A. Cattan

1975 current results of the first 100 cytologically typed acute lymphoid leukemia submitted to BCG active immunotherapy

SummaryThe first 100 acute lymphoid (and undifferentiated) leukemias, (of which the smears at the first presentation of the disease are still available for typing), treated successively with remission induction chemotherapy, complementary cell-reducing chemoradiotherapy and then active immunotherapy with irradiated pooled allogeneic leukemic cells and fresh Pasteur Institute BCG applied on scarifications, have been reviewed, especially in connection with BCG application.Tolerance of BCG has been good. Its application had to be stopped due to a side effect (choroiditis) in only one patient. This toxic cost is negligible compared to that of so-called maintenance chemotherapy.No subject of our first control trial started in 1963 has relapsed between 3 and 13 years.In the overall group of the 100 patients studied, no relapse has been observed after 48 months, which is quite different to the observations of frequent relapses after that time in patients submitted to maintenance chemotherapy.Moreover, second remissions are obtained in 94% of the patients who relapsed early under immunotherapy, and their life expectancy after a second remission is as high as it is after the first remission.The median of survival is longer than 5 years.The action of active immunotherapy on the immune machinery has been followed by several assays, of which the increase of null cells (which include K-cells) may be the most interesting.Several prognostic factors have been demonstrated among which are sex, the volume of the neoplasia, meningeal localizations, and the cytological types. Age has no prognostic value in immunotherapy patients, contrary to maintenance chemotherapy patients. Also the cytological types behave differently under immunotherapy and under maintenance chemotherapy. The disease-free survival of more than 85% of the microlymphoblastic patients submitted to immunotherapy is not observed in J. Bernards patients submitted to maintenance chemotherapy, which suggests that this high cure rate is due to active immunotherapy. Hence, these prognostic factors are probably factors of sensitivity to active immunotherapy. A statistical computerized study has shown that there is a link between the cytological types and other prognostic factors and that they all depend on the cytological type.Hence, our present protocol is adapted to this immunotherapy sensitivity factor. It comprises a nonrisk preimmunotherapy chemotherapy for the microlymphoblastic type, and a longer and more intensive chemotherapy for less immunotherapy sensitive types.

Pathogen-free isolation unit — Three years' experience

The results obtained during the first three years of a pathogen-free isolation unit containing five beds have shown that this type of unit can reduce the risk of infection in patients treated with intensive chemotherapy or in those who have granulocytopenia from various causes. It is suggested that treatment of cancer which involves these risks should be carried out routinely in sterile isolation units, and that it is urgent to build many more and much larger units.

Treatment of Blastic Crisis in Chronic Myelocytic Leukemia

The development of an acute leukaemic syndrome can perhaps be considered to be the usual evolution of chronic myeloid leukaemia. Its occurrence is feared and its prognosis is still very poor, despite recent advances in treatment. Twenty-nine patients have been studied, 14 males and 15 females, their ages were 16–71 years (median 40 years). The acute leukaemic syndrome appeared 3 weeks to 7 years after the apparent onset of chronic myeloid leukaemia (median 26 months).

Five Years Experience of the Clinical Use of a Pathogen-Free Isolation Unit

Intensive chemotherapy and radiotherapy in current use in the treatment of malignant disease have given some outstanding results (Mathe et al., 1968) but they can cause, virtually inevitably, periods of profound hypo- or aplasia of the haemopoietic and lymphopoietic systems, whose main complication is infection. Infection has become one of the principal problems in the practice of modern cancer therapy, being particularly formidable in malignant disease of the haemopoietic system, especially in leukaemiC., where bone marrow insufficiency is often present before giving any treatment. In a recent study of acute leukaemia, treated with intensive chemotherapy, Frei and his colleagues (1965) reported 60 per cent incidents of bacterial infection with 40 per cent of septicaemia, and 64 per cent incidents of fungal infections with 34 per cent of septicaemia. Autopsy examination has confirmed that infection is the commonest direct cause of death in these cases.

Blastic Leukemia Complicating Reticulo-Sarcoma and Lympho-Sarcoma

A blastic leukaemia may appear in the course of a malignant lymphoma (Table 1): it is exceptional in Hodgkin’s disease, in follicular lymphoma, in reticulosarcoma, histiocytic type and in lymphosarcoma, lymphocytic type, but it is frequent in reticulosarcoma, histioblastic type (distinction between these two types of reticulosarcoma has been justified and illustrated by Mathe et al., 1967, 1970) and in lymphosarcoma, lymphoblastic type.

Comparative Results Obtained in the Treatment of Acute Lymphoid Leukemia, Acute Myeloid Leukemia, and Acute Monocytoid Leukemia

Acute lymphoid leukemia (ALL) and acute myeloid leukemia (AML) patients have been treated in our Institute according to different therapeutic principles (Fig. 1). In ALL we have tried to induce remission with chemotherapy, then applied complementary cell-reducing systemic chemotherapy combined with CNS chemoradiotherapy in order to reduce by three or four orders of magnitude the number of leukemic cells left by induction chemotherapy; finally we have submitted the patients to active immunotherapy, which is a combination of the injection of allogeneic leukemic cells and the administration of systemic adjuvants of immunity such as BCG [1, 2].

Methods and Strategy for the Treatment1 of Acute Lymphoblastic Leukemia

Acute lymphoblastic leukaemia (A. L. L.) is a malignant disease in which the proliferating cells are conventionally identified as “lymphoblasts”, cells that are theoretically the precursors of lymphocytes (see Mathe and SEman, 1963).