Subject(s)
Aminoglutethimide/therapeutic use , Antineoplastic Agents, Hormonal/therapeutic use , Breast Neoplasms/drug therapy , Medroxyprogesterone/therapeutic use , Neoplasms, Hormone-Dependent/drug therapy , Progesterone Congeners/therapeutic use , Cross-Over Studies , Humans , Neoplasm Metastasis , Quality of LifeABSTRACT
The treatment of relapsing or refractory high-grade malignant non-Hodgkin lymphoma (NHL) following CHOP chemotherapy remains a challenge for the clinician. In this study, 29 patients with relapsing or refractory high- or refractory low-grade malignant NHL received a combination of mitoxantrone 12 mg/m2 i.v. on days 1-2, cytarabine 100 mg/m2 i.v., b.d. d 1-2, etoposide 100 mg/m2 i.v. d 1-3 and prednisone 100 mg/m2 orally d 1-3 (ENAP). An overall response rate of 55% encouraged us to use ENAP alternated with conventional CHOP chemotherapy in 45 previously untreated NHL patients (35 with high-grade and 10 with "aggressive" low-grade malignant NHL). All patients responded with a complete remission rate (CR) of (27%) and a partial remission rate (PR) of 73% after only one course of ENAP. After a median number of 3.5 ENAP/CHOP courses, the CR and PR rate was 69 and 22%, respectively. Myelosuppression was pronounced and fever of unidentified origin and documented infections followed 59% of all cases given ENAP courses. In the last 19 previously untreated patients mitoxantrone was given at a dose of 10 mg/m2 on d 1 and cytarabine 100 mg i.v., b.d. during d 1-2. Nonhematologic toxicity was mild. We conclude that this novel chemotherapy program is effective both as first-line and salvage treatment in patients with high-grade malignant NHL. Furthermore, ENAP appears clinically to be partly non-cross resistant with CHOP chemotherapy. The dose-limiting toxicity is myelosuppression. The combination should be explored as primary therapy in combination with other chemotherapy or radiotherapy programs.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lymphoma, Non-Hodgkin/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cyclophosphamide/adverse effects , Cyclophosphamide/therapeutic use , Cytarabine/administration & dosage , Doxorubicin/adverse effects , Doxorubicin/therapeutic use , Etoposide/administration & dosage , Humans , Leukocyte Count/drug effects , Lymphoma, Non-Hodgkin/pathology , Middle Aged , Mitoxantrone/administration & dosage , Neoplasm Recurrence, Local , Prednisone/administration & dosage , Prednisone/adverse effects , Prednisone/therapeutic use , Remission Induction , Vincristine/adverse effects , Vincristine/therapeutic useABSTRACT
Prednimustine, a new antitumour drug, is a chlorambucil ester of prednisolone. The present prospective randomized study compares the effect of continuous low-dose (B) and intermittent high-dose (C) prednimustine in previously untreated patients with progressive CLL and WDLL. The control group received continuous chlorambucil/prednisolone therapy (A). One hundred and eighteen patients, 88 CLL and 30 WDLL, were evaluable. Response to therapy (greater than 50% improvement) was noted in 61, 55 and 57% in groups A, B and C respectively. The difference was not statistically significant. Time to response, response duration and survival did not show any differences between the groups. Responding patients survived longer than patients with stationary and progressive disease. Median survival time was 72 months from diagnosis and 52 months from start of therapy, with no differences between the treatment groups. Toxicity of prednimustine was usually mild and similar to that of the two constituents. Treatment schedule C showed a slight advantage with regard to frequency of side effects. In conclusion, in this study the therapeutic effect of prednimustine was equal to that of its constituents administrated separately.
Subject(s)
Chlorambucil/analogs & derivatives , Chlorambucil/administration & dosage , Leukemia, Lymphoid/drug therapy , Lymphoma, Non-Hodgkin/drug therapy , Prednimustine/administration & dosage , Prednisolone/administration & dosage , Adult , Aged , Chlorambucil/adverse effects , Drug Administration Schedule , Drug Evaluation , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Prednimustine/adverse effects , Prednisolone/adverse effects , Prospective StudiesSubject(s)
Breast Neoplasms/radiotherapy , Lymphocytes/radiation effects , Breast Neoplasms/immunology , Breast Neoplasms/surgery , Cobalt Radioisotopes , Female , Humans , Leukocyte Count , Lymphocyte Activation , Neoplasm Metastasis , Phytohemagglutinins/immunology , Prognosis , Radioisotope Teletherapy , Tuberculin/immunologySubject(s)
Breast Neoplasms/radiotherapy , Lymphocytes/radiation effects , Adult , Aged , Breast Neoplasms/immunology , Breast Neoplasms/surgery , Female , Humans , Leukocyte Count , Lymph Nodes/radiation effects , Lymphocyte Culture Test, Mixed , Mastectomy , Middle Aged , Phytohemagglutinins/radiation effects , Radiotherapy/adverse effects , T-Lymphocytes/radiation effectsSubject(s)
Breast Neoplasms/immunology , Immunity, Cellular/radiation effects , Lymphocytes/radiation effects , Adult , Aged , Breast Neoplasms/radiotherapy , Female , Humans , Immunosuppression Therapy , In Vitro Techniques , Lymphocyte Culture Test, Mixed , Lymphocytes/immunology , Middle Aged , Monocytes/immunology , Monocytes/radiation effectsABSTRACT
A woman with multiple myeloma relapsed after 6 years of satisfactory tumor control with melphalan therapy. When progression then occurred, she was given exogenous human leukocyte interferon, 3 x 10(6) reference units twice daily i.m., as the sole therapy. Side-effects of the interferon therapy consisted of fever reactions and thrombocytopenia. One month after the initiation of interferon therapy there was 1) improvement of general health with less pain and tiredness, 2) reduction of the M-component, IgG-lambda, in the serum, and 3) a reduced plasma cell concentration in the bone marrow. After 5 months of interferon therapy tumor progression occurred despite continuous interferon treatment. At the same time, the tumor cells were less sensitive to interferon in in vitro tests than prior to interferon therapy. It is suggested that interferon therapy should be given as initial treatment to a few patients with multiple myeloma in a phase I trial.
Subject(s)
Interferons/therapeutic use , Multiple Myeloma/drug therapy , Aged , Bone Marrow/pathology , Bone Marrow Examination , Cell Count , Cells, Cultured , Drug Evaluation , Drug Resistance , Female , Fever/chemically induced , Hemoglobins/analysis , Humans , Immunoglobulin G/analysis , Immunoglobulin lambda-Chains/analysis , Interferons/adverse effects , Melphalan/therapeutic use , Neoplasm Recurrence, Local , Thrombocytopenia/chemically inducedABSTRACT
The extent of radiation induced immune suppression was analysed in 100 patients with carcinoma of the breast. The relative changes of lymphocyte counts and stimulations by PHA and PPD were similar in patients who differed with regard to age, size of tumour and its malignancy grade or axillary node condition. Moreover, no difference in the degree of radiation induced immune suppression existed between patients who developed recurrent disease and those who remained free of disease during a follow-up period of 4 1/2 to 7 years.