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Sapelli J, Filho JS, Matias Vieira GM, Moura FL, Germano JN, de Lima VCC. BuCyE can safely replace BEAM as a conditioning regimen for autologous stem cell transplantation in the treatment of refractory and relapsed lymphomas. Leuk Res 2021; 110:106689. [PMID: 34592699 DOI: 10.1016/j.leukres.2021.106689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Hodgkin's (HL) and non-Hodgkin's (NHL) lymphomas have usually high cure rates. The standard of care for chemosensitive relapsed/refractory lymphoma patients is salvage chemotherapy followed by AHSCT. Due to carmustine and melphalan shortages, alternative pre-AHSCT conditioning regimens with similar tolerance and response were needed. OBJECTIVES To compare the efficacy and toxicity profile between relapsed/refractory HL and NHL lymphomas given BEAM or BuCyE. METHODS A retrospective analyses of 122 patients in a Brazilian center was made. OS and PFS were calculated by Kaplan-Meier and compared by log rank. Toxicity and engraftment data were also compared. RESULTS Most clinical characteristics were similar between groups, although a higher frequency of grade ≥ 2 mucositis (p = .01) was seen in the BuCyE group. No significant difference in OS or PFS were observed between the groups. CONCLUSION BEAM and BuCyE are well tolerated with similar toxicity profiles and survival outcomes. Therefore, BuCyE conditioning regimen can be considered an alternative to BEAM.
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Affiliation(s)
- Jaqueline Sapelli
- Department of Hematology, Department of Bone Marrow Transplantation, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Jayr Schmidt Filho
- Department of Hematology, Department of Bone Marrow Transplantation, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Fernanda Lemos Moura
- Department of Hematology, Department of Bone Marrow Transplantation, AC Camargo Cancer Center, São Paulo, Brazil
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Shibahara I, Miyasaka K, Sekiguchi A, Ishiyama H, Inukai M, Yasui Y, Watanabe T, Sato S, Hide T, Kumabe T. Long-term follow-up after BCNU wafer implantation in patients with newly diagnosed glioblastoma. J Clin Neurosci 2021; 86:202-210. [PMID: 33775329 DOI: 10.1016/j.jocn.2021.01.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/17/2021] [Accepted: 01/23/2021] [Indexed: 12/12/2022]
Abstract
1,3-Bis(2-chloroethyl)-1-nitrosourea (BCNU, or Carmustine) wafers are intraoperatively implantable wafers used to achieve local tumor control. There is scarce data about the behavior of wafers in the long-term follow-up of implanted cases. We reviewed the data of 64 patients with newly diagnosed glioblastoma treated by surgery, BCNU wafers, radiation therapy, and temozolomide administration. This cohort included 55 patients who presented first recurrence, and 49 of them showed tumor progression to death. The MR imaging of each patient at the terminal stage and an autopsy case were used to elucidate the tumor progression pattern after the wafer implantation. We subdivided the first recurrence pattern into local, distant, and multifocal based on MR imaging or into infield, outfield, and marginal based on the radiation field. The first recurrence pattern was 33 patients (60%) with local, 13 (24%) with distant, and nine (16%) with multifocal recurrence, or 38 patients (69%) with infield, 13 (24%) with outfield, and four (7%) with marginal. The median and mean time intervals between MR imaging at the terminal stage and death were 2.0 and 2.3 months, respectively. Of note, 13 patients with first distant recurrence had no obvious radiological local tumor progression even at the terminal stage. Long-term follow-up after BCNU wafer implantation revealed that patients with first distant recurrence had long-lasting local tumor control until the terminal stage.
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Affiliation(s)
- Ichiyo Shibahara
- Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | - Kazuhiro Miyasaka
- Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Akane Sekiguchi
- Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hiromichi Ishiyama
- Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Madoka Inukai
- Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yoshie Yasui
- Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takashi Watanabe
- Department of General Internal Medicine, JCHO Sendai Hospital, Sendai, Miyagi, Japan
| | - Sumito Sato
- Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takuichiro Hide
- Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshihiro Kumabe
- Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Sippl C, Ketter R, Braun L, Teping F, Schoeneberger L, Kim YJ, List M, Nakhoda A, Wemmert S, Oertel J, Urbschat S. miRNA-26a expression influences the therapy response to carmustine wafer implantation in patients with glioblastoma multiforme. Acta Neurochir (Wien) 2019; 161:2299-2309. [PMID: 31478117 DOI: 10.1007/s00701-019-04051-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Glioblastoma multiforme is the most frequent malignant brain tumor in adults being marked with a very poor prognosis. Therapy concept implies concomitant radio-chemotherapy and facultative implantation of carmustine-eluted wafer. Current literature suggests microRNA 26a expression in glioblastoma to interact with alkylating chemotherapy. Subsequently, the aim of this study was to investigate the correlation of miRNA-26a expression and carmustine wafer implantation and its potential usefulness as a predictive marker for therapy response. METHODS In total, 229 patients with glioblastoma multiforme were included into the final analysis. Of them, 80 cases were recruited from the Saarland University Medical Center for a retrospective matched-pair analysis stratified after therapy regime: One group (carmustine wafer group; n=40) received concomitant radio-chemotherapy with carmustine wafer implantation. The other group (control group; n=40) only received concomitant radio-chemotherapy. The results were confirmed by comparing them with an independent dataset of 149 patients from the TCGA database. All tumor specimens were evaluated for miRNA-26a expression, MGMT promoter methylation, and IDH1 R132H mutation status, and the results were correlated with the clinical data. RESULTS Twenty-three patients in the carmustine wafer group showed low expression of miRNA-26a, while 17 patients showed a high expression. In the control group, 28 patients showed low expression, while 12 patients showed a high expression. The patients with high miRNA-26a expression in the carmustine wafer group were characterized by a significantly longer overall (hazard ratio [HR] 2.750 [95% CI 1.352-5.593]; p=0.004) and progression-free survival (HR 3.091 [95% CI 1.436-6.657]; p=0.003) than patients with low miRNA-26a expression. The 17 patients in the carmustine wafer group with high miRNA-26a expression showed a significantly longer progression-free survival (p=0.013) and overall survival (p=0.007) compared with the control group. There were no such correlations identified within the control group. TCGA datasets supported these findings. CONCLUSIONS MiRNA-26a expression turned out to be a promising predictor of therapy response and clinical outcome in glioblastoma patients treated with carmustine wafer implantation. For evaluation of the role of miRNA-26a in a combined therapy setting, further studies are needed in order to translate general findings to the patient's individual situation.
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Affiliation(s)
- Christoph Sippl
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Geb. 90 Kirrbergerstr, 66424, Homburg/Saar, Germany.
| | - Ralf Ketter
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Geb. 90 Kirrbergerstr, 66424, Homburg/Saar, Germany
| | - Luisa Braun
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Geb. 90 Kirrbergerstr, 66424, Homburg/Saar, Germany
| | - Fritz Teping
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Geb. 90 Kirrbergerstr, 66424, Homburg/Saar, Germany
| | - Louisa Schoeneberger
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Geb. 90 Kirrbergerstr, 66424, Homburg/Saar, Germany
| | - Yoo Jin Kim
- Institute of Pathology, Glockenstraße 54, Kaiserslautern, Germany
| | - Markus List
- Max-Planck-Institute of Informatics, Campus E1 4, Saarbrücken, Germany
| | - Arjang Nakhoda
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Geb. 90 Kirrbergerstr, 66424, Homburg/Saar, Germany
| | - Silke Wemmert
- Department of Otorhinolaryngology, Faculty of Medicine, Saarland University, Homburg/Saar, Germany
| | - Joachim Oertel
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Geb. 90 Kirrbergerstr, 66424, Homburg/Saar, Germany
| | - Steffi Urbschat
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Geb. 90 Kirrbergerstr, 66424, Homburg/Saar, Germany
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Bou Akl I, Matar M, Khalil PB, Massoud R, Ghaoui N, Karout L, Zahreddine A, Bazarbachi A, El-Cheikh J. Impact of the Conditioning Regimen Dose Intensity Before Autologous Stem Cell Transplantation on the Pulmonary Function Test Abnormalities in Patients With Lymphoma and Multiple Myeloma: Single Center Experience. Clin Lymphoma Myeloma Leuk 2019; 20:371-376.e1. [PMID: 32151585 DOI: 10.1016/j.clml.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most studies addressing the impact of hematopoietic stem cell transplantation (SCT) on pulmonary function test (PFT), and the various factors affecting that impact have been performed on the allogenic type. Few have addressed PFT changes in autologous SCT. This study describes PFT changes seen in autologous SCT recipients and addresses the various factors impacting these changes. PATIENTS AND METHODS We reviewed the medical records of 223 consecutive adult autologous SCT recipients. We collected pre-transplant and post-transplant data, as well as PFT data and long-term mortality. RESULTS A total of 123 patients with lymphoma receiving the BEAM (carmustine, etoposide, aracytin, and melphalan) conditioning regimen had a significant 5% drop in mean forced vital capacity and total lung capacity but no significant change in forced expiratory volume in one second/forced vital capacity ratio nor in diffusion lung capacity of carbon monoxide adjusted to volume. Fifteen percent of the patients with lymphoma had a clinically significant drop of 15% in their lung volume parameters. The patients with multiple myeloma receiving the melphalan conditioning regimen had no significant change in any of the PFT parameters. Smoking, baseline PFT parameters, and radiation did not affect lung function or mortality. CONCLUSIONS Autologous SCT impact on lung function depends on the disease and conditioning regimen. It leads to a drop in lung volumes but no obstruction or decrease in diffusion in patients with lymphoma receiving the BEAM regimen. Autologous SCT did not affect lung functions in patients with multiple myeloma, and these patients may not need screening PFTs.
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Affiliation(s)
- Imad Bou Akl
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Matar
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pierre Bou Khalil
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
| | - Radwan Massoud
- Bone Marrow Transplant Program, Division of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nohra Ghaoui
- Bone Marrow Transplant Program, Division of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Karout
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ammar Zahreddine
- Bone Marrow Transplant Program, Division of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Bazarbachi
- Bone Marrow Transplant Program, Division of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean El-Cheikh
- Bone Marrow Transplant Program, Division of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
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Salhotra A, Mei M, Stiller T, Mokhtari S, Herrera AF, Chen R, Popplewell L, Zain J, Ali H, Sandhu K, Budde E, Nademanee A, Forman SJ, Nakamura R. Outcomes of Patients with Recurrent and Refractory Lymphoma Undergoing Allogeneic Hematopoietic Cell Transplantation with BEAM Conditioning and Sirolimus- and Tacrolimus-Based GVHD Prophylaxis. Biol Blood Marrow Transplant 2018; 25:287-292. [PMID: 30227232 DOI: 10.1016/j.bbmt.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022]
Abstract
The current standard of care for patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) is high-dose conditioning followed by autologous stem cell transplantation (ASCT). For some patients (ie, those with highest-risk disease, insufficient stem cell numbers after mobilization, or bone marrow involvement) allogeneic hematopoietic cell transplantation (alloHCT) offers the potential for cure. However, the majority of patients undergoing alloHCT receive reduced-intensity conditioning as a preparative regimen, and studies assessing outcomes of patients after alloHCT with myeloablative conditioning are limited. In this retrospective study, we reviewed outcomes of 22 patients with recurrent and refractory NHL who underwent alloHCT with myeloablative BEAM conditioning and received tacrolimus/sirolimus as graft-versus-host disease (GVHD) prophylaxis at City of Hope between 2005 and 2018. With a median follow-up of 2.6 years (range, 1.0 to 11.2 years), the probabilities of 2-year overall survival and event-free survival were 58.3% (95% confidence interval [CI], 35.0% to 75.8%) and 45.5% (95% CI, 24.4% to 64.3%), respectively. The cumulative incidence of grade II to IV acute GVHD was 45.5% (95% CI, 23.8% to 64.9%), with only 1 patient developing grade IV acute GVHD. However, chronic GVHD was seen in 55% of the patients (n = 12). Of the 22 eligible patients, 2 had undergone previous ASCT and 2 had undergone previous alloHCT. Both patients with previous ASCT developed severe regimen-related toxicity. Patients who underwent alloHCT with chemorefractory disease had lower survival rates, with 1-year OS and EFS of 44.4% and 33.0%, respectively. In conclusion, alloHCT with a BEAM preparative regimen and tacrolimus/sirolimus-based GVHD should be considered as an alternative option for patients with highest-risk lymphoma whose outcomes are expectedly poor after ASCT.
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Affiliation(s)
- Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Division of Biostatistics, Department of Information Sciences, City of Hope, Duarte, California
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Tracey Stiller
- Division of Biostatistics, Department of Information Sciences, City of Hope, Duarte, California
| | - Sally Mokhtari
- Department of Clinical Translational Program Development, City of Hope, Duarte, California
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Elizabeth Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California
| | - Auayporn Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California.
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Cufer T, Kolaric K, Cervek J, Cerar O. Combination of 5-Fluorouracil, Imidazole Carboxamide, Bcnu and Prednisolone (FIB-P) as a Salvage Chemotherapy in Heavily Pretreated Breast Cancer Patients. Tumori 2018; 78:26-31. [PMID: 1609455 DOI: 10.1177/030089169207800106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The results of treatment with 5-fluorouracil, imidazole carboxamide, BCNU and prednisolone (FIB-P) salvage chemotherapy in 60 patients with heavily pretreated advanced breast cancer are presented. For most of the patients (82%) this was the third line of chemotherapy. Performance status (ECOG) was 1, 2 and 3 in respectively 13, 27, and 20 patients. Predominant metastatic sites were: soft tissue (3/60, 5%), bone (22/60, 37%), and viscera (35/60, 58%). Tumor burden (number of affected organic systems) was 1, 2 and 3 or more in respectively 18, 24 and 16 patients. Average dose intensity received was 0.74 (range, 0.47–0.98); the average number of cycles was 3.8 (range, 2–8). Objective response (CR + PR) was observed in 22 patients (1 CR, 21 PR), with a response rate of 37% (22/60). Median duration of remission was 7 months (range, 3–15). Tumor burden was the only pretreatment patient characteristic that significantly influenced the remission rate (p < 0.10). Dose intensity significantly affected tumor response (p < 0.05). Toxic side effects (gastrointestinal disorders, alopecia and myelotoxicity) were generally moderate and tolerable. No treatment-related death occurred. FIB-P proved to be an active salvage chemotherapy in heavily pretreated patients with advanced breast cancer.
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Affiliation(s)
- T Cufer
- Institute of Oncology, Ljublijana, Slovenia, Yugoslavia
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Comella G, Daponte A, Comella P, Casaretti R, Iervolino V, Santillo G, Zarrilli D. Combination Chemotherapy with Vinblastine, Bcnu and Cisplatin in Advanced Malignant Melanoma. Tumori 2018; 77:216-8. [PMID: 1862548 DOI: 10.1177/030089169107700306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A combination chemotherapy including vinblastine (6 mg/m2 i.v. days 1–2), BCNU (100 mg/m5 i.v. day 3), and cisplatin (50 mg/m1 i.v. day 5) was given as salvage treatment in 46 consecutive, previously treated patients affected by metastatic malignant melanoma. Courses were planned every 4 weeks provided that a complete bone marrow recovery occurred, otherwise they were delayed for 1–2 additional weeks. Objective responses (3 CRs and 10 PRs) were observed in 13/46 (28%) patients; 12 cases had stable disease and 21 patients progressive disease during treatment. Median duration of response was 13 months (range, 5–18), and median survival was 11 months (range, 3–20) for all patients. Nausea and vomiting were the most distressing side effects, whereas a grade I leukopenia caused a delayed treatment in 90% of patients. In conclusion, the combination chemotherapy was moderately toxic and did not seem to give substantially better results than obtained with other reported regimens.
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Affiliation(s)
- G Comella
- Division of Medical Oncology A, National Tumor Institute, Naples, Italy
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Foppoli M, Citterio G, Polastri D, Guerrieri R. The Feasibility of Repetitive Courses of High-Dose Continuous Intravenous Infusion Interleukin-2 and Subcutaneous Alpha-Interferon with Polychemotherapy in Advanced Malignant Melanoma. Tumori 2018; 81:102-6. [PMID: 7778212 DOI: 10.1177/030089169508100206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background A Phase I study of repetitive courses of chemotherapy (carmustine, cis-platinum, dacarbazine) and immunotherapy (continuous intravenous infusion recombinant interleukin-2 (rIL-2) and subcutaneous (sc) alpha-interferon 2b) plus tamoxifen was performed in order to establish a more efficaciuous way to sequence this kind of treatment for advanced malignant melanoma. Study design Patients who had measurable metastatic melanoma, a Karnofsky performance status ≥ 80, and no clinically significant hematologic or cardiac disfunction were considered eligible. Treatment consisted of BCNU, 150 mg/m2 i.v. day 1 in alternating cycles; DTIC, 220 mg/m2 i.v. days 1, 2 and 3; CDDP, 25 mg/m2 i.v. days 1, 2 and 3; tamoxifen 10 mg twice/day per os continuously; rIL-2, 18 × 106 IU/m2/day continuous i.v. infusion days 5-8 (96 h) and days 19-22 (96 h); alpha-interferon (IFN) s.c. 3 × 106 U day 12, 6 × 106 U day 14, 9 × 106 U days 16, 19, 21, 23, 26, and 28 (from cycle 2, 9 × 106 U days 2, 5, 7, 9, 12, 14, 16, 19, 21, 23, 26, and 28). Two consecutive cycles were planned until response evaluation. Results Three patients were treated according with the protocol; none of them was able to respect the planned dose-intensity schedule. The given dose intensity/planned dose intensity ratios were as follows: DTIC, 0.74 (range, 0.70-0.80); CDDP, 0.77 (0.72-0.80); BCNU, 0.77 (0.72-0.80); rIL-2, 0.65 (0.36-0.80); alpha-IFN, 0.01 (0-0.03); tamoxifen, 1.0. Systemic side effects of rIL-2 and myelotoxicity were the main reasons for treatment delay and/or dose-reduction, and for the long period of hospital care. Conclusions We conclude that the treatment schedule is not feasible. However, since we believe that combined chemo-immunotherapy is a potentially active treatment in metastatic malignant melanoma, we have modified it in order to make it more feasible and consequently efficacious.
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Affiliation(s)
- M Foppoli
- Divisione di Medicina II, IRCCS H S. Raffaele, Milan, Italy
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Carella AM, Giordano D, Santini G, Frassoni F, Podestà M, Van Lint MT, Bacigalupo A, Nati S, Vimercati R, Occhini D, Bistolfi F, Lucarelli G, Lercari G, Marmont AM. High Dose BCNU Followed by Autologous Bone Marrow Infusion in Glioblastoma Multiforme. Tumori 2018; 67:473-5. [PMID: 6275588 DOI: 10.1177/030089168106700513] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Four patients with glioblastoma multiforme were treated with high dose BCNU, 800 mg/m2, and autologous marrow transplantation. Two patients were treated in their first and 2 in their second remission. All patients are alive between 1 and 12 months from transplantation.
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Russo RG, Cattaneo MT, Bartosek I. Pharmacokinetics of Nitrosoureas: Comparison of 1,3-Bis-(2-Chloroethyl)-1-Nitrosourea (Bcnu) and 1-(2-Chloroethyl)-3-Cyclohexyl-1-Nitrosourea (Ccnu) after Oral and Intravenous Administration to Rats. Tumori 2018; 70:499-502. [PMID: 6531792 DOI: 10.1177/030089168407000605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Differential pulse polarographic assay of intact nitrosoureas revealed the lower bioavailability of CCNU (1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea) in stomach and liver after oral administration to rats in comparison to BCNU (1,3-bis-(2-chloroethyl)-1-nitrosourea); blood levels of CCNU were below the detection limit of the method (20 ng). After i.v. bolus the CCNU concentration in plasma fell faster than that of BCNU. The rate of CCNU decomposition during incubation with blood at 37 degrees C was 3 times lower than that of BCNU.
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Sulis E, Floris C, Chessa A, Desogus A, Muggiano A, Tedde A, Turno R. Sequential Treatment with Interferon and Chemotherapy of Metastatic Malignant Melanoma. Total Remission of Cutaneous and Visceral Metastasis, but not of Cerebral Metastasis. Tumori 2018; 73:55-8. [PMID: 3824533 DOI: 10.1177/030089168707300111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A woman 35 years of age suffering from cutaneous and visceral metastatic melanoma was treated with recombinant Interferon α 2b (rIFNα2b) subcutaneously 3 × 106 U/m2 3 times a week for 3 months with no apparent effect on the course of the illness. Two months after IFN therapy the patient developed cerebral metastasis. A cycle of carmustine, 100 mg/day for 3 days, was given, and complete disappearance of the cutaneous and visceral, but not of the cerebral manifestations was observed. Two consolidation cycles based on vincristine, dacarbazine and lomustine were then administered. The patient died 26 months after beginning treatment with IFN and 18 months after chemotherapy for the cerebral metastasis. No trace of tumor at the cutaneous or visceral level was found at autopsy.
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Bartosek I, Russo RG, Cattaneo MT. Pharmacokinetics of Nitrosoureas: Levels of 1,3-Bis-(2-Chloroethyl)-1-Nitrosourea (Bcnu) in Organs of Normal and Walker 256/B Carcinoma Bearing Rats after I.V. Bolus. Tumori 2018; 70:491-8. [PMID: 6531791 DOI: 10.1177/030089168407000604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The disappearance of 1,3-bis(2-chlorethyl)-1-nitrosourea (BCNU) from plasma, liver, kidney, lung, brain, spleen, tumor tissue and epididymal adipose tissue of Walker 256/B carcinoma-bearing rats and healthy animals was measured by differential pulse polarography after i.v. bolus of the drug. Only BCNU, not its decomposition products, was detected by the polarographic assay. Levels of BCNU in liver of tumor-bearing animals were significantly lower (about 10 times) than those on healthy rats. A bi-exponential fit was used to calculate the kinetics of BCNU in plasma, kidney, lung and brain, but no difference could be found between healthy and Walker tumor-bearing rats. BCNU disappeared faster from adipose tissue of tumor-bearing animals than from normals.
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13
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McCormack A, Dekkers OM, Petersenn S, Popovic V, Trouillas J, Raverot G, Burman P. Treatment of aggressive pituitary tumours and carcinomas: results of a European Society of Endocrinology (ESE) survey 2016. Eur J Endocrinol 2018; 178:265-276. [PMID: 29330228 DOI: 10.1530/eje-17-0933] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/08/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To collect outcome data in a large cohort of patients with aggressive pituitary tumours (APT)/carcinomas (PC) and specifically report effects of temozolomide (TMZ) treatment. DESIGN Electronic survey to ESE members Dec 2015-Nov 2016. RESULTS Reports on 166 patients (40 PC, 125 APT, 1 unclassified) were obtained. Median age at diagnosis was 43 (range 4-79) years. 69% of the tumours were clinically functioning, and the most frequent immunohistochemical subtype were corticotroph tumours (45%). Ki-67 index did not distinguish APT from PC, median 7% and 10% respectively. TMZ was first-line chemotherapy in 157 patients. At the end of the treatment (median 9 cycles), radiological evaluation showed complete response (CR) in 6%, partial response (PR) in 31%, stable disease (SD) in 33% and progressive disease in 30%. Response was more frequent in patients receiving concomitant radiotherapy and TMZ. CR was seen only in patients with low MGMT expression. Clinically functioning tumours were more likely to respond than non-functioning tumours, independent of MGMT status. Of patients with CR, PR and SD, 25, 40 and 48% respectively progressed after a median of 12-month follow-up. Other oncological drugs given as primary treatment and to TMZ failures resulted in PR in 20%. CONCLUSION This survey confirms that TMZ is established as first-line chemotherapeutic treatment of APT/PC. Clinically functioning tumours, low MGMT and concurrent radiotherapy were associated with a better response. The limited long-term effect of TMZ and the poor efficacy of other drugs highlight the need to identify additional effective therapies.
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Affiliation(s)
- Ann McCormack
- St Vincent's Hospital and Garvan Institute of Medical Research, Sydney, Australia
| | - Olaf M Dekkers
- Department of Internal Medicine (Section Endocrinology) & Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Jacqueline Trouillas
- Centre de Pathologie et de Biologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Gerald Raverot
- Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Université de Lyon, Bron, France
| | - Pia Burman
- Department of Endocrinology, Skåne University Hospital Malmö, University of Lund, Lund, Sweden
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14
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Bourdillon P, Boissenot T, Goldwirt L, Nicolas J, Apra C, Carpentier A. Incomplete copolymer degradation of in situ chemotherapy. J Mater Sci Mater Med 2018; 29:25. [PMID: 29455370 DOI: 10.1007/s10856-018-6032-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
In situ carmustine wafers containing 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) are commonly used for the treatment of recurrent glioblastoma to overcome the brain-blood barrier. In theory, this chemotherapy diffuses into the adjacent parenchyma and the excipient degrades in maximum 8 weeks but no clinical data confirms this evolution, because patients are rarely operated again. A 75-year-old patient was operated twice for recurrent glioblastoma, and a carmustine wafer was implanted during the second surgery. Eleven months later, a third surgery was performed, revealing unexpected incomplete degradation of the wafer. 1H-Nuclear Magnetic Resonance was performed to compare this wafer to pure BCNU and to an unused copolymer wafer. In the used wafer, peaks corresponding to hydrophobic units of the excipient were no longer noticeable, whereas peaks of the hydrophilic units and traces of BCNU were still present. These surprising results could be related to the formation of a hydrophobic membrane around the wafer, thus interfering with the expected diffusion and degradation processes. The clinical benefit of carmustine wafers in addition to the standard radio-chemotherapy remains limited, and in vivo behavior of this treatment is not completely elucidated yet. We found that the wafer may remain after several months. Alternative strategies to deal with the blood-brain barrier, such as drug-loaded liposomes or ultrasound-opening, must be explored to offer larger drug diffusion or allow repetitive delivery.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.
- Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France.
- Université de Lyon, Université Claude Bernard, Lyon, France.
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.
| | - Tanguy Boissenot
- Faculté de Pharmacie, Institut Galien Paris-Sud, UMR CNRS 8612, Paris, France
- Université Paris-Saclay, Université Paris-sud, Paris, France
| | - Lauriane Goldwirt
- Department of Pharmacology, Assistance publique hôpitaux de Paris, Saint-Louis Hospital, Paris, France
| | - Julien Nicolas
- Faculté de Pharmacie, Institut Galien Paris-Sud, UMR CNRS 8612, Paris, France
- Université Paris-Saclay, Université Paris-sud, Paris, France
| | - Caroline Apra
- Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
| | - Alexandre Carpentier
- Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
- Department of Neurosurgery, Assistance publique hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
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15
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Partanen A, Valtola J, Ropponen A, Vasala K, Penttilä K, Ågren L, Pyörälä M, Nousiainen T, Selander T, Mäntymaa P, Pelkonen J, Varmavuo V, Jantunen E. Preemptive plerixafor injection added to pegfilgrastim after chemotherapy in non-Hodgkin lymphoma patients mobilizing poorly. Ann Hematol 2017; 96:1897-1906. [PMID: 28879595 DOI: 10.1007/s00277-017-3123-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/27/2017] [Indexed: 12/15/2022]
Abstract
Filgrastim is usually combined with chemotherapy to mobilize hematopoietic progenitor cells in non-Hodgkin lymphoma (NHL) patients. Limited information is available on the efficacy of a preemptive plerixafor (PLER) injection in poor mobilizers after chemotherapy and pegfilgrastim. In this prospective study, 72 patients with NHL received chemotherapy plus pegfilgrastim, and 25 hard-to-mobilize patients received also PLER. The usefulness and efficacy of our previously developed algorithm for PLER use in pegfilgrastim-containing mobilization regimen were evaluated as well as the graft cellular composition, hematological recovery, and outcome after autologous stem cell transplantation (auto-SCT) according to the PLER use. A median 3.4-fold increase in blood CD34+ cell counts was achieved after the first PLER dose. The minimum collection target was achieved in the first mobilization attempt in 66/72 patients (92%) and 68 patients (94%) proceeded to auto-SCT. An algorithm for PLER use was fulfilled in 76% of the poor mobilizers. Absolute numbers of T-lymphocytes and NK cells were significantly higher in the PLER group, whereas the number of CD34+ cells collected was significantly lower. Early neutrophil engraftment was slower in the PLER group, otherwise hematological recovery was comparable within 12 months from auto-SCT. No difference was observed in survival according to the PLER use. Chemotherapy plus pegfilgrastim combined with preemptive PLER injection is an effective and convenient approach to minimize collection failures in NHL patients intended for auto-SCT. A significant effect of PLER on the graft cellular composition was observed, but no difference in outcome after auto-SCT was detected.
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Affiliation(s)
- A Partanen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland.
| | - J Valtola
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - A Ropponen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - K Vasala
- Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - K Penttilä
- Department of Medicine, Central Hospital of Savonlinna, Savonlinna, Finland
- The Finnish Medicines Agency, Kuopio, Finland
| | - L Ågren
- Department of Medicine, North Karelia Central Hospital, Joensuu, Finland
| | - M Pyörälä
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - T Nousiainen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - T Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - P Mäntymaa
- Laboratory Center of Eastern Finland, Kuopio, Finland
| | - J Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
- Laboratory Center of Eastern Finland, Kuopio, Finland
| | - V Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - E Jantunen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
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16
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Beez T, Burgula S, Kamp M, Rapp M, Steiger HJ, Sabel M. Space-Occupying Tumor Bed Cysts as a Complication of Modern Treatment for High-Grade Glioma. World Neurosurg 2017; 104:509-515. [PMID: 28512049 DOI: 10.1016/j.wneu.2017.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The management of high-grade glioma (HGG) has been affected by recent landmark trials and is now more proactive. More aggressive treatment leads to hospitalization due to side effects, however. Space-occupying tumor bed cysts have been described, but not systematically assessed. We sought to analyze this complication in a contemporary HGG cohort. METHODS We performed a retrospective review of patients with HGG treated between 2007 and 2013, identified patients with space-occupying tumor bed cysts, and reviewed their hospital notes for relevant variables. Statistical analyses were performed, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS Tumor bed cysts were found in 12 of 282 patients (4%). The main symptoms were increased intracranial pressure (n = 11), new focal deficits (n = 6), and pseudomeningocele (n = 3), presenting at a median of 19 days since the last resection. Cysts were treated with cystoperitoneal (n = 7) and ventriculoperitoneal (n = 5) shunts, resulting in clinical benefit in 75% of those treated. Intraoperative opening of ventricles is a risk factor, with an OR of 39.339. We propose a classification system comprising 3 cyst types: isolated cyst, cyst with local cerebrospinal fluid (CSF) disturbance, and cyst with global CSF disturbance. CONCLUSIONS In modern neuro-oncology, the rate of tumor bed cysts complicating HGG management appears stable compared with historical data. Shunt implantation is feasible and effective. We propose a classification system as a common data element for comparison across future studies.
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Affiliation(s)
- Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
| | - Sven Burgula
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Marcel Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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17
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MacArthur KM, Jariwala N, Kim EJ, Rook AH. Topical Carmustine as Monotherapy or as Multimodality Therapy for Folliculotropic Mycosis Fungoides. Acta Derm Venereol 2017; 97:373-374. [PMID: 27868149 DOI: 10.2340/00015555-2551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kelly M MacArthur
- Department of Dermatology, Johns Hopkins University, 601 North Caroline Street, 8 Floor, Baltimore, Maryland, 21287, USA.
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18
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Ichikawa T. [BCNU wafer]. Nihon Rinsho 2016; 74 Suppl 7:650-653. [PMID: 30634828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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19
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Kalitin NN, Buravtsova IV. [The significance of expression of isoforms RARa1 and RARa2 in response to medicinal therapy and in evaluation of total survival of patients with primarily detected multiple myeloma]. Klin Lab Diagn 2016; 61:474-478. [PMID: 30601638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The RARa is a transcription factor playing important role in such processes as proliferation, differentiation and apoptosis of cells in norm and in tumor. At the same time, it is little known about significance of expression of two major products of transcription of gene RARa - isoforms RARa and RARa - in pathogenesis of solid and non-solid tumors, including multiple myeloma. The actual data testify ambiguity of input made by isoforms RARa and RARa into processes of tumor development and progression of malignant tumors. THE RESULTS It was established that higher level of expression of isoform RARa in combination with increased expression of isoform RARβ (group 1) statistically reliable associated with lesser decreasing of concentration of Bence Jones protein in urine of patients in the result of applied treatment and, therefore, lesser effectiveness of response to standard treatment according protocol M-2 in comparison with group II which included patients with lesser levels of expression of RARa and RARβ (32.8% and 62.8% for groups I and II correspondingly; p=0.037). The analysis of indices of survival of examined patients in groups I and II demonstrated that median of total survival of patients from group I was reliably lower than in patients included into group II (30 and 84 correspondingly; p=0.046). CONCLUSION The results of study demonstrate that increased level of expression in the first instance of isoform RARa in combination with hyper-expression of isoform RARβ but not RARa can have unfavorable significance in case of evaluation of response to medicinal therapy and prognosis of total survival in patients with multiple melanoma.
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20
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Ishikawa E, Yamamoto T. [Intraoperative BCNU Wafer Implantation for High-Grade Glioma--A Questionnaire Targeting Japanese Neurosurgeons]. Gan To Kagaku Ryoho 2016; 43:603-607. [PMID: 27210091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Carmustine (BCNU) wafer implantation has been used in Japanese patients after resection of high-grade glioma (HGG) since 2013. Wafer implantation plays an important role in improving the prognosis of HGG patients, but it often causes particular changes as observed on neuroimaging and various adverse effects (AEs). Here, we conducted a questionnaire-based survey of Japanese neurosurgeons to determine how they feel about this treatment based on their actual observations. Most neurosurgeons had a positive impression of the treatment based on previous evidence of clinical effectiveness. Additionally, we found that the Japanese neurosurgeons are taking measures to cope with some AEs including cerebral edema, postoperative convulsions, cerebrospinal fluid leakage, and protracted wound healing.
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21
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Basak D, Punganuru SR, Srivenugopal KS. Piperlongumine exerts cytotoxic effects against cancer cells with mutant p53 proteins at least in part by restoring the biological functions of the tumor suppressor. Int J Oncol 2016; 48:1426-36. [PMID: 26848023 DOI: 10.3892/ijo.2016.3372] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/29/2015] [Indexed: 11/06/2022] Open
Abstract
Piperlongumine (PL), a small molecule alkaloid present in black pepper (Piper longum), has been reported to kill tumor cells irrespective of their p53 gene status, however, the mechanisms involved are unknown. Since p53 is a redox-sensitive protein, we hypothesized that the redox imbalance induced by PL may affect the structure and/or function of the mutant p53 protein and promote cell death. We used two human colon cancer cell lines, the HT29 and SW620 which harbor the R273H DNA contact abrogatory mutation in p53. PL treatment induced significant ROS production and protein glutathionylation with a concomitant increase in Nrf-2 expression in both cell lines. Surprisingly, immunoprecipitation with wt-p53 specific antibodies (PAb1620) or direct western blotting showed a progressive generation of wild-type-like p53 protein along with a loss of its mutant counterpart in PL-treated HT29 and SW620 cells. Moreover, the EMSA and DNA-affinity blotting revealed a time-dependent restoration of DNA-binding for the mutant p53, which was accompanied by the induction of p53 target genes, MDM2 and Bax. PL, while cytotoxic by itself, also increased the cell killing by many anticancer drugs. In nude mice bearing the HT29 tumors, PL alone (7.5 mg/kg daily) produced a 40% decrease in tumor volume, which was accompanied by diminished intratumoral mutant p53 protein levels. The antitumor efficacy of BCNU or doxorubicin in HT29 xenografts was highly potentiated by PL, followed by expression of apoptotic proteins. These clinically-relevant findings suggest that PL-induced oxidative milieu facilitates a weak functional restoration of mutant p53 through protein glutathionylation and contributes to the increased drug sensitivity.
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Affiliation(s)
- Debasish Basak
- Department of Biomedical Sciences and Cancer Biology Center, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Surendra R Punganuru
- Department of Biomedical Sciences and Cancer Biology Center, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Kalkunte S Srivenugopal
- Department of Biomedical Sciences and Cancer Biology Center, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
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22
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Rabitsch W, Bojic M, Wohlfarth P, Leiner M, Schörgenhofer C, Kalhs P, Schulenburg A, Sillaber C, Mitterbauer M, Sperr WR, Jäger U, Skrabs K, Greinix H, Hermann A, Lamm W. Alemtuzumab-BEAM as conditioning for allogeneic hematopoietic stem cell transplantation in relapsed/refractory Hodgkin lymphoma: a single-center analysis. J Cancer Res Clin Oncol 2016; 142:1307-14. [PMID: 26920356 PMCID: PMC4865538 DOI: 10.1007/s00432-016-2134-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
Purpose
Treatment of refractory Hodgkin disease deserves specific considerations. Recently, alemtuzumab-BEAM has been introduced in allogeneic hematopoietic stem cell transplantation (HSCT) in these patients. Methods We retrospectively analyzed the outcome of 20 patients with relapsed/refractory Hodgkin’s lymphoma (HL) who received allogeneic HSCT following conditioning therapy with alemtuzumab-BEAM. Results Treatment-related toxicity was tolerable. Half of the patients (50 %) had infections. Of these, 50 % were found to have pneumonia or catheter-related infections. In 20 %, an oral mucositis was observed. Acute graft-versus-host disease (GvHD) (≥grade 2) was seen in three patients. Complete remission (CR) could be achieved in 17 patients (85 %), 2 patients had persistent Hodgkin disease, and 1 patient died from infection prior to CR evaluation. Median progression-free survival and overall survival were 17.9 and 67.5 months, respectively. From the 17 CR patients, 8 had a relapse after a median of 10 months. Notably, of the eight patients relapsing after HSCT, all patients received another salvage treatment and four patients are still alive, whereas the other four patients died due to further progress. Six out of the remaining nine patients are still in CR, whereas the other three died from chronic GvHD and multi-organ failure. Overall, seven patients experienced chronic GvHD. Conclusion In summary, alemtuzumab-BEAM is a well-tolerated conditioning therapy for allogeneic HSCT with high response rates in refractory HL.
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Affiliation(s)
- W Rabitsch
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Bojic
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - P Wohlfarth
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Leiner
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Schörgenhofer
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - P Kalhs
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Schulenburg
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Sillaber
- Department of Medicine I, Clinical Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - M Mitterbauer
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - W R Sperr
- Department of Medicine I, Clinical Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - U Jäger
- Department of Medicine I, Clinical Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - K Skrabs
- Department of Medicine I, Clinical Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - H Greinix
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - A Hermann
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - W Lamm
- Bone Marrow Transplant Unit, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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23
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Sellner L, Boumendil A, Finel H, Choquet S, de Rosa G, Falzetti F, Scime R, Kobbe G, Ferrara F, Delmer A, Sayer H, Amorim S, Bouabdallah R, Finke J, Salles G, Yakoub-Agha I, Faber E, Nicolas-Virelizier E, Facchini L, Vallisa D, Zuffa E, Sureda A, Dreger P. Thiotepa-based high-dose therapy for autologous stem cell transplantation in lymphoma: a retrospective study from the EBMT. Bone Marrow Transplant 2016; 51:212-218. [PMID: 26569093 DOI: 10.1038/bmt.2015.273] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/08/2022]
Abstract
Clinical information about thiotepa-based autologous stem cell transplantation (auto-SCT) outside the primary central nervous system lymphoma (PCNSL) field is sparse. In this registry-based retrospective study, we evaluated potential risks and benefits of thiotepa-based preparative regimens compared with BEAM (carmustine, etoposide, cytarabine, melphalan) in auto-SCT for diffuse large B-cell lymphoma (DLBCL, excluding PCNSL), follicular lymphoma (FL) or Hodgkin lymphoma (HL). A total of 14 544 patients (589 thiotepa and 13 955 BEAM) met the eligibility criteria, and 535 thiotepa- and 1031 BEAM-treated patients were matched in a 1:2 ratio for final comparison. No significant differences between thiotepa and BEAM groups for any survival end point were identified in the whole sample or disease entity subsets. For a more detailed analysis, 47 TEAM (thiotepa, etoposide, cytarabine, melphalan)-treated patients were compared with 75 matched BEAM patients with additional collection of toxicity data. Again, there were no significant differences between the two groups for any survival end point. In addition, the frequency of common infectious and non-infectious complications including secondary malignancies was comparable between TEAM and BEAM. These results indicate that thiotepa-based high-dose therapy might be a valuable alternative to BEAM in DLBCL, HL and FL. Further evaluation by prospective clinical trials is warranted.
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Affiliation(s)
- L Sellner
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - A Boumendil
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
| | - H Finel
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
| | - S Choquet
- Department of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - R Scime
- Department of Hematology, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - G Kobbe
- University Hospital Düsseldorf, Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | | | - A Delmer
- Service d'Hématologie Clinique, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU) de Reims, Reims, France
| | - H Sayer
- Department of Hematology and Oncology, Helios Hospital Erfurt, Erfurt, Germany
| | - S Amorim
- APHP, Hopital Saint-louis, Hemato-Oncology Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - R Bouabdallah
- Hematology Department, Paoli Calmettes Institute, Marseille Aix-Marseille University, Marseille, France
| | - J Finke
- Department of Hematology, Freiburg University Medical Center, Freiburg, Germany
| | - G Salles
- Hematologie, Hospices Civils de Lyon and Université Claude Bernard Lyon-1, Pierre Bénite, France
| | - I Yakoub-Agha
- LIRIC-U995, Hematology Department and Hematopoietic Stem Cell Transplantation Unit, University-Hospital of Lille, Lille, France
| | - E Faber
- Department of Hemato-Oncology, Faculty Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | | | - L Facchini
- Hematology Unit, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - D Vallisa
- Hematology Unit, Ospedale Civile, Piacenza, Italy
| | - E Zuffa
- Hematology Unit, S Maria delle Croci Hospital, Ravenna, Italy
| | - A Sureda
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
- Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - P Dreger
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
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Khattry N, Gupta A, Jain R, Gore A, Thippeswamy R, Jeevangi N, Kannan S, Nair R, Saikia T. LACE versus BEAM conditioning in relapsed and refractory lymphoma transplant: retrospective multicenter analysis of toxicity and efficacy. Int J Hematol 2016; 103:292-8. [PMID: 26729297 DOI: 10.1007/s12185-015-1927-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 11/26/2022]
Abstract
We compared the lomustine, cytarabine, cyclophosphamide and etoposide (LACE) and BCNU, etoposide, cytarabine, melphalan (BEAM) conditioning regimens for toxicity, engraftment kinetics, and efficacy in 139 patients undergoing autologous hematopoietic stem cell transplant for primary refractory or relapsed lymphoma. Ninety-two patients with Hodgkin lymphoma and 47 with non-Hodgkin lymphoma were enrolled. Seventy-five patients received LACE while 64 received BEAM. The incidence of grade 3-4 oral mucositis (9 vs 38%; P < 0.001) and parenteral nutrition requirement (32 vs 69%; P < 0.001) were significantly lower in the LACE cohort. The median days to myeloid (10 vs 11; P = 0.007) and platelet engraftment (13 vs 15; P = 0.026) were shorter for the LACE cohort. Transplant-related mortality in the LACE group was 9% compared to 13% in patients treated with BEAM (P = NS). The probability of overall survival (OS) and progression-free survival (PFS) at 5 years for entire cohort was 46 and 41%, respectively. Probability of OS (LACE 46% vs BEAM 47%; P = NS) and PFS (LACE 37% vs BEAM 47%; P = NS) at 5 years was comparable between two groups. We conclude that LACE has better toxicity profile compared to BEAM and results in similar long-term survival in primary refractory or relapsed lymphoma transplant.
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Affiliation(s)
- Navin Khattry
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India.
| | - Alok Gupta
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India
| | - Reetu Jain
- Department of Medical Oncology, Jaslok Hospital, Mumbai, India
| | - Adwaita Gore
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Ravi Thippeswamy
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India
| | - Nandish Jeevangi
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India
| | - Sadhana Kannan
- Department of Biostatistics, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Reena Nair
- Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India
| | - Tapan Saikia
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
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Grossman R, Burger P, Soudry E, Tyler B, Chaichana KL, Weingart J, Olivi A, Gallia GL, Sidransky D, Quiñones-Hinojosa A, Ye X, Brem H. MGMT inactivation and clinical response in newly diagnosed GBM patients treated with Gliadel. J Clin Neurosci 2015; 22:1938-42. [PMID: 26249244 DOI: 10.1016/j.jocn.2015.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/01/2015] [Indexed: 11/17/2022]
Abstract
We examined the relationship between the O(6)-methylguanine-methyltransferase (MGMT) methylation status and clinical outcomes in newly diagnosed glioblastoma multiforme (GBM) patients who were treated with Gliadel wafers (Eisai, Tokyo, Japan). MGMT promoter methylation has been associated with increased survival among patients with GBM who are treated with various alkylating agents. MGMT promoter methylation, in DNA from 122 of 160 newly diagnosed GBM patients treated with Gliadel, was determined by a quantitative methylation-specific polymerase chain reaction, and was correlated with overall survival (OS) and recurrence-free survival (RFS). The MGMT promoter was methylated in 40 (32.7%) of 122 patients. The median OS was 13.5 months (95% confidence interval [CI] 11.0-14.5) and RFS was 9.4 months (95% CI 7.8-10.2). After adjusting for age, Karnofsky performance score, extent of resection, temozolomide (TMZ) and radiation therapy (RT), the newly diagnosed GBM patients with MGMT methylation had a 15% reduced mortality risk, compared to patients with unmethylated MGMT (hazard ratio 0.85; 95% CI 0.56-1.31; p=0.46). The patients aged over 70 years with MGMT methylation had a significantly longer median OS of 13.5 months, compared to 7.6 months in patients with unmethylated MGMT (p=0.027). A significant difference was also found in older patients, with a median RFS of 13.1 versus 7.6 months for methylated and unmethylated MGMT groups, respectively (p=0.01). Methylation of the MGMT promoter in newly diagnosed GBM patients treated with Gliadel, RT and TMZ, was associated with significantly improved OS compared to the unmethylated population. In elderly patients, methylation of the MGMT promoter was associated with significantly better OS and RFS.
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Affiliation(s)
- Rachel Grossman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Peter Burger
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Ethan Soudry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Betty Tyler
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States.
| | - Kaisorn L Chaichana
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Alessandro Olivi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - David Sidransky
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Alfredo Quiñones-Hinojosa
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
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26
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Chaichana KL, Kone L, Bettegowda C, Weingart JD, Olivi A, Lim M, Quinones-Hinojosa A, Gallia GL, Brem H. Risk of surgical site infection in 401 consecutive patients with glioblastoma with and without carmustine wafer implantation. Neurol Res 2015; 37:717-26. [PMID: 25916669 DOI: 10.1179/1743132815y.0000000042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Patients with glioblastoma (GBM) have an inherently shortened survival because of their disease. It has been recently shown that carmustine wafers in addition to other therapies (surgery, temozolomide, and radiation) can further extend survival. There is concern, however, that these therapies may increase infection risk. The goals of this study were to calculate the incidence of postoperative infection, evaluate if carmustine wafers changes the risk of infection and identify factors independently associated with an infection following GBM surgery. METHODS All patients who underwent non-biopsy, surgical resection of an intracranial GBM from 2007 to 2011 at a single institution were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify factors associated with infection, including the use of carmustine wafers. Variables with P < 0.05 were considered statistically significant. RESULTS Four hundred and one patients underwent resection of an intracranial GBM during the reviewed period, and 21 (5%) patients developed an infection at a median time of 40 [28-286] days following surgery. The incidence of infection was not higher in patients who had carmustine wafers, and this remained true in multivariate analyses to account for differences in treatment cohorts. The factors that remained significantly associated with an increased risk of infection were prior surgery [RR (95% CI); 2.026 (1.473-4.428), P = 0.01], diabetes mellitus [RR (95% CI); 6.090 (1.380-9.354)], P = 0.02], and increasing duration of hospital stay [RR (95% CI); 1.048 (1.006-1.078); P = 0.02], where the greatest risk occurred with hospital stays > 5 days [RR (95% CI); 3.904 (1.003-11.620), P = 0.05]. DISCUSSION These findings may help guide treatment regimens aimed at minimizing infection for patients with GBM.
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Feun LG, Lee YY, Wallace S, Charnsangavej C, Savaraj N, Carrasco CH, Gianturco C, Yung WK. New drugs and new delivery techniques. Prog Exp Tumor Res 2015; 29:131-9. [PMID: 2416007 DOI: 10.1159/000411633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Stukov AN, Filatova LV, Latipova DK, Bespalov VG, Belyaeva OA, Kireeva GS, Vasilieva IN, Alexandrov VA, Maidin MA, Semenov AL, Vershinina SF, Markochev AB, Abduloeva NK, Chubenko VA, Semiglazova TY. [Therapeutic activity of gemcitabine in intracranial tumors]. Vopr Onkol 2015; 61:274-279. [PMID: 26087611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Gemcitabine is known to exert a therapeutic effect on brain tumors despite the limited permeability of the blood-brain barrier (BBB). In our experimental research single intraperitoneal (i.p.) injection of gemcitabine 25 mg/kg provided increase in median survival of mice with intracranially transplanted Ehrlich carcinoma by 41-89% (p < 0.001). In this experimental model i.p. administration of gemcitabine (permeability of the BBB of less than 10%), carmustine (good permeability of the BBB), cyclophosphamide (poor permeability of the BBB) and cisplatin (doesn't penetrate through the BBB) increased median survival of mice by 88% (p < 0.001), 59% (p = 0.001), 35% (p = 0.005) and 18% (p = 0.302) respectively. Considering strong correlation between antitumor activity of the drugs (carmustine, cyclophosphamide and cisplatin) and their permeability of the BBB, efficacy of gemcitabine in intracranial tumors could be due to its wide range of therapeutic doses.
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31
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Nagai H. [Treatment strategy of Hodgkin lymphoma]. Rinsho Ketsueki 2014; 55:1941-1951. [PMID: 25297759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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32
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Swerdlow AJ, Cooke R, Bates A, Cunningham D, Falk SJ, Gilson D, Hancock BW, Harris SJ, Horwich A, Hoskin PJ, Linch DC, Lister A, Lucraft HH, Radford J, Stevens AM, Syndikus I, Williams MV. Risk of premature menopause after treatment for Hodgkin's lymphoma. J Natl Cancer Inst 2014; 106:dju207. [PMID: 25139687 DOI: 10.1093/jnci/dju207] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited. METHODS Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided. RESULTS During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of ≥5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of ≥6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided. CONCLUSIONS Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.
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Affiliation(s)
- Anthony J Swerdlow
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Rosie Cooke
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Andrew Bates
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - David Cunningham
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Stephen J Falk
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Dianne Gilson
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Barry W Hancock
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Sarah J Harris
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Alan Horwich
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Peter J Hoskin
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - David C Linch
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Andrew Lister
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Helen H Lucraft
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - John Radford
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Andrea M Stevens
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Isabel Syndikus
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
| | - Michael V Williams
- Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
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Fan CH, Liu HL, Ting CY, Lee YH, Huang CY, Ma YJ, Wei KC, Yen TC, Yeh CK. Submicron-bubble-enhanced focused ultrasound for blood-brain barrier disruption and improved CNS drug delivery. PLoS One 2014; 9:e96327. [PMID: 24788566 PMCID: PMC4008627 DOI: 10.1371/journal.pone.0096327] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/04/2014] [Indexed: 01/07/2023] Open
Abstract
The use of focused ultrasound (FUS) with microbubbles has been proven to induce transient blood-brain barrier opening (BBB-opening). However, FUS-induced inertial cavitation of microbubbles can also result in erythrocyte extravasations. Here we investigated whether induction of submicron bubbles to oscillate at their resonant frequency would reduce inertial cavitation during BBB-opening and thereby eliminate erythrocyte extravasations in a rat brain model. FUS was delivered with acoustic pressures of 0.1-4.5 MPa using either in-house manufactured submicron bubbles or standard SonoVue microbubbles. Wideband and subharmonic emissions from bubbles were used to quantify inertial and stable cavitation, respectively. Erythrocyte extravasations were evaluated by in vivo post-treatment magnetic resonance susceptibility-weighted imaging, and finally by histological confirmation. We found that excitation of submicron bubbles with resonant frequency-matched FUS (10 MHz) can greatly limit inertial cavitation while enhancing stable cavitation. The BBB-opening was mainly caused by stable cavitation, whereas the erythrocyte extravasation was closely correlated with inertial cavitation. Our technique allows extensive reduction of inertial cavitation to induce safe BBB-opening. Furthermore, the safety issue of BBB-opening was not compromised by prolonging FUS exposure time, and the local drug concentrations in the brain tissues were significantly improved to 60 times (BCNU; 18.6 µg versus 0.3 µg) by using chemotherapeutic agent-loaded submicron bubbles with FUS. This study provides important information towards the goal of successfully translating FUS brain drug delivery into clinical use.
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Affiliation(s)
- Ching-Hsiang Fan
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Hao-Li Liu
- Department of Electrical Engineering, Chang-Gung University, Tao-Yuan, Taiwan
| | - Chien-Yu Ting
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Ya-Hsuan Lee
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Chih-Ying Huang
- Department of Electrical Engineering, Chang-Gung University, Tao-Yuan, Taiwan
| | - Yan-Jung Ma
- Department of Electrical Engineering, Chang-Gung University, Tao-Yuan, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung University College of Medicine and Memorial Hospital, Tao-Yuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Chang Gung University College of Medicine and Memorial Hospital, Tao-Yuan, Taiwan
- Molecular Imaging Center, Chang Gung University College of Medicine and Memorial Hospital, Tao-Yuan, Taiwan
- * E-mail: (TCY); (CKY)
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
- * E-mail: (TCY); (CKY)
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Kothari J, Peggs KS, Bird A, Thomson KJ, Morris E, Virchis AE, Lambert J, Goldstone AH, Linch DC, Ardeshna KM. Autologous stem cell transplantation for follicular lymphoma is of most benefit early in the disease course and can result in durable remissions, irrespective of prior rituximab exposure. Br J Haematol 2014; 165:334-40. [PMID: 24438080 DOI: 10.1111/bjh.12741] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/08/2013] [Indexed: 11/30/2022]
Abstract
The role of autologous stem cell transplantation (ASCT) and the optimal timing of such transplants in patients with follicular lymphoma (FL) remains contentious. We present a single-centre experience documenting the outcomes of 70 FL patients who underwent BEAM (carmustine, cytarabine, etopside, melphalan)-conditioned ASCT between 1988 and 2009. With a median follow-up of 6·8 years (0·1-19·2), the 7-year overall survival (OS) and progression-free survival (PFS) from the date of ASCT was 76% and 60%, respectively. A significant difference in OS was found when comparing the patients transplanted in first or second remission versus those transplanted in later remissions (P = 0·02) and this significance was maintained when OS was calculated from the date of diagnosis (P = 0·03). There was a plateau on the PFS curves for patients transplanted in either first or second remissions after 9·3 and 6·4 years respectively, suggesting that these groups may never relapse. No differences were seen in OS or PFS in those treated with rituximab prior to transplant versus those who were not. Our data shows that BEAM ASCT can be a highly effective treatment in patients with FL early in the disease course, and that a proportion of patients experience prolonged disease-free survival and may be cured.
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Affiliation(s)
- Jaimal Kothari
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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Cecchin D, Schiorlin I, Della Puppa A, Lombardi G, Zucchetta P, Bodanza V, Gardiman MP, Rolma G, Frigo AC, Bui F. Assessing response using 99mTc-MIBI early after interstitial chemotherapy with carmustine-loaded polymers in glioblastoma multiforme: preliminary results. Biomed Res Int 2014; 2014:684383. [PMID: 24800247 PMCID: PMC3985177 DOI: 10.1155/2014/684383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
Abstract
Introduction. Early signs of response after applying wafers of carmustine-loaded polymers (gliadel) are difficult to assess with imaging because of time-related imaging changes. (99m)Tc-sestamibi (MIBI) brain single-photon emission tomography (SPET) has reportedly been used to reveal areas of cellularity distinguishing recurrent neoplasm from radionecrosis. Our aim was to explore the role of MIBI SPET in assessing response soon after gliadel application in glioblastoma multiforme (GBM). Methods. We retrospectively reviewed the charts on 28 consecutive patients with a radiological diagnosis of GBM who underwent MIBI SPET/CT before surgery (with intracavitary gliadel placement in 17 patients), soon after surgery, and at 4 months. The area of uptake was selected using a volume of interest that was then mirrored contralaterally to obtain a semiquantitative ratio. Results. After adjusting for ratio at the baseline, the effect of treatment (gliadel versus non-gliadel) was not statistically significant. Soon after surgery, however, 100% of patients treated with gliadel had a decreased ratio, as opposed to 62.5% of patients in the non-gliadel group (P = 0.0316). The difference between ratios of patients with radical versus partial resection reached statistical significance by a small margin (P = 0.0528). Conclusions. These data seem to suggest that the MIBI ratio could be a valuable tool for monitoring the effect of gliadel early after surgery.
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Affiliation(s)
- D. Cecchin
- Nuclear Medicine Service, Department of Medicine (DIMED), University Hospital, 35128 Padova, Italy
| | - I. Schiorlin
- Nuclear Medicine Service, Department of Medicine (DIMED), University Hospital, 35128 Padova, Italy
| | - A. Della Puppa
- Department of Neurosurgery, University Hospital, 35128 Padova, Italy
| | - G. Lombardi
- Department of Medical Oncology 1, IOV, IRCCS, Venetian Oncology Institute, 35128 Padova, Italy
| | - P. Zucchetta
- Nuclear Medicine Service, Department of Medicine (DIMED), University Hospital, 35128 Padova, Italy
| | - V. Bodanza
- Nuclear Medicine Service, Department of Medicine (DIMED), University Hospital, 35128 Padova, Italy
| | - M. P. Gardiman
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University Hospital, 35128 Padova, Italy
| | - G. Rolma
- Neuroradiology Unit, University Hospital, 35128 Padova, Italy
| | - A. C. Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital, 35128 Padova, Italy
| | - F. Bui
- Nuclear Medicine Service, Department of Medicine (DIMED), University Hospital, 35128 Padova, Italy
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36
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Liu HL, Fan CH, Ting CY, Yeh CK. Combining microbubbles and ultrasound for drug delivery to brain tumors: current progress and overview. Theranostics 2014; 4:432-44. [PMID: 24578726 PMCID: PMC3936295 DOI: 10.7150/thno.8074] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Malignant glioma is one of the most challenging central nervous system (CNS) diseases, which is typically associated with high rates of recurrence and mortality. Current surgical debulking combined with radiation or chemotherapy has failed to control tumor progression or improve glioma patient survival. Microbubbles (MBs) originally serve as contrast agents in diagnostic ultrasound but have recently attracted considerable attention for therapeutic application in enhancing blood-tissue permeability for drug delivery. MB-facilitated focused ultrasound (FUS) has already been confirmed to enhance CNS-blood permeability by temporally opening the blood-brain barrier (BBB), thus has potential to enhance delivery of various kinds of therapeutic agents into brain tumors. Here we review the current preclinical studies which demonstrate the reports by using FUS with MB-facilitated drug delivery technology in brain tumor treatment. In addition, we review newly developed multifunctional theranostic MBs for FUS-induced BBB opening for brain tumor therapy.
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Affiliation(s)
- Hao-Li Liu
- 1. Department of Electrical Engineering, Chang-Gung University, 259 Wen-Hwa 1st Road, Kuei-Shan, Tao-Yuan, Taiwan 33302
| | - Ching-Hsiang Fan
- 2. Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, No. 101, Section 2, Kuang-Fu Road, Hsinchu, Taiwan 30013
| | - Chien-Yu Ting
- 2. Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, No. 101, Section 2, Kuang-Fu Road, Hsinchu, Taiwan 30013
| | - Chih-Kuang Yeh
- 2. Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, No. 101, Section 2, Kuang-Fu Road, Hsinchu, Taiwan 30013
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Samis Zella MA, Wallocha M, Slotty PJ, Isik G, Hänggi D, Schroeteler J, Ewelt C, Steiger HJ, Sabel M. Evaluation of post-operative complications associated with repeat resection and BCNU wafer implantation in recurrent glioblastoma. Acta Neurochir (Wien) 2014; 156:313-23. [PMID: 24287680 DOI: 10.1007/s00701-013-1931-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/21/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with glioblastoma treated with BCNU wafer implantation for recurrence frequently receive frontline chemoradiotherapy with temozolomide as part of the Stupp protocol. A retrospective investigation was conducted of surgical complications in a cohort of these patients treated at a single institution. METHODS We searched our institutional database for patients treated between January 2006 and October 2012 who had recurrent glioblastoma previously treated with open surgery followed by the Stupp protocol and then underwent repeat resection with or without BCNU wafers for recurrent disease. Rates of select post-operative complications within 3 months of surgery were estimated. RESULTS We identified 95 patients with glioblastoma who underwent resection followed by the Stupp protocol as frontline treatment. At disease recurrence (first and second recurrence), 63 patients underwent repeat resection with BCNU wafer implantation and 32 without implantation. Generally, BCNU wafer use was associated with minor to moderate increases in rates of select complications versus non-implantation-wound healing abnormalities (14.2 vs. 6.2 %), cerebrospinal fluid leak (7.9 vs. 3.1 %), hydrocephalus requiring ventriculoperitoneal shunt (6.3 vs. 9.3 %), chemical meningitis (3.1 vs. 0 %), cerebral infections (3.1 vs. 0 %), cyst formation (3.1 vs. 3.1 %), cerebral edema (4.7 vs. 0 %), and empyema formations (1.5 vs. 0 %). Performance status was well maintained post-operatively in both groups. Median progression-free survival from the time of first recurrence was 6.0 and 5.0 months, respectively. CONCLUSIONS The use of the Stupp protocol as frontline therapy in patients with glioblastoma does not preclude the use of BCNU wafers at the time of progression.
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Affiliation(s)
- Maria Angela Samis Zella
- Department of Neurosurgery, Heinrich Heine University Hospital Düsseldorf, Medical Faculty, Moorenstraße 5, 40225, Düsseldorf, Germany,
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AOKI T, NISHIKAWA R, SUGIYAMA K, NONOGUCHI N, KAWABATA N, MISHIMA K, ADACHI JI, KURISU K, YAMASAKI F, TOMINAGA T, KUMABE T, UEKI K, HIGUCHI F, YAMAMOTO T, ISHIKAWA E, TAKESHIMA H, YAMASHITA S, ARITA K, HIRANO H, YAMADA S, MATSUTANI M. A multicenter phase I/II study of the BCNU implant (Gliadel(®) Wafer) for Japanese patients with malignant gliomas. Neurol Med Chir (Tokyo) 2013; 54:290-301. [PMID: 24739422 PMCID: PMC4533485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/17/2013] [Indexed: 03/14/2024] Open
Abstract
Carmustine (BCNU) implants (Gliadel(®) Wafer, Eisai Inc., New Jersey, USA) for the treatment of malignant gliomas (MGs) were shown to enhance overall survival in comparison to placebo in controlled clinical trials in the United States and Europe. A prospective, multicenter phase I/II study involving Japanese patients with MGs was performed to evaluate the efficacy, safety, and pharmacokinetics of BCNU implants. The study enrolled 16 patients with newly diagnosed MGs and 8 patients with recurrent MGs. After the insertion of BCNU implants (8 sheets maximum, 61.6 mg BCNU) into the removal cavity, various chemotherapies (including temozolomide) and radiotherapies were applied. After placement, overall and progression-free survival rates and whole blood BCNU levels were evaluated. In patients with newly diagnosed MGs, the overall survival rates at 12 months and 24 months were 100.0% and 68.8%, and the progression-free survival rate at 12 months was 62.5%. In patients with recurrent MGs, the progression-free survival rate at 6 months was 37.5%. There were no grade 4 or higher adverse events noted due to BCNU implants, and grade 3 events were observed in 5 of 24 patients (20.8%). Whole blood BCNU levels reached a peak of 19.4 ng/mL approximately 3 hours after insertion, which was lower than 1/600 of the peak BCNU level recorded after intravenous injections. These levels decreased to less than the detection limit (2.00 ng/mL) after 24 hours. The results of this study involving Japanese patients are comparable to those of previous studies in the United States and Europe.
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Affiliation(s)
- Tomokazu AOKI
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto
| | - Ryo NISHIKAWA
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - Kazuhiko SUGIYAMA
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima
| | | | | | - Kazuhiko MISHIMA
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - Jun-ichi ADACHI
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - Kaoru KURISU
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima
| | - Fumiyuki YAMASAKI
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
| | - Toshihiro KUMABE
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa (current affiliation)
| | - Keisuke UEKI
- Department of Neurosurgery, Dokkyo Medical University Hospital, Shimotsuga, Tochigi
| | - Fumi HIGUCHI
- Department of Neurosurgery, Dokkyo Medical University Hospital, Shimotsuga, Tochigi
| | - Tetsuya YAMAMOTO
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Eiichi ISHIKAWA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Hideo TAKESHIMA
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Miyazaki
| | - Shinji YAMASHITA
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Miyazaki
| | - Kazunori ARITA
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima
| | - Hirofumi HIRANO
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima
| | | | - Masao MATSUTANI
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - for the NPC-08 study group
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima
- Department of Neurosurgery, Kitano Hospital, Osaka, Osaka
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
- Department of Neurosurgery, Dokkyo Medical University Hospital, Shimotsuga, Tochigi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Miyazaki
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima
- Nobelpharma Co., Ltd., Tokyo
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa (current affiliation)
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Aoki T, Yamada S. [II. Current status of BCNU stent in the brain for treatment of glioma]. Gan To Kagaku Ryoho 2013; 40:708-717. [PMID: 23957061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Fan CH, Ting CY, Liu HL, Huang CY, Hsieh HY, Yen TC, Wei KC, Yeh CK. Antiangiogenic-targeting drug-loaded microbubbles combined with focused ultrasound for glioma treatment. Biomaterials 2012; 34:2142-55. [PMID: 23246066 DOI: 10.1016/j.biomaterials.2012.11.048] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 11/27/2012] [Indexed: 11/17/2022]
Abstract
Current chemotherapeutic agents do not only kill tumor cells but also induce systemic toxicity that significantly limits their dosage. Focused ultrasound (FUS) in the presence of microbubbles (MBs) is capable of transient and local opening of the blood-brain barrier (BBB) that enhances chemotherapeutic drug delivery into the brain parenchyma for glioma treatment. Our previous results demonstrated the success of combining the use of drug (1,3-bis(2-chloroethyl)-1-nitrosourea, BCNU)-loaded MBs with FUS-induced BBB opening to improve local drug delivery and reduce systemic toxicity. Here we introduce novel VEGF-targeting, drug-loaded MBs that significantly further enhance targeted drug release and reduce tumor progression in a rat model, using the FUS-BBB opening strategy. This study suggests a promising direction for future MB design aimed at targeted brain tumor therapy, and the possible future extension of MB application towards theragnostic use.
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Affiliation(s)
- Ching-Hsiang Fan
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan, ROC
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Bruserud O, Reikvam H, Kittang AO, Ahmed AB, Tvedt THA, Sjo M, Hatfield KJ. High-dose etoposide in allogeneic stem cell transplantation. Cancer Chemother Pharmacol 2012; 70:765-82. [PMID: 23053272 DOI: 10.1007/s00280-012-1990-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/19/2012] [Indexed: 12/19/2022]
Abstract
The anti-leukemic effect of etoposide is well documented. High-dose etoposide 60 mg/kg in combination with fractionated total body irradiation (TBI), usually single fractions of 1.2 Gy up to a total of 13.2 Gy, is used as conditioning therapy for allogeneic stem cell transplantation. Most studies of this conditioning regimen have included patients with acute leukemia receiving bone marrow or mobilized stem cell grafts derived from family or matched unrelated donors, and the treatment is then effective even in patients with high-risk disease. The most common adverse effects are fever with hypotension and rash, nausea and vomiting, sialoadenitis, neuropathy and metabolic acidosis. A small minority of patients develop severe allergic reactions. Etoposide has also been tested in a wide range of combination regimens, but for many of these combinations, relatively few patients are included, and some combinations have only been tested in patients who have undergone autologous transplants. However, the general conclusion is that many of these combinations are effective in patients with high-risk malignancies and the toxicity often seems acceptable. Thus, etoposide-based conditioning therapy should be further evaluated in patients having allogeneic transplants, but randomized trials are needed and the design of future trials should be based on the well-characterized TBI + high-dose etoposide regimen.
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Affiliation(s)
- Oystein Bruserud
- Department of Medicine, Section of Hematology, Haukeland University Hospital, Bergen, Norway
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Ferreri AJM, Bruno Ventre M, Donadoni G, Cattaneo C, Fumagalli L, Foppoli M, Mappa S, Govi S, Di Nicola M, Rossi G, Tirelli U, Caligaris-Cappio F, Spina M, Re A. Safety and activity of a new intensive short-term chemoimmunotherapy in HIV-positive patients with Burkitt lymphoma. Br J Haematol 2012; 159:252-5. [PMID: 22924636 DOI: 10.1111/bjh.12020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lane AA, Armand P, Feng Y, Neuberg DS, Abramson JS, Brown JR, Fisher DC, LaCasce AS, Jacobsen ED, McAfee SL, Spitzer TR, Freedman AS, Chen YB. Risk factors for development of pneumonitis after high-dose chemotherapy with cyclophosphamide, BCNU and etoposide followed by autologous stem cell transplant. Leuk Lymphoma 2012; 53:1130-6. [PMID: 22132836 PMCID: PMC3376378 DOI: 10.3109/10428194.2011.645208] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pneumonitis is a complication of high-dose chemotherapy and autologous stem cell transplant (HDC-ASCT) regimens containing BCNU. Our goal was to define the incidence and risk factors for pneumonitis in patients with lymphoma receiving a uniform conditioning regimen in the modern era. We studied 222 patients who received HDC-ASCT using cyclophosphamide, BCNU and VP-16 (CBV). Pneumonitis incidence was 22%, with 19% receiving systemic corticosteroid treatment and 8% requiring inpatient hospitalization for pneumonitis. Three patients died secondary to pneumonitis-related complications. The following variables were independently associated with pneumonitis: prior mediastinal radiation (odds ratio [OR] 6.5, 95% confidence interval [CI] 2.3-18.9, p = 0.0005), total BCNU dose above 1000 mg (OR 3.4, 95% CI 1.3-8.7, p = 0.012) and age less than 54 (OR 3.0, 95% CI 1.4-6.5, p = 0.0037). Increased vigilance for symptoms of pneumonitis is warranted for patients with prior mediastinal radiation and for younger patients, and dose reduction may be considered for patients who would receive greater than 1000 mg of BCNU.
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Affiliation(s)
- Andrew A. Lane
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Philippe Armand
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA
| | - Yang Feng
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Harvard Medical School, Boston, MA
| | - Donna S. Neuberg
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Harvard Medical School, Boston, MA
| | - Jeremy S. Abramson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jennifer R. Brown
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA
| | - David C. Fisher
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA
| | - Ann S. LaCasce
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA
| | - Eric D. Jacobsen
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA
| | - Steven L. McAfee
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Thomas R. Spitzer
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Arnold S. Freedman
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA
| | - Yi-Bin Chen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Rivero-Garvía M, Márquez-Rivas J, Rueda-Torres AB, Pascual-Argente D, Ramírez G. Treatment of glioblastoma multiforme with high doses of carmustine intracavitary, in an infant. Childs Nerv Syst 2012; 28:747-50. [PMID: 22205534 DOI: 10.1007/s00381-011-1665-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 12/14/2011] [Indexed: 11/26/2022]
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Abstract
This paper reviews the development of the polyanhydrides as bioerodible polymers for drug delivery applications. The topics include design and synthesis of the polymer, physical properties, techniques to fabricate the polymer into drug delivery devices, evaluation of biocompatibility, and example applications of the polyanhydrides. Discussion of the interrelationship between the physical-chemical properties of the polyanhydrides, fabrication methods, and drug release rates is included. One section is devoted to a case study to provide a historical perspective of the development a polyanhydride-based drug delivery treatment from the conception of the idea to the final stages of human clinical trials. This section includes an outline of the extensive in vitro and in vivo testing that is necessary for development of a new material for biomedical applications.
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Affiliation(s)
- J Tamada
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge 02139
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47
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Márquez-Rivas J, Rivero-Garvía M, Mayorga-Buiza MJ. Comment on Bock et al. Occlusion of surgical opening of the ventricular system with fibrinogen-coated collagen fleece: a case collection study. Acta Neurochir (2011) 153:533-539. Acta Neurochir (Wien) 2012; 154:375-6; author reply 377. [PMID: 22146843 DOI: 10.1007/s00701-011-1237-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 11/15/2011] [Indexed: 11/26/2022]
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Su PJ, Chen JS, Liaw CC, Chang HK, Wang HM, Yang TS, Lin YC, Liau CT, Yang HY, Yeh KY, Ho MM, Chang NJ, Wang CH, Chang JWC. Biochemotherapy with carmustine, cisplatin, dacarbazine, tamoxifen and low-dose interleukin-2 for patients with metastatic malignant melanoma. Chang Gung Med J 2011; 34:478-486. [PMID: 22035892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The toxicity and efficacy of biochemotherapy with low-dose interleukin-2 for patients with metastatic malignant melanoma (MM) were studied. METHOD Metastatic chemo-naive MM patients were given biochemotherapy (BCDT regimen) with carmustine (BCNU), cisplatin (CDDP), dacarbazine (DTIC), and tamoxifen and interleukin-2 (IL-2) 18 Million International Units in divided doses by subcutaneous injection three times a week for four weeks. BCDT consisted of BCNU (150 mg/m2, day l every 8 weeks), CDDP (25 mg/m2, days l-3 every 4 weeks), DTIC (220 mg/m2, days 1-3 every 4 weeks) and tamoxifen 10 mg twice a day. Treatment was repeated for a total of 6 cycles, or until disease progression or unbearable toxicity. RESULTS From Nov 2001 to July 2005, 40 patients (20 men; 20 women) were enrolled. Their median age was 54 years (range 22-79 years). Subtypes of melanoma included 23 (57.5%) acral lentiginous, 11 (27.5%) nodular, 1 (2.5%) mucosal, and 5 (12.5%) others. Grade 3-4 toxicities included neutropenia (27.5%), anemia (45%), and thrombocytopenia (40%). Constitutional IL-2 toxicities included indurate injection site (57.5%), fever (60%), chills (55%), itchy skin (42.5%), bone pain (32.5%) and myalgia (45%). Grade 1-2 hypotension was noted in 12.5% of patients. Eosinophilia (range 5% to 71%) was evident in 72.5% of patients. The response rate was 32.5% including 5% with a complete response, 27.5% with a partial response, and 17.5% with stable disease. The median progression-free survival was 6.2 months (95% CI: 2.9~9.6 months). The median overall survival was 11.3 months (95% CI: 7.0~15.6 months). Five patients (12.5%) who presented with oligo-metastasis achieved five-year survivals. CONCLUSIONS Our data demonstrated that low-dose IL-2 plus BCDT is tolerable. A durable response and long-term survival can be achieved in a small subgroup of patients.
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Affiliation(s)
- Po-Jung Su
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Paris A, Dib M, Rousselet MC, Urban T, Tazi A, Gagnadoux F. [Pulmonary Langerhans histiocytosis and Hodgkin's lymphoma]. Rev Mal Respir 2011; 28:928-32. [PMID: 21943541 DOI: 10.1016/j.rmr.2011.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 03/31/2011] [Indexed: 11/17/2022]
Abstract
Pulmonary Langerhans histiocytosis (PLH) is a rare disease due to the accumulation of Langerhans cells at the level of the bronchioles. These dendritic immunocytes form granulomata and destroy the wall of the airway. We report a case of PLH developing at the same time as Hodgkin's lymphoma in a young woman who smoked tobacco and cannabis. We observed a complete remission of the PLH lesions parallel to the remission of the Hodgkin's lymphoma after chemotherapy, in the absence of any change in the consumption of tobacco and cannabis. This observation leads us to discuss the potential relationships between PLH on one hand, and smoking, the lymphoma and its treatment on the other.
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Affiliation(s)
- A Paris
- Département de pneumologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
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Stummer W, van den Bent MJ, Westphal M. Cytoreductive surgery of glioblastoma as the key to successful adjuvant therapies: new arguments in an old discussion. Acta Neurochir (Wien) 2011; 153:1211-8. [PMID: 21479583 DOI: 10.1007/s00701-011-1001-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/16/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND This article discusses data from 3 randomized phase 3 trials, supporting a role for surgery in glioblastoma. METHODS Data were reviewed by extent of resection during primary surgery from the ALA-Glioma Study (fluorescence-guided versus conventional resection), the BCNU wafer study (BCNU wafer versus placebo), and the EORTC Study 26981-22981 (radiotherapy versus chemoradiotherapy with temozolomide). RESULTS For glioblastoma patients in the ALA study, median survival was 16.7 and 11.8 months for complete versus partial resection, respectively (P < 0.0001). Survival effects were maintained after correction for differences in age and tumor location. For glioblastoma patients who received ≥90% resection in the BCNU wafer study, median survival increased for BCNU wafer versus placebo (14.5 versus 12.4 months, respectively; P = 0.02), but no survival increase was found for <90% resection (11.7 versus 10.6 months, respectively; P = 0.98). In the EORTC study, absolute median gain in survival with chemoradiotherapy versus radiotherapy was greatest for complete resections (+4.1 months; P = 0.0001), compared with partial resections (+1.8 months; P = 0.0001), or biopsies (+1.5 months; P = 0.088), suggesting surgery enhanced adjuvant treatment. CONCLUSION Complete resection appears to improve survival and may increase the efficacy of adjunct/adjuvant therapies. If safely achievable, complete resection should be the surgical goal for glioblastoma.
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Affiliation(s)
- Walter Stummer
- Department of Neurosurgery, University of Münster, Albert-Schweitzer-Str. 33, 48149, Münster, Germany.
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