Adjuvant chemotherapy in operable breast cancer: cyclophosphamide, methotrexate, and fluorouracil versus chlorambucil, methotrexate, and fluorouracil--11-year results of Swiss Group for Clinical Cancer Research trial SAKK 27/82.

PURPOSE: To compare two adjuvant combination chemotherapies, cyclophosphamide, methotrexate, and fluorouracil (CMF) and chlorambucil, methotrexate, and fluorouracil (LMF), for patients who had undergone potentially curative surgery for unilateral breast cancer, in terms of relapse, survival, and toxicity. PATIENTS AND METHODS: Selection criteria was as follows: stage pT1-3a, N+ or N-, M0, less than 72 years of age. Eligible patients were randomized to receive either CMF (cyclophosphamide 100 mg/m2 orally on days 1 to 14, methotrexate 40 mg/m2 intravenously (I.V.) on days 1 and 8, fluorouracil 600 mg/m2 I.V. on days 1 and 8) or LMF (Leukeran [Wellcome A.G., Bern, Switzerland] 5 mg/m2 orally on days 1 to 14 with the some I.V. cytostatic drugs). Follow-up examinations were performed every 3 months during the first 3 years after mastectomy, and every 6 months thereafter. RESULTS: A total of 246 patients were randomized, of whom 232 who were fully eligible and contribute to the analyses presented here. No statistically significant difference in favor of adjuvant CMF over LMF emerges after a median follow-up duration of 11.2 years, for either overall survival (P = .15) or disease-free survival (P = .14). A consistent trend suggestive of a possible relative benefit associated with CMF should be pointed out. However, CMF presents a significantly worse toxicity profile as concerns hematologic parameters as well as alopecia, nausea, and vomiting. CONCLUSION: This prospective trial has not identified a statistically significant difference in disease-free survival or overall survival between the two adjuvant regimens LMF and CMF. Although a trend in favor of CMF has been observed in premenopausal patients, this has to be weighted against its definitely more pronounced toxicity profile.

[May-Hegglin anomaly: further studies on thrombocyte dysfunction]. / May-Hegglin-Anomalie: ergänzende Untersuchungen zur Frage der Thrombozyten-Funktionsstörung.

The May-Hegglin anomaly is an extremely rare, autosomal dominant inherited disorder characterized by alterations in white cells and in blood platelets. The granulocytes show basophilic inclusion bodies of no clinical importance. Usually moderate thrombocytopenia with variable platelet size, including giant platelets, is also found. Clinically a mild hemorrhagic diathesis may occur. We report on a so far asymptomatic patient from the second family described by Hegglin et al. in 1964 [1] who had to be treated for repeated life-threatening bleedings. A moderate prolongation of bleeding time was found, corresponding to the reduced platelet count; platelet aggregation induced by ADP, collagen, ristocetin or arachidonic acid was not impaired. Therefore, there is at present no evidence of a congenital platelet function defect in the May-Hegglin anomaly. The bleeding time improved temporarily in our patient on administration of DDAVP (Minirin); platelet substitution is indicated in special situations only.

[Malignant non-Hodgkin lymphoma of the stomach (author's transl)]. / Das maligne Nicht-Hodgkin-Lymphom des Magens. Eine morphologische Analyse von 23 primären malignen Lymphomen des Magens mit Einteilung der Tumoren nach der Nomenklatur von Rappaport (1966) und nach der Kieler Nomenklatur (1975).

Between 1970 and 1978 467 malignant non-Hodgkin lymphomas were newly registered by the St. Gallen-Appenzell cancer registry. Among these 23 (4.9%) were primary gastric lymphomas. Among the necropsy material between 1970 and 1978 23 patients (15.6%) were observed with secondary gastric involvement among 147 generalised malignant non-Hodgkin lymphomas. Among the 23 patients whose malignant lymphomas were investigated by use of gastric resection specimens 10 were in clinical stage IE at the time of operation, the other 13 were in stage IIE. Macroscopically there was an uncharacteristic picture of these tumours which were frequently localised in the antrum and ulcerated in most cases. Histologically 19 cases had diffusely growing malignancy. Four tumours showed nodular or follicular structures. Histiocytic and immunoblastic (n = 14 and 13, respectively) forms were the most frequently occurring malignant lymphomas. The diagnosis of malignant lymphoma in biopsy material could only be verified in 4 out of 12 patients investigated preoperatively by gastroscopy. Histological typing of the lymphomas was not possible in most cases. When there is a suspicion of malignant lymphoma macroparticle biopsies should be performed.

[Primary malignant lymphomas of the gastrointestial system]. / Primäre maligne Lymphome des Magen-Darm-Traktes.

In a retrospective analysis of 25 cases of primary non-Hodgkin's lymphoma of the gastrointestinal tract, tumors with diffuse histologic pattern predominated. Among the lymphomas of the small and large bowel there was an increased percentage of tumors of lympho-plasmocytoid type. The course of gastric lymphomas is less favourable than that of intestinal lymphomas. No correlation was found in this study, between histologic type and initial stage on the one hand, and the course of the disease on the other.

Proliferation activity and bacteriostatic potential of human blood monocytes, macrophages in pleural effusions, ascites, and of alveolar macrophages.

Human blood monocytes, macrophages from pleural effusions, ascites, and alveolar macrophages obtained by bronchopulmonary lavage were investigated. The proliferative activity of these cells was determined by the 3H-thymidine labeling index in vitro (3H-TDR L.I.). The bacteriostatic capacity was measured by the potential of the cells to block DNA-synthesis of proliferating Escherichia coli after phagocytosis. In most cases 3H-TDR L.I. of blood monocytes, macrophages from pleural effusions and ascites was less than 1%. However, macrophages of some patients with neoplastic diseases exhibited 3H-TDR L.I. between 4.0--9.6%. This probably reflected the action of factors, possibly lymphokines, which stimulated macrophage proliferation. In contrast, alveolar macrophages seemed to have almost totally lost their proliferative potential. The bacteriostatic capacity of blood monocytes proved to be significantly lower than that of macrophages. This demonstrates the functional immaturity of blood monocytes. In all type of macrophages investigated the bacteriostatic power was very high. No differences could be detected either between macrophages of different sources or between macrophages of benign, inflammatory, or malignant diseases.

[Proliferative activity and bacteriostatic capacity of human alveolar macrophages (proceedings)]. / Proliferationsaktivität und bakteriostatische Kapazität von humanen Alveolarmakrophagen.

Human alveolar macrophages were collected by bronchopulmonary lavage and their proliferation activity and bacteriostatic capacity determined in vitro. Compared with blood monocytes the alveolar macrophages show a higher degree of differentiation with a very high bacteriostatic capacity and no proliferation acitivity. There were no major differences between alveolar macrophages from healthy individuals, heavy smokers and patients with bronchogenic cancer.