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PubMed2004

Correlation of pre-operative coexistence of organ dysfunction with overall survival of patients with squamous cell carcinoma of the thoracic esophagus.

Coexistence of organ dysfunction has been regarded as a risk factor in the surgical treatment of digestive diseases. The aim of this study was to investigate the correlation between coexistence of organ dysfunction and post-operative outcome in patients with thoracic esophageal squamous cell carcinoma (SCC). One hundred and fifty-eight patients with SCC of the thoracic esophagus, who had been surgically treated were examined, including 37 cases associated with organ dysfunction. The proportion of post-operative complication in patients with organ dysfunction (32.4%, 12/37) was significantly higher than that in patients without organ dysfunction (15.7%, 19/121; p=0.025). The overall survival of patients with organ dysfunction was significantly more unfavorable than that of patients without organ dysfunction (p=0.031), and multivariate analysis demonstrated that coexistence of organ dysfunction (p=0.004), depth of tumors (p=0.012), lymph node metastasis (p=0.0003), blood vessel invasion (p=0.008) and the incidence of post-operative complications (p=0.026) were factors independently associated with worse overall survival of the patients with SCC of thoracic esophagus. Coexistence of organ dysfunction was found to be an independent indicator of worse overall survival in patients with SCC of the thoracic esophagus.

Adult↗
PubMed2004

Poor overall diet quality as a possible contributor to calculus formation.

PURPOSE: An association between diet and calculus deposits was suggested by animal studies. The objective of the present analysis was to examine whether or not there is an association between overall diet quality, as measured by the healthy eating index, and extent of dental calculus deposits using a subset of the third National Health and Nutrition Examination Survey (NHANES III) data. MATERIALS AND METHODS: NHANES III participants 18-years of age or older who had data on dental calculus and diet quality were selected (n = 12405). The healthy eating index (HEI), used as an indicator of overall diet quality, has a minimum score of zero (poorest) and a maximum score of 100 (best) and was divided into three categories, poor (HEI < 51), fair (HEI, between 51 - 80) and good (HEI > 80). Ordinal logistic regression models were used to examine the association between the HEI and the percentage of sites with calculus deposits. RESULTS: Overall diet quality was found to be significantly associated with calculus deposits controlling for: age, gender, race, education, poverty income ratio, smoking, diabetes, history of vitamin and mineral use, body mass index, time elapsed since last dental visit and gingival bleeding. The adjusted odds ratios for having a greater percentage of sites with calculus were 1.54 (1.19 - 1.98), 1.30 (1.02 - 1.60) and 1.00 (reference) for subjects with poor, fair, and good diet quality respectively. CONCLUSION: Poor diet quality is significantly associated with more calculus deposits. Further studies are needed to examine if poor diet quality is a predisposing factor for calculus formation and/or a risk factor for periodontal diseases.

Adolescent↗
PubMed1993

[Influence of the overall time of radiotherapy on local control for T2 cancer of the tongue].

Forty patients with T2 cancer of the tongue treated with external irradiation plus radium implants at Aichi Cancer Center were reviewed retrospectively to analyze the influence of overall treatment time on local control. One hundred percent (11/11) local control was achieved in patients irradiated within 35 days, in contrast to only 52% (13/25) local control in those irradiated over 35 days. This result indicates that prolonged overall time is associated with loss of local control. This prolongation is mainly due to the prolonged interval between external and interstitial irradiation. The interval was likely to be longer because of enhanced acute radiation mucositis, especially in patients administrated bleomycin during external irradiation. External irradiation should be followed by interstitial irradiation as soon as possible to keep overall time shorter.

Bleomycin↗
PubMed1995

Glutathione S-transferase pi in colorectal tumors is predictive for overall survival.

Glutathione S-transferases (GSTs) are enzymes involved in the detoxification of xenobiotics and are divided into four subclasses, alpha, mu, pi, and theta, with different although overlapping substrate specificities. Most human gastrointestinal tumors contain increased amounts of GST-pi and GST enzyme activity. The relationship between GST parameters and tumor and patient characteristics, including overall survival, were studied retrospectively in 100 primary colorectal adenocarcinomas. Levels of GST-alpha, GST-mu, GST-pi, and GST enzyme activity were not related to the Dukes stage, differentiation grade, localization, histological type and diameter of the tumor, or gender and age of the patient. Fifty-seven patients died (median survival, 21 months; range, 1-65 months) during follow-up, and 43 patients were still alive at the closing date of the study (median follow-up, 68 months; range, 60-87 months). Optimal dichotomization and uni- and multivariate analyses were done with the Cox proportional hazard model. Multivariate analysis with all clinicopathological parameters revealed higher Dukes stage (hazard ratio, 2.7; P < 0.001) and older age (hazard ratio, 2.8; P = 0.001) to be the only independent prognostic variables for overall survival. In contrast to GST-alpha and GST-mu, high levels of GST-pi (hazard ratio, 3.1; P = 0.002) and GST enzyme activity (hazard ratio, 2.0; P = 0.020) in the tumors were found to have a significant prognostic value independent from the clinicopathological parameters when added separately to this Cox model. Thus, this study indicates that GST subclass levels in colorectal adenocarcinomas are not related to clinicopathological parameters and that the GST-pi level and GST enzyme activity have a prognostic value for the overall survival of the patients.

Adenocarcinoma↗
PubMed1995

The response of mouse skin to fractionated doses of fast neutrons (66 MeVp-Be) with variable interfraction and overall treatment times.

PURPOSE: Beam availability for neutron therapy at the National Accelerator Centre at Faure, South Africa is such that treatment fractions are given at irregularly spaced intervals. Such treatment scheduling may not be optimal. METHODS: Investigations were made using the acute skin reaction of the mouse foot to determine the effect of different numbers of regularly and irregularly spaced fractions of p(66)/Be neutrons. Assessment of results was both by average skin reaction and by ED50 values for the incidence of moist desquamation as established by probit analysis. RESULTS: Different numbers of fractions (between 6 and 11) and different times between fractions did not appear to affect the mouse foot response significantly when fractionation was completed within 11 days, i.e. before repopulation began to have an effect. When overall treatment times were longer than 11 days, the mouse foot responses to 6 and 9 fractions with variable interfraction times were similar, provided the overall treatment times were the same and the fractions were at least 24 h apart. The alpha/beta ratio was 87 +/- 27 (SE) Gy for the early response of the BALB/c mouse foot skin to p(66)/Be neutrons. CONCLUSIONS: The response of mouse skin to fractionated p(66)/Be neutrons was independent of fraction number or interfraction time, provided that the overall treatment time was the same.

Animals↗
PubMed1996

[Historical experiences in trying different overall treatment times in x-ray therapy of malignant head and neck tumors in the 1920s and 1930s].

UNLABELLED: BACKGROUND/MATERIAL: Today as well as in the first decades of this century the time factor has been one central subject of radio-oncological research. Before World War II, all possible overall treatment times ranging from 1 day to several months were under clinical investigation. A major portion of these historical irradiation schemes is documented in the German written literature of this time period, particularly in the journal "Strahlentherapie". RESULTS: In Paris, Coutard continuously extended treatment duration in X-ray therapy of malignant head and neck tumors. As illustrated by a reevaluation of these treatment results, with his work Coutard has laid the first foundation for today's international widely used conventional overall treatment times of 6 to 7 weeks. Other authors in the 1920s and 1930s, like Zuppinger or Holthusen, preferred use of slightly shorter overall times. CONCLUSIONS: In retrospect, evidence from these historical evaluations must be regarded as very limited especially from a statistical standpoint of view. Without knowledge of the underlying raw data, particularly the results and conclusions of Coutard which had major impact on the later development of radiation therapy cannot be verified anymore. This indicates the value of publishing raw data in modern radio-oncology as well.

France↗
PubMed1997

p53 status affects the rate of the onset but not the overall extent of doxorubicin-induced cell death in rat-1 fibroblasts constitutively expressing c-Myc.

To better understand the effects of p53 on the process of DNA damage-induced cell death, we examined the influence of p53 status on the rate of the onset and the overall extent of cell death induced by doxorubicin. We performed this study with Rat-1 fibroblasts, with Rat-1/myc cells which constitutively express c-Myc, and with Rat-1/myc/p53His175 cells derived from Rat-1/myc cells, which, in addition, express the full-length dominant-negative p53His175 mutant gene. The p53His175 mutant suppresses the transactivation function of endogenous p53 in these cells. In contrast to the parental Rat-1 cells, which exhibited only low levels of apoptosis within the first 24 h of treatment with 0.1 to 1 microM doxorubicin, similarly treated Rat-1/myc cells underwent massive and rapid apoptosis. Introduction of p53His175 into Rat-1/myc cells reversed this effect, indicating that Myc-accelerated doxorubicin-induced apoptosis requires functional p53. However, when the overall extent of cell death was measured using clonogenic assays, we found that greater than 90% of cells did not survive upon a 24-h pretreatment with doxorubicin at a concentration as low as 0.1 microM. Moreover, the effect of doxorubicin on all three cell lines was similar, irrespective of their p53 or c-Myc status. Taken together, our experiments indicate that: (a) constitutive expression of c-Myc accelerates the onset of doxorubicin-induced apoptosis in Rat-1 fibroblasts; (b) wild-type p53 function is necessary for this acceleration; and (c) neither overexpression of c-Myc nor the p53 status influences the overall extent of doxorubicin-induced cell death.

Animals↗
PubMedDate not supplied

Enhanced ligand-induced activation of EGF-receptor and overall tyrosine kinase and phospholipase C in colonocytes isolated from azoxymethane-treated rats.

BACKGROUND/AIMS: In order to evaluate the role of epidermal growth factor (EGF) and transforming growth factor alpha (TGF-alpha) in colorectal cancer, the present investigation examines changes in EGF and TGF-alpha-mediated activation of overall and EGF receptor (EGF-R) associated tyrosine kinase activity in isolated rat colonocytes after administration of the colonic carcinogen azoxymethane. METHODOLOGY: Five days after a single injection of azoxymethane (20 mg/kg) or saline solution to 3-4 month old Fischer-344 rats, colonocytes were isolated, exposed for 2 minutes to 1 x 10(8) M EGF and TGF-alpha, and assessed for overall and EGF-R associated tyrosine kinase and phospholipase C activity. RESULTS: In colonocytes isolated from control animals, incubation with EGF and TGF-alpha resulted in a small (21-35%) increase in overall tyr-k. However, a marked (113-127%) rise of this enzyme occurred in colonocytes from AOM-treated rats, when compared with the corresponding basal levels. These differences were even more pronounced in colonocytes isolated from the distal part of the colon, as regards to the proximal part. In addition, EGF and TGF-alpha activated EGF-R tyr-k by 40-60% in controls and by 84-85% in AOM-treated animals. Incubation of colonocytes with these growth factors also stimulated PLC activity (in controls by 120-150% and in AOM injected rats by 204-271%) when compared with corresponding basal values. CONCLUSIONS: We conclude that AOM enhances the responsiveness of colonocytes to EGF and TGF-alpha, which may be one of the mechanisms involved in colorectal carcinogenesis.

Animals↗
PubMed1999

Overall and single-kidney clearance in children with urinary tract infection and damaged kidneys.

UNLABELLED: The overall and single-kidney clearance in children with acute urinary tract infection was investigated retrospectively using the combination of the relative 99mTc-dimercaptosuccinic acid (DMSA) uptake and the 51Cr-ethylenediaminetetraacetic acid clearance. METHODS: There were 180 patients with both normal kidneys, 56 with clear unilateral abnormalities on DMSA scintigraphy and 11 with two abnormal kidneys. Half of the patients were younger than 2 y, and because of the progressive maturation of the renal function, they were not considered in the analysis of the absolute overall and single-kidney clearance; nevertheless, they were included in the analysis of the relative DMSA percentage uptake. RESULTS: When only one kidney was affected on DMSA scintigraphy, the clearance of the affected kidney was lower than on the normal side and often abnormally low. In these unilaterally affected kidneys, contralateral compensation mechanisms tended to occur, resulting in preservation of overall clearance. This compensation was probably not present only on the contralateral side. On the abnormal side, the clearance was normal in about half of the cases, probably because of intrarenal compensation occurring in regions not damaged by the infection. In addition to these compensation mechanisms, hyperfiltration was probably present in many cases of acute urinary tract infection with intact or unilaterally damaged kidneys.

Acute Disease↗
PubMed2002

Overall clinical breast examination as a factor in delayed diagnosis of breast cancer.

HYPOTHESIS: A standardized description of clinical breast examination (CBE) can predict the risk of delayed diagnosis of breast cancer. DESIGN: Survey of case series. SETTING: Breast surgery referral practice. PATIENTS: Consecutive sample of 371 women with 386 breast cancers of any stage for whom overall characteristics of CBE were recorded at the initial consultation. INTERVENTION: None. MAIN OUTCOME MEASURES: Overall breast "durity" (from Latin duritia, meaning "hardness") was recorded as the inverse of whether rib edges could be felt through breast tissue in the most "dur" (firm or hard) part of the breast, usually the upper outer quadrant adjacent to the areola. "Nodularity" was recorded in this same area by means of an ordinal scale ranging from "surface is smooth" to "coarse nodularity." Delayed diagnosis was tabulated if the patient was told that cancer was not present when there was a sign of cancer on CBE, mammogram, and/or pathology slides. Relative risk of delayed diagnosis was determined within categories of nodularity or durity and within nodularity and durity categories combined. RESULTS: Diagnosis was delayed for 35 (9.1%) of cancers. Delay was least common (2 [2.2%] of 92) for less dur and less nodular breasts (relative risk, 1.0), most common (18 [13.5%] of 133) for less dur and more nodular breasts (relative risk, 6.23; 95% confidence interval, 3.58-10.22), and intermediate for other descriptions (chi(2) = 9.08; P =.03). Neither nodularity alone nor durity alone correlated with delay. CONCLUSIONS: A standardized system to describe CBE will alert physicians to an increased risk of delayed diagnosis of breast cancer (especially for women with less dur and more nodular breasts), help improve interpretation of CBE, and reduce delayed diagnosis of breast cancer.

Biopsy↗
PubMed2002

Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada.

CONTEXT: Prenatal diagnosis and termination of affected pregnancies can prevent infant deaths due to congenital anomalies, but an effect at the population level has not been shown. OBJECTIVE: To examine the impact of recent changes in congenital anomaly-related fetal and infant deaths on overall population-based infant mortality. DESIGN, SETTING, AND SUBJECTS: Birth cohort-based study of all live births, stillbirths, and infant deaths in Canada (excluding Ontario) for 1991-1998. MAIN OUTCOME MEASURES: Cause-specific infant mortality rates and gestational age-specific fetal death rates. RESULTS: The birth cohort-based infant mortality rate fluctuated between 6.4 and 6.1 per 1000 live births between 1991 and 1995, then dropped to 5.4 per 1000 in 1996 and 5.5 per 1000 in 1997. The rate of infant death from congenital anomalies was stable between 1991 and 1995 but declined by 21% (95% confidence interval, 19%-32%) from 1.86 per 1000 in 1995 to 1.47 per 1000 in 1996 and 1997. Fetal deaths due to pregnancy termination at 20 to 23 weeks' gestation increased dramatically in 1994, while fetal deaths due to congenital anomalies at 20 to 21 weeks increased in 1995 and subsequently. Provinces/territories with high rates of fetal death due to pregnancy termination/congenital anomalies at 20 to 23 weeks had fewer infant deaths due to congenital anomalies. CONCLUSION: A large decrease in infant deaths due to congenital anomalies was associated with the most recent decline in infant mortality in Canada, suggesting that increases in prenatal diagnosis and pregnancy termination for congenital anomalies are related to decreases in overall infant mortality at the population level.

Abortion, Induced↗
PubMed1976

Radiation reaction of rat skin. The role of the number of fractions and the overall treatment time.

Acute skin reactions resulting from orthovoltage x-irradiation were measured in the WAG/Rij rat. A wide range of combination of fraction number and overall time were used in an attempt to determine their relative importance. There appeared to be little effect of prolongation of overall treatment time until periods of over 2 weeks were reached. In treatment periods of 3 weeks and over the stimulation of extensive time-dependent recovery was seen. A model based on cell kill with provision for the stimulation of accelerated proliferation at about 17 days adequately describes the experimental results.

Animals↗
PubMed1993

Overall survival from breast cancer in Kerala, India, in relation to menstrual, reproductive, and clinical factors.

BACKGROUND: Breast cancer accounts for one-fourth of cancer cases seen in female patients in Kerala, India. Results of a retrospective analysis of breast cancer in Kerala are presented in this article. METHODS: Case records of 449 patients with breast carcinoma treated during 1983-1984 were reviewed. Survival analysis was done by the Kaplan-Meier product limit method. The survival curves were compared by the log-rank test. A forward stepwise procedure with the Cox proportional hazards regression analysis was performed to identify factors influencing survival. RESULTS: The overall 5-year survival rate was 40%. The 5-year survival rates were 85% for patients with T1, 63% for T2, 32% for T3, and 21% for T4 lesions. Those with N0 disease had a 68% 5-year survival rate. The survival rates were 90% for patients with Stage I, 65% for Stage II, 33% for Stage III, and 6% for Stage IV disease. On multivariate analysis, the following factors were found to significantly influence survival: response to treatment (P < 0.001), stage (P < 0.01), and regional nodal involvement (P < 0.05). CONCLUSIONS: Two-thirds of patients with advanced-stage disease on presentation seem to account for the poor overall survival. Early detection of breast cancer by breast self-examination and physician breast examination should be encouraged in developing countries to improve treatment results in breast cancer.

Adult↗
PubMed1994

Significance of overall treatment time for the development of radiation-induced intestinal complications. An experimental study in the rat.

BACKGROUND: Late normal tissue reactions generally are believed to be independent of treatment time. However, previous studies suggest a relationship between acute mucosal injury and development of intestinal obstruction and enterocutaneous fistula formation. Thus, the pathogenesis of late intestinal complications may be complex, and mucosal cell proliferation during treatment may be important. This study assessed the influence of overall radiation treatment time on development of intestinal injury and complications after localized fractionated irradiation of rat ilium. METHODS: Ninety-four male rats underwent orchiectomy, and a loop of small intestine was transposed to the scrotum. Orthovoltage irradiation was administered to the transposed, but functionally intact, intestine using 9 fractions of 5.6 Gy with interfraction intervals of 24, 48, or 72 hours. The animals were observed for complications and killed in groups 2 and 26 weeks after irradiation for assessment of injury. Incidence of intestinal complications and quantitative and semiquantitative histopathologic assessment of injury were used as endpoints. RESULTS: Increasing total treatment time by extending interfraction intervals from 24 to 48 hours significantly reduced radiation injury and the incidence of intestinal complications. Differences in mucosal and fibrotic changes were most prominent. No significant differences were found between groups with interfraction intervals of 48 and 72 hours. CONCLUSIONS: Overall treatment time significantly influenced development of chronic radiation enteropathy. Thus, rapidly proliferating cells, as found in the intestinal mucosa, appear to be involved in the pathogenesis of intestinal complications. This probably represents consequential damage secondary to disruption of mucosal integrity.

Animals↗
PubMed2001

Angiogenesis in pancreatic carcinoma: thymidine phosphorylase expression in stromal cells and intratumoral microvessel density as independent predictors of overall and relapse-free survival.

BACKGROUND: Recently, the usefulness of intratumoral microvessel density (IMD) and expression of several angiogenic factors as prognostic indicators have been demonstrated in several human solid tumors. METHODS: One hundred four patients with pancreatic ductal adenocarcinoma were examined retrospectively. The investigated clinicopathologic and immunohistologic data included staining for vascular endothelial growth factor (VEGF), thymidine phosphorylase (TP), basic fibroblast growth factor (bFGF), CD34 (for calculating IMD), p53, and Ki-67. RESULTS: Multivariate analysis for both overall and relapse-free survival revealed two independent variables, IMD and TP staining in stromal cells (TPs, P < 0.02). Whereas the frequency of hepatic metastasis was correlated significantly with cytoplasmic expression of TP or bFGF in tumor cells (TPc, bFGFc), IMD, and p53 status, local recurrence was significantly more common in patients with positive staining for TPs, bFGF in stromal cells (bFGFs), and for the pM category (P < 0.05). TPc, bFGFc, VEGF, and p53 expression correlated with IMD (P < 0.01), although TPs and bFGFs expression did not. VEGF and IMD status correlated with p53 expression (P < 0.001), although TP, bFGF, and Ki-67 status did not. CONCLUSIONS: TPs expression and IMD were revealed to be valuable tools for predicting overall and relapse-free survival in patients with pancreatic adenocarcinoma. Whereas TPc and bFGFc are likely to participate in hepatic metastasis by means of their angiogenic properties, TPs and bFGFs may be related to local tumor progression. Angiogenesis in human pancreatic carcinoma may be dependent on VEGF, TP, and bFGF. p53 abnormality is likely to take part in VEGF-related angiogenesis.

Adenocarcinoma↗
PubMed2001

Introduction of antisense CD44S CDNA down-regulates expression of overall CD44 isoforms and inhibits tumor growth and metastasis in highly metastatic colon carcinoma cells.

We created antisense CD44 transfectants using LS174T, a colon adenocarcinoma cell line and assessed the effects of overall CD44 down-regulation on colorectal tumor growth and metastasis. The expression of antisense CD44s (the standard form of CD44) cDNA markedly inhibited the overall expression of CD44 variants. In vitro studies showed a significantly reduced ability of the stable antisense transfectants (LS174TAS1 and LS174TAS2) to bind hyaluronate and osteopontin, ligands for CD44. These cells developed tumors more slowly than controls (parental LS174T and mock transfectants) when the cells were subcutaneously injected into SCID mice. However, in vitro proliferation assays demonstrated no significant difference between the antisense transfectants and the controls on a hyaluronate-coated surface, suggesting the participation of ligands other than hyaluronate in tumor growth in vivo. Intrasplenic injection of parental LS174T cells produced colonies in the liver in 10 of 11 mice, whereas mice injected with the antisense transfectants were completely free of metastasis. In peritoneal dissemination, the weight of nodules and amount of ascites were significantly reduced in LS174TAS1 and AS2 compared with the controls. In vitro adhesion assays between the transfectants or controls and human peritoneal mesothelial cells revealed that the binding of LS174T cells to mesothelial cells was partly mediated by CD44-hyaluronate interaction. These data suggest that CD44-hyaluronate interaction plays a crucial role in peritoneal dissemination in colorectal carcinoma. The results of our study demonstrate the possible application of antisense CD44s to the treatment of colorectal carcinoma.

Adenocarcinoma↗
PubMed2000

Overall and peripheral inhomogeneity of ventilation in patients with stable cystic fibrosis.

We studied distribution of ventilation in patients with cystic fibrosis (CF) who had not had an exacerbation for some time. Patients performed either the vital capacity nitrogen (N(2)) single-breath washout test (VC test) or a modified single-breath washout consisting of 1 L inspired from functional residual capacity (FRC test) of 90% oxygen (O(2)), 5% helium (He), and 5% sulfur hexafluoride (SF(6)). We computed the slopes of phase III of N(2) concentration from the VC test (S(N2) (VC)) and the phase III slopes of the He (S(He)): The SF(6) (S(SF6)), and curves from the FRC test. S(N2) (VC) may be regarded as an index of overall ventilation and the difference (S(SF6) - S(He)) as an index of peripheral ventilation. Three groups were studied: CF, 28 CF patients (8-36 years of age); normal controls (NC), 33 normal nonsmokers (9-55 years of age); and a smoking group (SG), 42 non-CF smoking patients (39-79 years of age). Compared to the NC group, S(N2) (VC) is increased in the CF group, reflecting an overall ventilation impairment. There is no difference in S(N2) (VC) between the CF group and the SG group, suggesting that S(N2), though sensitive, is nonspecific. Compared to both NC and SG groups, (S(SF6) - S(He)) is decreased in the CF group, being on the average negative. This may imply that there is a peripheral impairment in the distribution of ventilation that originates in terminal and respiratory bronchioles. Negative (S(SF6) - S(He)) is statistically associated with the youngest CF patients, suggesting that terminal and respiratory bronchiolar involvement is linked to early stages of the disease. In older CF patients, (S(SF6) - S(He)) is more often positive, suggesting that even more distal airways, such as alveolar ducts, become involved in peripheral inhomogeneity of ventilation.

Adolescent↗
PubMed2006

Maintenance therapy with thalidomide improves overall survival after autologous hematopoietic progenitor cell transplantation for multiple myeloma.

BACKGROUND: High-dose chemotherapy with autologous hematopoietic progenitor cell (HPC) transplantation improves survival for patients with multiple myeloma (MM); however, most patients develop recurrent disease after undergoing transplantation, and new treatment approaches are needed. The objective of this retrospective review of autologous HPC transplantation for patients with MM was to evaluate the impact of conditioning regimens and posttransplantation therapy on survival. METHODS: The authors reviewed 112 patients with MM who received autologous HPC grafts at their institution. Between June 1992 and August 2001, 54 patients received busulfan, cyclophosphamide, and etoposide (Bu/Cy/VP-16), and 58 patients received high-dose melphalan (MEL-200) followed by autologous HPC transplantation. After transplantation, 36 patients received thalidomide for maintenance or salvage therapy, and 76 patients received no posttransplantation thalidomide. RESULTS: At a median follow-up of 58 months, the median survival was 54 months. There was no statistically significant difference noted with regard to response to conditioning regimen, progression-free survival, or overall survival between the Bu/Cy/VP-16 and MEL-200 cohorts. Patients who received thalidomide after transplantation had improved median survival (65.5 months) compared with patients who did not receive thalidomide (44.5 months; P = .09). When they were separated according to reasons for thalidomide use, patients who received thalidomide as maintenance had improved overall survival compared with patients who received thalidomide as salvage (65 months vs. 54 months; P = .05). CONCLUSIONS: Combination chemotherapy provided no advantage over high-dose melphalan in patients with MM who underwent autologous HPC transplantation. The posttransplantation use of thalidomide seemed to improve the survival of patients compared with historical controls from the prethalidomide era. Further prospective trials are underway to confirm the benefit of thalidomide in the posttransplantation setting.

Adult↗