TREATMENT OF MALIGNANT DISEASE WITH NITROGEN MUSTARD

Abstract

The authors review the literature on the application of nitrogen mustards to the therapy of malignant diseases up to April 1948. Their own experience with 64 patients suffering from a variety of malignant diseases is in general agreement with the reports of other investigators. Brief remissions were obtained in 20 of 24 cases of Hodgkin''s Disease, including several who had become roentgen-ray resistant. Remissions averaged two months in duration. Early causes of HN2 were usually followed by more prolonged improvement than later courses. Occasionally refractory cases responded to closely spaced repeated courses of HN2 although this is likely to be attended by dangerous granulocyto-penia and thrombocytopenia. One patient with generalized Hodgkin''s Disease was practically freed of all objective evidence of the disease with fibrosis of previously involved nodes, but succumbed to the toxic effect of the drug. Symptoms which responded favorably, often dramatically, were fever, malaise, lymphadeno-pathy, respiratory distress due to pulmonary infiltration, cutaneous infiltrates and hepato-splenomegaly. Carcinomata were uniformly unresponsive. Reticulum cell sarcoma and chronic lymphatic leukemia were only fleetingly benefitted. Lympho-sarcoma and mycosis fungoides responded variably, but the results were usually poor. Chronic myelogenous leukemia failed to respond. One patient with chronic nonleukemic myelosis with huge splenomegaly and moderate myelofibrosis improved dramatically with regression of the spleen and return of the blood picture to normal. The remission persisted for 7 months and then grad- ually receded during the next 8 months. It was concluded that HN2 is of principal value in the treatment of Hodgkin''s Disease and that in selected cases, the method of choice is to administer two 4 day courses of 0.1-0.15 mg. HN2 per/kg. body weight with about two weeks interval. In cases of wide-spread lymphomatous disease, fever due to lymphoma, moribund caseses, constructive lymphomatous lesions of great vessels or spinal cord, HN2 often gives better results than x-ray.