Ronald Bodley Scott

Combination Chemotherapy in Generalized Hodgkin's Disease

Fifty-two patients with generalized Hodgkins disease were treated with a combination of mustine hydrochloride, vinblastine, procarbazine, and prednisolone. Complete remissions were obtained initially in six out of seven patients (86%) who had previously received no treatment, in 15 out of 19 (79%) who had had only radiotherapy in the past, and in 9 out of 26 (35%) who had previously been given chemotherapy with or without radiotherapy. Of these 30 patients in whom a complete remission was obtained 22 have been free of any symptoms or signs of disease for periods ranging from 4 to 22 months. The response to treatment was rapid, and toxicity was not a major problem, except in those who had previously been treated with cytotoxic drugs used continuously and not in courses. A comparative trial of radiotherapy and combination therapy in the treatment of Stage III Hodgkins disease is strongly recommended.

Management of Adult Acute Myelogenous Leukaemia

Consecutive adult patients admitted to St. Bartholomews Hospital with acute myelogenous leukaemia have been treated with a remission induction drug schedule consisting of daunorubicin and cytosine arabinoside. Intermittent five-day courses were used in 72 patients, and a complete remission was obtained in 39 patients (54%). An alternative drug schedule in 22 patients resulted in fewer remissions but this may have been due to age differences in the two groups. Age and initial platelet count were found to be important factors in determining the success of remission induction therapy; the older patients and those with low platelet counts responded less well. A series of 23 patients who achieved remissions was divided into two groups; one received intermittent combination chemotherapy as the only form of maintenance, and the other was given weekly immunotherapy in addition to the chemotherapy. The immunotherapy consisted of irradiated allogeneic leukaemic cells and B.C.G. Eight of the 10 patients on chemotherapy alone have already relapsed compared with five out of 13 patients in the immunotherapy group. It is hoped that these promising initial results with this form of maintenance will be confirmed as more patients enter the maintenance trials.

Combination chemotherapy using L-asparaginase, daunorubicin, and cytosine arabinoside in adults with acute myelogenous leukaemia.

Cytosine arabinoside and daunorubicin used in an intensive intermittent regimen have been shown to be an effective combination for the induction of complete remissions in 14 out of 23 adult patients with acute myelogenous leukaemia. This gives an overall complete remission rate of 60%. A further patient had a good partial remission. The addition of L-asparaginase to the regimen has not increased the incidence of remission and there were more side effects in the L-asparaginasetreated group. Of the 10 patients treated with L-asparaginase in addition to cytosine arabinoside and daunorubicin, five achieved a complete remission. Of the 13 patients treated with cytosine arabinoside and daunorubicin without L-asparaginase, nine achieved a complete remission and one a good partial remission.

L-Asparaginase in Treatment of Acute Leukaemia and Lymphosarcoma

L-Asparaginase was used to treat 40 patients with acute leukaemia or lymphosarcoma. Fifteen with acute lymphoblastic leukaemia either untreated or in relapse after previous therapy were given “Squibb,” “Bayer,” or “Porton” L-asparaginase. Five of these patients had complete remission of their disease, and four had good partial remission. Eleven patients with acute myeloid leukaemia were treated for a short period with L-asparaginase alone. None of them went into remission though a pronounced fall in the numbers of circulating white cells was seen. Six patients with lymphosarcoma received L-asparaginase, two of them having good partial remissions. The toxic side-effects of the L-asparaginase from the three sources seemed to vary, and L-asparaginase from Erwinia carotovora appeared to be antigenically different from the enzyme produced by Escherichia coli. The way in which leukaemic cells become resistant to the action of the enzyme requires further investigation. To overcome this resistance asparaginase should be used in combination with other drugs in the treatment of acute leukaemia.

Hypogammaglobulinaemia in Chronic Lymphatic Leukaemia

and Norwich Hospital; Northampton General Hospital; Northern General Hospital, Edinburgh; Orpington Hospital; Princess Louise Hospital; Queen Elizabeth Hospital, Birmingham; Queen Marys Hospital, Sidcup; Radcliffe Infirmary, Oxford; Redhill County Hospital, Surrey; Royal Alexandra Hospital, Rhyl; Royal Infirmary, Cardiff; Royal Infirmary, Manchester; Royal National Hospital for Rheumatic Diseases, Bath; Royal Sussex County Hospital, Brighton; St. Alfeges Hospital, Lewisham; St. Asaph Hospital, Flints; St. Davids Hospital, Cardiff; St. Martins Hospital, Bath; St. Mlarys Hospital, Paddington; St. Thomass Hospital, London; University College Hospital, London; Western General Hospital, Edinburgh; Westminster Hospital, London; Willesden General Hospital, London.

Thymic Tumour and Erythroblastic Aplasia Report of Three Cases and a Review of the Syndrome

A SELECTIVE aplasia of erythroblasts, resulting in what has been called ‘pure red-cell anaemia’, has been accepted as a rare variant of aplastic anaemia for many years (Kaznelson, 1922; Lescher and Hubble, 1932). Its frequent association with a tumour of the thymus is of more recent recognition, but twenty-nine instances have now been reported (Table I). The purpose of this paper is to describe three further patients in whom erythroblastic aplasia of the bone marrow accompanied a thymoma and to review our knowledge of the syndrome.

Hypoplastic Acute Myelogenous Leukaemia

The clinical course, diagnosis and management of nine cases of hypoplastic acute myelogenous leukaemia are described. Such cases may follow a slowly progressive course and should not receive anti‐leukaemic chemotherapy unless the disease is advancing rapidly or unless some specific complication develops. If chemotherapy has to be given, usually because of severe and recurrent infections, then prompt and prolonged remission of disease may occur.

Chemotherapy of Hodgkin's Disease with Cyclophosphamide, Vinblastine, and Procarbazine

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THE INDICATIONS FOR BLOOD TRANSFUSION

“ Die Transfusion ist indiciert bei allen denjenigen krankhaften Zustanden, wo das Blut, sei es quantitativ sei es qualitativ so verandert ist dass es seine physiologischen Pflichten nicht mehr erfullen kann. ”—H. Leisrink, 1870.

Medical charities and prevention

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