Four cases of therapy-related leukemia in multiple myeloma

We have experienced 4 cases of therapy-related leukemia (TRL) in 119 patients with multiple myeloma (MM) who had received combination chemotherapy including alkylating agents between 1988 and 1998. All 4 cases were acute myelogenous leukemia, 3 were males and 1 was female. Median age at diagnosis of MM was 60 years, and median time to TRL from diagnosis of MM was 5.5 years. The chromosome abnormalities were found in 3 of those cases. All 4 cases were resistant to antileukemic chemotherapy, and median survival time from TRL was only 5.5 months. The TRL in MM is thought to be a more important problem, because recently the treatment for this disease has become more intensive, including high-dose chemotherapy supported by autologous stem cell transplantation.     

Antitumor activity of histone deacetylase inhibitors in non-small cell lung cancer cells: development of a molecular predictive model

To ascertain the potential for histone deacetylase (HDAC) inhibitor-based treatment in non-small cell lung cancer (NSCLC), we analyzed the antitumor effects of trichostatin A (TSA) and suberoylanilide hydroxamic acid (vorinostat) in a panel of 16 NSCLC cell lines via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. TSA and vorinostat both displayed strong antitumor activities in 50% of NSCLC cell lines, suggesting the need for the use of predictive markers to select patients receiving this treatment. There was a strong correlation between the responsiveness to TSA and vorinostat (P < 0.0001). To identify a molecular model of sensitivity to HDAC inhibitor treatment in NSCLC, we conducted a gene expression profiling study using cDNA arrays on the same set of cell lines and related the cytotoxic activity of TSA to corresponding gene expression pattern using a modified National Cancer Institute program. In addition, pathway analysis was done with Pathway Architect software. We used nine genes, which were identified by gene-drug sensitivity correlation and pathway analysis, to build a support vector machine algorithm model by which sensitive cell lines were distinguished from resistant cell lines. The prediction performance of the support vector machine model was validated by an additional nine cell lines, resulting in a prediction value of 100% with respect to determining response to TSA and vorinostat. Our results suggested that (a) HDAC inhibitors may be promising anticancer drugs to NSCLC and (b) the nine-gene classifier is useful in predicting drug sensitivity to HDAC inhibitors and may contribute to achieving individualized therapy for NSCLC patients.     

Critical assessment of the methylphenidate transdermal system

Introduction of the methylphenidate transdermal system (MTS) provides a different way of delivery for the most widely prescribed agent used to treat attention-deficit hyperactivity disorder (ADHD). The MTS delivery system provides good absorption of the active ingredient. Maximal plasma concentration of methylphenidate occurs from seven to nine hours after patch placement. Onset of action in pharmacodynamic studies has been registered at the two-hour mark after patch placement. As a result of the transdermal delivery system, the effect of first-pass metabolism is greatly diminished. Removal of the patch is associated with a biexponential decrease in methylphenidate levels. Recommended placement of the MTS is on a patient's hip, with a suggested application time of nine hours. Efficacy was demonstrated at all time points measured in ADHD, from 2-12 hours. Most adverse events reported were mild to moderate in severity; the most frequent adverse events reported were disturbances in sleep and appetite.     

Tumor doubling time and local immune response to hepatic metastases from colorectal cancer

BACKGROUND AND OBJECTIVES: A number of studies have investigated the role of tumor-infiltrating lymphocytes in cancer, yet the local immune response to hepatic colorectal cancer metastasis remains unclear. As the tumor doubling time (DT) of hepatic colorectal cancer metastases is a good index of tumor growth, we examined the correlation between tumor DT and the local immune response by phenotype in hepatic colorectal cancer metastases. METHODS: Tumor DT and local immune response were examined in 20 patients with hepatic colorectal cancer metastases by analyzing tumor-infiltrating lymphocytes using flow cytometry or immunohistochemical studies. Tumor proliferative activity was also investigated by determining the expression levels of Ki-67 and proliferating cell nuclear antigen (PCNA). RESULTS: Locally abundant populations of CD83(+) dendritic cells (DCs) and CD8(+) T cells were positively related to longer tumor DT (P < 0.05), as were abundant CD8(+) T cells having interferon-gamma-producing potentials (P < 0.05). There was no significant correlation between tumor cell expression levels of Ki-67 or PCNA and tumor DT. CONCLUSIONS: Longer DT tumors have increased local populations of CD8(+) T cells and CD83(+) DCs even in hepatic colorectal cancer metastases.     

Sevoflurane with continuous epidural anesthesia for removal of pheochromocytoma

A 66-year-old female was scheduled for right adrenalectomy because of a pheochromocytoma. Preoperative blood pressure was well controlled with an alpha.beta blocker, amosulalol hydrochloride 40 mg per day po for 2 weeks. The patient received midazolam 2.5 mg im and scopolamine 0.4 mg im 60 minutes before induction. Anesthesia was induced with midazolam 5 mg iv, fentanyl 0.1 mg iv and vecuronium 12 mg iv, and maintained with continuous epidural infusion of 1.5% lidocaine, and inhalation of 66% nitrous oxide in oxygen and sevoflurane (0.5-3%). Blood pressure was controlled with nicardipine (1-6 micrograms.kg-1.min-1) before removal of the pheochromocytoma. After removal of the tumor blood pressure was maintained with intravenous infusion of lactated Ringer's solution, dopamine (3-8 micrograms.kg-1.min-1), dobutamine (3-8 micrograms.kg-1.min-1) and norepinephrine (0.1-0.2 micrograms.kg-1.min-1). A combination of continuous epidural block and sevoflurane anesthesia was very useful for removal of the pheochromocytoma. Swan-Ganz catheter monitoring was also very useful before and during operation to determine the optimal doses of nicardipine, catecholamine and the volume of transfusion.     

Oral administration of chicken breast extract increases brain carnosine and anserine concentrations in rats

Carnosine (beta-alanyl-L-histidine) and its derivative anserine (beta-alanyl-1-methyl-L-histidine) are antioxidants and putative neurotransmitters in the brain. These dipeptides are rich in the commercially available supplement chicken breast extract (CBEX). To clarify the effects of CBEX on the brain, we examined whether single oral administration of CBEX (20 ml/kg) affects brain dipeptide and free amino acid concentrations in male Wistar rats. CBEX significantly and time-dependently increased carnosine and anserine levels in the plasma (at 120 min after injection, increase rates were 2976 and 4142%, respectively), hippocampus (64 and 78%), and hypothalamus (188 and 120%), but not in cerebral cortex. Significant and time-dependent increases in citrulline in the hippocampus (49%) and hypothalamus (41%) demonstrated generation of nitric oxide due to the increased carnosine and/or anserine levels in these brain regions. These findings suggest that CBEX modifies brain functions by increasing levels of these dipeptides.     

Prognostic factors in elderly multiple myeloma patients aged 65 years or older: Comparison with nonelderly patients with multiple myeloma

Background:   Although age is a prognostic factor in multiple myeloma (MM), the prognostic factors in elderly MM patients may be different to those in nonelderly MM patients due to the patient's age. The difference in the significance of prognostic factors between elderly MM patients and the nonelderly MM patients was studied.
Methods:   Forty-two elderly MM patients aged 65 years or older were compared with 68 nonelderly MM patients, who were less than 65 years of age. The characteristics of the elderly patients included: aged 65–81 years (median, 72 years); female/male ratio of 22 : 20; 24 IgG type cases, 13 IgA type cases, one non-secretory case and four cases of Bence-Jones type; one case of stage I, 12 cases at stage II and 29 cases at stage III. The prognostic factors were evaluated by means of univariate analysis and Cox's multivariate analysis.
Results:   The median survival time was significantly shorter in the elderly MM patients (24 months) than in the nonelderly patients (50 months) ( P  < 0.01). Of the univariate prognostic factors, corrected serum Ca (cCa), hemoglobin, serum P, bone marrow plasma cell and uric acid were significant prognostic factors in the elderly MM patients, while nine factors including those listed here, were significant in nonelderly controls. Multivariate analysis showed that serum cCa was the only independent prognostic factor ( P  = 0.019) in elderly MM patients, while serum P and bone lesions were significant prognostic factors in nonelderly MM patients.
Conclusion:   Corrected serum c. (cCa) was an independent prognostic factor in elderly MM patients.