Multiple defects of T helper cell function in newly diagnosed patients with Hodgkin's disease.

T helper cell (TH) function, as assessed by interleukin-2 (IL-2) production and [3H]thymidine incorporation, was studied in 47 newly diagnosed untreated patients with Hodgkin's disease (HD) and 34 healthy controls. Three different stimuli were used to stimulate in vitro peripheral blood mononuclear cells (PBMC): influenza A vaccine (FLU), HLA alloantigens (ALLO) and phytohaemagglutinin (PHA). Four different patterns of TH function were observed in HD patients: (1) IL-2 production in response to all of the stimuli (40%); (2) IL-2 production in response to ALLO and PHA but not to FLU (26%); (3) IL-2 production in response to PHA alone (19%); and (4) failure to respond by IL-2 production to any of the three of the stimuli (15%). Thus, defective in vitro TH function was detected in the majority of these patients (60%). Defective TH function was observed in none of the 34 controls. Severely compromised TH function (patterns 3 and 4) tended to be associated with more advanced clinical presentation and more compromised haematological parameters (P < 0.05). The IL-2 production assay was more sensitive than the proliferative assay as only 30% of the HD patients failed to proliferate in response to FLU, and none failed to proliferate in response to either ALLO or PHA; this assay can detect subtle, multiple patterns of immune dysregulation in untreated HD patients. Our results suggest that HD is associated with a fundamental dysregulation in TH function, illustrate the complexity of such dysregulation, and raise the possibility that HD progression will be associated with a type-1-type-2 switch in immunoregulatory cytokine production.

A phase II trial of ProMACE-CytaBOM in previously untreated non-Hodgkin's lymphoma of intermediate- or high-grade histology.

Between November 1985 and June 1989 the aggressive combination chemotherapy programme ProMACE-CytaBOM was used at a community-based hospital as primary treatment for non-Hodgkin's lymphoma (NHL) of intermediate or high-grade histology in Ann-Arbor stages IB-IV. The 53 patients entering the study represented 90 per cent of all consecutive eligible patients with NHL diagnosed during the time period considered. Their median age was 54 years and median observation time was 36 months. Of 50 patients evaluable for response, 35 (70 per cent) achieved complete remission (CR), seven (14 per cent) partial remission, and five (10 per cent) were refractory. Treatment was given on an outpatient basis. Actually delivered drug doses ranged from 88 per cent to 97 per cent of the theoretical doses. Life-threatening toxicity was experienced by four patients. Treatment was stopped in three cases (6 per cent) because of toxicity and there was one treatment-related death. Actuarial 2-year disease-free survival of patients in CR was 73 per cent. Overall actuarial 3-year survival and disease-free survival were 67 per cent and 51 per cent respectively. High LDH level was a significant adverse prognostic factor both for achievement of CR (P less than 0.005) and for survival (P less than 0.0002). Age was of no prognostic importance. We conclude that ProMACE-CytaBOM is an effective, easy to administer and well-tolerated regimen for patients with aggressive NHL.

[Clinical usefulness of non-invasive automatic monitoring of arterial blood pressure]. / Utilità clinica del monitoraggio automatico non invasivo della pressione arteriosa.

Recently, new devices for ambulatory blood pressure monitoring have been developed, which have become widely used as highly reliable diagnostic tools. It is now necessary to establish the rationale for their use, and to fully elucidate the diagnostic, prognostic and therapeutic advantages for their use in hypertensive patients. Average 24-hour blood pressure is more closely correlated with the degree of structural cardiovascular alterations than casual blood pressure measurements. Non-invasive blood pressure monitoring therefore seems to be more useful, from a prognostic point of view, than traditional, sphygmomanometric measurement. There is some evidence that ambulatory blood pressure monitoring is more reliable than casual measurements in assessing the efficacy of antihypertensive therapy. From a diagnostic point of view, the significance of blood pressure values obtained with these devices, and the most appropriate index to evaluate the 24-hour blood pressure load remain to be clarified. It is necessary to identify new normal limits for monitored blood pressure values i.e. to establish the baseline level for the start of treatment. At present, due to the lack of widely accepted upper limits of monitored blood pressure, the therapeutic decision should be based on casual blood pressure values, obtained with traditional mercury sphygmomanometer.