Search PubMed⌕ Search

Biomedical subjects

T R Spitzer

Publications and source records attributed to T R Spitzer.

At least 73 records · Page 4Linked to original sources
PubMed1989

Rapid infusion amphotericin B: effective and well-tolerated therapy for neutropenic fever.

A retrospective analysis was carried out of the results of 115 intensively-treated cancer inpatients receiving 91 treatment courses of amphotericin B given in an empirical fashion. Amphotericin B was administered over 1.5 to 2 hours at a dose of 0.6 to 0.7 mg/kg/day. Median duration of neutropenic fever before amphotericin B administration was 5 days (range 1 to 32 days) and median total amphotericin B dose was 480 mg (range 10 to 2450 mg). In 56 (61%) of 91 amphotericin B courses, neutropenic fevers resolved; this occurred a median of 3 days (range 1 to 15 days) after amphotericin B was begun and at a median dose of 120 mg (range 10 to 850 mg). Response to amphotericin was independent of positive cultures for fungus or sites of positive culture. Adverse reactions to amphotericin B included rigors (89% of courses), fever (23%), bronchospasm (9%), and transient hypotension (9%). Median increase above baseline serum creatinine in patients given amphotericin B was 0.5 mg/dl (range 0 to 2.6 mg/dl) compared to a median of 0.1 mg/dl (range 0 to 2.9 mg/dl) in a similar group of intensively-treated cancer patients who did not receive amphotericin B. Amphotericin B was well tolerated when given by rapid infusion and was associated with prompt resolution of neutropenic fever in the majority of patients.

Adolescent↗
PubMed1988

Treatment of myelodysplastic syndromes with low-dose oral 6-thioguanine.

Several cytotoxic agents when used in vitro in very low concentrations have been shown to induce differentiation of leukemic cells. We treated 18 patients with myelodysplastic syndromes with low-dose oral 6-thioguanine (6-TG; 20 to 60 mg daily). Four patients demonstrated significant improvement in peripheral blood counts. An additional three patients had significant reductions in the percentage of leukemic myeloblasts in the marrow without a corresponding improvement in peripheral counts. With the exception of a fall in the peripheral neutrophil count in four patients requiring dose reductions, no toxicity was observed. Low-dose oral 6-TG gives a response rate in myelodysplastic syndromes similar to that of parenteral agents such as cytosine arabinoside. Given the ease of administration and lack of toxicity, oral 6-TG may be a useful treatment modality for these syndromes either alone or in combination with other differentiation-enhancing agents.

Administration, Oral↗
PubMed1988

Acute esophageal stricture after bone marrow transplantation.

Gastrointestinal complications following bone marrow transplantation are common and may result from the conditioning regimen, immunosuppression, graft-versus-host disease, or a combination of these factors. These effects may be acute (mucositis, enteritis, esophagitis) or delayed (xerostomia, stricture formation) in onset. We describe here a case of esophageal stricture developing within 1 month of allogeneic bone marrow transplantation.

Adult↗
PubMed1987

Escalating doses of sequential methotrexate and 5-fluorouracil, doxorubicin, and vincristine for the treatment of metastatic breast cancer.

Antitumor efficacy of sequential methotrexate, 5-fluorouracil, and mid-cycle doxorubicin regimens has been established in advanced gastric cancer. Based on similar theoretical kinetic considerations, we treated 15 women with metastatic breast cancer with a five-drug nonalkylating agent regimen. Six of 14 evaluable patients had an objective response. Three patients achieved a complete remission (duration 9, 14, 19+ months), and 3 attained a partial remission (duration 2, 3, 6 months). Hematologic toxicity was significant, with 8 patients developing moderate to severe (ECOG grade 3 or 4) toxicity. Although significant antitumor activity with this nonalkylating agent regimen was observed, hematologic toxicity was considerable and limits the usefulness of this regimen in its present schedule.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Well-differentiated lymphocytic lymphoma with peripheral blood involvement, osteolytic bone lesions, and hypercalcemia. A case report and review of the literature.

It is rare for small lymphocytic B-cell malignancies to be associated with osteolytic bone lesions and/or hypercalcemia. The authors present an unusual case of well-differentiated lymphocytic lymphoma (DWDL) in a 70-year-old man who had osteolytic bone lesions and subsequently developed severe refractory hypercalcemia. The possible etiologic mechanisms responsible for these findings are discussed, and a brief review of the literature is presented.

Aged↗
PubMed1985

Treatment of metastatic malignant melanoma with intensive melphalan and autologous bone marrow transplantation.

Twenty patients with metastatic malignant melanoma were treated with melphalan (180-225 mg/m2 iv over 3 days) followed by re-infusion of previously harvested and cryopreserved autologous bone marrow. Granulocyte (greater than 500/microliter) and platelet (greater than 20,000/microliter) count recovery occurred a median of 14 days (range, 12-22) and 19.0 days (range, 12-28) after bone marrow transplantation, respectively. Three patients died due to hemorrhage or infection. One of these patients and another (who ultimately achieved a complete response), both with brain metastases, developed intralesional hemorrhage when the platelet count was only moderately reduced. Complete responses occurred in six patients and ranged from 4 to 14 months, with a median of 5 months. Six patients achieved a partial remission lasting 2-5 months. High-dose melphalan and autologous bone marrow transplantation are a promising therapy for patients with metastatic malignant melanoma.

Adult↗
PubMed1985

High-dose cytosine arabinoside and daunorubicin as consolidation therapy for acute nonlymphocytic leukemia in first remission: a pilot study.

High-dose (HD) cytosine arabinoside (ARA-C) is more effective treatment than conventional-dose ARA-C regimens for patients with relapsed acute nonlymphocytic leukemia (ANLL). We report here that HD ARA-C given during the first remission of ANLL has resulted in long remission durations and a high proportion of patients who survive more than three years free of disease. From August 1979 to September 1983, 36 adult patients with ANLL in first remission received one to three courses of HD ARA-C (3 g/m2 by one-hour infusion every 12 hours for 12 doses on days 1 through 6) alone or with daunorubicin (30 mg/m2 for two or three doses on days 7 through 9). Three patients died of sepsis or hemorrhage during consolidation, and 14 patients have relapsed from five to 48 months after diagnosis. The remaining 19 patients are in continued complete remission (CCR) from 11 to 62 months. Denoting all deaths in remission as relapse, the actuarial probability of CCR is 42% at 62 months, with an apparent plateau in the survival curve. Of the first 22 patients treated, ten remain in CCR from 37 to 62 months with no therapy for at least three years. Due to its heightened anti-leukemic activity, HD ARA-C allows brief but effective consolidation of ANLL in first remission, with long-term disease-free survival comparable to other approaches.

Acute Disease↗
PubMed1984

Effects of staphylococcal protein A-treated human leukemic serum on autologous leukemic blast growth and mitogenesis of lymphocytes.

Sera and leukemic blasts of 14 patients with acute myelogenous leukemia were stored at -70 degrees C. In eight patients in whom a remission was achieved, peripheral blood lymphocytes were cultured together with irradiated autologous leukemic cells in treated serum (serum adsorbed with protein A Sepharose) or control serum (Sepharose-treated). Lymphocyte activation was determined after 7 days in culture by [3H]thymidine incorporation. In the absence of stored leukemic blasts, significantly more [3H]thymidine incorporation occurred in six of the eight patients' lymphocytes cultured in treated serum compared to control. Enhanced activity was observed in all eight patients when irradiated leukemic blasts were cocultured with autologous lymphocytes in treated serum. In five patients, the addition of 10% or more of control serum to treated serum inhibited lymphocyte mitogenesis. Protein A immunoadsorption may allow increased stimulation of acute myelogenous leukemia remission peripheral blood lymphocytes, which is further enhanced in some patients by the presence of autologous leukemic cells. This change in lymphocyte activation may contribute to the antitumor effects of treating serum with protein A.

Cytotoxicity, Immunologic↗
PubMed1984

Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients.

Methotrexate has been used as the mainstay therapy to prevent or ameliorate graft-versus-host disease (GVHD) in allogeneic bone marrow transplantation. We began a nonrandomized study in which methotrexate was not given routinely. Fifty-five patients underwent transplant for acute leukemia (44 patients), aplastic anemia (6 patients), and other malignancies (5 patients). Methotrexate was given to 34 patients (MTX +) and was withheld in 21 patients (MTX -). Median (range) age of patients was 12 (0.8-43) years in the MTX + group, and 16 (3-45) years in the MTX- group. Mean days (+/- SEM) to engraftment (neutrophils greater than 500/microL, and platelets greater than 20,000/microL untransfused) occurred earlier in the MTX- patients (19.6 +/- 1.4 v 24.9 +/- 1.8 days for granulocytes, and 19.3 +/- 1.5 v 27.4 +/- 2.8 days for platelets, P less than .05). There were no statistically significant differences between the patient groups for the incidence or severity of GVHD (10/34 in the MTX + group had grade O-l GVHD compared to 9/21 in the MTX- group). The interstitial pneumonitis occurred at a significantly increased rate in patients who received methotrexate (15/34) compared to those patients who did not (3/21) (P = .02). However, there was also a significant relationship between the interstitial pneumonitis and the preparative regimen: if the preparative regimen contained 1,000 rad single fraction total body irradiation, 8/14 patients were affected compared to 5/22 patients affected when 1,200 rad fractionated total body irradiation was used (P = .03). Because methotrexate significantly retards hematopoietic reconstitution, randomized trials for GVHD prevention are recommended.

Acute Disease↗
PubMedDate not supplied

A comparison of related and unrelated marrow donors.

OBJECTIVE: The purpose of this investigation is to test whether related bone marrow donors experience more distress from marrow donation than volunteer unrelated donors. METHOD: Participants in the study were 77 related and unrelated marrow donors who agreed to complete 11 pre- and 8 postdonation self report questionnaires. Related and unrelated donors were recruited from the Bone Marrow Transplant Programs at the Brigham and Women's Hospital and the Massachusetts General Hospital in Boston, MA. Additional unrelated donors were recruited from the American Red Cross-Carolinas and the Heart of America Bone Marrow Donor Registry in Kansas City, MO. RESULTS: The 41 unrelated and 36 related marrow donors who participated in this prospective study had similar demographic backgrounds and predonation questionnaire results, although related donors endorsed more items on the Beck Depression Inventory, both before and after narrow harvesting. After narrow donation, related donors reported significantly more pain than unrelated donors (p = .0001). CONCLUSIONS: It is unlikely that intraoperative events alone could account for the increased pain experienced by related donors. Related donors were more likely to experience moderate to severe physical pain after marrow donation than unrelated donors, on the basis of logistic regression analysis (odds ratio = 7.63; 95% confidence interval 2.74, 23.01).

Adolescent↗
PubMedDate not supplied

High-dose i.v. thiotepa and cryopreserved autologous bone marrow transplantation for therapy of refractory cancer.

Twenty-five patients with malignancies resistant to conventional chemoradiation therapy or for which no effective therapy is known were treated with escalating doses of thiotepa (135-1215 mg/m2 iv over 3 days) followed by reinfusion of previously cryopreserved autologous bone marrow. The hematological and nonhematological toxic effects, therapeutic effects, and pharmacokinetics of this regimen were evaluated. Granulocyte (greater than 500/microliter) and platelet (greater than 20,000/microliter) count recovery occurred at a median of 16 (range, 11-38) and 18.5 (range, 11-40) days after marrow reinfusion, respectively. Six patients experienced severe infection, four of which were fatal. One patient died due to intracranial hemorrhage. Toxicity to the gastrointestinal and central nervous systems was dose-limiting, and the maximum tolerated dose of thiotepa was 1005 mg/m2. Objective tumor regression occurred in six of the patients. Serum thiotepa concentration peaked immediately after infusion and declined rapidly in a biphasic manner. No relationship between thiotepa serum concentration or pharmacokinetic parameter estimates was observed for tumor response or toxicity. High-dose thiotepa and autologous bone marrow transplantation may represent an alternative therapeutic modality for patients with advanced cancer.

Adolescent↗