melphalan and Pleural-Effusion

Topics: Aged; Amyloidosis; Anti-Inflammatory Agents; Dexamethasone; Diagnosis, Differential; Disease Progression; Early Diagnosis; Fatal Outcome; Female; Heart Failure; Humans; Immunosuppressive Agents; Mass Screening; Melphalan; Myeloablative Agonists; Nurse's Role; Patient Education as Topic; Pleural Effusion; Proteinuria; Rare Diseases; Stem Cell Transplantation; Thalidomide

The primary cardiac lymphoma (PCL) is an extremely infrequent tumor suffered by immunocompetent patients with a difficult diagnosis and slow progress leading to a serious prognosis and few therapeutically possibilities. It's a primary-cardiac non-Hodgkin's lymphoma (NHL) in a patient of 46-year-old, immunocompetent, who started with a congestive heart failure and atrial flutter. Some examinations were carried out such as a transesophageal echocardiography (TEE), a computed tomography (TC) and a magnetic resonance imaging (MRI) and an intracardiac tumor placed in the interauricular septum was detected. The diagnosis was based on a pleural fluid cytological examination. It was decided to follow a chemotherapy treatment and the autologous peripheral blood stem cells transplantation was carried out. The patient remains in full remission thirty-six months after diagnosis and twenty-nine months after the autotransplant. Our clinical experience indicated that an early and accurate diagnosis combined with the appropriate and aggressive antilymphoma therapy can thus help in obtaining a long survival in patients with PCL.

Topics: Antineoplastic Combined Chemotherapy Protocols; Atrial Flutter; Carmustine; Cyclophosphamide; Cytarabine; Doxorubicin; Echocardiography, Transesophageal; Etoposide; Heart Failure; Heart Neoplasms; Heart Septum; Hematopoietic Stem Cell Transplantation; Humans; Hydrocortisone; Immunocompetence; Injections, Spinal; Lymphoma, Large B-Cell, Diffuse; Magnetic Resonance Imaging; Male; Melphalan; Methotrexate; Middle Aged; Pleural Effusion; Prednisone; Remission Induction; Tomography, X-Ray Computed; Transplantation Conditioning; Transplantation, Autologous; Vincristine

Pharmacokinetic modeling has suggested, and clinical investigations have confirmed, that intracavitary drug administration can result in a much greater drug exposure for the cavity into which the agent is instilled compared to the plasma. Both the safety and the efficacy of several agents administered individually or in combination have now been demonstrated. Several malignancies, in particular ovarian carcinoma and malignant mesothelioma, which remain confined to body cavities for much of their natural history, might be most rationally treated by the intracavitary treatment approach. Early clinical trials have demonstrated significant activity of intracavitary chemotherapy in both of these malignancies. Optimal drugs and dosages as well as appropriate scheduling for the various tumors involving body cavities remain to be defined. Whether or not combination intracavitary chemotherapy will significantly improve survival of patients with malignant disease confined to body cavities must await carefully controlled clinical trials comparing this treatment approach to standard systemically administered chemotherapy.

Topics: Absorption; Animals; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Ascitic Fluid; Bacterial Infections; Bleomycin; Cisplatin; Cytarabine; Diffusion; Doxorubicin; Drug Synergism; Female; Fluorouracil; Humans; Immunotherapy; Melphalan; Methotrexate; Mitomycins; Neoplasms; Ovarian Neoplasms; Peritoneal Cavity; Permeability; Pleura; Pleural Effusion; Radiation-Sensitizing Agents; Sclerosis; Streptozocin

Refractory pleural effusions present a challenging management problem and are associated with a poor prognosis in patients with primary systemic amyloidosis (AL). We report a series of four patients with AL who presented with bilateral pleural effusions that were refractory to diuretic therapy. After treatment with bevacizumab, an antivascular endothelial growth factor (VEGF) antibody, three of the four patients had improvement in their pleural effusions, peripheral edema, and functional status. Additional studies are needed to further define the role of bevacizumab in the management of this group of patients.

Topics: Amyloidosis; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bevacizumab; Captopril; Chest Tubes; Combined Modality Therapy; Dexamethasone; Diuretics; Drug Resistance; Edema; Fatal Outcome; Furosemide; Humans; Hypoalbuminemia; Male; Melphalan; Metolazone; Middle Aged; Multiple Myeloma; Nephrotic Syndrome; Peripheral Blood Stem Cell Transplantation; Pleural Effusion; Prednisolone; Serum Albumin; Spironolactone; Thalidomide; Thoracostomy; Transplantation, Autologous; Vascular Endothelial Growth Factor A

Amyloidosis is often difficult to diagnose and cardiac involvement worsens the prognosis.. We report the case of a 72-year old man consulting for cardiac failure with pleural effusion. A restrictive cardiomyopathy was discovered by echocardiography, and amyloidosis was then suspected. First histological localization was pleural. Cardiac involvement was confirmed. The diagnosis was supported by digestive and cutaneous localizations. It was an AL amyloidosis. Treatment with melphalan and dexamethasone allowed stabilization during more than six months.. This is an original case report, because of the first clinical signs (cardiac failure), the histological proof (pleural histology). Echocardiography is particularly helpful in internal medicine.

Topics: Aged; Amyloidosis; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Cardiomyopathy, Restrictive; Dexamethasone; Drug Therapy, Combination; Echocardiography; Humans; Male; Melphalan; Pleural Effusion; Treatment Outcome

Immunoglobulin D (IgD) multiple myeloma is rare, accounting for less than 2% of all patients with multiple myeloma. The main presenting features are bone pain in 70% of patients. Extramedullary involvement is less common. We report a case of Ig D lambda multiple myeloma in a 74-year-old man that was revealed by pleural effusion and dyspnea. This effusion was found to be caused by multiple myeloma after electrophoretic and cytologic assays. The patient received a course of chemotherapy with melphalan and prednisone. The patient died one month later with signs of septic shock. Pleural effusion as a first sign of Ig D multiple myeloma is rarely described and the prognosis associated with such a localisation is very poor.

Topics: Aged; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Drug Therapy, Combination; Dyspnea; Humans; Immunoelectrophoresis; Immunoglobulin D; Immunoglobulin lambda-Chains; Male; Melphalan; Multiple Myeloma; Pleural Effusion; Prednisone; Time Factors

We describe here an extremely rare case of primary amyloidosis which presented moderate pleural effusion and high fever. A 71-year-old man was admitted to our hospital because of exertional dyspnea, fatigue and fever. A chest X-ray showed right-sided moderate pleural effusion. A thoracocentesis revealed an exudative pleural effusion. Cytology and cultures of the effusion were negative. External drainage failed to control the effusion. To determine the etiology of the effusion and fever, bronchoscopy was performed. Biopsies of the tracheal wall showed amyloid deposition. The pleural effusion might have been due to the inflammation and the disturbed lymphatic drainage caused by the amyloid deposition. Treatment with melphalan (6 mg) and prednisolone (35 mg) for 4 days every 6 weeks decreased the fever and alleviated his symptoms.

Topics: Aged; Amyloidosis; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Bronchoscopy; Dyspnea; Exudates and Transudates; Fever; Humans; Lung Diseases; Male; Melphalan; Pleural Effusion; Prednisolone; Treatment Outcome

While pleural effusion in multiple myeloma is relatively infrequent, myelomatous pleural effusion is extremely rare. We experienced a 61-year-old woman with IgD-lambda multiple myeloma and pleural effusion. The diagnosis was made originally by pleural biopsy, pleural fluid cytology and immunoelectropheresis of pleural fluid. Transient improvement of the pleural effusion was observed after administration of combination chemotherapy of vincristine, melphalan, cyclophosphamide, prednisone (VMCP)/vincristine, cyclophosphamide, adriamycin, prednisone (VCAP). Two months later, myelomatous pleural effusion recurred and no response to salvage therapy was observed. We reviewed the clinical feature of this case and literature concerning myelomatous pleural effusion.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Female; Humans; Melphalan; Middle Aged; Multiple Myeloma; Plasma Cells; Pleural Effusion; Prednisone; Tomography, X-Ray Computed; Vincristine

Pleural effusion caused by plasma cell involvement in multiple myeloma has been reported unfrequently, and has been described at a frequency below 1% of multiple myeloma. In this study, we report an observation with pleural effusion as first symptom of multiple myeloma. The analysis of the pleural liquid showed plasma cells with a monoclonal IgG Kappa immunoglobulin. In addition, there was a bone marrow infiltration by plasma cells, a serum monoclonal immuno-globulin of the same type and osteolytic lesions. Our patient has received one course of chemotherapy with: vincristine, melphalan, cyclophosphamide and prednisone. The patient did not respond to the therapy and died one month later. Pleural effusion seems to be an expression of aggressive myeloma. Survival exceeds rarely 4 months.

Topics: Antibodies, Monoclonal; Antineoplastic Agents, Alkylating; Antineoplastic Agents, Hormonal; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Cyclophosphamide; Fatal Outcome; Female; Humans; Immunoglobulin G; Immunoglobulin kappa-Chains; Melphalan; Middle Aged; Multiple Myeloma; Osteolysis; Plasma Cells; Pleural Effusion; Prednisone; Vincristine

To clarify cellular biological varieties of myeloma cells, biological differences were analyzed between 2 human myeloma cell lines, KMS-12-PE and KMS-12-BM, derived from pleural effusion and bone marrow, respectively, of a single patient. Although both lines were considered to be derived from the same clone because both had the same chromosomal marker and immunoglobulin H rearrangement, several biological differences were noted. CD11a and CD20 were highly expressed in the KMS-12-BM line, whereas the KMS-12-PE line showed a higher expression of CD7 and CD95/Fas. Although growth was stimulated in KMS-12-BM by interleukin-6 and interferon-alpha, it was inhibited in KMS-12-PE. In addition, apoptosis inhibitors Bcl-2 and Bcl-X(L) were highly expressed in KMS-12-BM cells. Because KMS-12-PE was cultivated 2 months before KMS-12-BM, these differences might be related to their origin (pleural effusion and bone marrow) or the phases of disease progression. However, these biological differences may help clarify myeloma cell biology and lead to improvement in treatment for myeloma patients.

Topics: Antigens, Surface; Antineoplastic Agents, Alkylating; Antineoplastic Agents, Phytogenic; Blotting, Western; Bone Marrow; Cell Division; Clone Cells; Etoposide; Female; Humans; Immunophenotyping; Interferon-gamma; Interleukin-6; Japan; Melphalan; Middle Aged; Multiple Myeloma; Pleural Effusion; Proto-Oncogene Proteins c-bcl-2; Tumor Cells, Cultured

We report a case of IgA-kappa multiple myeloma in a 68-year-old woman that was revealed by concomitant pleural and pericardial effusion. These effusions were found to be caused by myeloma and were verified by cytological examination of the pleural fluid and pericardial biopsy. The patient had neither osteolytic lesions nor Bence-Jones proteinuria. After a pericardiocentesis, her condition improved with a melphalan and prednisolone treatment. As far as we know, such a phenomenon is rare and has never been reported yet as a way of diagnosing multiple myeloma.

Topics: Aged; Antineoplastic Agents, Alkylating; Antineoplastic Agents, Hormonal; Female; Follow-Up Studies; Humans; Melphalan; Multiple Myeloma; Pericardial Effusion; Pleural Effusion; Prednisolone; Radiography, Thoracic; Time Factors

A 73-year-old female patient with myelomatous pleural effusions is described. She was admitted to our hospital with lumbago and emaciation. Laboratory findings revealed cytopenia and hypogammaglobulinemia. Immunoelectrophoresis demonstrated Bence-Jones monoclonal protein in the serum, but not in the urine. Bence-Jones myeloma was diagnosed by the bone marrow aspiration. Chest X-ray film, however, showed bilateral pleural effusions. Fluid cytology revealed numerous immature plasma cells, indicating pleural involvement. Intrapleural administration of alpha-interferon combined with systemic chemotherapy (oral melphalan-prednisolone with alpha-interferon im.) was successful in maintaining the resolution of pleural effusions. Intrapleural alpha-interferon administration seems to be effective in the management of myelomatous pleural effusions.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bence Jones Protein; Combined Modality Therapy; Female; Humans; Interferon Type I; Melphalan; Multiple Myeloma; Pleural Effusion; Prednisolone; Recombinant Proteins

To clarify the role of standard chest radiography in prostatic adenocarcinoma, the pulmonary manifestations of 198 patients with Stage D disease were evaluated. All patients were treated with chemotherapeutic protocols allowing for adequate clinical and radiographic correlation. Retrospective interpretation of serial chest radiographs revealed that 35% of our patients had visible intrathoracic abnormalities; however, only 24% of the patients had abnormalities attributable to intrathoracic metastases. Twenty-two percent of patients had pleural effusions, 16% reticular opacities, 3.5% reticulonodular opacities, 8% isolated or discrete pulmonary nodules, and 4.5% adenopathy. Etiologies of these opacities included metastatic disease in 93.5% of those with adenopathy and nodular or reticulonodular opacities, but 39% of pleural effusions and 52% of reticular opacities were best attributed to concomitant processes. Four patients had intrathoracic metastases without bone metastases. Standard chest radiography is a valuable screening procedure that should be correlated with clinical data to differentiate metastases from concomitant processes.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Fluorouracil; Humans; Lung; Lung Neoplasms; Lymphatic Metastasis; Male; Melphalan; Methotrexate; Middle Aged; Pleural Effusion; Prednisone; Prostatic Neoplasms; Radiography; Retrospective Studies; Vincristine

Efficacy of local treatment of neoplastic pleural effusions may be related to the administered drugs, as judged by our series of 225 patients. The evaluation of the local improvement--which did not interfere with the evolution of the primary cancer--showed good (45.9%) or satisfactory (48.6%) results in a series of 148 patients treated with peptichemio. This local improvement was practically devoid of any adverse side-effect even when the treatment was particularly prolonged. This survey deals with 15 years of therapeutical experience concerned with neoplastic pleural effusions from malignant epithelial tumours.

Topics: Dose-Response Relationship, Drug; Humans; Lung Neoplasms; Melphalan; Peptichemio; Phagocytosis; Pleural Effusion

Topics: Adult; Aged; Antineoplastic Agents; Busulfan; Chlorambucil; Female; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Male; Melphalan; Middle Aged; Multiple Myeloma; Pleural Effusion; Pulmonary Fibrosis

Assays that assess the ability of cells to incorporate labeled precursors into acid-precipitable material in the presence of adriamycin, daunorubicin, puromycin, vinblastine, melphalan, or methotrexate were investigated as an approach to the detection of resistant cells in human tumor samples. Each assay was evaluated with suitable drug-resistant Chinese hamster ovary cell lines and normal human fibroblasts to determine whether the assays reflected the drug sensitivity of these lines. Moreover, the ability to detect the presence of drug-resistance cells in a mixed population was evaluated. Validated assays were then used to measure the drug sensitivity of cell samples from pleural and peritoneal effusions of patients, mainly with carcinoma of the breast or ovary. Though the responsiveness of the majority of the samples in these assays was similar to that of a human fetal lung fibroblast line, 37 of 142 samples displayed responses consistent with the presence of a significant proportion of drug-resistant cells. Of these 37 nonresponsive samples, 12 displayed nonresponsiveness to three drugs.

Topics: Antineoplastic Agents; Ascitic Fluid; Cell Division; Cell Line; Daunorubicin; DNA, Neoplasm; Doxorubicin; Drug Evaluation, Preclinical; Drug Resistance; Humans; In Vitro Techniques; Melphalan; Methotrexate; Neoplasms; Phenotype; Pleural Effusion; Puromycin; RNA, Neoplasm; Vinblastine

Topics: Aged; Autopsy; Biopsy; Bone Marrow Cells; Cyclophosphamide; Female; Heart Neoplasms; Humans; Kidney Neoplasms; Leukemia, Lymphoid; Lymphocytes; Male; Melphalan; Middle Aged; Multiple Myeloma; Nasal Polyps; Nose Neoplasms; Osteitis Deformans; Plasmacytoma; Pleural Effusion; Prednisolone; Radiography