Long-term follow-up in 51 patients with mycosis fungoides and Sézary syndrome treated by interferon-alfa.

Although interferon-alfa (IFN-alpha) has proved effective in treating epidermotropic cutaneous T-cell lymphoma (ECTL), few studies have considered the follow-up of treated patients and whether complete remission was maintained. We studied 51 patients (one stage Ia, seven stage Ib, one stage IIa, 30 stage IIb, 11 stage III (Sézary syndrome) and one stage IV) who received low-dose IFN-alpha as monotherapy for ECTL (mean daily dose of IFN-alpha 2.7 x 106 units for 14.9 months), giving special consideration to the significance of My7 (CD13) antigen expression by epidermal basal cells in predicting the maintenance of complete remission. For a mean follow-up period of 43.4 months, the results showed 21 complete remissions, 13 partial remissions and 17 patients with stable or progressive disease. Twelve patients died during the follow-up (3-52 months). IFN-alpha led to an improved response in the early stages, with a greater number of complete remissions (P = 0.03) and partial remissions (P = 0.01). The mean time to complete remission was 4 months, regardless of clinical stage (P = 0.1). Of 21 patients in complete remission, 57% had a relapse within a mean period of 7.5 months. For patients maintained in complete remission, the mean period of response was 31 months. The length of complete remission was independent of clinical stage, and My7 antigen expression was not predictive of complete remission.

Skin cancers in transplant patients.

Skin tumors are frequent in transplant patients, and their potential for progression (locoregional recurrences, metastases) is much greater than in the general population. The viral element with HPV probably represents one of the etiologic factors, although other only partially known factors play a role, including the sun and genetic factors. The high frequency of these skin tumors in transplant patients and their potential for progression require preventive and therapeutic measures: regular examination of the skin, strict advice about protection from sun exposure, excision of any suspect lesion, and treatment of warts that might be conducive to the development of skin cancers. Finally, it must be decided whether immunosuppression should be reduced or stopped during treatment of skin tumors with a high risk of progression.

[Combination of dacarbazine, cisplatin and interferon alpha in the treatment of metastatic melanoma]. / Association dacarbazine, cisplatinium et interféron alpha dans le traitement du mélanome métastatique.

INTRODUCTION: The aim of this work was to study the effectiveness and safety of a combined therapy with dacarbazine, cisplatin and interferon alpha in the treatment of metastatic melanoma. PATIENTS AND METHODS: Sixteen patients, including 15 with one or more visceral metastases, were treated with dacarbazin 400 mg/m2, cisplatin 100 mg/m2 repeated every 28-day and interferon alpha-2a 3.10(6) IU subcutaneously 3 times weekly. Fifty percent of patients had at least 3 different sites of metastases. Ten patients had previously received one or more specific treatment for their melanoma. RESULTS: The overall response was 25 p. 100 (2 complete responses and 2 partial responses). The two complete responses were obtained on liver, lung and cutaneous metastases and remain in sustained, unmaintained remission for 22 and 24 months. Administration of this treatment was well tolerated, the most prevalent toxicity being hematologic. At present, responding patients have a median survival of 26 months+ since the beginning of the treatment, compared to 7 months for non responding patients. DISCUSSION: Dacarbazine and cisplatin combined chemotherapy has been used at various doses with an overall response rate of 14 to 37 p. 100, similar to our results. However, duration of complete response in our study (22 months+ and 24 months+) seem more prolonged than in studies using dacarbazine and cisplatin at dose of 100 mg/m2/21 d (7 to 9 months) and comparable to studies using dacarbazine and cisplatin at dose of 150 mg/m2/28 d or more (15 months+ to 19 months+ and 24 months+) but with less toxicity. Therefore addition of interferon alpha might be of interest in the maintain of complete remissions and perhaps in the prolongation of survival of responding patients as it has already been suggested with the dacarbazine-interferon alpha combination.

[Cardiac metastasis of melanoma disclosed by tamponade]. / Métastases cardiaques d'un mélanome révélées par une tamponnade.

INTRODUCTION: Melanoma is the most frequent cause of neoplastic metastasis to the heart. The diagnosis is however usually made after the patient's death as clinical signs are discrete, non-specific or masked by other visceral metastases. CASE REPORT: A 50-year-old man who was given chemotherapy for metastatic melanoma limited to the mediastinal lymph nodes suddenly developed acute dyspnea due to cardiac tamponnade. Puncture biopsy of the pericardium revealed melanoma cells and nodular infiltration of the pericardium. A pleuro-percardial window gave functional relief. The patient died 5 months later due to a recurrent episode of cardiac tamponnade. DISCUSSION: The diagnosis of metastasis to the heart of a malignant melanoma may be suspected in patients developing heart failure, rhythm or conduction disorders or pericardial effusion. The diagnosis can usually be confirmed with transthoracic sonography. Endocavitary or transmural tumors may require transesophageal echography or magnetic resonance imaging before surgery to determine extension and myocardial infiltration. Despite the severe prognosis, in case of immediate life-threatening emergencies or isolated cardiac metastases, a surgical treatment may be considered.

Study of the neurobehavioural toxicity of styrene at low levels of exposure.

Thirty workers in a dockyard exposed to concentrations of styrene lower than the TLV-TWA of 50 ppm and 30 control workers not subject to exposure but employed by the same company were subjected to three psychometric tests on one Monday morning and evening. The results were usually better in the evening than in the morning in both groups, which proves the lack of acute intoxication at the end of the day at this level of exposure. On the other hand, all of the tests conducted on the exposed subjects are significantly less good than those on the controls. The results suggest the existence of minor but significant organic mental disorders in the subjects exposed to a mean dose of 30 ppm in this study. These results are inconsistent with those of several recent studies. The advisability of lowering the TLV of 50 ppm in discussed.

["Primary" pulmonary arterial hypertension associated with HIV infection. Two cases]. / Hypertension artérielle pulmonaire "primitive" associée à l'infection par le VIH. Deux observations.

We report two cases of pulmonary arterial hypertension (PAHT) in HIV infected patients who never were, or had ceased to be, drug addicts. A study of these cases and a review of the literature show that this association is not fortuitous and persists after the classical causes of PAHT (pulmonary embolism, toxic factors, cirrhosis) have been excluded. The clinical features and the results of complementary cardiovascular examinations are identical with those of the so-called "primary" PAHT. The prognosis is severe: 50 percent of the patients died of the consequences of PAHT 1 year after the first clinical signs. Histology displays signs of plexogenic pulmonary arteriopathy, as in primary PAHT. In HIV patients pulmonary arterial hypertension occurs independently of the degree of immunodeficiency. Its relation with other HIV-related vasculites and their physiopathology are discussed.