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Biomedical subjects

B A Chabner

Publications and source records attributed to B A Chabner.

At least 199 records · Page 11Linked to original sources

Dose-dependent metabolism of methotrexate in man and rhesus monkeys.

Humans and rhesus monkeys receiving high-dose methotrexate (MTX) (greater than 50 mg/kg) excrete significant quantities of the metabolite, 7-hydroxy-MTX. This metabolite, though 200-fold less potent than MTX as an inhibitor of mammalian dihydrofolate reductase, is of very limited aqueous solubility, and thus may contribute to the renal toxicity of the high-dose regimen. The metabolite was not observed in previous pharmacologic studies in which conventional doses of MTX were administered (less than 10 mg/kg).

Adolescent↗

The relative contribution of drug concentration and duration of exposure to mouse bone marrow toxicity during continuous methotrexate infusion.

The effects of exposure of bone marrow to specific methotrexate (MTX) concentrations were studied by constant infusion of the drug into C57BL mice. The residual marrow nucleated cell count was determined in 168 mice at specific intervals. In vitro culture of colony-forming cells (CFU-C) was also performed in 69 of these mice. Duration of exposure varied from 12 to 72 hr. Plateau plasma MTX concentrations were studied in the range from 10(-8) to 10(-5) M. The total number of nucleated cells per femur fell to a nadir of 30% of control for all drug concentrations studied. The nadir was reached earliest with the highest drug concentrations. The percentage of CFU-C per 7.5 X 10(4) nucleated cells plated increased after 48-hr infusions compared to the percentage after 24-hr infusions. This increase was seen at all plasma concentrations studied. The total number of CFU-C per femur at plasma MTX concentrations above 10(-6) M decreased in the first 24 hr to 40% of control, but then the number significantly increased to 66% of control between 24 and 48 hr. In contrast, no change was observed in CFU-C per femur between 24 and 48 hr during constant infusion at plasma concentrations below 10(-6) M. Wright's-stained smears showed no change in the differential count of marrow specimens at 24 and 48 hr that might account for the increased percentage of CFU-C at 48 hr. The increase in CFU-C per femur during high-dose infusions is probably the result of recruitment of CFU-C. The increased percentage of CFU-C suggests recruitment at the lower concentrations as well, but selective elimination of non-CFU-C cells cannot be excluded. Marrow [6-3]deoxyrudine incorporation studies in vivo during exposure to 10(-7) M MTX showed that the phenomenon of recruitment observed in vitro was initiated during the absence of DNA synthesis in vivo.

Animals↗

Sequential staging in non-Hodgkin's lymphoma.

The results of staging in 170 patients with non-Hodgkin's lymphoma have been reviewed; all patients were subjected to a series of sequential procedures, including lymphangiography, bone marrow biopsy, and liver biopsy (performed percutaneously, by peritoneoscopy, or by laparotomy). A high incidence of involvement of bone marrow, liver, and abdominal nodes was found in patients with nodular types of lymphoma and in those with diffuse lymphocytic lymphoma, with less than or equal to 20% remaining in stage I or II at the completion of staging in each of these subgroups. Only in patients with histiocytic lymphoma was there an appreciable percentage (31%) remaining in the stage I-II categories after staging. In this study, 75 patients remained in stage III or less after completing the non-surgical phase of staging, and laparotomy was utilized in only 50 patients (30%). At laparotomy, involvement of the liver or the mesenteric or portal lymph nodes was found in 81% of patients with a positive lymphangiogram but in only 18% of those with a negative lymphangiogram.

Biopsy↗

Abnormal pulmonary gallium accumulation in P. carinii pneumonia.

The potentially fatal interstitial pneumonia of Pneumocystis carinii is a frequent opportunistic invader of patients treated for malignancy with immunosuppressive and cytotoxic agents. Generalized Ga-67 pulmonary localization which is markedly disproportionate to the clinical and radiographic findings has led to earlier diagnoses by open lung biopsy in this setting. The potential usefulness of gallium scintigraphy in patients with suspected P. Carini pneumonia is presented.

Adult↗

7-Hydroxymethotrexate as a urinary metabolite in human subjects and rhesus monkeys receiving high dose methotrexate.

Human subjects and rhesus monkeys receiving the antitumor agent methotrexate at the high dose levels recently introduced into clinical use (greater than 50 mg/kg) excrete significant amounts of the metabolite 7-hydroxymethotrexate. The metabolite is not detected in these species after methotrexate therapy at conventional dose levels. The evidence indicates that in primates, the in vivo conversion of methotrexate to 7-hydroxymethotrexate is a dose-dependent phenomenon, with the enzyme system(s) catalyzing the reaction having a low affinity for the drug.

Adult↗

Combination chemotherapy for advanced breast cancer: response and effect on survival.

Forty patients with metastatic breast cancer who had received no previous cytotoxic therapy were treated with a combination chemotherapy program CMF (P), which included methotrexate, 60 mg/m2, and 5-fluorouracil, 700 mg/m2 intravenously on the first and eighth days, in addition to cyclophosphamide, 100 mg/m2, and prednisone, 40 mg/m2, by mouth daily from the first to the fourteenth day of a 28-day cycle. Only 2 of 25 patients responded to hormonal therapy or endocrine ablation. Twenty-seven of the 40 patients (68%) had a complete response (8 patients) or partial response (19 patients). Lung, soft tissue, and nodal metastases were the most responsive sites. The median survival of 18 months for the responding group. The nonresponders had a median survival of 4 months. The toxicity was primarily hematologic and was especially severe in patients with functional liver impairment due to metastatic disease.

Adult↗

Sequential nonsurgical and surgical staging of non-Hodgkin's lymphoma.

The yield of specific diagnostic procedures in the staging of non-Hodgkin's lymphoma was assessed in 170 consecutive patients who were evaluated with a sequence of diagnostic procedures. Stage III or Stage IV disease was established in 141 of 170 patients (80%) by nonsurgical procedures, including lymphangiography (positive in 78%), bone-marrow biopsy (positive in 39%), percutaneous liver biopsy (positive in 21%), and peritoneoscopy-directed liver biopsy (positive in 29% of those tested). Staging laparotomy showed disease outside conventional nodal irradiation fields in 21 of 26 patients with a positive lymphangiogram, but in only three of 17 patients with a negative lymphangiogram. The yield of staging procedures was highest in patients with nodular lymphomas, only 6% of whom were Stage I or Stage II after staging, but was lowest in patients with histiocytic lymphoma, 30% of whom had localized disease. This study shows that the presence of disseminated disease can be detected in the majority of patients with non-Hodgkin's lymphoma without the use of staging laparotomy.

Adult↗

Bleomycin, adriamycin, cyclophosphamide, vincristine, and prednisone (BACOP) combination chemotherapy in the treatment of advanced diffuse histiocytic lymphoma.

A new combination chemotherapy program for patients with diffuse histiocytic and mixed histiocytic-lymphocytic lymphoma was designed to prevent tumor recurrence during the recovery period of each treatment cycle. A myelosuppressive phase consisting of adriamycin, cyclophosphamide, and vincristine was followed by the nonmyelosuppressive agents bleomycin and prednisone to suppress regrowth of lymphoma while allowing for a return in bone marrow function. Twelve of 25 patients (48%) with advanced, previously untreated, diffuse histiocytic lymphoma achieved a complete remission as determined by restaging 1 month after discontinuation of treatment. The median duration of complete response after completion of therapy is in excess of 1 year (range, 5 to 30 months), and no patient has relapsed. Based on previous experience, it is anticipated that the majority of these patients will achieve an extended disease-free survival for what had previously been regarded as an invariably fatal disease.

Adult↗

Sepsis with a new species of Corynebacterium.

Sepsis with a previously undescribed species of Corynebacterium was documented in four patients. All patients had predisposing illness at the time of infection, three patients having leukemia in relapse and one having a porencephalic cyst and a ventriculoatrial shunt. The isolates from blood cultures had a characteristic metallic sheen when grown on blood agar. They were resistant to most antibiotics tested, including the penicillins, but were uniformly sensitive to vancomycin. Common biochemical characteristics, the metallic sheen, and the unusual antibiotic sensitivity pattern suggest that these isolates comprise a new species or group of closely related species of Corynebacterium that is capable of infection in man.

Adult↗

Chemotherapy of the blastic phase of chronic granulocytic leukemia: hypodiploidy and response to therapy.

Thirty-two patients in the blastic phase of Philadelphia chromosome-positive chronic granulocytic leukemia (CGL) were studied in a prospective randomized trial in which vincristine--prednisone (19 patients) was compared with cytosine arabinoside--6-thioguanine (13 patients). Seven remissions (37%), including two complete remissions, were achieved in the vincristine--prednisone group. Three of the five with predominant hypodiploid blast cell lines treated with vincristine--prednisone had complete or partial remissions. Both complete remitters presented with hypodiploidy consisting of 44 chromosomes. Four patients (30%) who were treated with cytosine arabinoside--6-thioguanine responded with one complete remission. The median survival of the responders was 8 mo, as compared to 1--2 mo for the nonresponders. Crossover to the opposite regimen as secondary therapy following refractoriness or resistance resulted in only 3 partial responses out of 21 treated. All three had previously responded to vincristine--prednisone. Of the 32 cases, 14 had an elective splenectomy during the chronic phase of the disease. Prior splenectomy did not influence the response to chemotherapy, as all three complete remitters occurred in the nonsplenectomized group. Similarly, survival in the blastic phase was not affected by prior splenectomy.

Adolescent↗

The reversal of methotrexate cytotoxicity to mouse bone marrow cells by leucovorin and nucleosides.

The cytotoxic effect of methotrexate (MTX) for mouse bone marrow cells has been studied by in vitro of the granulocyte precursor cell (CFU-C) in a medium containing dialyzed fetal calf serum and dialyzed L-cell supernatant. The formation of 50-cell colonies was inhibited to 50% of control by 10(-8) M MTX. Further increases in MTX concentration rapidly abolished colony formation by CFU-C. The potential of leucovorin and nucleosides to rescue the CFU-C from MTX toxicity was studied. Toxicity of 10(-7) M MTX was completely reversed by equimolar concentrations of leucovorin, but with higher MTX concentrations, relatively more leucovorin was required. While 10(-5) M MTX was rescued by 10(-3) M leucovorin, rescue of the toxic effect of 10(-4) M MTX by 10(-3) M leucovorin was not observed. In contrast to the rescue by Leucovorin, toxicity of all MTX concentrations up to 10(-4) M was completely prevented by 10(-5) M thymidine with 10(-5) M adenosine, inosine, or hypoxanthine. Single nucleosides or thymidine with guanosine were ineffective, as were lower concentrations (less than or equal to 10(-6)M) of the effective combinations. Thus, while leucovorin reversed the MTX toxicity to CFU-C competitively, rescue by nucleosides was noncompetitive. The significance and possible usefulness of these findings for chemotherapeutic protocols are discussed.

Adenosine↗

Kinetic alterations induced by 5-fluorouracil in bone marrow, intestinal mucosa, and tumor.

In order to provide a more rational approach to the design of chemotherapeutic programs involving 5-fluorouracil (5-FU), the kinetic effect of this drug on bone marrow, gastrointestinal epithelium, and tumorous tissues in mice was monitored by determining the rate of incorporation of labeled deoxyuridine (UdR) into DNA following doses of 15, 50, and 100 mg/kg i.p: In BALB/c x DBA/2 F1 (hereafter called CD2F1) mice bearing P1534 ascites tumor, the magnitude and duration of suppression of [3H]UdR incorporation into DNA were directly related to drug dose for both the normal and tumorous tissues. However, the impact of 5-FU was clearly greater upon the P1534 ascites tumor than on either normal tissue, so that, after a dose of 100 mg/kg, the tumor did not initiate recovery until Day 5, while duodenal mucosa and bone marrow returned to 50% of control levels of UdR incorporation at 2 and 3 days, respectively. In order to determine whether the duration of suppression of [3H]UdR incorporation, such as observed in the P1534 ascites tumor, correlated with sensitivity of Ehrlich ascites tumor to 5-FU, the effect of 50 and 100 mg/kg of 5-FU i.p. on this less 5-FU-sensitive tumor was determined. No difference was observed in the time course of suppression and recovery between Ehrlich ascites tumor and the duodenal mucosa and bone marrow of the G.P. Swiss host. In non-tumor-bearing CD2F1 mice, the toxicity of a 2nd dose of 100 mg/kg 5-FU i.p. was found to be predictably related to the kinetic effect of a 1st dose of 100 mg/kg on [3H]UdR incorporation in the bone marrow and duodenal mucosa. In the time period from 12 hr through Day 6, when [3H]UdR incorporation into DNA rose to a maximum, administration of a 2nd dose of 5-FU was associated with 95% lethality. In contrast, during the period between 0 and 12 hr that preceded recovery of UdR incorporation, a 2nd dose resulted in less than 40% lethality, and, in the period from Day 6 through Day 8, when UdR incorporation was declining, lethality of a 2nd dose also declined to less than 25% lethality. In addition, the antitumor effectiveness of a 2nd dose of 5-FU, 100 mg/kg i.p., was predictably related to the differential effect of the 1st dose of 100 mg/kg on [3H]UdR incorporation in the P1534 tumor as compared to the host bone marrow and duodenal mucosa. Administration of a 2nd dose of 5-FU was maximally effective on Day 7, at a time when [3H]UdR incorporation was declining in the host target tissues and increasing to a maximum in the P1534 ascites tumor. Thus, the present study has demonstrated that [3H]UdR incorporation into DNA may be used to monitor the differential effect of 5-FU on tumor versus normal proliferating host tissues and, where such differences exist, to provide an in vivo method of value in designing a schedule of optimum therapeutic benefit.

Animals↗

Evidence for early recruitment of granulocyte precursors during high-dose methotrexate infusions in mice.

The effects of constant exposure to high concentrations of methotrexate in vivo on the committed stem cell (CFU-C) were studied by in vitro culture of mouse bone marrow. Bone marrow samples were obstained from animals receiving a continuous infusion, and were cultured in a methotrexate-free semisolid gel system. The effects of methotrexate infusion on the pluripotent stem cell population (CFU-S) were studied as well. Constant exposure to 10(-5) M methotrexate produced a rapid decrease in total nucleated cells per femur, reaching 35% of control at 12 hr and remaining at approximately this level throughout 48 hr of drug infusion. A decrease in the number of both CFU-C and CFU-S per femur was observed, which paralleled the drop in nucleated cells during the first 24 hr. However, in contrast to an additional drop in the number of CFU-S, an increase of CFU-C number per femur was observed from 24 to 48 hr. These data indicated a self-limited cell kill of nucleated bone marrow cells, and suggested recruitment of CFU-C from the CFU-S pool between 24 and 48 hr of infusion despite continued methotrexate infusion.

Animals↗