High-dose cyclophosphamide with autologous marrow transplantation as initial treatment of small cell carcinoma of the bronchus

Sixteen patients with untreated small cell carcinoma of the bronchus received cyclophosphamide in a total dose of 160-200 mg/kg. Autologous marrow transplantation was used to minimise the period of hypoplasia and 2-mercaptoethane sulphonate to prevent urothelial toxicity. The procedure was well tolerated, with predictable and manageable toxicity. Complete radiological and bronchoscopic response was achieved in seven patients and partial response in a further seven. High-dose cyclophosphamide may be a useful initial treatment for this disease.

Prognostic factors in clinical stage I non-seminomatous germ-cell tumours of the testis

Prognostic factors have been studied in 59 men with clinical Stage I non-seminomatous germ-cell tumours of the testis (NSGCTT) seen at the Royal Marsden Hospital between 1973 and 1978. Fourteen of the patients relapsed, and 45 have remained continuously disease-free. Two factors were identified which showed a significant correlation with relapse following radiotherapy: local extent of the primary tumour, and rate of decline of serum alpha-foetoprotein (AFP) and beta-human chorionic gonadotrophin (hCG) levels following orchidectomy. High serum marker levels at the time of referral after orchidectomy were not prognostically significant per se. The presence of tissue-associated hCG in the primary tumour was not prognostically significant. The results were compared with histology and pathological stage of the primary tumour in patients presenting with lung metastases but no clinical evidence of lymph-node disease. Embryonal carcinoma was more commonly associated with a locally invasive primary tumour and with extralymphatic spread than was teratocarcinoma.

Lipid Oxidative Stability of Reconstituted Partially Defatted Peanuts1

Changes in tocopherol content, peroxide value and fatty acid composition were measured during storage of reconstituted partially defatted peanuts. These values were compared with those of unreconstituted partially defatted peanuts, whole peanuts and the corresponding oils. Reconstitution effectively inactivated the enzyme lipoxygenase and was destructive on tocopherols, particularly α- tocopherol. The stability of the oil during storage, as measured by the peroxide value, is much greater within the peanuts than in the corresponding extracted oil. No changes in fatty acid composition could be observed in reconstituted partially defatted peanuts. A need for immediate reconstitution following mechanical oil extraction could not be demonstrated as both products had equal oxidative stability.

Combination chemotherapy with adriamycin-cyclophosphamide for advanced ovarian carcinoma

Combination chemotherapy with Adriamycin-cyclophosphamide was employed after surgical treatment in 60 women with Stage III-IV ovarian adenocarcinoma. Of 53 evaluable patients, objective response was noted in 34 of 41 (83%) without prior cytotoxic therapy but in only two of 12 (17%) who had failed a single alkylating agent or radiotherapy (P < .005). Complete response was confirmed by a negative biopsy at the site(s) of prior disease in 12 patients. Eleven of the 12 biopsy-confirmed complete responses were achieved in patients without pretreatment palpable tumor. Twenty-four out of 41 patients with palpable masses responded but only one was confirmed as complete. Confirmed complete responses had a median duration of 24 months, whereas the median duration of all other responses was only seven months. The median survival for patients in whom Adriamycin-cyclophosphamide was the initial chemotherapy was 24 months. The median survival in patients with palpable tumor exceeds that of historical controls matched for age, tumor cell type, and grade (P = .05); the median survival for the confirmed complete responders has not been reached. The toxicity of this regimen was acceptable at doses of Adriamycin and cyclophosphamide of 45 mg and 500 mg/M2 body surface area, respectively. Extensive excision of tumor followed by effective combination chemotherapy offers the best current approach toward improved patient survival in advanced ovarian cancer.

Clinical staging in multiple myeloma

Analysis of 237 patients with myeloma, retrospectively classified according to the staging system proposed by Durie and Salmon, showed highly significant differences (P less than 0.0001) in the survival of patients with low, intermediate and high tumour cell masses (Stages I, II and III respectively). The median survival for Stage I patients was 64 months, Stage II 32 months, and Stage III 6 months. The median survival of patients presenting with renal impairment was only 2 months, compared to 21 months for those presenting with normal renal function (P less than 0.0001). The use of this clinical staging system, which is based on myeloma protein synthesis rates and the calculation of total body tumour cell mass, should be considered in planning future trials of therapy in this disease.

Combined amphotericin B-flucytosine therapy in Aspergillus pneumonia

The incidence of aspergillosis is increasing while the prognosis remains dismal. Standard single-drug therapy with amphotericin B offers unacceptably low cure rates. A patient with Aspergillus pneumonia was treated with a synergistic combination of amphotericin B and flucytosine. A prompt clinical response and progressive resolution of the infection were observed. Combination therapy appeared to decrease the dose of amphotericin B needed for effective therapy. It may provide improved results with decreased toxic effects.

Recent advances in the treatment of systemic mycotic infections

Serious therapeutic problems are posed by the increasing incidence of invasive fungal infections in transplant recipients as well as in patients with compromised immune defenses, prosthetic devices and grafts and several other predisposing factors. A number of new approaches, including combination drug treatment and the development of newer agents, may justify increased optimism in the management of these infections.

Evidence for lack of phosphatidic acid and phospholipase D activity in milk

Phosphatidic acid could not be demonstrated when milk was assayed for phospholipase D activity even when lecithin was added. The concentration of "free" choline in milk remained the same before and after addition of lecithin. However, phosphatidic acid and an increased concentration of "free" choline were demonstrated when cabbage phospholipase D was added to raw milk. The concentration of phosphatidic acid and "free" choline in milk increased appreciably when both lecithin and cabbage phospholipase D were added to raw milk. Phospholipase D activity in milk was assayed at 23.5 C, pH 5.6, in the presence of 10% vol/vol of diethyl ether and .015M calcium chloride. "Free" choline was determined by adjusting the acid whey from milk to pH 11 and adding a freshly prepared 3% methanolic solution of ammonium reineckate. The precipitated choline reineckate was washed, dissolved in acetone, and its absorbance measured at 520 nm. The absence or presence of phosphatidic acid was shown by thin-layer chromatography. These results refute a previous report which proposed that both phosphatidic acid and phospholipase D were in milk.

Fatal graft-versus-host disease following transfusion of granulocytes from normal donors

A case of fatal graft-versus-host disease was seen in an adult with acute leukaemia, after transfusion of leucocytes from normal donors. This is the first reported case of graft-versus-host disease following transfusion of normal blood-products to a patient with a disease not usually associated with severe immunoincompetence. The number of lymphocytes transfused was no higher than that given when platelet concentrates are prepared from a single donor.