In a prospective, controlled, randomized study to evaluate the efficacy of filtration-leukapheresis granulocytes in granulocytopenic, febrile patients with leukemia, 19 patients received antibiotics alone, and 12 received antibiotics plus daily granulocyte transfusions from ABO-matched donors. In skin-chamber studies the granulocytes appeared at sites of inflammation for at least six hours after transfusion. Infected subjects survived longer if they received granulocytes. Differences between control and transfused patients were greatest in patients with persistent bone-marrow failure, the 21-day survival being 20 per cent in controls, and 75 per cent in transfused patients. Granulocytes appeared to have no effect on the outcome of febrile episodes in which infection was not documented, the 21-day survival being 79 per cent for controls and 88 per cent for transfused patients. The transfusion of granulocytes thus appears to offer a survival advantage to infected, persistently granulocytopenic patients.
A study of the value of small doses of platelets given prophylactically in thrombocytopenic patients was carried out. Transfusions of two dose levels of platelets were compared: 0.03 units/1b (low dose) and 0.06 units/lb of body weight (high dose). The incidence of bleeding in nontransfused patients seen here prior to this study was also determined. The difference in incidences of bleeding among patients transfused with low or high dose was not significant. The differences between the transfused and nontransfused patients were highly significant.
Ten patients with metastatic osteogenic sarcoma were treated with 6-hour infusions of methotrexate in high dosage. Citrovorum factor was injected 2 hours later and repeated at 6-hour intervals for 12 doses. Methotrexate infusions were repeated at intervals of 2 to 3 weeks. Dosage was escalated until response or toxicity occurred. Doses between 100 and 200 mg/kg of methotrexate resulted in disappearance of pulmonary metastases in two patients and partial regression in pulmonary or bone metastases in two others. Between courses, radiation therapy was administered to five patients, all of whom achieved a partial response. Two patients who relapsed after initial response to chemotherapy alone, responded to subsequent radiotherapy. Toxicity and side effects were unpredictable. Of 57 treatments 30% were followed by stomatitis, 23% by myelosuppression, and 7% by renal abnormalities.
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