Massive Nitrogen Mustard Therapy in Hodgkin’s Disease with Protection of Bone Marrow by Tourniquets

Abstract

1. Eight patients with far advanced Hodgkin’s disease were treated with massive single doses of nitrogen mustard (0.95-1.5 mg. /Kg.) with tumor regression in each case. 2. An attempt was made to protect the bone marrow of the extremities from the effects of the nitrogen mustard by applying orthopedic tourniquets during the injection. There was definite evidence that the marrow was protected by this procedure. Marrow in the tibia became progressively more cellular during the time that the marrow in the torso degenerated to almost complete aplasia. During the period of recovery, radioactive iron was given and more of it localized in the protected arm than in the unprotected, evidence of greater erythropoietic activity. 3. Neurologic complications occurred at the doses employed. 4. Serious gastrointestinal pathology was not demonstrated at these doses. 5. Prior extensive radiation therapy prolonged the hemopoietic depression due to nitrogen mustard. This was not produced by previous mustard therapy. 6. Color change in ecchymotic areas may be used to predict bone marrow recovery. 7. Dividing the massive dose seems to result in less toxicity.