Chemotherapy in non-Hodgkin's malignant lymphomas according to potential evolutive groups.
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Biomedical subjects
Publications and source records attributed to R Schaerer.
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Peripheral blood lymphocytes forming E rosettes in the presence of sheep red blood cells and those bearing surface immunoglobulins (SIg) have been studied quantitatively as an evaluation of T and B lymphocytes in Hodgkin's disease. 62 patients were investigated, 21 of whom before any treatment. It appears that the lymphocytes forming E rosettes are significantly lower in percentage in 86% of the patients and in absolute count in 65%. SIg bearing lymphocytes are elevated in percentile in 61% of the cases, but the absolute count is normal in 50% of the patients and elevated in 30% only. At diagnosis the T/B lymphocytes equilibrium is modified in 13 among 21 patients but, after the initial treatment of the disease, the ratio is modified in 90% of the patients in complete remission and remains unchanged for years even in the absence of relapse or immnunosuppressive treatment. It is suggested that SIg + lymphocytes from the peripheral blood are actually B lymphocytes and not anti-T-antibody coated T lymphocytes or antigen-antibody lacking of membrane markers, which are numerous in one third of the investigated patients, might be T lymphocytes with qualitative abnormality.
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Addition of a daily dose of androgen in the form of 0.15 mg/kg of Stanzolol, given without interruption, gave an average survival of more than 4 years in patients suffering from granulocyte series acute leukaemias after complete remission was obtained. The simplicity of this treatment is apparent only from the appearance of marked manifestations of androgen impregnation in women from the 8th month of treatment onwards. These results, superior to those obtained up to the present time in the survival of myeloid leukaemias (non-lymphoblastic) were also better in terms of the stability and X "quality" of the remission in comparison to those obtained in acute lymphoblastic leukaemias. Confirmation of these results by controlled clinical trial will open up interesting perspectives, along side immunotherapy which remains of unproven effectiveness in myeloid leukaemias. The effectiveness of androgen stimulation of haematopoiesis as a stabilising factor of complete remissions in acute leukaemias has, in addition, interesting implications with regard to the theory of the leukaemic process.
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An androgen (stanozolol: 0,15 mg/kg/d) was systematically associated to the treatment of acute non lymphoblastic leukemias, since the beginning of induction therapy (vincristin, daunorubicin, prednisone) and throughout the maintenance period (6-mercaptopurine and methotrexate). Thirty-six patients less than 60 years old (median age: 44 years) presenting with acute non-lymphoblastic leukemia were entered to the study. Sixteen achieved complete remission (C.R.), i.e. 44% of the whole and 53% of treated patients. Out of 16 patients with complete remission, 4 relapsed during the observation period which lasted 4-1/2 years. The stability of the hematologic equilibrium in patients in C.R. is the main finding of the present study. The actuarial curve of the duration of the first complete remission reaches a "plateau"; after the 8th month only one relapse was observed in 9 patients. The rate of C.R. at 2 years is 76 +/- 23%. As compared to the results from other schedules of treatment, this rate appears significantly better, specially in the case of immunotherapy (p less than 0,001). A prospective randomized study is now suggested as to confirm this result; its therapeutic and theoretical basis and perspectives are discussed.
In untreated CML patients (at diagnosis or in relapse) we find about the same number of CFC per 1.10(6) nucleated cells in the blood and bone marrow (sometimes, slightly greater in the blood than in the marrow). Application of density-cut separation shows normal number of CFC in the low density fraction (Ldf-CFC) of bone marrow cells from patients in remission. In 7 untreated patients (at diagnosis or in relapse), we have always found a greater number of Ldf-CFC in the blood than in the marrow, when the study is performed on the same day and in the same technical conditions. This difference is observed even if the leukocytes count is elevated and thence, the contamination of bone marrow cells by blood cells is presumably important. The percentage of peripheral blood Ldf-CFC seems to be positively correlated with the number of peripheral blood leukocytes. The highest percentage of Ldf-CFC (greater than 60%) have been found in 5 patients in relapse. Two of these have entered into the blastic phase of CML and the three others relapse repeatedly in the chronic form of the disease.
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