Interleukin-2 in autologous bone marrow transplantation.

Interleukin-2 results in the generation of lymphokine activated killer cells which exhibit a potent effect against a wide variety of tumours. Consequently, interleukin-2 therapy has been used to induce a graft versus tumour effect following autologous bone marrow transplantation. Preclinical studies have shown that this results in successful engraftment, and an enhanced reconstitution of the immune system.

Low dose, oral lorazepam: a safe and effective adjuvant to antiemetic therapy.

Twenty-five patients with acute nonlymphoblastic leukemia undergoing 41 cycles of chemotherapy with daunorubicin/cytosine arabinoside (ara-C) or with etoposide/ara-C received metoclopramide (MCP; 0.5 mg/kg 6 hourly i.v.) or MCP (same dose) plus oral lorazepam (1 mg/d) during and 24 hours following the chemotherapy as antiemetic medication. Control of vomiting was achieved is 55% (complete 5%, partial 50%) of the patients receiving MCP alone and in 100 percent (complete 76.1%; partial 23.8%) of those receiving MCP plus lorazepam (p less than 0.001). Eighteen of the 21 patients (85.7%) receiving MCP plus lorazepam opted for the same antiemetic regimen as compared to six of the 20 (30%) receiving MCP alone (p less than 0.01). One patient in each group developed mild sedation during the treatment. It is concluded that oral lorazepam is an effective and safe adjuvant to MCP for the control of vomiting during cancer chemotherapy.

Cytotoxic therapy. Role of durable venous access.

Aggressive chemotherapy regimens and supportive measures in haemato-oncology patients demand reliable venous access. Experience with this method in India has been limited. During a period of six months, we have used 42 subclavian indwelling catheters and 31 cubital Cavafix long lines. The mean age of patients in the two groups was 32 years and 7 years respectively. Subclavian catheters had a median duration of catheter placement of 46 days (range 4-145) and total 1494 catheter days, while cubital longlines yielded a median duration of insertion of 14 days (range 4-27) and total 508 catheter days. Catheter related complications were infection in 25% of patients, thrombophlebitis in 22%, blockade in 12% and misplacement in 17% in both groups taken together. The patients and families were extremely satisfied with the devices. Our experience supports further use of durable venous access in cancer patients. Implanted central venous catheters should be preferred whenever feasible.

Primary pulmonary non-Hodgkin's lymphoma: a report of four cases.

Four cases of primary non-Hodgkin's lymphoma of the lung are described. Two cases had low and two intermediate grade lymphoma at the time of diagnosis. The patient who had disease for long duration and received pulmonary radiotherapy developed intractable chest infection and died six months after diagnosis; the three patients having short history of disease and treated with surgery and/or chemotherapy have been doing well for 4 to 77 months after the diagnosis. It is concluded that diagnosis of primary pulmonary lymphoma should be suspected in patients with nodular or interstitial lung disease and bronchoalveolar lavage with aspiration cytology should be done to make an early diagnosis.

Use of central venous catheters for prolonged venous access in cancer chemotherapy.

A preliminary experience in the use of central venous catheters, including Hickman (15), subclavian jugular (Desseret) (50) and Secalon Hydrocath (3), in cancer chemotherapy is presented. There were no technical complications and no mortality attributable to catheterisation. Infections formed the major complication in Hickman (30%) and subclavian jugular (Desseret) (36%) catheters, while the use of Secalon Hydrocath was event-free. The commonest organism isolated was P aeruginosa (60%), followed by staphylococci (30%). Prolonged venous access was achieved with minimum morbidity. It is concluded that central venous catheters are safe and convenient both for the patient and the treating team, and should be used in all patients undergoing protracted chemotherapy and supportive care.

Effect of hydroxyurea on foetal haemoglobin in myeloproliferative & myelodysplastic syndromes.

The effect of hydroxyurea on foetal haemoglobin (HbF) levels was evaluated in 36 patients of myeloproliferative and myelodysplastic disorders. In 17 (47.2%) patients, HbF levels increased from 1.40 +/- 1.17 to 3.03 +/- 1.97 per cent after 4 wk therapy with hydroxyurea. In the responders this increase was highly significant (P less than 0.001). The rise in the HbF levels after hydroxyurea therapy was significant in patients with chronic myeloid leukaemia but not in the other groups.

Amphotericin B-related thrombocytopenia. A report of two cases.

Thrombocytopenia is a rare side effect of amphotericin B. Two patients with acute leukaemia in remission who developed severe thrombocytopenia during amphotericin B therapy are reported. Thrombocytopenia recovered after the withdrawal of the drug in one patient and after reducing the dose in the other patient.

Acute non-lymphoblastic leukemia in children: prognostic factors and results of chemotherapy.

Twenty-nine children (age range 1-14, median 8 years) with acute non-lymphoblastic leukemia (ANLL) were induced in remission with daunorubicin and cytosine arabinoside. Twenty-three (79.3%) patients achieved complete remission (CR) and were administered two cycles of the same drugs as consolidation therapy; no maintenance treatment was given. Three (10.3%) patients died during induction; 3 (10.3%) patients were resistant to therapy. Multivariate analysis showed that female sex, TLC less than 50 X 10(9)/L, absence of in ection, albumin greater than 3.5 g/dl and high myeloperoxidase activity had a favourable influence on achievement of CR. TLC less than 50 X 10(9)/L and albumin greater than 3.5 g/dl also had a favourable prognostic value. Eight patients are alive between 13 and 32 months with overall survival at 2 years being 27.5%; four patients are free of disease with projected DFS at 2 years being 13.7%. The present data indicates the need for newer approaches to improve the long term survival in childhood ANLL.

Epithelial ovarian cancer following cure of cervical carcinoma (a case report).

A case of patient developing epithelial ovarian cancer 15 years after carcinoma of cervix treated successfully with radiotherapy, is reported. The patient has shown good initial response to chemotherapy and surgery.

Cisplatin-based chemotherapy in advanced ovarian cancer: initial experience in an Indian set-up.

Forty patients of advanced ovarian carcinoma were treated with monthly cycles of cyclophosphamide, adriamycin and cisplatin. Debulking surgery was done in 29 cases. Clinical complete response was seen in 70 percent and an overall response in 85 percent of cases. The median follow-up was 30 months. The actuarial overall survival was 45 percent and the disease free survival was 35 percent at 3 years. The present protocol appears to have an important influence on initial control of disease but relapses continue to occur following the treatment. Cytoreductive surgery before or after three cycles of chemotherapy has a favourable influence on disease free survival (DFS). Prolonged follow up will be necessary to determine the overall influence on long term survival.

Hodgkin's disease with bone marrow involvement.

Bone marrow involvement was seen in 11 percent of patients with Hodgkin's Disease which was determined from pre-treatment biopsy specimens using established histopathologic criteria. Analysis of 32 evaluable patients with marrow involvement showed male preponderance with a peak in fourth decade of life. Twenty four cases (75%) had B-symptoms and 15 (46%) presented within six months of onset of symptoms. On categorizing for clinical staging, 21 (65%) belonged to stage III and IV. Hepatomegaly (greater than or equal to 2 cms) was present in seven cases (21%) and splenomegaly in 13 cases (40%). Mixed cellularity and lymphocytic depletion histopathologic subtypes showed the highest frequency of involvement (21 cases; 65%). Out of 28 cases ESR was raised in 27 cases (96%). Eighteen cases (56%) showed elevated serum alkaline phosphatase levels. Serum copper levels were determined in 14 cases, out of which 12 (85%) showed elevated levels. These parameters along with anemia (hemoglobin of 12 g/dl or less) in 26 cases (81%), correlated well with the disease activity. Only four cases had leukopenia at presentation pointing to no hindrance for aggressive chemotherapy. All cases received minimum of six courses of standard combination chemotherapy with or without local radiotherapy. Sixteen cases (50%) relapsed subsequently and were managed accordingly. A five year follow-up revealed a minimal 31 percent overall survival, and 18 percent of patients were disease free and well since the time of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Platelet transfusion therapy in thrombocytopaenia of haematologic malignancies.

Thirty thrombocytopaenic patients of acute leukaemias and myelodysplastic syndrome were transfused platelets collected from ABO-matched donors using Haemonetics V30 and V50 blood processors. Twenty-seven patients had septicaemia and/or splenomegaly; 2 patients had disseminated intravascular coagulation (DIC). Pre-transfusion platelet count was 11.0 +/- 4.0 X 10(9)/L. The mean corrected count increments (CCI) 1 hour and 18 hours post-transfusion were 13.02 X 10(9)/L and 3.88 X 10(9)/L respectively, in the absence of DIC. Active bleeding stopped when platelet count was above 15.0 X 10(9)/L. There was no difference between the platelet yield from two blood processors.

Spontaneous complete remission in acute lymphoblastic leukaemia.

Case records of 78 patients of acute lymphoblastic leukemia have been reviewed. Complete remission occurred in seven cases following an episode of septicemia and supportive care.

Idiopathic thrombocytopaenic purpura in patients during remission of Hodgkin's disease.

Four patients with Hodgkin's disease developed thrombocytopaenic purpura during remission phase. The interval at which it occurred following chemotherapy ranged from a period of 4 months to 4 years. Detailed investigations failed to reveal recurrence of Hodgkin's disease. All patients responded well to steroid therapy. In the median duration of one year follow-up Hodgkin's disease remained under control. Thus, the occurrence of thombocytopaenic purpura in patients treated for Hodgkin's lymphoma need not imply recurrence or active Hodgkin's disease.