Bone marrow transplantation following busulfan and cyclophosphamide for acute myelogenous leukemia.

Twenty-five consecutive patients with acute myelogenous leukemia (AML) underwent 26 allogeneic bone marrow transplants at Hahnemann University Hospital. Marrow ablation for all patients consisted of busulfan 16 mg/kg and cyclophosphamide 120 mg/kg (BUCY2). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and methylprednisolone. Seventeen transplants were performed during first remission and the rest during subsequent remission or relapse. All patients engrafted and all but one achieved a complete remission (CR) following a short period of aplasia. Twenty-two of 25 patients are alive. All 17 patients with AML transplanted in first CR are alive and 15 of these patients are in sustained hematologic remission with an estimated 2-year disease free survival of 85%. The estimated 2-year disease free survival is 70% for all patients followed for a median of 622 days (range 134-1533). Acute GVHD of grades 2-4 occurred in 23% of these patients. Toxicities of the regimen including interstitial pneumonitis, veno-occlusive disease (VOD) and hemorrhagic cystitis were minimal. There were no treatment related deaths. These results demonstrate that BUCY2 should be considered as a preparative regimen for allogeneic bone marrow transplantation for patients with AML in first remission.

Effect of extracorporeal photopheresis on selected immunologic parameters in psoriasis vulgaris.

Extracorporeal photopheresis (ExP) was administered every other week in an outpatient setting to four patients with chronic refractory psoriasis vulgaris without arthropathy. The duration of treatment ranged from six to 13 months. Two patients received methotrexate concomitantly during the initial phase of the study. All patients demonstrated a decrease in erythema, induration, and scaling of lesional skin, accompanied by incomplete clearing of lesions such that the percentage of involvement (SI) ranged between 40 to 80 percent of baseline scores. Exacerbations of psoriasis occurred with minor provocations, and two patients who were predisposed to developing epithelial skin neoplasms as a consequence of prior treatments continued to develop tumors during the study interval. Prolonged ExP treatment was otherwise well tolerated, without evidence of toxicity on routine laboratory safety tests or changes in lymphocyte counts. All patients, however, exhibited decreased intradermal skin responses to recall antigens and a decreased capacity of peripheral lymphocytes to produce interleukin 2 (IL-2) in response to polyclonal stimuli in vitro. These observations suggest that the observed anti-inflammatory effect of alternate-week ExP on psoriasis is mediated in part to a direct inhibition of lymphokine production or release by psoralen-ultraviolet-exposed lymphocytes.

Adjuvant chemoimmunotherapy with LMF plus BCG in node-negative and node-positive breast cancer - intermediate report at 4 years.

A randomized surgical adjuvant trial in 242 evaluable patients with T1-3a, N0-1, and M0 breast cancer was initiated 4 years ago. The well-tolerated, oral combination chemotherapy with six cycles of Leukeran plus methotrexate plus fluorouracil (LMF) plus repeated BCG skin scarifications was used. After 4 years, the following results were seen: (1) significant increase of relapse-free (RFS) and also overall survival (S) in both pre- and postmenopausal node-negative patients versus surgical controls (RFS 91.1 vs. 701%, P = 0.003; S 96 vs. 88%, P = 0.03); (2) no significant increase of RFS or S in pre- and postmenopausal node-positive patients versus surgical controls (RFS 50.1 versus 44%, P = 0.49; S 70 versus 68 %, P = 0.9, respectively); (3) Patients receiving greater than 90% of the planned LMF dose showed significantly better survival after 4 years; and (4) Nonrandomized comparison with concurrent Swiss adjuvant studies with LMF alone indicate no beneficial or harmful effect of BCG skin scarifications in addition to the six-cycle LMF.