Factors effecting remission and survival in adult acute nonlymphocytic leukemia (ANLL).
About: This article is published in Medicine.The article was published on 1970-11-01. It has received 84 citations till now.
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TL;DR: This study shows that a strategy based on modern supportive care and a wait and see approach yields extremely poor results and is not superior in regard to the frequency of hospital admission and is inferior regarding survival outcome.
Abstract: We report the results of a prospective study in patients more than 65 years of age in whom two different therapeutic strategies were compared: immediate intensive-induction chemotherapy (arm A) versus "wait and see" and supportive care and mild cytoreductive chemotherapy only for relief of progressive acute myeloid leukemia (AML)-related symptoms (arm B). The major objective of the study was to compare survival outcome of both regimens. Thirty-one patients on arm A received one or two courses of daunorubicin, vincristine, and cytarabine for remission induction followed by one additional cycle for consolidation in case of complete remission (CR). Among 29 patients on arm B, cytoreductive chemotherapy (hydroxyurea, cytarabine) had to be initiated for palliation of leukemia-associated complications in 21 patients at a median of 9 days after diagnosis. Overall survival duration for patients treated on arm A was significantly (P = .015) longer than the survival in arm B (median survival, 21 weeks v 11 weeks; p...
372 citations
TL;DR: The LAF plus A and the W plus A patients had higher complete remission rates and longer median survival than the unprotected ward patients and those who could not tolerate the antibiotics had an incidence of infection comparable to the ward patients.
Abstract: Reverse isolation and prophylactic oral nonabsorbable antibiotics were evaluated among 64 consecutive noninfected adults with acute nonlymphocytic leukemia admitted for remission induction. Patients were randomly allocated to laminar air flow room reverse isolation with oral nonabsorbable antibiotics (LAF plus A), routine hospital ward care with antibiotics (W plus A), or ward care alone (W). The LAF plus A patients had a significantly decreased incidence of total infection, bacteremias, pneumonias, rectal abscesses, urinary tract infection, and pharyngitis. Infectious deaths were reduced in the LAF plus A group and the time to the first infection or to fatal infection was delayed. The W plus A patients who regularly ingested the antibiotics had a reduction in infections similar to that of the LAF plus A patients but those who could not tolerate the antibiotics had an incidence of infection comparable to the ward patients. The LAF plus A and the W plus A patients also had higher complete remission rates and longer median survival than the unprotected ward patients.
310 citations
TL;DR: It is hoped that specific pharmacological inhibitors of the interaction between leukemic cells and vascular endothelum will result in an improved outcome for this very high-risk population of patients with AHL.
Abstract: Acute hyperleukocytic leukemias (AHL) are associated with a very high early mortality rate mostly due to respiratory failure or intracranial bleeding. The pathophysiological process leading to thes...
280 citations
TL;DR: Treatment-related complications significantly reduce survival in overweight and underweight children with AML.
Abstract: ContextCurrent treatment for acute myeloid leukemia (AML) in children cures
about half the patients. Of the other half, most succumb to leukemia, but
5% to 15% die of treatment-related complications. Overweight children with
AML seem to experience excess life-threatening and fatal toxicity. Nothing
is known about how weight affects outcomes in pediatric AML.ObjectiveTo compare survival rates in children with AML who at diagnosis are
underweight (body mass index [BMI] ≤10th percentile), overweight (BMI ≥95th
percentile), or middleweight (BMI = 11th-94th percentiles).Design, Setting, and ParticipantsRetrospective review of BMI and survival in 768 children and young adults
aged 1 to 20 years enrolled in Children’s Cancer Group-2961, an international
cooperative group phase 3 trial for previously untreated AML conducted August
30, 1996, through December 4, 2002. Data were collected through January 9,
2004, with a median follow-up of 31 months (range, 0-78 months).Main Outcome MeasuresHazard ratios (HRs) for survival and treatment-related mortality.ResultsEighty-four of 768 patients (10.9%) were underweight and 114 (14.8%)
were overweight. After adjustment for potentially confounding variables of
age, race, leukocyte count, cytogenetics, and bone marrow transplantation,
compared with middleweight patients, underweight patients were less likely
to survive (HR, 1.85; 95% confidence interval [CI], 1.19-2.87; P = .006) and more likely to experience treatment-related
mortality (HR, 2.66; 95% CI, 1.38-5.11; P = .003).
Similarly, overweight patients were less likely to survive (HR, 1.88; 95%
CI, 1.25-2.83; P = .002) and more likely
to have treatment-related mortality (HR, 3.49; 95% CI, 1.99-6.10; P<.001) than middleweight patients. Infections incurred during the
first 2 courses of chemotherapy caused most treatment-related deaths.ConclusionTreatment-related complications significantly reduce survival in overweight
and underweight children with AML.
262 citations
Cites background from "Factors effecting remission and sur..."
...Finally, technologists, nurses, and physicians should examine whether overweight patients are receiving suboptimal care because of difficulties in assessing them, as suggested by Wiernik and Serpick.(40) If that is the case, then it must be determined as to how to change practice to overcome these barriers....
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...These authors postulate that subclinical diabetes, difficulties in performing thorough physical examinations, or nuances in carrying out routine nursing care could contribute to early demise.(40) This study has the limitations of a retrospective study: CCG-2961 was not designed to investigate BMI as a variable....
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...Finally, technologists, nurses, and physicians should examine whether overweight patients are receiving suboptimal care because of difficulties in assessing them, as suggested by Wiernik and Serpick.40 If that is the case, then it must be determined as to how to change practice to overcome these barriers....
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