Jaundice caused by a clinically undetectable T-cell lymphoma infiltrating the sphincter of Oddi.

Malignant lymphoma rarely presents with jaundice. We describe a patient who had a unique etiology for painless jaundice, dilated ducts, and a normal ampulla of Vater. A Whipple's procedure was performed for the suspicion of pancreatic cancer, and initial pathological review detected only mild focal chronic pancreatitis. Seven months later, the patient developed ascites, retroperitoneal mass, and splenomegaly caused by a T-cell lymphoma. Reevaluation of the Whipple's specimen revealed previously unrecognized microscopic infiltration and fibrosis of the sphincter of Oddi by atypical T-lymphocytes. Obstructive jaundice caused by a clinically undetectable primary duodenal T-cell lymphoma has not been previously reported and is contrasted with other causes of jaundice associated with malignant lymphoma and ampullary lesions.

Anti-Yo positive paraneoplastic cerebellar degeneration associated with ovarian carcinoma: case report and review of the literature.

Paraneoplastic cerebellar degeneration (PCD) is a rare nonmetastatic neurological complication in cancer patients. Anti-Yo is one of the anti-onconeural antibodies found in PCD patients. It is believed that anti-Yo occurs almost always in women and is most likely associated with gynecologic or breast cancers, although exceptions exist. Here we report a PCD patient with ovarian cancer having high-titer anti-Yo. The acute onset of her PCD symptoms mimicked that of a stroke. Her ovarian cancer tissue contained abundant plasma cells and lymphocytes. After a thorough review of the literature, we propose a schematic hypothesis for the autoimmune pathogenesis of PCD. Despite anecdotal case reports of neurological improvement with different combinations of treatment, including IVIg, there is still no definitely effective treatment for PCD. Further research on the pathogenesis of PCD may lead to more effective therapies.

Mobilization of peripheral blood stem cells with docetaxel and cyclophosphamide (CY) in patients with metastatic breast cancer: a randomized trial of 3 vs 4 g/m2 of CY.

The purpose of this study was to develop a regimen of docetaxel, cyclophosphamide (CY) and filgrastim for mobilization of peripheral blood stem cells (PBSC) in patients with metastatic breast cancer (n = 66). A phase I trial of CY 2, 3 or 4 g/m2 with docetaxel 100 mg/m2, in consecutive cohorts of four patients each, did not reveal any dose-limiting toxicities and subsequent patients were randomized to receive 3 or 4 g/m2 of CY. The median yield of CD34+ cells from all patients was 11.06x10(6)/kg (range, 0.03-84.77) from a median of two aphereses (range, 1-7); 6.52x10(6) CD34+ cells/kg/apheresis (range, 0.01-52.07). Target CD34+ cell doses > or =2.5 and > or =5.0x10(6)/kg were achieved in 89% and 79%, respectively. There were no statistically significant differences in CD34+ cell yields or target CD34+ cell doses achieved following 3 or 4 g/m2 of CY. Patients with only one prior chemotherapy regimen yielded a median of 12.82x10(6) CD34+ cells/kg/apheresis compared to 5.85 for those receiving > or =2 regimens (P = 0.03). It was concluded that the combination of docetaxel, 100 mg/m2, CY 3 g/m2 without mesna could be administered with acceptable toxicity with collection of adequate quantities of PBSC from the majority of patients.

Cefotetan-induced hemolytic anemia causing severe hypophosphatemia.

Phosphorus is a major component of proteins, phospholipids, and nucleotides. The increased uptake of phosphorus by cells during erythropoiesis can result in severe hypophosphatemia. A case of severe hypophosphatemia due to accelerated erythropoiesis in response to Cefotetan-induced hemolytic anemia is described. The hypophosphatemia seen during hemolysis may be the result, rather than the cause, of the hemolysis.

Phase II study of chlorozotocin in malignant melanoma: a Southeastern Cancer Study Group report.

Seventy-nine patients with metastatic melanoma received chlorozotocin (150 mg/m2) every 6 weeks. Two complete and five partial responses were observed: 18% in patients who had not previously received chemotherapy and 6% in previously drug-resistant patients. Dose-limiting toxic effects were vomiting and myelosuppression.

Chemotherapy of advanced prostatic cancer with adriamycin, BCNU, and cyclophosphamide.

A phase II trial of Adriamycin, BCNU, and cyclophosphamide was performed in 29 patients with advanced prostatic carcinoma (Southeastern Cancer Study Group protocol SEG 76 PR 0102P). Therapy consisted of BCNU 100 mg/m2, plus cyclophosphamide, 300 mg/m2 i.v., on day 1, followed by Adriamycin, 30 mg/m2 i.v., on day 2. Therapy was repeated every four weeks. In 27 evaluable patients refractory to prior estrogen therapy, one patient had a complete response, six patients had partial responses, and two patients had objective improvement (complete plus partial response rate 26%, and overall response rate 33%). Responders had a median time to progression of disease of 5.5 months, compared with a median time to progression of 4.0 months for those patients with stable disease. The median survival of responders was 9.3 months, compared with 6.7 months for stable disease and 3.9 months for patients with progression. Patients with higher pretreatment performance status did not have higher response rates. No life-threatening toxicity was observed. Only five patients had nadir platelet counts below 50,000/mm3, and only six patients had nadir granulocyte counts below 750/mm3. This regimen palliates the effects of hormone-resistant metastatic prostatic carcinoma.

Implementation of adjuvant therapy for breast cancer in the St. Louis Metropolitan area: 1976-1977.

In order to determine the extent of implementation of adjuvant chemotherapy for stage II carcinoma of the breast in the St. Louis area, records of all patients with stage II carcinoma of the breast treated with standard or modified radical mastectomy in five different St. Louis hospitals were reviewed. Between July 1, 1976, and July 1, 1977 (17 months after publication of preliminary L-PAM results and 4 months after publication of preliminary L-PAM results and 4 months after publication of preliminary CMF results), 73% of 24 premenopausal patients and 55% of 58 postmenopausal patients received adjuvant chemotherapy. Ten percent of premenopausal and 31% of postmenopausal patients received therapy other than CMF or L-PAM. Compared to premenopausal patients in university-affiliated hospitals, premenopausal patients in community hospitals tended to receive radiation therapy more commonly and chemotherapy alone less often (P < 0.1). Compared to postmenopausal patients in university-affiliated hospitals, postmenopausal patients in community hospitals more commonly received chemotherapy alone, and less often received no adjuvant therapy (P < 0.05). We conclude that results of adjuvant chemotherapy trials can be rapidly implemented into standard practice both in university-affiliated and community hospitals. Since 12 of 52 patients receiving adjuvant chemotherapy in fact received nonstandard, unpublished regimens, improvements in phase IV drug development may be required to prevent potentially deleterious modifications of published recommendations.

Influenza immunization of adult patients with malignant diseases.

To characterize the immunogenicity of influenza vaccine in patients with malignant disease, 21 patients with lymphoreticular neoplasms and 21 patients with solid tumors were immunized with inactivated influenza A/New Jersey/76 whole virus vaccine. The patients were randomized with respect to time of vaccine administration in relation to administration of chemotherapy. Fourfold or greater antibody titer increases occurred in 94% of controls and 71% of cancer patients (P less than 0.05), and the magnitude of antibody response was also significantly lower in cancer patients (P less than 0.01). There was no correlation of antibody responsiveness with sex, age, tumor type, absolute lymphocyte count, disease status, or type of chemotherapeutic agent used. Fifty percent of patients immunized at the time of chemotherapy administration showed seroconversion, which is significantly less than the 93% response rate observed in patients immunized between chemotherapy courses. It is thus recommended that individuals with malignant disease should receive influenza immunization between chemotherapy courses.

Adriamycin, 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU, NSC 409962) and cyclophosphamide therapy of drug-resistant metastatic breast carcinoma.

Thirty-two evaluable patients with metastatic carcinoma of the breast received chemotherapy consisting of BCNU plus cyclophosphamide followed in 18 hours by Adriamycin. Treatments were repeated every 4 weeks. Complete or partial responses were observed in 14 patients (43.7%) and in 12 of 27 drug-resistant patients (44.4%). An additional 26% of patients had objective improvement, for an overall objective response rate of 70.4% in drug-resistant patients. Skin, lymph node, and soft tissue metastases more frequently responded to therapy, while hepatic, peritoneal, and osseous metastases responded with an intermediate frequency. Pulmonary, pleural, and central nervous system metastases did not respond to therapy. The median duration of complete and partial responses was 6.8 months, and the median survival of these patients was 9.6 months. Overall, the median survival of all patients in this study was 6.5 months. The dose-limiting toxicity was myelosuppression, particularly granulocytopenia. Congestive heart failure and stomatitis were rare. This combination of drugs is a reasonably well-tolerated regimen for treating advanced breast carcinoma in an ambulatory setting, and produces a high rate of objective antitumor response of moderate duration.