Haematologica
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Idarubicin in patients with diffuse large cell lymphomas: a randomized trial comparing VACOP-B (A = doxorubicin) vs VICOP-B (I = idarubicin).
Idarubicin is an effective drug in acute leukemia but its use in non-Hodgkin lymphomas (NHLs) is not yet well established. We evaluated its efficacy in patients with diffuse large cell lymphoma (DLCL) by means of a randomized trial comparing two 12-week regimens (VACOP-B and VICOP-B) which differed only in the anthracycline drug used (doxorubicin vs idarubicin). ⋯ Idarubicin is slightly less toxic than doxorubicin; at a dose of 10 mg/sqm the former is easily tolerated and shows the same efficacy as doxorubicin in the treatment of DLCL.
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Patients with hematologic malignancies and a history of an invasive fungal infection are considered to be at high risk of suffering reactivation of the infection during subsequent intensive chemotherapy. ⋯ Despite lack of definite evidence, administration of an active antifungal drug before, during and after the period of neutropenia appears to be useful. In IPA, residual masses, nodules or cavities in the lung usually contain viable invasive fungal elements and should be resected whenever possible. On the other hand, the risk of reactivation and progression of an active fungal infection during intensive chemoradiotherapy is very high, and novel therapeutic strategies appear warranted in this setting.
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Pulmonary embolism (PE), with an incidence of 23 per 100,000 patients per year, is a frequent clinical problem, responsible for 200,000 deaths each year in the United States. Pulmonary angiography, the gold standard for diagnosing PE, is invasive, costly and not universally available. Moreover, PE is confirmed in only approximately 30% of patients in whom it is suspected, rendering noninvasive screening tests necessary. Several strategies have been recently proposed to reduce the need for pulmonary angiography in the diagnostic workup of pulmonary embolism. The objective of this article is to analyze the individual performance of the new diagnostic instruments and their combination in rational diagnostic strategies. ⋯ Even though PE remains a difficult diagnostic challenge, the availability of novel noninvasive tests (plasma D-dimer and ultrasonography of the lower limbs) and the rehabilitation of clinical assessment allow a more rational and sparse prescription of pulmonary angiography. More work needs to be done to assess test performances and refine diagnostic strategies in distinct patient subgroups, particularly those hospitalized. Screening patients with plasma D-dimer and ultrasonography of the lower limbs may be the most cost-effective strategy, at least in outpatients.
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Comparative Study Clinical Trial
Use of granulocyte-macrophage colony-stimulating factor (GM-CSF) in combination with hydroxyurea as post-transplant therapy in chronic myelogenous leukemia patients autografted with unmanipulated hematopoietic cells.
Allogeneic bone marrow transplantation remains the only potentially curative treatment for CML, but more than 70% of patients will be ineligible for allogeneic marrow transplant either because they do not have a suitable HLA-matched related or unrelated donor or because they are more than 50 years old. Several experimental and clinical findings support a role for autologous stem cell transplantation (ASCT) in CML. It has been suggested that in the early phase following autografting the Ph-negative clone has a proliferative advantage over the Ph-positive clone. We hypothesized that post-transplant GM-CSF administration could reactivate the functional activity of quiescent normal progenitors and prolong the duration of the post-transplant proliferative advantage of Ph-negative over Ph-positive progenitors. In order to evaluate the effect of post-transplant GM-CSF administration, a pilot clinical study was performed in which CML patients resistant to IFN-alpha therapy were autografted with unmanipulated marrow or blood cells and given prolonged GM-CSF therapy post-transplant. ⋯ This pilot study demonstrates that combined GM-CSF and hydroxyurea therapy seems to be effective in inducing and/or prolonging a transient period of Ph-negative hematopoiesis. The late appearance of Ph-negative hematopoiesis detected in two patients suggests an antileukemic activity of the combined GM-CSF/hydroxyurea therapy rather than an antileukemic effect of the conditioning regimen.
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Comparative Study
Relationship of blood transfusion, post-operative infections and immunoreactivity in patients undergoing surgery for gastrointestinal cancer.
The immunosuppression induced by perioperative blood transfusion (BT) and its effect on the incidence of post-surgical infectious complications remains controversial. In this study, the relationship between BT and postoperative infections was investigated in 136 gastrointestinal cancer patients submitted to curative surgery. ⋯ These results indicate that other factors, beside BT, can induce immunosuppressive effects in these patients and thus increase their susceptibility to postoperative infections.