Subacute toxicity of paraquat in beagle dogs: clinicopathology and pathologic examinations

Beagle dogs were allocated to 4 groups, each consisting of 3 males and 3 females, which received 0.055, 0.165 or 0.495 mg paraquat (PQ)/kg/day sc for 4 w to investigate subacute toxicity. Recovery 4 and 8 w postadministration was studied. In the early stage there was vomiting, decreased activity and undernourishment. Induration and ulcers at the injection sites were seen. The group receiving 0.495 mg PQ/kg had reduced food ingestion and occasional decreases in water consumption until the end of the 4-w injection period. Three animals in the 0.495 mg PQ/kg group were sacrificed in the moribund stage with marked decreases in body weight. Ophthalmologic examination at 4 w of recovery detected hemorrhage around the nasalis vein of the left fundus in 1 animal that received 0.495 mg PQ/kg. No abnormal changes in electrocardiography (ECG) were noted throughout the experimental period. Slightly increased urinary protein, reticulocyte counts, and fibrinogen were observed in a few animals in each group. A few animals that received 0.165 or 0.495 mg PQ/kg had increased phospholipid, blood urea nitrogen, and creatine phosphokinase. The lungs of the moribundly sacrificed animals had moderate atelectasis, localized atelectasis, moderate thickening of alveolar wall and pleura, proliferation of fibroblast-like cells, and abundant fibers in interstitium and alveoli. In the liver there was slight hemorrhage along the gallbladder. On electron microscopy of the lung, proliferation of fibroblasts, myofibroblasts and type II alveolar cells, and some mast cells were observed in thickened alveolar walls. Abundant collagen fibers, destroyed cell debris and mitotic figures of spindle-shaped fibroblasts were also observed in the dilated interstitium.(ABSTRACT TRUNCATED AT 250 WORDS)

The hemostatic effect of deacetylated chitin membrane on peritoneal injury in rabbit model

In this study, we determined the effect of 80% deacetylated chitin (DAC-80) membrane on postsurgical bleeding after visceral and parietal peritoneal abrasion. Japanese white rabbits underwent a midline laparotomy followed either by a bilateral peritoneal sidewall abrasion (4 x 4 cm) or an abrasion of liver surface (3 x 2 cm). The injured surface was then covered with a 0.2 mm thick DAC-80 membrane. On postsurgical day 2, the rabbits were sacrificed and the amounts of postsurgical bleeding was determined by quantitating the number of red blood cells recovered in 50 ml peritoneal lavage fluid. The DAC-80 membrane was found to reduce postsurgical bleeding after the abrasion of liver surface (treated with DAC-80 membrane: 2.9 +/- 0.8; control: 24.6 +/- 5.9 x 10(8) cells/peritoneal cavity, P less than 0.005). This same hemostatic activity was not observed after application in the peritoneal sidewall abrasion model. We also measured plasminogen activator activity (PA) and urokinase inhibitory (PAI) activity in the spent culture media of macrophages recovered from the postsurgical peritoneal exudate. The DAC-80 membrane reduced the PA secretion from postsurgical macrophages after liver surface abrasion (treated with DAC-80: 2.8 +/- 0.7; control: 3.9 +/- 0.9 mPU/ml). The DAC-80 membrane also showed similar effects on PA secretion after peritoneal sidewall abrasion. No significant effects were found in the secretion of PAI by postsurgical macrophages in both surgical models. These findings suggest that the DAC-80 membrane may have hemostatic activity through the modulation of fibrinolytic activity of peritoneal exudative macrophages.

[Application of the Nd-YAG laser for surgical resection of pulmonary metastases]

We used Nd-YAG laser equipment for operations on pulmonary metastatic tumors in order to preserve the residual pulmonary functions simultaneously with local curability by utilizing the features of the contact and non-contact types of equipment. The subjects were patients showing no lymph node metastasis in the preoperative diagnosis. The equipment used was Nd-YAG laser model 6,000 with a surgical probe and contact tip attached. Thoracotomy was performed by a method involving minimum invasion in accordance with the tumor localization to prevent reduction of the postoperative respiratory function as much as possible. An incision was made in the pleura and lung using the contact tip with an output of about 25 Watts with the surgical margin separated sufficiently from the tumor, and the tumor was resected. Coagulative hemostasis was apt to occur in the small vessels. To eliminate postoperative hemostasis and residual tumors, non-contact type irradiation was performed at the surgical margin at an output of about 50-70 Watts. Finally, the pleura were sutured. This method has been used so far on 10 cases of pulmonary metastatic tumors, and in all cases, the amount of hemorrhaging during the operation was small, the operating time was short and the postoperative reduction in respiratory function was slight. In cases of bilateral multiple pulmonary metastases, as many as 30 resections were performed, but no recurrences have been seen in any of the cases to date. Although the usefulness of this method still cannot be confirmed because of the small number of cases involved, this method seems promising from the standpoints of local curability and preservation of pulmonary functions.

[A study of combination chemotherapy (BHAC-ACVP) for adult acute lymphocytic leukemia. Hanshin Co-operative Study Group of Hematological Malignancies]

Twenty-nine adult patients with acute lymphocytic leukemia (ALL) were treated with combination chemotherapy consisting of behenoyl-ara-C, adriamycin, cyclophosphamide, vindesine and prednisolone (BHAC-ACVP regimen). Complete remission (CR) was obtained in 7 of 13 (54%) of the previously untreated, and 4 of 16 (25%) of the previously treated patients. Six of 10 (60%) L1 and 5 of 17 (29%) L2 patients achieved CR. Side effects such as nausea, GPT elevation and fever were observed, but these were not severe in most cases. The result indicates that BH-AC is useful for the treatment of adult patients with ALL.

Effects of azamethiphos, an organophosphorus insecticide, on serum cholinesterase activity and isoenzymes in the rat

The inhibitory effect of azamethiphos (Az), an organophosphorus insecticide, was detected in both the serum cholinesterase (ChE) activity and the ChE isoenzyme concentration in male Wistar rats. In our highest Az dosage group (270 mg/kg), following a single po administration, the serum ChE activity was significantly inhibited at 6 and 24 h post-Az administration. Five days after Az treatment, the ChE activity was still inhibited, but the observed difference was not statistically significant. The ChE activity increased to levels comparable to the control group by day 10. For the other Az-dosed groups, the ChE activities were inhibited only 6 h following administration. The serum ChE isoenzymes for all Az-dosed and control groups had 6 bands, indicating that Az did not effect the number of isoenzyme bands, indicating that Az did not effect the number of isoenzyme bands. However, Az had a significant effect on the ratios of the concentrations of these isoenzyme bands. The ratio of the main ChE isoenzyme bands (bands 5 and 6) was band 6 greater than band 5 for the young control group. As our control group aged, this ratio was reversed, with band 5 greater than band 6. For the highest Az dosage group (270 mg/kg), the ChE isoenzyme band ratio was band 5 greater than band 6 6 h after Az dosing. This proportion of band 6 decreased in parallel with an increase in band 5 during our 30-d experimental period. A correlation between the total ChE activity and ChE isoenzyme band 6 was found.

[Early phase II study of MST-16 (sobuzoxane) on malignant lymphoma]

Early phase II study of MST-16[4,4-(1,2-ethanediyl) bis (1-isobutoxycarbonyloxy-methyl-2, 6-piperazinedione], a derivative of ICRF-154, on malignant lymphoma was conducted by multi-institutional cooperative group. MST-16 was administered orally at doses of 1,600 mg/body/day for 5 days or 1,200 mg/body/day for 10-14 days, mainly. The number of registered and evaluated patients were 29 and 28, respectively (Hodgkin's disease 3 patients and non-Hodgkin lymphoma 25). Twenty-seven of 28 patients had received prior chemotherapy and/or radiation therapy. Of 28 evaluable patients, overall response rate (CR + PR) was 32.1%. In high-dose administration group, the response rate was not significantly high. The response rate seemed to be high in patients who were treated repeatedly (number of courses greater than 3). Major side effects observed were myelosuppression and gastro-intestinal disorders which were reversible in a rest period. Myelosuppression seemed to be severe in high-dose administration group. This study indicated that MST-16 was a useful agent against malignant lymphoma including primary resistant or relapsed patients, and that the recommended regimen for a late phase II study was considered to be 1,600-2,400 mg/body/day for 5-7 days repeatedly with a pause of several days. Furthermore, the study should be considered at the dose of 3,200 mg/body because half cases administered at this dose showed some response.

[Clinical evaluation of sulbactam/cefoperazone for severe infections associated with hematological disorders]

The effectiveness of sulbactam/cefoperazone (SBT/CPZ) on severe infections associated with hematological diseases was evaluated in a nation-wide multicenter clinical study. SBT/CPZ (4-6 g/day), a 1:1 combination of SBT and CPZ, was given intravenously to 437 patients with hematological disorders. The underlying diseases included acute nonlymphocytic leukemia, acute lymphocytic leukemia, malignant lymphoma, multiple myeloma, myelodysplastic syndrome and others. Thus, 94.3% of the patients had hematological malignancies. The complicating infections included sepsis in 41 cases; sepsis suspected in 205; pneumonia in 47; urinary tract infection in 15; fever of unknown origin in 59; and others in 70. Clinical efficacies of SBT/CPZ were as follows; markedly effective, 83 cases; effective, 170; fairly effective, 59; and ineffective, 110. The efficacy rate (markedly effective plus effective) was 60.0% as a whole. The efficacy rate of SBT/CPZ in sepsis and suspected cases, which accounted for 56.3% of the infections, was 59%. Mild side effects such as skin rash were observed in 15 patients (3.1%). As for abnormal laboratory test results, transient increases in GOT, GPT, A1-P, LDH, etc. were observed in 42 patients (8.6%). Therefore, SBT/CPZ is considered to be a useful drug in empiric therapy for severe infections associated with hematological diseases.

Deficiency of complement decay-accelerating factor (DAF, CD55) in non-Hodgkin's lymphoma

We have assessed levels of surface-expressed complement regulatory proteins, decay-accelerating factor (DAF) and membrane cofactor protein (MCP) on cells from patients with hematological malignancies. Neither malignant cells nor unaffected nucleated blood cells from the patients lacked MCP. On the other hand, complete deficiency of DAF was found in 2/10 of non-Hodgkin's lymphoma (NHL), while none of the 38 patients with acute nonlymphocytic leukemia (ANLL) (14 cases), chronic myelogenous leukemia (CML) (6 cases), acute lymphocytic leukemia (ALL) (12 cases) and chronic lymphocytic leukemia (CLL) (6 cases) lacked DAF. The two patients with DAF-negative NHL had no history of paroxysmal nocturnal hemoglobinuria (PNH), and their peripheral blood cells were DAF-positive. One DAF-negative NHL exhibited T cell markers and the other those of B cell. In both cases, treatment of the DAF-negative lymphoma cells with antibody against MCP (M177) followed by Mg(2+)-EGTA-serum resulted in efficient deposition of homologous C3. These results infer that some NHL specifically lack DAF and, through treatment with M177, are targeted by homologous C3.

[Cervical and mediastinal node dissection four and a half years after operation for pulmonary adenocarcinoma]

Metastasis to bilateral mediastinal and cervical lymphnodes was noted in a 58 year old male four and a half years after left lower lobectomy of the lung with lymphnode dissection (R2a, P-T1N2M0) by posterolateral incision. This case was treated by dissection of the left cervical and bilateral mediastinal lymphnodes from left cervical and median sternal incisions. Metastasis to the right supraclavicular lymphnodes was noted 11 days after discharge, and additional right cervical dissection was performed with satisfactory results. These possible routes include the tracheobronchial lymphnodes and the carinal nodes, via the upper or anterior portion of the left main bronchus. The routes continue via the nodes surrounding the trachea and the right paratrachea to the cervical nodes. This case suggests the necessity of bilateral mediastinal dissection and the significance of cervical dissection in left lung cancer.

[Cost of leukemia treatment]

Medical cost has increasingly become an important problem in the medical practice. As one of the useful fields of computer in the hospital, we have analyzed the costs of chemotherapy and bone marrow transplantation in patients with leukemia who were diagnosed between 1983 and 1986 and followed up till Dec. 1989. For CML the difference in the cost was 5 million yen and a survival rate was 75% and was higher in BMT than in chemotherapy. For Acute leukemia the difference of the costs was 8 million yen and survival rates were 89% and 30%. These data may show that BMT is a very effective and economical treatment for leukemia. In this study we have analyzed only the direct medical cost paid by the governmental insurance, however there seems necessary many other costs which are not covered by the insurance such as the cost for the family members, the cost for cryopreservation of cells and sterilization tentatively covered by the hospital or the cost of blood or marrow bank which are covered or should be covered by the government. Evaluation of the treatment outcome by the parameters such as length and quality of life, productivity of the patient, prevention of the loss of social investment including education on the patient, seemed also necessary for justification of the medical cost.

Bone marrow transplantation from related donors other than HLA-identical siblings: effect of T cell depletion

Results of 470 bone marrow transplants from related donors other than genotypically HLA-identical siblings (alternative related donors) were analysed to identify factors associated with transplant outcome and to determine whether T cell depletion improved results. As compared to 3648 transplant from HLA-identical siblings, alternative related donor transplants were associated with increased graft failure, increased acute graft-versus-host disease (GVHD), and lower disease-free survival. The likelihood of adverse outcome correlated with increasing donor-recipient HLA-disparity. In multivariate analysis of alternative related donor transplants, donor age greater than or equal to 30 years, (relative risk [RR] 1.7, p less than 0.006), intermediate and advanced leukemia (RR 1.5 and 1.6, p less than 0.01 and p less than 0.003), infection pretransplant (RR 1.7, p less than 0.005) and 2- and 3-locus donor-recipient HLA-disparity (RR 1.3, p less than 0.04) were associated with increased risks of treatment failure. The 2-year probability of leukemia-free survival after alternative related donor transplants (n = 43) with none of these adverse prognostic features was 44% (95% confidence interval 28-59%) compared to 56% (95% confidence interval 52-59%) for similar patients receiving HLA-identical sibling transplants (n = 868, univariate p less than 0.03). T cell depletion increased graft failure and decreased acute GVHD after alternative related donor transplants but did not improve leukemia-free survival.

Clinical effect of granulocyte colony-stimulating factor on neutrophils and leukemic cells in myelogenous leukemia: analysis

Clinical experiences with recombinant granulocyte colony-stimulating factor (rhG-CSF) in 13 acute (AML) and four chronic (CML) myelogenous leukemia patients are reported. Sixteen patients received rhG-CSF in support of treatment for life threatening infections and one CML patient in support of induction chemotherapy. After their first induction chemotherapy, six out of eight AML patients showed a rapid increase of neutrophils, recovered from infections and achieved complete remission (CR). One patient, in whom both neutrophils and blasts had increased during rhG-CSF administration, achieved CR through the next administration of chemotherapy (CR rate 87.5%). The last of the eight AML patients showed no increase of neutrophils, and died of interstitial pneumonitis. Two of five AML patients who received rhG-CSF after reinduction chemotherapy for relapsed or refractory leukemia achieved CR, a rate of 40%. In one of the two, the administration of rhG-CSF prior to induction chemotherapy seemed advantageous in achieving CR. During rhG-CSF administration, an increase of blastic cells in peripheral blood was observed in four out of all 13 AML patients. One of three CML patients, with a lymphoid crisis, showed an increase only of neutrophils, and recovered from infection. The other two showed increases of both neutrophils and blasts. One patient with CML in blastic crisis, undergoing induction chemotherapy with rhG-CSF administration, returned to the chronic phase. These clinical experiences suggest rhG-CSF to be effective in supporting infection therapy and in possibly enhancing the sensitivity of myelogenous leukemic blasts to antileukemic agents.

[Control of graft-versus-host disease and infection associated with immunosuppression]

Graft-versus-host disease (GVHD) in leukemia patients following allogeneic bone marrow transplantation (BMT) has a lot of demerits but it also has a merit, namely graft-versus-leukemia effect. We reported the results of our recent trials on prevention, treatment and induction of GVHD, and prevention of viral infection after BMT. The results were as follows: 1) Twenty-four percent of patients who received prophylactic administration of cyclosporine and short term methotrexate still developed II degree-IV degree acute GVHD. 2) Patients with I degree or II degree acute GVHD showed good clinical courses. But, most patients with III degree GVHD gradually developed chronic GVHD. All patients with IV degree GVHD died of GVHD or infection. 3) Mizoribine and deoxyspergualin were effective for steroid-resistant GVHD. 4) Bestatin was administered to recipients who did not develop GVHD until day 30 after BMT. An interim report suggests that bestatin may induce chronic GVHD and suppress the relapse of leukemia. 5) Oral administration of gamma-globulin may prevent viral enteritis. Intravenous administration of anti-cytomegalovirus monoclonal antibody may prevent cytomegalovirus pneumonia.

Clinical effect of BV-araU on varicella-zoster virus infection in immunocompromised patients with haematological malignancies

We evaluated the treatment of varicella-zoster infection with BV-araU in immuno-compromised patients with haematological malignancies in a randomized controlled study. Comparison was made between doses of 150 and 30 mg/day. For ethical reasons there was no placebo group. The percentage of patients given a 'very effective' rating by both attending physicians and the Evaluation Committee was significantly higher in the 150 mg/day group (56.0%) compared to the 30 mg/day group (15.0%). There was no significant difference in efficacy rate ('very effective' plus 'effective') between the two groups. The incidence of side effects was low (7.8%), all were mild and disappeared on stopping treatment. These results suggest that BV-araU is clinically useful, especially at a dose of 150 mg/day in immunocompromised patients. Further comparative studies between BV-araU and acyclovir or vidarabine are indicated.

Protective effect of taurine against acute paraquat intoxication in rats

The effect of taurine (TA) on acute paraquat (PQ) intoxication was investigated in rats. Treatment with TA was begun 10 min after rats received a s. c. injection of PQ 40 mg/kg. Saline (0.9%) or 5% TA solution were infused i.v. for 5-6 min (short-interval infusion study). One hour after TA infusion, PQ concentration in the blood was increased and that in the urine was lowered, as compared with those in the saline-infused group. Significant increases of the PQ concentration was observed in kidney at 3 hours after TA administration. Excreted urine volume was significantly higher in the TA group during the time-period of 0-1 and 0-5 hours after the 5% TA administration compared with that of the saline group. However, there were no significant differences in total urinary PQ excretion between the two groups. Saline or 2.5% and 5% TA was infused continuously during the time-period of 0-1, 0-3 or 0-5 hours (long-interval infusion study). A marked increase in PQ concentration in blood and a reduction of PQ concentration in kidney were noticed during the time-period of 1-5 hours after the 5%TA infusion. Urinary excretion was remarkably accelerated by 5% TA infusion and the total urine volume increased to 20 times during the time-period 0-1 hour and 1.7 times during the time-period of 3-5 hours as compared with the saline control. In addition, urinary volume during the time-period of 0-5 hours almost reached that of 5% TA volume which infused to animals. The mortality rate of the groups that received either single or double short-time infusion of 5% TA was 100%. Thus, these results suggest that a long continuous infusion of 5% TA increased urine output and inhibits of PQ accumulation in renal tissue despite a rise in blood PQ concentration.

Hemorrhagic cystitis after bone marrow transplantation: importance of a thin sectioning technique on urinary sediments for diagnosis

We used a thin-sectioning technique for the electron microscopic detection of viral particles within the cells of urinary sediments in three recipients who developed hemorrhagic cystitis after allogeneic bone marrow transplantation. Results of viral cultures of urine and electron microscopic (EM) observations on urinary sediments were consistent in only one recipient. In this recipient, EM observations revealed many viral particles within the cells of urinary sediments with diameter of about 80 nm corresponding to adenovirus, of which type 11 was produced in viral cultures. In one of the other two recipients many viral particles with a mean diameter of 41.6 nm corresponding to papovavirus were observed, but viral cultures using conventional cells were negative. Re-cultures using HEK cells produced polyomavirus BK. EM observation was a clue to the correct diagnosis. In the remaining recipient, no viral particles were observed within the cells of urinary sediments, suggesting the hemorrhagic cystitis to be of non-viral origin, despite a positive result of viral culture. These results suggest that a thin-sectioning technique on the cells of urinary sediments is important for the differential diagnosis between a viral-induced and non-viral hemorrhagic cystitis.

[Surgical indication of T1-2N2-3M0 lung cancer based on the prognosis]

Effusion-type lung cancer with postoperative T1N2-3M0 and primary tumor diameter less than 3 cm was regarded as small sized progressive lung cancer. There were 8 cases of pT1N2-3, with a 3-years survival rate of 37.5%, and, 5 years survival rate of 25.0%. There were 5 cases of effusion-type lung cancer with primary tumor diameter less than 3 cm, who were treated with panpleuropneumonectomy. Their 3 years survival rate was 51.9%. In small sized progressive lung cancer in total, the 3 years survival rate was 40.7%, and the 5 years survival rate was 29.1%. In comparison there were 29 cases of pT2N2-3, with a 3 years survival rate of 40.9% and a 5 years survival rate of 37.0%. There was no significant difference concerning the survival rate between T1 and T2 groups, T2 and pleuropneumonectomy group, and between small progressive lung cancer group and T2 group. Therefore, there seems to be a less correlation between progressive lung cancer and T-factor disease prognosis. It was suggested to improve the prognosis by extending lymph node dissection even in progressive lung cancer.

Double-blind test of human urinary macrophage colony-stimulating factor for allogeneic and syngeneic bone marrow transplantation: effectiveness of treatment and 2-year follow-up for relapse of leukaemia

A randomized, double-blind placebo-controlled phase III clinical trial was performed to study the effects of human urinary macrophage colony-stimulating factor (hM-CSF) after allogeneic and syngeneic bone marrow transplantation (BMT) in 60 hM-CSF treated and 59 placebo control patients. HM-CSF was administered at a daily dose of 2 x 10(5) units/kg from day 1 to day 14 after BMT. Significant differences between hM-CSF and control patient were found in the recovery time to greater than 0.5 x 10(9) granulocytes/l and the survival rate during the initial 120 d without retransplantation. There was no difference in the incidence or grade of graft-versus-host disease (GVHD). There was no difference in the rate of leukaemic relapse at 24-36 months after BMT in patients with acute lymphocytic, acute nonlymphocytic, or monocytic leukaemia. The results of this trial show that human M-CSF improves the outcome of BMT without any influence on the occurrence of leukaemic relapse or GVHD.

[Phase II study of YNK01 (1-beta-D-arabinofuranosylcytosine-5'-stearylphosphate) on hematological malignancies]

Phase II study of YNK01 (1-beta-D-arabinofuranosylcytosine-5'-stearylphosphate), a derivative of cytosine arabinoside, on hematological malignancies was conducted by multi-institutional cooperative group. YNK01 was administered orally at dose of 100-300 mg/body/day for more than 2 weeks. The number of registered and evaluated patients were 211 and 156, respectively. Of 23 patients with acute myelogeneous leukemia (AML), 2 complete response (CR), one partial response (PR) were observed (CR + PR: 13.0%). Hypoplastic leukemia (1/4: 25%), acute unclassified leukemia (1/1: 100%). Of 45 patients with MDS, 2CRs, 6 good response (GR) and 5PRs were observed (CR + PR: 28.9%). AML developing after a prior history of MDS (5/17: 29.4%), CML-BC (2/9: 22.2%). Of 19 patients with CML, 9 achieved CR, 3 achieved PR (63.2%). Of 11 patients with polycythemia vera, 4 achieved CR, 5 achieved PR (81.8%). Of 6 patients with essential thrombocytosis, 2 achieved CR, one achieved PR (50%). The major adverse effects included gastrointestinal toxicities such as nausea, vomiting, anorexia, diarrhea, and elevation of GOT and GPT which were tolerable and reversible. This study indicates that YNK01 is a useful agent against acute leukemia and MDS, especially RAEB, RAEB in T, CMMoL.

An early phase II study of CPT-11: a new derivative of camptothecin, for the treatment of leukemia and lymphoma

An early phase II study of a new camptothecin analog and an inhibitor of topoisomerase I, CPT-11, was conducted in 62 patients with refractory leukemia and lymphoma by four different treatment schedules in a multiinstitutional cooperative study. CPT-11 therapy resulted in four complete remissions (CRs) and three partial remissions (PRs) in 29 assessable non-Hodgkin's lymphoma (NHL) patients, one PR in three Hodgkin's disease (HD), one CR and one PR in 11 acute lymphoblastic leukemia (ALL), and one PR in 15 acute myelogenous leukemia (AML) patients. Single infusion of 200 mg/m2 every 3 to 4 weeks produced no response in both leukemia and lymphoma patients. Sixty-minute infusions of 40 mg/m2/d for 5 days every 3 to 4 weeks or for 3 days weekly produced four CRs (17%) and four PRs (17%) in 24 patients with malignant lymphoma. Sixty-minute infusions of 20 mg/m2 twice a day for 7 days every 3 to 4 weeks resulted in one CR and two PRs in 12 patients with acute leukemia. No response was seen in an acute leukemia patient by another treatment schedule. CPT-11 was effective in two (15%) of 13 primarily refractory leukemia and lymphoma cases, in two of four relapsed cases, and in seven (17%) of 41 relapsed and refractory cases. Major side effects were leukopenia (91%) and gastrointestinal (GI) (76%). CPT-11 was shown to be effective against refractory leukemia and lymphoma, and thus deserves further clinical study; the novel antitumor activity mode of this drug predicts no cross-resistance to presently available antitumor drugs.

Effect of granulocyte colony-stimulating factor after intensive induction therapy in relapsed or refractory acute leukemia

Background. Although colony-stimulating factors have been shown to accelerate recovery from severe neutropenia after intensive chemotherapy or bone marrow transplantation, their use in acute leukemia has been controversial because in vitro they stimulate leukemic colonies as well as normal granulocyte colonies. Methods. We conducted a prospective, randomized, controlled study to determine the safety and efficacy of recombinant human granulocyte colony-stimulating factor (CSF) after a standard course of intensive therapy in 108 patients with relapsed or refractory acute leukemia (67 with acute myelogenous leukemia, 30 with acute lymphocytic leukemia, 9 in blast crisis from chronic myelogenous leukemia, and 2 with acute leukemia arising from myelodysplastic syndromes). Treatment with granulocyte CSF (200 micrograms per square meter of body-surface area per day in a 30-minute infusion) was begun two days after the end of the chemotherapy and continued until the neutrophil count rose above 1500 per cubic millimeter. Results. Treatment with granulocyte CSF accelerated the recovery of neutrophils significantly (P less than 0.01), shortening it by about a week, but it had no effect on platelet recovery. Although the incidence of febrile episodes was almost the same, documented infections were significantly less frequent in the group treated with granulocyte CSF (P = 0.028). There was no evidence that granulocyte CSF accelerated the regrowth of leukemic cells. Fifty percent of 48 patients in the CSF group who could be evaluated and 36 percent of 50 controls had complete remission. The rate of relapse was almost the same in the two groups. Conclusions. It appears that recombinant human granulocyte CSF is safe in acute leukemia, accelerating neutrophil recovery and thereby reducing the incidence of documented infection without affecting the regrowth of leukemic cells. It should be used with caution, however, pending further confirmation of these early results.