In the case of large B-cell lymphoma, generally thought to arise from the chronic lymphocytic leukemia clone, approximately one half of the patients had genetically unrelated cancers. In prolymphocytic transformation, all cases studied appeared to evolve from the chronic lymphocytic leukemia clone. The few studies of acute lymphoblastic leukemia and multiple myeloma showed genetic relatedness in some cases and unrelatedness in others. These data indicate that progression to more aggressive B-cell cancers in persons with chronic lymphocytic leukemia can result from either clonal evolution or from an independent transforming event.

Initial myeloma presentation as discrete liver nodules is unusual. A 59-year-old man who presented with hepatomegaly and multiple space-occupying lesions in the liver and who was found to have a lambda light chain multiple myeloma with hepatic plasmacytomas is described and a review of liver involvement in multiple myeloma is presented.

The prognosis for advanced non-small cell lung cancer remains poor. Response to chemotherapy is infrequent and overall survival is low. Trans-retinoic acid (tRA), a differentiating agent whose mechanism of action is thought to be different from conventional chemotherapy has activity in preclinical models and low but definite activity in the clinical setting. Its use has been hampered by decrease in bioavailability during continuous administration. We used an interrupted dosing schedule with a drug holiday for tRA that has since been confirmed to restore blood levels in combination with chemotherapy (Cisplatin-VP 16) in 20 patients with stage IIIB and IV non-small cell lung cancer. Ten patients had partial responses among 19 evaluable pts (53%; 95% confidence interval 30-75%) and 4 had minor responses. Neutropenia was the most common acute toxicity-grade 3/4 neutropenia occurring in 90% of patients at some point in the treatment course. Median survival was 25.5 weeks. This regimen of trans-retinoic acid given with drug holiday and chemotherapy has significant activity in advanced non-small cell lung cancer, is fairly well tolerated and is worthy of confirmation in a larger, multi-institutional setting.

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