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Biomedical subjects

W Wilmanns

Publications and source records attributed to W Wilmanns.

At least 163 records · Page 9Linked to original sources
PubMed1988

Prognostic risk factors in advanced Hodgkin's lymphoma. Report of the German Hodgkin Study Group.

In a national multicentre trial in the FRG patients with Hodgkin's lymphoma in stages CS/PS III B/IV were entered into the HD 3 protocol and received induction chemotherapy with 3 x (COPP + ABVD). Patients in complete remission (CR) received consolidation therapy by either radiotherapy (20 Gy IF) or chemotherapy (COPP + ABVD). Patients not in CR received salvage therapy (40 Gy in case of persisting nodal disease, else 4 x CEVD chemotherapy). Between July 1983 and May 1987 230 untreated patients aged 15 to 60 qualified for this HD 3 protocol. This analysis is based on the first 137 patients evaluable for response. Of these, 86 (63%) achieved CR after induction chemotherapy. Including salvage therapy a total of 104 patients (76%) achieved CR. Univariate and multivariate prognostic risk factor analyses were performed using freedom from treatment failure (FFTF) as endpoint. Sex, age, splenectomy, bone marrow, liver and bone involvement had no prognostic impact nor had stage according to the Ann Arbor classification. In contrast, a pretreatment erythrocyte sedimentation rate (ESR) above 80 mm/h and a serum alkaline phosphatase (AP) above 230 IU/ml appeared as significant risk factors (p less than 0.01, relative risk 2.3). The two parameters were not independent. Comparing a group A (ESR less than or equal to 80 and AP less than or equal to 230) versus a pooled group B (ESR greater than 80 and/or AP greater than 230) increased the difference (p less than 0.001, relative risk of 2.8) which was also significant for survival (p less than 0.04).

Adolescent↗
PubMed1988

Non-cardiogenic pulmonary edema complicating intermediate and high-dose Ara C treatment for relapsed acute leukemia.

Infection, hemorrhage and adult respiratory distress syndrome (ARDS) are pulmonary complications occurring after remission induction therapy for acute leukemia. The aim of this study was to analyze the incidence of these causes by serial roentgenogram, clinical, microbiological and laboratory tests in 21 patients (pts) with relapsed acute leukemia (18 X myeloid, 3 X lymphoblastic), an AML-pt (acute myeloid leukemia) suffering from secondary leukemia, and three pts with primary refractory leukemia following treatment with intermediate (IM) and high-dose cytosine arabinoside (HD-Ara C), in combination with amsacrine (AMSA)(n = 19), etoposide (VP 16) (n = 5) or Mitoxantrone (n = 1). Eleven out of 25 pts developed pulmonary complications, one of them with massive hemoptysis and roentgenographic signs of pulmonary bleeding, one suffering from protracted shock after a tumor lysis syndrome, two pts showing symptoms of a cardiogenic pulmonary edema complicating severe Candida pneumonia in one case and legionnaires' disease in the other. Seven of the eleven pts had a non-cardiogenic pulmonary edema with respiratory failure 1-14 days after cessation of induction or consolidation therapy. In six of the seven, there were no signs of cardiogenic, infectious or metabolic reasons, including fluid overload, for the pulmonary edema, one had as a contributing factor a Candida infection of the lung. Three of the seven patients recovered, four died (two following IM and two after HD-Ara C). Other adverse side effects, clearly attributable to HD-Ara C, included delirious state (n = 3), generalized erythema (n = 3), acute pancreatitis (n = 2), acute abdomen (n = 1) and conjunctivitis in almost all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1988

Tumour associated antigens in diagnosis of serous effusions.

The use of tumour associated antigens in the diagnosis of serous effusions was studied in 76 patients with benign and 200 patients with malignant disease. Tissue polypeptide antigen (TPA), alpha fetoprotein, and CA 125 were found to be of little value. At cut off points of 3 ng/ml, 10 U/ml, and 30 U/ml, respectively, carcinoembryonic antigen (CEA), biliary glycoprotein I (BGP I), and CA 19-9 discriminated between benign and malignant serous effusions with a sensitivity of between 24% and 67%. The immunocytochemical staining for these markers resulted in malignant cells being detected in 18% to 33% of cases. Various combinations of conventional cytological examination, effusion fluid tumour marker determination, and immunocytochemical analysis identified malignant cells in serous effusions in up to 72% of cases; conventional cytology alone detected tumour cells in only 30%.

Antigens, CD↗
PubMed1988

Intensive maintenance treatment in acute myelogenous leukemia (AML): single institution experience of a multicenter randomized trial.

Sixty-three AML patients were entered into a randomized, prospective trial to investigate the impact of intensive maintenance treatment on remission duration and survival. The maintenance program consisted of either a rotating combination of alternative drugs (HD-Ara C, mAMSA, 5-AZA) not used during induction and consolidation or, alternatively, of a repeated induction type chemotherapy early after consolidation (DNM, VCR, Ara C). In 48 out of 63 patients reaching CR, no prolongation of either remission duration or survival was achieved as compared to a preceding randomized study using conventional maintenance treatment.

Adolescent↗
PubMed1988

[Therapy of Hodgkin's lymphomas. Results of the German Hodgkin's Disease Study Group].

Between July 1983 and May 1987 143 untreated patients with Hodgkin's lymphoma in stages I-IIIA with risk factors qualified for the HD1 protocol, and 230 patients in stages IIIB/IV qualified for HD3. Patients in HD1 received a combined chemo-radiotherapy (2 x COPP + ABVD + 20 Gy EF vs. 40 Gy EF). Patients in HD3 received induction chemotherapy (3 x COPP + ABVD) and were randomized into consolidation by radiotherapy (20 Gy IF) vs. chemotherapy (1 x COPP + ABVD). In HD1, 73 of 89 evaluable patients (82%) achieved a complete remission. The survival of patients in stages I-IIIA with risk factors treated according to HD1 is as good as the survival of patients in stages I and II without risk factors. In HD3, 86 of 137 patients (63%) achieved complete remission after induction chemotherapy with 3 x COPP + ABVD. This is significantly better than the 31% complete remission rate observed in a pilot study with COPP alone (p less than 0.01). Including salvage therapy (radiotherapy in case of persisting nodal disease; chemotherapy with 4 x CEVD in case of persisting disseminated disease), a total of 76% complete remissions in stages IIIB/IVAB were achieved. An ESR greater than 80 mm/h was the most significant single risk factor in stages IIIB/IV for induction of CR and freedom from progression.

Adolescent↗
PubMed1988

Elevated serum CA 125 levels in patients with benign ascitic or pleural effusions.

The tumor-associated antigen CA 125 is widely used in monitoring of ovarian carcinomas. As this determinant is also expressed in proliferating mesothelia, we studied CA 125 levels in serum and effusion fluid of patients with ascitic and pleural effusions. Patients with benign and malignant disease were included. There was no statistically significant or diagnostically useful difference between 26 benign and 44 malignant cases in the CA 125 levels in effusions or sera. In 77% of benign cases, serum levels exceeding 105 U/ml (3 times the recommended upper limit of normal values) were found. Thus, in patients with serous effusions, elevated serum CA 125 values alone do not provide evidence for the presence of an (ovarian) malignancy, but may also indicate a proliferation of mesothelium due to benign disease.

Adult↗
PubMed1988

Carcinoma-associated hemolytic-uremic syndrome in a patient receiving 5-fluorouracil-adriamycin-mitomycin C combination chemotherapy.

A patient receiving the antitumor agent mitomycin C (MMC) in combination with 5-fluorouracil and adriamycin because of adenocarcinoma of Vater's papilla manifested hemolytic-uremic syndrome (HUS) after five cycles of 5-fluorouracil-adriamycin-MMC combination chemotherapy. The syndrome most likely was caused by MMC, since an association between HUS and the use of MMC has been observed. We report on the clinical course in such a patient and review the pertinent literature.

Adenocarcinoma↗
PubMed1988

Biochemical and cytokinetic characterization of leukemic cells: prediction of treatment results and early diagnosis of relapse.

Selected key-steps in the biochemical pathways of DNA-synthesis and cytokinetic parameters were measured in human bone marrow cells: Thymidine kinase (TK), incorporation of nucleosides (thymidine = dTR and deoxyuridine = dUR), % cells in DNA-synthesis-phase of the cell division cycle (%S). 26 normal marrow and a total of 369 marrow specimens from patients with acute leukemia were assayed either at first diagnosis, during remission or at relapse. A significant 5-fold increase of TK was found in leukemic cells, thus, being a suitable marker for follow-up of these patients. The sensitivity to detect a high TK at primary diagnosis of acute leukemia is 83%. An increase of TK during remission can indicate an imminent relapse before an increase of blast cells can be detected in the bone marrow. The incorporation-rates of dTR and dUR were also significantly increased in leukemic cells. Patients who did not achieve complete remission after induction treatment had higher incorporation-rates. In contrast to the enhanced biochemical activity of DNA-metabolism, %S-phase-cells were significant lower in leukemic cell populations. %S-phase cells did not correlate with treatment results. An inhibition of DNA synthesis, estimated by the incorporation rates of dTR and dUR for more than 50% during the first 3-4 days after start of induction treatment corresponds with cytoreduction in the leukemic bone marrow which does not predict complete remission in all cases.

DNA↗
PubMed1988

Azathioprine lymphocytotoxicity. Potentially lethal damage by its imidazole derivatives.

The immunosuppressive agent 6-(1-methyl-4-nitroimidazole-5-yl)-thiopurine (azathioprine, AZA) is metabolized to the purine antagonist 6-mercaptopurine (6-MP) and to 5-substituted 1-methyl-4-nitro-5-thioimidazoles or- aminoimidazoles. Besides the cytostatic (growth inhibition) and cytocidal (cell killing) effect of the anti-metabolite 6-MP, which can be antagonized by exogenous purine supplementation, AZA has an additional effect, which cannot be antagonized by purines. This effect is due to electron-affine imidazole derivatives, which are generated by a nucleophilic attack on the AZA molecule. A synthetic imidazole derivative (1-methyl-4-nitro-5-chloro-imidazole, MNCI) develops cytostatic and cytocidal effects in two different permanent human lymphoblastoid cultures (LS2 and CH4) with threshold concentrations of 8 x 10(-5) and 6 x 10(-5) mol/l, respectively. This imidazole derivative with the nitro- and chloro-group in ortho-position seems to be more reactive than other imidazole derivatives. It interferes with the redox potential of the cells. It causes glutathione depletion and sublethal conditioning of the cells (reduced repair capacity = potentially lethal damage = PLD = chemosensitization). The immunosuppressive action of AZA depends on the synergistic cooperation of the relatively weak cytostatic effect of low doses of 6-MP and the chemosensitizing effect of PLD which is induced by highly reactive imidazole derivatives.

Azathioprine↗
PubMed1987

[Successful chemotherapy of a metastatic malignant thymoma].

An epithelial thymoma was diagnosed in June 1978 in a 42-year-old-woman. The tumor had already encased the great vessels and infiltrated into sternum and both lungs. Full remission followed local radiotherapy with 25 Gy. In February 1979, intrapulmonary and bony metastases were discovered. After 12 cycles of the COP schema after Bagley (cyclophosphamide, vincristine and prednisolone) full remission was again achieved, which still persists. This case and other published results suggest that cytostatic combinations are often successful in the treatment of advanced malignant thymoma and could be an alternative to the present practice of radiotherapy of inoperable or incompletely resectable thymomas.

Adult↗