Acute graft-versus-host disease resulting from normal donor blood transfusions.

2 fatal cases of graft-versus-host disease (GvHD) occurred following blood product transfusions given to patients receiving standard chemotherapy for Hodgkin's disease. GvHD was established by HLA typing, clinical course, and compatible skin biopsy. 23 cases of GvHD following transfusion of blood products from normal donors are also reviewed. It should be suspected when fever or rash appear 1-2 weeks after transfusion of unirradiated blood products into a compromised host or when pancytopenia following chemotherapy is prolonged or unexpectedly severe. Prevention of GvHD by irradiation of granulocytes, platelets and packed red blood cells given to immunosuppressed patients is recommended to prevent this often fatal disease.

Phase II study of amonafide in patients with recurrent glioma.

Amonafide, a novel imide derivative with broad preclinical antitumor activity, achieves significant cerebrospinal fluid levels in animal models. In order to test its antitumor activity in patients with recurrent diffuse infiltrative glioma of the astrocytic and oligodendroglial type, we performed a phase II clinical trial. Of the 22 eligible and evaluable patients treated, 2 (9%) experienced tumor regression lasting more than one year. No other patients experienced tumor regression; one remained stable more than six months. Toxicities consisted primarily of myelosuppression, vomiting, and venous irritation at the infusion site. We conclude that amonafide has minimal activity in recurrent glioma patients. Further investigations are not warranted in this study population.

Phase II evaluation of infusional etoposide and cisplatin in patients with recurrent astrocytoma.

The purpose of this study was to determine the efficacy of 24-hour concomitant infusions of etoposide (100 mg/m2/day, days 1-3) and cisplatin (45 mg/m2/day, days 2-3) in the treatment of patients with recurrent astrocytoma. All 36 patients entered on this trial had histologic proof of astrocytoma with CT scan evidence of tumor progression despite prior radiotherapy and nitrosourea chemotherapy. At initial diagnosis, three patients had low-grade astrocytoma, but 33 (92%) had high-grade astrocytomas. ECOG performance score was 0-1 in 20 patients and 2-3 in 16 patients. The median age of all patients was 45.5 years. Dose-limiting toxicity was myelosuppression with median leukocyte and platelet nadirs of 2,150/mcL and 56,500/mcL respectively. One life-threatening infection occurred, but there were no treatment-related deaths. Vomiting occurred in 78% of patients, but was severe in only 6%. Peripheral neuropathy occurred in 28% but was severe in only 6%. Six patients (17%; 1 CR, 5 REGR) responded to therapy with median time to progression of 6.0 months (range 1.5-17.7 months). Five additional patients (14%) remained stable greater than 6 months and 1 has not progressed at 17.0+ months. Median time to progression and survival in all patients were 2.7 and 5.8 months, respectively. In conclusion, etoposide and cisplatin at this dose and schedule have limited activity in the treatment of recurrent high grade astrocytomas, although durable responses or periods of stability occurred in some patients. Considering the extent of myelosuppression, near maximal doses of the drugs were given.