Cases reported "Melanoma"

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1/5. hypotension and disseminated intravascular coagulation following intralesional bacillus Calmette-Guerin therapy for locally metastatic melanoma.

    Four patients developed serious hypotension and signs of disseminated intravascular coagulation shortly after a second round of Tice bacillus Calmette-Guerin (BCG) injections into locally recurrent cutaneous melanoma satellite nodules. Each of these patients survived following intensive therapy with isoniazid, pyridoxine, steroids, pressors, antibiotics, and cardio-renal support including, in one case, three acute hemodialyses. plasma specimens from two of the four patients caused gelation of lysate from the amebocytes of Limulus polyphemus, indicating the presence of endotoxin or an endotoxin-like substance. in vitro studies on the BCG preparations led us to conclude that this endotoxin activity in the plasma is not the result of direct injection of endotoxin with the BCG preparation, but rather from release of endotoxin from endogenous sources, such as the intestinal tract during a period of relative hypotension following an allergic reaction. Prior immunity appeared to be the consistent factor in the toxic reactions reported herein. Finally, we present recommendations for serial monitoring of these patients and discuss the use of an alternative agent for intralesional therapy.
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ranking = 1
keywords = bacillus
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2/5. Active immunotherapy of human melanoma exploiting the immunopotentiating effects of cyclophosphamide.

    Malignant tumors may escape rejection by the immune system because they induce a state of immunological tolerance mediated by tumor antigen-specific suppressor T cells. In animal systems, cyclophosphamide can reverse the tolerance and thereby facilitate immunologically mediated tumor destruction. We have applied these concepts to the immunotherapy of human malignant melanoma. Forty-three patients with metastatic disease were treated with a whole cell vaccine 3 days after intravenous administration of cyclophosphamide, 300 mg/m2. The vaccine consisted of cryopreserved, irradiated autologous melanoma cells, obtained from metastatic masses by dissociation with collagenase and DNAse, mixed with bacillus Calmette-Guerin (BCG) and injected intradermally. The cyclophosphamide (CY) vaccine combination was repeated every 28 days. Delayed-type hypersensitivity (DTH) was tested by injecting 1 x 10(6) melanoma cells intradermally and measuring the diameter of induration at 48 h. Most patients had minimal pretreatment DTH responses to melanoma cells (mean /- SE, mm = 2.4 /- 0.5). After two vaccine treatments, the responses increased significantly (mean increase /- SE = 12.1 /- 1.6 p less than .001) and that level of response was maintained after 4, 6, and 8 treatments. The patients were also skin-tested with a mixture of the enzymes used to dissociate the tumors. No patients exhibited DTH to collagenase DNAse prior to vaccine injection, but every patient developed DTH to the mixture following two treatments (mean, mm = 26.4 /- 3.9). Although extracting viable cells from tumor tissue without the use of enzymes proved difficult, we were able to test DTH to mechanically dissociated tumor cells in 23 patients. After two vaccine treatments, there was a significant increase in DTH to enzyme-free autologous melanoma cells (mean DTH /- SE, mm: 5.4 /- 1.0, p less than .01). Whereas 5 of 23 patients had positive DTH responses (5 mm induration or greater) before treatment, 11 of 23 were positive after two treatments. Further significant increases in DTH enzyme-free cells were observed after 6 and 8 treatments. Thus, it appears that patients receiving CY vaccine developed DTH to tumor-associated antigens as well as to residual collagenase and DNAse on the cell surface. Thirty-three patients could be evaluated for antitumor effects of cyclophosphamide vaccine. There were 3 complete remissions, 1 partial remission, and 2 minor responses. Two complete responders remain alive and free of disease after 57 and 12 months, respectively, and the third died after 39 months. The partial remission consisted of 75% regression of a pulmonary metastasis.(ABSTRACT TRUNCATED AT 400 WORDS)
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ranking = 0.2
keywords = bacillus
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3/5. Fatal disseminated bacillus Calmette-Guerin infection and arrested growth of cutaneous malignant melanoma following intralesional immunotherapy.

    An 84-year-old man with aggressive cutaneous malignant melanoma, which failed to respond to systemic chemotherapy, was electively treated with intralesional bacillus Calmette-Guerin (BCG) immunotherapy. He died with widespread miliary granulomas, most likely representing disseminated BCG infection. However, at autopsy, the patient was found to have a minimal tumor burden and only a single focus of visceral metastatic malignant melanoma. In view of the clinically documented aggressive nature of this patient's disease, the arrested growth of his tumors is best attributed to the beneficial effect of BCG immunotherapy.
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ranking = 1
keywords = bacillus
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4/5. Regression of melanoma nodules in a patient treated with ranitidine.

    Human malignant melanoma may regress spontaneously or with immunotherapy, such as Calmette-Guerin bacillus, interferon alfa, interleukin-2, and interleukin-2 plus lymphokine-activated killer cells. histamine type 2 receptor antagonists can modulate immune function by inhibiting suppressor T-cell induction and activity, and melanoma regressions have been reported after the use of cimetidine with coumarin or interferon alfa. This article describes the complete regression of melanoma nodules in a patient treated with ranitidine hydrochloride, another histamine type 2-receptor antagonist. ranitidine and cimetidine should be considered to be possibly active immunotherapeutic agents in the design and evaluation of clinical trials.
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ranking = 0.2
keywords = bacillus
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5/5. Intralesional immune therapy: methanol extraction residue of BCG or purified protein derivative.

    6 patients with cutaneous malignant melanoma and multiple secondary cutaneous lesions were treated with intralesional methanol extraction residue of bacillus Calmette Guerin (MER-BCG). Separate lesions were injected with purified protein derivatives (PPD) in 5 of the study patients. 5 of the 6 MER-BCG injection lesions developed marked inflammation clinically. Excisional biopsy 7-14 days later demonstrated complete dissolution of tumor in 2 patients and was accompanied by infiltration with acute and chronic inflammatory cells; 3 lesions revealed necrosis with residual tumor, and in 1 patient there was no apparent host response. Clinical tumor regression was not observed with PPD applied intralesionally, although histopathologic analysis revealed a granulomatous inflammatory response in 3 of 5 patients. No patient demonstrated regression of uninjected cutaneous lesions (4 evaluable patients) or visceral lesions (2 patients). The critical determinants of tumor regression are the size, site and depth of the lesion in relationship to the cutaneous surface. The mechanism of tumor eradication may be related to 'innocent bystander' necrosis secondary to nonspecific inflammation rather than immunologically mediated via host sensitization.
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ranking = 0.2
keywords = bacillus
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