Seventy-eight patients with modified Stage II or Stage IIIM0 adenocarcinoma of the lung were evaluated retrospectively with regard to the impact of prophylactic cranial irradiation (PCI) (30 Gy in 15 fractions) in preventing central nervous system (CNS) metastases. Twenty patients received PCI and 58 did not. There were no significant differences between these groups with respect to age, sex, stage, or median survival (17.4 months with PCI versus 16.9 months without PCI; P = 0.6). One (5%) of 20 patients receiving PCI developed CNS metastases, compared with 14 (24%) of 58 patients not receiving PCI (P = 0.06). The time from diagnosis to development of CNS metastases and survival after CNS involvement was 51 weeks and 14 weeks, respectively, for the patient who received PCI; and a median time of 50 weeks and 26 weeks, respectively, for the patients not receiving PCI. In nine (64%) of the 14 non-PCI patients the CNS was the first and only site of relapse. A Cox regression analysis demonstrated that nodal involvement was significantly associated with an increased risk of CNS metastases. These data suggest that PCI may decrease the incidence of CNS metastases, and that it may be beneficial in the management of patients with N1 or N2 disease.

Among 172 patients with hairy cell leukemia (HCL) seen at the University of Chicago over a 10-year period, 15 were found to have a second malignancy. Neoplasia of the skin was noted most frequently; there were three cases of basal cell carcinoma, one case of anaplastic squamous cell carcinoma, and one case of malignant melanoma. This was followed in frequency by three cases of carcinoma of the lung. The clinical characteristics of these 15 patients did not differ from those of the general population of patients with HCL. A variety of second hematologic malignant disorders and solid tumors were identified. In one case, the second neoplasm occurred before the diagnosis of HCL; six were diagnosed concurrently; and eight followed the diagnosis of HCL. Since HCL is a well-defined clinicopathologic entity, patients with HCL who exhibit unusual features of the disease should be investigated further for the presence of second malignancies.Cancer 56:1462-1467, 1985. AIRY CELL LEUKEMIA (HCL) is a well-defined clin-H icopathologic entity characterized by the presence of abnormal circulating mononuclear cells with large cytoplasmic projections.' Patients often have initial symptoms related to cytopenias, as well as massive splenomegaly and absent or minimal lymphadenopathy.',' The disease has a chronic course; however, progressive infiltration of bone marrow by hairy cells can occur. Granulocytopenia and monocytopenia are known to predispose patients to a variety of infectious complications.'~~ When cytopenias exist, splenectomy is generally regarded as appropriate initial therapy. ' The origin of hairy cells remains a subject of continued debate. Generally, HCL is considered to be a B-cell neoplasm'; however, hairy cells also have monocytic features7** The occurrence of second malignancies in HCL noted in published reports has led to further questions regarding the etiology of HCL. In addition, the presence of a second malignancy can complicate the management of the patient. In this report, we describe second malignancies in 15 patients with HCL. Materials and MethodsWe reviewed the records of all patients with hairy cell leukemia who were referred to the University of Chicago from 1975 through February 1984. Of 172 patients who were identified, 15 had a malignant disease in addition to HCL. We recorded patient sex, age at diagnosis of HCL, the nature of the second malignancy, the interval to the diagnosis of the second malignancy, the treatment for HCL and the other disease, and the hematologic status of the patients with HCL at the time the second malignancy was diagnosed. When splenectomy was undertaken within I month of the diagnosis of HCL, it was considered as being done at the time of diagnosis. The second malignancy and HCL were considered to be concurrent if they were diagnosed within 12 months of each other. ResultsPatient characteristics, as well as data on the diagnosis and treatment of HCL and the nature of the second malignancy, are summarized in Table 1. In our series, there were 14 men and 1 woman. The ag...

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Nine patients with progressive hairy cell leukemia were treated with subcutaneous injections of recombinant alpha 2 interferon (2 to 10 X 10(6) U/m2) three times weekly. Eight patients completed at least eight weeks of treatment and were evaluable; one patient with refractory thrombocytopenia died of an intracerebral hemorrhage after two doses of interferon. Seven of eight patients responded, with responses occurring as early as two weeks. Four patients also had resolution of their monocytopenia. No complete responses were seen with up to 30 weeks of treatment. Bone marrow biopsies demonstrated improvement in all eight patients. No unforeseen toxicity occurred, but most patients had transient myelosuppression during the first few weeks of treatment. Recombinant alpha 2 interferon is effective in the treatment of hairy cell leukemia, with acceptable toxicity.

Twenty patients with disseminated cancer both untreated and previously treated received bialkylator chemotherapy, thiotepa, and cyclophosphamide and reinfusion of cryopreserved autologous bone marrow (ABMR). The cyclophosphamide dose was constant at 7.5 g/m2 over three days, while thiotepa was started at 1.8 mg/kg for three days in escalating dose by a modified Fibonacci schema to 7 mg/kg. The median time to recovery of more than 500 granulocytes and more than 50,000 platelets/microL was 18 and 27 days, respectively. Four patients died as a consequence of severe, overwhelming infections or progressive disease during their period of aplasia. Of the 18 evaluable patients, a complete response (CR) was achieved in three patients and a partial response (PR) in ten patients for an overall response rate of 72%. The median duration of response was 14 weeks. Other nonhematologic toxicities included nausea/vomiting, diarrhea, stomatitis, skin rash, and cardiomyopathy. The maximum tolerated dose (MTD) of thiotepa was 700 mg/m2 or 6 mg/kg for three doses. Although there are substantial toxicities associated with this regimen, high-dose thiotepa and cyclophosphamide produce high response rates in patients with disseminated cancer.