15 results on '"Jane N. Winter"'
Search Results
2. Response to 'The WHO classification of haematolymphoid tumours' (Editorial)
- Author
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Steven H. Swerdlow, Elias Campo, Daniel A. Arber, Mario Cazzola, James R. Cook, Hartmut Döhner, Martin Dreyling, Robert P. Hasserjian, Elaine S. Jaffe, Attilio Orazi, Leticia Quintanilla-Martinez, David W. Scott, Ayalew Tefferi, Jane N. Winter, and Andrew D. Zelenetz
- Subjects
Cancer Research ,Oncology ,Hematology - Published
- 2022
3. Concordant bone marrow involvement of diffuse large B-cell lymphoma represents a distinct clinical and biological entity in the era of immunotherapy
- Author
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M. Ponzoni, Wayne Tam, J.H.J.M. van Krieken, Lijuan Deng, Praveen Jain, Luis Fayad, Jianxiang Wang, Govind Bhagat, Ganiraju C. Manyam, Hagop M. Kantarjian, L. J. Medeiros, Y Liu, Ken H. Young, Karen Dybkær, Jorge E. Cortes, C. Visco, Yong Li, Jane N. Winter, Zhilei Yao, Robert Z. Orlowski, Anna Ferreri, Alexandar Tzankov, Zijun Y. Xu-Monette, M A Piris, Eric D. Hsi, Yongping Song, Michael Boe Møller, Yao, Z., Deng, L., Xu-Monette, Z. Y., Manyam, G. C., Jain, P., Tzankov, A., Visco, C., Bhagat, G., Wang, J., Dybkaer, K., Tam, W., Hsi, E. D., Van Krieken, J. H., Ponzoni, M., Ferreri, A. J. M., Moller, M. B., Winter, J. N., Piris, M. A., Fayad, L., Liu, Y., Song, Y., Orlowski, R. Z., Kantarjian, H., Medeiros, L. J., Li, Y., Cortes, J., and Young, K. H.
- Subjects
Male ,Oncology ,Cancer Research ,Pathology ,Lymphoma ,Cancer development and immune defence Radboud Institute for Molecular Life Sciences [Radboudumc 2] ,medicine.medical_treatment ,0302 clinical medicine ,International Prognostic Index ,Bone Marrow ,hemic and lymphatic diseases ,Antineoplastic Combined Chemotherapy Protocols ,80 and over ,Stage (cooking) ,Aged, 80 and over ,Bone Marrow/drug effects ,Hematology ,Middle Aged ,Prognosis ,Diffuse ,Lymphoma, Large B-Cell, Diffuse/drug therapy ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Immunotherapy/methods ,Female ,Rituximab ,Immunotherapy ,Lymphoma, Large B-Cell, Diffuse ,Adolescent ,Adult ,Aged ,Disease-Free Survival ,Humans ,Immunologic Factors ,Young Adult ,medicine.drug ,medicine.medical_specialty ,Article ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Internal medicine ,Large B-Cell ,medicine ,Performance status ,business.industry ,medicine.disease ,Antineoplastic Combined Chemotherapy Protocols/therapeutic use ,Bone marrow ,business ,Immunologic Factors/metabolism ,Diffuse large B-cell lymphoma ,030215 immunology - Abstract
In diffuse large B-cell lymphoma (DLBCL), the clinical and biological significance of concordant and discordant bone marrow (BM) involvement have not been well investigated. We evaluated 712 de novo DLBCL patients with front-line rituximab-containing treatment, including 263 patients with positive and 449 with negative BM status. Compared with negative BM disease, concordant BM adversely impacted overall and progression-free survival, independent of the International Prognostic Index (IPI) and cell-of-origin classification. Once BM is concordantly involved, poor prognosis was not associated with the extent of BM involvement. Conversely, patients with discordant BM showed favorable overall survival similar to stage I-II DLBCL. A BM-adjusted IPI, using three parameters: concordant BM involvement, age >60 years, and performance status >1, improves the risk stratification for DLBCL with positive BM. Intensive immunochemotherapy seemingly rendered survival benefit for patients with concordant BM, as did rituximab maintenance for the discordant BM group. Frequently revealing adverse clinical and molecular characteristics, patients with concordant BM demonstrated gene expression signatures relevant to tumor cell proliferation, migration and immune escape. In conclusion, clinical and biological heterogeneity is seen in DLBCL with positive BM but concordant BM involvement represents a distinct subset with unfavorable gene signatures, high-risk clinicopathologic features and poor prognosis.
- Published
- 2017
4. Actual or ideal body weight to calculate CD34+ cell dose in patients undergoing autologous hematopoietic SCT for myeloma?
- Author
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Martin S. Tallman, Andrew M. Evens, Joanne Monreal, M. Villa, Seema Singhal, Olga Frankfurt, Jayesh Mehta, S. Duffey, Jairam Krishnamurthy, Leo I. Gordon, Stephanie F. Williams, Richard Meagher, V. Singh, Jessica K. Altman, and Jane N. Winter
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,Cd34 cells ,Population ,Urology ,CD34 ,Antigens, CD34 ,Body weight ,Transplantation, Autologous ,Body Mass Index ,Internal medicine ,medicine ,Humans ,Platelet ,In patient ,education ,Melphalan ,Aged ,Retrospective Studies ,Transplantation ,education.field_of_study ,Hematology ,business.industry ,Body Weight ,Hematopoietic Stem Cell Transplantation ,Middle Aged ,Combined Modality Therapy ,Hematopoietic Stem Cell Mobilization ,Haematopoiesis ,Hematologic Neoplasms ,Female ,Multiple Myeloma ,business ,Biomarkers - Abstract
CD34+ cell dose calculations are usually based on actual body weight (ABW). We have shown that ideal body weight (IBW) may provide a better basis for this in a small population of patients with hematologic malignancies. This was studied further in 514 myeloma autografts. The CD34+ cell doses (10(6)/kg) by IBW and ABW were 1.37-39.36 (median 6.03) and 1.15-29.67 (median 4.84), respectively. IBW-based cell doses correlated slightly better with engraftment than ABW-based doses (higher r(2)): 0.5 x 10(9)/l neutrophils 0.83 versus 0.82, 1.0 x 10(9)/l neutrophils 0.78 versus 0.77, 20 x 10(9)/l platelets 0.54 versus 0.53 and 50 x 10(9)/l platelets 0.57 versus 0.55. When outliers (hematologic recovery in8 or16 days) were excluded, the findings were similar: 0.5 x 10(9)/l neutrophils 0.85 versus 0.84, 1.0 x 10(9)/l neutrophils 0.85 versus 0.84, 20 x 10(9)/l platelets 0.86 versus 0.85 and 50 x 10(9)/l platelets 0.85 versus 0.84. CD34+ cell doses based on IBW as well as ABW significantly affected engraftment when analyzed separately as continuous variables. However, when analyzed together, only the dose based on IBW retained significance. We conclude that calculation of CD34+ cell numbers for autotransplantation should be based on IBW.
- Published
- 2008
5. Prognostic markers in diffuse large B-cell lymphoma: Keys to the underlying biology
- Author
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Jane N. Winter
- Subjects
Cancer Research ,Disease ,Bioinformatics ,Antibodies, Monoclonal, Murine-Derived ,immune system diseases ,hemic and lymphatic diseases ,Antineoplastic Combined Chemotherapy Protocols ,Multicenter Studies as Topic ,Randomized Controlled Trials as Topic ,Hematology ,Antibodies, Monoclonal ,Prognosis ,BCL6 ,Combined Modality Therapy ,Neoplasm Proteins ,DNA-Binding Proteins ,Proto-Oncogene Proteins c-bcl-2 ,Oncology ,Vincristine ,Proto-Oncogene Proteins c-bcl-6 ,Rituximab ,Immunotherapy ,Lymphoma, Large B-Cell, Diffuse ,medicine.drug ,Cyclin-Dependent Kinase Inhibitor p21 ,medicine.medical_specialty ,Anthracycline ,Context (language use) ,Internal medicine ,Biomarkers, Tumor ,medicine ,Humans ,Immunologic Factors ,Cyclophosphamide ,Retrospective Studies ,L-Lactate Dehydrogenase ,business.industry ,Genes, p53 ,medicine.disease ,Survival Analysis ,Genes, bcl-2 ,Lymphoma ,Doxorubicin ,Prednisone ,Tumor Suppressor Protein p53 ,beta 2-Microglobulin ,business ,Diffuse large B-cell lymphoma - Abstract
Prognostic markers identify subgroups of patients with similar risk profiles, helping to guide clinical care. The addition of rituximab to conventional anthracycline-based chemotherapy has improved clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL). Studies suggest that rituximab eliminates or modulates the significance of some markers (eg, BCL6 or BCL2), whereas other previously unimportant markers may emerge as significant prognostic indicators in the setting of treatment that now includes rituximab. These changes in the prognostic profile are likely to reflect the impact of rituximab on survival pathways important to some groups of patients with DLBCL but not to other groups, and thereby may provide clues to the underlying biology of the disease. They also identify subgroups of patients likely to benefit most from rituximab therapy and those who seem to garner no advantage from its inclusion in their treatment. Studies of prognostic indicators in the context of modern therapy have the potential to identify new, rational therapeutic targets for this biologically diverse disease.
- Published
- 2007
6. Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole
- Author
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Andrew M. Evens, Jane N. Winter, Jayesh Mehta, Stephanie F. Williams, J. Pi, Leo I. Gordon, Olga Frankfurt, Seema Singhal, Martin S. Tallman, and Steven Trifilio
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Male ,medicine.medical_specialty ,Antifungal Agents ,Itraconazole ,Premedication ,Aspergillosis ,Gastroenterology ,Zygomycosis ,Candida krusei ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Mycosis ,Voriconazole ,Transplantation ,biology ,Candida glabrata ,business.industry ,Data Collection ,Candidiasis ,Hematopoietic Stem Cell Transplantation ,Hematology ,Triazoles ,biology.organism_classification ,medicine.disease ,Surgery ,Pyrimidines ,Mycoses ,Drug Evaluation ,Female ,business ,medicine.drug - Abstract
Seventy-one allograft recipients receiving voriconazole, in whom complete clinical, microbiologic and pharmacokinetic data were available, were studied to determine the efficacy of voriconazole in preventing fungal infections. The length of voriconazole therapy was 6-956 days (median 133). The total number of patient-days on voriconazole was 13 805 ( approximately 38 years). A total of 10 fungal infections were seen in patients on voriconazole (18% actuarial probability at 1 year): Candida glabrata (n=5), Candida krusei (n=1), Cunninghamella (n=1), Rhizopus (n=2) and Mucor (n=1). Two of the four zygomycosis cases were preceded by short durations of voriconazole therapy, but prolonged itraconazole prophylaxis. The plasma steady-state trough voriconazole levels around the time the infection occurred were0.2,0.2, 0.33, 0.55, 0.63 and 1.78 microg/ml in the six candidiasis cases. Excluding the four zygomycosis cases, all the six candidiasis cases were seen among the 43 patients with voriconazole levels ofor =2 microg/ml and none among the 24 with levels of2 microg/ml (P=0.061). We conclude that voriconazole is effective at preventing aspergillosis. However, breakthrough zygomycosis is seen in a small proportion of patients. The role of therapeutic voriconazole monitoring with dose adjustment to avoid breakthrough infections with fungi that are otherwise susceptible to the drug needs to be explored prospectively.
- Published
- 2007
7. How long after neutrophil recovery should myeloid growth factors be continued in autologous hematopoietic stem cell transplant recipients?
- Author
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Stephanie F. Williams, Amit Verma, Joanne Monreal, Jayesh Mehta, Martin S. Tallman, Seema Singhal, Steven Trifilio, J Pedicano, Jane N. Winter, and Leo I. Gordon
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Fever ,Neutrophils ,medicine.medical_treatment ,Filgrastim ,Neutropenia ,Transplantation, Autologous ,Gastroenterology ,Drug Administration Schedule ,Leukocyte Count ,Sargramostim ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,reproductive and urinary physiology ,Aged ,Retrospective Studies ,Transplantation ,Leukopenia ,business.industry ,Incidence (epidemiology) ,Hematopoietic Stem Cell Transplantation ,Granulocyte-Macrophage Colony-Stimulating Factor ,Hematology ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Autotransplantation ,Hematopoiesis ,Granulocyte colony-stimulating factor ,Surgery ,Hospitalization ,Absolute neutrophil count ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Growth factors are routinely used after autotransplantation to accelerate hematopoietic recovery, and are continued until the absolute neutrophil count (ANC) is/=0.5 x 10(9)/l on 3 consecutive days. Since ANC often increases to very high levels with this strategy, we discontinued growth factor on the first day ANC reached 0.5 x 10(9)/l in 45 patients (Study Group), and compared their subsequent ANC to 108 historic controls who received growth factor longer. While ANC on the day after reaching 0.5 x 10(9)/l was comparable between groups, ANC on the third day was significantly higher in the Control Group (2.3 vs 4.9 x 10(9)/l; P=0.0003). When compared to the first day, ANC in the Study Group was higher by a median of 140% on the third day and by 450% in the Control Group (P=0.0002). A significantly higher proportion of patients experienced a decline in ANC after the first day in the Study Group. However, only one patient in the Study Group became neutropenic transiently and ANC recovered spontaneously the next day. The incidence of fever and hospitalization were comparable. We conclude that growth factors can be discontinued after autotransplantation the day the ANC reaches 0.5 x 10(9)/l, without compromising neutrophil recovery.
- Published
- 2004
8. Ideal or actual body weight to calculate CD34+ cell doses for allogeneic hematopoietic stem cell transplantation?
- Author
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Leo I. Gordon, Jayesh Mehta, C Rihn, Martin S. Tallman, Jane N. Winter, Jeffrey Cilley, Seema Singhal, Stephanie F. Williams, and Joanne Monreal
- Subjects
Adult ,Male ,medicine.medical_specialty ,Lymphoma ,Neutrophils ,Cd34 cells ,medicine.medical_treatment ,Antigens, CD34 ,Hematopoietic stem cell transplantation ,Body weight ,Animal science ,Cell dose ,medicine ,Humans ,Transplantation, Homologous ,Inverse correlation ,Retrospective Studies ,Transplantation ,Leukemia ,Hematopoietic cell ,business.industry ,Body Weight ,Hematopoietic Stem Cell Transplantation ,Hematology ,Middle Aged ,Hematopoietic Stem Cells ,Neutrophil recovery ,Surgery ,Acute Disease ,Chronic Disease ,Female ,business - Abstract
The number of CD34+ cells infused influences hematologic recovery after transplantation. Limited data suggest that cell dose should be based on ideal (IBW) rather than actual (ABW) body weight for autotransplantation, but none in allografts. We compared the correlation between recovery to 0.5 x 10(9)/l neutrophils and the CD34+ cell dose based upon ABW and IBW in 78 allograft recipients. ABW wasor =25% over IBW in 47% of patients. The median CD34+ cell dose was 5.1 x 10(6)/kg IBW and 4.4 x 10(6)/kg ABW. The time to neutrophil recovery was 8-26 days (median 12). There was a stronger inverse correlation between CD34+ cell dose/IBW and neutrophil recovery (r(2)=0.160; P0.0001) than between CD34+ cell dose/ABW and neutrophil recovery (r(2)=0.138; P=0.001). When neutrophil recovery in patients receiving3 or5 x 10(6) CD34+ cells/kg was compared to those receivingor =3 oror =5 x 10(6) CD34+ cells/kg, respectively, separately by IBW and ABW, the magnitude and significance of the differences were greater for IBW-based comparisons. These data suggest the CD34+ cell dose based on IBW is a better predictor of neutrophil recovery after allografting. Further work in a larger, more homogeneous group of patients is required to confirm this observation.
- Published
- 2003
9. Lack of caregivers limits use of outpatient hematopoietic stem cell transplant program
- Author
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Alfred Rademaker, Jane N. Winter, P Frey, A Traynor, T. J. Stinson, E Ferdman, K O'Gara, Sara J. Knight, Charles L. Bennett, and Amy K. Siston
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,medicine.medical_treatment ,Breast Neoplasms ,Hematopoietic stem cell transplantation ,Indirect costs ,Breast cancer ,Quality of life ,Ambulatory Care ,medicine ,Hematologic malignancy ,Humans ,Aged ,Transplantation ,business.industry ,Hematopoietic Stem Cell Transplantation ,Hematology ,Middle Aged ,medicine.disease ,Hospitalization ,Caregivers ,Hematologic Neoplasms ,Emergency medicine ,Ambulatory ,Costs and Cost Analysis ,Quality of Life ,Female ,business ,Medical costs - Abstract
Our goal was to compare direct and indirect medical costs and quality of life associated with inpatient vs outpatient autologous hematopoietic stem cell transplantation (AuHSCT). Twenty-one sequential outpatients and 26 inpatients were enrolled on this prospective trial. All candidates for AuHSCT were screened for eligibility for outpatient transplantation. Patients with either breast cancer or hematologic malignancy, insurance coverage for the outpatient procedure, one to three caregivers available to provide 24 h coverage, and no significant comorbidities were eligible to participate. Patients without caregivers or insurance coverage for outpatient transplant were accrued to the study in a consecutive manner as inpatient controls, based on willingness to participate in the quality of life portion of the study and to permit review of their hospital and billing records. Approximately half of all 139 prospective outpatient candidates were ineligible because they lacked a caregiver. Most commonly, the patient without a caregiver was single or widowed or their family and friends were needed to provide childcare. Most caregivers were college educated from families with incomes greater than US dollars 80000. Indirect costs to the caregivers totaled a median of US dollars 2520 (range US dollars 684-US dollars 4508), with the majority attributed to lost 'opportunity costs'. Overall, there were significant differences in the total costs of treatment for inpatient vs outpatient AuHSCT (US dollars 40985 vs US dollars 29210, P0.01)). In general, no significant differences were detected between inpatient and outpatient scores on quality of life measures. Although significant cost savings were associated with outpatient transplantation, this approach was applicable to only half of our otherwise eligible candidates because of a lack of caregivers. The financial burden associated with the caretaking role may underlie this finding.
- Published
- 2002
10. Reassessing the definition of myeloid engraftment after autotransplantation: it is not necessary to see 0.5 × 109/l neutrophils on 3 consecutive days to define myeloid recovery
- Author
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Martin S. Tallman, Jayesh Mehta, MY Ali, Jane N. Winter, Yu Oyama, Seema Singhal, Leo I. Gordon, Joanne Monreal, and Stephanie F. Williams
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Myeloid ,Adolescent ,Neutrophils ,medicine.medical_treatment ,Breast Neoplasms ,Hematopoietic stem cell transplantation ,Transplantation, Autologous ,Leukocyte Count ,Terminology as Topic ,medicine ,Humans ,Myeloid Cells ,Early discharge ,Aged ,Retrospective Studies ,Transplantation ,Hematopoietic cell ,business.industry ,Graft Survival ,Hematopoietic Stem Cell Transplantation ,Retrospective cohort study ,Hematology ,Middle Aged ,Autotransplantation ,Surgery ,medicine.anatomical_structure ,Hematologic Neoplasms ,Absolute neutrophil count ,Female ,business - Abstract
The time to myeloid recovery after autologous hematopoietic stem cell transplantation (HSCT) is usually defined as the first of 3 consecutive days with an absolute neutrophil count (ANC) of >or=0.5 x 10(9)/l (ANC500). Universal documentation of ANC500 for 3 consecutive days, historically required to ensure robust myeloid recovery, has become difficult with a trend towards early discharge and outpatient HSCT. We studied 90 autografted patients to see how frequently ANC declined after having reached >or=0.5 x 10(9)/l. ANC500 was documented on 2 and 3 consecutive days in 14 and 63 patients, respectively. ANC increased by a median of 213% from the 1st to the 2nd day (rise in 75 and unchanged in two), and by a median of 142% from the 2nd day to the 3rd (rise in 60, unchanged in one, and decline in two; higher than the 1st day in the latter three). The increase from the 1st to the 3rd day was 13-3433% (median, 557%). Thus, in all 63 patients, no decline below ANC500 was seen, and the first day with ANC500 was also the first of 3 consecutive days with ANC500. The remaining 13 patients had repeat counts 2-7 days after the 1st day with ANC500 documenting further increase in ANC with no evidence of failed engraftment. These data show that the first day with ANC500 is also consistently the first of 3 consecutive days with ANC500 in autografted patients. Therefore, the traditional definition of myeloid engraftment should be changed to consider the first day with ANC500 as the day of engraftment without necessarily documenting ANC500 on the subsequent 1-2 days. This simple change in definition has significant implications for how data are reported to transplant registries and how peer-review organizations such as the Foundation for the Accreditation of Hematopoietic Cell Therapy (FAHCT) define completeness of data.
- Published
- 2002
11. Cobe Spectra is superior to Fenwal CS 3000 Plus for collection of hematopoietic stem cells
- Author
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T. Shook, Seema Singhal, Martin S. Tallman, MY Ali, Jane N. Winter, Yu Oyama, M. Villa, Leo I. Gordon, Jayesh Mehta, R Luyun, and Stephanie F. Williams
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,Cd34 cells ,CD34 ,Hematology ,Leukapheresis ,Hematopoietic Stem Cells ,Hematopoietic Stem Cell Mobilization ,Peripheral blood ,Blood Cell Count ,Surgery ,Blood cell ,Haematopoiesis ,medicine.anatomical_structure ,Cobe spectra ,Hematologic Neoplasms ,medicine ,Humans ,Stem cell ,business ,Nuclear medicine - Abstract
One hundred and seventy-seven stem cell apheresis procedures performed on 91 patients using the Fenwal CS 3000 Plus cell separator and 61 procedures performed on 37 patients using the Cobe Spectra cell separator were studied to compare the CD34(+) cell collection efficiencies (CE; the proportion of the total CD34(+) cell content in the blood volumes processed that is harvested) of the two machines. The absolute peripheral blood CD34(+) cell count was comparable for the two groups (P = 0.27). A strong correlation was seen between the blood CD34(+) cell count and the total number of CD34(+) cells collected for the Spectra (r(2) = 0.59; P10(-6)) and for the CS 3000 Plus (r(2) = 0.60; P10(-6)). No significant correlation emerged between the peripheral blood CD34(+) cell count and the CE of either machine. The total number of CD34(+) cells collected per procedure was comparable (P = 0.51): median 113 x 10(6) for CS 3000 Plus and median 218 x 10(6)for Spectra. CE was significantly higher with the Spectra (median 45.7%, range 9.8-98.6%) than the CS 3000 Plus (median 30.3%, range 1.7-89.3%; P0.00001). We conclude that the CD34(+) cell CE of the Spectra is superior to that of the CS 3000 Plus. Therefore, under the usual clinical conditions, Cobe Spectra should be used preferentially for peripheral blood progentor cell collection to maximize the number of hematopoietic stem cells collected.
- Published
- 2002
12. High-dose chemotherapy, autologous bone marrow or stem cell transplantation and post-transplant consolidation chemotherapy in patients with advanced breast cancer
- Author
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C. Kelly, William J. Gradishar, Krystyna Kiel, Martin S. Tallman, John M. Shaw, Merrill S. Kies, S. G. Brown, C. Mangan, Jane N. Winter, A. Bauman, Leo I. Gordon, Alfred Rademaker, L. Jahnke, and Halina Rubin
- Subjects
Adult ,medicine.medical_specialty ,Cyclophosphamide ,medicine.medical_treatment ,Breast Neoplasms ,Hematopoietic stem cell transplantation ,ThioTEPA ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Medicine ,Antineoplastic Agents, Alkylating ,Bone Marrow Transplantation ,Transplantation ,Chemotherapy ,business.industry ,Hematopoietic Stem Cell Transplantation ,Induction chemotherapy ,Consolidation Chemotherapy ,Hematology ,Middle Aged ,Combined Modality Therapy ,Chemotherapy regimen ,Surgery ,Regimen ,Treatment Outcome ,Female ,business ,medicine.drug - Abstract
This study was designed to determine the complete response (CR) rate, event-free survival (EFS) and overall survival (OS) in patients with metastatic breast cancer treated with an adriamycin-based induction regimen, high-dose chemotherapy consisting of cyclophosphamide and thiotepa with autologous bone marrow or stem cell reinfusion, followed by post-transplant 5-fluorouracil and cisplatin. Forty-eight consecutive patients were enrolled and 35 received two to four cycles of a cytoreductive chemotherapy regimen followed by high-dose chemotherapy which included cyclophosphamide and thiotepa. Thirty-three patients with non-progressive disease received at least one cycle of post-transplant 5-fluorouracil and cisplatin. Fifty percent of patients with evaluable disease responded to induction chemotherapy. Three of the 34 patients (9%) evaluable for response to high-dose chemotherapy achieved CR, eight (24%) achieved partial response (PR), 12 (35%) had stable disease (SD) and 11 (32%) had progressive disease (PD). The median time to neutrophil recovery was 11.5 days (range, 8 to 40 days) post- reinfusion. The median time to platelet independence was 14.5 days (range, 8 to 44 days). The median follow-up is 24.5 months (range, 1 to 96 months). The actuarial probability of EFS for all patients is 17% at 4 years. The EFS for patients receiving all four cycles of post-transplant chemotherapy is 27% at 4 years, compared to 36% at 1 year for patients not receiving any post-transplant chemotherapy. Ten of the 48 patients (21%) are alive, and seven of these (15%) have no evidence of disease. High-dose chemotherapy with autologous bone marrow or peripheral blood-derived stem cell transplantation followed by post-transplant consolidation chemotherapy in patients with metastatic breast cancer results in a proportion of patients without evidence of disease at 4 years.
- Published
- 1997
13. Inflammatory pseudotumor of the pancreas
- Author
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Gulchin A. Ergun, M. Sambasiva Rao, Jane N. Winter, Steven J. Stryker, and Steven H. Kroft
- Subjects
Adult ,Abdominal pain ,Pathology ,medicine.medical_specialty ,Pancreatic disease ,Population ,Malignancy ,Granuloma, Plasma Cell ,Endocrinology ,medicine ,Humans ,education ,Histiocyte ,education.field_of_study ,business.industry ,Gastroenterology ,Pancreatic Diseases ,DNA ,medicine.disease ,Immunohistochemistry ,Lymphoma ,medicine.anatomical_structure ,Oncology ,Inflammatory pseudotumor ,Female ,medicine.symptom ,business ,Pancreas - Abstract
We describe a rare example of inflammatory pseudotumor of the pancreas in a 42-yr-old woman, which developed following chemotherapy for lymphoma of the uterine cervix. The patient had developed fatigue, weight loss, abdominal pain, and anemia; abdominal CT scan showed a large mass in the pancreas. Examination of the resected specimen revealed a fleshy, well-circumscribed, 7-cm mass. Histologically, there was a hypocellular to moderately hypercellular, bland spindle-cell proliferation admixed with a prominent infiltrate of lymphocytes, histiocytes, and plasma cells. The spindle cells were vimentin positive but negative for muscle markers; electron microscopy revealed only fibroblastic cells. DNA analysis revealed a diploid population with low S-phase fraction. The patient was well at 6-mo follow-up. It is important for the pathologist to be aware of the existence of this entity in unusual locations such as the pancreas so as to avoid a mistaken diagnosis of malignancy.
- Published
- 1995
14. Erratum: Ideal rather than actual body weight should be used to calculate cell dose in allogeneic hematopoietic stem cell transplantation
- Author
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L. Kaminer, Martin S. Tallman, Olga Frankfurt, Leo I. Gordon, Seema Singhal, Stephanie F. Williams, Andrew M. Evens, David L. Grinblatt, Richard Meagher, Jane N. Winter, and Jayesh Mehta
- Subjects
Transplantation ,Ideal (set theory) ,Bone marrow transplantation ,Cell dose ,business.industry ,medicine.medical_treatment ,Cancer research ,Medicine ,Hematology ,Hematopoietic stem cell transplantation ,business ,Body weight - Published
- 2006
15. The evaluation of low-dose cytarabine in the treatment of myelodysplastic syndromes: a phase-III intergroup study
- Author
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Francis S. Morrison, John M. Bennett, K. Kyungmann, Peter A. Cassileth, Richard S. Neiman, Michael J. O'Connell, Jane N. Winter, Kenneth B. Miller, and David R. Head
- Subjects
Oncology ,medicine.medical_specialty ,Chemotherapy ,Hematology ,business.industry ,Myelodysplastic syndromes ,medicine.medical_treatment ,Concordance ,Incidence (epidemiology) ,Low dose cytarabine ,General Medicine ,medicine.disease ,Surgery ,Supportive psychotherapy ,Internal medicine ,medicine ,Cytarabine ,business ,medicine.drug - Abstract
One hundred and forty one patients were treated in a combined Eastern Cooperative Oncology Group and Southwest Oncology Group phase-III study evaluating low-dose cytarabine (LDAC) versus supportive therapy for the treatment of myelodysplastic syndrome (MDS). Patients were randomized to either cytarabine 10 mg/m2 subcutaneously BID or supportive therapy. Central pathology review was required. All patients were classified according to the FAB criteria for MDS. The overall concordance rate for the MDS subtype was 52%, and 25 patients were pathology exclusions, including 20 with AML. The overall response rate to a single cycle of LDAC was 32%, with 11% complete and 21% partial responses. The median duration of response was 5.9 months, with a range of 1.4–33.5 months. Responses were seen in all subtypes. Infections were more common in the LDAC arm. There was no difference in the time to progression or the overall survival for patients treated with LDAC or supportive therapy. The incidence of leukemic transformation was similar in both arms at 15%, but it differed according to the MDS subtype. Patients receiving LDAC had a decreased transfusion requirement after 3 months. There was a significant correlation between the degree of cytoreduction after receiving a single cycle of LDAC and survival. This survival difference was most marked in patients with the RAEB and RAEB-T subtypes. Although LDAC produced responses in all subtypes of the MDS, there was no effect on overall survival or transformation to AML. However, selected patients benefited from a single cycle of LDAC with durable responses. A cytoreductive effect appears to be required for a durable response. Future studies should include pathology review and must address the clinical and biological heterogeneity of MDS.
- Published
- 1993
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