Combination of ABVD and radiotherapy in early stages of Hodgkin's disease: analysis of a series of 94 patients. Pierre and Marie Curie Group (GPMC).

In order to reduce, if not completely suppress, late complications of combined chemotherapy and radiotherapy in Hodgkin's disease (HD), MOPP regimen (mechlorethamine, vincristine, procarbazine and prednisone) was replaced by ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine). Ninety-four patients with HD clinical stages I to IIIA with no staging laparotomy were treated by three courses of ABVD followed by radiotherapy. Irradiation was performed on extended fields in 41 cases and on involved fields in 53 others. Consolidation chemotherapy was planned in 67 cases with at least one unfavorable prognostic factor, but achieved only in 33 cases. Seventeen patients relapsed within 1 to 46 months after the beginning of treatment. Ten patients died, 7 of HD and 3 of intercurrent diseases or accident. Disease-free survival rate with a median follow-up of 60 months is 80%. This study showed, on the one hand, many digestive and general side-effects after ABVD and, on the other, a satisfactory hematological tolerance. Furthermore, mediastinitis or cardiovascular complications were not more frequent than with MOPP. These results point out the development and use of better tolerated regimens for initial chemotherapy in HD, without jeopardizing the good results of the treatment.

Refractory anemia with excess of blasts in transformation. Clinical, hematologic, and cytogenetic findings in nine patients.

Clinical, hematologic, and cytogenetic data of nine patients with refractory anemia with excess of blasts in transformation (RAEB-t), classified according to the French-American-British Cooperative Group for myelodysplastic syndrome (MDS), are reported. At diagnosis, eight out of nine cases, had chromosomal abnormalities and three out of nine developed acute leukemia. Karyotype studies allowed individualization of two groups of patients: five with nonrandom major karyotype abnormalities (MAKA) including hypodiploidy, chromosomes 5 and 7 involvement, at least four other abnormalities, and a poor prognosis (survival always under 3.5 months); and four patients with either normal karyotypes or minor karyotype abnormalities (MIKA) (no more than three abnormalities) and a better prognosis (survival from 14 to 38 months). Karyotype appears to be a major prognostic factor among RAEB-t.

Translocation 1;7 in preleukemic states.

A translocation t(1;7) interpreted as t(1;7)(p11;p11) was first reported by Scheres et al. in eight patients with various hematologic disorders. The karyotype of the abnormal cells was trisomic for 1q and monosomic for 7q. Those investigators reported having found four other cases in the literature. We report herein studies of two patients with the same t(1;7).

Hematologic and cytogenetic study of two cases of acute leukemia associated with breast cancer.

The authors present two cases of patients with breast cancer with lymph node extension and who both had surgery. As a pancytopenia with hypercellular bone marrow was discovered at the same time in the first patient, she received no complementary treatment; 4 months later, she presented with an acute lymphocytic leukemia (ALL) for which a remission was easily induced, but she died of a pulmonary infection. The second patient received local radiotherapy (50 grays) and adjuvant chemotherapy (Alkeran for 26 months). Forty-seven months after the diagnosis of breast cancer and 16 months after the end of the treatment, an acute nonlymphoblastic leukemia (ANLL; M6) was diagnosed after 8 months of a preleukemic state. Treatment did not produce any results and death occurred on the 17th day. Cytogenetic studies on the bone marrow cells of both patients were performed. In the first patient in the ALL phase normal cells coexisted with a 47 chromosome clone, the extra chromosome being a D (+ 13?). In the second patient, several karyotype abnormalities were already present in the preleukemic state and also during the acute leukemic phase. No normal mitoses were found; hypodiploidy was present as well as major abnormalities such as markers, rings, and, among others, the systematic loss of a #5 and a #7. The first patient seems to have presented with a de novo ALL, associated with the malignant tumor; whereas, the second patient showed all the characteristics of an induced ANLL. The clinical, hematologic, and cytogenetic characteristics of these two patients are analyzed and compared to those of other cases in the literature.

Cytogenetic studies in twelve patients with primary myelofibrosis and myeloid metaplasia.

Chromosome studies on bone marrow and/or peripheral blood cells without phytohemagglutinin were performed on 12 patients with primary myelofibrosis with myeloid meta-plasia (PMMM) between 1980 and 1984. Abnormal clones were found in six patients (50%). In five cases the abnormal clone involved the long arm of chromosome #7, two of which also had partial trisomy of chromosome #1 and trisomy of 9. Additional abnormalities involving chromosomes #3, #5, #11, #13, #15, and #21 were each found once. Review of the literature showed few studies on the cytogenetics of PMMM. No specific chromosomal pattern can be established; however, abnormalities described are nonrandom.

[Relationship between blood zinc level and EEG changes under the influence of hyperpnea in normal subjects]. / Relations entre le traux du zinc sanguin et les modifications de l'E.E.G. sous l'influence de l'hyperpnée chez l'homme normal.

The red blood cell and serum zinc levels have been determined by atomic absorption spectrophotometry on 27 human subjects in apparent good state of health, tested monthly for five months successively. The subjects who present a decreased frequency of the E.E.G. pattern during hyperventilation, also show a diminished red blood cell Zn level, by comparison with the other subjects. This phenomenon suggests a possible relationship between red blood cell zinc concentration and E.E.G. signs of cortical hyperexcitability. These findings are discussed in the light of the recent literature.

[Complications after perhexiline maleate and amiodarone chlorhydrate treatment in a same patient: hypoglycemia, polyneuritis and hyperthyroidism (author's transl)]. / Complications du maléate de perhexiline et du chlorhydrate d'amiodarone chez le même sujet: hypoglycémie, polynévrite et hyperthyroïdie.

The authors report the case of a 65 year old man treated with amiodarone chlorhydrate since 4 years and perhexiline maleate since 15 months, admitted for constitutional symptoms with fever, neurologic troubles particularly polyneuritis and pronounced hypoglycemia. A diagnostic of hyperthyroidism was made and attributed to amiodarone. The hypoglycemia and the polyneuritis were related to perhexiline maleate as other signs presented by the patient. All the symptoms disappeared after discontinuation of the drugs. The complications secondary to maleate perhexiline administration are reviewed.

[Comparative trial between two drugs in the treatment of vomiting induced by anti-cancer chemotherapy (author's transl)]. / Essai comparatif de deux médicaments dans le traitement des vomissements induits par la chimiothérapie anti-cancéreuse.

In order to prevent vomiting induced by anti-cancer chemotherapy, the efficiency of domperidone has been compared to metoclopramide in a randomised trial. No difference has been observed between both emetic treatments.

[Monoclonal paraproteins other than in Kahler's and Waldenström's diseases. Apropos of 67 cases]. / Les paraprotéines monoclonales en dehors des maladies de Kahler et de Waldenström. A propos de 67 observations.

On the basis of 67 cases of patients suffering from monoclonal dysglobulinaemias other than multiple myeoloma and Waldenström's disease, the authors report the characteristics of their series. The review current diagnostic criteria and, in this context, present their experience of caryotypic determination which was carried out in 24 subjects. These dysglobulinaemias may occur in isolation, on a familial basis or in association with some other pathology, which leads to the suggestion of a number of aetiopathogenic hypotheses, which are probably interlinked.

[Headache following intrathecal therapy in acute leukemia: trial of tiapride as a symptomatic treatment (author's transl)]. / Traitement des céphalées secondaires à l'injection intra-rachidienne d'antimitotiques.

11 patients experienced 40 intrathecal injections of cytotoxic drugs during the treatment of acute leukemia. Tiapride was used as a preventive or curative therapy for headache. Results were found excellent or good in 70% of cases. Frequency and intensity of headache were reduced by half. Tiapride seems more effective in early headache than in cephalalgia occuring later.

[The treatment of acute myeloblastic leukemia in the elderly patients (author's transl)]. / Traitement des leucémies aiguës myéloblastiques chez les sujets âgés.

Thirty eight patients over 60 years with acute myeloblastic leukemia are studied. 16 p. cent (3 out 19) of the patients 60--69 year-old and 42 p. cent (8 out 19) over 70 died before any treatment or effective chemotherapy. Among the patients who received and effective chemotherapy, 48 p. cent responded and 7 complete remissions were obtained. The rate of responders is lower in oldest patients; nevertheless when a response whether complete or partial is observed, the survival of responders is dramatically improved. This invites to treat with effective chemotherapies every patients suffering from acute myeloblastic leukemia in the elderly. However, the comfort and the quality of survival must not be omitted.

[Hematologic and cytogenetic study of 7 cases of preleukemic state or acute leukemia following the treatment of a first malignancy]. / Etude hématologique et cytogénétique de sept cas d'état préleucémique ou de leucémie aiguë secondaire au traitement d'une première affection maligne.

The authors present 7 cases of preleukemic state and/or acute leukemia following the treatment of a first malignancy (3 malignant lymphomas, 3 epithelial cancers and one polycythemia vera). A preleukemic state was found in all patients. In 6 cases it was followed by an acute non-lymphoblastic leukemia which was rapidly fatal; in one case, death occurred during the preleukemic phase. A karyotype was prepared during the preleukemic phase in 6 out of 7 patients and in 4 out of 6 during the leukemia. Karyotypes prepared during the preleukemic state presented at least one of the abnormalities which are characteristic of secondary hematopoietic disorders: -5/5q; -7/7q; involvement of 17. The same major clone was found in 3 of the 6 patients who were karyotyped during the acute leukemic phase. These karyotype abnormalities are not only characteristic of secondary acute leukemias but also of secondary dysmyelopoietic syndromes.

[Abnormality of chromosome number 1 in 3 cases of acute transformation of chronic myeloid leukemia]. / Anomalies du chromosome no 1 dans trois cas de transformation aiguë de leucémie myéloïde chronique.

The authors report three cases of Ph1-positive chronic myelogenous leukemia (CML) with chromosome no 1 abnormalities. Such abnormalities have seldom been reported: three cases out of 42 in blast crisis and none of the 70 patients in the chronic phase in our series. In case no 1 a translocation: (t(1q;14q) was noted. In case no 2 the rearrangement was more complex: partial duplication of the long arm of chromosome no 1 and presence of a 21q+ corresponding to chromosome no 21 on which a part of the long arm of chromosome no 1 was transferred. In case no 3 a double translocation was noted between chromosomes no 1 and no 11, involving either the p or q arm. A review of the literature shows that abnormalities of chromosome no 1 are more frequent during the blast crisis that in the chronic phase of CML. Chromosome no 1 abnormalities are found in a number of myeloproliferative syndromes but even more frequently in solid tumors. The rearrangement sites are reviewed by the authors. Such rearrangements of chromosome no 1 may indicate an increased potential of malignancy.

[Acute leukemia associated with breast cancer (author's transl)]. / Leucémie aiguë et cancer du sein.

Two cases of acute leukemia in patients with breast cancer are reported. In the first patient, erythroleukemia occurred three years after breast cancer was treated by mastectomy, followed by local radiotherapy ; complementary chemotherapy (melphalan) has been given for twenty-six months. The second patient had onset of acute lymphoblastic leukemia four months after breast cancer was treated by surgery only. This patient subsequently has complete remission. Both patients died shortly after onset of leukemia. In the first patient, bone marrow cytogenetic studies evidenced major abnormalities at an early stage of the disease, with abnormal mitoses in all the cells, whereas, in the second patient, only minor abnormalities were found. A review of previously published cases of breast cancer with acute leukemia was done. Our findings suggest that the association of leukemia with breast cancer may result from therapy is some cases (secondary induced acute leukemias) while in others it may occur spontaneously.

[Hypertrophic pulmonary osteoarthropathy with paraneoplastic secretion of four hormones. Considerations on pathogenesis (author's transl)]. / Ostéoarthropathie hypertrophiante pneumique associée à une quadruple sécrétion hormonale paranéoplasique. Réflexions pathogéniques.

The case of a patient with small-cell carcinoma of the lung, bone marrow metastases, and hypertrophic pulmonary osteoarthropathy is reported. Normal growth hormone serum concentrations contrasted with significant increases in ACTH, beta-MSH, calcitonin, and gastrin. A hormonal etiology has previously been suggested for hypertrophic pulmonary osteoarthropathy. Our findings indicate that the hormone responsible for hypertrophic pulmonary osteoarthropathy may be an APUD polypeptidic substance, that differs from immunoreactive GH but is related to somatomammotropins.

[Two cases of agnogenic myeloid metaplasia associated with chronic lymphocytic leukemia (author's transl)]. / Association de leucémie lymphoïde chronique et de splénomégalie myéloïde. A propos de deux observations.

Two cases of agnogenic myeloid metaplasia associated with chronic lymphocytic leukemia are reported. Both cases are documented by clinic, bone marrow biopsy, immunologic and isotopic studies. Such observations allow to point out the lymphoproliferative pattern that can be found among any agnogenic myeloid metaplasia. It is suggested that this disease includes a monoclonal lymphoid proliferation which may become the prevailing symptom.