Infection in the myelodysplastic syndromes
Article Abstract:
Myelodysplastic syndromes (MDS) are a group of disorders of the bone marrow, and are characterized by decreased numbers of cell elements in the blood and other tissues as well as structural abnormalities of the blood and bone marrow. MDS may occur in as many as one in 500 persons over the age of 55 years. The transformation, or progression, of the disease to acute leukemia and complications of bone marrow failure, such as infections and bleeding, may cause death in patients with MDS. The incidence, characteristics, outcome, and risk factors for infection in 86 patients with MDS were assessed; patients were treated between 1968 and 1986 at one medical center. The patients were divided into groups based on the presence of anemia, an abnormally low number of red blood cells; excess blasts, or immature cells; and transformation. The incidence of infection was approximately one per patient year and was highest in MDS patients with refractory anemia with excess blasts in transformation (RAEB-T). The frequency of infection was lower in patients with refractory anemia with excess blasts (RAEB), and even lower in patients with refractory anemia with or without ringed sideroblasts (RA +/- RS), an immature red blood cell containing a form of iron. The lowest rate of infections was detected in patients with RA +/- RS with abnormalities of the red blood cells but without defects in other cell types. Infection rates were higher in patients with 1,000 neutrophils per microliter of blood or less. The type of MDS and number of neutrophils, a type of white blood cell, influenced the risk of infection. The skin and lungs were the most common sites of infection. Infection accounted for 64 percent of deaths in patients with MDS, and caused more deaths than did transformation to acute leukemia. These findings show that infections are a common and life-threatening complication of MDS. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Small non-cleaved-cell lymphoma (undifferentiated lymphoma, Burkitt's type) in American adults: results with treatment designed for acute lymphoblastic leukemia
Article Abstract:
Small non-cleaved-cell lymphoma (SNCL), also referred to as Burkitt's type lymphoma, is a rapidly growing cancer of the lymphoid tissue which rarely occurs in adults in the United States. However, the incidence of SNCL among adults has increased with the AIDS epidemic. The effectiveness of a drug regimen used to treat acute lymphoblastic leukemia (ALL), another cancer of the blood, was assessed in 28 patients with SNCL. Nine patients had evidence of infection with the human immunodeficiency virus (HIV), which causes AIDS. The drug regimen designed for ALL consisted of the anticancer agent, cyclophosphamide, in the L-2, L-10, L-17, and L-20 protocols. Complete remission was achieved in 16 of 28 patients (57 percent). Fifty percent of all patients and 59 percent of patients with no known HIV disease had survived 47 months and were probably cured at the time of publication. A shorter duration of survival was associated with: levels of the enzyme, lactic acid dehydrogenase, that were greater than 500 units per liter; advanced stages of cancer; and involvement of the bone marrow. These findings show that intensive chemotherapy is effective in treating about 50 percent of patients with SNCL. Therapy that enhances bone marrow function, such as hematopoietic growth factor, may improve treatment of SNCL. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Preleukemic state preceding adult acute lymphoblastic leukemia
Article Abstract:
Acute lymphoblastic leukemia (ALL), a type of blood cancer, is characterized by the unrestrained growth of lymphoblasts, which are cells that give rise to lymphocytes (a type of immune cell). ALL often progresses rapidly and may develop after a blood disorder. Blood disorders that precede the development of ALL are characterized by the lack of physically distinct lymphoblasts and abnormalities in several types of bone marrow cells. Two unusual cases are described of patients who underwent a prolonged pre-leukemic phase. Both patients developed leukopenia, an abnormal decrease in white blood cells. There were no physical abnormalities observed in other blood cells types. These two cases differ from previous cases of ALL in that the patients developed the cancer in adulthood and had elevated lymphoblasts for up to a year before developing the cancer. In addition, both patients had decreased numbers of granulocytes, granular white blood cells. The cause of neutropenia, an abnormal decrease in neutrophils (a type of white blood cell), which was noted in both cases, is not known. It remains unclear if the development of ALL after a prolonged preleukemic phase is associated with a poorer prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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