Steven A. Armentrout

Successful pregnancy during chemotherapy for acute leukemia

A 26‐year‐old patient with acute lymphatic leukemia conceived while on systemic chemotherapy. This patient experienced relapse during the second trimester, and a second complete hematologic remission was achieved with doxorubicin hydrochloride, vincristine, and prednisone. A 2400‐gram, but otherwise normal, male infant was delivered by Caesarean section during the 36th gestational week. Growth and development of this child is normal at six months. Cancer 47:845–846, 1981.

Remission of pure red cell aplasia associated with nonthymic malignancy

Two patients with acquired pure red cell aplasia associated with malignancy are presented. One patient has breast cancer and the other had poorly differentiated nodular lymphoma; neither patient had evidence of a serum inhibitor of hemoglobin synthesis and both achieved complete hematologic remission following prolonged immunosuppressive therapy. The literature describing the association of pure red cell aplasia and nonthymic malignancy is reviewed and potential for responsiveness discussed.

Third trimester chemotherapy and neonatal hematopoiesis

SummaryAn 18-year-old woman with severe pancytopenia secondary to chemotherapy given in the third trimester of pregnancy and who delivered an infant with normal peripheral blood counts is reported. The literature is reviewed, and recommendations for the method of delivery in this setting are discussed.

Combination chemotherapy in metastatic carcinoma of the breast Results with a three‐drug combination

Forty‐two patients with Stage IV carcinoma of the breast were treated with an oral program of combination chemotherapy consisting of three drugs: methotrexate, 5‐fluorouracil, and cyclophosphamide (substituting 1, 3‐bis (2‐chloroethyl)‐1‐nitrosourea in cases with central nervous system involvement). Sixtyfour percent of the patients responded to the therapy, with a mean and a median duration of remission of 10.7 and 10.0 months, and a mean and median survival of 12.3 and 13 months. This therapeutic program is equally effective for pre‐ and postmenopausal patients and does not appear to be influenced by prior response to hormonal manipulation, single or combination drug therapy, or duration of disease. The results are comparable to those shown by previous authors. Toxicity in this group, however, was minimal, and patient acceptance excellent.

Multiple myeloma complicated by myelomatous obstructive uropathy

Two patients with multiple myeloma with large retroperitoneal myelomatous masses are discussed. This extraosseous extension of disease caused obstructive uropathy in both patients. This complication has not been previously recognized in multiple myeloma and must be added to the potential causes of renal failure in this disease.

Hepatic artery-biliary fistula. An unusual complication of infusion therapy

This report describes a patient with carcinoid metastatic to the liver in whom a hepatic artery catheter was placed for infusion therapy. This resulted in a previously unreported complication of a hepatic artery-biliary fistula. The clinical presentation of this complication and mode of management are described. The etiologic factors responsible for this complication are discussed. It is speculated that as more aggressive therapy for hepatic metastases is undertaken, this potential complication will be seen more frequently.

CYTOTOXIC CHEMOTHERAPY IN KAPOSI'S SARCOMA

Kaposi’s sarcoma, recognized in the Western Hemisphere as an indolent malignant cutaneous disease affecting primarily elderly males of Jewish extraction, has in recent years been the principle malignancy associated with acquired immune deficiency syndrome (AIDS). The wide-spread cutaneous lesions are frequently associated with viseral involvement, particularly in the pulmonary and gastrointestinal systems. The early cutaneous manifestations of Kaposi’s sarcoma appear to respond to the administration of interferon. This biologic has not, however, afforded permanent control in this disease. A variety of chemotherapeutic regimens have been employed in an effort to control advanced cutaneous and viseral Kaposi’s sarcoma (1–7). The use of cytotoxic chemotherapy has resulted in a substantial percentage of partial and complete responses in the malignant lesions. The duration of both complete and partial responses has, however, proved disappointingly short. Another theoretical as well as practical disadvantage of cytotoxic chemotherapy, has been a further suppression of the immune system in the patient with AIDS. Although frequently difficult to quantitate, this appears to have resulted in a further increase in systemic life threatening infections by both common and opportunistic pathogens. Recent trials of chemotherapy employing both cytotoxic chemotherapy and biologic response modifiers, although too early to evaluate, seem to produce results similar to cytotoxic chemotherapy alone.

Doxorubicin—hexamethylmelamine therapy of small cell carcinoma of the lung

Eighteen patients with small cell carcinoma of the lung treated with doxorubicin hydrochloride and hexamethylmelamine are presented. Fifteen of these patients had extensive disease at presentation. Four patients in this group died after one or fewer courses of chemotherapy. The median duration of survival for the entire group of patients is 15 months. Six patients are alive from 18 to 56 months without evidence of disease. Drug toxicity was minimal and well tolerated, which permitted this regimen to be given in an outpatient setting.