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Age and cytogenetics as predictors of event free survival in patients with acute non-lymphocytic leukemia receiving high dose cytosine arabinoside and daunorubicin as consolidation chemotherapy.

Between 1991 and 1999, 67 patients with acute non-lymphocytic leukemia (ANLL) in complete remission received high dose cytarabine (HiDAC) 3 gm/m2 q12h x 12 doses followed by daunorubicin 45 mg/m2/day x 3 days as consolidation therapy. Five year actuarial event free survival (EFS) was 34% +/- 6%. Age was significantly associated with EFS. EFS was 60% +/- 15% in patients age 20 to 29, 48% +/- 16% in patients age 30 to 39, 23% +/- 10% in patients age 40 to 49, 31% +/- 11% in patients age 50 to 59, and 0% in patients age > or = 60. Contrary to other reports which have used different HiDAC regimens, we found no relationship between cytogenetics and EFS. Cytogenetics were defined as favorable risk: t(8;21), inv (16), and del (16); neutral risk: normal or t(15;17); and unfavorable risk: any abnormality not included in favorable risk or neutral risk. EFS was 29% +/- 17% in patients with favorable cytogenetics, 37% +/- 14% in patients with neutral cytogenetics, and 31% +/- 12% in patients with unfavorable cytogenetics. These differences were not statistically significant. Because of the successful use of allogeneic transplantation at relapse in patients with matched related donors, five year actuarial survival (S) in this series was 40% +/- 6%. Five year actuarial survival was 57% +/- 9% for patients age < or = 44 and 25% +/- 8% for patients age > or = 45. This difference is statistically significant, p < .025. Clinicians should be cautious about making clinical decisions regarding consolidation therapy of ANLL on the basis of the presence or absence of cytogenetic abnormalities as the importance of cytogenetics may depend on the specific therapy which is employed.

Actuarial Analysis↗

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Cartilage necrosis due to pin penetration: experimental studies in rabbits.

An animal model was used to evaluate the role of pin penetration into the hip joint as the cause of chondrolysis. The gross and microscopic studies, as well as the biochemical studies, showed changes indicating cartilage destruction. These changes were more severe when the pins remained in the joint. Immunologic studies showed some type of immunological interaction. The immunologic response may be initiated by release of cartilage byproducts. The initial insult of the slip may cause release of cartilage byproducts from the exposed growth plate within the joint, and is compounded by penetration of the pin in the hip joint.

Animals↗

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'Uncumphtable'.

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Attitude to Health↗

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Hip motion changes in hemophilia.

We reviewed early and late motion changes of the hip in 102 hemophiliacs with a mean follow-up of 7 years. Sixty patients (59%) had at least one hip bleed. Sixty-four hips in 49 patients demonstrated at least a 15 degree change in range of motion (ROM) at some time. At final review, only 34 of these 64 hips (53%) lost motion. Patients whose hips lost motion were just as likely to report hip bleeds as those who lost no motion. Twenty hips examined within 2 months of bleeding lost significant motion, but most motion returned within a year. The relationship between hip girdle bleeding and ROM remains obscure.

Adolescent↗