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Sixty-three cases of Hodgkin's disease in intravenous drug users (IVDUs) have been collected by the Italian Cooperative Group on AIDS-Related Tumors (GICAT). In most patients (74%) the histological pattern was that of mixed cellularity and lymphocyte depletion. In 39% of patients the initial symptom was a persistent lymph node enlargement due to persistent generalized lymphadenopathy (PGL). Unusual presentations included Waldeyer's ring, skin, meninges, colon, and pleura. After MOPP alternated or followed by ABVD, MOPP alone, or ABVD alone, 15 of 32 patients (47%) had a complete remission (CR) and 15 of 32 (47%) had a partial remission (PR). The median duration of CR was 14 months, while the median survival of patients with CR has not been reached; the median survival of patients treated with chemotherapy who had CD4 levels at presentation greater than or equal to 400/mm3 was significantly superior to that of those who had CD4 less than 400/mm3. The overall median survival was only 14 months. Forty-four percent of patients receiving chemotherapy, with or without radiotherapy, developed opportunistic as well as nonopportunistic infections. Lethal hepatic toxicity was observed in one patient. Among IVDUs, unusual presentations of Hodgkin's disease occurred at a lower rate than was previously reported for homosexuals. Complete remissions could be achieved in almost half the patients, but non opportunistic infections, in addition to parenchymal function impairment due to drug abuse, may limit treatment administration in IVDUs.

Thanks to the impressive development and application of new sophisticated technologies, the last decade has offered remarkable advances in our understanding of the molecular and biological features of human neoplastic cells. DNA analysis in particular has contributed to the unravelling of some of the possible events which give rise to a transformed cell and which enable it to proliferate indiscriminately and to infiltrate. Cloning techniques which have allowed researchers to obtain and utilize purified molecules represent another milestone. This has opened the era of cytokines and growth factors, both in terms of their possible role in the establishment and/or progression of neoplastic conditions (autocrine/paracrine models) and of their use in clinical practice. Thus, growth factors such as granulocyte-macrophage colony stimulating factors (GM-CSF) and interleukin 3 (IL-3) are currently being employed in the management of cancer patients, mainly to support normal hemopoiesis. Conversely, recombinant interleukin 2 (IL-2) through its unique capacity to generate previously unrecognized cytotoxic activity, lymphokine active killer (LAK), has brought about new and more specific immunotherapeutic strategy. Further therapeutic possibilities will arise from the clinical use of monoclonal antibodies. Finally, the development of genetic engineering has opened the way to the early and revolutionary clinical exploitation of gene therapy; the possibility of utilizing in vivo anti-sense oligonucleotides in an attempt to block the action of specific genes is also being contemplated.(ABSTRACT TRUNCATED AT 250 WORDS)

Five patients with lymphoid blastic transformation of chronic myeloid leukemia have been treated with IL2 associated with Vincristine (VCR) plus Prednisone (PDN). Our study indicates that IL2 may be employed in the management of this disease without excessive toxicity at the higher doses in hospitalized patients and at the lower doses as outpatients. Concerning the therapeutic efficacy, our preliminary results indicate that IL2 might be useful in enhancing the chemosensitivity of the leukemic blasts. It remains to be seen if this will result in a rapid return to the CP and in a prolongation of survival.

The pattern of immunoglobulin (Ig) gene rearrangement and the genomic structure of the Myc locus were investigated in the DNA of 20 lymphnode biopsies of patients suffering from lymphoadenopathy-associated syndrome (LAS) and from 3 patients with Burkitt's lymphoma. Although polyclonality was the prevalent pattern of Ig gene rearrangement observed in LAS, in 30% of the cases discrete bands of Ig heavy chain gene rearrangement were identifiable due to the presence of monoclonal or oligoclonal cell populations. However, structural alterations of the Myc gene were not detected in any cases. As expected, in all three Burkitt's lymphomas studied, the lymphnode DNA displayed a clonal pattern of Ig heavy chain gene rearrangement. The Myc was altered in two cases, which presented a truncation of the gene beginning within a very short region of the first intron. By contrast, the breakpoint positions on chromosome 14 mapped in different regions of the Ig loci, which in both cases involved the switch (SH) area. Data confirm the relatively common occurrence of oligoclonal expansions within B cells in LAS and the frequent involvement of the Myc oncogene in the process of lymphomagenesis in individuals positive for human immunodeficiency virus (HIV).

Hemodynamic and ventilatory studies were carried out in a large series of patients who underwent mitral surgery for mitral stenosis or insufficiency. A diminution of cardiac index was found, which paralleled the narrowing of the mitral orifice. However, left ventricular failure seemed to be operative in some of the cases, even in the presence of pure, tight mitral stenosis. This hypothesis was also suggested by the observation that pulmonary artery and venous wedge pressures were significantly higher in patients with combined heart failure, independently of the size of the mitral orifice. A positive linear correlation was found between pulmonary artery pressures and pulmonary vascular resistances, when the latter were more than 200 and less than 900 dynes sec cm−5. No significant increase of pulmonary blood volume could be found in patients with mitral stenosis. Lack of correlation was found between ventilatory and hemodynamic findings studied simultaneously in 50 patients. Vital capacity was significantly impaired only in decompensated patients. Residual volume was increased in every case of mitral disease. Ventilatory dynamics were also altered in every instance, particularly when congestive heart failure was present. Functional dead space was consistently increased, in spite of an increased alveolar ventilation. These findings confirm that in mitral stenosis the ventilatory perfusion ratio is consistently impaired. Results of postcommissurotomy ventilatory studies were quite variable in spite of good clinical results. In 26 patients the hemodynamic behavior was studied before and at varying intervals (30 days to 3.5 years) after mitral commissurotomy. The hemodynamic findings in patients who underwent a successful commissurotomy are similar to those observed in subjects with anatomically and functionally mild mitral stenosis.