Myeloproliferative disorders in patients with rheumatoid arthritis treated with total body irradiation
Identifieur interne : 003525 ( Main/Exploration ); précédent : 003524; suivant : 003526Myeloproliferative disorders in patients with rheumatoid arthritis treated with total body irradiation
Auteurs : Murray B. Urowitz [Canada] ; Walter D. Rider [Canada]Source :
- The American Journal of Medicine [ 0002-9343 ] ; 1985.
English descriptors
- Teeft :
- Acute leukemia, Alkylating agents, American journal, Aplastic anemia, Arthritis, Arthritis rheum, Auer rods, Azathioprine, Binding decision, Blood cell count, Blood cell count platelet count, Body irradiation, Bone marrow, Bone marrow transplantation, Boston series, Clinical improvement, Count number, Cyclophosphamide, Cytotoxic, Effusion, Erythrocyte sedimentation rate, Hemoglobin level, Immunosuppressive cytotoxic drugs, Irradiation, January, Joint count, Lower body, Lymphoid, Malignancy, Many years, Medicine volume, Myelodysplastic preleukemia, Myeloproliferative, Myeloproliferative disorder, Ontario cancer institute, Platelet, Platelet count, Princess margaret hospital, Rad, Radiation therapy, Rheumatoid, Rheumatoid arthritis, Second malignancies, Second malignancy, Serious side effects, Severe seropositive, Single dose, Stanford series, Total body irradiation, Total lymphoid irradiation, Total nodal irradiation, Upper body, Wellesley hospital, White blood cell count.
Abstract
Abstract: Four patients with refractory rheumatoid arthritis were treated with total body irradiation administered in two sittings, 300 to 400 rads to each half of the body. All four patients had taken antimetabolites prior to receiving total body irradiation, and two continued to use them after total body irradiation. Two patients had taken alkylating agents before, and one had used them after total body irradiation. All patients showed clinical improvement. However, in two patients myeloproliferative disorders developed: a myelodysplastic preleukemia at 40 months after total body irradiation in one and acute myelogenous leukemia at 25 months in the other. Total body irradiation differs from total nodal irradiation in the total dose of irradiation (300 to 400 rads versus 2,000 to 3,000), and in the duration of the therapy (two sittings versus treatment over several weeks to months). Furthermore, the patients in the total body irradiation study frequently used cytotoxic drugs before and/or after irradiation, whereas in one total nodal irradiation study, azathioprine (2 mg/kg per day or less) was permitted, but no other cytotoxic agents were allowed. Rheumatologists may therefore face a binding decision when deciding to treat a patient with rheumatoid arthritis with either a cytotoxic drug or irradiation.
Url:
DOI: 10.1016/0002-9343(85)90248-7
Affiliations:
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All four patients had taken antimetabolites prior to receiving total body irradiation, and two continued to use them after total body irradiation. Two patients had taken alkylating agents before, and one had used them after total body irradiation. All patients showed clinical improvement. However, in two patients myeloproliferative disorders developed: a myelodysplastic preleukemia at 40 months after total body irradiation in one and acute myelogenous leukemia at 25 months in the other. Total body irradiation differs from total nodal irradiation in the total dose of irradiation (300 to 400 rads versus 2,000 to 3,000), and in the duration of the therapy (two sittings versus treatment over several weeks to months). Furthermore, the patients in the total body irradiation study frequently used cytotoxic drugs before and/or after irradiation, whereas in one total nodal irradiation study, azathioprine (2 mg/kg per day or less) was permitted, but no other cytotoxic agents were allowed. Rheumatologists may therefore face a binding decision when deciding to treat a patient with rheumatoid arthritis with either a cytotoxic drug or irradiation.</div></front></TEI><affiliations><list><country><li>Canada</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Urowitz, Murray B" sort="Urowitz, Murray B" uniqKey="Urowitz M" first="Murray B." last="Urowitz">Murray B. Urowitz</name></region><name sortKey="Rider, Walter D" sort="Rider, Walter D" uniqKey="Rider W" first="Walter D." last="Rider">Walter D. Rider</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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