Richard A. Binder

A comparison of efficacy of sargramostim (yeast-derived RhuGM-CSF) and filgrastim (bacteria-derived RhuG-CSF) in the therapeutic setting of chemotherapy-induced myelosuppression

A randomized, double-blind, multicenter study in 181 afebrile cancer patients with ANC levels < 500/microL receiving myelosuppressive chemotherapy was undertaken to compare sargramostim (yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor, RhuGM-CSF) and filgrastim (bacteria-derived recombinant human granulocyte colony-stimulating factor, RhuG-CSF) in the treatment of chemotherapy-induced myelosuppression. Patients received daily subcutaneous (SC) injections of either agent until ANC levels reached at least 1500/microL. There was no statistical difference between treatment groups in the mean number of days to reach an ANC of 500/microL, but the mean number of days to reach ANC levels of 1000/microL and 1500/microL was approximately one day less in patients receiving filgrastim. Fewer patients in the sargramostim arm were hospitalized, and they had a shorter mean length of hospitalization, mean duration of fever, and mean duration of i.v. antibiotic therapy compared with patients who received filgrastim. Both growth factors were well tolerated. No patient was readmitted to the hospital after growth factor was discontinued. Sargramostim and filgrastim have comparable efficacy and tolerability in the treatment of standard-dose chemotherapy-induced myelosuppression in community practice.

Simultaneous presentation of acute myelomonocytic leukemia and multiple myeloma

A patient with acute myelomonocytic leukemia and multiple myeloma occurring simultaneously prior to initiation of chemotherapy is described. Possible. mechanisms for this occurrence are discussed.

Randomized trial comparing the tolerability of sargramostim (yeast-derived RhuGM-CSF) and filgrastim (bacteria-derived RhuG-CSF) in cancer patients receiving myelosuppressive chemotherapy

Abstract A prospective, randomized, double-blind, multicenter study in cancer patients receiving myelosuppressive chemotherapy was undertaken to evaluate and compare the tolerability of sargramostim (yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor, RhuGM-CSF) and filgrastim (bacteria-derived recombinant human granulocyte colony-stimulating factor, RhuG-CSF) in the prophylaxis or treatment of chemotherapy-induced neutropenia. In all, 137 evaluable patients received sargramostim (300 μg; 193 mg/m2) or filgrastim (481 mg; 7 mg/kg) once daily by self-administered s.c. injection, usually beginning within 48 h after completion of chemotherapy. With the exception of a slightly higher incidence of grade 1 fever (/38.1  °C) with sargramostim, there were no statistically significant differences in the incidence or severity of local or systemic adverse events possibly related to the growth factors. Although the study was not designed to evaluate efficacy directly, there also were no statistically significant differences between treatment groups in total days of growth factor therapy, days of hospitalization, or days of i.v. antibiotic therapy during the treatment period. Both sargramostim and filgrastim were comparably well tolerated when given by s.c. injection in this group of patients, and no clinically significant differences between the growth factors were demonstrated.

Malignant histiocytosis in a patient presenting with leukocytosis, eosinophilia, and lymph node granuloma

A patient with malignant histiocytosis presented with a number of unusual features including fever, leukemoid reaction, and eosinophilia. Other confusing findings included lymph node biopsies which showed reactive changes, noncaseating granuloma, and atypical Reed‐Sternberg cells. These features are compared with cases appearing in the literature. The course was rapidly progressive despite combination chemotherapy.

“B” cell origin of malignant cells in a case of american burkitt's lymphoma characterization of cells from a pleural effusion

Ninety‐eight percent of the cells isolated from a malignant pleural effusion in a case of American Burkitts lymphoma showed membrane fluorescence to antihuman IgM antisera, while only 2% of the cells formed spontaneous rosettes with sheep red blood cells. It is concluded that the Burkitt cells in the malignant effusion are derived from bursal equivalent lymphocytes. Epstein‐Barr (E‐B) viral titers to both viral capsule antigen and early antigen were not elevated. The significance of these findings is discussed.

The nitroblue tetrazolium (NBT) dye test in determining fever source in lymphoma

A prospective evaluation of the nitroblue tetrazolium (NBT) dye reduction reaction revealed that the response of neutrophils from 76 lymphoma patients was comparable to a control population of 44 patients without underlying malignancy. The NBT test proved to be a useful adjunct in distinguishing fever as a systemic manifestation of underlying lymphoma from that secondary to bacterial infection. In contrast to lymphoma patients with „B”︁ fever, bacterially‐infected lymphoma patients had elevated resting NBT scores comparable to a control population with bacterial infections. Lymphoma chemotherapy, including prednisone, did not inhibit neutrophilic response to infection or latex particle phagocytosis, but Procarbazine may have produced a false positive response in some patients. It is essential to perform a simultaneous latex particle stimulation control to rule out an acquired intracellular defect that would otherwise be interpreted as a false negative response.