Acute leukemia in two patients treated with high-dose melphalan and autologous marrow transplantation for malignant solid tumors.
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Biomedical subjects
Publications and source records attributed to Y Carcassonne.
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We report three cases of malignant T cell lymphoma of peripheral T lymphocyte origin. This morphological entity was first described by Lennert and Waldron. The diagnosis based on morphological criteria only is difficult because of the many lymphoid malignancies. Immunological characterization is necessary for the identification of the proliferative T lymphocyte subset with a panel of T monoclonal antibodies. Correlations were established between immunological phenotype and clinical and evolutive aspects which are particularly varied in T lymphoproliferative disorders.
High-dose melphalan followed by "rescue" with autologous marrow stored for 12-24 hours at room temperature was used in the treatment of 14 patients with advanced tumors refractory to conventional treatment. Twelve patients were evaluable, with three complete responses (25%), five partial responses (42%), and two minimal responses (16%). Response durations ranged from 4 to 38 weeks (median, 7). There were two treatment-related deaths and one patient developed acute nonlymphocytic leukemia 3 months after a second course of high-dose melphalan.
The immunocompetent subrenal capsule assay tumour graft is a good chemosensitivity test. We have compared it to immunocompetent white hamster cheek pouch tumour graft. These two assays are both easy to perform. Each has specific advantages and disadvantages. However the six days immunocompetent mouse subrenal capsule assay tumour graft is the most practicable and reproducible. The hamster cheek pouch assay would be used when mouse subrenal capsule assay would not be efficient for the molecules under study.
It now seems possible to predict response to anti-cancer drugs by means of several methods classified into three groups. Methods in the first group are aimed at determining the intracellular mechanisms required for the drugs to act on the tumoral cells; apart from hormone receptor assays, few of these have practical applications. Methods in the second group are concerned with the action of cytostatic drugs on malignant cells; clonogenic cultures and human tumour xenografts in mice are already routinely used. Finally, methods to evaluate the pharmacokinetics of anticancer drugs are being developed. These three groups of methods can be used in the pre-clinical screening of these drugs or at the clinical trial phase to predict individual responses to chemotherapy.
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Two cases of mistaken diagnosis of polycythemia vera leading to useless or dangerous treatments exemplify the old saying "primum non nocere". Absolute polycythemia which lacks both the specific characteristics of polycythemia vera and lacks both the specific characteristics of polycythemia vera and any tumoral etiology (particularly renal) but is accompanied with normal arterial oxygen saturation should suggest the possibility of an anomalous hemoglobin with increased affinity for oxygen. Two alternative mechanisms may be present: anomalous hemoglobins due to the substitution of an amino acid or, as in the two reported cases, a deficit in intraerythrocytic 2,3 diphosphoglyceride. In both cases, polycyhthemia is compensative and does not warrant therapy.
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The possible development of giant-cell lymphoma in the course of a B cell monoclonal lymphopathy is well documented. This occurrence is however exceptional in the course of myeloma. We describe a case in which typing of cell populations established the immunologic identity between the myelomatous proliferation and the sarcomatous process.
The occurrence of a large cell lymphoma in the course of chronic lymphocytic leukemia is rare and its evolution is fatal at short term. This is the definition of Richter's syndrome. The authors report three cases documented by cytology, histology. The immunological study was performed for one of these by typing on a suspension of fresh bone marrow and lymph node cells. It showed the immunological identity of the chronic phase and the transformation phase (Richter's syndrome). These findings are in line with recent studies showing the immunocellular filiation of the two hemopathies despite the morphological differences, the transformation phase showing the differentiation of the B clone of the chronic phase.
In adults, chronic aquired pure red cell aplasia (CAPRCA) with no thymic tumor may be idiopathic, fitting the description of Kaznelson syndrome, or a preleukemic disorder which will develop into a malignant hemopathy. Diagnosis of the second possibility is difficult to establish at onset. We report a case with a course suggestive of a possible relationship between CAPRCA and acute leukemia.
A clinical trial of NPT 15392, a purine derivative, was run in ten head and neck cancer patients presenting signs of immunosuppression and undergoing repeated chemotherapy. A battery of ten tests was used to assess the immune status of the subjects. Those tests included skin tests, lymphocyte investigations (count, E-rosetting, membrane fluorescence and lymphoblastic transformation) and determination of serum levels of C'3 fraction of complement and IgA. The drug induced transitory, immune stimulation during or after treatment without any side effects. NPT 15392 seemed to selectively exert an action on T lymphocytes. Inasmuch as transitory, immune stimulation and secondary immune depression were noted after treatment, the therapeutic protocol for use of this drug should be reexamined.
Seven patients with relapsed acute leukaemia were treated with high-dose melphalan (HDM) followed by the infusion of autologous cryopreserved remission marrow. Toxicity was minimal and all seven patients had a complete response. Four patients are still in unmaintained remission at 14, 13, 10, and 3 months, the first two having received a second course of HDM to consolidate the result. The role of HDM as a form of intensification therapy for patients with acute myeloid leukaemia in first remission should be investigated.
Adriamycin was administered by IV injection to seven patients with various solid tumors at a dose of 30 mg/m2 during successive courses. Extraction was carried out by the SEP-PAK method for plasma and by solvents for urine. Plasma and urinary levels of adriamycin and adriamycinol were determined by high-performance liquid chromatography over 72-h period after injection. Pharmacokinetic parameters for adriamycin and adriamycinol were calculated for each course of treatment. The results show significant inter- and intra-individual variations in the kinetics and elimination of both compounds. The analysis of pharmacokinetic data reveals a wide variability in the fluctuations observed during the successive courses in different patients. This study confirms the time-dependency of ADR kinetics.
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