levoleucovorin and Lymphatic-Diseases

Topics: Antineoplastic Agents; Asparaginase; Daunorubicin; Humans; Leucovorin; Leukemia; Lymphatic Diseases; Mercaptopurine; Methotrexate; Prednisolone; Vincristine

We report a 59-year-old woman diagnosed with metastasic colorectal cancer who developed immune hemolytic anemia during FOLFOX chemotherapy (oxaliplatin/leucovorin/5-fluorouracil). Immunohematologic studies demonstrated that immune hemolysis was oxaliplatin-mediated. On the basis of this case and in a review of the literature in which 13 cases of previously reported oxaliplatin-induced immune cytopenia have been identified, we suggest some clinical clues regarding the use of oxaliplatin in cancer patients.

Topics: Adenocarcinoma; Anemia, Hemolytic, Autoimmune; Antidotes; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Autoantibodies; Colorectal Neoplasms; Erythrocytes; Female; Fluorouracil; Hemoglobins; Humans; Leucovorin; Liver Neoplasms; Lymphatic Diseases; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Platelet Count

Some conditions are predisposed to excessive lymphocyte responses, which can progress to a benign condition, ie, atypical cutaneous lymphoid hyperplasia (ACLH), or a malignant lymphoma. Clinical diagnosis of drug-associated pseudolymphoma can be based on a temporal association between drug ingestion and lesion onset followed by resolution without recurrence after discontinuation of drug administration. Herein, we report the case of a 66-year-old man with advanced colon carcinoma with ACLH developed while receiving chemotherapy regimen with oxaliplatin/5-fluorouracil/leucovorin. The authors postulate that chemotherapy can promote an aberrant immune response to an antigen that can be the drug itself or other self-antigens.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Drug Eruptions; Fluorouracil; Humans; Immunophenotyping; Leucovorin; Lymphatic Diseases; Male; Organoplatinum Compounds

A 36-year-old woman, presenting with fever, pancytopenia, hepatosplenomegaly, and striking effacement of the bone marrow by true malignant histiocytes, was found to have no benefit from the systemic administration of cyclophosphamide, vincristine sulfate, doxorubicin, prednisone, and high-dose methotrexate with calcium leucovorin rescue. Striking histologic and clinical improvement was noted after the administration of two cycles of etoposide and amsacrine, each cycle consisting of 100 mg/sq m/day of each agent for five days. We believe that this therapy should be considered for future patients demonstrating aggressive presentations of malignant histiocytosis.

Topics: Adult; Aminoacridines; Amsacrine; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Cyclophosphamide; Doxorubicin; Drug Resistance; Etoposide; Female; Hepatomegaly; Humans; Leucovorin; Leukocyte Count; Lymphatic Diseases; Methotrexate; Prednisone; Splenomegaly; Vincristine

Twenty-four consecutive cases of malignant histiocytosis (MH) treated at Stanford Medical Center between 1973 and 1983 have been reviewed. Most patients presented with systemic symptoms (91%) and advanced disease (stage IV, 80%). Multiple organ involvement was common. In six cases, pathologic tissue was further characterized by frozen section immune histochemistry, using a panel of monoclonal antibodies known to react with monocytes and macrophages, as well as a variety of hematopoietic cells. One case expressed a mature monocyte/macrophage phenotype; three cases were considered null cell or primitive lesions; and two cases were identified as probable T cell lymphomas. Seven patients underwent splenectomy. Two patients died prior to any treatment. Twenty-two patients were treated with CHOP (cyclophosphamide, Adriamycin, vincristine, prednisone) +/- bleomycin (B), +/- midcycle high-dose methotrexate (HD-MTX) with leucovorin rescue. Seven patients received prophylactic intrathecal MTX. Of 22 evaluable patients, there was a 68% complete response rate (CR), a 23% partial response rate (PR), and a 9% no response rate (NR). Median duration of CR was 30+ months; median duration of PR was 2.4 months. Median survival for patients attaining a CR has not been reached v 3 months for the PR and NR groups. For all 24 patients, median survival was 2 years, with a 5-year actuarial survival of 40%. Multivariate analysis revealed that a platelet count less than 150,000 (P Cox = .005) and the dose of drug delivered (P Cox = .057) were the most important prognostic factors. Prophylactic intrathecal MTX therapy and splenectomy did not influence survival. Although MH is an aggressive disease with a poor prognosis, it is potentially curable. Systematic and aggressive treatment should further improve the outcome.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Dose-Response Relationship, Drug; Doxorubicin; Female; Humans; Leucovorin; Liver Neoplasms; Lymphatic Diseases; Male; Methotrexate; Middle Aged; Platelet Count; Prednisone; Prognosis; Splenectomy; Splenic Neoplasms; Vincristine

Three patients with primary central nervous system (CNS) lymphoma have had major tumor regression with multiagent chemotherapy given in association with reversible blood-brain barrier opening used to enhance drug delivery to the tumor. In addition, in one patient barrier modification was carried out in the posterior fossa by mannitol infusion into the vertebral artery without untoward effects, an approach not heretofore accomplished. Computed tomographic (CT) studies documented that discontinuation of steroids rapidly effected an increase in the delivery of contrast agent to the tumor. CT monitoring of the degree of barrier modification showed tumor nodules and tumor size not apparent on the control scans, thereby providing additional evidence of the existence of a blood-brain barrier in CNS tumors. These studies further show that drug (contrast) delivery to the tumor, as well as to the surrounding barrier, is enhanced after reversible blood-brain barrier modification. Finally, chemotherapy administered by this approach resulted in defined, objective tumor responses in these three patients.

Topics: Adult; Aged; Antineoplastic Agents; Blood-Brain Barrier; Brain Neoplasms; Cyclophosphamide; Dexamethasone; Female; Humans; Hypertonic Solutions; Leucovorin; Lymphatic Diseases; Male; Mannitol; Methotrexate; Middle Aged; Procarbazine; Tomography, X-Ray Computed

Topics: Adult; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Humans; Leucovorin; Lymphatic Diseases; Male; Methotrexate