Complete remission

Pentostatin is effective in the treatment of hairy cell leukemia, producing 80-90% remissions (with a complete remission rate of more than 50%). The common side effects of pentostatin include myelosuppression, nausea, and skin rashes. Renal failure,... 

It is common for lithium to be combined with other mood-stabilizing drugs or antipsychotic drugs, if necessary, in order to achieve more complete remission of symptoms. Studies indicate that monotherapy is often insufficient to reach this goal.17... 

Pharmacotherapy generally is reserved for patients (1) in whom the ectopic adrenocorticotropic hormone-secreting tumor cannot be localized (2) who are not surgical candidates (3) who have failed surgery (4) who have had a relapse after surgery or (5) in whom adjunctive therapy is required to achieve complete remission. 

Splenectomy generally is considered after 3 to 6 months if the patient continues to require 10 to 20 mg/day of prednisone to keep the platelet count greater than 30,000/mm3 (30 x 103/jliL or 30 X 109/L) or within 6 weeks of diagnosis in patients with platelet counts of less than 10,000/mm3 (10 x 103/ju,L or 10 x 109/L) despite treatment. Even though individual patient response cannot be predicted, approximately two-thirds of refractory patients have a favorable response to splenectomy within a couple of days. After splenectomy, approximately 85% of adults attain a stable hemostatic response, and 70% to 80% of children attain complete remission. Within 5 to 10 years, approximately 25% of responding adult patients relapse. Laproscopic splenectomy is preferable to open splenectomy because it speeds the recovery and shortens the duration of hospitalization. The major drawback of splenectomy is bacterial sepsis, occurring at incidence rates of about 1%. 

In adults, there is a steady decline in the rate of complete remission (CR) following initial induction therapy with increasing age. While induction treatment produces 95% CR in children, it decreases to 40% to 60% in patients older than 60 years of age. The prognostic implication is due in part to decreased tolerance of stringent induction/consolidation... 

Allogeneic hematopoietic stem cell transplantation (HSCT) has been used in the treatment of pediatric AML in first complete remission. In most clinical trials, the availability of HLA-matched sibling donors determined whether patients underwent HSCT as postremission treatment. To facilitate this process, it is important to obtain HLA typing on all younger patients with AML and siblings shortly after diagnosis. Patients who do not have an HLA-matched sibling will proceed to postremission therapy. 

The primary goal in the treatment of CML is to eradicate the Ph-positive clones. Elimination of the Ph is termed cytogenetic complete remission. If treatment produces RT-PCR-negative disease, this is termed molecular complete remission and indicates a several-log reduction over cytogenetic complete remission. An early goal of therapy is to achieve hematologic complete remission or to normalize peripheral blood. 

Approximately 30-40% of patients will not respond to a given antidepressant and 60-75% may fail to achieve complete remission [16]. Consequently, in its least restricted definition, treatment resistance could be detected in the majority of depressed patients under treatment. Moreover, prior treatment failure negatively influences the response to subsequent antidepressant treatment, decreasing the odds of treatment response by a factor of 15-20% for each failed treatment [17]. The delayed onset of symptom relief (which takes three to eight weeks to occur) and the presence of adverse drug reactions contribute significantly to low treatment compliance. 

In 1990, Burke et al. [29] published a double-blind, placebo-controlled trial on the use of oral tobramycin in acute UC. Eighty-four patients were randomized to receive steroid plus tobramycin or placebo. After 1 week of treatment, 74% of patients in the tobramycin treatment group versus 43% in the placebo group (p < 0.003) achieved a complete remission. Subsequently, tobramycin and metronidazole were associated with a standard steroid treatment in severely acute UC. At the end, no difference was found between the two groups [30]. 

The ultimate goal of RA treatment is to induce a complete remission, although this may be difficult to achieve. 

Lack of complete remission after initial therapy or relapse within one year after completing initial therapy is associated with poor prognosis. Patients with these prognostic factors are candidates for high-dose chemotherapy and HSCT. 

Eliminate mood episode with complete remission of symptoms (i.e, acute treatment)... 

Fig. 13.3 Clinical response, adverse effects, and hematological parameters were determined and correlated with thiopurine methyl transferase (TPMT) enzyme activity and genotype in 106 patients with inflammatory bowel disease. The odds of achieving complete remission (CR) to azathioprine is approx, five times lower if TPMT is greater than 14 units/mL red blood cells (RBCs). (Reproduced from ref 39.)...

The symptoms of OCD generally arise in an insidious manner, though acute onset of OCD has been reported. Considerable evidence indicates that OCD, once it arises, is a chronic lifetime disorder. Even with treatment, only a small fraction of OCD sufferers experience complete remission of their symptoms. Although patients with OCD are seldom, if ever, completely symptom free, the severity of the illness fluctuates over time. During periods of heightened stress, patients with OCD are especially prone to symptomatic exacerbation. Eor example, the postpartum period,... 

Antidepressants. In the early 1980s, the recognition that depression is a frequent comorbid feature of BN coupled with the observation that appetite changes are a common feature of depression led researchers to evaluate antidepressant treatment for BN. Since that time, a series of controlled studies have demonstrated efficacy for a wide assortment of antidepressants including the TCAs imipramine (Tofranil) and desipramine (Norpramin), the MAOl phenelzine (Nardil), the SSRl fluoxetine (Prozac), and the atypical antidepressants trazodone (Desyrel) and bupropion (Wellbutrin). Overall, approximately two-thirds of antidepressant-treated patients with bulimia experience symptomatic improvement while nearly one-third achieves complete remission of binging and purging. In addition, the improvement in the symptoms of BN is not dependent on the presence of comorbid depression. 

Number of patients responding/total number of evaluable patients. CR, complete remission/response PR, partial response MR, minor response OR, objective response SD, stable disease. 

Novel approaches to therapeutically downregulate DNA methylation include the DNMTl antisense compound MG98. However, clinical phase trials with the single drug showed no effect (partial or complete remission) or the effects could not be linked to DNMT inhibition [95-97]. 

Auperin A, Arriagada R, Pignon JP, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 1999 341(7) 476-J84. 

DMARDs seldom induce complete remission and relapses frequently occur. However, oral combina-... 

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