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In 1950, demecolcine (Colcemid) was isolated from Colchicum autumnale.1 In 1953, Moeschlin et al.2 reported its use and beneficial effects in a case of chronic granulocytic leukemia, with a fall in white cell count, a decrease in splenomegaly, and increased erythroid elements in the marrow. The doses ranged from 3 to 8 mg. daily.In 1955, Leonard and Wilkinson3 confirmed Moeschlin's findings in eight cases of chronic granulocytic leukemia in which a dosage of 3 to 10 mg. daily for four to nine months was used. The toxic effects were mild and consisted of some loss of scalp hair, erythema of the scrotum, and, in one case, congestion and erythema of the pharynx.Our report is prompted by the sudden and severe side-effects in one patient with follicular lymphoma and in another patient with chronic granulocytic leukemia who were both given demecolcine. Report of CasesCase 1.\p=m-\A 38-year-old white man was admitted on May 15, 1956, because of chills, fever, night sweats, and a 10 lb. weight loss due to malignant follicular lymphoma. Diagnosis had been estab¬ lished one year earlier following an inguinal node biopsy. Originally, the patient manifested axillary, inguinal, and supraclavicular lymphadenopathy which responded well to radiation therapy. In September, 1955, weakness and fatigue de¬ veloped, and a subsequent study revealed pancytopenia due to hypersplenism. Splenectomy was successful in alleviating this complication. Postoperatively, the blood elements returned to normal. Pathological study of the spleen was consistent with the original diagnosis. A liver biopsy showed lymphocytic infiltration.Three months prior to the patient's present ad¬ mission, constitutional symptoms developed for the second time. These became progressively worse, and he was readmitted for study and therapy.His past history was negative except for pneu¬ monia in 1945, with subsequent penicillin reaction manifested by a maculopapular eruption and urti¬ caria.Physical examination revealed a mesomorphic white man in no acute distress. His weight was 165 lb., his temperature, 100.2 F orally. His blood pressure was 124/82 ; his pulse, 74, and his respira¬ tions, 20. He was oriented and showed no overt signs of marked weight loss. A 3 by 5 cm. mass was present in the left supraclavicular area, and shot-like nontender nodes were found in both ax¬ illary and inguinal regions. Hepatomegaly of moderate degree-the liver extending 2.5 cm. below the right costal margin-was the only other posi¬ tive finding.The initial laboratory data showed a white blood cell count of 8600, with 72% neutrophils, 22% lymphocytes, 2% monocytes, 1% basophils, 3% eosinophils, hemoglobin 15.2 gm., hematocrit 44%, and platelets 294,000 by phase microscopy (Fig. 1). The serology was negative. The blood urea ni¬ trogen and liver-function studies were normal.
In 1950, demecolcine (Colcemid) was isolated from Colchicum autumnale.1 In 1953, Moeschlin et al.2 reported its use and beneficial effects in a case of chronic granulocytic leukemia, with a fall in white cell count, a decrease in splenomegaly, and increased erythroid elements in the marrow. The doses ranged from 3 to 8 mg. daily.In 1955, Leonard and Wilkinson3 confirmed Moeschlin's findings in eight cases of chronic granulocytic leukemia in which a dosage of 3 to 10 mg. daily for four to nine months was used. The toxic effects were mild and consisted of some loss of scalp hair, erythema of the scrotum, and, in one case, congestion and erythema of the pharynx.Our report is prompted by the sudden and severe side-effects in one patient with follicular lymphoma and in another patient with chronic granulocytic leukemia who were both given demecolcine. Report of CasesCase 1.\p=m-\A 38-year-old white man was admitted on May 15, 1956, because of chills, fever, night sweats, and a 10 lb. weight loss due to malignant follicular lymphoma. Diagnosis had been estab¬ lished one year earlier following an inguinal node biopsy. Originally, the patient manifested axillary, inguinal, and supraclavicular lymphadenopathy which responded well to radiation therapy. In September, 1955, weakness and fatigue de¬ veloped, and a subsequent study revealed pancytopenia due to hypersplenism. Splenectomy was successful in alleviating this complication. Postoperatively, the blood elements returned to normal. Pathological study of the spleen was consistent with the original diagnosis. A liver biopsy showed lymphocytic infiltration.Three months prior to the patient's present ad¬ mission, constitutional symptoms developed for the second time. These became progressively worse, and he was readmitted for study and therapy.His past history was negative except for pneu¬ monia in 1945, with subsequent penicillin reaction manifested by a maculopapular eruption and urti¬ caria.Physical examination revealed a mesomorphic white man in no acute distress. His weight was 165 lb., his temperature, 100.2 F orally. His blood pressure was 124/82 ; his pulse, 74, and his respira¬ tions, 20. He was oriented and showed no overt signs of marked weight loss. A 3 by 5 cm. mass was present in the left supraclavicular area, and shot-like nontender nodes were found in both ax¬ illary and inguinal regions. Hepatomegaly of moderate degree-the liver extending 2.5 cm. below the right costal margin-was the only other posi¬ tive finding.The initial laboratory data showed a white blood cell count of 8600, with 72% neutrophils, 22% lymphocytes, 2% monocytes, 1% basophils, 3% eosinophils, hemoglobin 15.2 gm., hematocrit 44%, and platelets 294,000 by phase microscopy (Fig. 1). The serology was negative. The blood urea ni¬ trogen and liver-function studies were normal.
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