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CHEMOTHERAPY OF ADVANCED HISTIOCYTIC LYMPHOMAS
129 weeks. Using this regimen, response characteristically occurred within two courses of therapy and was dramatic in 5 (19%), and was objectively good in 12 (44%): the remaining 10 (37%) either failed to respond or had only slight objective change. Side-effects were very mild and, significantly, myelotoxicity was not a limiting factor. The schedule was very acceptable to patients, but 8 of the 17 patients (47%) who responded well relapsed within three months. The addition of 500 mg. per sq.m. of cyclophosphamide to the regimen at this stage resulted in remission again being achieved in these patients. We conclude that VP 16-213 is effective in diffuse histiocytic lymphoma but of limited value when used on its own. Prospective studies are now in progress role in combination therapy.
to
evaluate its
We thank Sandoz for the VP 16-213.
7.0 S
1 U
am.
1
7.45
pm. p.m. lymphocyte-antigen (purified
Departments of Haematology and Radiotherapy, University of Cape Town and Groote Schuur Hospital, Observatory 7900, South Africa.
Effect of naudicelle capsules on protein derivative of tubercle) interaction as measured by slowing of macrophage electrophoretic mobility.e’s
Arrows indicate 2 capsules taken. Normal subject fasting (except for black coffee) until third set of capsules. L.A.L.A.= linoleic-acid-like activity. Ether-soluble fraction is that extracted from serum by ether, leaving the unaltered protein moiety.
animals appeared healthy. All animals on a vitamin-rich Oxoid breeders’ diet. In 6 control
were
maintained
(oleic acid) animals tail-graft survival averaged
12-5 ±1-87 days (range 10-15 days). In the experimental group (9 mice) mean tail-graft survival was 14°9 2°02 days (range 12-18 days). p= 0-05-0-025—a level of significance we are reluctant to accept. In a second experiment, skin was grafted on to CBA mice, and in both control and experimental groups all animals showed rejection between the llth and 13th days. We would treat the result of both naudicelle series with caution, since clearly the oleic acid did produce much more local reaction (and therefore perhaps more stress) than did naudicelle itself.
We agree with Mertin that there is a need for " extended in vitro and in vivo investigations into the role of PUFAs in immunity " but would caution against the too-ready acceptance of the results of inadequately controlled animal studies in formulating policies and dosage regimens for clinical trials in human subjects.
Newcastle University Hospitals, Newcastle upon Tyne.
P. R. ULDALL R. WILKINSON M. I. MCHUGH E. J. FIELD B. K. SHENTON K. BAXBY R. M. R. TAYLOR.
CHEMOTHERAPY OF ADVANCED HISTIOCYTIC LYMPHOMAS SIR,-We read with interest the letter by Dr Sweet and his colleagues (May 17, p. 1136) on this subject. We have also found M.o.p.p. and c.o.p.p. of limited value in stage III and IV disease, and one year ago we began an evaluation of the epipodophyllotoxin VP 16-213. Early results 10 in 27 patients are encouraging. Of these 27 patients, 20 had previously failed to respond to all other forms of chemotherapy and radiotherapy. Induction of remission was attempted by intravenous administration of 60 mg. per sq.m. VP 16-213 daily for five consecutive days every two 8. 9. 10.
Field, E. J., Caspary, E. A. Lancet, 1970, ii, 1137. Caspary, E. A., Field, E. J. Br. med. J. 1971, i, 612. Jacobs, P., King, H. S., Sealy, G. R. H. S. Afr. med. J. 1975, 49, 483.
PETER JACOBS HELEN S. KING.
N.B.T. TEST AND S.L.E.
SiR,—Your periodical has given attention
to the evaluatest.1-3 We have used this test4 in two groups of patients with systemic lupus erythematosus (S.L.E. with fever, cough, and radiological evidence of pulmonary involvement) in order to distinguish S.L.E. exacerbation (lupus pulmonary infiltration) from bacterial pneumonia. In a group of ten patients with lupus pulmonary infiltration the N.B.T. test was negative (5%, range [normal 6%, range 2-10%]), and further treatment with immunodepressants and glucocorticoids sufficed. In another group of ten s.L.E. patients with bacterial pneumonia (confirmed bacteriologically) the N.B.T. test was positive (28%, range 20-40%). Additional antibiotic treatment appeared to be effective in these cases. Thus the N.B.T. test can be applied to the differential diagnosis of lupus pulmonary infiltration from the bacterial pneumonia which often complicates s.L.E.
tion of the
N.B.T.
2-8%
Hospital Therapy Department, Medical Institute, Novosibirsk 630091, U.S.S.R.
ALEK A. DEMIN.
MEDICAL AID TO DEVELOPING COUNTRIES
SIR,-Mr Dass’s point of view (June 21,
interesting reading.
I
p. 1373) makes gather he is writing mostly about
India. He suggests that the " economic lure of the West " is the only reason for the migration of the technically expert. If this were entirely true, Britain would find it very hard indeed to get any doctors from the Subcontinent. Corruption, nepotism, and gross political interference in almost every walk of life are but a few of the other motivating factors. I graduated from a first-class medical college (Roman Catholic and hence not under State aegis) in Bangalore in South India and returned to my home State of Madras to apply for a post in the Government service seeking to work anywhere, even in the remotest primary health centre. After months of delay, I was told that, as I had graduated from outside the State of Madras, I was ineligible for service there. Local graduates had to be accommodated first. I returned to the State of Mysore, only to be told that, as I was a Tamil Madrasi and not a 1. Lancet, 1974, i, 664. 2. Nathan, G. ibid. 1975, i, 225. 3. Freeman, R., King, B. ibid. p. 104. 4. Gordon, A., Rowan, R., Brown, T., 1973, 26, 52.
Carson, H. G. J. clin. Path.
to
evaluate its
We thank Sandoz for the VP 16-213.
7.0 S
1 U
am.
1
7.45
pm. p.m. lymphocyte-antigen (purified
Departments of Haematology and Radiotherapy, University of Cape Town and Groote Schuur Hospital, Observatory 7900, South Africa.
Effect of naudicelle capsules on protein derivative of tubercle) interaction as measured by slowing of macrophage electrophoretic mobility.e’s
Arrows indicate 2 capsules taken. Normal subject fasting (except for black coffee) until third set of capsules. L.A.L.A.= linoleic-acid-like activity. Ether-soluble fraction is that extracted from serum by ether, leaving the unaltered protein moiety.
animals appeared healthy. All animals on a vitamin-rich Oxoid breeders’ diet. In 6 control
were
maintained
(oleic acid) animals tail-graft survival averaged
12-5 ±1-87 days (range 10-15 days). In the experimental group (9 mice) mean tail-graft survival was 14°9 2°02 days (range 12-18 days). p= 0-05-0-025—a level of significance we are reluctant to accept. In a second experiment, skin was grafted on to CBA mice, and in both control and experimental groups all animals showed rejection between the llth and 13th days. We would treat the result of both naudicelle series with caution, since clearly the oleic acid did produce much more local reaction (and therefore perhaps more stress) than did naudicelle itself.
We agree with Mertin that there is a need for " extended in vitro and in vivo investigations into the role of PUFAs in immunity " but would caution against the too-ready acceptance of the results of inadequately controlled animal studies in formulating policies and dosage regimens for clinical trials in human subjects.
Newcastle University Hospitals, Newcastle upon Tyne.
P. R. ULDALL R. WILKINSON M. I. MCHUGH E. J. FIELD B. K. SHENTON K. BAXBY R. M. R. TAYLOR.
CHEMOTHERAPY OF ADVANCED HISTIOCYTIC LYMPHOMAS SIR,-We read with interest the letter by Dr Sweet and his colleagues (May 17, p. 1136) on this subject. We have also found M.o.p.p. and c.o.p.p. of limited value in stage III and IV disease, and one year ago we began an evaluation of the epipodophyllotoxin VP 16-213. Early results 10 in 27 patients are encouraging. Of these 27 patients, 20 had previously failed to respond to all other forms of chemotherapy and radiotherapy. Induction of remission was attempted by intravenous administration of 60 mg. per sq.m. VP 16-213 daily for five consecutive days every two 8. 9. 10.
Field, E. J., Caspary, E. A. Lancet, 1970, ii, 1137. Caspary, E. A., Field, E. J. Br. med. J. 1971, i, 612. Jacobs, P., King, H. S., Sealy, G. R. H. S. Afr. med. J. 1975, 49, 483.
PETER JACOBS HELEN S. KING.
N.B.T. TEST AND S.L.E.
SiR,—Your periodical has given attention
to the evaluatest.1-3 We have used this test4 in two groups of patients with systemic lupus erythematosus (S.L.E. with fever, cough, and radiological evidence of pulmonary involvement) in order to distinguish S.L.E. exacerbation (lupus pulmonary infiltration) from bacterial pneumonia. In a group of ten patients with lupus pulmonary infiltration the N.B.T. test was negative (5%, range [normal 6%, range 2-10%]), and further treatment with immunodepressants and glucocorticoids sufficed. In another group of ten s.L.E. patients with bacterial pneumonia (confirmed bacteriologically) the N.B.T. test was positive (28%, range 20-40%). Additional antibiotic treatment appeared to be effective in these cases. Thus the N.B.T. test can be applied to the differential diagnosis of lupus pulmonary infiltration from the bacterial pneumonia which often complicates s.L.E.
tion of the
N.B.T.
2-8%
Hospital Therapy Department, Medical Institute, Novosibirsk 630091, U.S.S.R.
ALEK A. DEMIN.
MEDICAL AID TO DEVELOPING COUNTRIES
SIR,-Mr Dass’s point of view (June 21,
interesting reading.
I
p. 1373) makes gather he is writing mostly about
India. He suggests that the " economic lure of the West " is the only reason for the migration of the technically expert. If this were entirely true, Britain would find it very hard indeed to get any doctors from the Subcontinent. Corruption, nepotism, and gross political interference in almost every walk of life are but a few of the other motivating factors. I graduated from a first-class medical college (Roman Catholic and hence not under State aegis) in Bangalore in South India and returned to my home State of Madras to apply for a post in the Government service seeking to work anywhere, even in the remotest primary health centre. After months of delay, I was told that, as I had graduated from outside the State of Madras, I was ineligible for service there. Local graduates had to be accommodated first. I returned to the State of Mysore, only to be told that, as I was a Tamil Madrasi and not a 1. Lancet, 1974, i, 664. 2. Nathan, G. ibid. 1975, i, 225. 3. Freeman, R., King, B. ibid. p. 104. 4. Gordon, A., Rowan, R., Brown, T., 1973, 26, 52.
Carson, H. G. J. clin. Path.