Phase II trial of 2-chlorodeoxyadenosine in patients with relapsed/refractory acute myeloid leukemia: a study of the Eastern Cooperative Oncology Group (ECOG), E5995.

2-Chlorodeoxyadenosine (2-CdA) is a purine analog which has anti-leukemic activity in phase II trials in pediatric acute myeloid leukemia (AML) patients. An adult phase I trial suggested possible similar activity although neurotoxicity at higher doses was seen. We conducted a phase II trial of 2-CdA in patients with relapsed or refractory AML. 2-CdA was administered by continuous intravenous infusion at a dose of 17 mg/m(2) per day x5 days. Patients not achieving aplasia by day 21 were eligible for a second course of therapy. Fifteen patients (nine relapsed and six refractory AML) were enrolled including seven men and eight women with a median age of 60 years and median ECOG PS of 1. There were five deaths on study due to infections (two), AML (two), or hepatic failure (one). The 2-CdA was well tolerated without severe nausea, vomiting or stomatitis (all

[99mTc-generator eluates: effects on the radiochemical purity of the labelling products]. / Verschiedene 99mTc-Generatoreluate: Auswirkungen auf die radiochemische Reinheit der Markierungsprodukte.

Relatively sensitive kits--which are known for low tin content (HMPAO) or for a complicated chemical labelling procedure (MAG3)--were tested for their efficiency of labelling with eluates of different generators. The radiochemical purity of the labelling products was determined according to the manufacturer's instructions (HMPAO: Amersham Buchler, MAG3: Mallinckrodt Diagnostica) after adding the 99mTcO4- eluates from the different Tc-generators (Amersham Buchler, Mallinckrodt Diagnostica, CIS Biointernational). The radiochemical purity was determined by using radioanalytical methods such as high performance liquid chromatography, thin layer chromatography, paper chromatography and reversed phase chromatography. The quality of the three different generator eluates was sufficient for the labelling of HMPAO and MAG3. The small differences in quality did not limit the use in nuclear medical routine.

Doxorubicin, cyclophosphamide, and whole body hyperthermia for treatment of advanced soft tissue sarcoma.

Eleven patients with advanced soft tissue sarcoma were treated with whole body hyperthermia (41.8 degrees C-43.0 degrees C) for 2 hours, doxorubicin (45 mg/m2) at the beginning of peak temperature and cyclophosphamide (1000 mg/m2) 6 hours after doxorubicin. Warming was accomplished with a nylon and vinyl mesh water perfused suit and heating blankets under barbiturate anesthesia. Thirty-five thermochemotherapy treatments were administered after an initial baseline euthermic course. There were two complete and two partial responses including three of three liposarcomas and one of two leiomyosarcomas, and there were two disease stabilizations . Morbidity included anasarca, nausea and vomiting, diarrhea, myalgias, mild surface burns, perioral herpes simplex, reversible neuropathy, hypotension, and cardiac arrythmias . Hyperglycemia and hypophosphatemia were found during heating, and normalized at 24 hours. Liver enzyme elevations occurred 24 hours after heating and normalized within 1 week. A uniform platelet decrease (mean, 107,000/microliter) was found at 24 hours. Thermochemotherapy was found to be a feasible approach for selected patients with advanced soft tissue sarcoma for the subset of liposarcomas and leiomyosarcomas.

An unusual instance of leukemic infiltrate. Diagnosis and management of periapical tooth involvement.

The clinical course of an adult patient with relapsed acute myelogenous leukemia and leukemic infiltrate periapical to the dentition is described. While the oral symptoms were indicative of pulpal disease requiring dental therapy to resolve the patient's complaint, roentgenographic, dental pulp testing, and histologic analysis revealed extramedullary infiltrate apical to a mandibular molar. The findings developed coincident with relapse of leukemia; the medical and dental testing described above were essential in establishing an accurate diagnosis. While most oral leukemic infiltrates affect the gingiva, in this patient the infiltrate involved periapical tissue which was not clinically observable.

Renal failure and platinum pharmacokinetics in three patients treated with cis-diamminedichloroplatinum(II) and whole-body hyperthermia.

Three patients with advanced refractory malignancies were treated with whole-body hyperthermia (WBH: 42-42.3 degrees C) for 2 h during which time they also received an infusion of 60 or 80 mg/m2 of cis-diamminedichloroplatinum II (DDP). Each patient developed an elevated serum creatinine (2.7-13.6 mg/dl), with maximum creatinine occurring between days 7 and 12 after treatment. WBH did not alter plasma or urinary pharmacokinetics of total or ultrafilterable platinum compared with pharmacokinetic data of the same or other patients given DDP euthermically. Although the mechanism of the renal damage is unclear, it appears that WBH can potentiate the nephrotoxic actions of DDP and that further study of this combination is not warranted.