melphalan and Remission--Spontaneous

Topics: Animals; Carmustine; Cytarabine; Doxorubicin; Drug Evaluation, Preclinical; Fluorouracil; Humans; Melphalan; Methotrexate; Mice; Mice, Inbred BALB C; Multiple Myeloma; Myeloma Proteins; Prednisone; Procarbazine; Remission, Spontaneous

Topics: Adult; Aged; Antineoplastic Agents; Bone Marrow; Bone Marrow Cells; Drug Therapy, Combination; Female; Hematocrit; Hemoglobins; Humans; Immunoglobulins; Leukemia; Leukemia, Myeloid, Acute; Leukocyte Count; Male; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Remission, Spontaneous; Syndrome

Topics: Adrenal Cortex Hormones; Antineoplastic Agents; Carmustine; Cell Division; Cyclophosphamide; Drug Resistance; Humans; Melphalan; Multiple Myeloma; Nitrosourea Compounds; Prednisone; Procarbazine; Prognosis; Remission, Spontaneous

Topics: Adolescent; Adult; Antineoplastic Agents; Bone Marrow; Clinical Trials as Topic; Drug Therapy, Combination; Female; Hodgkin Disease; Humans; Male; Mechlorethamine; Melphalan; Middle Aged; Prednisone; Procarbazine; Remission, Spontaneous; Vinblastine; Vincristine

Topics: Adult; Aged; Clinical Trials as Topic; Drug Administration Schedule; Drug Evaluation; Drug Therapy, Combination; Female; Fluorouracil; Humans; Melphalan; Methotrexate; Middle Aged; Ovarian Neoplasms; Remission, Spontaneous; Time Factors

Topics: Clinical Trials as Topic; Cyclophosphamide; Doxorubicin; Drug Evaluation; Drug Therapy, Combination; Female; Fluorouracil; Humans; Melphalan; Methotrexate; Middle Aged; Organothiophosphorus Compounds; Ovarian Neoplasms; Remission, Spontaneous

A total of 144 patients with advanced sarcomas were entered into a randomized prospective protocol with four treatment arms utilizing different combinations of chemotherapeutic agents. Of these, 120 patients (83%) were judged acceptable. Treatment 1: actinomycin-D (Act-D), 0.01 mg/kg IV, days 1--5; phenylalanine mustard (L-PAM), 4 mg PO, days 1--10 every six weeks. Treatment 2: Act-D, 0.01 mg/kg IV, days 1--5; L-PAM, 4 mg PO, days 1--10; vincristine, 1 mg IV, days 1, 8, 15, 22, 29, 36, repeat every six weeks. Treatment 3: Act-D, 0.01 mg/kg IV, days 1--5; L-PAM, 4 mg PO, DAYS 1--10; NSC-1026, 200 mg/kg IV, days 1--6. Treatment 4: Adriamycin, 0.4 mg/kg IV, days 1, 2, 3, 8, 9, 10, then 2XWK starting day 15 (max. 1,200 mg). There was a provision that upon progression of the disease in the first three treatment regimens, patients would be crossed over to Treatment 4. Responses were as follows: 1 - Partial Response (PR) 1/25; No Change (NC) 9/25 (36%). gF2 - NC 17/26 (65%). 3 - NC 13/25 (52%). 4 - Complete Response (CR) 1/41; PR 6/41; (15%); NC 27/41 (66%). Clearly Treatment 4 was the best arm, with a 17% response rate and an initial progression rate of 17%. The only other response was a partial in 1. The difference is statistically significant (H = 17.247, P = 0.0006). If the responders to Adriamycin were analyzed without crossovers, the response rate would be 22% (6/27). (H = 14.079, P = 0.003). Median times to progression were 12.5, 8.7 weeks for 1 and 2, and 5 weeks for 3 and 4. There was no significant difference in the median survival times among the four treatment arms. It appears that Adriamycin as a single drug is superior to the drug combinations and would probably be even more effective used in combination with known active agents.

Topics: Antineoplastic Agents; Clinical Trials as Topic; Cycloleucine; Dactinomycin; Doxorubicin; Drug Evaluation; Drug Therapy, Combination; Humans; Melphalan; Remission, Spontaneous; Sarcoma; Soft Tissue Neoplasms; Time Factors; Vincristine

Breast cancer patients participating in a prospective randomized clinical trial who were less than or equal to 49 years of age, had positive axillary nodes, and who received prolonged 1-phenylalanine mustard (L-PAM) as an adjuvant to mastectomy continue (after 4 years) to demonstrate a significantly greater disease-free survival (p = .007) than do patients who received placebo. Benefit was achieved in patients who were less than or equal to 39 years as well as those who were 40-49 years of age. Those in the younger age group showed a greater improvement in disease-free survival at 4 years relative to their controls (32% vs. 69%; p = .01) than did those in the older age group (48% vs. 61%; p = .09). When patients were examined relative to their nodal status, a highly favorable effect was found to have been achieved with L-PAM in those with 1-3 positive nodes (54% vs. 86%; p = .006). Results indicate that both age groups were benefited. When considered over time, they demonstrate that a relatively greater effect was achieved in the younger women. While L-PAM failed to significantly alter the disease-free survival of those with greater than or equal to 4 positive nodes a slightly better effect was achieved in the group less than or equal to 39 years. Since adjuvant chemotherapy has been found to be more effective in premenopausal than postmenopausal women, it has been presumed that decreased ovarian function, as a result of the chemotherapy, is responsible for the findings. To support or repudiate that concept, information regarding serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), as well as menstrual function, has been obtained from women receiving L-PAM or L-PAM plus 5-FU therapy. In contrast to findings relative to disease-free survival, ovarian function and menses were most affected in patients 40-49 years of age. Amenorrhea occurred in 73% of patients in that age group and in only 22% of those less than or equal to 39 years (p less than .001). Similarly, a significant increase in LH and FSH and a decrease in E2, all indicative of ovarian suppression, was observed only in the older group of patients. Thus, it is concluded that while ovarian suppression may account for some of the adjuvant chemotherapeutic effect in premenopausal women, the dichotomy of findings in younger and older premenopausal women relative to therapeutic response and ovarian function indicates that other factors could be responsible.

Topics: Adult; Age Factors; Breast Neoplasms; Clinical Trials as Topic; Female; Hormones; Humans; Lymphatic Metastasis; Melphalan; Menstruation; Middle Aged; Ovary; Remission, Spontaneous; Time Factors

172 patients who had had mastectomy for breast cancer were treated by repeated adjuvant chemotherapy, either with phenylalanine mustard (P.A.M.) or a combination of cyclophosphamide, 5-fluorouracil, and prednisone (C.F.P.) with and without radiotherapy. Tumours recurred significantly more frequently and mortality tended to be higher in P.A.M.-treated patients than in patients on other treatment. The interval between surgery and disease recurrence was significantly shorter for P.A.M.-treated premenopausal but not postmenopausal patients than for patients of equivalent menstrual status treated with C.F.P. with or without radiation. The associations in premenopausal patients between the mode of treatment and both survival and the disease-free interval were significant before and after adjustment for variations between the treatment groups in the number of involved lymph nodes and the size of the primary tumour.

Topics: Adult; Breast Neoplasms; Clinical Trials as Topic; Cyclophosphamide; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluorouracil; Follow-Up Studies; Humans; Mastectomy; Melphalan; Middle Aged; Neoplasm Recurrence, Local; Postoperative Care; Prednisone; Remission, Spontaneous; Time Factors

A randomized trial of Adriamycin (A) in combination with melphalan (M), (MA therapy), and in combination with M plus cyclophosphamide (C) (MAC therapy), was initiated in 40 evaluable patients with metastatic breast cancer. Twenty-two patients demonstrated an objective response to therapy: 9/20 to the MA regimen, and 13/20 to the MAC regimen. For the 22 responders, median duration of response is not yet achieved for either complete or partial responders, at 10 and 9 months, respectively. The addition of the two alkylating agents to Adriamycin was superior to the single alkylating agent addition, both in total response rate and in completeness of response. Maintenance therapy, after achieving the maximum cumulative dose of Adriamycin, was provided by cyclophosphamide plus methotrexate and 5-fluorouracil (CMF). In 19 patients completing induction and entering maintenance therapy, only one relapse has developed with maximun follow-up at 15 months.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Clinical Trials as Topic; Cyclophosphamide; Doxorubicin; Drug Therapy, Combination; Female; Humans; Melphalan; Middle Aged; Neoplasm Metastasis; Remission, Spontaneous; Skin Neoplasms; Time Factors

The effect of six different chemotherapy regimens were evaluated in 462 previously untreated patients with multiple myeloma. In comparison with other treatments, drug combinations that included vincristine and were given at 3-week intervals were associated with higher response rates and longer survival times. No gain was noted from the use of Adriamycin or from combinations of alkylating agents unless vincristine was given and the treatment intervals were short. Seventy-one responding patients were allocated at random to maintenance treatment with intermittent courses of either azathioprine--prednisone or a combination of melphalan--cyclophosphamide--carmustine (BCNU)--prednisone. The survival time was not prolonged with either maintenance treatment in comparison with that for responding patients continued on other therapies or on no therapy in previous studies. Attempts to reduce tumor was maximally with a change in the therapeutic modality, such as with immunotherapy or radiotherapy, remain to be evaluated.

Topics: Antineoplastic Agents; Azathioprine; Carmustine; Cyclophosphamide; Doxorubicin; Drug Therapy, Combination; Female; Humans; Male; Melphalan; Multiple Myeloma; Prednisone; Remission, Spontaneous; Time Factors; Vincristine

The therapeutic effects of adriamycin and of melphalan in patients with advanced carcinoma of the ovary were tested in a prospective randomized study. Complete and partial remission occurred in eight of 19 patients treated with adriamycin and in four of 20 patients given melphalan. The difference, however, is not statistically significant. The median duration of complete and partial remissions was slightly longer after treatment with melphalan than with adriamycin. The number of cycles required to produce the initial regression state was less in the patients in the group given adriamycin as compared with those in the group treated with melphalan. No cross resistance was observed between the two drugs. These data indicate that, in patients with carcinoma of the ovary, the therapeutic efficacy of adriamycin is competitive with that of the most effective conventional agents, such as melphalan.

Topics: Adenocarcinoma; Carcinoma; Clinical Trials as Topic; Doxorubicin; Drug Evaluation; Endometriosis; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Melphalan; Neoplasm Metastasis; Ovarian Neoplasms; Remission, Spontaneous

The effects of various regimens of melphalan combination chemotherapy were evaluated in 508 patients with multiple myeloma. No value was confirmed from the addition of procarbazine or vincristine sulfate to melphalan-prednisone combinations. Ninety-six patients who responded to treatment were allocated at random to one of three maintenance regimens, namely intermittent courses of carmustine with prednisone, continued courses of melphalan with prednisone, or no chemotherapy. There were no differences in the frequency of relapse, the remission duration, or the survival time among these maintenace groups. The frequencies of pneumonia and herpes zoster were higher in patients receiving continued chemotherapy. Continued melphalan-prednisone chemotherapy after the first year is of no major value to responding patients with multiple cyeloma. Attempts to reduce tumor mass maximally with a change in therapy are justified.

Topics: Bone Neoplasms; Carmustine; Drug Therapy, Combination; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Procarbazine; Recurrence; Remission, Spontaneous; Time Factors; Vincristine

A randomized study compared the response of patients with multiple myeloma to chlorambucil, melphalan, and azathioprine. All patients also received a combination of prednisone and fluoxymesterone. Seventy-three of 86 patients entered on the study could have evaluations. The results indicate that melphatan produced more responses than either azathioprine or chlorambucil, but responses to both of these agents were observed. No difference was noted between survival curves for patients with no poor-risk factors as compared to those having at least one poor-risk factor. The only poor-risk factor affecting survival in this group of patients was the blood urea nitrogen level.

Topics: Azathioprine; Blood Urea Nitrogen; Bone Neoplasms; Chlorambucil; Drug Therapy, Combination; Fluoxymesterone; Humans; Melphalan; Multiple Myeloma; Prednisone; Remission, Spontaneous; Risk; Time Factors

The effect of certain disease parameters on remission and survial time was evaluated in 482 patients with multiple myeloma treated with intermittent courses of melphalan-prednisone combinations. Increasing degrees of anemia, hypercalcemia, azotemia, and high serum myeloma protein levels were associated with progressive lifespan shortening. The short survival of patients with anemia and hypercalcemia was associated with short remissions in responding patients with these abnormalities. The extent of tumor mass was defined from specific laboratory parameters reported by Durie to be associated with large numbers of plasma cells. More advanced stages of myeloma were associated with higher frequencies and degrees of normal immunoglobulin depression. The response rate was not affected by the tumor mass grade, but increasing tumor mass was associated with a shorter lifespan. Greater degrees of tumor reduction were associated with longer remission and survival times. Patients in whom a marked tumor reduction was rapid had shorter survival and remission times than patients who responded more slowly.

Topics: Aged; Anemia; Drug Therapy, Combination; Female; Humans; Hypercalcemia; Immunoglobulins; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Plasma Cells; Prednisone; Prognosis; Remission, Spontaneous; Serum Albumin; Time Factors; Uremia

A study was designed to evaluate the effectiveness of prednisone therapy in poor-risk patients with multiple myeloma. Patients were treated with melphalan alone or in combination with prednisone at doses of either 0.6 mg/kg or 0.3 mg/kg. The group of patients receiving melphalan and prednisone 0.6 mg/kg had significantly improved responses in hemoglobin, lowering of the M-protein concentration, and reduction of azotemia. Significant benefits attributable to prednisone were not demonstrated in the group receiving 0.3 mg/kg. Good responses have been shown to produce improved survival. The combination of melphalan and prednisone is effective in producing good responses, but the dose of steroids is important. A dose of prednisone of 0.6 mg/kg in gradually decreasing doses has been found to be effective in production of good responses, especially in the uremic patient.

Topics: Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Melphalan; Multiple Myeloma; Prednisone; Prognosis; Remission, Spontaneous; Risk; Uremia

Twenty-four fully staged, previously untreated patients with advanced ovarian carcinoma were prospectively randomized to either intensive intravenous cyclophosphamide or conventional oral Melphalan therapy. The median durations of initial remissions (5 and 6 mo) and the median durations of survival (15 and 14 mo) were similar for the two regimens but the toxicity of the intensive regimen was excessive. Followup indicates that long term disease free survivals are possible in those patients who achieve complete remissions on chemotherapy alone as three of the four patients achieving complete remission in the present study remain free of disease with a median survival in excess of 30 mo. High dose intensive alkylating agent therapy in the manner used in the present study fails to enhance the response to chemotherapy and produces unacceptable toxicity.

Topics: Adenocarcinoma; Adenocarcinoma, Mucinous; Administration, Oral; Cyclophosphamide; Cystadenocarcinoma; Dose-Response Relationship, Drug; Female; Humans; Injections, Intravenous; Laparoscopy; Melphalan; Ovarian Neoplasms; Remission, Spontaneous; United States

Topics: Adult; Aged; Clinical Trials as Topic; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Prognosis; Remission, Spontaneous

Topics: Adult; Aged; Bone Neoplasms; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Remission, Spontaneous; Time Factors

Topics: Aniline Compounds; Antineoplastic Agents; Blood Sedimentation; Carmustine; Clinical Trials as Topic; Drug Synergism; Hemoglobinometry; Humans; Melphalan; Multiple Myeloma; Mustard Compounds; Prednisone; Procarbazine; Prognosis; Remission, Spontaneous

Topics: Antineoplastic Agents; Benzoates; Drug Combinations; Evaluation Studies as Topic; Humans; Immunoglobulin G; Melphalan; Multiple Myeloma; Prednisone; Procarbazine; Remission, Spontaneous

37 consecutive, previously untreated patients with advanced multiple myeloma (16 patients Stage II, 21 patients Stage III) were treated with a five drug regimen consisting of carmustine, melphalan, vincristine, cyclophosphamide and prednisolone (M-2-protocol) in a prospective manner. Remission was achieved in 24 patients (65%). The median time to remission was 10 weeks, the median duration of remission 15,3 months. Median survival time from the onset of treatment was 24 months for all patients. Responding patients have a projected 65% three year survival. Median survival in non-responders was 10 months. 8 patients died during the first year of treatment. These results do not confirm the favourable results with this drug combination obtained in a previous trial. The discrepancy may be explained by a higher proportion of poor risk patients in the present study.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Cyclophosphamide; Drug Therapy, Combination; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Remission, Spontaneous; Vincristine

Topics: Adenocarcinoma; Aged; Breast Neoplasms; Female; Humans; Leukemia, Erythroblastic, Acute; Melphalan; Pulmonary Fibrosis; Radiotherapy; Remission, Spontaneous

Sixty-eight previously untreated patients with IgG myeloma who were entered into five protocols of Cancer and Leukemia Group B (CALGB) were studied in order to determine the possible influence of excretion of kappa versus lambda urinary light chains on responses to treatment and survival. All patients in these protocols were included if the serum and urine protein abnormalities were confirmed by one of the two group reference laboratories. Pretreatment characteristics of the two groups of patients did not differ significantly. Of 44 patients with kappa Bence Jones proteinuria, 19 patients (43%) had good responses to treatment, whereas only 3 of 24 patients (13%) with lambda Bence Jones proteinuria had good responses (p = 0.02). Survival for the patients excreting kappa light chains was significantly better than survival for patients excreting lambda chains (median survival 31 versus 12 mo, p = 0.02).

Topics: Humans; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; Immunoglobulin Light Chains; Melphalan; Multiple Myeloma; Prednisone; Prognosis; Remission, Spontaneous; Testosterone

Topics: Adult; Antineoplastic Agents; Bone Marrow; Burns; Creatine Kinase; Electroencephalography; Etoposide; Female; Humans; Hyperthermia, Induced; L-Lactate Dehydrogenase; Male; Melanoma; Melphalan; Middle Aged; Neoplasm Metastasis; Neoplasms; Peripheral Nervous System Diseases; Remission, Spontaneous; Tachycardia

Topics: Acid Phosphatase; Aged; Drug Evaluation; Humans; Male; Melphalan; Middle Aged; Neoplasm Metastasis; Prostatic Neoplasms; Remission, Spontaneous

The effectiveness of chemoimmunotherapy was evaluated in 45 previously untreated stage III ovarian cancer patients. Response rate, progression-free interval, and survival were considerably better than in a similar group of 63 patients treated with a single alkylating agent alone.

Topics: Evaluation Studies as Topic; Female; Humans; Immunotherapy; Melphalan; Ovarian Neoplasms; Propionibacterium acnes; Remission, Spontaneous; Time Factors

Topics: Acid Phosphatase; Adenocarcinoma; Aged; Humans; Male; Melphalan; Middle Aged; Prostatic Neoplasms; Remission, Spontaneous; Time Factors

Topics: Adult; Aged; Bone Marrow; Drug Evaluation; Drug Therapy, Combination; Fluorouracil; Gastrointestinal Neoplasms; Humans; Melphalan; Middle Aged; Remission, Spontaneous

Topics: Chemotherapy, Cancer, Regional Perfusion; Dactinomycin; Drug Therapy, Combination; Extremities; Female; Hot Temperature; Humans; Male; Melanoma; Melphalan; Paralysis; Remission, Spontaneous; Sarcoma; Soft Tissue Neoplasms

A case of proved delayed recurrence of a granulosa cell tumor 18 years after initial diagnosis is presented. L-Phenylalanine mustard was given after radiation was refused for the unresectable mass. A prolonged complete remission was produced. The present status of palliative therapy of recurrent granulosa cell tumor is discussed with a request for the reporting of experiences with more patients treated with chemotherapy.

Topics: Female; Granulosa Cell Tumor; Humans; Melphalan; Middle Aged; Neoplasm Metastasis; Ovarian Neoplasms; Palliative Care; Remission, Spontaneous; Time Factors

Twenty-eight patients with multiple myeloma responding to prior melphalan-prednisone combinations, but without additional chemotherapy, were followed until relapse. Patients receiving no further treatment had a median survival time similar to that of those receiving indefinite courses of melphalan-prednisone or carmustine-prednisone. Prolonged periods of unmaintained remission occurred primarily in patients without extensive disease at the time of diagnosis or in whom the abnormal protein disappeared from the electrophoresis strip. The initial relapse after an unmaintained remission was controlled in 80% of patients with the resumption of melphalan-prednisone, but second remissions were usually less marked in degree and shorter in duration. Results supported the long-term evaluation without chemotherapy of selected patients with low numbers of plasma cells after treatment who were likely to experience long durations of disease stability and respond again to retreatment with melphalan-prednisone.

Topics: Cell Transformation, Neoplastic; Drug Therapy, Combination; Humans; Melphalan; Multiple Myeloma; Myeloma Proteins; Nitrosourea Compounds; Prednisone; Remission, Spontaneous; Time Factors

Criteria for the diagnosis of multiple myeloma and differential diagnostic considerations are presented. The indications for treatment are discussed. Combination of melphalan or cyclophosphamide with prednisone may be considered standard therapy today. This produces objective tumor regression in 50-70% of patients. The parameters for determining remission and their significance with regard to survival and tumor cell mass are discussed. The importance of supportive measures is stressed. Persistent problems and potential for improving present therapy are discussed.

Topics: Blood Transfusion; Cyclophosphamide; Drug Therapy, Combination; Humans; Melphalan; Multiple Myeloma; Orthopedic Equipment; Pain; Plasmapheresis; Prednisone; Prognosis; Remission, Spontaneous

Fourteen patients with multiple myeloma resistant to melphalan plus prednisone were treated with BCNU 50 mg/m2 plus cyclophosphamide 200 mg/m2 on day 1, adriamycin 20 mg/m2 on day 2 and prednisone 60 mg orally, daily for days 1 through 5. Therapy was repeated every four weeks. Depending upon criteria used, objective antitumor responses were achieved in five to nine of the 14 patients. Mean survival was 9.5 months and actuarial median survival was 7.0 months. Six patients are alive, four to 35 months after initiation of therapy. This preliminary report indicates that this combination may be a useful treatment program in the management of patients with advanced multiple myeloma. A review of studies employing adriamycin plus BCNU suggests that these regimens currently offer the most effective treatment of melphalan-resistant patients.

Topics: Aged; Antineoplastic Agents; Bone Marrow; Carmustine; Cyclophosphamide; Doxorubicin; Drug Resistance; Drug Therapy, Combination; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Prednisone; Remission, Spontaneous; Time Factors

Of 476 patients with multiple myeloma treated during a 9-year period, 11 developed acute myelogenous leukemia or sideroblastic anemia. In all, the myeloma was in remission from chemotherapy with melphalan-prednisone combinations that had been continued for a median duration of 3 years. The incidence of acute leukemia or sideroblastic anemia was about 100 times higher than found in normal individuals of the same age. In all patients studied, major cytogenetic abnormalities were present, with hypodiploidy and evidence of chromosomal damage being noted most frequently. The frequency and nature of the chromosome changes were attributed to effects resulting from the prolonged drug therapy. These findings supported the long-term follow-up of selected patients with myeloma without any chemotherapy when marked degrees of remission followed the initial treatment courses.

Topics: Aged; Chromosomes; Diploidy; Female; Humans; Leukemia, Myeloid, Acute; Long-Term Care; Male; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Remission, Spontaneous

Topics: Adult; Age Factors; Aged; Anemia; Blood Urea Nitrogen; Calcium; Cyclophosphamide; Drug Evaluation; Female; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Prognosis; Remission, Spontaneous; Serum Albumin; Serum Globulins; Time Factors; Uric Acid

Topics: Amyloidosis; Drug Therapy, Combination; Humans; Immunoglobulin D; Immunoglobulin Light Chains; Male; Melphalan; Multiple Myeloma; Nails; Prednisone; Remission, Spontaneous; Sebaceous Glands; Skin Diseases

Topics: Antineoplastic Agents; Carmustine; Cyclophosphamide; Drug Therapy, Combination; Female; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Male; Melphalan; Middle Aged; Multiple Myeloma; Prednisone; Remission, Spontaneous; Time Factors; Vincristine

Topics: Adrenal Cortex Hormones; Adult; Aged; Cyclophosphamide; Drug Therapy, Combination; Female; Humans; Male; Melphalan; Middle Aged; Plasmacytoma; Remission, Spontaneous; Urethane

The peripheral blood cells of a patient with acute plasma cell leukemia were examined with transmission (TEM) and scanning (SEM) electron microscopes. The TEM features of the immature plasma cells comprised lobulated and irregulary shaped nuclei, with scanty heterochromating and bizarre nucleoli, parallel arrays of endoplasmic reticulum, cytoplasmic fibrils and numerous polymorphic mitochondria. SEM examination of the cells showed long, thin irregular ruffles, or round blebs on the cell surface, with appearance different from this observed on other types of leukemia. A remarkable clinical and hematological remission was achieved with administration of melphalan and steroids.

Topics: Acute Disease; Cell Nucleolus; Cell Nucleus; Endoplasmic Reticulum; Humans; Leukemia, Plasma Cell; Male; Melphalan; Microscopy, Electron; Microscopy, Electron, Scanning; Middle Aged; Mitochondria; Plasma Cells; Prednisone; Remission, Spontaneous

Serial changes in tumor mass were evaluated in 61 patients with multiple myeloma who had received intermittent courses of melphalan-prednisone until death. The variations in the kinetics of tumor reduction and relapse could be explained by a mathematical model based on two cell populations, one sensitive to and one resistant to chemotherapy. For all responding patients, the median tumor halving-time was 1.3 months and the median doubling time was 2.9 months. The duration of a constant tumor mass during remission was brief in most patients. A larger fraction of resistant cells prior to therapy was associated with a slower tumor doubling-time during relapse. With a constant fractional reduction of sensitive cells and a tumor halving-time of one month or less, all cells sensitive to alkylating agents would be eliminated with 3 years of uninterrupted intermittent therapy.

Topics: Cell Division; Female; Humans; Kinetics; Male; Melphalan; Middle Aged; Models, Biological; Multiple Myeloma; Prednisone; Remission, Spontaneous

Asaley is an L-leucine derivative of sarcolysin which is more active against some rodent tumors. Studies in the USSR demonstrated activity in patients with ovarian and breast carcinoma, Hodgkin's disease, and multiple myeloma. This study in 73 evaluable patients indicated that an appropriate oral dose for patients with adequate bone marrow is 800 mg/M2/day X 4 days at 5-6 week intervals. The most common toxicities were myelosuppression, nausea, and vomiting. Antitumor activity was observed in 2 of 24 evaluable patients with melanoma, and stabilization of previously progressive disease was observed in patients with adenocarcinoma of the colon, multiple myeloma, lymphoma, breast carcinoma, and thyroid carcinoma. Responses were minimal and of short duration but most of the patients had received extensive prior therapy.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Animals; Bone Marrow; Colonic Neoplasms; Drug Administration Schedule; Drug Evaluation; Female; Humans; Male; Melanoma; Melphalan; Middle Aged; Multiple Myeloma; Nausea; Neoplasm Metastasis; Neoplasms; Rats; Remission, Spontaneous; Vomiting

Topics: Adult; Amyloidosis; Antigens; Cadaver; Colchicine; Female; Humans; Immune Complex Diseases; Immunoglobulin Light Chains; Kidney; Kidney Diseases; Kidney Transplantation; Male; Melphalan; Middle Aged; Postoperative Complications; Remission, Spontaneous; Renal Dialysis; Transplantation, Homologous

Topics: Asparaginase; Child; Cyclophosphamide; Cytosine; Daunorubicin; Doxorubicin; Drug Therapy, Combination; Hodgkin Disease; Humans; Infant; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Lymphoma; Melphalan; Mercaptopurine; Methotrexate; Neoplasms; Nitrogen Mustard Compounds; Osteosarcoma; Prednisone; Procarbazine; Prognosis; Remission, Spontaneous; Rhabdomyosarcoma; Teniposide; Thioguanine; Vincristine; Wilms Tumor

A 41-year-old woman, presenting with renal failure, renal glucosuria and moderate anemia, was found to have light chain myeloma, indicated by a kappa chain M-component in the serum, heavy urinary excretion of kappa chains and plasma cell infiltration of the bone marrow. After administration of one course of melphalan, resulting in transient pancytopenia, the light chains disappeared completely, renal function returned to normal, glucosuria disappeared and the Hb concentration normalized. During an observation period of six years she has remained in good health and there has been no sign of relapse.

Topics: Adult; Female; Glycosuria; Humans; Immunoglobulin kappa-Chains; Immunoglobulin Light Chains; Kidney Diseases; Leukopenia; Melphalan; Multiple Myeloma; Remission, Spontaneous; Time Factors

A 30-year-old Turk was admitted with signs of exudative enteropathy together with malabsorption. There was no improvement on a gluten-free diet. Immunological investigations demonstrated atypical IgA-immunoglobulin in the serum which did not precipitate with antisera against L-chains. Peroral ileal biopsy and surgical biopsy material showed a diffuse proliferation of plasma cells in an altered ileal mucosa and in the mesenteric lymph nodes. Skeletal X-rays showed no osteolysis and the bone marrow showed no evidence for multiple myeloma. Treatment with melphalan and steroids resulted in a three year remission. In the terminal stage an intra-abdominal malignant lymphoma developed.

Topics: Adrenal Cortex Hormones; Adult; Biopsy; Heavy Chain Disease; Humans; Immunoglobulin alpha-Chains; Immunoglobulin Heavy Chains; Intestine, Small; Malabsorption Syndromes; Male; Melphalan; Plasma Cells; Protein-Losing Enteropathies; Remission, Spontaneous

Topics: Antineoplastic Agents; Carmustine; Cyclophosphamide; Drug Therapy, Combination; Humans; Melphalan; Multiple Myeloma; Plasmacytoma; Prednisolone; Prognosis; Remission, Spontaneous; Testosterone

Topics: Adult; Aged; Antineoplastic Agents; Chlorambucil; Cyclophosphamide; Drug Therapy, Combination; Female; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Male; Melphalan; Middle Aged; Plasmacytoma; Prognosis; Remission, Spontaneous

Lymphocyte-mediated cytotoxicity (cell-mediated immunity) to ovarian carcinoma cells and serum blocking factor were measured in 37 patients. Short-term cultures of tumor cells and a low ratio of effector to target cells were used throughout the study, minimizing nonspecific cytotoxicity. Sixteen patients were followed for long periods of time, and correlation with the course of the disease and with therapy could be obtained. Although the level of cell-mediated immunity did not always correspond to the clinical status of the patient, the presence of blocking factor was associated with clinical relapse in 14 of 16 patients. Chemotherapy with single alkylating agents or combinations of drugs caused no significant or permanent depression of cell-mediated immunity as measured in this way. In addition, blocking factor disappeared in 2 patients during remission. It appears that the chemotherapy for ovarian carcinoma may not be significantly immunosuppressive against established levels of cell-mediated immunity and may in certain instances have effects potentially beneficial to the host as evaluated by lymphocyte-mediated cytotoxicity and blocking factor studies.

Topics: Antibodies, Neoplasm; Antigen-Antibody Complex; Antigens, Neoplasm; Cytotoxicity Tests, Immunologic; Female; Follow-Up Studies; Humans; Immunity, Cellular; Melphalan; Ovarian Neoplasms; Recurrence; Remission, Spontaneous

In a patient with essential cryoglobulinemia with systemic, cutaneous, and neurologic manifestations and a mixed IgG-IgM cryoprotein, elimination of systemic and cutaneous disease manifestations, as well as notable reversal of neurologic impairment, followed therapy with melphalan. Levels of circulating cryoprotein decreased, but protein structure was unchanged by chemotherapy. Experience to date with alkylating agents suggests that this mode of treatment is the most effective currently available.

Topics: Cryoglobulins; Female; Humans; Immunoglobulin G; Immunoglobulin M; Melphalan; Middle Aged; Neurologic Manifestations; Paraproteinemias; Prednisone; Remission, Spontaneous; Skin Manifestations

Because cross-resistance between alkylating agents has not been observed, we attempt in a prospective trial to determine the advantages, if any, in administering three alkylating agents sequentially, alternately, or concurrently. A patient with myeloma, showing progressive shortening of M-protein doubling time from 98 to 15 days, developed an acute terminal phase, characterized by fever and pancytopenia. A similar acute terminal phase was observed in 17 of 50 deaths from myeloma. Since alkylating agents are only effective in controlling the chronic phase of myeloma, future improvements will require the discovery of agents that delay, prevent, or are effective in the treatment of the acute phase. Forty-five patients with kappa- and 36 with lambda-light-chain disease showed no differences in frequency of amyloidosis, renal failure, response to treatment, or survival after treatment with alkylating agents.

Topics: Acute Disease; Alkylating Agents; Bence Jones Protein; Bone Neoplasms; Carmustine; Cell Count; Cyclophosphamide; Drug Therapy, Combination; Humans; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; Mechlorethamine; Melphalan; Multiple Myeloma; Myeloma Proteins; Prednisone; Remission, Spontaneous; Time Factors

Topics: Adult; Blood Protein Disorders; Dexamethasone; Drug Therapy, Combination; Female; Humans; Melphalan; Plasmacytoma; Remission, Spontaneous

A patient with primary amyloidosis with evidence for a plasma cell dyscrasia but no abnormal immunoglobulin components had nephrotic syndrome with severe renal impairment. Kidney and bone marrow had extensive amyloid infiltration. She was treated with penicillamine, malphalan, prednisone, and fluoxymesterone; through 6 months renal function gradually improved; urine protein excretion dropped dramatically, serum albumin rose; liver size decreased; the bone marrow returned towards normal. During the next 4 1/2 years melphalan, prednisone, and fluoxymesterone treatment was continued with further improvement in renal function to normal levels. The morphologic characteristics and cellular relations of amyloid fibrils in the bone marrow were studied before, during, and after successful chemotherapy; the findings are evidence for a dual role for the reticuloendothelial cell in the formation and destruction of primary amyloidosis. This patient's response suggests that a multi-agent chemotherapy approach should be further studied.

Topics: Adult; Amyloidosis; Biopsy; Bone Marrow; Bone Marrow Cells; Female; Fluoxymesterone; Humans; Kidney Glomerulus; Melphalan; Microscopy, Electron; Nephrotic Syndrome; Penicillamine; Phagocytosis; Prednisone; Remission, Spontaneous

Topics: Cyclophosphamide; Humans; Male; Melphalan; Middle Aged; Plasmacytoma; Remission, Spontaneous

Topics: Acid Phosphatase; Cyclophosphamide; Cytarabine; Drug Therapy, Combination; Fluorescent Antibody Technique; Glucuronidase; Histocytochemistry; Humans; Immunoelectrophoresis; Immunoglobulin Fragments; Karyotyping; Leukemia, Plasma Cell; Male; Melphalan; Microscopy, Electron; Microscopy, Fluorescence; Middle Aged; Plasma Cells; Prednisone; Prognosis; Remission, Spontaneous; Staining and Labeling; Vincristine

Topics: Chlorambucil; Cyclophosphamide; Dermatitis, Exfoliative; Humans; Keratoderma, Palmoplantar; Lymphatic Diseases; Lymphoma; Melphalan; Methotrexate; Nitrogen Mustard Compounds; Prednisone; Pruritus; Remission, Spontaneous; Syndrome; Time Factors; Triethylenemelamine; Vinblastine

Topics: Antistreptolysin; Arthritis; Clone Cells; Electrophoresis; Female; Humans; Immunoelectrophoresis; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Necrosis; Radiography; Remission, Spontaneous; Skull; Spine; Tonsillitis

Topics: Animals; Antineoplastic Agents; Biological Assay; Carmustine; Cyclohexanes; Cyclophosphamide; Cytarabine; Daunorubicin; Disease Models, Animal; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Fluorouracil; Hodgkin Disease; Humans; Leukemia; Leukemia L1210; Leukemia, Experimental; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Lymphoma; Male; Mechlorethamine; Melphalan; Mice; Mice, Inbred AKR; Multiple Myeloma; Nitrosourea Compounds; Prednisone; Remission, Spontaneous; Vinblastine; Vincristine

Topics: Bence Jones Protein; Bone Neoplasms; Electrophoresis; Female; Fluorescent Antibody Technique; Humans; Immunoelectrophoresis; Immunoglobulins; Male; Melphalan; Middle Aged; Multiple Myeloma; Remission, Spontaneous

Topics: Blood Cell Count; Bloodletting; Humans; Melphalan; Polycythemia Vera; Remission, Spontaneous

Topics: Chlorambucil; Humans; Hydroxyurea; Melphalan; Phosphorus Isotopes; Polycythemia Vera; Remission, Spontaneous; Time Factors

Topics: Chlorambucil; Cyclophosphamide; Humans; Melphalan; Multiple Myeloma; Prednisone; Purpura, Hyperglobulinemic; Remission, Spontaneous; Time Factors

Topics: Adult; Aged; Blood Urea Nitrogen; Bone Regeneration; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Prednisone; Procarbazine; Radiography; Remission, Spontaneous; Skull; Texas

Topics: Adenocarcinoma; Adult; Aged; Carcinoma; Carcinoma, Squamous Cell; Chemotherapy, Cancer, Regional Perfusion; Female; Humans; Male; Melphalan; Middle Aged; Parotid Neoplasms; Remission, Spontaneous; Thiotepa

Topics: Ambulatory Care; Antineoplastic Agents; Chlorambucil; Cyclophosphamide; Drug Combinations; Estrogens; Female; Hospitalization; Humans; Melphalan; Methotrexate; Ovarian Neoplasms; Prognosis; Remission, Spontaneous; Thiotepa; Triaziquone

Topics: Cytarabine; Humans; Leukemia, Myeloid, Acute; Male; Melphalan; Middle Aged; Multiple Myeloma; Remission, Spontaneous