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Biomedical subjects

S A Feig

Publications and source records attributed to S A Feig.

At least 37 records · Page 2Linked to original sources
PubMed1999

Immune thrombocytopenia after umbilical cord progenitor cell transplant: response to vincristine.

An 8-month-old male with X-linked lymphoproliferative disease underwent an unrelated, partially matched (with major mismatch at DR locus), cord blood stem cell transplant. Four months following the transplant, he developed immune thrombocytopenia with hemolytic anemia (Evans syndrome). He received multiple courses of intravenous immunoglobulin, anti-Rh D immunoglobulin, a pulse of high-dose corticosteroids and cyclosporine with some improvement of hemolytic anemia, but no improvement of the thrombocytopenia. Addition of vincristine, resulted in long-term resolution of thrombocytopenia and anemia. No major toxicity was observed during treatment. Vincristine should be considered as a treatment for refractory immune thrombocytopenia after hematopoietic stem cell transplantation.

Fetal Blood↗
PubMed1999

Developing asymmetric breast tissue.

PURPOSE: To show that benign asymmetric breast tissue detected mammographically may increase over time. MATERIALS AND METHODS: Serial mammograms obtained in 21 women with negative physical examination results and mammographically detected developing asymmetric breast tissue were reviewed, and findings were correlated with results of biopsy (n = 16), ultrasonography (US) (n = 8), and contrast material-enhanced magnetic resonance (MR) imaging (n = 3). Five patients who did not undergo biopsy were followed up for 13-84 months. Thirteen of 16 biopsy specimens were reviewed. RESULTS: At the time of mammographic change, 12 patients without baseline asymmetric tissue had a mean age of 41.7 years and a mean size of asymmetric tissue of 2.4 cm. The mean age of nine patients with baseline asymmetric tissue was 46.9 years. In eight patients, the mean size increase was 2.5 cm. One patient showed increased tissue density but stable size. All US and MR images were negative. Pseudoangiomatous stromal hyperplasia was present in all 13 biopsy specimens reviewed and extensive in 12. No malignancies have been reported in five of the followed-up patients, and two have had continued enlargement of asymmetric tissue. CONCLUSION: Pseudoangiomatous stromal hyperplasia is a common histopathologic finding in developing asymmetric breast tissue. Follow-up, rather than biopsy, is a management option if benign imaging and clinical criteria are met.

Adult↗
PubMed1998

High-dose cytosine arabinoside and L-asparaginase in refractory acute lymphoblastic leukemia: the Children's Cancer Group experience.

PROBLEM: Therapy of children with relapsed acute lymphoblastic leukemia (ALL) not achieving a second remission (CR2) after an initial reinduction attempt is problematic. METHODS: 52 children with ALL in first relapse received high-dose cytosine arabinoside and L-asparaginase (HDAraC/L-Asp) after failed attempts to achieve CR2. AraC was given at a dose of 3 gm/m2 q12 h x 4 on days 0-1 and 7-8. L-asparaginase was given IM 6,000 IU/m2 3 hours after completion of each 2-day cycle of AraC. RESULTS: Of the 42 surviving to day 28, 22 (42% of all patients) achieved CR2. Ten died before day 28 (19%); four from leukemia and six from infections or toxicity (12% regimen-related mortality), There were 17 bacterial infections (three fatal), 17 invasive fungal infections (12 fatal), one fatal adenoviral infection, and one-non-fatal Pneumocystis pneumonia. One patient was surviving when lost to follow-up at four months and one patient survives over 5 years after transplant. Sixteen of the 22 patients who entered CR2 subsequently relapsed, five died of non-leukemic causes, and one was lost to follow-up. The median duration of second remission was 3 months (range 0.7 to 19 months). CONCLUSIONS: HDAraC/L-Asp rescue reinduction for relapsed childhood ALL achieves CR2 in approximately 40% of patients who fail reinduction, but remissions are short for most patients and maintenance of CR2 remains unsatisfactory.

Adolescent↗
PubMed1998

Feasibility, toxicity, and biologic response of interleukin-2 after consolidation chemotherapy for acute myelogenous leukemia: a report from the Children's Cancer Group.

PURPOSE: Although remission can be achieved in 80% of children with acute myelogenous leukemia (AML), many patients experience relapse. Because interleukin-2 (IL-2) can induce remission in patients with overt evidence of AML, we hypothesized that IL-2 given to patients in first remission after intensive consolidation chemotherapy might prevent relapse. This study sought to determine whether such an approach was feasible. PATIENTS AND METHODS: Twenty-one patients in complete remission received IL-2 after completion of treatment on Children's Cancer Group (CCG) protocol 2941. Recombinant IL-2 9 x 10(6) IU/m2 daily by continuous intravenous infusion (c.i.v.) was given for 4 days. After 4 days rest, IL-2 1.6 x 10(6) IU/m2 daily c.i.v. was resumed for 10 days. We monitored patients for toxicity and measured absolute lymphocyte count, the absolute count of cells that express CD56 and CD3 antigen, and soluble IL-2 receptor alpha-chain (sIL-2R alpha) levels before the start of IL-2 and after completion of each of the two courses of IL-2. RESULTS: Observed toxicities included fever (57%), vascular leak (48%), hypotension (38%), tachycardia (14%), rash (29%), septicemia (5%), thrombocytopenia (29%), elevated transaminase (14%), electrolyte disturbance (29%), and hyperglycemia (10%). No patient required cardiac pressors or transfer to an intensive care unit. All patients studied developed an increase in lymphocyte count, CD56 count, CD3 count, and sIL-2R alpha levels after treatment with IL-2. CONCLUSION: This schedule of IL-2 was reasonably well tolerated by children with AML in first remission. After treatment, increased levels of sIL-2R alpha were observed. CCG is conducting a randomized prospective trial to assess the efficacy of IL-2 to prevent the relapse of AML (CCG-2961).

Adolescent↗
PubMed1998

Rationale for annual screening mammography for women ages 40-49 years.

Proof of the benefit for mammographic screening of women ages 40-49 years is now available. Randomized controlled trials (RCTs) conducted in Gothenburg and Malmo, Sweden have shown statistically significant breast cancer mortality reductions of 36% and 45% respectively. A meta-analysis of all five Swedish trials has found a statistically significant mortality reduction of 29% for woman in this age group. Substantially greater reductions in mortality would likely have resulted if women in these trials had been screened annually. Because the benefits are substantial, and the risks from screening are relatively small and acceptable, screening mammography beginning at age 40 is now recommended by the American Cancer Society, as well as the National Cancer Institute.

Journal Article↗
PubMed1997

Bone marrow transplantation versus chemotherapy for maintenance of second remission of childhood acute lymphoblastic leukemia: a study of the Children's Cancer Group (CCG-1884).

BACKGROUND: Maintenance of second remission of childhood acute lymphoblastic leukemia (ALL) with intensive chemotherapy is often unsuccessful. The major cause of treatment failure is relapse. MATERIALS AND METHODS: Of 96 children with ALL who relapsed in the marrow while on or within 1 year of completing initial therapy, 62 achieved a second remission. Nineteen patients underwent bone marrow transplantation in second remission, 11 from a human leukocyte antigen (HLA)-matched related donor, seven using autologous marrow, and one from a matched unrelated donor. The event-free survival (EFS) of transplanted patients was compared to that of patients treated with intensive chemotherapy using high-dose cytarabine, vincristine, escalating dose methotrexate, L-asparaginase, and an anthracycline (daunorubicin or idarubicin). Only those patients treated with chemotherapy who survived in second remission up to the mean time that patients were transplanted (135 days) were included in the control group (33 of 43 patients who achieved second remission). RESULTS: The actuarial 2-year event-free survival of transplanted patients is 37+/-22% (95% C.I.) compared to 18+/-13% for chemotherapy-treated patients (P=0.017). EFS for allo-transplant recipients was similar to that for auto-transplant recipients. Duration of initial remission was a strong predictor of the outcome of retrieval therapy. Patients whose initial remission was greater than 3 years had better EFS after achieving second remission (five of 11 still in remission, compared to four of 41 patients whose initial remission was less than 3 years). Adjustment in the multivariate analysis for duration of initial remission did not diminish the benefit of transplant over chemotherapy. CONCLUSIONS: While there remains considerable possibility for further improvement in EFS after achieving second remission of childhood ALL, bone marrow transplant is superior to chemotherapy in maintaining second remission.

Adolescent↗
PubMed1997

Intracardiac right-to-left shunting and the risk of stroke during bone marrow infusion.

We describe a patient who developed a paradoxical embolus to the brain during infusion of bone marrow. She had a patent foramen ovale through which right-to-left shunting led to multiple cerebral emboli. This complication can be prevented by positioning the tip of the infusion catheter in the main pulmonary artery and reducing the volume of marrow product infused.

Bone Marrow Transplantation↗
PubMed1997

Radiation risk from screening mammography of women aged 40-49 years.

Although direct evidence of carcinogenic risk from mammography is lacking, there is a hypothetical risk from screening because excess breast cancers have been demonstrated in women receiving doses of 0.25-20 Gy. These high-level exposures to the breast occurred from the 1930s to the 1950s due to atomic bomb radiation, multiple chest fluoroscopies, and radiation therapy treatments for benign disease. Using a risk estimate provided by the Biological Effects of Ionizing Radiation (BEIR) V Report of the National Academy of Sciences and a mean breast glandular dose of 4 mGy from a two-view per breast bilateral mammogram, one can estimate that annual mammography of 100,000 women for 10 consecutive years beginning at age 40 will result in at most eight breast cancer deaths during their lifetime. On the other hand, researchers have shown a 24% mortality reduction from biennial screening of women in this age group; this will result in a benefit-to-risk ratio of 48.5 lives saved per life lost and 121.3 years of life saved per year of life lost. An assumed mortality reduction of 36% from annual screening would result in 36.5 lives saved per life lost and 91.3 years of life saved per year of life lost. Thus, the theoretical radiation risk from screening mammography is extremely small compared with the established benefit from this life-saving procedure and should not unduly distract women under age 50 who are considering screening.

Adult↗