect prognosis in adult patients undergoing high-dose therapy and autologous bone marrow transplantation (ABMT) for lymphoblastic lymphoma (LBL). PATIENTS AND METHODS: The study was a retrospective analysis of 214 patients reported to the Lymphoma Registry of the European Group for Bone Marrow Transplantation (EBMT) between January 1981 and December 1992, including 105 patients undergoing marrow transplantation in first complete remission (CR). Data on all patients were reviewed, and analysis of prognostic factors conducted. RESULTS: The actuarial overall survival rate at 6 years for the entire group is 42%. Disease status at ABMT was the major determinant of outcome: 6-year actuarial overall survival was 63% for patients transplanted in first CR, compared with 15% for those with resistant disease at the time of transplantation. Transplantation in second CR resulted in a 31% rate of actuarial overall survival at 6 years. For patients transplanted in first CR, univariate analysis failed to identify any factors at presentation that predicted for outcome after transplantation. CONCLUSION: These results suggest that ABMT is effective therapy for adults with LBL, even in patients with disease that is resistant to conventional-dose therapy. Results for patients transplanted in second CR are superior to those reported for conventional-dose salvage regimens. The results in first CR require verification in a prospective randomized clinical study.

Actuarial Analysis↗
PubMed1994

High-dose therapy and autologous bone marrow transplantation for intermediate and high grade non-Hodgkin's lymphoma in patients aged 55 years and over: results from the European Group for Bone Marrow Transplantation. The EBMT Lymphoma Working Party.

The results of high-dose therapy and autologous BMT for patients with intermediate/high grade NHL were analysed in 82 patients aged > or = 55 years, identified from the EBMT lymphoma database. These were compared with the results for 82 patients aged < 55 years who were matched on the basis of disease status at transplantation, presence of bone marrow or CNS involvement and closest date of transplantation. The 5 year actuarial progression-free survival (PFS) for patients aged < 55 years was 33% compared with 37% for the > or = 55 year group (p = 0.08). Corresponding figures for overall survival (OS) were 39% and 38%, respectively (p = 0.19). No difference in outcome was observed according to histological subtype. Although the number of patients receiving total body irradiation (TBI) is small, a significantly lower PFS was observed in patients > or = 55 years receiving TBI-based high-dose regimens compared with younger patients. This difference was due to a higher toxic death rate in the older patient group. In this retrospective matched analysis, age > or = 55 years was not associated with lower PFS or OS following high-dose therapy and autologous BMT. The increased toxic death rate in patients receiving TBI suggests that this should be avoided in older patients, who should receive chemotherapy only high-dose regimens.

Adolescent↗
PubMed1994

Detection and significance of pulmonary Hodgkin's disease at autologous bone marrow transplantation.

Pulmonary Hodgkin's disease (HD) is considered to carry a poor prognosis both at presentation and at relapse. We have therefore studied the incidence and significance of pulmonary involvement in 190 poor risk HD patients undergoing BEAM therapy and ABMT for relapsed or resistant disease. Forty-one of 190 patients (22%) had clinically diagnosed pulmonary HD at some stage of their disease prior to ABMT. In 29 patients, in whom a full set of CT scans was available, the patterns of pulmonary HD were characterised. Four of 29 patients had pulmonary disease at presentation only, 8 of 29 at presentation and ABMT and 17 of 29 developed pulmonary involvement at relapse and proceeded to ABMT with persistent pulmonary disease. The commonest pulmonary abnormalities at presentation and relapse were discrete nodules (72%), masses extending from hilar or mediastinal nodes (34%) and pleural effusion/thickening (28%); 52% had two or more patterns of involvement and 66% had coexistent mediastinal lymphadenopathy. There was no relationship between pattern or bulk of pulmonary involvement and outcome. Consideration of the outcome following ABMT in all 190 patients revealed no significant difference in progression-free survival at 5 years between the pulmonary HD group (43%) and those without lung involvement (48%). Furthermore, there was no significant difference in complete remission or transplant-related death rates between the two groups. This would suggest that pulmonary involvement is not in itself a contraindication to ABMT and some patients with bulky pulmonary disease are capable of long-term survival.

Adult↗