Sir, X-linked ichthyosis (XLI) appears in the immediate neonatal period as a generalized large, slightly adherent, lightly coloured desquamation commonly affecting the scalp, preauricular area and posterior neck (1). In time, large, often dark scales, preferentially located on the trunk and extensor aspect of the extremities, become prominent. The palms, soles and face are generally spared (1). Cutaneous histopathological findings of XLI are not diagnostic, being characterized by orthokeratotic hyperkeratosis and a normal or slightly thickened granular layer. In the dermis, oedema and a slight perivascular inflammatory infiltrate can be observed (1). The most common associated extracutaneous findings include corneal opacities, cryptorchidism, epilepsy and electro-encephalographic changes (1). XLI is caused by deficient activity of the steroid sulphatase (STS) enzyme due, in most patients, to complete or partial deletions of the STS gene mapped on Xp22.3 (2-5). Therapeutic approaches for the treatment of mild to moderate cutaneous manifestations of XLI include keratolytic agents, moisturizers and topical retinoids, while systemic retinoids have been successfully employed in severe forms (6, 7). We describe a 22-year-old man with XLI associated with epilepsy. A within-patient study comparing topical tazarotene 0.05% and glycolic acid 70%
Background. The efficacy and toxicity of total body irradiation (TBI) in patients with chronic lymphocytic leukemia (CLL) and low grade non‐Hodgkin's lymphomas (NHL) were evaluated.
Methods. Between January 1984 and September 1992, 81 consecutive patients, 40 affected with CLL and 41 with low grade NHL, with symptomatic Stage III and IV disease, were treated with TBI followed by prednimustine.
TBI was given with a 6 MV linear accelerator, applying two opposite alternating fields, including total body, with two fractions of 15 cGy given per week (3‐day interval). A total dose of 150 cGy was given over 5 weeks. Six to nine courses of prednimustine (100 mg/m2 orally for 5 consecutive days every 4 weeks) was administered 2 months after TBI treatment as consolidation therapy.
Results. Of 40 patients with CLL, 18 (Group I; median age 58.5 years) were younger than 65 years and 22 (Group II; median age 73 years) were older. The overall response rates were 78% in Group I and 91% in Group II, with a median response time of 16.5 and 16 months, respectively. Hematologic toxicity was 72% in Group I and 73% in Group II. It was reversible in all but one heavily pretreated patient who died of progressive anemia and thrombocytopenia after TBI alone. In the 40 patients with CLL, the response rate was 85%; there were 5 complete responses (CRs) (12.5%) and 29 partial responses (PRs) (72.5%).
Of the 41 patients with NHL, 29 (Group I; median age 55 years) were younger than 65 years and 12 (Group II; median age 71.5) were older. The overall response rate in both groups was 83%, with median response times of 18.5+ and 14.5+ months for Groups I and II, respectively. Hematologic toxicity was 59% in Group I, whereas it was 50% in Group II. It was reversible in all patients. Overall, in the 41 patients with symptomatic Stage III and IV low grade NHL, the response rate was 82.8%; there were 10 CRs (24.3%) and 24 PRs (58.5%).
The prednimustine regimen was generally well tolerated.
Conclusions. In our experience, TBI given in a dose of 150 cGy in 10 fractions twice a week, followed by prednimustine, is an effective treatment for patients with CLL and patients with low grade NHL. This treatment also is effective in patients older than 65 years. The toxicity is acceptable, particularly when TBI and prednimustine are given as initial treatment. Pretreated patients should be monitored strictly.
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