Level of the A, B and H blood group glycosyltransferases in red cell membranes from patients with malignant hemopathies

Eight patients (4 suffering from acute myeloid leukemia) exhibiting a loss of ABO red cell antigens, as seen by a mixed-field reaction pattern in agglutination tests, were selected and examined for the level of the A, -B, -H blood group glycosyltransferases within membranes prepared from erythrocyte subpopulations (A or B positive and A or B negative red cells). A or B enzyme activities were largely decreased in membranes which had lost A or B antigens (A or B negative subpopulations) but were within normal level in membrane from cells which had not lost A or B antigens (A or B positive subpopulations). The H enzyme level which was frequently low in the serum was within normal limits in the membrane preparations examined. Since A or B negative subpopulations were normally glycosylated in vitro into A or B reactive structures, the results demonstrate that loss of A or B antigens is related to some alteration of the blood group gene products rather than to significant abnormalities of the membrane precursors.

Alternating combination chemotherapy of advanced soft tissue sarcomas in adults

The possibility of improving treatment results using an alternating combination chemotherapy was explored in 40 evaluable patients with advanced soft tissue sarcomas. Treatment regimen consisted of adriamycin and DTIC alternating with vincristine, actinomycin D, and cyclophosphamide. Four patients achieved a complete response and eight achieved a partial response, with an overall response rate of 30%. The median duration of response was 14 months. The median survival time was 28 months for responders compared with 7 months for nonresponders (p = 0.001). Toxicity was predominantly limited to nausea, vomiting, and myelosuppression. Although this alternating regimen failed to improve response rates over other combinations, survival times observed in the present study should provide impetus to evaluate further the concept of sequential noncross-resistant combinations.

Phase II study of epirubicin in advanced malignant melanoma

Twenty patients with advanced malignant melanoma refractory to conventional chemotherapy, were entered into a Phase II study of epirubicin, one of the new doxorubicin analogues. The drug was given at a dose of 90 mg/m2 IV every 3 weeks. One partial response and three disease stabilizations were observed. Nausea and vomiting and alopecia were common. Mild to moderate leukopenia occurred in 6 patients. Three cases of reversible ST-T changes were recorded. The observed response rate of 5% with a 39.2% probability of a true response rate greater than or equal to 10%, does not suggest that epirubicin, in the dose and schedule chosen, is active in metastatic malignant melanoma.

Controlled study of DTIC versus DTIC plus epirubicin in metastatic malignant melanoma

Forty-two previously untreated patients with metastatic malignant melanoma were randomized to receive DTIC at a dose of 250 mg/m2/day 4 IV on days 1-5 or the same drug plus epirubicin (Epi-DX) at a dose of 90 mg/m2 on day 1. Cycles were repeated every 3 weeks. Partial responses were observed in two out of 22 patients (9.1%) treated with DTIC, and in four out of 19 evaluable patients (21.1%) treated with Epi-DX + DTIC. Overall, Epi-DX + DTIC combination was well tolerated, thus permitting administration after a 3-week interval of the full drug dosages in all but two patients. No major cardiotoxicity was observed. Although patients in the Epi-DX + DTIC group had a better response rate than those in the DTIC group, the difference was not statistically significant, and the 21.1% response rate observed with the two-drug combination does not differ from that reported with DTIC used alone.

Terminations of DNA synthesis on 'proflavine and light'-treated phi X174 single-stranded DNA

Bacteriophage phi X174 single-stranded DNA molecules were primed with five different restriction fragments and irradiated with visible light in the presence of proflavine. This photodamaged DNA was used as template for the in vitro complementary chain synthesis by E. coli DNA polymerase I (Klenow fragment). Chain terminations were observed by polyacrylamide gel electrophoresis of the synthesized products and localized by comparison with standard sequencing performed simultaneously on the untreated template. 90% of the chain terminations occurred one nucleotide before a guanine residue in the template strand. More than 80% of the sequenced guanine residues were blocking lesions demonstrating the absence of 'hot-spots' for the photodamaging effect of proflavine. At a defined position, the chain termination frequency increased linearly with the irradiation time and was directly influenced by the proflavine concentration present. An important part of lesions resulted from the action of singlet oxygen produced by excited proflavine as shown by the effect that both NaN3 and 2H2O exerted on the reaction. The induced blocking lesions must be important in vivo since no complete replicative forms could be extracted from cell infected with bacteriophages inactivated by 'proflavine and light' treatment.

5-fluorouracil, adriamycin, and BCNU (FAB) combination chemotherapy for advanced gastric cancer

Thirty-two evaluable patients with advanced measurable gastric adenocarcinoma were treated with a combination of 5-fluorouracil, adriamycin, and BCNU (FAB). Two complete and fourteen partial responses were observed, with an overall response rate of 50%. The median duration of response was 10 months, and the median survival of all 32 patients, 7 months. Responding patients had significantly better survival than the nonresponders (P less than 0.001). Analysis of the results according to pretreatment performance status, resectability of the primary tumor, and histologic differentiation of the malignancy demonstrates that only the first influenced the therapeutic results. The FAB regimen was well tolerated, allowing administration of nearly the whole of the projected drug dosages during the course of the therapy in all but three patients. These results indicate that the FAB combination is an effective chemotherapeutic regimen in metastatic or locally advanced gastric carcinoma. Incorporation of this regimen into the design of combined-modality treatment would result in improved prognosis.

Autologous bone marrow transplantation in the treatment of poor prognosis non-Hodgkin's lymphomas

Twelve patients with non-Hodgkin's lymphomas of poor prognosis were treated by TACC high-dose chemotherapy (cyclophosphamide 45 mg/kg/day X 4, cytosine arabinoside 200 mg/m2 i.v. q 12 hr X 7,6-thioguanin 100 mg/m2 p.o. X 7 and CCNU 200 or 250 mg/m2 p.o., single dose) followed by autologous bone marrow transplantation (ABMI) (infused dose: 853-20,000 CFU-c/kg). Patients were divided into 2 groups: those in primary therapy with high tumor load (group 1; 3 initial diagnoses, 3 relapses) and those in consolidation therapy for a low tumor load (group 2; 5 complete and 1 partial remissions). Results show that: (1) the aplasia following autologous bone marrow transplantation was short. Leukocyte (greater than 10(9)/1) and platelet (greater than 50 X 10(9)/1) recoveries were observed on day 12 (range, 9-19) and day 14 (range, 8-27). (2) In group 1 there were 3 complete remissions (8,21, 45+ months) and 3 failures, including 1 death to toxicity of TACC. The 3 remissions occurred in patients in primary therapy and overall survival of these patients from the time of initial diagnosis was 48+, 48+ and 60+ months. In group 2 there were 5 persisting complete remissions (12+ to 40+ months) and 1 failure. Overall survival of these patients was 23+, 24+, 27+, 42+ and 70+ months. In both groups failures were associated with contamination of the frozen marrow by tumor. The toxicity of the association TACC + ABMT was acceptable and dominated by the risk of pericardial effusion and infection. The latter was absent in group 2 and occurred in 5/6 cases in group 1. These preliminary results indicate that autologous bone marrow transplantation has a possible role in the aggressive treatment of non-Hodgkin's lymphomas of high-grade malignancy and that its use should preferentially be in the consolidation mode.

ASTA Z 7557 (INN mafosfamide) for the in vitro treatment of human leukemic bone marrows

The in vitro treatment of leukemic bone marrows, collected during complete remission, aims at eliminating residual blast cells prior to freezing and preservation, while sparing normal hematopoietic stem cells. We report our experience on the activity of ASTA Z 7557 on human leukemic (CFU-L) and normal hematopoietic stem cells. The sensitivity of human leukemic and normal progenitor cells (CFU-c), detected in semi-solid media cultures, is similar. However, pre-CFUc progenitors detected in long term marrow cultures are much less sensitive to ASTA Z 7557. Therefore autologous bone marrow transplantation can successfully be done with pretreated marrows containing 5 +/- 5% residual CFUc. The wide range of stem cells sensitivity to ASTA Z 7557 justify the predetermination of the optimal dose of drug for incubation prior to marrow collection for each individual patient. Our preliminary clinical experience is exposed.

[Non-Hodgkin's malignant lymphoma. Therapeutic value of autologous bone marrow transplantation]

Twelve patients with non-Hodgkin malignant lymphoma of poor prognosis were treated with heavy chemotherapy of the TACC type (cyclophosphamide 45 mg/kg/day i.v. X 4; cytosine arabinoside 200 mg/m2/12 hours i.v. X 7; 6-thioguanidine 100 mg/m2/12-hourly p.o X 7 and CCNU 200 or 250 mg/m2 p.o. single dose) followed by autologus bone marrow transplantation (853 to 20.000 CFUc/kg). The patients were divided into 2 groups depending on whether they received an induction treatment for large visible tumoral mass (group I: 3 initial presentations, 3 relapses) or a consolidation treatment for small residual tumour (group II: 6 complete and 1 partial remissions). The results show that autologous bone marrow transplantation shortens the duration of the therapeutic aplasia. White cell (greater than 10(9)/l) and platelet (greater than 50.10(9)/l) recovery was observed on days 12 (range 9-19) and 14 (range 8-27) respectively. In group I, 1 patient died of myocardial TACC toxity and acute renal failure on tumoral kidney; there were 2 failures and 3 complete remissions (8, 21, 45 + months). Remissions occurred in patients treated initially; the overall survival since diagnosis was 48+, 48+ and 60+ months. In group II patients there were 1 failure and 5 complete remissions persisting after a 2+ months to 30+ months follow-up; the overall survival was 23+, 24+, 27+, 42+ and 70+ months. The 3 failures in the series occurred in circumstances suggesting contamination of the cryopreserved bone marrow by tumoral cells. The toxicity, largely due to infection, of the TACC-bone marrow transplantation combination was tolerable. It was clearly lower in group II (6 patients, no septicaemia) than in group I (5/6 patients with septicaemia). These preliminary results confirm that there is room for autologous bone marrow transplantation in highly malignant non-Hodgkin lymphomas, particularly during complete remissions to facilitate the use of an aggressive consolidation chemotherapy.

Cytotoxicity of anti-PP1Pk antibodies and possible relationship with early abortions of p mothers

IgG and IgM anti-PP1Pk antibodies of human sera from p individuals were examined for their ability to agglutinate red blood cells (RBC) of various P phenotypes and to mediate ADCC of these RBC by human effector cells. Agglutinating antibodies were found in either the IgG or the IgM fraction, while ADCC active antibodies were found mainly in the IgG fraction and were essentially cytotoxic with Pk RBC. The possible relationship of these antibodies with early abortions of p mothers is discussed.

HNK-1 monoclonal antibody (Leu-7) in the identification of abnormal expansions of large granular lymphocytes

Among 12 cases of chronic T lymphoproliferative disorders we observed, six patients showed an expansion of mononuclear cells with azurophilic granules usually referred to as large granular lymphocytes or LGL. Cells obtained from five patients with these abnormal LGL proliferations were studied with several surface markers including their reactivity with the HNK-1 monoclonal antibody reported to be specific for LGL. Cells in four out of five cases were HNK-1 positive. Whereas normal LGL have been reported to be unreactive with several T cell markers, three cases showed the co-existence of HNK-1 and surface markers expressed by T cells. Two cases were characterized by the proliferation of OKT8 cells. Cells from one patient were HNK-1 positive but did not express T or monocytic antigens. These cells were apparently not completely mature since alpha-naphthyl acetate acid esterase activity was negative. Cells from the remaining case were HNK-1 negative and positive for T and monocytic antigens. An increase of OKT-10 cells was observed in only one patient. Our data indicate that proliferations of LGL represent a remarkable proportion of the rare cases of sheep erythrocyte rosetting chronic lymphocytic leukaemias or lymphomas. Besides the morphology of LGL, the rosetting ability and the negativity for peroxidase, cells from these cases showed a vast heterogeneity of other structural and functional markers, possibly reflecting different stages in the maturation of these cells. The HNK-1 monoclonal antibody proved to be an important marker in the identification of these cases.

Plasmacytoma of the thyroid gland

Solitary plasmacytoma of the thyroid is very rare. Thus far, only 12 cases have been reported in literature. This report describes the clinical and histological features of two additional cases. One patient developed bone metastases 1 month after diagnosis and died 17 months later. The second patient is alive with no evidence of disease, 19 months after diagnosis. At the present time there are insufficient data to assess the prognosis in any single case.

Measurement of IgG antibody and airborne antigen to control an industrial outbreak of hypersensitivity pneumonitis

An outbreak of hypersensitivity pneumonitis in a textile plant was attributed on epidemiological grounds to a chilled water air-conditioning system where a slime was growing in the chilled water sump and on demister vanes. All of the patients and about 80% of their asymptomatic co-workers had strongly positive precipitin tests to extracts of the slime. An adaptation of a radioiodinated staphylococcal protein A solid-phase radioimmunoassay was applied to monitor antigen and specific antibody. To control the outbreak, a variety of cleaning and water treatment measures were taken between 1977 and 1979 to reduce the amount of antigen in the water and in the air. The amount of slime in the water was greatly reduced though the antigen content per gram of slime did not change. Airborne antigen in the affected work areas decreased progressively.

Mitomycin C in patients with metastatic breast cancer refractory to hormone therapy and chemotherapy

43 patients with advanced breast cancer, resistant to conventional therapies, were treated with mitomycin C at a dose of 20 mg/m2 i.v. every 6 weeks. No response was observed. The most common side effect was myelotoxicity. Leukopenia occurred in 63% of the patients, thrombocytopenia in 67%, and anemia in 14%. Two episodes of acute dyspnea were observed which were thought to be pulmonary hypersensitivity reactions. This study does not suggest that mitomycin C is of value as second- or third-line treatment in metastatic breast cancer. It is likely that the drug could play a more important role in combination with other chemotherapeutic agents.

Congenital ichthyosis and endodermal sinus tumor of the ovary in a ten-year-old child

Acquired ichthyosis is very likely to be associated with a malignancy, especially with Hodgkins disease. The association of congenital ichthyosis with malignant tumors has been so far reported only in two instances. Herein we report on a third case. Due to the small number of cases, no conclusion can be drawn about the correlations between the two diseases.

Effects of intravenous diltiazem on sinus node function and atrioventricular conduction in patients

We studied the electrophysiologic effects of injectable diltiazem (dosage: bolus of 0.15 mg/kg, maintenance infusion of 0.3 mg/kg/h for 20 min) on sinus node function and atrioventricular function in 33 patients (22 men and 11 women, mean age 63.6 +/- 15.8 years). Seventeen patients had an electrophysiological exploration considered as normal, eight had sinus node dysfunction (corrected sinus recovery time greater than 525 ms), and eight had AV nodal block (PH greater than 160 ms and/or a Wenckebach point less than 125/min). Effects of the drug were assessed 20 min after the beginning of the infusion, which was continued until the end of examination. In normal subjects diltiazem lengthened corrected sinus node recovery time (305 +/- 115 ms leads to 451 +/- 283 ms) and slightly depressed AV nodal conduction (Wenckebach point: 163 +/- 23 leads to 147 +/- 25). In patients with sinus node dysfunction diltiazem provoked a bradycardia without significant changes in corrected sinus node recovery time or in estimated atrio-sino-atrial conduction time. In patients with AV nodal block diltiazem provoked a lowering of the Wenckebach point (137 +/- 47 leads to 122 +/- 38). There was no effect on hissian or infrahissian conduction, even when this was abnormal in the basal state. These data suggest that diltiazem must be utilized with caution in patients with sinus node dysfunction and AV nodal block.