No abstract

Factor-VIII-related von Willebrand factor (vWF) multimers are synthesized by endothelial cells, and plasma vWF antigen levels are elevated in some disorders associated with endothelial cell perturbation. We studied 13 patients during cisplatin-basedcombination chemotherapy for squamous cell carcinoma of the head and neck, esophagus, or lung. Before therapy, 3 of the patients had vWF antigen levels that were ≥400% of normal; and further elevations occurred during chemotherapy. Two of these patients had cerebrovascular accidents, and the third had complications similar to the hemolytic-uremic and acute respiratory distress syndromes. No abnormalities in plasma vWF patterns were detected. Elevated plasma vWF antigen levels before therapy may identify a subgroup of patients at special risk for arterial occlusive complications following cisplatin-based chemotherapy.

Vindesine is a new vinca alkaloid antineoplastic agent derived from vinblastine. However, its antineoplastic spectrum more closely resembles that of vincristine. Clinical studies indicate activity against acute leukemia, lung cancer, carcinoma of the breast, squamous cell carcinoma of the esophagus and head and neck, Hodgkin's disease and non-Hodgkin's lymphomas. Pharmacokinetic studies indicate that vindesine exhibits a triphasic elimination pattern with a terminal half-life of 24.2 hours. Elimination is primarily through hepatic metabolism. The major side effects associated with vindesine therapy are myelosuppression and neurotoxicity. Other side effects include alopecia, nausea and vomiting and local tissue irritation associated with extravasation. Vindesine will be a positive addition to the antineoplastic armamentarium. The full extent of its activity remains to be established.

A case of a 69-year-old man admitted with procarbazine pneumonitis and a review of the literature are presented. The patient completed a second course of MOPP chemotherapy for Hodgkin's disease three days before admission. He presented with a recent onset of fever, chills, anorexia, and malaise. Chest radiography indicated diffuse bilateral interstitial pneumonitis, and pulmonary function studies revealed restrictive lung disease. Attempts to identify an infectious etiology, including open lung biopsy, were negative, and empirical antibiotic therapy was ineffective. The diagnosis was drug-induced hypersensitivity reaction, most likely due to procarbazine. Corticosteroid therapy was instituted with gradual improvement. Six other cases of pneumonitis associated with procarbazine therapy are briefly reviewed, and the use of pulmonary function tests to identify the type and degree of injury and monitor therapy is discussed.