Abstract:
BACKGROUND:AL amyloidosis is a fatal disease resulting from tissue deposition of amyloid fibrils derived from monoclonal immunoglobulin light chains. Treatment with oral chemotherapy is minimally effective. OBJECTIVE:To test survival and organ response in a large sample of patients treated with high-dose intravenous melphalan (100 to 200 mg/m2) and autologous blood stem-cell transplantation. DESIGN:8-year longitudinal analysis of clinical effectiveness. SETTING:University-affiliated specialty referral clinic. PATIENTS:701 consecutive new patients with AL amyloidosis. INTERVENTION:High-dose chemotherapy and autologous stem-cell transplantation for patients who met eligibility requirements based on organ involvement and clinical status. MEASUREMENTS:Survival analysis of all patients evaluated and a detailed analysis of treatment outcome in the subgroup that received high-dose melphalan and stem-cell transplantation. RESULTS:Among 701 patients with AL amyloidosis, 394 (56%) were eligible for high-dose melphalan and stem-cell transplantation; 82 did not proceed with treatment because of patient choice or disease progression. Median survival of the 312 patients who initiated treatment was 4.6 years. A complete hematologic response, defined as no evidence of an underlying plasma cell dyscrasia 1 year after treatment, was achieved in 40% of patients and was associated with prolonged survival. Statistically significant improvements occurred in end-organ disease and were greater in patients with a complete hematologic response. Mortality rate within 100 days of treatment with high-dose melphalan and stem-cell transplantation was 13%; patients with cardiomyopathy had the highest mortality rates. CONCLUSIONS:Treatment of selected patients with AL amyloidosis by using high-dose melphalan and stem-cell transplantation resulted in hematologic remission, improved 5-year survival, and reversal of amyloid-related disease in a substantial proportion.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Skinner M,Sanchorawala V,Seldin DC,Dember LM,Falk RH,Berk JL,Anderson JJ,O'Hara C,Finn KT,Libbey CA,Wiesman J,Quillen K,Swan N,Wright DGdoi
10.7326/0003-4819-140-2-200401200-00008subject
Has Abstractpub_date
2004-01-20 00:00:00pages
85-93issue
2eissn
0003-4819issn
1539-3704pii
140/2/85journal_volume
140pub_type
临床试验,杂志文章abstract::Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measurement; 2) use a balanced set of process, outcome, and cost measures; 3) keep measurement simple (think big, bu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-6-199803150-00007
更新日期:1998-03-15 00:00:00
abstract:OBJECTIVE:To describe how the results of bone densitometry affect women's decisions about measures to prevent fractures and to determine whether labeling women as having below-normal bone density has adverse effects. DESIGN:Mail survey of a random sample of women. SETTING:Four community hospitals in the San Francisco...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-116-12-990
更新日期:1992-06-15 00:00:00
abstract:DESCRIPTION:The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed a recommendation on screening for anxiety in adolescent and adult women to improve detection; achieve earlier diagnosis and treatment; and improve healt...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/M20-0580
更新日期:2020-07-07 00:00:00
abstract:BACKGROUND:The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century. OBJECTIVE:To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies. DESIGN:Compartmental epidemic model in conjunction with a Markov mod...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-151-12-200912150-00156
更新日期:2009-12-15 00:00:00
abstract:PURPOSE:To review the status of emergency, urgent, routine, and selective angiography after intravenous thrombolytic therapy. DATA SOURCES:Relevant English-language articles published from January 1985 to July 1990 were identified through MEDLINE. STUDY SELECTION:For emergency angiography, four major randomized studi...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-114-10-877
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abstract::A controlled clinical trial compared three-drug and four-drug combination chemotherapy in 109 patients with advanced small-cell anaplastic carcinoma of the lung. The combination of vincristine, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), cyclophosphamide, and methotrexate was significantly superior to the com...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-89-2-177
更新日期:1978-08-01 00:00:00
abstract:BACKGROUND:The optimal strategy for diagnosis of deep venous thrombosis (DVT) is less well established for the upper extremities than for the lower extremities. Duplex color ultrasonography can be difficult to perform in the upper extremities because of their anatomy, and contrast venography is often indicated. Moreove...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-136-12-200206180-00007
更新日期:2002-06-18 00:00:00
abstract::During a 4.4-year period, nonspecific interstitial pneumonitis was seen in 41 of 110 (38%) patients with the acquired immunodeficiency syndrome and accounted for 32% (48/152) of all episodes of clinical pneumonitis. Diffuse alveolar damage was typically a feature of nonspecific interstitial pneumonitis, but neither lu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-1-7
更新日期:1987-07-01 00:00:00
abstract:STUDY OBJECTIVE:To define the prevalence, severity, type and pathogenesis of osteopenia in idiopathic hemochromatosis. DESIGN:Prospective study conducted over 18 months. SETTING:Tertiary care center. SUBJECTS:Twenty-two men with idiopathic hemochromatosis and 20 age-matched controls. There were 5 hypogonadal patient...
journal_title:Annals of internal medicine
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doi:10.7326/0003-4819-110-6-430
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abstract::Between June 1980 and September 1981 we evaluated 24 cases of endocarditis from methicillin-resistant Staphylococcus aureus. All of the cases occurred in drug addicts and all were community-acquired. The patients ranged in age from 21 to 59 years and represented an older population than that generally reported for bac...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-97-3-330
更新日期:1982-09-01 00:00:00
abstract:STUDY OBJECTIVE:To determine if the combination of ganciclovir and intravenous cytomegalovirus immunoglobulin is effective in patients with cytomegalovirus pneumonia after bone marrow transplant. DESIGN:Consecutive entry trial with treatment for a minimum of 14 days. PATIENTS:Consecutive sample of 25 patients with bo...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-109-10-783
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abstract::Colony-stimulating factors are growth factors responsible for the proliferation and the maturation of bone marrow stem cells to fully differentiated granulocytes and monocytes. In addition to their effects on hematopoiesis, some colony-stimulating factors prime mature cells for enhanced chemotaxis, phagocytosis, and k...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,评审
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abstract:BACKGROUND:Indinavir, a protease inhibitor widely used to treat patients with HIV infection, has been associated with nephrolithiasis. Distinctive urinary crystals and a spectrum of urologic disorders were noted in patients receiving indinavir. OBJECTIVE:To determine the composition of urinary crystals and the frequen...
journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-134-9_part_1-200105010-00009
更新日期:2001-05-01 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-114-7-573
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abstract::Recently, antibodies to human T-cell leukemia virus membrane antigens (HTLV-MA) and elevated levels of beta 2-microglobulin and thymosin alpha 1 have been found with high frequency in patients with the acquired immunodeficiency syndrome. Prospective studies of asymptomatic persons at high risk for this syndrome will a...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-2-178
更新日期:1984-02-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the value of a history and physical examination findings in diagnosing the carpal tunnel syndrome, and to determine whether constellations of clinical findings identify patients at high or low risk for the carpal tunnel syndrome. DESIGN:Comparison of diagnostic tests with neurophysiologic tes...
journal_title:Annals of internal medicine
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doi:10.7326/0003-4819-112-5-321
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abstract::Experimental findings in animals and epidemiologic studies in humans provide strong evidence that hypertension promotes the onset and progression of atherosclerosis. However, effective antihypertensive therapy has not consistently reduced the incidence of cardiac events in the major trials of treatment for mild hypert...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,评审
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:1990-05-15 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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更新日期:1994-10-01 00:00:00
abstract::Cost-effectiveness analysis and other forms of decision analysis are becoming more common in the medical literature and are increasingly influential in the development of health policy. Nevertheless, many clinicians find it difficult to apply policies developed from these analyses to individual encounters with patient...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-122-11-199506010-00007
更新日期:1995-06-01 00:00:00
abstract::Fifty-three consecutive patients with inferior myocardial infarction were evaluated prospectively, by physical examination and right heart catheterization within 36 hours of the onset of symptoms, to determine whether physical findings can separate such patients into those with and without associated right ventricular...
journal_title:Annals of internal medicine
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更新日期:1983-11-01 00:00:00
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journal_title:Annals of internal medicine
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doi:10.7326/0003-4819-130-10-199905180-00004
更新日期:1999-05-18 00:00:00
abstract:OBJECTIVE:To determine the rate of use of prophylaxis for venous thromboembolism in high-risk hospital patients. DESIGN:A retrospective medical record review. SETTING:A community-wide study in 16 short-stay hospitals in central Massachusetts. PATIENTS:A total of 2017 patients with multiple risk factors for venous th...
journal_title:Annals of internal medicine
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更新日期:1991-10-15 00:00:00
abstract::Patients with serious psychiatric disorders are frequently treated by primary care physicians, who may have difficulty keeping up with recent advances in psychiatry. This paper presents an updated synopsis for three major psychiatric illnesses: major depression, bipolar disorder, and schizophrenia. Current definitions...
journal_title:Annals of internal medicine
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更新日期:2001-01-02 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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更新日期:1979-02-01 00:00:00
abstract::Chronic lymphocytic leukemia developed in four of five siblings, whose father succumbed to the same disease. The pattern of immune deficiency in the leukemic siblings resembled that found in nonfamilial cases of chronic lymphocytic leukemia, and was correlated with the severity of clinical involvement. In three siblin...
journal_title:Annals of internal medicine
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doi:10.7326/0003-4819-84-5-554
更新日期:1976-05-01 00:00:00
abstract::Research participants require ongoing protection of the kind already established in law and regulation. However, "special scrutiny" for certain types of research is also needed. Three criteria for special scrutiny are 1) research that involves initial experiences of translating new scientific advances into humans, esp...
journal_title:Annals of internal medicine
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更新日期:2004-02-03 00:00:00
abstract::All practicing physicians should be prepared to respond to requests from patients for advice about participating in clinical trials research. Even physicians who choose not to conduct clinical trials but rather devote their practice to clinical care may have patients who consider volunteering for research. In advising...
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更新日期:2003-04-15 00:00:00