Interferon-alpha is the frontline therapy of the majority of chronic myeloid leukemia (CML) patients who are not eligible for bone marrow transplantation. Many patients are treated for long periods, and there is concern about the long-term immune effects of its use. Autoimmune disorders in patients treated with IFN-alpha may be related to the direct immunomodulating properties of IFN or may be linked to a possible toxic effect in target organs, triggering autoimmunity. On the other hand, the immune effects of IFN may play a role in its therapeutic actions. The aims of our study were to assess the incidence of autoimmune phenomena in these patients, and to measure the possible association between the generation of autoimmune phenomena and the antileukemic effect of IFN alpha. Therefore, 46 patients with Ph1(+) CML in the first chronic phase were studied for the appearance of immune complications, their connection to IFN dose, time of appearance, and the possible association with the response to treatment. Autoimmune abnormalities have been found in 28% of our patients. Moreover, a significant association was found between autoimmune alterations and female sex (P = 0.02, OR 4.5, 95% CI 1.13-17.9) and a longer treatment time (1.6 vs. 4.1 years) (P = 0.02; OR 1.01, 95% CI 1-1.02). The Kaplan-Meier estimated probability of obtaining a cytogenetic response was significantly higher in patients who developed autoimmune alterations (P = 0.049), and this difference was also evident in Cox's analysis when controlling with other potentially confounding variables (P = 0.078). We conclude that CML patients treated with IFN alpha have a high incidence of autoimmune phenomenon.

BACKGROUND: We aimed at comparing the effectiveness and safety of piperacillin/tazobactam (PIP-TAZ) versus imipenem/cilastin (IMI) administered as empiric monotherapy in patients with febrile neutrapenia.PATIENTS AND METHOD: Patients with hematological diseases who were randomly assigned either PIP-TAZ or IMI were enrolled in the study. A sequential strategy antibiotic therapy addition was applied as long as fever persisted or microorganisms were isolated at 72 h. Moreover, if bacteriologically unconfirmed fever persisted after 5-7 days, an antifungal therapy was started. The treatment was considered successful if fever and clinical signs resolved and/or pathogens were cleared without adding further antibiotics at 72 h. Differences between percentages were analyzed using the chi (2) test.RESULTS: 137 patients were evaluated. The successful response rate of PIP-TAZ after 72 h was similar to IMI (32.2 and 35.2%). The defervescence time was shorter (3.6 and 4.2 days) and the bacterial response more favourable with PIP-TAZ than with IMI, but statistically significant differences were not reached. The overall response in bath groups was 91%. 18.2% of episodes were bacteriologically confirmed. The most frequent isolated microorganism was Staphylococcus coagulase-negative (48.8%). There was one only case of septic shock, within the IMI group, and the overall mortality of the group was 8.7%. The occurrence of vomiting in the IMI group was significantly higher than in the PIP-TAZ group (39.9 and 5.6%; p < 0.0001).CONCLUSIONS: PIP-TAZ is as effective as IMI and it constitutes a good choice as an initial empiric monotherapy of febrile neutropenia.

PURPOSE A phase III trial to compare PIXY321 with granulocyte-macrophage colony-stimulating factor (GM-CSF) following high-dose therapy and autologous bone marrow transplant (ABMT) was conducted to evaluate the time to hematopoietic recovery. PATIENTS AND METHODS One hundred seventy-seven patients with non-Hodgkin's lymphoma (NHL) receiving ABMT were randomized to receive either PIXY321 750 micrograms/m2/d divided into two subcutaneous (SC) doses or GM-CSF 250 micrograms/m2/d as a 2-hour intravenous (IV) infusion starting on day 0 post-ABMT for a maximum of 28 days. RESULTS The median time to reach an absolute neutrophil count (ANC) > or = 500/microL in the PIXY321 group was 17 days versus 19 days in the GM-CSF group (P = .07) and the median time to reach platelet transfusion independence in the PIXY321 group was 25 days versus 23 days in the GM-CSF group (P = .30). The toxicity profiles of the two agents appeared to be equivalent with the exception of more patients in the PIXY321 group with a rash (64%) compared with the GM-CSF group (48%) (P = .028). A logistic regression model identified the use of a non-total-body irradiation (TBI) regimen and/or receipt of unpurged marrow and a body-surface area greater than 2.0 m2 as predictive of faster neutrophil engraftment, and those three factors, as well as the receipt of < or = two prior chemotherapy regimens as predictive for rapid platelet engraftment. CONCLUSION There was a trend toward a slight improvement in neutrophil engraftment post-ABMT with the PIXY321 administered by an SC route compared with GM-CSF administered by an IV route. However, no differences could be identified between the two agents with respect to the time to platelet transfusion independence. Patient, regimen, and graft characteristics were most predictive of the engraftment tempo.

Purpose: CAMPATH-1H is a human immunoglobulin G(1) (IgG(1)) anti-CD52 monoclonal antibody (MAb) that binds to nearly all B- and T-cell lymphomas and leukemias. We report the results of a multicenter phase II trial that used CAMPATH-1H in previously chemotherapy-treated patients with chronic lymphocytic leukemia (CLL).Materials and Methods: Twenty-nine patients who had relapsed after an initial response (n = 8) or were refractory (n = 21) to chemotherapy were treated with CAMPATH-1H administered as a 30-mg 2-hour intravenous (IV) infusion thrice weekly for a maximum period of 12 weeks.Results: Eleven patients (38%) achieved a partial remission (PR) and one (4%) a complete remission (CR) (response rate, 42%; 95% confidence interval [CI], 23% to 61%). Three of eight patients (38%) with a relapse and nine of 21 refractory patients (43%) responded to CAMPATH-1H therapy, CLL cells were rapidly eliminated from blood in 28 of 29 patients (97%), CR in the bone marrow was obtained in 36% and splenomegaly resolved completely in 32%. Lymphadenopathy was normalized in only two patients (7%). The median response duration was 12 months (range, 6 to 25+). World Health Organization (WHO) grade IV neutropenia and thrombocytopenia developed in three (10%) and two patients (7%), respectively. Neutropenia and thrombocytopenia recovered in most responding patients during continued CAMPATH-1H treatment. Lymphopenia (< 0.5 x 10(9)/L) occurred in all patients, Two patients had opportunistic infections and four had bacterial septicemia.Conclusion: CAMPATH-1H had significant activity in patients with advanced and chemotherapy-resistant CLL, The most pronounced effects were noted in blood, bone marrow, and spleen, preferential clearance of blood may allow harvesting of uncontaminated blood stem cells for use in high-dose chemotherapy protocols. (C) 1997 by American Society of Clinical Oncology.

Three representative cases of the clinical heterogeneity of Castleman's disease are presented: one localized form with hialine vascular histology (HV) and 2 multicentric forms corresponding to the plasmocellular variety (PC). The asymptomatic patient with HV was treated with surgical resection of one tumor. The 2 patients with the symptomatic PC variant were characterized by the different clinical presentation receiving polychemotherapy and steroids, respectively with good response. The literature is reviewed and the pathogenetic, clinical and therapeutic aspects of the disease, which remains difficult to define as a sole entity, are discussed.

We present our experience with bone marrow transplantation (BMT) in 30 consecutive patients with high risk acute lymphoblastic leukemia. With a median follow-up of 4 years the disease-free survival (DFS) was 44% for the whole group, with a significant difference between patients in first or second complete remission (CR 1 and 2, as one group), compared with patients with more advanced disease (greater than CR2), 69.5% versus 15.4% (p less than 0.01). The main cause of BMT failure was leukemic relapse, with a relapse rate of 15% for patients in CR 1 and 2 and of 77% for patients with greater than CR2 (p less than 0.01). Among patients with active disease at BMT those who had 15% blast cells or less in the marrow fared better than those with more advanced disease or extramedullary relapse. Transplant-related death was 17%. Graft-versus-host disease (GVHD) was associated with an antileukemic effect; the DFS for patients with acute and/or chronic GVHD was better than for patients with no GVHD at all.

Bone marrow transplantation is an effective treatment for several hematologic diseases. Acute renal failure is one of the posible complications following this therapy.To assess the incidence, ethiology, clinical data and outcome of acute renal failure following bone marrow transplantation, the hospital courses of 2.43 patients transplanted between Oct. 1982 and Aug. 1991 at the Hospital de la Princesa were retrospectively reviewed. One hundred and sixty five were allografts and seventy eight autografts.Acute renal failure was defined as an increase up to 2 mg/dl of serum creatinine or an increase over 50 % of previous levels of serum creatinine in patients with renal dysfunction.Seventy theree cases of acute renal failure were diagnosed in 69 of the 243 patients (transplanted (30.04 %). The incidence was higher in allogeneic (40 %) than in autologous grafts (8,97 %). The ethiology was multifactorial (venocclusive disease of the liver, septicemia, nephrotoxic drugs, graft-versus-host disease) in 36.9 % of the cases, due to nephrotoxics drugs in 34.2 %, venocclusive disease of the liver in 15.6 %, septicemia 2.7 %, volumen depletion in severe acute graft-versus host disease 5.4 %, hemolytic-uremic syndrome 2.7 %, hemoglobinuria 2.7 %.Acute renal failure occurs in 69.9 % of the cases within the first month post transplant. Dialysis and/or ultrafiltration was required in 22 % of the cases.Acure renal failure was associated with worse prognosis and higher mortality than in the no renal dysfunction group (62.3 % versus 29.8 % at six month).In conclusion: Acute renal failure is a common complication following bone marrow transplantation. Incidence was higher in allografted than in autografted patients. Impaired renal function confers a bad prognosis.

British Journal of HaematologyVolume 75, Issue 1 p. 140-141 IS THE NEWLY PROPOSED PROGNOSTIC SYSTEM FOR MULTIPLE MYELOMA USEFUL? J. M. Montero Garcia, J. M. Montero Garcia Department of Medical Oncology, Hospital ‘La Paz’, MadridSearch for more papers by this authorJ. Feliu, J. Feliu Department of Medical Oncology, Hospital ‘La Paz’, MadridSearch for more papers by this authorA. Artal, A. Artal Department of Medical Oncology, Hospital ‘La Paz’, MadridSearch for more papers by this authorM. González Barón, M. González Barón Department of Medical Oncology, Hospital ‘La Paz’, MadridSearch for more papers by this authorJ. López Pascual, J. López Pascual Department of Haematology, Hospital Doce de Octubre, MadridSearch for more papers by this authorJ. M. Fernández Rańtada, J. M. Fernández Rańtada Department of Haematology, Hospital de la Princesa, Universidad Autónoma, MadridSearch for more papers by this author J. M. Montero Garcia, J. M. Montero Garcia Department of Medical Oncology, Hospital ‘La Paz’, MadridSearch for more papers by this authorJ. Feliu, J. Feliu Department of Medical Oncology, Hospital ‘La Paz’, MadridSearch for more papers by this authorA. Artal, A. Artal Department of Medical Oncology, Hospital ‘La Paz’, MadridSearch for more papers by this authorM. González Barón, M. González Barón Department of Medical Oncology, Hospital ‘La Paz’, MadridSearch for more papers by this authorJ. López Pascual, J. López Pascual Department of Haematology, Hospital Doce de Octubre, MadridSearch for more papers by this authorJ. M. Fernández Rańtada, J. M. Fernández Rańtada Department of Haematology, Hospital de la Princesa, Universidad Autónoma, MadridSearch for more papers by this author First published: May 1990 https://doi.org/10.1111/j.1365-2141.1990.tb02634.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume75, Issue1May 1990Pages 140-141 RelatedInformation