A comparison of vincristine and doxorubicin infusional chemotherapy with methylprednisolone (VAMP) with the addition of weekly cyclophosphamide (C-VAMP) as induction treatment followed by autografting in previously untreated myeloma

In a sequential nonrandomized study, 204 consecutive unselected patients aged < 70 years received induction chemotherapy with infusional vincristine and adriamycin with oral methyl prednisolone (VAMP; n =75) or with additional cyclophosphamide, C-VAMP ( n =129). 38/129 C-VAMP patients also received verapamil during induction as part of a controlled trial with the aim to overcome drug resistance. A median of five courses (range 1–11) of chemotherapy were required before maximal response was attained and this was similar in both groups. An over-all response rate of 71% was noted at the end of induction. The complete remission (CR) rate with C-VAMP was 24%, which was significantly higher ( P =0.04) than the CR rate with VAMP alone (8%). The addition of verapamil did not alter the response rate of C-VAMP. Compliance to VAMP was overall 83% and not affected by the addition of cyclophosphamide. The proportion of patients going on to receive high-dose chemotherapy and an autograft was the same for VAMP and C-VAMP treated patients (71%). The median overall survival (OS) and progression-free survival (PFS) for the whole group were 4.4 years and 2.0 years and no difference in outcome was observed between the different treatment groups. Therefore the addition of weekly cyclophosphamide to VAMP induction therapy has significantly improved the response rates of previously untreated myeloma patients. C-VAMP was not more toxic and did not compromise the chances of receiving an autograft. Verapamil was without influence on any parameters in this study.     

A LONGITUDINAL STUDY OF PERIPHERAL BLOOD MONONUCLEAR CELL PROLIFERATTVE RESPONSES TO BACTERIAL ANTIGENS IN REACTTVE ARTHRITIS

Reactive arthritis (ReA) is a sterile inflammatory arthritiswhich usually occurs after an enteric or genitourinary infection.In recent years it has been recognized that synovial fluid mononuclearcells from an affected joint demonstrate marked proliferativeresponses if incubated with preparations of the organism triggeringthe arthritis; peripheral blood mononuclear cell (PBMC) responsesare typically much smaller. One interpretation of this findingis that recognition of the triggering organism is enhanced withinthe joint compared to peripheral blood, but it could also beargued that the PBMC responses are actually depressed duringacute arthritis. We have examined this possibility in a longitudinalstudy of PBMC proliferative responses in patients with ReA.In this study we have demonstrated that PBMC proliferative responsesto the triggering organism were indeed depressed during acuteReA, and showed a significant increase after recovery from thearthritis. These findings also applied to PBMC recognition ofthe recall antigen PPD, and to the response to IL-2. KEY WORDS: T cells, Reactive arthritis     

The BILAG index: a reliable and valid instrument for measuring clinical disease activity in systemic lupus erythematosus

The British Isles Lupus Assessment Group (BILAG) index is acomputerized index for measuring clinical disease activity insystemic lupus erythematosus (SLE), which was developed accordingto the principle of the physician's ‘intention to treat’.The index allocates separate alphabetic scores to each of eightorgan-based systems; a total score is not calculated. This studydemonstrated good between-rater reliability for the BILAGindex for each organ-based system. There was no evidence ofbias between observers. The BILAG index had good overall sensitivity(87%) and specificity (99%) when compared with the 'gold standard'criterion (starting or increasing disease-modifying therapy).There were high positive predictive values overall (80%), andfor each organ-based system, with the exception of the neurologicalsystem.     

Retrospective survey of 1271 patients diagnosed as perennial rhinitis

Data from 1271 patients with perennial rhinitis has been assessed. This condition predominantly affects children and young adults; 31·5% stated that symptoms first appeared before the age of 10 years, less than 10% were aged 50 years or more suggesting that the disease process may well disappear in later life. The total sample size was equally divided between the sexes and the mean age for the sexes was similar. In terms of age distribution a sex difference was found in that the peak incidence for males occurred in the age group 10–19 years whereas for females it was in the third decade (P < 0·001). The duration of the disease was, in most cases, between 2 and 9 years but it can extend to over 15 years and thus become subacute or chronic. The major symptom is blocking which could be due to either histological changes in the mucosa or immunological reactions. Skin tests showed that 64% had a positive reaction to common allergens; however, nasal challenge tests were of little value in determining whether a patient could be classified as allergic. Eosinophils were noted in 66%. The value of skin tests and nasal smears is discussed.