Acute monoblastic leukaemia in child receiving chlorambucil for juvenile rheumatoid arthritis

Chlorambucil carcinogenesis in BALB/c mice

Chlorambucil, a drug used in the treatment of neoplastic and non-neoplastic disease, was administered by gavage to BALB/c mice at a dose of 1.0 mg/kg body wt. 5 times per week for 12 weeks to test its carcinogenicity. The survival was statistically reduced in treated animals of both sexes (P less than 0.001). The treatment induced a significant increase in lung tumours (males, P less than 0.001; females, P less than 0.001) and lymphoreticular system tumours (males P less than 0.01; females, P less than 0.001) in both sexes and mammary carcinomas in female mice (P less than 0.05). These results with other investigations reported in literature, suggest that chlorambucil is carcinogenic in laboratory animals, mutagenic and that it could be a potential carcinogenic hazard to man.

High-dose short-term chlorambucil for intractable sympathetic ophthalmia and Behçet's disease

We treated five patients with intractable sympathetic ophthalmia and six patients with severe Behçet's disease by high-dose, short-term chlorambucil therapy. We used a total dose ranging from 306 mg to 4.2 g and a duration of therapy no longer than 36 weeks and in most cases less than 24 weeks. After termination of therapy all 11 patients had a sustained remission of their eye disease. Unless subretinal neovascularisation was present, all had a final visual acuity of 20/50 or better. Malignancy has not developed in any of our cases, with a follow-up ranging from 6 months to 12 years (mean, 4.5 years). Although 30- and 40-year follow-ups and larger numbers of patients may be necessary fully to realise the risks of chlorambucil, we believe that our high-dose, short-term regimen (Behçet's disease: average duration, 23 weeks; average total dose 2.2 g; sympathetic ophthalmia: average duration, 11 weeks; total average dose, 0.9 g) may be safer than previously reported chlorambucil regimens of one to two years or longer. In addition we fulfilled our aim of discontinuing all concomitant systemic corticosteroids within a relatively short time (usually six to eight weeks).

Methotrexate therapy in juvenile rheumatoid arthritis: a retrospective study

Nineteen selected patients with severe, mostly systemic onset, juvenile rheumatoid arthritis were treated with methotrexate (MTX) for an average of 10.5 months. Twelve patients showed statistically significant improvement, as measured by the number of affected, swollen, tender, and functionally impaired joints, and by decreases in erythrocyte sedimentation rate and C-reactive protein and an increase in hemoglobin level. Systemic manifestations improved in 6 of 8 patients. In 10 children receiving corticosteroids, the dosage was reduced. Seven patients did not respond to MTX therapy. Six of them showed an unchanged disease course, and 1 had a relapse after 4 months of MTX treatments. Probable side effects included gastrointestinal symptoms, elevated liver enzymes, and herpes zoster infection. MTX treatment should be considered for children with life-threatening or severe disabling arthritis that is unresponsive to other therapy.

Chlorambucil therapy in rheumatoid arthritis: clinical experience in 28 patients and literature review

Our clinical experience in 28 patients receiving chlorambucil for rheumatoid arthritis (RA) and the reports on chlorambucil therapy are reviewed. Our study population and other reports generally represent patients with severe RA who had either failed to improve or developed significant toxicity during previous treatment with conventional slow acting anti-rheumatic drugs (SAARDs). Seventy-two percent of patients had a significant clinical improvement during chlorambucil therapy and reports of complete remission are given, although the incidence of remission is unknown. Hematologic complications are often reported, but appeared more frequently in our experience than previously reported. Hematologic toxicity required that chlorambucil be discontinued in the majority of our cases. Two deaths from suspected drug induced malignancies are reported. Although chlorambucil appears to be effective in the control of active RA, the potential for drug induced toxicity and malignancies may outweigh the benefit of continued use of this experimental therapy in RA.

Waldenström macroglobulinemia terminating in acute leukemia: a report of three cases

Acute leukemia was observed to develop in three patients with Waldenstöm macroglobulinemia. Each patient had been treated with cytotoxic drug therapy. Pancytopenia preceded the onset of the terminal leukemia in two of the three cases. The acute leukemias were all of acute myelogenous type. All of the patients died soon after the development of the terminal leukemia. A number of recent reports have documented acute terminal leukemia in patients with macroglobulinemias and multiple myeloma, as well as other malignant and nonmalignant diseases. The role of the cytotoxic drugs, especially chlorambucil, cyclophosphamide, and melphalan, in leukemogenesis has been raised by these recent reports.

Chromosomes and causation of human cancer and leukemia. L. Cytogenetics of leukemias complicating other diseases

Complicating (secondary) leukemias in 20 patients, 18 of whom had various forms of neoplasia treated with chemotherapy and/or radiation, have been examined in regard to the karyotypic findings present in the leukemic cells of the marrow. In addition, the published cases of complicating leukemia have been tabulated. Based on the results of the present study and those in the literature it appears that chromosomes #3 and #17 should be stressed as being nonrandomly involved in complicating leukemia in addition to the previously stressed chromosomes #5 and #7. The results of the present study are discussed in relation to those reported in the literature, and stress put on the significance of cytogenetic changes in relation to possible causative factors of the complicating leukemia. The hypothesis is advanced that these nonrandom chromosome changes may reflect causative specificity of the complicating leukemia and that a concerted effort must be made to obtain more cogent information on the role of noxious agents in the causation of complicating leukemia.