ABSTRACT
Five hundred and sixty-six patients with either Stage III or IV Hodgkin's disease were prospectively randomized to test whether CCNU and/or vinblastine are more effective than mechlorethamine and/or vincristine with procarbazine and prednisone. The combination of CCNU, vinblastine, procarbazine, and prednisone (CVPP) was shown to be a highly effective program with a complete response frequency of 69%. The use of CCNU as part of the induction program was also shown to be the most significant determinant of prolonged remissions (P = .025). Reduced vomiting and neurotoxicity, as well as the oral administration, were the chief advantages of the CVPP as compared with MOPP. These factors resulted in improved patient and physician compliance. The MVPP regimen was also shown to be a highly effective regimen with a complete response frequency of 73% in patients without prior exposure to chemotherapy. However, the induction regimens containing vinblastine were associated with a significantly higher frequency of fatal hematopoietic toxicities than the induction regimens containing vincristine (P = .05). This higher frequency was almost exclusively seen in the elderly or in patients previously treated with both chemotherapy and radiotherapy. At this time, the remission durations maintained by vinblastine with periodic reinforcement are longer when compared with vinblastine maintenance alone (P = .06), but there is no corresponding increase in survival.
Subject(s)
Antineoplastic Agents/administration & dosage , Hodgkin Disease/drug therapy , Adult , Drug Administration Schedule , Drug Therapy, Combination , Female , Hematopoiesis/drug effects , Humans , Lomustine/administration & dosage , Male , Mechlorethamine/administration & dosage , Prednisone/administration & dosage , Procarbazine/administration & dosage , Prognosis , Prospective Studies , Vinblastine/administration & dosage , Vinblastine/pharmacologyABSTRACT
Eighty-nine patients with multiple myeloma resistant to melphalan were randomized to receive cyclophosphamide plus prednisone (CP) (47 patients) or cyclophosphamide plus BCNU plus prednisone (CBP) (42 patients). No differences were detected in the two groups prior to therapy. Objective responses occurred in three (7%) of the CP patients and in seven (17%) of the CBP patients. About 40% of the patients in each group achieved some response. Toxic reactions consisted mainly of leukopenia and thrombocytopenia. Median survival was not different in the two groups. The median survival time was 31 months among those patients with an objective response and 9.4 months among those without an objective response. The addition of BCNU to CP increased the frequency of objective response, but not significantly. This triple combination (CBP) cannot be recommended.
Subject(s)
Carmustine/administration & dosage , Cyclophosphamide/administration & dosage , Melphalan/therapeutic use , Multiple Myeloma/drug therapy , Prednisone/administration & dosage , Drug Resistance , Drug Therapy, Combination , Humans , Multiple Myeloma/mortalityABSTRACT
An unusual case of granulocytic sarcoma (chloroma) of the parenchyma of the brain occurring in a patient with acute myelocytic leukemia in remission is described and the literature reviewed. The patient presented with an intracranial mass without clinical evidence of meningeal involvement. The value of 99mTc scan in CNS leukemia is shown.
Subject(s)
Brain Neoplasms/pathology , Leukemia, Myeloid/pathology , Brain Neoplasms/diagnosis , Female , Humans , Leukemia, Myeloid/diagnosis , Middle Aged , Radionuclide ImagingSubject(s)
Leukemia, Myeloid/diagnosis , Adrenal Insufficiency/chemically induced , Adult , Bone Marrow Examination , Busulfan/adverse effects , Disseminated Intravascular Coagulation/etiology , Gynecomastia/etiology , Hemorrhagic Disorders/etiology , Histiocytes , Humans , Leukemia, Myeloid/complications , Leukemia, Myeloid/drug therapy , Male , Radionuclide Imaging , Skin ManifestationsABSTRACT
A prospective randomized study of the effects of two different therapeutic regimens was conducted in 41 patients with multiple myeloma resistant to therapy with melphalan. The results of treatment with cyclophosphamide plus prednisone were compared with those of cyclophosphamide, prednisone, and chloroquine. Chloroquine, which inhibits the repair process of DNA in animals, has reportedly produced responses to alkylating agents to which the animal had been resistant. No significant differences in response to the doses used with either regimen could be found. Toxocity consisted mainly of leukopenia and thrombocytopenia.
