Attempted prevention of blast crisis in chronic myeloid leukemia by the use of pulsed doses of cytosine arabinoside and cis-chloronitrosurea during the course of busulfan-maintained remission.

We performed this chemotherapeutic trial to try to delay the onset of the blast crisis of chronic myeloid leukemia (CML) by pulsing doses of drugs most likely to be effective against emerging "blast" cells characteristic of acute phase disease. A randomized trial in patients with CML comparing busulfan maintenance to busulfan maintenance plus pulsed doses of cytarabine and lomustine did not yield any differences in either time to blast crisis or death.

A comparative assessment of home versus hospital comprehensive treatment for advanced cancer patients.

A prospective comparative analysis of home and hospital comprehensive treatment for advanced non-ambulatory cancer patients was conducted. Patients were assigned to hospital (group A) and home (group B) treatment groups based on geographic location. Home treatment was provided by the Don Monti Home Oncology Medical Extension (HOME) program. A multidisciplinary health team, including an oncologist, oncology nurse, social worker, dietitian, and medical technologist, was transported to the home in a medically equipped van. Services included physical examinations, pain control, psychosocial interventions, chemotherapy and blood transfusions, nutrition consultation, and bereavement counseling. One hundred seventy-four patients were treated at home and 44 in the hospital. Pretreatment characteristics were similar for both groups, with the exception that age under 50 years was more frequent in the hospital group, and home patients were more likely to have gastrointestinal (GI) cancer. Medical benefits for home treatment included decreased narcotic analgesic requirements, decreased hospitalization and length of stay, and improved measurements of fat stores for female patients. Improved survival for home patients was related to Karnofsky performance status, since there was no difference in survival for sicker patients with lower performance status whether they received home or hospital treatment. Patient and family acceptance of home treatment was excellent. Comprehensive home treatment provided by a multispecialty oncology team is an effective alternative to hospitalization for terminal cancer patients.

Comparative cost analysis of home and hospital treatment.

A comparative study evaluating home and hospital treatment for terminal cancer patients is reported. Home care was provided by a comprehensive home care program, the Don Monti Home Oncology Medical Extension (H.O.M.E.). A multispecialty team including an oncologist, oncology nurse, social worker, dietitian and technologist is transported to the home in a medically-equipped van to render treatment. Services provided include physical assessments, pain control, chemotherapy and transfusion administration, psychosocial support, nutrition education and bereavement counseling. Two-hundred eighteen patients were entered of which 174 were treated at home and 44 in the hospital. Patients were comparable in age, diagnosis, sites of metastases, prior treatment and Karnofsky status. Both groups received similar supportive care either at home or in the hospital. Cost analysis of home and hospital care revealed a per diem cost benefit of $256.00 for home treatment. Comprehensive home treatment provided by a multi-specialty team can deliver effective care with medical and financial benefits to terminal cancer patients.

Phase I trial of vinzolidine.

Vinzolidine is a new, orally active, semisynthetic vinca alkaloid which shows broad anti-tumor activity against murine tumor test systems. This phase I study established a 1 day every 2 week schedule of 35 mg/m2 in good-risk patients and of 30 mg/m2 in poor-risk patients. Maximal tolerated dose was 45 mg/m2 with severe neutropenia, syndrome of inappropriate antidiuretic hormone, and paralytic ileus. Significant antitumor responses were seen in two patients with lymphoma and in one with squamous cell cancer of the lung.

Phase II trial of mitomycin, vinblastine, and cisplatin (MVP) in non-small cell bronchogenic carcinoma.

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.

Biclonal IgM gammopathy in a lymphoproliferative disorder.

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.

Acquired idiopathic sideroblastic anemia: a new chromosomal abnormality.

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.

Morphologic and clinical observations in human infection with Babesia microti.

On admission to the hospital, a splenectomized man was found to have 85% of his erythrocytes parasitized by Babesia microti. His extensive parasitemia allowed for direct study of the morphology and ultrastructure of this organism as it appears in human infection; the need for animal inoculation and rescue techniques was thus eliminated. Positive characteristics (other than the tetrad form) that are diagnostic for babesiosis were identified. By transmission and scanning electron microscopy, parasite-induced changes in the erythrocyte membrane were observed; these alterations may explain the hemolysis seen in babesiosis. Factors that may have allowed the patient to sustain such high-level parasitemia are considered. The experience with this patient confirms that exchange transfusion is a reliable, rapid method for reduction of the parasite load in serious infection with B microti.

De novo disseminated intravascular coagulation in angioimmunoblastic lymphadenopathy (AILD).

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.

Cytogenetic findings in the dysmyelopoietic syndrome.

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.

Burkitt's leukemia: a re-evaluation.

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.

Phase II study of divided-dose vinblastine in non-small cell bronchogenic carcinoma.

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.

Phase I trial of spirogermanium given by infusion in a multiple-dose schedule.

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.