Phase II study of aclarubicin in patients with lymphoma

Aclarubicin, a new anthracycline antibiotic with less cardiotoxicity relative to doxorubicin, was utilized in 33 patients with advanced lymphoma at a dose of 100 mg/m2 iv every 3 weeks. Five patients developed partial response (2, 2, 2, 4, and 8+ months). None of the patients who had received prior anthracycline responded to aclarubicin. The dose-limiting toxic effect was hematologic. One of ten patients having serial measurements of cardiac function had a significant reduction in left ventricular function, but cardiac symptoms did not occur.

Combination chemotherapy for multiple myeloma with BCNU, cyclophosphamide, vincristine, melphalan, and prednisone (M-2 protocol)

54 consecutively referred, previously untreated patients with stage II and III multiple myeloma have been treated with the M-2 protocol. 50% of patients had a performance status of less than 50%. 13% were stage II and 87% stage III. In 50 of 54 patients (90%), and objective response according to the Myeloma Task Force was achieved; 10% of the responses have been complete (9+, 15+, 17+, 18+ and 66+ months). Remissions now range from 1 to 86+ months. The actuarial median survival determined from the initiation of therapy will exceed 4 years. Toxicity was acceptable with mild myelosuppression. These results confirm the efficacy of the M-2 protocol in multiple myeloma with regards to response rate and survival.

Phase II study of aziridinylbenzoquinone in refractory lymphoma

Aziridinylbenzoquinone (AZQ), an alkylating agent with lipophilic properties allowing CNS penetration, has been studied in a phase II trial in patients with refractory lymphoma. Thirty-five patients (ages, 24-84 years) have been treated using AZQ at a dose of 30 mg/m2 every 3 weeks. Nine patients (26%) have responded (complete responses for 14+, 12+, 4, 3, and 3 months; partial responses for 7, 2, 2, and 2 months). Seven of the nine responses were seen in patients with diffuse histologies, particularly diffuse histiocytic lymphoma. One of two patients with CNS lymphoma responded completely. Complete remissions were observed only in patients receiving not more than one prior chemotherapeutic protocol. The drug was well-tolerated. Neutropenia was brief and acceptable. However, cumulative thrombocytopenia occurred even in patients without prior nitrosourea therapy and necessitated significant dosage reductions with subsequent cycles. AZQ appears active in lymphomas, especially in diffuse histiocytic lymphoma. The possibility of using AZQ in CNS lymphoma should be further explored.

Stable E rosette-forming lymphocytes in the peripheral blood in non-Hodgkin's lymphoma

The peripheral blood of 49 patients with non-Hodgkin's lymphoma and the same number of normal controls was examined for the presence of lymphocytes forming rosettes with sheep erythrocytes at 37 degrees C (stable E rosettes). Nineteen lymphoma patients but only five normal controls showed increased absolute levels. (P less than 0.01). There was no correlation between the occurrence of increased Stable E Rosette levels and the histological type of lymphoma but there appears to be a positive relationship with the presence of clinical stage III-IV disease at presentation (P = 0.011). It is suggested that stable E rosettes represent an immunological response to residual lymphoma in our patients. A longitudinal study in one patient is reported in detail to demonstrate the occurrence of fluctuations in stable E rosette levels coinciding with clinical changes.

Size Distributions and Mineralogy of Ash Particles in the Stratosphere from Eruptions of Mount St. Helens

Samples from the stratosphere obtained by U-2 aircraft after the first three major eruptions of Mount St. Helens contained large globules of liquid acid and ash. Because of their large size, these globules had disappeared from the lower stratosphere by late June 1980, leaving behind only smaller acid droplets. Particle-size distributions and mineralogy of the stratospheric ash grains demonstrate in-homogeneity in the eruption clouds.

Combination chemotherapy for non-Hodgkin lymphomas: a ten year follow-up study

In 1968 the Cancer and Acute Leukemia Group B (CALGB) demonstrated optimal control of disseminated non-Hodgkin lymphomas (NHL) with vincristine-prednisone induction followed by cyclophosphamide maintenance. A study was then begun to determine whether four drugs in combination or sequence could achieve greater control. NHL patients at each participating CALGB institution were randomly assigned to one of three regimens:I) Cyclic vincristine-streptonigrin alternating every 2 weeks with cyclophosphamide-prednisone up to 155 days; II) Sequential treatment with the same 4 drugs taken singly up to 182 days; and III) Vincristine-prednisone induction for 6 weeks followed by cyclophosphamide maintenance. Results are now reported after a 10 year follow-up period. The 203 evaluable patients are those on whom Rappaport histopathologic classification was available. Frequency of complete-response did not differ significantly among the three regimens: I) 38%; II) 30%; and III) 45%. Remission durations were significantly longer among patients receiving maintenance therapy. After ten years, two patients from Regimen I, one from Regimen II, and five from Regimen III remain alive and well. It was concluded that neither of the four-drug regimens conferred a significant advantage in terms of response rate or survival time over the standard treatment.

Perceptions of cancer care by professionals and nonprofessionals

Critical incident descriptions were obtained by questionnaire from 472 practicing physicians, 59 medical students, 31 house officers, 50 clinical faculty, and 43 allied health professionals. Descriptions were obtained by interview from 660 cancer patients and their families, and from 250 noncancer patients. The resulting 4,877 vignettes were analyzed and dissected to yield 13,009 separate, identifiable critical behaviors, i.e., behaviors deemed critical to the delivery of optimal care. After elimination of duplication and those items not specifically relevant to cancer, there remained 339 distinct attributes of an effective cancer care system. The results confirmed that the nonprofessionals are most concerned with items in the affective domain while the professionals are most concerned with items of a technological nature. However, there was a good deal of overlap in these areas of concern, and it appears from it that "needs" as expressed by professionals and "wants" as expressed by nonprofessionals often represent the same things couched in different terms. This study also yielded a list of desirable competencies of value as educational objectives for programs of profes sional education in cancer care.

Acute renal failure after cis-dichlorodiammineplatinum(II) and gentamicin-cephalothin therapies

Combined gentamicin-cephalothin therapy in four patients after treatment with cis-dichlorodiammineplatinum(II) (CPDD) for advanced solid tumors was complicated by severe acute renal failure. The total dose of gentamicin varied from 240 to 945 mg and that of cephalothin varied from 28 to 48 g. Low-dose (0.5 mg/kg x 8) CPDD was given to one patient, high-dose (3 mg/kg) CPDD was given to two patients, and very high-dose (5 mg/kg) CPDD was given to one patient. The high and very high doses of CPDD were given with concomitant mannitol diuresis. CPDD therapy was complicated by mild transient azotemia in three patients and by severe acute renal failure in one. In the latter, the azotemia began to improve on Day 7 after CPDD treatment. Following gentamicin-cephalothin therapy, all patients developed severe acute renal failure which persisted until death. At autopsy, all patients had extensive renal tubular necrosis at various stages. These findings indicate that gentamicin-cephalothin therapy after treatment with CPDD can be severely nephrotoxic, and that this antibiotic combination should be given with great caution, if at all, to patients receiving CPDD treatment for malignancy.

The renal pathology in clinical trials of cis-platinum (II) diamminedichloride

The pathologic changes induced by Cis-platinum (II) diamminedichloride (CPDD) therapy in the kidneys are described in 12 patients with solid tumors and malignant lymphomas. According to dosage of CPDD the patients were divided into two groups: 1) low-dose group--.0.5-2 mg/kg daily, for 1 to 6 days; and 2) high-dose group--single injection of 3 or more mg/kg with concommitant mannitol-induced diuresis. Pathologic changes in the kidneys were essentially similar in both groups and consisted of focal acute tubular necrosis, affecting primarily the distal convoluted tubules and collecting ducts, dilatation of convoluted tubules, and formation of casts. These changes persisted as long as 29 days post CPDD therapy. In addition, the collecting ducts exhibited significant epithelial atypia. BUN and serum creatinine levels were elevated in both groups. The mean BUN/serum creatinine values were 54/2.2 mg/100 ml and 32/2.0 mg/100 ml for low and high-dose groups, respectively. Since the nephrotoxicity of CPDD is known to be dose-related, our findings suggest that mannitol-induced diuresis has considerably decreased the renal toxic damage of CPDD therapy in these patients.

High dose cis-platinum diammine dichloride: amelioration of renal toxicity by mannitol diuresis

A clinical trial was undertaken to improve the therapeutic index of cis-platinum diammine dichloride with a concomitantly administered mannitol induced diuresis. Sixty patients, heavily pretreated, were entered; fifty-one are evaluable. The technique of concomitant osmotic diuresis and CPDD administration is described in detail. Doses ranged from 3 mg/kg to 5 mg/kg. At 5 mg/kg, dose-limiting renal, marrow and ototoxicity were seen, and resulted in one drug death. Marrow toxicity was moderate. Renal toxicity was limited to transient elevations in serum creatinine levels, except in some patients who had renal impairment prior to CPDD treatment. These patients had moderate renal toxicity. Serial treatments as frequently as once every 3 weeks were used to maintain responses. Serial high dose CPDD produced only mild renal dysfunction. Ototoxicity, usually subclinical, was quantitated audiometrically, and found to be dose related, but not clinically prohibitive at 4 mg/kg or less. The overall response rate (PR/MR) was 42%. Clinically significant responses in epidermoid carcinoma of the head and neck, adenocarcinoma of the ovary, and germ cell tumors of the testis were seen. All six responding patients with germ cell tumor of the testis, had been resistant to low dose (1mg/kg) CPDD. Two responding patients with ovarian adenocarcinoma had been resistant to alkylating agents.

Comparison of the combination of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and vincristine with two dose schedules of 5-(3,3-dimethyl-1-triazino) imidazole 4-carboxamide (DTIC) in the treatment of disseminated malignant melanoma

One hundred twenty patients with inoperable metastatic malignant melanoma were randomly allocated to treatment with either a combination of BCNU 150 mg/m2 and vincristine 2 mg/m2 given every 30 days, or one of two regimens of DTIC: 300 mg/m2/day x 6 or 100 mg/m2/8 hours x 18 given every 30 days. Eight of the 51 (16%) patients who were originally treated with the BCNU and vincristine combination had 50% or more objective tumor regression, compared to 6 out of 25 (24%) patients treated with daily injections of DTIC, and 6 out of 21 (29%) patients treated with DTIC injections every 8 hours. The median duration of response to the BCNU and vincristine combination was 60 days, and the median duration of survival from initiation of treatment was 6.5 months in the responders and 3.3 months in the nonresponders. The median duration of response was 90 and 100 days for the daily and 8-hour regimens of DTIC respectively, andthe median duration of survival from commencement of treatment was 8.5 months for the responders and 3.5 months for the nonresponders. None of the 43 patients who failed to respond to the initial treatment program or whose disease progressed after initial improvement responded to the alternate treatment regimen.

Lymphadenopathy due to toxoplasmosis

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