Poor bone marrow is also associated with a decline in bone architectural quality.
The two exceptions were a 14-year-old patient (case 11, cohort B) who moved to another country and an 11-year-old patient (case 13, cohort B) who was operated in another hospital and was switched to craniospinal irradiation following major postoperative infectious complications and poor bone marrow tolerance.
Moreover, since the drug dose and treatment schedule can be easily modified in a weekly regimen, this protocol is considered to be suitable for relapsed SCLC patients, who usually present with severe haematological toxicities during salvage chemotherapy because of poor bone marrow reserve (Masuda et al, 1990; Faylona et al, 1995).
Further, elderly patients have poorer bone marrow function compared to younger patients and also seem to be more vulnerable to infectious diseases.
The International Prognostic Scoring System (IPSS) identified three critical factors that influence survival and AML evolution: risk-based cytogenetic subgroups (good, intermediate and poor karyotypes), bone marrow blast percentage and the number of cytopenias.
Additionally, poorer baseline ECOG PS and disease-related factors, such as poor cytogenetics, higher bone marrow blast counts, low baseline platelet counts, and high WBC counts, all predicted worse OS.
Classic therapy-related myeloid leukemia typically occurs 5 to 7 years after exposure to alkylating agents and/or irradiation, has a myelodysplastic phase with trilineage involvement, and is characterized by abnormalities of the long arms of chromosomes 5 and/or 7. Response to treatment is poor, and allogenic bone marrow transplantation is recommended.
Patients included in the study had either primary MDS with poor-risk features: bone marrow blast count ≥10% and/or poor-risk karyotype according to IPSS (Greenberg et al. 1997 ) or therapy-related, secondary MDS or AML, or AML according to WHO criteria (Harris et al. 1999 ) or chronic myelomonocytic leukemia (CMML-II).
Patient characteristics appearing to negatively influence OS at the 0.05 level included advanced age, poorer baseline ECOG PS, poor cytogenetic risk, higher bone marrow blast counts, low baseline platelet counts, and higher WBC counts.
Among the determinants of mortality in hematology patients with ARF, mechanical ventilation remains the major determinant of death [1, 4], as well as the type of ARF etiology (e.g., Invasive aspergillosis) [1, 5], poor performance status, allogeneic bone marrow stem cell transplantation, delayed ICU admission [6] or associated organ dysfunction [1, 3, 7].
Unfortunately, as well as having low therapeutic indices, the drugs are poor at penetrating the bone marrow, where some of the Leishmania amastigotes reside, and so cure of the disease – especially the visceral form – is very difficult.
