Disorders of hemostasis in malignancy

Disorders of hemostasis are frequent in malignant disease and their cause is often multifactorial and complex. Both primary (platelets and vessel walls) and secondary (coagulation factors) hemostasis are impaired, often concurrently. Therapy is most often directed toward the underlying disease; however, a knowledge of the complications and treatment of each malignancy will often prevent a number of the problems cited in this chapter. The hypercoagulable states are still poorly understood and need better definition, but their recognition, treatment and prevention may decrease morbidity significantly.

Phase II trial of pyrazofurin, alone and in combination with trifluorothymidine, in non-Hodgkin's lymphoma

A phase II trial of pyrazofurin, alone and in combination with trifluorothymidine, was carried out in patients with advanced non-Hodgkin's lymphoma. None of the 19 patients evaluable for response had complete or partial remissions but 14 had minor regressions. Toxicity, consisting primarily of myelosuppression and stomatitis, was of moderate severity. These studies suggest that pyrazofurin, alone or in combination with trifluorothymidine, is of limited utility in advanced non-Hodgkin's lymphoma.

Prophylactic heparin therapy in acute promyelocytic leukemia

Twenty-four patients with acute promyelocytic leukemia were reviewed. Group I, treated between July 1970 and September 1973, received arabinosylcytosine and 6-thioguanine, and there was one complete remission, with 4/7 dying during induction with intracerebral hemorrhages, and 2/7 dying within one month. Group II, treated between May 1974 and March 1975, received daunomycin and arabinosylcytosine without heparin and 2/8 went into remission, with 6/8 dying during induction, 5 with intracerebral hemorrhages. Group III, treated between March 1975 and November 1976, received the identical chemotherapy as group II but with the addition of prophylactic heparin and there were 7/9 complete remissions, with 2/9 dying with intracerebral hemorrhages. In Group III there was an increased incidence of remission induction when compared to Group II (p less than .05) or when compared to Groups I and II combined (p less than .05). There was also a decreased incidence of fatal hemorrhage in Group III. This suggests that prophylactic heparin is useful during remission induction in acute promyelocytic leukemia.