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The most common complications in patients receiving chemotherapy are neutropenia with fever, and infections. The risk-adapted application of antibodies, antimycotics and G-CSF is discussed. Nausea and vomiting can usually be avoided by appropriate prophylactic antiemetic treatments. Less common are thrombocytopenia requiring replacement treatment. The frequent anemias associated with tumor treatment have a multifactorial genesis. Red cell concentrates and, where indicated, erythropoietin are available. Typical organ-related side effects of cytostatic agents are rare, but then usually serious. Problems with veins may be resolved with "undertunneled" central venous catheters or completely implanted port systems.

The influence of cholesterol added as cholesterol containing liposomes [sphingomyelin/cholesterol (1: 1; mol/mol)] or as cholesterol suspensions on cultured bovine aortic endothelial cells was investigated. 10(-6) mol/l cholesterol enhanced membrane potential, 10(-5) mol/l caused depolarisation. The proliferation of the cells was dependent on the concentration influenced in opposite directions too. The proliferation was stimulated by 10(-6) mol/l cholesterol and inhibited by 10(-5) mol/l. The migratory rate of the cells was increased by 10(-6) mol/l and 10(-5) mol/l cholesterol. Our results suggest that exogenous cholesterol is integrated in membranes of the endothelial cells and causes in this way changes of membrane potential, proliferation rate and migratory activity.

Microangiopathic hemolytic anemias (MHA) are frequently at the root of metastasizing gastric carcinoma. If the characteristic fragmented erythrocytes ("schistocytes") are found to be increased in the blood smear, this can be taken as a pointer to gastric neoplasm. Consumption coagulopathy frequently intensifies the clinical symptoms. A report of a 51-year-old woman with gastric carcinoma, MHA and consumption coagulopathy is given in whom the determination of numerous schistocytes in the peripheral blood was of decisive significance for the diagnosis.

The most common side effects of melphalan administration include nausea, vomiting, and bone marrow suppression. Less well known is the fact that allergic reactions can become evident after both intravenous and oral melphalan administration. In the present study we report a patient with a plasmocytoma, who developed an allergic reaction with melphalan intravenously, but tolerated melphalan orally.

16 adult patients with granulocytopenia and septicemia resistant to antibiotics received 42 granulocyte transfusions. The granulocytes were obtained from healthy donors with a blood cell separator by continuous flow centrifugation. Adding hydroxyethyl-starch an average of 1.8 X 10(10) leukocytes with 69% granulocytes were harvested in 3.5 hours. A small leukocyte increment after the transfusion was seen in half of the recipients. No correlation could be found between fever lysis and survival of the infection, which occurred in half of the cases too. A granulocyte transfusion is indicated in patients, who have granulocytopenia, sepsis and no evidence of bone marrow recovery.

Forty-six patients with non-small cell lung cancer were treated with a combination of cis-platinum 90 mg/m2 i.v., day 1 and VP 16-213 100 mg/m2 i.v. on days 1, 3 and 5. The overall remission rate was 22% (10 out of 46 patients) with a median remission duration of 7 months. Squamous cell and large cell undifferentiated carcinomas responded to the chemotherapy with a remission rate of 27% (7 out of 26 patients) and 22% (3 out of 13 patients). Seven patients with adeno-carcinoma did not respond to chemotherapy. The overall survival was 7 months (1-27+). The survival time for patients entering remission was 11.5 months (7-27+), for those with stable disease 8.5 months (3-27+), and for patients with progressive disease 5 months (1-9). Performance status of less than 80%, a weight loss of more than 10.0 kg in the last three months before starting treatment and a "major" atelectasis (collapse of at least one superior or inferior lobe) adversely influenced prognosis. Only 1 out of 31 patients with one or more poor prognostic factors came into remission. In contrast, 9 out of 15 patients (60%) without poor prognostic factors had a remission. Stage, limited versus extensive disease, and age did not affect the results. Hematologic and renal toxicity of the combination were mild, but poor subjective tolerance (nausea, vomiting, loss of appetite) was prominent.

18 of 36 consecutive patients with small cell carcinoma of the lung received a combination of chemotherapy (Adriblastin, Oncovin, Cyclophosphamide) and radiotherapy (primary tumor and CNS). This treatment resulted in a response rte of 78%, and in a median survival of 10.6 months ("limited disease" 13 months, "extensive disease" 9 months). Complete remissions were obtained only in 4 of 18 patients, 4 patients of these were long-term survivors (greater than 18 months). Due to heart diseases, age, or poor general condition 18 patients received a milder combination of chemotherapy ("COM", "VP-O-C") and tumor irradiation. The response rate was 66%. Complete remission was achieved in only 2 of 18 patients. The median survival rate was 8.6 ("limited disease" 10.5 months, "extensive disease" 6.0 months). Survival exceeded 18 months in 4 of these patients. The toxicity was mild, the mean cumulative duration of hospitalization was 78 (30-120) days per patient.

11 patients (age 36-60 years) with breast cancer and CT-scan documented brain metastases (BM) were treated with hormonochemotherapy: 5-fluorouracil 500 mg/m2 i.v. day 1 + 8, adriamycin 50 mg/m2 i.v. day 1, cyclophosphamide 500 mg/m2 i.v. day 1-q4 weeks (FAC) and tamoxifen (TXF) 20 mg/day per os. Ovarectomy was carried out in 3 praemenopausal patients. In 3 cases single BM were surgically resected (2 subtotal, 1 total). One patient was shunted due to a hydrocephalus occlusus. Complete response (CR), i.e. normalization of CT-scan and disappearance of CNS related symptoms, was achieved in 9 out of 11 patients. One patient with partial remission (PR) and another with progressive disease died 6 and 5 months after diagnosis of BM. The median duration of remissions of all patients was 12 (5-43) months. The median survival time from diagnosis of BM was 15 (5-44) months and from mastectomy 46 (26-142) months. The cumulative probability of surviving was 63% one year after diagnosis of BM. One relapsing patient achieved a second CR, another a PR by whole brain irradiation. 4 patients survived more than 18 months from the diagnosis of BM. It appears that chemo-hormonotherapy provides a rational approach to palliation in breast cancer patients with BM in prolonging the survival.

Extraordinary platelet adherence to polymorphonuclear leukocytes was seen in EDTA anticoagulated blood smears of two patients. From the same blood samples platelets were greatly reduced in number. Platelet satellitism (granulocyte platelet rosettes) is a rare phenomenon in vitro, only seen in EDTA anticoagulated blood, and the platelets surrounded polymorphonuclear leukocytes only. Phagocytosis of platelets was also observed. The cause of platelet satellitism is unknown. Capillary blood should be investigated in order to prevent a false thrombocytopenia.

Cancerostatical active synthetic alkyl-lysophospholipids were examined with regard to their effects on membrane potential, proliferation and migration of isolated endothelial cells. In sublytic concentrations all alkyl-lysophospholipids tested caused a hyperpolarization of the membrane of endothelial cells. The effect of alkyl-lysophospholipids on proliferation of endothelial cells was dependent on the serum supplement. The migration of endothelial cells was strongly inhibited by 1-O-octadecyl-2-O-methyl-glycero-phosphocholine. Possible mechanisms of action are discussed.

It has been recognized during the past decade that it may be advantageous to develop complex strategies for treatment of metastatic breast cancer (MBC). In these strategies the type and efficacy of preceding therapies and the compliance of the patients have to be considered. Since about 80% of all patients with MBC are treated outside university hospitals it should be tested if a complex strategy for treatment of MBC can be realized in these institutions. The method was based on three principles: There was an exchange of data between participating institutions and study center after each visit of a patient. Second, there was one data sheet for admission of a patient to the study and fifteen sheets for follow-up documentation each with a different bottom line; in the bottom line of these sheets two therapies according to the strategy were proposed, one in case of 'no progression' and another in case of 'progression' of the disease. Third, a copy of completed sheets had to be returned to the study center; the study center provided the next sheet with the appropriate treatment recommendation. 335 evaluable patients were prospectively recruited from 27 participating institutions between January 1983 and December 1985. Based on the estimated incidence of MBC in the region, it was calculated that 45% of all MBC patients of the region had been admitted to the study. Only 27% of these patients were treated at the university hospital indicating that 85% of all MBC patients of the region were treated outside university hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

On account of 2 own observations, main clinical and diagnostic features of Hairy cell leukemia (HCL) will be discussed. HCL is a rare, unusual type of chronic leukemia and is predominantly particular of middle-aged men. The occurrence of middle-sized lymphoid cells having a hairy cytoplasmic edge, and a tartrate-resistant acid PHOsphatase isoenzyme are the characteristic criteria of the HCL. The diffuse infiltration by hairy cells affecting primarily the spleen and bone marrow results in anaemia, granulocytopenia, thrombocytopenia and splenomegaly. Differential diagnosis have to be made in relation to other lymphatic leukemias, leukemic malignant lymphomas and monoclonal gammopathies as well as lymphotropic viral infections. Immunologic behaviour of hairy cells is like that of B-lymphocytes. Therefore, the term "leukemic reticuloendotheliosis" should no longer be applied.

A girl of 10-5/12 years is described, who had diabetes mellitus from the age of 5 years on and who developed bilateral ptosis, pigment degeneration of the retina and bilateral impairment of hearing at the age of nine years. A few weeks before death she suffered from an acute gastrointestinal infection which was successfully treated by a hydroxyquinoline derivative. In the days following a severe encephalopathy and signs of cardiac involvement appeared. A month later the girl died of bulbar paralysis and acute heart failure. Histology showed remnants of a granulomatous inflammation in the heart, the kidneys, the pancreas and the skeletal muscles. Furthermore there was a widespread spongiosis in the white substance of the brain, with large astrocytes, and partly also in the basal ganglia, the brain stem and the cerebellum. Foci of sudanophilic tissue necrosis resembling Wernicke's Encephalopathy were found in the medulla oblongata and the spinal cord. The peripheral nerves appeared partially demyelinated and showed axonal lesions. This case is classified as a Juvenile Type of so-called Canavan's Disease. It shows some resemblence to the "Progressive Chronic Ophthalmoplegia with Spongiform Encephalopathy described by Daroff, Kearn and Sayre. The possible neurotoxical effects of the hydroxyquinoline therapy are discussed.

In ten patients with IRSA, chromosome analysis and bone marrow cytology were performed once or several times during 24 months. Bone marrow chromosomes from eight patients showed a normal karyotype. Two patients were found to have stable clonal chromosome aberrations (45, X,-Y[male] and 46, XX,+mar). In a median duration of 6.8 years of IRSA no patient has yet developed acute leukemia. In another ten deceased patients with IRSA no evidence of leukemia, but a carcinoma of colon and prostate were observed in a latency of 7.7 years. Three patients with symptomatic SA developed in 1-15 months an acute leukemia. Two of them showed severe instable clonal chromosome abnormalities. Distinct bone marrow abnormalities (increase of blasts, normal cellularity, reversed M:E ratio, PAS-pos. erythroblasts), thrombocytopenia, and major clonal chromosome aberrations may help to differentiate IRSA from preleukemic states with symptomatic SA.