led us to investigate the feasibility of early discharge and outpatient follow-up. High-dose chemotherapy (HDCT) followed by autologous blood cell (ABC) transplantation has been used Accordingly, a three-step approach was planned and executed. The results of this study are reported here. widely for patients with metastatic breast cancer (MBC). It has been shown by our group and others to be an effective means of achieving very high response rates including complete remission. Therefore, furtherPatients and methods reduction in toxicity and increased patient satisfaction is necessary. Fifty-three patients with MBC wereBetween January 1994 and December 1995, a total of 53 patients were enrolled in this feasibility study using HDCT enrolled in a feasibility study at our cancer centre with a three-step approach to outpatient observation after with ABC support for MBC. HDCT was delivered to patients between 18-55 (median 40) years of age who HDCT and ABC transplantation discharging our patients from hospital 6 days after reinfusion of ABC, qualified for our clinical trials. Patients with CNS involvement were excluded. All patients had chemosensitive dis-1 day after reinfusion of ABC and 1 day prior to reinfusion of ABC. The supportive care consisted of the use ease and underwent successful apheresis after mobilization methods as described previously. 10 The apheresis product of 5-HT3 antagonists for nausea and vomiting, DMSO depletion, thorough body hygiene, prophylactic antiobtained was cryopreserved in 10% dimethylsulfoxide (DMSO) and stored in liquid nitrogen until required. 10 biotic, antifungal and virustatic drugs. In the event of febrile neutropenia, a standard evaluation and treat-The HDCT consisted of cyclophosphamide (CY) 6 mg/m 2 ; mitoxantrone 70 mg/m 2 ; and one of the following ment was used. Only 22 patients were admitted for febrile neutropenia and two for haemorrhage. The three drugs: vinblastine 12 mg/m 2 , carboplatin 800 mg/m 2 , or paclitaxel between 250-400 mg/m 2 . This high-dose treatmedian hospital stay was 2 days (range 1-7). The time to engraftment, need for transfusion and other toxicities ment was delivered on 4 consecutive days. After a day of rest, the ABCs were prepared as previously described and were not different in patients who stayed entirely as outpatients. No toxic deaths occurred. In conclusion, reinfused. 10 Since the introduction of DMSO depletion, 11 the nausea, vomiting, and cardiovascular symptoms during HDCT followed by ABC transplantation can be safely administered to patients in the clinic with outpatient and after transplantation, have almost entirely disappeared. When we began using recombinant human granulocyte colpost-transplant observation. Keywords: high-dose chemotherapy; breast cancer; outony-stimulating factor (rhG-CSF) instead of recombinant human granulocyte-macrophage colony-stimulating factor patient transplantation (rhGM-CSF), no growth factor-induced fever was observed. 12 The haematologic recovery after reinfusion of ABC was supported by administration o...

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by fluorescence in situ hybridization. Computed tomography imaging revealed lesions in keeping with small-volume lung and liver metastases and bilateral ovarian metastases.The patient was therefore started on first-line systemic therapy for metastatic breast cancer, using nanoparticle albumin bound (nab)-paclitaxel 260 mg/m 2 intravenously every 21 days. She initially tolerated the nab-paclitaxel well, with toxicities limited to alopecia and mild fatigue. After the third infusion, she developed a new skin eruption consisting of several ill-defined erythematous papules located symmetrically over the extensor surfaces of her arms. No pruritus, pain, or constitutional symptoms accompanied these skin lesions. In addition, the patient had no history of a known inciting exposure, significant sun exposure, or local trauma. She had no past history of photosensitivity, dermatoses, smoking, or rheumatic disease.The skin lesions progressed over the subsequent weeks, though the patient remained otherwise asymptomatic. At the assessment preceding the patient's 5th cycle of nab-paclitaxel, the skin eruption was noted to have progressed dramatically. Physical examination now showed a symmetrical, photodistributed rash involving the extensor surfaces of both arms and hands, as well as the anterior chest (Figure 1). The skin lesions were psoriasiform and consisted of erythematous papules coalescing into plaques with overlying scale (Figure 2). No demonstrable mucous membrane involvement, nail changes, or other skin lesions were evident. The remainder of the physical examination was remarkable only for findings of the known breast cancer.The current eruption was felt, clinically, to be in keeping with subacute cutaneous lupus erythematosus (scle). Upon review, the patient was not taking any medications known to be associated with scle. Her chronic medications included losartan, atorvastatin, and pantoprazole. In addition to nabpaclitaxel, she had recently used metoclopramide as needed for nausea. ABSTRACTDrug-induced lupus erythematosus (dile) syndromes are documented complications of chemotherapeutic agents, including paclitaxel. Subacute cutaneous lupus erythematosus (scle) is a distinct dile syndrome presenting with characteristic annular or papulosquamous skin lesions in a photosensitive distribution with associated high anti-ssa titres. Previously, dile syndromes complicating paclitaxel therapy have been attributed to polyethoxylated castor oil (Kolliphor EL: BASF, Ludwigshafen, Germany), the biologic solvent included in the drug's original formulation (Taxol: Bristol-Myers Squibb, Montreal, QC), rather than the parent chemotherapy molecule. Here, we report a characteristic case of drug-induced scle complicating treatment with nanoparticle albumin bound (nab)-paclitaxel (Abraxane: Celgene, Summit, NJ, U.S.A.), a solvent-free taxane formulation. The pertinent English-language literature is also discussed. This case report is the first to link solvent-free paclitaxel with scle, and it suggests that the parent molecule is respo...

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Summary.-Mononuclear-cell suspensions of lymph nodes, spleen and blood from 24 patients with active Hodgkin's disease (HD) were studied for possible imbalance of T and B lymphocytes, and T-lymphocyte subsets, using monospecific anti-T antibodies and other reagents. A profile showing T-cell predominance was demonstrated ln lymph nodes and blood, with total T-cells ranging from 50-70% of the cell count. As defined by monoclonal antibodies, 70-85% of the latter comprised the "inducer" subclass, the remainder being "suppressor" cells. There were no essential differences between histologically involved and uninvolved lymph nodes from HD patients, though total T-cell proportions were lower in "normal lymph node" controls. The profiles of spleens electively removed, as part of pre-treatment staging procedures, showed reduced total T-cell numbers, whether these were involved with HD or not. These differences are accounted for principally by fewer T "inducer" cells (24%, in spleen, v. 54% in involved lymph nodes and 47% in "normal" control nodes).Possible explanations for these findings are discussed. Our results demonstrate similar profiles in histologically diseased and normal tissue, rather than any clear imbalance of T-cell proportions which might explain the profound disturbances of T-cell function frequently demonstrated in vivo and in vitro.