Autologous Bone Marrow Transplantation Followed by Involved Field Radiotherapy in Patients with Relapsed or Refractory Hodgkin's Disease.

Twenty-six patients with refractory or relapsed Hodgkin's disease were treated with high dose cyclophosphamide, BCNU, etoposide, and thiotepa followed by autologous hematopoietic stem cell rescue. Involved field radiotherapy was given following hematologic recovery in selected patients. The overall response rate to the high dose chemotherapy was 69% with 34% complete responses. Following radiotherapy, the complete response rate increased to 50%. The predicted disease-free survival at two years is 22%. Toxicity with this regimen was significant, with five patients dying as a result of transplant related complications. We conclude that the addition of thiotepa to the standard CBV regimen did not result in improved therapeutic efficacy and possibly contributed significantly to the toxicity of the treatment.

A phase I-II study of high-dose cyclophosphamide, thiotepa and escalating doses of mitoxantrone with autologous stem cell rescue in patients with refractory malignancies.

Twenty-five patients with refractory solid tumors were treated with high-dose cyclophosphamide, thiotepa and mitoxantrone followed by autologous stem cell rescue in a phase I dose escalation study. The dose-limiting toxic effect was mucositis at 60 mg/m2 of mitoxantrone in combination with cyclophosphamide and thiotepa. The early death rate due to toxic effects was 24%; all deaths were attributed to infections. Hematopoietic recovery was quite prolonged with median times to granulocyte (greater than 500 x 10(6)/l) and platelet (greater than 50 x 10(9)/l) recovery at 58 and 148 days, respectively. The overall response rate was 56%. The median time to progression was 14 weeks. Thus, this regimen has activity against refractory malignancies although early and prohibitive toxicity occurs when mitoxantrone is escalated in this setting.

The Treatment of Hairy Cell Leukemia: A Review.

Hairy cell leukemia is a chronic lymphoproliferative malignancy first described by Bouroncle et al. over 30 years ago(1). Representing less than 2% of adult leukemias, hairy cell leukemia has become the focus of intense interest over the past few years as a result of therapeutic advances. The malignant cell has characteristic irregular cytoplasmic projections visible on the peripheral blood smear and cytoplasmic vesicles staining positive for tartrate-resistant acid phosphatase. The origin of the hairy cell appears to be a preplasma cell B lymphocyte based on immunoglobulin gene rearrangements and B-cell-specific antigens, although very rare T-cell variants have been reported. While the diagnosis may be suspected from the clinical manifestations and examination of the peripheral smear, a bone-marrow biopsy is frequently necessary for definitive diagnosis. The typical patient is a middle-aged man with complaints of fatigue or weakness; symptoms of splenic pain, bleeding or bruising, or recurrent infections are less common at presentation(2). Splenomegaly without peripheral adenopathy occurs in 70-80 % of newly diagnosed patients(2). Pancytopenia is present in approximately two-thirds of patients, although 10% of patients present with a leukocytosis resulting from a high circulating hairy cell count.

The t(2;5)(p23;q35): a recurring chromosomal abnormality in Ki-1-positive anaplastic large cell lymphoma.

In lymphoid neoplasms, nonrandom cytogenetic abnormalities correlate with clinical, morphologic and immunophenotypic features. A subtype of non-Hodgkin's lymphoma, which expresses the Ki-1 antigen (CD30) and has distinct morphologic and clinical features, has recently been described. We now report the association of a reciprocal translocation involving the short arm of chromosome 2 (band p23) and the long arm of chromosome 5 (band q35), t(2;5)(p23;q35), with Ki-1 positive anaplastic large cell lymphoma. Rearrangement of the genes that are located at the breakpoints on chromosomes 2 and 5 may be a critical step in the pathogenesis of this lymphoma.