1,721,016 research outputs found
Corso di malattie del sangue e degli organi emolinfopoietici
No full textQuesta nuova edizione del Corso di Malattie del Sangue e degli Organi Emolinfopoietici incorpora tutti gli aggiornamenti dell'ultima revisione della classificazione delle neoplasie del tessuto emopoietico e linfoide edita dall'Organizzazione Mondiale della Sanità. Inoltre, presenta in modo completo le più recenti acquisizioni biologiche e terapeutiche nell'ambito delle patologie dell'eritropoiesi, della piastrinopoiesi e della coagulazione del sangue, con particolare enfasi sia su molecole recentemente approvate, sia su farmaci in sperimentazione.
Sono passati 5 anni dalla stesura dell’ultima edizione di questo Manuale e a giudicare dalla mole di nuove acquisizioni di biologia, prognosi e terapia delle malattie del sangue sembra che sia passato un secolo. Le nuove conoscenze, nella maggior parte dei casi, hanno un impiego clinico che ha modificato il decorso di molte emopatie, la “qualità” della vita durante la terapia, la sopravvivenza e la percentuale di guarigioni. Lo studente di medicina deve sapere che, oggi, la maggior parte dei pazienti, compresi quelli a peggiore prognosi, possono essere curati ambulatorialmente con grandi vantaggi per la qualità della loro vita. Tutto questo è il frutto d’importanti acquisizioni di biologia molecolare, cellulare e di farmacologia che hanno portato alla sintesi di nuovi farmaci che vengono messi sul mercato con incredibile frequenza e mirati a distruggere le cellule patologiche risparmiando quelle sane. Sono farmaci ben tollerati e molto spesso somministrati per via orale
Corso di malattie del sangue e degli organi emolinfopoietici
No full textIl metodo della ricerca clinic
Melphalan-prednisone versus alternating combination VAD/MP or VND/MP as primary therapy for multiple myeloma: final analysis of a randomized clinical study
No full textIn the absence of a cure for multiple myeloma (MM) with standard-dose therapy, any strategy that can be expected to increase tumor reduction and to extend survival duration is likely to be of clinical relevance. The primary end-point of the present study was to investigate whether the alternating combination of vincristine-doxorubicin-dexamethasone (VAD) and melphalan-prednisone (MP) or vincristine-mitoxantrone-dexamethasone (VND) and MP could improve the clinical outcome of MM patients thus treated in comparison with those receiving MP alone
Adult lymphoblastic lymphoma: Clinical features and prognostic factors in 53 patients
No full textLymphoblastic lymphoma (LBL) in adult patients is recognized as a particular entity in the high-grade non-Hodgkin's lymphoma (HG-NHL) group with characteristic clinical and prognostic features. Initially, polychemotherapy normally used in HG-NHL failed to produce long-term relapse-free survival because of progression disease in the CNS and in the bone marrow. Subsequently, the intensification of therapy using multimodality aggressive acute lymphoblastic leukemia (ALL) treatments led to an increase in long-term relapse-free survival. We analyzed retrospectively 53 adult patients with LBL according to the Kiel classification and the criteria by Nathwani et al. Therapeutic modifications depended upon the different times of diagnosis. Twenty-one patients received the modified L17 regimen, 13 patients were treated with the L0288 regimen, and 19 patients were submitted to the L20 protocol. There was no significant differences in CR rates among the three protocols: 48% vs 54% vs 63%, respectively. Nineteen of 29 patients who achieved CR were alive and relapse-free at a median follow-up of 84 months. Ten of the CR patients underwent autologous bone marrow transplantation (ABMT) to consolidate the first response and 7 of them are alive and relapse-free. Early stage of disease, age < 30 years, low LDH levels, the absence of leukemic phase at diagnosis, and, in particular the attainment of CR were all features of patients with good prognosis. Our study confirms the role of intensive polychemotherapeutic regimens including CNS prophylaxis, the significance of a score model of prognostic factors, and of the role of ABMT (or allogeneic bone marrow transplantation) in the treatment of adult LBL
Critical concepts, practice recommendations, and research perspectives of pixantrone therapy in non-Hodgkin lymphoma: a SIE, SIES, and GITMO consensus paper
Full text linkObjectives: In this paper, we present a review of critical concepts and research perspectives and produce recommendations on the optimal use of pixantrone in non-Hodgkin lymphoma (NHL) by group discussion from an expert panel appointed by the Italian Society of Hematology and the affiliate societies, Societa Italiana di Ematologia Sperimentale and Gruppo Italiano Trapianto di Midollo Osseo. Methods: Recommendations were produced using the Delphi process. Scientific evidence on pixantrone efficacy was analyzed using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology in the areas where at least one randomized trial was published. The following key issues were addressed for practical recommendations: pixantrone monotherapy in aggressive relapsed or refractory non-Hodgkin B-cell lymphomas and toxicity risk management in patients candidates to pixantrone. Results and conclusions: After a balanced and value-oriented discussion, the panel agreed that the benefit/risk profile was in favor of pixantrone in the treatment of adult patients with multiply relapsed or refractory aggressive NHL B-cell lymphomas. Pixantrone was deemed to be contraindicated in patients with uncontrolled cardiovascular disease. Despite a low rate of cardiotoxicity of pixantrone reported in clinical trials, the panel recommended that all patients receiving pixantrone should undergo periodical cardiac monitoring
Allogeneic bone marrow transplantation for the treatment of multiple myeloma: An overview of published reports
No full textAllogeneic bone marrow transplantation (BMT) was first explored for the treatment of multiple myeloma (MM) in the mid 1980s. Since then, there has been a rapidly growing clinical demand for the use of this modality of treatment, so that the number of patients receiving worldwide transplants from HLA‐identical siblings is actually estimated to be at least several hundreds. Although it is difficult to compare results between different centers because of differences in patient characteristics, selection criteria for transplantation and conditioning regimens, a certain number of conclusions have emerged from these experiences. There is evidence that allogeneic BMT performed in different phases of MM and with different conditioning regimens yields a high frequency of complete remissions (CR), in the range of 50% to 60%, and long‐term survival and remission rates, both averaging approximately 20%. Although a toxic‐related mortality rate of 40% has been consistently reported for many years, the outcome of patients in whom BMT was performed as consolidation of remission has recently improved. Prior responsiveness to conventional chemotherapy, also the presence of low tumor cell mass (both at diagnosis and before transplant) predicts for increased CR rate (up to 70% or more), as well as long‐term survival and remission rates (both averaging approximately 50%). The continued relapse‐free survival, up to and beyond ten years, reported for some of these patients provides strong evidence that allogeneic BMT has the potential ability to cure MM, probably as the result of an immunologic effect of the infused donor's marrow T lymphocytes against residual myeloma cells (graft‐versus‐myeloma). It can be concluded that allogeneic BMT is an effective, potentially curative treatment strategy for carefully selected MM patients with unfavorable prognostic features at diagnosis. Copyright © 1995 AlphaMed Pres
Combined Use of Growth Factors to Stimulate the Proliferation of Hematopoietic Progenitor Cells after Autologous Bone Marrow Transplantation for Lymphoma Patients
No full textWe studied the kinetic response and concentration of bone marrow (BM) progenitor cells of patients with lymphoid malignancies submitted to autologous bone marrow transplantation (ABMT), treated with a granulocyte-colony-stimulating factor (G-CSF)/interleukin-3 (IL-3) combination. The results were compared with those of lymphoma patients receiving the same pretransplant conditioning regimen followed by G-CSF alone. Recombinant human (rh)G-CSF was administered as a single subcutaneous (s.c.) injection at the dose of 5 μg/kg/day from day +1 after reinfusion of autologous stem cells, while rhIL-3 was added from day +6 at the dose of lOμg/kg/day s.c. (overlapping schedule). In both groups (i.e. G-CSF-and G-CSF/ IL-3-treated patients), cytokine administration was discontinued when the absolute neutrophil count was < 0.5× 109/l of peripheral blood for 3 consecutive days. Following treatment with the CSF combination, the percentage of marrow CFU-GM and erythroid progenitors (BFU-E) in the S phase of the cell cycle increased from 9.3 ± 2 to 33.3 ± 12% and from 14.6 ± 3 to 35 ± 6%, respectively (p < 0.05). The number of actively cycling megakaryocyte progenitors (CFU-MK and BFU-MK) also increased. Conversely, G-CSF augmented the proliferative rate of CFU-GM (22.6 ± 6% compared to a baseline value of 11.5 ± 3%; p < 0.05) but not of BFU-E, CFU-MK or BFU-MK, and the increase in S-phase CFU-GM was significantly lower than that observed in the posttreatment samples of patients receiving IL-3 in addition to G-CSF. The absolute number of both CFU-GM and BFU-E/ml of BM was significantly augmented after treatment with G-CSF/IL-3 but not G-CSF alone. Similarly, administration of the cytokine combination resulted in a higher number of CD34+ cells and their concentration was significantly greater than that observed in the posttreatment samples of G-CSF patients. We also investigated the responsiveness to CSFs, in vitro, of highly enriched CD34+ cells, collected after priming with G-CSF in vivo (i.e. after 5 days of G-CSF administration). Our results demonstrated that pretreatment with G-CSF modified the response of BM cells to subsequent stimulation with additional CSFs. When the hematological reconstitution of patients treated with G-CSF/IL-3 was compared to that of individuals receiving G-CSF alone, the addition of IL-3 resulted in a significant improvement in granulocyte and platelet recovery, a lower transfusion requirement and shorted hospitalization. In conclusion, our results indicate that in vivo administration of two cytokines increases the proliferative rate and concentration of BM progenitor cells better than G-CSF alone and support a role for growth factor combinations for accelerating hematopoietic recovery after high-dose chemotherapy. © 1996 S. Karger AG, Basel
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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