Results of a randomized phase III trial in children and adolescents with advanced stage diffuse large cell non Hodgkin's lymphoma: a Pediatric Oncology Group study.

The Pediatric Oncology Group (POG) adopted a histology-based approach to the management of pediatric non-Hodgkin's lymphomas (NHL) utilizing the National Cancer Institute Working Formulation for Clinical Usage. Patients with diffuse large cell lymphoma (DLCL) were treated on a separate protocol from small cell diffuse undifferentiated or lymphoblastic lymphomas. This study assessed the overall and event free survival of children with DLCL and determined the effects of cyclophosphamide upon these end-points in a prospective randomized trial. One hundred and twenty eligible stage III or IV NHL patients with the confirmed diagnosis of diffuse large cell or immunoblastic histology were enrolled on study between October 1986 and November 1991. Patients were randomized to receive or not receive cyclophosphamide; 58 received cyclophosphamide, doxorubicin, vincristine, 6-mercaptopurine (6-MP), and prednisone (ACOP+) and 62 were treated with doxorubicin, vincristine, 6-MP, and prednisone (APO). In both treatment programs methotrexate was substituted when the doxorubicin cumulative dose reached 450 mg/m2. Radiation was administered to bulky disease if progression or no response were observed after induction therapy. Planned duration of therapy was 12 months. The 5-year event free survival (EFS) rates of patients treated with ACOP+ versus APO were 62% +/- 7% and 72% +/- 6%, respectively. While there was no statistically significant difference between the two treatment arms (p = 0.28), we can only say that we are 95% confident that the difference in 5-year EFS falls in the wide range from 28% in favor of APO to 8% favoring ACOP+. Marrow suppression was the main toxicity with one fatal infection. There were three other deaths on study due to respiratory failure in patients with mediastinal masses. Only one patient experienced cardiotoxicity requiring discontinuation of doxorubicin. Ten patients received radiation therapy to achieve. In conclusion the efficacy of elimination of cyclophosphamide from the treatment program of children and adolescents with advanced stage diffuse large cell lymphoma was inconclusive as to its effect on EFS. Furthermore, the majority of the patients (92%) did not require any radiation therapy to bulky disease indicating that the chemotherapy regimens are quite efficient for achievement of complete remission.

Use of disinfectants in open-air dairying.

Disinfection systems are essential in providing dairy foods which are safe for consumption by all sectors and age groups of the human population. The New Zealand dairy industry ensures quality competition under International Organisation for Standardisation (ISO) general systems standards (ISO 9002 and ISO Guide 25) and is subject to food safety assurance legislation (Dairy Industry Regulations 1990). This latter regulation requires that safe foods be produced in accordance with Product Safety Programmes approved by the Ministry of Agriculture and Fisheries. Safety can be demonstrated by compliance with the Codes of Practice of the industry. Farm dairy detergents and sanitisers must be approved for use. These disinfection systems are described.

Beneficial effect of brief pre-transfusion incubation of platelets at 37 degrees C.

The effects of brief warming of stored platelet concentrates were assessed in 15 children undergoing transfusion for stable thrombocytopenia due to chemotherapy (n = 13) or aplastic anaemia. Half of a pool of platelet concentrates stored at 22 degrees C was incubated at 37 degrees C for 1 hour and the other half at room temperature. Each patient received one bag of warmed and one of unwarmed cells transfused in random order 2 h apart. Platelet warming improved transfusion efficacy, as assessed on the basis of corrected platelet count increments (CCIs) and platelet morphology. Compared with unwarmed bags, warmed bags had a higher morphology score (p = 0.0001) and a higher CCI (adjusted for the transfusion order) at 1 h (n = 11; p = 0.014) and at 2 h (n = 15, p = 0.006) post transfusion. Thus, with platelets stored at room temperature bags warmed before transfusion to 37 degrees C for 1 h provide a larger number of circulating platelets after transfusion than do unwarmed bags.

Lymphocytic surface markers in lymphoid leukemoid reactions.

Although mononuclear cell surface markers are primarily used to determine the lineage and stage of differentiation of leukemias and lymphomas, they can also be helpful in discriminating between some cases of neoplastic and reactive conditions. Peripheral blood lymphocytosis secondary to infection most often shows increased numbers of activated T cells of the suppressor/cytotoxic subset. A few exceptions, such as in pertussis, show predominantly T-helper cells. Although persistent B-cell lymphocytosis is most often associated with neoplastic conditions, B-cell predominant reactive conditions may also occur. Lack of light chain restrictions on B-cell membranes suggests non-neoplastic disorders. Reactive lymphadenopathy most often shows a predominance of T cells with normal to increased T-helper/T-suppressor cell ratios. In addition, normal ratios of kappa/lambda light chain surface immunoglobulin usually occur on B cells of reactive lymph nodes. Benign lymphocytic infiltrates in skin most often show a predominance of activated T-helper cells. Distinguishing reactive from neoplastic dermal infiltrates by mononuclear cell markers can be extremely difficult and may require DNA genotypic analysis. Mononuclear cell markers applied to bone marrow in patients treated for leukemia and other disorders must also be interpreted with caution. The presence of CD10 antigen (CALLA) may herald recurrence of leukemia; however, this determinant is not leukemia-specific and may be found on normal cells. Similarly, lymphoid cells bearing TdT often represent recurrent leukemia, and they must be differentiated from immature nonmalignant TdT-positive cells. Immunologic surface markers must be interpreted together with a careful review of the morphology of the tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

T6 monoclonal antibody reacts with blasts from cases of common antigen acute lymphocytic leukemia.

The expression of the T6 antigen on malignant lymphoid cells has been considered strong evidence in support of T-cell lineage and thymic stage of differentiation of the neoplastic cells. Thus, the authors have used the T6 monoclonal antibody for the last three years in the immunophenotyping of blasts from 60 consecutive cases of acute lymphocytic leukemia (ALL) and 8 cases of T-cell lymphoma. Blasts from 12 of 46 (26%) cases of common type ALL, 4 of 7 (57%) cases of T-cell ALL, 2 of 3 (66%) cases of lymphoblastic lymphoma, and 1 of 5 (20%) cases of peripheral (postthymic) T-cell lymphoma were positive for the T6 antigen. The authors conclude that the expression of T6 antigen on malignant lymphoid cells may not always indicate T-cell lineage.

Structure of ristocetin A.

Acid hydrolysis of ristocein A yields a number of amino acids of unusual structure. One set of diastereoisomeric pairs has a molecular weight of 362 and an empirical formula of C(17)H(18)N(2)O(7). Mass spectral and nuclear magnetic resonance (NMR) evidence suggest a diphenyl ether with hydroxyl and alpha-amino acid [-CH-(NH(2))COOH] groups on one ring, and methyl, hydroxyl and alpha-amino acid groups on the other ring. Coupling in the NMR and nuclear Overhauser effect experiments favor certain substitution patterns, which are shown. Another set of diastereoisomers seems to be a lower homolog of the previous set, without the aromatic methyl group.