David Berd

Long-term remission in diffuse histiocytic lymphoma treated with combination sequential chemotherapy†

Seventeen patients with Stage III or IV reticulum cell sarcoma were treated with three cycles of a 5‐drug regimen between February, 1969 and December, 1970. Of the 17 patients, 9 attained a complete remission and 6 had a partial remission; 2 were considered unevaluable. Recently, the original biopsies from these patients were reclassified according to the criteria of Rappaport et al.7 The results were: diffuse histiocytic—8; nodular histiocytic—2; diffuse mixed—2; nodular mixed—3; diffuse lymphocytic poorly differentiated—1; nodular lymphocytic poorly differentiated—1. Of the 8 patients with diffuse histiocytic lymphoma 6 attained complete remission, 1 had a partial remission, and 1 was unevaluable. One of the 6 with complete remission relapsed at 7 months and died 2 months later. However, the other 5 are alive and in continued unmaintained remission for 55 to 65 months.

A pilot study of low-dose thalidomide and interferon ??-2b in patients with metastatic melanoma who failed prior treatment

Melanoma is a hypervascular tumor and angiogenesis plays a critical role in the development/progression of metastases. As various pathways are involved in tumor angiogenesis, a combination of agents with different antiangiogenesis activities is a reasonable approach. To determine the efficacy and toxicity of combination treatment with low-dose thalidomide and low-dose interferon (IFN) in patients with stage IV melanoma who failed prior treatment(s), fifteen patients with metastatic melanoma (nine cutaneous, six uveal) received oral thalidomide (200 mg daily) with subcutaneous interferon (IFN)-&agr;2b (3 MIU, 3×/week). Stabilization or regression of metastases (as evidenced by computed tomographic measurement) was the primary endpoint of the study. Patients were evaluated monthly for toxicity and every 2 months for clinical response. At a median follow-up of 22.8 months (range, 12–32 months), one patient with metastatic cutaneous melanoma achieved partial response, three patients achieved stable disease (one uveal, two cutaneous), nine patients progressed, and two were not evaluable. The time to progression was 6 months for the patient with partial response, and 2, 5.5+ and 11 months for three patients with stable disease. The estimated median overall survival was 4.7 months (confidence interval, 2.2–9.9 months; range, 0.9–31.5 months), and median progression-free survival was 1.8 months (confidence interval, 1.5–3.0 months; range, 0.5–14 months). Grade 3 toxicities related to treatment included neutropenia (n=5), elevation of transaminases (n=2), and neuropathy (n=1). No treatment-related deaths were experienced. Thalidomide+IFN is a safe and tolerable palliative treatment for previously treated stage IV melanoma.