1,721,242 research outputs found
Systematic review of purine analog treatment for chronic lymphocytic leukemia: lessons for future trials
No full textA systematic review of purine analogs revealed heterogeneity between trials in treatment effects on response and progression free survival, but not survival, perhaps partly due to variations in analytical methods. In addition, combination treatments required evaluation. Therefore, individual patient data were sought for all randomized trials in untreated chronic lymphocytic leukemia which involved a purine analog, but which did not include antibody therapies. Sixteen trials were found, addressing seven comparisons. Eight trials, with 2,753 patients, showed that single agent purine analog improved progression free survival (odds ratio=0.71; 95% confidence interval=0.63-0.79). Heterogeneity remained substantial. Three trials, with 1,403 patients, showed that progression free survival was further improved by the addition of cyclophosphamide (odds ratio=0.54; 0.47-0.62). Fewer data were available on the addition of other drugs to purine analog, and none showed clear benefit. Two trials, with 544 patients, suggested cladribine improved progression free survival compared to fludarabine (odds ratio=0.77; 0.63-0.95). No differences were seen in overall survival for any comparisons. In conclusion, purine analogs, particularly combined with cyclophosphamide, significantly improve progression free survival but not survival. Some groups, such as the elderly, may not see the same benefits and maximizing doses may be important for all treatments, including chlorambucil. Longer follow up, consistent definitions and detailed reporting of trials should be encourage
A randomized trial comparing different alfa-interferon at different dose and duration as therapy for chronic hepatitis C.
No full textLow-dose interferon-alpha in stage-I multiple myeloma and IgM monoclonal gammopaty
No full textInterferon (IFN)-alpha can induce objective responses in advanced-stage multiple myeloma (MM) and can delay disease progression in patients responsive to chemotherapy. We studied the effects of low-dose (3 MU daily) human recombinant IFN-alpha 2b for 6-12 months in 29 consecutive cases of previously untreated, stable-phase, early stage, monoclonal gammopathy (MG) (23 cases of stage I MM and six cases of IgM MG). In 25/29 patients, the disease remained stable throughout the study period. A major objective response was observed in one of five cases of IgA MG. Normal Ig levels increased in all five cases of IgA MG. A significant disease progression occurred in 2/29 cases during the 1-year study period. These data showed that the objective response rate of early-stage MG to low-dose IFN was low and suggested that further investigation should focus on IgA MG
LOW-DOSE A-INTERFERON AND PREDNISONE FOR TREATMENT OF B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA.
No full textInterferon therapy in chronic HCV hepatitis: Evidence of different outcome with respect to different viral strain
No full textThe aim of the study was to assess the role of different viral strains of hepatitis C virus (HCV) in determining the outcome of the alpha-interferon (IFN) therapy. Fifty-seven patients (34 from Italy and 23 from Japan) with HCV-positive liver disease were enrolled in the study. The NS4 region of HCV was amplified in sera by 'nested' polymerase chain reaction (PCR) using a primer pair synthesized according to the sequence of JK-1. The NS4 region was positive in 14 (41%) Italian and in 13 (56%) Japanese patients. In positive patients the sequence of the NS4 region was also obtained. Subsequently, HCV genotype was determined in all patients by PCR amplification of the core region. All patients received recombinant alpha2a-interferon (IFN), 6 million units 3 times a week for 1 month followed by 3 million units 3 times a week for 5 months. The patients were followed for 1 year after the end of treatment. At the end of the follow-up, 17 (30%) had sustained normal revels of serum alanine aminotransferase (ALT). The outcome of treatment was not correlated with race, age, sex, histology, and pretreatment ALT level, but was significantly (P < 0.00001) associated with the presence of both the NS4-JK-1 region and HCV type II. Among the 27 NS4-positive patients, only 1 patient (3.7%) achieved a complete response, whereas the remaining 26 patients (96.3%) either were non-responders or relapsed after IFN was discontinued. In contrast, among the 30 NS4-JK-1-negative patients, 15 (53%) had a sustained remission. HCV genotyping showed type I in 3 (6%), type II in 40 (74%), type III in 4 (7%), and type IV in 3 (6%) cases. Coinfection was present in 4 (7%), while in 3 cases amplification was not obtained. Patients with type II were all non-responders or relapsers, while a response to the treatment was oberved in 17 of 77 (100%) of the remaining patients. These data indicate that the presence of JK-1 variant of HCV or HCV type II is almost always predictive of a poor response rate of IFN therapy
Hematologic problems in the Critically III
No full textThis book covers a wide array of hematologic problems commonly encountered in the daily practice of critical care and Emergency medicine. Unfortunately, the symptoms and sign associated with underlyng hematologic disorders are frequently rather unspecific and confounding; furthemore, the clinical course of patients admitted to intensive care units with such disorders can be fulminant, warrating pompt diagnosis
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