Ondansetron for nausea and vomiting associated with moderately emetogenic cancer chemotherapy

This multicenter, randomized, double-blind study compared the efficacy and tolerability of ondansetron 8 mg twice daily for 3 days with placebo in preventing nausea and vomiting in 81 patients receiving cyclophosphamide-doxorubicin-based chemotherapy. The first dose of study drug was administered 30 minutes before the initiation of chemotherapy. Patients received a rescue antiemetic if the investigator deemed it necessary or if the patient experienced more than two emetic episodes during the 3-day study. Sixty-one percent of patients treated with ondansetron compared with 6% of patients receiving placebo (P < 0.001) had no emetic episodes during the 3-day study. Among patients with at least one emetic episode, the mean time to emesis was 24 hours 18 minutes in the ondansetron group compared with 8 hours 1 minute in the placebo group (P < 0.001). In the intent-to-treat analysis, 78% of patients in the ondansetron group and 29% of patients in the placebo group completed the study with no need for rescue therapy. Clinical laboratory and adverse-event profiles were similar between groups. The most common adverse event was headache, occurring in 23% of ondansetron patients and 24% of placebo patients. This study is the first double-blind, placebo-controlled trial to demonstrate that ondansetron 8 mg twice daily is effective in the prevention of nausea and vomiting associated with cyclophosphamide-doxorubicin-based chemotherapy. The twice-daily regimen may encourage patient compliance and may be more cost-effective than regimens that need to be given three times daily.

Apnea monitoring by acoustic detection of airflow

An acoustic monitor to detect apnea in infants has been developed. Recordings of a signal derived from breath sounds at the nose were made in eight premature infants and compared with observation of the infant and with transthoracic impedance and ECG monitoring. The acoustic monitor detected 26 episodes of apnea lasting 15 seconds or longer which were confirmed by observation and by heart rate slowing of at least 20 beats per minute. Only seven of these episodes were detected by the impedance monitor. The ECG monitor alarmed during the nine spells in which heart rate dropped below 100 beats per minute, 27.5 +/- 9.7 seconds after breath sounds ceased. Inasmuch as the acoustic device detects absent airflow during central or obstructive apnea before bradycardia occurs and is insensitive to body movements, it represents an improved monitoring technique for infants with apnea.

Reversal of cyclophosphamide induced neutropenia by hypertransfusion and androgen therapy

We injected 300 mg/kg Cyclophosphamide i.p. into female AKR mice and rendered them reversably neutropenic. Group A was hypertransfused; Group B received 5 mg Nandrolone decanoate i.m. q.d X 2; and Group C received both. Group D served as a control. White blood cell counts were followed every other day for 10 days. The nadirs seen on all groups appeared on day 5. At day 10 counts in Groups A, B, and D had returned to normal, while the pattern of granulocyte decline and recovery in Group C was significantly faster than that seen in other groups, returning to normal at day 8. Hypertransfusion and androgen administration together significantly ameliorated drug-induced leukopenia, suggesting synergism. Thus manipulation of the stem-cell compartment may be clinically feasible.

Pure red cell hypoplasia associated with long-arm deletion of chromosome 5

A further instance of the new hematologic entity of pure red cell hypoplasia with deletion of the the long arm of a chromosome 5(5q-) was seen in a 59-year-old white male. Examination of the bone marrow showed depressed erythroid cells with normal granulocytic and megakaryocytic precursors. Chromosomal analysis showed deletion of a chromosome 5 without any apparent translocation. This karyotype may be associated with acute leukemia.

Phase II study of melphalan in colorectal carcinoma

In a prospective phase II study, 25 patients with advanced (Duke's D) colorectal adenocarcinoma received 0.25 mg/kg of melphalan orally daily for 4 days every 28 days. There were 17 men and eight women. All patients had measurable areas of known malignant disease which served as objective indicators of the response to chemotherapy. All patients were evaluated for at least two cycles of therapy. Each patient had had previous treatment with 5-fluorouracil and, in addition, 24 of 25 patients had had treatment with methyl-CCNU; all patients had disease progression with both regimens. Toxicity consisted of mild gastrointestinal symptoms and transient leukopenia (wbc count less than 4000/mm3) in nine of 25 (36%) patients and thrombocytopenia (platelet count less than 100,000/mm3) in six of 25 (24%). One of 25 (4%) patients had an objective response for 12 weeks, 15 of 25 (60%) had disease progression, and nine of 25 (36%) remained stable for 2 months. We conclude that melphalan is ineffective for patients with metastatic colorectal carcinoma who have previously failed to respond to both 5-fluorouracil and methyl-CCNU.

Anemia and extramedullary hematopoiesis associated with carcinoma of the breast

Three patients with carcinoma of the breast, extensive metastasis, and splenomegaly are described. Radioisotope studies with 59Fe and 51Cr revealed extramedullarly hematopoiesis and hemolysis. In addition to red cell hemolysis, ineffective erythropoiesis in the marrow and extramedullary sites contributed to the persistence of the anemic syndrome. Extramedullary hematopoiesis is not an effective compensatory mechanism in some patients with anemia and carcinoma of the breast.