Cell-mediated immune-type response of the American cockroach

Cell-mediated immunity in the American cockroach, Periplaneta americana, was measured by counting nuclei in a transect through the mass of host hemocytes reacting against transplanted xenograft or autograft integument. Responses to xenografts (Leucophaea maderae) were significantly higher than control responses to autograft integument. Responses to Leucophaea xenografts increased with longer durations of xenograft exposure to hosts for up to eight days, then decreased by day sixteen. Responses to cockroach species from a phylogenetically graded series of donors were stronger and correlated with increasing phylogenetic distance between various donors and hosts (Periplaneta americana).

Adjuvant treatment of node-positive breast cancer with adriamycin-cyclophosphamide with or without radiation therapy: interim results of an ongoing clinical trial

During 1974-1980, 138 women with node-positive stage II breast cancer were treated with either eight courses of adriamycin-cyclophosphamide (AC) chemotherapy (82 patients) or AC chemotherapy plus comprehensive regional radiotherapy (56 patients). The overall relapse-free survival of the treated patients was significantly superior (P less than 0.001) to a comparable group of women who underwent surgery alone. This effect of adjuvant therapy was clearly manifest in all groups of patients irrespective of nodal involvement or menopausal status. To date, relapse-free survival for patients receiving AC compared to AC plus radiotherapy is not different (P = 0.7). In summary, wer have demonstrated that a brief 6-month course of adjuvant chemotherapy with AC can significantly reduce the recurrence rate in women with stage II breast cancer.

Vineland social maturity scale norm examined--the Wisconsin experience with 0- to 3-year-old children

Inspection of the Vineland social Maturity Scale scores of a representative sample of 150 nonretarded children between the ages of 2 weeks and 36 months revealed that the social ages of most of these children using the original norm table were consistently higher than their chronological ages. A table of adjusted Vineland ages based on the performance of these children was provided, along with the original Vineland norms. Comparison of the original and adjusted scores suggests that the social ages on the Vineland may be overestimated in the 1- to 2-year range.

A Southwest Oncology Group: chemotherapy versus chemotherapy plus radiotherapy in treatment of stage III Hodgkin's disease

The Southwest Oncology Group (SWOG) performed a randomized study (SWOG 7518, CAR 2) of chemotherapy using ten courses of nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP) plus low-dose bleomycin (LDB), versus three courses of combined therapy, MOPP + LDB plus radiotherapy (XRT) from October, 1974, to April 1980, in pathologic stage III Hodgkin's disease. The present report includes data on 136 registered patients, of whom 112 are fully or partially evaluable. At this preliminary analysis, complete remission rates are 82% for chemotherapy alone and 82% for combined treatment. There are no statistically significant differences in survival or relapse-free survival between the two treatment programs, and no specific trends for stage IIIA versus IIIB. The estimated 3-year survival rate for all patients was 82%. Toxicities are comparable when considering the highest grades. There was one case of acute myeloblastic leukemia on combined treatment. Preliminary evidence suggests that patients with nodular sclerosis histologic type are more likely to relapse on chemotherapy alone than on combined treatment.

Immunocompetence and malignant lymphoma: immunologic status before therapy

One-hundred-eighty-six previously untreated patients with malignant lymphoma were evaluated for immunocompetence by means of several tests of immune function: total circulating lymphocytes, T cells (E-rosettes), B cells (EAC-rosettes), delayed hypersensitivity to six recall antigens, serum immunoglobulins, mixed lymphocyte culture, and lymphocyte mitogenic response to phytohemagglutinin and pokeweed mitogen. The results were correlated with histology, stage, and clinical features. Diffuse lymphomas, especially diffuse histiocytic (large cell) (DHL), were associated with decreased absolute lymphocytes and E-rosette forming cells. Skin test reactivity varied with both histology and stage. For example, only one of six tests was impaired in diffuse lymphocytic well differentiated (DLWD) lymphoma in contrast to two of six in localized DHL and five of six in advanced DHL. Patients with nodular lymphoma exhibited depressed mean levels of IgA and IgG, while only IgA was significantly decreased in diffuse lymphoma. Mitogen stimulation was depressed in all groups, although mixed lymphocyte cultures did not differ significantly from controls. In summary, there is a spectrum of immunodeficiency of both B and T cell type in patients with malignant lymphoma that correlated with histology and stage. Implications and possible mechanisms of these observations are discussed.

Continuous positive airway pressure in bronchiolitis

Over five years 23 infants with evidence of respiratory insufficiency due to bronchiolitis were managed with continuous positive airway pressure (CPAP). This was applied through either a short nasal cannula (14 patients) or an endotracheal tube (nine patients). Clinical improvement was seen in all patients, and there were significant falls in mean respiratory and pulse rates and pressure of carbon dioxide (PCO2). Seven infants with PCO2 values exceeding 8.0 KPa (60.2 mm Hg) responded particularly well. CPAP is effective in bronchiolitis, and when applied by the nasal route it is relatively free from complications.

Lymphoblastic lymphoma: a clinicopathologic study of 95 patients

A retrospective clinicopathologic study of lymphoblastic lymphoma was based on 95 patients from the files of the Repository Center for Lymphoma Clinical Studies. All patients were treated according to different protocols of Cooperative Oncology groups sponsored by the National Cancer Institute. The patients ranged in age from 4 to 84 years, with a median of 30 years. Sixty-eight patients were male and 27 female, with respective median ages of 27 and 50 years. The male-to-female ratio was 2.5:1. Forty patients had mediastinal masses; 30 (75%) of whom were male. The median survival of all patients was 17 months (range 1-100 months). To ascertain the influence of various clinical and morphologic parameters of survival, univariate and multivariate statistical analyses were performed. Patients older than 30 years of age had significantly lower incidences of mediastinal involvement (P = 0.01), number of mitotic figures (P = 0.04), and development of leukemia (P = 0.02) than patients younger than 30. Whereas lymphoblastic lymphoma is generally considered to be a disease of children and young adults, this study indicates that lymphoblastic lymphoma occurs in all age groups. These findings further suggest that lymphoblastic lymphoma may have a different biologic behavior in older patients.

Outbreak of aplastic crises in sickle cell anaemia associated with parvovirus-like agent

Since 1952, 112 children with sickle cell anaemia (SCA) in Jamaica have had an aplastic crisis. Outbreaks occurred in 1956, 1960, 1065-67, 1971-73, and 1979-80. Most cases occurred in children under 10 years of age, and an aplastic crisis in a patient over the age of 15 years is rare. There were 38 cases in 1979-80 and stored serum specimens from 28 of these were available for virus studies. Evidence for infection with a parvovirus-like agent was found in 24 of these 28 cases. Viral antigen was detected in 2 patients, both of whom demonstrated seroconversion. Seroconversion during 1980 was detected in a further 7, increasing amounts of antibody during the convalescent period were found in 5, antibody was found in 2 of 4 patients from whom only an acute phase specimen was available and the remaining 10 were antibody positive in the only convalescent phase sample available for testing. Antibody was found in 4 of 94 controls with the SS genotype (in retrospect 2 of these may have had an aplastic crisis) and in 17% of 48 controls with a normal haemoglobin (AA) genotype. The results accord with the possibility that the parvovirus-like agent is the principal cause of aplastic crisis in SCA.

Internal histoincompatability during amphibian metamorphosis?

Larval amphibia are immunologically competent. Yet during metamorphosis, various regressive and progressive processes replace larval with adult structures. These new structures are thought to arise in an immunological environment which provides protection from rejection of non-larval targets. Pre-metamorphic larvae and post-metamorphic adults require carrier-primed amplification in order to generate an anti-hapten response. However, we find that the response to a single challenge of the hapten, TNP, conjugated to a thymus-dependent (TD) carrier, sheep erythrocytes, is substantial in the absence of carrier priming early in metamorphosis. In contrast, the response to TNP on LPS, a thymus-independent carrier, is unaffected by metamorphosis, We suggest that a unique internal histoincompatibility between larval and adult lymphoid cells may provide a substitute for the carrier-priming requirement in the hapten-TD carrier response during metamorphosis.

Amino acid transport via the red cell anion transport system

Evidence is presented that the red cell anion-exchange transporter (Band 3) can selectively transport small neutral amino acids, including glycine, serine and cysteine, but not alanine, proline, valine and threonine. This transport is inhibited by micromolar concentrations of SITS (4-acetamido-4'-isothiocyanostilbene-2,2'-disulphonate), and increased by raising the pH from 6.5 to 8.5.

Treatment of recurrent lymphomas with vincristine, BCNU, doxorubicin, and prednisone (VBAP): a Southwest Oncology Group Study

Chemotherapy with vincristine, BCNU, doxorubicin, and prednisone (VBAP) was administered to 75 patients with malignant lymphoma, including both Hodgkin's disease and non-Hodgkin's lymphoma. All patients had prior chemotherapy with or without radiation therapy. Remissions were achieved in 41% of all patients, with only minor toxicity. The median duration of remission for Hodgkin's disease and non-Hodgkin's lymphoma was 51 and 22 weeks, respectively. The median survival for all patients was 34 weeks. The VBAP program is effective palliative chemotherapy for advanced malignant lymphoma.

Glycine transport in human erythrocytes

1. Glycine transport in human erythrocytes was resolved into five separate components of uptake. The first and major component of uptake was transport by a high-affinity (apparent Km 25 microM) Na+- and Cl- -dependent system. This system was specific for glycine, sarcosine and proline; Br- but not I- was able to substitute for Cl-. Uptake by this route was inhibited less than 20% by the loop diuretics, bumetanide and furosemide (10(-4) M), suggesting that it was distinct from the Cl- -dependent system responsible for Na+/K+ transport. Its properties closely resembled those of the gly transport system described previously in avian erythrocytes. 2. The second uptake route was transport by the Na+-dependent, Cl- -independent small neutral amino acid transport system (designated ASC). Neither NA+-dependent uptake route was present in sheep erythrocytes. 3. Two Na+-independent uptake mechanisms were also identified; first, uptake by the amino acid transport system (designated L), and secondly, SITS-sensitive uptake by the anion-exchange (band 3) transport mechanism (SITS is 4-acetamido-4'-iso-thiocyanatostilbene-2,2'-disulphonic acid, an effective inhibitor of anion transport by this route). Uptake by the latter route was increased markedly when fluxes were measured in isotonic SO42- medium or when the pH was increased. 4. At 0.2 mM extracellular glycine, the relative contributions of each of these uptake routes to the total glycine flux were 42, 11, 15 and 16% for the gly, ASC, L and band 3 systems, respectively. 5. Finally, there was a residual Na+-independent component of glycine uptake which contributed 16% of the total flux. With the exception of the gly system, all uptake routes showed a linear concentration dependence up to 2 mM-glycine.

The chemotherapy of lymphoblastic lymphoma

Thirty-two patients treated on consecutive Southwest Oncology Group (SWOG) protocols for malignant lymphoma were subsequently diagnosed as having lymphoblastic lymphoma. Combination chemistry, usually adriamycin-based, produced complete responses (CR) in 17 patients (53%). Median survival was 15 mo. Patients achieving a CR survival significantly longer than patients with partial or no response (p < 0.01). Ten of 24 patients not receiving central nervous system (CNS) prophylaxis developed leptomeningeal lymphoma while none of the seven patients who received prophylactic intrathecal cytosine arabinoside or methotrexate developed CNS lymphoma (p = 0.04). Implications of these results for planning future treatment programs of lymphoblastic lymphoma are discussed.

Prediction of outcome in metastatic breast cancer treated with adriamycin combination chemotherapy

Univariate and multivariate regression methods were used to analyze 17 potential clinical prognostic factors among 138 patients with advanced breast cancer who received Adriamycin-cyclophosphamide combination chemotherapy between 1973 and 1977 at the University of Arizona. Follow-up of patients was through September 1979, and survival data were nearly complete. Different factors varied in the relationship to outcome, but age, treatment, and response were important. Selecting the three most strongly related factors, predictive regression equations were developed, which described three types of possible outcome: 1) objective response (age, treatment, and liver involvement), 2) freedom from relapse (age, lung involvement, and response), and 3) survival (age, the number of involved sites [less than or equal to 2 or > 2], and treatment). Since use of the regression equations is cumbersome for clinical practice, three simplified tables were constructed to readily predict response, duration of response, and survival before the initiation of treatment.

Malignant hyperthermia in a patient with an ankylosed jaw

Difficult intubation was followed by malignant hyperthermia in a girl with an ankylosed jaw. The treatment, including the use of intravenous dantrolene, is described. The patient's subsequent management, and the anaesthetic implications of these two conditions are discussed.

Amino acid transport in human and in sheep erythrocytes

Amino acid transport was compared in human and in sheep erythrocytes. Kinetic studies established that human cells have three discrete amino acid transport systems, designated L, Ly+ and ASC. The L system is partially stereospecific, with a preference for large neutral amino acids. L-leucine has a threefold lower apparent Km and a twofold smaller Vmax than D-leucine. Alanine, cysteine and possibly dibasic amino acids are transported by this route, but with a low affinity. The Ly+ system is highly stereoselective, and specific for dibasic amino acids, including arginine. The ASC system is Na-dependent and selective for neutral amino acids of intermediate size. It has a particularly low apparent Km for cysteine and is stereospecific. Sheep erythrocytes lack these systems. Instead they possess an additional system (C system) responsible for the transport both of neutral and of dibasic amino acids, with cysteine as the optimal substrate. Although the substrate specificities of the human ASC and sheep C systems are similar, the sheep system does not require Na and has considerably higher apparent Km values. Dibasic amino acid transport (of lysine, but not of arginine) by the C system occurs with a low affinity.

Phase II trial of vindesine in the treatment of lymphomas, breast cancer, and other solid tumors

A phase II study of vindesine in 41 evaluable patients demonstrated the drug to be active in heavily pretreated patients with breast cancer, non-Hodgkin's lymphoma, and other tumors. There were two partial responses in 11 patients with breast cancer (18%) and five partial responses and one complete response in 11 patients with non-Hodgkin's lymphoma (40%). Other responses were seen in small cell carcinoma of the lung, ovarian carcinoma, and Hodgkin's disease. Prior vinca exposure did not adversely affect the response rate. Neutropenia was dose-limiting. Neurotoxic effects occurred in 10% of the patients. A high incidence of local tissue reactions at the injection site (27%) could be reduced by a careful administration technique. Vindesine should be studied further in combination with other agents.

Salvage treatment of patients relapsing after breast cancer adjuvant chemotherapy

We analyzed the efficacy of salvage therapy with systemic agents in 33 women who initially received adjuvant chemotherapy with Adriamycin and cyclophosphamide (AC) for early breast cancer. Relapses occurred at a median of 9 months after completion of adjuvant therapy, and six patients relapsed while receiving adjuvant treatment. Nonetheless, salvage treatment produced objective responses in three of ten patients (30%) receiving hormonal therapy alone, in five of 11 (45%) receiving AC plus hormonal therapy, and in none of 12 receiving cyclophosphamide, methotrexate, and 5-fluorouracil (P < 0.05). Survival from the time of relapse from adjuvant chemotherapy was superior for patients receiving hormonal therapy with or without AC chemotherapy compared to that of patients receiving cyclophosphamide, methotrexate, and 5-fluorouracil (P < 0.05), and the median survival time of responders is > 12 months. On the basis of these findings, we believe that patients relapsing after adjuvant chemotherapy should receive aggressive treatment employing Adriamycin combination chemotherapy along with hormonal therapy.

Anesthesia for pediatric day-surgery

Five years anesthetic experience of children undergoing day-surgery is reviewed. There were 1278 patients, including 176 infants, having general surgical procedures. Most operations were performed in the afternoon. Subsequently, 104 patients (8.1%) remained in hospital overnight, and of these, 15 were detained for anesthetic reasons. No serious complications were seen. The preoperative anesthetic preparation, general anesthesia, and postoperative care are described. Reasons for subsequent admission are detailed with specific reference to anesthesia. Most limitations placed on the selection of children for day-surgery are unnecessary. Age, distance from hospital, timing of operation, and expected intubation should not be critical factors determining selection of patients.

Clinical correlations of drug sensitivity in the human tumor stem cell assay

We have applied an in vitro soft-agar tumor-colony assay (which is now applicable to a variety of human cancers) to measurement of in vitro sensitivity to drugs and prediction of clinical response to cancer chemotherapy. The assay predicts drug resistance with 96% accuracy and sensitivity (in healthy pretreated patients) with 62% accuracy. On a pharmacokinetic basis the zone in vitro sensitivity for any given drug was only 5%-10% of the clinical concentration-time product (Cxt) achievable. This suggests that intratumoral drug concentrations in vivo may be lower than those in the plasma, and/or that > 2 log kills of tumor stem cells (not measurable in the assay) are required for clinical response. Serial in vitro studies showed that acquisition of drug resistance is a common clinical phenomenon which can be directly detected and quantitated in vitro.

1-year followup of cardiac status after adriamycin therapy

To study the natural history of the alterations in cardiac function produced by Adriamycin therapy, serial M-mode echocardiograms, electrocardiograms, and systolic time intervals were obtained in 15 patients prior to Adriamycin therapy and at 3-month intervals during and 1 year after cessation of therapy. The echocardiographic E-point septal separation increased from a median 0 dose value of 0.40 cm to 0.70 cm (P less than 0.003) at the time of the maximum dose of Adriamycin. The electrocardiographic frontal plane voltage decreased 13% (P less than 0.008) and the pre-ejection period/left ventricular ejection time ratio increased from a median value of 0.37 to 0.40 (P less than 0.01) during this same period. During the first year after Adriamycin was discontinued, no significant change was noted in any of these values. Thus, as a group, the slight deterioration of ventricular function that occurred during Adriamycin therapy remained unimproved during the 1-year followup period.

Coarctation in children. Controlled hypotension using labetalol and halothane

Hypotension was induced with halothane and labetalol, an alpha and beta adrenergic blocking agent, in nine children undergoing operation for postductal coarctation of the aorta. The mean arterial pressure decreased by an average of 30% following labetalol, and in six patients the initial halothane concentration (1%) had to be reduced during this period. The heart rate decreased by an average of 8% after labetalol. Profound beta-blockade did not occur, and operating conditions were considered satisfactory. The usefulness of labetalol in the postoperative period is suggested.

Phase II evaluation of cis-dichlorodiammineplatinum(II) in lymphomas: a Southwest Oncology Group Study

The Southwest Oncology Group has evaluated the activity of cis-dichlorodiammineplatinum(II) at a dose of 75 mg/m2 given as an iv bolus injection every 3 weeks to 25 fully and partially evaluable patients with advanced Hodgkin's disease and non-Hodgkin's lymphoma. One complete response, two partial responses, and one improvement less than a partial response were noted. Myelosuppression, in the form of leukopenia and thrombocytopenia, was identified and seemed to be more prevalent and more severe than in previous studies. We have attributed this to the extensive prior treatments which these patients had received and to the presence of tumor-bearing marrow which was observed in some of them. The anticipated toxic effects which were noted included nausea and vomiting, anorexia, diarrhea, renal injury, and hyperuricemia. The precise role of cis-dichlorodiammineplatinum(II) in the management of human lymphomas awaits elucidation.

Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy

Two double-blind, crossover trials comparing the antiemetic effectiveness of nabilone, a new synthetic cannabinoid, with that of prochlorperazine were conducted in patients with severe nausea and vomiting associated with anticancer chemotherapy. Of 113 patients evaluated, 90 (80 per cent) responded to nabilone therapy, whereas only 36 (32 per cent) responded to prochlorperazine (P less than 0.001). Complete relief of symptoms was infrequent, occurring only in nine patients (8 per cent) given nabilone. When both drugs were compared, both nausea (P less than 0.01) and vomiting episodes (P less than 0.001) were significantly lower in patients given nabilone. Moreover, patients clearly favored nabilone for continued use (P less than 0.001). Predominant side effects noted by patients were similar for both agents and included somnolence, dry mouth and dizziness but were about twice as frequent and more often severe in patients receiving nabilone. In addition, four patients (3 per cent) taking nabilone had side effects (hallucinations in three, hypotension in one) that required medical attention. Euphoria associated with nabilone was infrequent (16 per cent) and mild.

Combination chemotherapy for mycosis fungoides: a Southwest Oncology Group study

Between 1972 and 1977, the Southwest Oncology Group studied the following three chemotherapy programs for the treatment of patients with advanced forms of mycosis fungoides: (a) cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) (seven patients); (b) adriamycin, vincristine, and prednisone (HOP) (five patients); and (c) cyclophosphamide, vincristine, prednisone, and bleomycin (COP plus bleomycin) (12 patients). Among the 24 evaluable patients there was an overall objective response rate of 95% with seven (29%) achieving a complete remission. With the adriamycin-containing chemotherapy, five (42%) of 12 patients achieved a complete remission compared to two (17%) of 12 patients treated with COP plus bleomycin. The median duration of remission (partial plus complete) was longer with the COP plus bleomycin combination (median, 47 weeks) than with the adriamycin-containing combinations (median, 22 weeks; P = 0.03). The median survival for all 24 evaluable patients was 95 weeks and was similar regardless of remission-induction therapy. In summary, combination chemotherapy proved to be effective palliative therapy for advanced mycosis fungoides.

[Combination of adriamycin and cyclophosphamide (alone or with other substances) in the treatment of breast cancer]

This paper reviews clinical trials at the University of Arizona Cancer Center which were designed to improve the outcome in breast cancer by utilizing the combination of adriamycin and cyclophosphamide (A--C) alone or with the addition of other agents or modalities. Our initial trial in advanced breast cancer with A--C produced an overall objective response rate of 78% in 51 patients with advanced breast cancer without prior chemotherapy. The median duration of disease control was 12 months. Subsequent studies showed that the addition of either vincristine or the androgen, calusterone, effectively doubled the remission duration and prolonged survival. In our surgical adjuvant trial with 6 months of treatment with A--C there has been only a 9% relapse rate in stage II patients thus far, with a median follow-up of close to 2 years. A subset of stage II patients who received regional radiotherapy along with A--C have not yet shown added benefit compared to the use of A--C alone. Since 1975, stage I patients have been treated with an abbreviated treatment schedule (3 courses of A--C over 9 weeks). While there have not yet been relapses in this category, much longer periods of follow-up will be required. The use of A--C (plus other drugs) has clearly provided excellent palliation and improved survival in patients with advanced or recurrent breast cancer; in our opinion it should be used as initial cytotoxic chemotherapy. The brief intensive program of A--C as a surgical adjuvant also shows considerable promise for erradicating occult micrometastases in both pre- and postmenopausal women.

Chemotherapy of localised histiocytic lymphoma

22 patients with localised (stage I or II) diffuse lymphoma were treated with chemotherapy at the time of diagnosis. 14 patients received chemotherapy as the only treatment, and 8 received chemotherapy plus local irradiation. Doxorubicin-containing drug regimens were used in 20 patients. All 22 patients achieved a complete remission and remain alive with a median survival from the time of diagnosis of 27+ months. 21 patients (95%) have remained continuously free of disease with a median disease-free survival from the completion of chemotherapy of 23+ months. These findings provide a strong rationale for further clinical trials of chemotherapy alone or chemotherapy followed by regional radiotherapy for localised stages of diffuse lymphoma.

Superiority of adriamycin-containing combination chemotherapy in the treatment of diffuse lymphoma: a Southwest Oncology Group study

As a part of an ongoing prospective controlled trial, the Southwest Oncology Group compared the results of treatment of advanced non-Hodgkin's lymphoma with two CHOP regimens (cyclophosphamide, adriamycin, vincristine and prednisone with either low-dose bleomycin or BCG by scarification) to a COP regimen (cyclophosphamide, vincristine and prednisone) with low-dose bleomycin (COP-Bleo). The study design emphasized histopathology review and systematic restaging to define complete remission (CR). Confirmed rates of CR for 443 evaluable patients were 59% for 286 patients receiving the CHOP regimens and 59% for 157 patients receiving COP-Bleo. Rates of CR were higher for patients with nodular lymphoma (69%) compared to those with diffuse lymphoma (54%) (p = 0.005). For patients with nodular lymphoma there was no difference in CR rates according to treatment. For patients with diffuse lymphomas the CR rate was higher with the CHOP programs (58%) than with COP-Bleo (44%) (p = 0.10). Overall duration of CR and survival was significantly longer for patients with nodular lymphoma compared to diffuse lymphoma (p less than 0.01). At this time, remission duration and survival were similar regardless of induction regimen used in patients with nodular lymphoma. However, in patients with diffuse lymphoma, the duration of CR and overall survival were improved by treatment with the CHOP regimens compared to COP-Bleo (p = 0.02). Thus, in this controlled study we have demonstrated that initial combination chemotherapy employing the CHOP regimen was a superior remission induction therapy for patients with diffuse lymphoma.

Combination chemotherapy for advanced breast cancer utilizing vincristine, adriamycin, and cyclophosphamide (VAC)

Thirty-two patients with advanced breast cancer were treated with a combination of vincristine (1 mg/m2, not exceeding 2 mg, administered intravenously on day 1), adriamycin (40 mg/m2 administered intravenously on day 1), and cyclophosphamide (200 mg/m2 administered orally for 4 days on days 3-6). Courses were repeated at 21-28-day intervals. The mean age of the patients was 57 years (range, 30-79 years) and 18 patients were postmenopausal. None of the patients had received prior chemotherapy although 15 had prior endocrine treatment. Objective response was observed in 23 (72%) of the 32 patients and 9 responses (28%) were complete. The median remission duration was estimated to be 22 months. Median survival has not been reached but exceeds 24 months with a median time of follow-up of 17 months. Toxicity was acceptable and included mild nausea, vomiting, alopecia, and paresthesias. Only one instance of serious infection and no instances of bleeding were observed. The addition of vincristine to combination chemotherapy with adriamycin and cyclophosphamide appears to prolong the remission duration and survival in patients with advanced breast cancer to a greater extent than is achieved with adriamycin and cyclophosphamide alone.

Comparative trial of low-dose adriamycin plus cyclophosphamide with or without additive hormonal therapy in advanced breast cancer

We treated 56 women with advanced metastatic breast cancer who had not received prior chemotherapy in a comparative trial of cytotoxic chemotherapy with low-dose adriamycin plus cyclophosphamide alone or in combination with the androgenic steroid calusterone. The response rate to chemohormonal therapy (65%) could not be shown to be statistically better than that for chemotherapy alone (53%) for this size patient population. However, the median remission duration (21.5 months) was significantly prolonged over the 11.5-month remission duration for chemotherapy alone (p = 0.03). The median survival of the chemohormonal therapy group was 23.5 months, whereas that for chemotherapy alone was 13.5 months (p = 0.05). These results indicate that the addition of a potent hormonal agent to effective cytotoxic chemotherapy improves the results of treatment of women with metastatic breast cancer.

Inapparent infiltrations associated with vindesine administration

Vindesine is des-acetyl vinblastine amide sulfate (Eldisine, Eli Lilly and Co), an investigational derivative of the vinca alkaloid, vinblastine. Initial phase I results with vindesine have determined that myelotoxicity is dose-limiting and that, contrary to preclinical studies in animals [1], a neurotoxic potential is indeed present [2]. Another phase I study also observed a rather high incidence of phlebitis (16%) and of cellulitis (10%), however, myelosuppression remained the dose-limiting toxicity [3]. Because good clinical responses have been noted in lymphomas, leukemias [4] and some solid tumors including breast cancer [5], the drug has a potential for wide utility. However, while we have noted several clinical responses with vindesine, injections of the drug have been complicated by serious infiltration with atypically delayed presentation. The purpose of this communication is to briefly describe the incidence and course of these infiltrations.

Systematic restaging in patients with Hodgkin's disease: a Southwest Oncology Group Study

Eighty-two patients with advanced Hodgkin's disease who were in apparent complete remission (CR) after receiving 10 courses of combination chemotherapy were systematically reevaluated for persisting disease. Occult Hodgkin's disease was found in 10 (12%) of these patients and was predominantly present in nodal sites (91%) which were known to have been involved at initial staging (100%). Repeat chest radiography, Gallium-67 tumor scanning and lymphography were the most helpful procedures for detecting residual disease. Nine of the 72 (13%) patients felt to be free of disease after negative restaging subsequently relapsed within 8 months. Sites of early relapse, like the sites of disease found at restaging, occurred almost always in previously involved nodal areas. We conclude that systematic restaging should be incorporated into subsequent lymphoma trials in order to define more clearly complete remission and that every patient treated for lymphoma should undergo a careful restaging evaluation before therapy is discontinued.