HISTIOCYTIC MEDULLARY RETICULOSIS : A CASE REPORT

Chemotherapy of malignant histiocytosis in adults

Malignant histiocytosis is a fulminant neoplasm resistent to single agent chemotherapy and resulting in death within 6 months. Sixteen patients have received chemotherapy for this disorder between 1965-1975 at Stanford. Nine patients responded to chemotherapy. Responders had a median survival of 23 months from onset of symptoms and a significantly longer survival than non-responders (p = 0.03). The most promising responses were in seven patients treated with a combination of cyclophosphamide, adriamycin, vincristine and prednisone. Five of the seven responded, with two of the five later relapsing and dying, two having equivocal evidence of disease while on chemotherapy for 6 and 9 months, and one free of disease for 17 months after completing 8 months of chemotherapy. Three patients had central nervous system (CNS) relapses, two during peripheral remission. One of these had control of CNS disease with brain irradiation and intrathecal methotrexate, but all three eventually died. It is hoped that with combination chemotherapy and prophylactic CNS treatment, long term disease-free survivals will be achieved.

Malignant histiocytosis: complete remission with combination chemotherapy

A case of a 16-year-old girl with malignant histiocytosis involving the lymph nodes, bone marrow, peripheral blood, liver, and spleen is described. This patient achieved a complete remission with cyclic quadruple chemotherapy consisting of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). She is alive and free of disease more than 4 years after the completion of COPP and after having had maintenance treatment with a small dose of cyclophosphamide for 2 3/4 years. Such good results with the COPP regimen in malignant histiocytosis have not been reported previously, and it is suggested that this modality of treatment warrants further trial.

Splenectomy for histiocytic medullary reticulosis

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