Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 100
Filtrar
2.
Talanta ; 83(5): 1436-41, 2011 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-21238733

RESUMO

This paper is the first report of a fiber optic SPR biosensor with nanobead signal enhancement. We evaluated the system with a bioassay for the fast and accurate detection of peanut allergens in complex food matrices. Three approaches of an immunoassay to detect Ara h1 peanut allergens in chocolate candy bars were compared; a label-free assay, a secondary antibody sandwich assay and a nanobead enhanced assay. Although label-free detection is the most convenient, our results illustrate that functionalized nanobeads can offer a refined solution to improve the fiber SPR detection limit. By applying magnetite nanoparticles as a secondary label, the detection limit of the SPR bioassay for Ara h1 was improved by two orders of magnitude from 9 to 0.09 µg/mL. The super paramagnetic character of the nanoparticles ensured easy handling. The SPR fibers could be regenerated easily and one fiber could be reused for up to 35 times without loss of sensitivity. The results were benchmarked against a commercially available polyclonal ELISA kit. An excellent correlation was found between the Ara h1 concentrations obtained with the ELISA and the concentrations measured with the SPR fiber assay. In addition, with the SPR fiber we could measure the samples twice as fast as compared to the fastest ELISA protocol. Since the dipstick fiber has no need for microchannels that can become clogged, time consuming rinsing step could be avoided. The linear dynamic range of the presented sensor was between 0.1 and 2 µg/mL, which is considerably larger than the ELISA benchmark.


Assuntos
Alérgenos/análise , Arachis , Técnicas Biossensoriais , Nanopartículas/química , Alérgenos/química , Arachis/imunologia , Limite de Detecção , Óptica e Fotônica , Ressonância de Plasmônio de Superfície , Fatores de Tempo
3.
Ann Biol Clin (Paris) ; 66(6): 647-55, 2008.
Artigo em Francês | MEDLINE | ID: mdl-19091664

RESUMO

Seven hospital-based glucose monitoring systems (meters) were evaluated with particular attention to those analytical interferences encountered in intensive care patients. Imprecision differed little between meters and remained altogether within acceptable limits. Inaccuracy, as measured by comparison with a hexokinase method presented with significant differences, yet without exceeding acceptable limits either. All meters but one showed an important bias when hematocrit departed from the reference interval. Two meters would not distinguish maltose from glucose. Three showed an important positive bias in the presence of acetaminophen and four a comparable bias in the presence of ascorbate. Only one meter was unaffected by both such exogenous interferences and hematocrit variations, owing to built-in hematocrit and electrochemical blank measuring devices. This meter also showed narrowest correlation with hexokinase methods. At a time when intensive care patients are being submitted to ever tighter glycemic control, it is desirable and our results show that it is now possible to tighten accordingly the acceptability criteria of glucose meters used to this end.


Assuntos
Glicemia/análise , Hematócrito , Sistemas Automatizados de Assistência Junto ao Leito , Acetaminofen/farmacologia , Ácido Ascórbico/farmacologia , Análise Química do Sangue , Glicemia/efeitos dos fármacos , Eletroquímica , Hexoquinase/sangue , Humanos , Unidades de Terapia Intensiva , Maltose/sangue , Valores de Referência , Reprodutibilidade dos Testes
4.
J Clin Microbiol ; 45(7): 2334-6, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17507518

RESUMO

Campylobacter fetus is associated with invasive disease, while other Campylobacter species, such as C. coli and C. jejuni, are a common cause of bacterial diarrhea. Bacteremia has been well described, but pleurisy remains very uncommon. We report the recurrent isolation of a C. fetus subsp. fetus strain during two episodes of pleural effusion with a fatal outcome.


Assuntos
Infecções por Campylobacter/microbiologia , Campylobacter fetus/isolamento & purificação , Pleurisia/microbiologia , Idoso , Antibacterianos/uso terapêutico , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/tratamento farmacológico , Evolução Fatal , Humanos , Masculino , Pleurisia/diagnóstico , Recidiva
5.
Rev Med Interne ; 26(5): 374-80, 2005 May.
Artigo em Francês | MEDLINE | ID: mdl-15893027

RESUMO

INTRODUCTION: Despite a wide national use, the usefulness of the protein profile has only been evaluated in a small number of studies, essentially in patients with unknown diagnoses. METHODS: We conducted a survey on 339 french internal medicine departments to evaluate how the protein profile was used in these services. Concomitantly we achieved a prospective study on 229 patients in our department, with a mean follow up of 9 months, to evaluate how did the protein profile influence the diagnosis process. RESULTS: We received 183 responses to our national survey: the protein profile was available in 110/183 (60%) departments with 94/110 (85%) using it during hospitalisation and 20/94 (21.3%) using it systematically. Among the 229 protein profile analysed in our department, 44 (19.2%) were considered useful with 20 (8.7%) of them allowing the diagnosis of a new pathology. If the profile had not been done systematically, the physicians of our department would have performed the profile in 102/229 (44.5%) cases, whereas seven (3%) useful profiles would not have been done. CONCLUSION: We think that the profile has a consistent interest in hospitalized patients with a known or unknown pathology but performing systematically such a test appears to be of limited benefit.


Assuntos
Proteínas Sanguíneas/análise , Testes Diagnósticos de Rotina/estatística & dados numéricos , Departamentos Hospitalares , Humanos , Medicina Interna , Estudos Prospectivos , Inquéritos e Questionários
6.
Med Mal Infect ; 34(7): 303-9, 2004 Jul.
Artigo em Francês | MEDLINE | ID: mdl-15679234

RESUMO

OBJECTIVE: The authors wanted to assess the level of Streptococcus pneumoniae antibiotic resistance in Ile de France. METHOD: In 2001, 637 clinical strains of S. pneumoniae were prospectively collected from 32 microbiology laboratories. RESULTS: Fifty one percent of strains were isolated from children under 15 years of age and 49% from adults. In children, 76% of strains came from otitis media, 20% from blood culture, in adults most strains (92%) came from blood culture. The overall prevalence of non-susceptible penicillin pneumococci was 61% higher in children (73%) than in adults (50%). Among the non-susceptible penicillin pneumococci 21.8% were resistant (CMI > 1 mg/l). Strains with decreased susceptibility to amoxicillin and cefotaxime were 38% and 17% respectively. Resistant strains to these two drugs (CMI > 2 mg/l) were rare 2.6% and 0.4% respectively. Among other antimicrobial agents, rate of resistance was 63% to erythromycin, 47% to cotrimoxazole, 40% to tetracycline, and 23% to chloramphenicol. The most frequent serogroups were serogroups 19 and 14, respectively 23% and 18%. Serotypes included in heptavalent vaccine covered 90% of children strains under 2 years of age. CONCLUSIONS: The prevalence of resistance to penicillin was high in children particularly in otitis media pus (76%).


Assuntos
Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos , Adulto , Criança , Farmacorresistência Bacteriana , França/epidemiologia , Humanos , Prevalência , Estudos Prospectivos , Streptococcus pneumoniae/isolamento & purificação
7.
Biochim Biophys Acta ; 1500(1): 59-69, 2000 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-10564718

RESUMO

The cystic fibrosis transmembrane conductance regulator (CFTR) is a cyclic AMP-activated chloride channel comprising two membrane-spanning domains (MSDs), two nucleotide-binding domains (NBDs) and a unique regulatory (R) domain. The most frequent cystic fibrosis (CF) mutation, a deletion of Phe508 in NBD1, results in the retention of the DeltaF508 CFTR in the endoplasmic reticulum, as do many other natural or constructed mutations located within the first NBD. In order to further define the role of NBD1 in CFTR folding and to determine whether the higher frequency of mutations in NBD1 with respect to NBD2 results from its position in the molecule or is related to its primary sequence, we constructed and expressed chimeric CFTRs wherein NBD domains were either exchanged or deleted. Synthesis, maturation and activity of the chimeras were assessed by Western blotting and iodide efflux assay after transient or stable expression in COS-1 or CHO cells respectively. The data showed that deletion of NBD1 prevented transport of CFTR to the cytoplasmic membrane whereas deletion of NBD2 did not impair this process but resulted in an inactive chloride channel. On the other hand, substituting or inverting NBDs in the CFTR molecule impaired its processing. In addition, while the NBD1 R555K mutation is known to partially correct the processing of CFTR DeltaF508 and to increase activity of both wild-type and DeltaF508 individual channels, it showed no positive effect when introduced into the double NBD1 chimera. Taken together, these observations suggest that the proper folding process of CFTR results from complex interactions between NBDs and their surrounding domains (MSDs and/or R domain).


Assuntos
Regulador de Condutância Transmembrana em Fibrose Cística/biossíntese , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Processamento de Proteína Pós-Traducional/genética , Animais , Western Blotting , Células CHO , Células COS , Membrana Celular/metabolismo , Cricetinae , AMP Cíclico/farmacologia , Glicosilação , Iodetos/metabolismo , Transporte de Íons/efeitos dos fármacos , Mutagênese Sítio-Dirigida , Dobramento de Proteína , Estrutura Terciária de Proteína/genética , Proteínas Recombinantes de Fusão/biossíntese , Proteínas Recombinantes de Fusão/genética , Relação Estrutura-Atividade , Transfecção
8.
Br J Haematol ; 103(2): 512-7, 1998 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9827927

RESUMO

263 patients (median age 65+/-10 years) with multiple myeloma were treated with cyclophosphamide-prednisone. Out of this cohort, 103 patients had progressive disease and were randomly assigned to either VAD (vincristine, doxorubicin, dexamethasone; 50 cases) or VMBCP (vincristine, BCNU, cyclophosphamide, melphalan and prednisone; 53 cases). There were no statistical differences between the two groups with the respect to clinical, biological and radiological parameters. There was no difference in survival between the VAD and VMBCP groups. The 4 months response rate was similar in the two groups (50% VAD, 56% VMBCP). With multivariate analysis for survival (Cox model), two factors had a statistically significant impact: Karnofsky index (> 60) and albuminaemia (< 34 g/l). With both Karnofsky index > 60 and albuminaemia > or = 34 g/l, the median survival was 29 months v 2 months with a Karnofsky index < or = 60 and albuminaemia < 34 g/l (P<0.05). In conclusion, VAD or VMBCP had similar activity for salvage treatment in MM refractory or relapsing to first-line treatment with cyclophosphamide-prednisone.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carmustina/administração & dosagem , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Humanos , Masculino , Melfalan/administração & dosagem , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prognóstico , Terapia de Salvação , Taxa de Sobrevida , Resultado do Tratamento , Vincristina/administração & dosagem
9.
Cancer Radiother ; 2(1): 19-26, 1998.
Artigo em Francês | MEDLINE | ID: mdl-9749092

RESUMO

PURPOSE: Retrospective analysis of results of treatment of 132 subclinical ductal carcinomas in situ, non-palpable. MATERIAL AND METHODS: Patients were treated with limited surgery and 70 Gy radiation therapy (70 Gy). RESULTS: With a median follow-up of 7 years, the total recurrence rate was 6%, and the actuarial rate at 5 years 4% and at 10 years 13% at. These have no influence on recurrence on the specific actuarial survival rate which was 100% at 10 years. In spite of five infiltrating recurrences of seven, no metastasis appeared 48 months after the salvage surgery. The global rate of breast preservation was 92% at 7 years. DISCUSSION AND CONCLUSION: Therapeutic indications were developed taking into account the present analysis and a literature review (2,338 in situ ductal carcinomas, palpable or not, treated with conservative surgery, with or without adjuvant radio-therapy).


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma in Situ/radioterapia , Carcinoma in Situ/cirurgia , Carcinoma Intraductal não Infiltrante/radioterapia , Carcinoma Intraductal não Infiltrante/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento
10.
Br J Haematol ; 95(4): 660-5, 1996 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8982042

RESUMO

There are no well-defined host markers to determine which patients with a diagnosis of monoclonal gammopathy of undetermined significance (MGUS) will progress to multiple myeloma (MM). In this preliminary study we measured plasmatic soluble Fe gamma receptor type III (sFe gamma RIII or sCD16) in 54 individuals with MGUS. 35 patients with multiple myeloma (MM) and 29 healthy controls. We confirmed, through receiver operating characteristic (ROC) curve analysis, that a low level of sCD16 discriminates MM patients from controls. Indeed, for a sCD16 value of 1.3 micrograms/ml, the sensitivity, as well as the specificity, of this discrimination were both equal to 83%, i.e. 83% of MM patients had a plasmatic sCD16 value < 1.3 micrograms/ml compared with only 17% of controls. Moreover, ROC curve analysis showed that a low sCD16 level also identifies among MGUS patients a subgroup of patients who rapidly progress towards multiple myeloma: in this comparison, for a sCD16 level of 1.3 micrograms/ml. sensitivity and specificity were 70% and 79% respectively. Therefore a low sCD16 level in MGUS indicated a high likelihood of rapid evolution of MM. In contrast to sCD16, soluble IL-6R did not appear to be discriminant in this study.


Assuntos
Mieloma Múltiplo/diagnóstico , Paraproteinemias/diagnóstico , Receptores de IgG/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade
11.
Ann Chir ; 49(1): 56-61, 1995.
Artigo em Francês | MEDLINE | ID: mdl-7741470

RESUMO

102 patients with sub-clinical intra ductal non invasive breast cancer (T0N0) treated by limited surgery and curative radiation therapy. Follow-up ranged from 2 to 10 years with a median follow-up of 59 months. The long term survival rate of this therapeutic approach, consisting of simple excision without any adjuvant treatment and radical mastectomy was close to 100%. The actuarial local recurrence rate was only 8.6% at 10 years (confidence interval: 4.6 to 12.6%), which strongly suggests that radiation therapy is active on multicentric foci. Salvage surgery could be performed in every case of local recurrence. The survival rate of in situ breast cancer (T0N0) treated by conservative radio-surgery is comparable to that of radical mastectomy, while cosmetic results and psychological impact appear to be better for the conservative technique (breast preservation rate = 91 to 96%).


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma in Situ/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Neoplasias da Mama/radioterapia , Carcinoma in Situ/radioterapia , Carcinoma Intraductal não Infiltrante/radioterapia , Terapia Combinada , Feminino , Seguimentos , Humanos , Mastectomia Simples , Pessoa de Meia-Idade , Recidiva Local de Neoplasia
12.
Nouv Rev Fr Hematol (1978) ; 37(4): 241-4, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-8904204

RESUMO

The majority of low grade non-Hodgkin's follicular lymphoma undergo clinical progression to intermediate and high grade lymphoma, but the molecular mechanisms involved in this transformation are not yet well understood. In this article, we describe the case of a 66 year old man with follicular non-Hodgkin's lymphoma (NHL), in whom a centroblastic leukaemic transformation led to death in six months, despite a transient period of remission. At the time of transformation, cytogenetic analysis revealed the original coexistence of t(14;18)(q32;q21) and t(8;22)(q24;q11). These results were confirmed by fluorescent in situ hybridization, while molecular analysis showed a BCL2-JH rearrangement but failed to detect a c-myc rearrangement or any additional p53 mutation. Our observations would therefore suggest other mechanisms to be involved in the transformation of follicular NHL.


Assuntos
Cromossomos Humanos , Linfoma Folicular/genética , Transformação Genética , Translocação Genética , Idoso , Cromossomos Humanos Par 14 , Cromossomos Humanos Par 18 , Cromossomos Humanos Par 22 , Cromossomos Humanos Par 8 , Evolução Fatal , Humanos , Masculino
13.
Ann Hematol ; 66(6): 303-8, 1993 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8318560

RESUMO

We retrospectively analyzed overall survival and survival after progression in 91 patients with low-grade follicular lymphoma (LGFL). Histological subtype was B in 75 patients and C in 16 patients. Twelve patients with localized disease received involved-field radiotherapy; seven patients without bulky disease had no initial therapy. The remaining 72 patients received long-term chlorambucil (9 patients), MOPP or COPBleo (42 patients), or a CHOP-derived regimen (21 patients). Forty-two patients (46%) achieved a complete remission (CR) and 28 patients (31%) achieved a partial remission; 48 of these 70 patients relapsed or progressed. Nineteen of the other 21 patients with stable LGFL progressed. Two other patients failed to respond and rapidly died. Thirty-two of the 67 patients with progressive or relapsed LGFL have died. Median overall survival was 111 months. Age > or = 70 years, male sex, B symptoms, histological subtype follicular mixed-cell NHL, tumor size > or = 10 cm, number of extranodal sites of disease > or = 2, pleural effusion, and Ann Arbor stage III or IV were found to adversely influence overall survival. Failure-free survival < 24 months, failure to achieve a CR after the progression, initial histological subtype follicular mixed cell, initial Ann Arbor stage III or IV, and initial tumoral size > or = 10 cm were found to adversely influence survival after progression. Our results suggest that most prognostic factors for overall survival in LGFL are related to histological subtype or tumor burden. Some initial adverse prognostic factors for survival may be also associated with a poor survival after progression.


Assuntos
Linfoma Folicular/epidemiologia , Linfoma não Hodgkin/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfoma Folicular/mortalidade , Linfoma não Hodgkin/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
14.
Mol Biochem Parasitol ; 57(1): 117-26, 1993 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8426607

RESUMO

The DNA coding for the circumsporozoite protein of Plasmodium falciparum (CSP; aa 1-412) has been placed under the control of the mycobacterial promoter derived from the gene encoding the 64-kDa antigen of Mycobacterium bovis-BCG. This expression cassette was cloned into pJRD184, an Escherichia coli multicloning site vector, together with the kanamycin resistance gene from Tn903 and the attachment site and integrase gene from the temperate mycobacteriophage FRAT1. One of the resulting plasmids, pNIV2173, introduced by electroporation into both Mycobacterium smegmatis and M. bovis-BCG, integrated at a specific site in the genome of each recipient. Recombinants expressed immunoreactive polypeptides, ranging in size from 62 to 43 kDa, at a level of about 1% of total soluble proteins. Part of this material was present in the culture medium indicating that mycobacterial recombinants were able to secrete the CSP. The M. smegmatis and M. bovis-BCG recombinants, transformed with pNIV2173 and grown in absence of antibiotic, were followed for more than 400 and 50 generations respectively. Over this time span, neither DNA rearrangement nor loss of expression was observed. Inoculation of the recombinant BCG to mice did not induce humoral response to CSP nor proliferative response to CSP Th2R CD4+ T lymphocyte epitope.


Assuntos
Genes de Protozoários , Plasmodium falciparum/genética , Proteínas de Protozoários/genética , Animais , Sequência de Bases , Clonagem Molecular , DNA de Protozoário/genética , Expressão Gênica , Dados de Sequência Molecular , Mycobacterium/genética , Plasmídeos , Proteínas de Protozoários/biossíntese , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/genética
16.
Br J Haematol ; 80(2): 199-204, 1992 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-1550777

RESUMO

A randomized trial has been performed in which 91 patients with stage III myeloma and additional severe criteria were randomly allocated to either VAD or VMBCP. No significant difference was noted between these two groups using the following criteria: response rate (VMBCP: 54%; VAD: 39%), impact on symptoms, median survival (VMBCP: 14 months, VAD: 17 months). However, toxic effects and refusal to pursue treatment were more frequent with VAD than with VMBCP (12 v 6). Therefore, in this trial, VMBCP appears to be more useful than VAD.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carmustina/administração & dosagem , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Humanos , Masculino , Melfalan/administração & dosagem , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Prednisona/administração & dosagem , Prognóstico , Vincristina/administração & dosagem , Vincristina/efeitos adversos
17.
Chemotherapy ; 37(5): 382-8, 1991.
Artigo em Inglês | MEDLINE | ID: mdl-1804600

RESUMO

100 febrile patients with chemotherapy-induced neutropenia (less than 0.5 x 10(9)/l) were empirically treated by ceftriaxone (2 g daily in adults, 50 mg/kg daily in children, as a once daily injection) and amikacin (15-20 mg/kg daily). The mean age was 41 years (range 8-72). 51 patients had acute leukemia, 29 non-Hodgkin's lymphoma, 12 Hodgkin's disease, 8 other disorders. 23 febrile episodes were bacteriologically documented (gram-positive: 13 patients; gram-negative: 8 patients; Candida: 2 patients) including 13 cases of bacteremia; 10 were clinically documented, and 67 remained of undetermined origin. Apyrexia was obtained in 39 patients by ceftriaxone plus amikacin alone (success), in 36 patients after the addition of vancomycin and/or amphotericin B (improvement), whereas in the remaining 25 patients it was necessary to substitute the study drug. The failure rate was correlated to the duration of neutropenia: 0/13 when neutropenia less than 6 days; 3/41 (7%) when 6-10 days; 22/46 (48%) when greater than 10 days. Only 2/20 (10%) of patients with neutropenia greater than 20 days were treated with ceftriaxone plus amikacin alone. 9 of the 23 bacteriologically documented episodes were successes (including 6 of the 11 cases due to Staphylococcus), 7 were improvements and 7 were failures (including the 3 cases due to Pseudomonas). No side effects were seen. Ceftriaxone plus amikacin is an effective firstline antibiotic combination in the treatment of febrile neutropenic patients.


Assuntos
Amicacina/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Ceftriaxona/uso terapêutico , Neutropenia/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Infecções Bacterianas/etiologia , Criança , Quimioterapia Combinada/uso terapêutico , Humanos , Leucemia/complicações , Linfoma não Hodgkin/complicações , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente
18.
Leuk Lymphoma ; 4(4): 239-48, 1991.
Artigo em Inglês | MEDLINE | ID: mdl-27463043

RESUMO

Over a period of 14 years, we treated 70 cases of acute promyelocytic leukemia (APL) with 3 different chemotherapy protocols. In protocol 1, patients received high dose daunorubicin (DNR) alone for induction, followed by regular reinduction courses and continuous maintenance therapy with 6 mercaptopurine (6 MP) and methotrexate (MTX) during 3 years. In protocol 2, induction with high dose DNR and Ara C was also followed by regular reinduction courses, but without continuous maintenance therapy. Protocol 3 randomized high dose Amsacrine (AMSA) or Rubidazone in association with Ara C, for induction and consolidation, this was followed by reinduction courses and continuous maintenance therapy with 6 MP and MTX. During the induction all patients received, prophylactic heparinization and platelet transfusions. Fifty six patients (80%) achieved complete remission (CR), 13 patients (18.5%) had early death (ED) or hypoplastic death (HD), and 1 patient had true resistant leukemia. Only two patients died of hemorrhage. Median actuarial disease free survival (DFS) was 16.5 months and a plateau at 29.1% was reached after 29 months. Patients with fever at diagnosis had a significantly lower CR rate while age below 20 years and circulating blasts above 0.5 × 10(9)/1 were associated with shorter DFS. The CR rate did not significantly differ between protocols 1, 2 and 3 (87.5%, 80% and 60% respectively) but 9 of the 30 patients on protocols 2 or 3 had ED or HD, compared to 4 of the 40 treated with protocol 1 (p < 0.05). DFS was significantly shorter in protocol 2, which included no continuous maintenance chemotherapy, than in protocols 1 and 3. Median actuarial survival was significantly shorter in patients treated with protocols 2 or 3, compared to protocol 1. These results suggest that high dose DNR alone, associated with adequate prophylaxis of disseminated intravascular coagulation, gives very high CR rates in APL, with short periods of aplasia and limited toxicity. Combinations of an anthracycline or AMSA at the doses used with regular dose Ara C may be too toxic. Although this was not a randomized trial, our findings also suggest a possible benefit of prolonged continuous maintenance therapy with 6 MP and MTX in APL.

19.
Rev Med Interne ; 11(1): 13-8, 1990.
Artigo em Francês | MEDLINE | ID: mdl-2109345

RESUMO

IgM myeloma is a rare plasma cell neoplasia, with an estimated incidence of 0.5% in patients with myeloma. Approximately, between 2 and 3.3% of IgM monoclonal gammopathy are IgM myeloma. Six unpublished cases of IgM myeloma, association of an IgM monoclonal gammopathy and an exclusive plasma cell neoplasia, are reported. Forty-six other cases have been found in the literature. The initial clinical characteristics of these patients are: sex-ratio of 1.1, mean age of 62 years, fatigue in 95% of the cases, bone pain in 80%, osteolytic lesions in 78%, fever in 13%, hepatomegaly and splenomegaly in 8%, lymphadenopathy in 10%, hemorrhagic diathesis in 35% and neurologic involvement in 18%. Initial biological features are: anemia in 62% of the cases, creatininemia greater than 20 mg/l in 10%, calcemia greater than 120 mg/l in 24%. Mean serum IgM level is 33 g/l, mean medullary plasmocytosis is 52%. 80% of the patients presented with IgM kappa and only 20% with IgM lambda. Proteinuria with light chains are found in 65%. One-year survival is estimated at 82%, 2-year at 62%, 3-year at 46% with a median of 30 months. No prognostic factor is found. IgM myeloma with characteristics of both myeloma and macroglobulinemia appears well individualized among B-cell neoplasia. However, the distinction between Waldenström's macroglobulinemia and IgM myeloma can be difficult in case of lympho-plasmocytic bone marrow proliferation with osteolytic lesions.


Assuntos
Imunoglobulina M/imunologia , Mieloma Múltiplo/imunologia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Prognóstico , Fatores de Tempo , Macroglobulinemia de Waldenstrom/diagnóstico , Macroglobulinemia de Waldenstrom/imunologia
20.
Leuk Lymphoma ; 2(6): 399-405, 1990.
Artigo em Inglês | MEDLINE | ID: mdl-27457044

RESUMO

We report 11 children (aged less than 20 years) with acute promyelocytic leukemia (APL), who represented 14% of our total number of patients with APL. There were 8 girls and 3 boys and the median age was 13.5 (range 3-19). Extramedullary leukemia was present in only 1 patient and hyperleukocytosis in 3 patients. Cytologically, 9 patients had "classical" APL, and 2 had the microgranular variant APL. Translocation (15;17) was present in all 4 karyotyped patients. Disseminated intravascular coagulation was seen in 8 patients at diagnosis, and was triggered by chemotherapy in 2 other cases. Induction chemotherapy was daunorubicin (DNR) alone in 6 patients, DNR + Ara C in 4 and zorubicin + Ara C in the remaining case. All patients received heparin during induction. Seven patients (64%) achieved complete remission (CR), 2 had resistant leukemia and 2 died during induction. Among the complete remitters, one received no further therapy and relapsed after 4 months, and another died of an unrelated cause after 4 weeks, while still in CR. The 5 others all relapsed after 3 to 13 months. Median survival was 5.5 months. Disease free survival (DFS) was significantly shorter than in our adult APL patients treated with the same regimens. APL is a rare disease in children and our results suggest that it may be associated with short remissions, especially when compared with adult APL. This could justify therapeutic reinforcement in these cases, such as allogeneic bone marrow transplantation, whenever possible, after CR has been achieved.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA