melphalan and Sclerosis

Pharmacokinetic modeling has suggested, and clinical investigations have confirmed, that intracavitary drug administration can result in a much greater drug exposure for the cavity into which the agent is instilled compared to the plasma. Both the safety and the efficacy of several agents administered individually or in combination have now been demonstrated. Several malignancies, in particular ovarian carcinoma and malignant mesothelioma, which remain confined to body cavities for much of their natural history, might be most rationally treated by the intracavitary treatment approach. Early clinical trials have demonstrated significant activity of intracavitary chemotherapy in both of these malignancies. Optimal drugs and dosages as well as appropriate scheduling for the various tumors involving body cavities remain to be defined. Whether or not combination intracavitary chemotherapy will significantly improve survival of patients with malignant disease confined to body cavities must await carefully controlled clinical trials comparing this treatment approach to standard systemically administered chemotherapy.

Topics: Absorption; Animals; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Ascitic Fluid; Bacterial Infections; Bleomycin; Cisplatin; Cytarabine; Diffusion; Doxorubicin; Drug Synergism; Female; Fluorouracil; Humans; Immunotherapy; Melphalan; Methotrexate; Mitomycins; Neoplasms; Ovarian Neoplasms; Peritoneal Cavity; Permeability; Pleura; Pleural Effusion; Radiation-Sensitizing Agents; Sclerosis; Streptozocin

Scleromyxedema is a rare fibromucinous disorder that is often difficult to treat and that is associated with significant morbidity and mortality.. Our purpose was to study the natural history of the disease and its response to therapy with alkylating agents.. A clinicopathologic review of 26 patients with scleromyxedema was performed, and the extracutaneous findings and response to therapy with alkylating agents were noted.. Extracutaneous manifestations, most often gastrointestinal, were present in 20 of 26 patients. An abnormal paraprotein was found in 23 of 26 patients, most commonly IgG-lambda (18 patients). Melphalan was used as therapy for 17 patients. The disease proved fatal in 10 of the treated patients.. The overall prognosis in scleromyxedema is poor. Therapy is difficult. Although alkylating agents may prove beneficial in the short term, significant toxicity of these agents is apparent with long-term use.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Male; Melphalan; Middle Aged; Myxedema; Sclerosis; Skin

Topics: Blood Protein Disorders; gamma-Globulins; Humans; Male; Melphalan; Middle Aged; Sclerosis; Skin Diseases