Fortuny Ie

Granulocyte Transfusion: A Controlled Study in Patients with Acute Nonlymphocytic Leukemia

Granulocyte transfusions are frequently used during the leukopenic phase of induction chemotherapy for acute nonlymphocytic leukemia (ANLL) although no controlled study has documented their usefulness. We have compared the morbidity and mortality of febrile episodes in granulocytopenic (< 500/mm3) adults with ANLL who received granulocytes and those who did not. Granulocytes were obtained from related normal donors using a continuous flow centrifuge. Seventeen patients who received 98 transfusions during 23 febrile episodes were compared with 22 patients who received no granulocytes during 35 febrile episodes. No significant difference in clearing of documented infection occurred between the transfused (71%) or the control (76%) group. Granulocytes did not result in more rapid termination of febrile episodes nor in significant decrease in fever 24 hours following the transfusion. Factors contributing to the lack of obvious clinical benefit are discussed.

Studies on the neutropenia of cancer chemotherapy

Cancer patients who are receiving chemotherapy are considered to be at an increased risk of infection when the peripheral neutrophil count falls below 2000 cells/mm3. To protect them from such risk, the treatment is discontinued. The size of the marginal neutrophil pool, the extent of marrow neutrophil reserves, the patients ability to develop a tissue neutrophil and mononuclear cell response to a non‐specific inflammatory stimulus, and the in vitro metabolic activity of neutrophils were measured in 25 patients with solid tumors betore and after a course of chemotherapy. Results indicate that infection only occurred with a depression of marrow neutrophil reserves and/or a depression in the tissue neutrophil and mononuclear cell response to non‐specific inflammation. The functional capability of neutrophils, as measured by the in vitro metabolic responses to phagocytosis of latex particles, remained intact despite peripheral neutropenia. Chemotherapy may be safely continued, despite peripheral neutropenia, as long as the marrow reserves and tissue leukocyte inflammatory responses remain intact.

Combined chemotherapy with cyclophosphamide, vinblastine, procarbazine, and prednisone (CVPP) for patients with advanced Hodgkin's disease. An alternative program to MOPP

Thirty‐eight patients with advanced Hodgkins disease were treated with a combination of cyclophosphamide, vinblastine, procarbazine, and prednisone (CVPP). Complete remissions were obtained in 74% of patients. Response rates were similar for previously untreated and previously extensively irradiated patients. Fifty‐six percent of patients older than 50 and 50% of patients with bone marrow involvement responded. All patients with mixed cellularity Hodgkins disease responded compared with 74% of patients with nodular sclerosis. At the present time the median duration of complete remission is 27+ months. However, of the responders, 75% (21 of 28) remain in continuous complete remission for 14+ to 49+ months. Only five patients have relapsed but two have died from apparent sepsis without evidence of recurrent disease. The complete remission rate for CVPP is comparable to that for MOPP. CVPP is an easily administered, well‐tolerated alternative to MOPP chemotherapy for patients with advanced Hodgkins disease.

Adult herpes simplex hepatitis

Abstract The development of hepatitis in adult patients with generalized herpes simplex infections, although rare, is fatal if complicated by hepatic and adrenal necrosis and intravascular coagulation. The presumptive diagnosis is made possible by the demonstration of intranuclear inclusions in material obtained from scrapings of mucosal lesions and liver biopsy material. The infection can be effectively treated with cytosine arabinoside, a pyrimidine nucleoside that inhibits deoxyribonucleic acid synthesis and that is a potent antiviral agent particularly against the herpes virus group. Without a specific agent to control the infection, herpes virus hepatitis leads to disseminated intravascular coagulation, which cannot be controlled by heparin.

Pneumocystis carinii pneumonia diagnosed from sputum and successfully treated with pentamidine isethionate.

A patient with leukemic lymphosarcoma in partial remission gradually developed dyspnea and patchy lung infiltrates. Pneumocystis carinii organisms were demonstrated on sputum smears the pneumonia resolved rapidly during pentamidine therapy. With reactivation of the leukemia, death ensued, and at postmortem examination, pneumocystis organisms could not be demonstrated in searl sections of the previously involved lung.

Continuous Flow Centrifuge Leucapheresis in the Management of Chronic Myelogenous Leukaemia

Summary. Six patients with chronic myelogenous leukaemia (CML) were treated by repeated continuous flow centrifuge (CFC) leucapheresis. In six of seven courses of leucapheresis there was no improvement in splenomegaly. In no instance was the leucocyte count reduced to the normal range. The immediate changes in peripheral leucocytosis produced by each CFC leucapheresis procedure were quite variable. There was no correlation between the intensity of a series of CFC leucapheresis procedures and the total clinical effectiveness of the therapy. Balancing potential benefits against definite costs to the patient, CFC leucapheresis seems justified in only a minority of CML patients. Untreated CML patients who have cyclic leucocytosis may be the best candidates for this therapy. Currently this form of therapy for CML remains experimental.

The Role of Continuous Flow Centrifuge Leucapheresis in the Management of Chronic Lymphocytic Leukaemia

Continuous flow centrifuge leucapheresis (CFCL) provides a simple, mechanical technique for removing large numbers of circulating lymphocytes without cytotoxicity. Seven sequences of CFCL were performed on six patients with chronic lymphocytic leukaemia (CLL). In six, the median course consisted of six procedures in 10 days. A median total of 27.7 × 1011 leucocytes were removed and a 70% drop in leucocyte counts (from 433 × 109/l. to 130 × 109/l.) was observed with little fall in haemoglobin and platelet counts. Tissue masses decreased in two patients. A similar effect was seen in one patient managed less intensively with 21 procedures being performed over 73 days, removing a total of 87.6 × 1011 leucocytes. The peripheral leucocyte count decreased from 760 × 109/l. to 114 × 109/l. and hepatomegaly diminished markedly. One patient has survived for over 9 months since CFCL but stayed in control only briefly after each of two courses. Short courses of daily CFCL can produce short‐term benefit in the management of advanced CLL but at present its main value is as an investigational form of therapy which provides a unique opportunity to study the cytokinetics of advanced CLL without the complications of superimposed cytotoxic therapy.

Lymphocyte transformation in malignant lymphoma.

SummaryThe PHA response of lymphocytes from lymph nodes and peripheral blood of patients with well differentiated lymphocytic lymphoma was studied over a period of time. A single control was used to provide a cross-index of these responses for the purpose of comparing the clinical state of the patients. In almost all instances the response was lower than normal. The results fail to indicate any constant relationship between PHA responsiveness of peripheral blood lymphocytes and the extent of clinical disease. It is suggested that there may be alterations in the microcirculation of lyrhphoid and other organs which determine the random accumulation of lymphocytes seen in this disease.

Therapeutic Versus Prophylactic Castration in Breast Cancer

A comparative analysis was made of the efficacy of prophylactic castration in 79 patients with breast cancer (performed at the time of initial tumor therapy) versus therapeutic castration in 96 patients (performed when cancer recurred). The interval from initial therapy to recurrence of cancer was greater in the prophylactic group. The interval from recurrence of cancer to death was greater in the therapeutic group. The total survival time from initial therapy to death was not significantly different in the two groups.