Recombinant leukocyte A interferon: an active agent in advanced cutaneous T-cell lymphomas

High-dose recombinant leukocyte A interferon (50 X 10(6) U/m2 body surface area, intramuscularly, three times weekly) was tested in a clinical trial involving patients with advanced cutaneous T-cell lymphomas to determine its effectiveness and toxicity. All 20 patients had advanced stages of disease refractory to two or more standard therapies. Objective partial remissions lasting 3 months to more than 25 months (median, 5 months) were documented in 9 patients. The major dose-limiting toxicity was a severe influenza-like syndrome with malaise, anorexia, depression, weight loss, and decreased performance status; this effect was reversible after dose reductions in all patients and did not recur with re-escalation of doses in 10 patients. This interferon preparation is highly effective in the treatment of advanced refractory cutaneous T-cell lymphomas, and new schedules to reduce toxicity and achieve complete responses, combined treatment with chemotherapy or serotherapy, and its use in earlier stages of disease should be investigated.

VP-16-213 salvage therapy for refractory germinal neoplasms

Thirty-three patients with advanced refractory germinal neoplasms were treated with VP-16-213 alone or in combination with cis-platinum, bleomycin, and frequently Adriamycin. All had prior chemotherapy, which in most was extensive. There were 14 complete and 15 partial remissions. Five of the patients with partial remission were rendered disease free by resection of residual tumor. Eleven remain disease free from 6+--23+ months. Toxicity was considerable. One-third were hospitalized for fever and granulocytopenia and four had life-threatening thrombocytopenia. There was one drug-related death. VP-16 is an active drug in germinal neoplasms. It appears to be an important component of "salvage" regimens for refractory patients, but severe toxicity may ensue.

A system for obtaining large numbers of cryopreserved human monocytes purified by leukapheresis and counter-current centrifugation elutriation (CCE)

A system has been developed for the isolation of large numbers of unfractionated mononuclear cells from single, well characterized normal individuals and for the separation by elutriation of these cells into populations of greater than 90% pure monocytes and greater than 99% pure lymphocytes. The total number of monocytes obtained from a single donor averaged about 550 million. After cryopreservation and thawing of these cells, the viability remained greater than 90%, 80% of original cells were recovered, and the ability to ingest antibody-coated targets was comparable to that of fresh monocytes. The cells remained sterile without the use of antibiotics and were suitable for long-term culture. The monocytes that were isolated and cryopreserved by these procedures functioned reproducibly as inhibitors of tumor cell growth and in an assay of responsiveness to monocyte migration inhibitory factor (MIF).

Randomized phase III comparison of three doxorubicin-based chemotherapy regimens in advanced non-small cell lung cancer: a Southeastern Cancer Study Group trial

From 1978 to 1981, 537 patients with advanced non-small cell lung cancer were randomly assigned to three regimens containing cyclophosphamide and doxorubicin alone or in combination with methotrexate or cisplatin. Eligible patients had measurable disease and had no prior exposure to chemotherapy. Of the patients entered on the study, 505 were evaluable for toxicity and 488 were evaluable for response. The overall response rate (complete and partial responses) was only 9%. Response rates did not vary significantly with respect to treatment regimen, histologic subtypes, extent of disease, or performance status. There was no survival advantage for any regimen. The major toxicities were myelosuppression and nausea-vomiting. These doxorubicin-based chemotherapy regimens produced disappointing results in patients with advanced non-small cell lung cancer. A search for more active antitumor agents in lung cancer is necessary.

Lentiviral vectors in cancer immunotherapy

Basic science advances in cancer immunotherapy have resulted in various treatments that have recently shown success in the clinic. Many of these therapies require the insertion of genes into cells to directly kill them or to redirect the host's cells to induce potent immune responses. Other analogous therapies work by modifying effector cells for improved targeting and enhanced killing of tumor cells. Initial studies done using γ-retroviruses were promising, but safety concerns centered on the potential for insertional mutagenesis have highlighted the desire to develop other options for gene delivery. Lentiviral vectors (LVs) have been identified as potentially more effective and safer alternative delivery vehicles. LVs are now in use in clinical trials for many different types of inherited and acquired disorders, including cancer. This review will discuss current knowledge of LVs and the applications of this viral vector-based delivery vehicle to cancer immunotherapy.

Management of painful shoulder

55 patients with 60 shoulders painful at rest, and with limitation of all ranges of movement, were treated with multiple injections of methylprednisolone acetate into the subacromial space and glenohumeral joint cavity. Pain was abolished in 80%, two weeks after starting therapy and 95% were pain-free four weeks after the first injection. Maximum functional recovery (at least 150 degrees abduction, 80 degrees internal rotation, and 45 degrees external rotation), was achieved in 90% of patients eight weeks after starting treatment. It is suggested that the "frozen" shoulder--i.e., pain-free shoulder with severe limitation of all movement--is the end result of a neglected painful shoulder and it is essential that painful shoulders be treated as early as possible if normal function is to be preserved.

Characterization of purified cryopreserved human monocyte function in assays of superoxide production, accessory cell function, chemotaxis, and in fluorescent cell sorter analysis

The ability to use highly purified cryopreserved human monocytes in various in vitro assays has a number of practical and theoretical advantages, including convenience and the potential for enhanced reproducibility. Large numbers (up to 1 X 10(9)) human monocytes can be isolated from a single donor in a purified suspension state, by a combination of leukapheresis and counter-current centrifugal elutriation (CCE) technologies. Following short- and long-term periods of cryopreservation, the viability and phagocytic function of these CCE-purified monocytes was unimpaired. Cryopreserved monocytes were similar to fresh cells in their ability to release superoxide anion (O2-), although unstimulated and stimulated O2- release values tended to increase slightly following weeks to months of cryopreservation. In contrast, even short-term cryopreservation diminished both the random migration and chemotactic responses of human monocytes; however, cryopreserved monocytes could be employed in this assay provided the calculated chemotactic ratio (chemotactic migration/spontaneous migration) was used. Cryopreserved monocytes demonstrate 70% of fresh monocyte accessory cell function in pokeweed mitogen-induced lymphocyte proliferation assays. When the binding of OKT3, OKM1, anti-DR, and fluoresceinated pokeweed mitogen to monocytes was analyzed in the fluorescence activator cell sorter (FACS), cryopreserved and fresh monocytes displayed a similar pattern of membrane reactivity.

Recurrent acute renal failure with interstitial nephritis due to D-penicillamine

A 60-year-old man with rheumatoid arthritis, who developed acute reversible renal failure with nephrotic syndrome and tubulointerstitial nephritis in association with multiple-drug therapy, is described. The episode was ascribed to the nonsteroidal anti-inflammatory agent fenbufen, and the patient was reexposed to D-penicillamine within 6 months, reproducing the same renal lesion. There was no evidence of the glomerular lesions characteristically associated with D-penicillamine nephrotoxicity. D-penicillamine was the only drug therapy common to both episodes and it is concluded that it may cause tubulointerstitial nephritis with nephrotic syndrome.

Combination chemotherapy based on a model of cell recruitment by partial synchronization

A noncomparative, phase II clinical trial on chemotherapy of leukemias and solid tumors has been undertaken. It has been attempted: (a) to synchronize cells by a first administration of an M-dependent agent (vincristine or VM 26) which blocks them during the mitotic phase (M) (this has been verified by the mitotic index), from where they start again to go into the other phases of the cycle, more or less at the same time (this has been verified by the labeling index) and (b) to destroy a greater number of cells by a second administration of cycle-dependent or phase-dependent agent(s). Remarkable results have been obtained, the most interesting one being apparently complete remissions or regressions given by the sequence of two agents in patients who during previous trials proved to be resistent to both agents administered separately. The chemotherapy protocols thus composed are administered intermittently, comprising cycles with free intervals, the duration of which depends on the time of the bone marrow and blood restoration. The hematological, immunological, and visceral tolerance is, on the whole, satisfactory.

Cell-mediated immunity in human acute leukemia

The general cell-mediated immunological reactivity of patients with acute leukemia has been found to be intact, although it may be depressed by extensive disease or by chemotherapy. Patients with acute leukemia also have cellular immune reactivity against tumor associated antigens, as measured by skin tests for delayed hypersensitivity, lymphocyte stimulation, and 51Cr release cytotoxicity. Skin reactions to autologous and allogeneic crude membrane extracts of blast cells correlated with disease state, positive in many patients in remission and negative in most patients in relapse. Extracts of human lymphoid tissue culture cell lines derived from lymphomas or leukemia also gave positive reactions in patients with acute leukemia, and also in patients with lymphoma and nasopharyngeal carcinoma. The antigens detected in the skin tests with the lymphoid cell lines appear to be different from those associated with Epstein-Barr virus (EBV) and from those detected in the 51Cr release assay. Evidence is presented which suggests a complex variety of antigens on blast cells and on the cell lines. Although leukemia associated antigens were also detected by lymphocyte stimulation and by cytotoxicity assays, the results did not correlate with the skin tests nor with each other. The possible use of these assays for monitoring the chemotherapy and immunotherapy of acute leukemia patients is discussed.

Phase II trial of piperazinedione in malignant melanoma: a report by the Southeastern Cancer Study Group

Forty-one evaluable patients with malignant melanoma resistant to other chemotherapeutic agents received 9 mg/m2 of piperazinedione every 3 weeks. Two patients had partial responses and one additional patient had stable disease. One of the partial responses occurred in a patient with subcutaneous metastases and the other occurred in a patient with pulmonary and osseous metastases. Both antitumor responses occurred in the 17 patients with a performance status of greater than or equal to 80%. The dose-limiting toxicity was myelosuppression; thrombocytopenia was more frequently observed than granulocytopenia.

Characterization of 3H-uridine incorporation and messenger RNA synthesis in human monocytes activated to secrete alpha interferon or monocyte-derived fibroblast growth factor

Human monocytes are multifaceted cells with a wide range of immunoregulatory functions and distinct secretory products. This manuscript reports on initial attempts to identify specific early macromolecular synthetic events associated with various types of human monocyte activation by observing the patterns of RNA synthesis displayed by human monocytes that are exposed to well characterized activating stimuli. It was found that muramyl dipeptide (MDP), an activator of monocyte-derived fibroblast growth factor (MD-FGF) release from monocytes, also stimulates a reproducible increase in human monocyte total 3H-uridine incorporation and cytoplasmic messenger RNA (mRNA) synthesis at 4 h following activation. In contrast, polyriboinosinic acid:polyribocytidilic acid (poly I:C), an excellent stimulator of monocyte alpha interferon (IFN alpha) release, did not cause a change in either 3H-uridine incorporation or cytoplasmic mRNA production at any of the time points tested. Poly I:C was also found to be a poor stimulator of MD-FGF release. Conversely, MDP did not stimulate any detectable IFN release from human monocytes. The discrepancy between the patterns of macromolecular synthesis observed in human monocytes activated to secrete MD-FGF as compared with IFN indicates that divergent postactivation control mechanisms may be operative at the RNA level in the monocyte following activation of these two distinct functions.

Phenytoin in rheumatoid arthritis

In a prospective open study, 18 patients with active rheumatoid arthritis were treated with phenytoin (300 mg/day) for 32 weeks. Clinical assessments improved significantly and there was no relapse 8 weeks after drug withdrawal. Serum C-reactive protein, plasma viscosity and hemoglobin also improved but changes were not significant. Serum phenytoin concentrations were lower than anticipated. Side effects were mild and caused 2 patients to withdraw. Our observations and the known effects of phenytoin on the immune system and collagen metabolism suggest that further controlled studies using higher doses are warranted.