Antifungal treatment by amphotericin B and 5-fluorocytosine delays the recovery of normal hematopoietic cells after intensive cytostatic therapy for acute myeloid leukemia
Article Abstract:
From 50 to 70 percent of patients with newly diagnosed acute myeloid leukemia are likely to achieve complete remission following intensive chemotherapy, and many of these patients are likely to enjoy long-term disease-free survival. However, the intensive chemotherapy itself has serious adverse effects which may be fatal for some patients. The two most significant side effects of treatment are thrombocytopenia and neutropenia. Thrombocytopenia is a reduction of the number of platelets, which induce blood clotting; the condition may result in uncontrolled bleeding. Neutropenia is the depletion of neutrophils, an important type of white blood cell necessary to fight certain infections. The bleeding complications are being successfully reduced through modern techniques of transfusion, but the risk of infection during the period of neutropenia remains a serious threat. Antibiotics may be used to reduce the risk of bacterial infection, but fungal infections are common during this period. The antifungal drug amphotericin B is often given as prophylactic treatment. Recently, some evidence has suggested that 5-fluorocytosine may improve the antifungal effectiveness of amphotericin B, but there are also serious concerns that this drug may impede the recovery of the immune system after chemotherapy. A study was conducted to evaluate the recovery of the immune system in 87 patients who underwent intensive chemotherapy for acute myeloid leukemia. Twenty-two patients had either a proven or suspected fungal infection and were treated with the combination of amphotericin B and 5-fluorocytosine; a control group consisting of the other 65 patients did not receive the antifungal therapy. The average recovery period for granulocytes, including neutrophils, was 24 days in the controls and 29 days for the patients who received the treatment. These results indicate that the recovery of the immune system is slowed somewhat by the combination of amphotericin B and 5-fluorocytosine. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Malignancies in children with human immunodeficiency virus type 1 infection
Article Abstract:
The suppression of the immune system in patients with AIDS leaves them susceptible to numerous opportunistic infections, which pose little threat to healthy individuals. In addition, some cancers appear to be more common among AIDS patients, indicating an important role for the immune system in preventing cancers in at least some cases. Cancers appear to be less common as a complication of AIDS among children than among adults, however. A review of the cases of 1,321 Italian children registered as HIV-infected found only 7 cases of cancer. Four cases were non-Hodgkin's lymphoma; there was one case each of Kaposi's sarcoma, hepatoblastoma, and acute B cell lymphoblastic leukemia. Non-Hodgkin's lymphoma is common among patients with AIDS, and Kaposi's sarcoma is, of course, a hallmark of the disease. However, hepatoblastoma, a form of liver cancer, has never before been reported in a patient infected with the AIDS virus. It is worth noting that all four of the lymphomas involved B cells, the type of white blood cell responsible for making antibodies as well as other key functions in the immune system. Five of the seven cancers observed among these children, therefore, involve B cells. Only one of the seven children is still alive. Unfortunately, the treatment of cancer is difficult in children with AIDS. Chemotherapeutic treatment impairs the immune system of children already ravaged by the effects of the AIDS virus. Even if regression of the cancer can be achieved, the children are rendered more susceptible to potentially fatal infections. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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