[Problems with radiation protection for adjuvant radiotherapy of thyroid cancer]. / Problemy ochrony radiologicznej w izotopowym leczeniu uzupelniajacym raka tarczycy.

Ablative treatment of thyroid cancer with 131I is associated with the exposure to ionizing radiation of not only the target cells but also other cells and organs in the patient's body. Thermoluminescent dosimetry showed that the mean dose equivalent in ovaries equaled to several dozen mSv when the mean therapeutic dose was 2.8 GBq of 131I. In the treated young women the performed ovulation tests revealed no dysfunction of the ovaries. The highest dose equivalent in the clinic staff would not exceed 20 mSv per year. Accordingly, the dose equivalents to the public would not exceed the threshold limit of 1 mSv per year. In order to fulfill the requirements of regulations for disposal of radioactive waste and the necessity to store the waste for as long as 80 days it is obligatory to utilize setting tanks of very large capacity.

[Environmental radiation exposure of a thyroid cancer patient resulting from adjuvant iodine radiotherapy]. / Narazenie radiacyjne otoczenia chorego na raka tarczycy w wyniku uzupelniajacego leczenia jodem promieniotwórczym.

The aim of the study was to evaluate radiation risk in the environment of patients treated with 131I as an ablative therapy following radical surgery for the differentiated thyroid cancer. The activities of radioiodine used in this form of therapy approximate 2.8 GBq (76 mCi) and the in cases of the cancer metastases to other organs may be as high as 7.4 GBq (200 mCi). Dose equivalent rates were estimated in nine seated patients at the level of the thyroid close to the gland surface, and 0.5 and 1 m away from it. The measurements were performed at one, 24, 48, 72, 96, 120, 144, and 168 hours after the injection of 131I. The dose equivalent rates at various distances from the thyroid surface at different times were approximated with the exponential function by the least square method. Then, the dose equivalents were calculated from the moment of 131I application to the moment of the total removal of the isotope from the organism. From this relation, time intervals after which the annual threshold doses of 1, 5, and 50 mSv would be exceeded were computed as the function of the applied 131I activity. The results of the present study indicate that attendants of the patients treated with 131I will not be exposed to the doses of ionising radiation exceeding the acceptable annual thresholds provided with the limited time intervals. In addition, the present results may be useful in elaborating procedures of dealing with and handling the patients during their stay at hospital, at home, and at work.

[Evaluation of the relationship between chosen factors and results of whole body scintigraphy with 131I in patients with differentiated thyroid cancers]. / Ocena zaleznosci wybranych czynników i wyników badan scyntygraficznych calego ciala za pomoca 131I u chorych ze zróznicowanymi rakami tarczycy.

Treatment and diagnostics with 131I play an important role in patients with differentiated thyroid cancer (DTC) after thyreoidectomy. The aim of the study was to assess the influence of some factors on ablative therapy results. Fifty seven patients with DTC were investigated (44 females--mean age 46.6 yrs, 13 males--mean age 55.6 yrs.). Papillary thyroid cancer was diagnosed in forty five patients (79%) however, follicular thyroid cancer in the others (21%). We performed post-therapeutic whole-body scan (WBS) after high fixed doses of 131I (median = 75 mCi) and six months later diagnostic WBS (mean 4.3 mCi) in every patient. Postoperative radioiodine uptake, levels of TSH and thyroglobulin (Tg) serum concentrations were assessed after thyroid hormones withdrawal before imaging. The absence of radioiodine uptake in the thyroid bed (effective ablation) was observed in 64.9% of patients. In other cases scans showed significantly diminished uptake of the tracer in the remnants. Statistically significant difference in TSH levels before and after radioiodine therapy (75.6 vs. 106.7 microIU/ml, p < 0.001) was found in all patients. However, effectiveness of the ablative therapy did not depend on radioiodine uptake, TSH and Tg levels before radioiodine treatment.

[Interleukin-2 in the treatment of malignant melanoma. A case report]. / Interleukin-2 (IL-2) w leczeniu czerniaka zlosliwego. Opis przypadku.

Interleukin-2 is a lymphokine with documented antineoplastic influence, with not completely understood mechanism of action. The case of 46-years old patient with relapsed metastatic malignant melanoma treated with constant-infusion of rIL-2 is described. 9-month remission was achieved. During the course of treatment a lot of side effects including flu-like symptoms, hypotonia, anemia and thrombocytopenia, and also many biochemical disturbances were observed.

Allogeneic bone marrow transplantation from HLA-identical siblings following conditioning with busulfan and cyclophosphamide. First results.

In the time period from November 1984 to January 1987 eight allogeneic bone marrow transplantation were performed from HLA-identical siblings. The theoretical chance of success in this group was between 21 and 50%, according to the recent data of the International Bone Marrow Transplant Registry, depending on the diagnosis and clinical condition. The average chance was 37.5%. Haemopoietic reconstitution was achieved in 6 recipients, while 2 died of early complications (cytostatic induced hepatocellular damage and fungal sepsis). Another 3 patients died of complications of the intermediate period (pulmonary bleeding, virus hepatitis, graft rejection). The remaining 3 recipients are alive, in excellent clinical condition, including one girl surviving more than 2 years after the transplantation.

[Rejection of allogeneic bone marrow transplant. Case report]. / Odrzucenie allogenicznego przeszczepu szpiku. Opis przypadku.

In a patient aged 22 years with acute myeloblastic leukaemia during complete remission an allogenic transplant of bone marrow identical in the HLA antigen range was rejected despite administration before transplantation of a full marrow-ablating dose of busulphan (16 mg/kg) and severe graft-versus-host disease. Graft rejection manifested itself as disappearance of its haemopoietic function which was confirmed during the life and on autopsy. The case deserves attention in view of the rarity of HLA-identical marrow graft rejections in patients treated for leukaemias.

Success of bone marrow transplantation in congenital Diamond-Blackfan anaemia: a case report.

A 6-yr-old girl with congenital corticosteroid-resistant pure red cell aplasia was treated with bone marrow transplant from her HLA-identical, MLC-unreactive sister in November 1984 following conditioning with busulfan and cyclophosphamide. Full engraftment was obtained and the patient at 21 months post-transplant is in excellent clinical condition maintaining normal red cell counts. We conclude that BMT should be considered as a therapy for at least the most severe cases of Diamond-Blackfan anaemia resistant to corticosteroids. Successful outcome of this therapy provides an argument for the stem cell origin of this disorder.

Hemopoiesis in mouse heterozygous for the W trait. Difference in postirradiation recovery related to the defect in formation of transient endogenous spleen colonies.

The hemopoietic regeneration following midlethal irradiation in Wv/+ mice had similarly biphasic kinetics as in their hematologically normal +/+ littermates. The first abortive phase of regeneration was either severely reduced (formation of transient endogenous spleen colonies, reticulocyte count, granulocyte count) or absent (spleen and femur cellularity, platelet count, PCV) in Wv/+ mice, when compared to +/+ mice. The second phase leading to permanent recovery of hemopoiesis was in Wv/+ mice delayed in time. Moreover, although to a lesser extent the values of spleen and femur cellularity, PCV and platelet count were decreased in Wv/+ mice. Postirradiation bleeding, which stimulated particularly the 1st phase of regeneration both in Wv/+ and +/+ mice did not lead to the minimization of differences between above two genotypes. It is suggested that the observed differences in the abortive regeneration between Wv/+ and +/+ mice are primarily dependent on the presence in Wv/+ mice of selective defect of transient endogenous colony forming units (TE-CFUs). Moreover, it is possible that the differences in the second phase of regeneration leading to permanent recovery are secondarily dependent on the TE-CFUs defect, as most probably the TE-CFU is the step in stem cell differentiation to mature cells.

Changes in peripheral blood composition following single and repeated courses of intermittent cancer chemotherapy.

In fifteen patients treated for lung cancer with a combination of vincristine (VCR) (2 x 0.325 mg/kg), amethopterin (MTX) (3 x 0.4 mg/kg) and cyclophosphamide (CY) (30-50 mg/kg) at monthly intervals the peripheral blood parameters were determined every 2-4 days. The values of these parameters including neutrophils, lymphocytes, platelets, erythrocytes and reticulocytes decreased uniformly reaching the lowest level about the 11th day post each course of chemotherapy. Subsequently, by the 17th day, the values of all these parameters except the red cell count returned to the pretreatment levels. The only parameter whose nadir value was associated with known risk to the health was the absolute neutrophil count. The period of dangerous decrease of this count began on the 6th day and ended approximately on the 17th day after cyclophosphamide infusion. Repeated courses had no additive toxicity since the time interval between courses allowed for hematopoietic recovery. However, the gradual decrease in the red cell count was observed during intermittent chemotherapy.

Modified megathrombocyte index in the diagnosis of thrombopoiesis injury produced by cancer chemotherapy.

The border-line separating the normal platelet from the megathrombocyte was lowered from 2.5 microns, classically used, to 2 microns. This modification allowed more precise definition of normal frequency of megathrombocytes among platelets (megathrombocyte index--MI) which was 10-35%. The modified MI determination demonstrated the same kinetics of changes following the intensive cancer chemotherapy as the classical one and, moreover, enabled individual diagnosis of thrombopoiesis perturbation induced by chemotherapy which was not possible with the classical MI.

Treatment with antitheta serum affects hemopoietic stem cell HSC proliferation in an in vivo culture system.

Marrow cells from normal WBB6F1 +/+ mice were treated in vitro with either anti-Thy 1.2 serum and complement (C') or normal mouse serum (NMS) and C' and then they were cultured in diffusion chambers implanted into peritoneal cavity of Balb/c mice. Following 1-19 days of culture, chamber contents were injected into W/Wv mice to test for either the capacity to form spleen colonies or to cure the W/Wv anemia. In contrast to NMS-treated marrow, anti-Thy 1.2 serum treated marrow hemopoietic stem cells almost completely failed to proliferate in this system. Number of cells per chamber upon termination of culture was less affected.

Critical evaluation of the usefulness of different reticulocyte parameters in monitoring the erythropoiesis reaction to cancer chemotherapy.

Eighteen patients with various solid tumors were treated with combination of vincristine and 30-50 mg/kg of cyclophosphamide. Prior therapy and in 1-3 day intervals these patients had determined in peripheral bloods: frequency of reticulocytes (%R), absolute reticulocyte count (ARC), corrected reticulocyte count (CRC), reticulocyte production index (RPI) and hematocrit (Ht). These studies have shown that the impairment of reticulocyte production is earlier diagnosed by RPI than ARC and CRC, and finally by %R. On the other hand, %R was the parameter which allowed for the earliest detection of the beginning of recovery post chemotherapy. It is concluded that the RPI is the parameter of choice for detecting the impairment of erythropoiesis during evaluation of new drugs and protocols of cancer chemotherapy.

Aplastic anaemia with marrow defective in formation of fibroblastoid cell colonies in vitro.

The formation of fibroblastoid colonies by marrow cells in vitro has been used as a putative assay for a stem cell of haemopoietic stroma. Bone marrow from one patient with aplastic anaemic did not form any of these colonies, while its growth in diffusion chambers as an indirect measure of a haemopoietic stem cell was even better than normal. On the other hand, marrow from the other aplastic patient showed only quantitative decrease in the formation of fibroblastoid colonies and simultaneously grew very poorly in diffusion chambers. These patients were indistinguishable by the cytological examination of their marrow, however, the peripheral blood abnormalities were expressed less severely in the first patient. These results suggest the contribution of the defect in marrow cells, which form fibroblastoid colonies in vitro to the development of aplastic anaemia in these patients.

Antitheta immunization affects hemopoietic colony growth in a theta-incompatible mouse system.

Seeking a system with which to study the antitheta-sensitive regulatory cell (TSRC), other than the W/Wv anemic mouse, we tested a model which utilizes mouse strains differing almost exclusively in theta allotype. AKR/FuRd Thy 1.1 mice were immunized against CBA Thy 1.2 mouse thymocytes to produce antibody. The immunized mice were lethally irradiated and grafted with marrow cells from AKR/Cum Thy 1.2 mice. It was reasoned that in this situation antitheta-sensitive cells present in or produced by the graft will be destroyed, while theta-incompatible host cells may not be as capable of collaboration with the graft stem cells as are the graft's theta-compatible cells. Anti-Thy 1.2 immunization did not influence the number of spleen colonies formed by marrow from Thy 1.2 mice; but the colonies formed, especially the erythropoietic colonies, were reduced in size. Also, both the relative and absolute frequencies of erythropoietic colonies were decreased, while those of granulopoietic colonies were increased. Therefore, the destruction of antitheta-sensitive cells in this system resulted in decreased effectiveness of spleen colony growth and altered the differentiation pattern of colony-forming cells. These effects were not observed in control groups immunized with CBA tissues not bearing the Thy 1.2 antigen. This study further stresses the importance of the theta antigen in hemopoietic differentiation and may provide an alternative in vivo model for studying the TSRC.