Endangering cutaneous infantile hemangioma treated with vincristine: a case report

Infantile hemangiomas are the most common tumors of childhood. They have a well-defined self-limiting natural history. In about 10% of patients, the hemangioma threatens or potentially threatens life or function during the proliferative phase. The most common treatments for such endangering hemangiomas are intralesional and/or oral steroids. Although steroids are well known to slow growth and promote involution in hemangiomas, there may be no effect on proliferation in up to 30% of patients. There are several reports of the use of intravenous vincristine being successfully used for steroid-resistant hemangiomas, although most of these have been described as hemangioendotheliomas. The degree of improvement in such cases is somewhat subjective. We describe a patient with a large steroid-resistant cervicofacial infantile hemangioma causing stridor. The use of intravenous vincristine rapidly improved the clinical state so much that immediate tracheostomy was avoided, and adrenaline nebulizers could be stopped within 1 day of starting vincristine. We believe that this is the first report of objective improvement in the symptom associated with an infantile hemangioma as a result of treatment with vincristine.     

5-氟尿嘧啶、长春新碱与去甲二氢愈创木酸配伍对人恶性胶质瘤细胞株的作用

 目的 观察体外应用去甲二氢愈创木酸（ＮＤＧＡ）、予氟尿嘧啶（５－Ｆｕ）、长春新碱（ＶＣＲ）三种药物单用或合用对人恶性胶质瘤细胞系 ＳＨＧ－４４细胞的作用，并探讨其作用的可能机制。方法用 ＭＴＴ法检测药物作用效应，用免疫组化染色法检测细胞 ｃｙｃｌｉｎ Ｄ１基因的蛋白表达情况。结果 （１）三种药物单用及两药合用时随着药物浓度的增加其抗肿瘤效应也增加，且两药合用时药物的效应增强；（２）先给ＮＤＧＡ ２４ｈ后再给 ５－Ｆｕ或 ＶＣＲ，与同时给药对该细胞的抗肿瘤效应无显著差异（Ｐ＞０．０５），而先给 ５－Ｆｕ或 ＶＣＲ ２４ｈ后再给 ＮＤＧＡ，与同时给药对细胞的抗肿瘤效应有显著差异（Ｐ＜０．０５）；（３）免疫组化染色结果表明，与对照组相比，ＮＤＧＡ处理后该细胞 ｃｙｃｌｉｎ Ｄ１基因的蛋白表达明显降低。结论 ＮＤＧＡ与 ５Ｆｕ或 ＶＣＲ间有协同作用，且这种作用可能与 ＮＤＧＡ降低细胞 ｃｙｃｌｉｎ Ｄ１基因的蛋白表达有关。     

Successful treatment of recurrent thrombotic thrombocytopenic purpura with plasmapheresis and vincristine

An adolescent girl with severe thrombotic thrombocytopenic purpura (TTP) remained in a critical condition after 3, weeks of combined treatment with antiplatelet drugs, plasma infusions and plasma exchange. The introduction of vincristine resulted in gradual improvement and eventual complete remission which lasted for 2 years. When she relapsed, immediate improvement was observed with the combined treatment of plasmapheresis and vincristine. She has now been in complete remission again for 10 months. It is suggested that plasmapheresis plus vincristine should be used as the initial treatment for children with TTP.     

VD方案治疗难治性特发性血小板减少性紫癜

目的研究VD方案治疗难治性特发性血小板减少性紫癜的治疗效果。方法用长春新碱、地塞米松组成VD方案治疗难治性特发性血小板减少性紫癜46例。结果显效8例(8/46),良效25例(25/46),进步13例(13/46),无效0例(0/46)。结论VD方案治疗难治性特发性血小板减少性紫癜疗效确切,无严重副作用,值得推广应用。     

Inadvertent intramuscular administration of vincristine: lack of untoward effects without any treatment except administration of hot compresses

A seven-year-old boy with acute lymphoblastic leukemia received vincristine sulphate 1 mg, 1 ml intramuscularly, into his glutea, inadvertently, in the local hospital. The mother, applied hot compresses for 16 hours, starting 6.5 hours after the injection. Then, she told, the slight pain and the reddened area which developed around the injection site dissappeared completely and he turned back to his daily activities. His physical examination, 2 weeks after the injection and during his follow-up revealed no abnormality.     

POEMS syndrome: experience with fourteen cases

The POEMS syndrome, also known as Crow-Fukase disease, is a rare multisystem disorder, which may take several years to evolve fully. The combination of symptoms and signs is highly complex and some of the features are detected at sub-clinical level requiring high level of suspicion. The clinical data on POEMS is still evolving with only a few case reports from India. Herein, we report a series of 14 cases with POEMS syndrome at our centre over the past 8 years, which were analysed retrospectively for their clinical features, response to therapy and treatment outcome. Presence of plasma cell dyscrasia (PCD) was essential for inclusion in this study. Confirmation of PCD was done by positive "M" spike in serum and/or urine, bone marrow plasmacytosis or presence of plasmacytoma on biopsy. In addition, the diagnosis of POEMS syndrome needed the presence of at least two of the following features: polyneuropathy, organomegaly, endocrinopathy and/or skin changes. Patients were excluded from study if there was a secondary cause of polyneuropathy like amyloidosis, drugs like vincristine, nerve root or spinal cord compression. Two patients had complete form (all five features) of the syndrome, whereas 12 had incomplete form. Median age was 48 years (range 32-65). Peripheral neuropathy was seen in 13 (92.85%) cases, organomegaly 10 (71.42%), endocrinal involvement 7 (50%) and skin changes 9 (64.28%). An association with Castleman's disease and vasculitis was also noted. With different chemotherapy protocols, all treated patients (n=12), had significant symptomatic improvement with or without objective improvement at median follow up of 48 months (range 6-120). In conclusion, high level of suspicion is required to detect this rare entity.     

Degradation of vincristine by myeloperoxidase and hypochlorous acid in children with acute lymphoblastic leukemia

Vincristine (VCR) is an effective drug against acute lymphoblastic leukemia (ALL), many solid tumors, but not acute myeloid leukemia. It has been hypothesized that resistance of myeloblasts to VCR is related to myeloperoxidase (MPO) and production of hypochlorous acid (HOCl). We investigated the relationship between VCR degradation and MPO expression and serum HOCl concentrations in pediatric patients with ALL, lymphoma and solid tumors. We studied the sera from 43 children, of which 23 were newly diagnosed and as yet untreated cancer patients, 10 on chemotherapy and 10 healthy control subjects. Patients’ sera were incubated with VCR alone or in the presence of taurine (T) or acetaminophen (APAP) and post-incubation VCR and HOCL concentrations were measured. Significant correlations between serum MPO expression, HOCl concentrations and VCR degradation were seen. In the chemotherapy group, MPO-positive patients produced high levels of HOCl and reciprocally low post-incubation VCR levels. HOCl and VCR concentrations in this group were significantly different than other groups studied. Both APAP and T inhibited VCR degradation in the sera of the chemotherapy group but not to the same degree. The effects seen here were consistent for both ALL and the lymphoma/solid tumor cases. Our results indicate that HOCl can increase VCR degradation in vitro in the serum and this effect is significantly more pronounced in pediatric patients undergoing chemotherapy.     

Concurrent Cisplatin, Prolonged Oral Etoposide, and Vincristine plus Chest and Brain Irradiation for Limited Small Cell Lung Cancer: A Phase II Study of the Southwest Oncology Group (SWOG-9229)

Purpose: The primary objectives of the study were to evaluate the efficacy and safety of prolonged oral (PO) etoposide as part of cisplatin-based chemotherapy plus concurrent chest/brain irradiation induction, followed by CAV consolidation, in the treatment of patients with limited-stage small cell lung cancer (SCLC-LD) within a cooperative group setting.

Methods and Materials: Fifty-six eligible patients with SCLC-LD received three 28-day cycles of cisplatin 50 mg/m² i.v. (days 1, 8; 29, 36; and 57, 64), PO etoposide 50 mg/m² (days 1–14, 29–42, and 57–70), and vincristine 2 mg i.v. (days 1, 29, and 57). Thoracic irradiation (TRT) was administered at 1.8 Gy in 25 daily fractions to a total dose of 45 Gy via an AP:PA arrangement, to begin concomitantly with induction chemotherapy. Prophylactic cranial irradiation (PCI) was started on day 15 of induction therapy. Fifteen daily fractions of 2.0 Gy were administered to the entire brain to a total dose of 30 Gy to finish at approximately the same time as TRT. Two 21-day cycles of consolidation cyclophosphamide 750 mg/m² i.v., doxorubicin 50 mg/m² i.v., and vincristine 2 mg i.v. (all on days 1 and 22), were given beginning on day 106 or week 16, from the start of induction therapy.

Results: Among 56 eligible patients, 93% had SWOG performance status 0–1. All had adequate organ function and had not received prior therapy. The overall confirmed response rate was 46%, including 16% complete responders and 30% partial responders. After a minimun follow-up duration of 17 months, the Kaplan-Meier median progression-free (PFS) and overall survival (OS) were 10 and 15 months, respectively. Two-year survival is 28%. Only 28 of 56 patients (50%) completed chemotherapy per protocol, while 52 of 56 patients (93%) completed radiation per protocol. Eleven patients (20%) discontinued secondary to toxicity and two patients died from treatment. The major toxicity was hematologic. The two deaths were secondary to infection. Of the nonhematologic toxicities, there were 10 cases of pulmonary fibrosis (including one Grade 3) and six cases of pneumonitis (including one Grade 3).

Conclusion: Concomitant chemoradiation with oral etoposide as part of a platinum-based chemotherapy and TRT induction regimen is toxic. The CR rate is not better than our prior best group-wide experience. The progression-free and overall survival are similar to published trials utilizing short-course i.v. etoposide. As in chemotherapy for extensive-stage SCLC, there is no apparent advantage to prolonged exposure to etoposide, and toxicity resulted in an inferior therapeutic index compared to programs with shortened exposure.     

姜黄素体外增敏抗肿瘤药物作用

目的 探讨姜黄素与抗癌药物长春新碱、阿霉素合用对KB及KBv200细胞的体外杀伤作用。方法 采用MIT法测定药物的体外杀伤作用，用荧光分光光度法进行细胞内阿霉素蓄积测定。结果 姜黄素与长春新碱、阿霉素合用，在KB及KBv200细胞中均有增敏作用。蓄积实验说明，在KBv200细胞，其增敏作用与增加细胞内阿霉素蓄积有关；而在KB细胞中的增敏作用与细胞内阿霉素蓄积量无关。结论 姜黄素通过不同机理增敏抗癌药对敏感细胞KB及其耐药细胞KBv200的毒性。