Biomedical subjects
Publications and source records attributed to D R Budman.
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An unusual case of an IgM producing lymphoproliferative disorder is presented. Using immunofluorescent techniques, this study shows that the heavy chain is associated with kappa light chain in some cells, and with lambda light chain in other cells. This indicates the presence of two distinct malignant cell populations in this patient.
An elderly woman with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) presented de novo with DIC in the absence of other etiologic causes for DIC. Complete reversal of the defibrination process occurred with vincristine, methyl-prednisolone, and heparin therapy. This case illustrates that defibrination can occur de novo in the presence of a clinically, although not pathologically, malignant process. AILD should be considered in the differential diagnosis of DIC.
We describe two patients with acquired idiopathic sideroblastic anemia and a terminal deletion of chromosome No. 11. In spite of the marked chromosomal abnormality neither patient has developed acute leukemia.
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A phase II trial of mitomycin, vinblastine, and cisplatin was undertaken in 26 patients with non-small cell carcinoma of the lung. A major response rate of 46% was seen in measurable and evaluable disease, with a complete response rate of 12%. Median duration of response is 6.5+ months (range, 2.5-19+). Toxic effects included moderate myelosuppression, mild neuropathy, mild azotemia, and severe nausea and vomiting. These results are similar to previously reported studies using vinca alkaloids and cisplatin alone.
Cytogenetic studies of bone marrow specimens from 15 patients with dysmyelopoietic syndrome are presented. The group consists of nine patients with refractory anemia with excess of blasts (RAEB), three patients with chronic myelomonocytic leukemia (CMMoL), and three patients with acquired idiopathic sideroblastic anemia (AISA). None of these patients had a prior history of therapeutic or occupational exposure to potential carcinogenic agents, G(TG)-banding revealed clonal abnormalities in nine of the 15 patients. Five of these patients exhibited one or more of the following cytogenetic abnormalities: 5q deletion, -7, +8, or +21. The AISA group appeared to be unique as chromosome abnormalities were seen in two of the three patients and the clinical course in these patients had been prolonged without progression to acute leukemia. No other clinical correlation could be made in the blast RAEB and CMMoL groups, except for possible survival benefit in patients with normal karyotypes.
Two patients who presented with acute leukemia of Burkitt's cell type are discussed. Although one patient died within four months of diagnosis, the other has maintained a one year clinical complete remission. The clinical and morphologic picture of Burkitt's leukemia is nonspecific and therefore requires complementary studies including cytochemistry, transmission electron microscopy, cell surface markers and cytogenetics studies to establish diagnosis. Serial bone marrow aspirations with marker analyses may detect relapse at an earlier stage than conventional cytology, allowing therapy to be modified prior to overt clinical relapse.
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Twenty-two adult patients with relapsed leukemia were given aziridinylbenzoquinone (AZQ) intravenously in a phase I clinical trial. AZQ was administered as a 30-minute infusion daily for 17 days. Courses were repeated when the bone marrow returned to normal cellularity and full recovery from nonhematologic toxicity had occurred. The initial dose of AZQ was 8 mg/m2/d x 7. The highest dose given was 28 mg/m2/d x 7. A maximum of three patients were treated at each dose level and patients received at least two courses at a given dose level before they were eligible to be escalated to the next higher available AZQ dose level. Nonhematologic side effects were mild and included nausea/vomiting (32%), mucositis (18%), and alopecia (0%). Dose-limiting toxicity was bone marrow aplasia at the 28 mg/m2/d x 7 level. No complete or partial responses were observed in this initial study. For phase II adult leukemia studies using this schedule, it is recommended that the AZQ dose should be 24 mg/m2/d.
A role for vinblastine (VBL) in lung cancer has never been clearly defined. Because of recent pharmacokinetic data suggesting a biweekly schedule for VBL and recent antitumor activity shown for vindesine, a phase II trial of divided-dose VBL was initiated. Among 22 evaluable patients, a 27% major response rate was seen, with a median duration of 5.5 months (range 3.5-12+). The major toxic effect was myelosuppression but was easily manageable and tolerated. These results suggest schedule dependency for VBL and open the question of its efficacy in lung cancer.
In a phase I study of spirogermanium, a new azaspiran-germanium compound, 28 patients were given a multiple-dose schedule. When infused over 1 hour, the maximum tolerated single dose of this agent was greater than 120 mg/m2 but significant chronic neurologic toxicity occurred after 1-2 weeks of treatment. Patients with a poor performance status (PS) were the most likely to manifest toxic reactions. Suggested phage II dose levels for infusion treatment with spirogermanium are 120 mg/m2 for patients with a PS of 0-2 and 80 mg/m2 for patients with a PS of 3.
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Thrombocytosis may reflect a primary myeloproliferative disorder or be a secondary reaction to other pathologic processes. Patients with persistent unexplained thrombocytosis meeting criteria of primary thrombocythemia had elevated levels of serum lactic dehydrogenase, whereas comparable patients with secondary thrombocytosis did not. The findings of an elevated serum lactic dehydrogenase supports the diagnosis of a myeloproliferative syndrome in patients who have unexplained thrombocytosis, and should be useful in the differential diagnosis of this hematologic abnormality.