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A human tumor cloning assay was used to analyze drug sensitivity profiles for 99 pairs of tumor samples taken simultaneously from the same patient. These pairs included two areas of the same primary (12 pairs), primary tumor versus metastasis (29 pairs), and metastasis versus metastasis (45 pairs). In addition, to assess variability in the culture and sensitivity techniques, 13 specimens were divided equally and processed twice. One hundred fourteen evaluable drug sensitivity tests were performed on the specimen pairs. Drug sensitivity profiles for the same specimen processed twice demonstrated good agreement (P = 0.03). Sensitivity profiles from two different areas of the same primary were also quite similar (P = 0.002). However, when one sampled a primary tumor and its metastasis for drug sensitivity testing, the agreement (in terms of percent survival) was poor (P = 0.84). Agreement was also poor for drug sensitivity profiles of one metastasis versus another metastasis (P = 0.39). This heterogeneity in drug sensitivity profiles of primary versus metastasis and of metastasis versus metastasis could account for some of the false positives and false negatives noted in clinical correlation trials with the cloning assay. It may also have implications for adjuvant treatment programs where chemosensitivity of the primary tumor can be determined, but will probably not be predictive for chemosensitivity of the micrometastases.

Retinoid analogs are being actively evaluated as antitumor agents in man. A human tumor cloning system was used to assess the antineoplastic activity of all-trans-retinoic acid, all-trans-retinol and 13-cis-retinoic acid. The effect of retinoids on the formation of tumor colony forming units (T-CFU) was surveyed for 67 different human tumors. These analogs showed minor activity in a variety of neoplasms. The decrease in T-CFU varied between histologic tumor types and between tumor of the same type. No significant difference between retinoid analogs was noted.

Extensive bone marrow necrosis is an unusual histologic finding most commonly identified after autopsy. We describe a patient with poorly differentiated lymphocytic lymphoma who manifested pancytopenia and marrow necrosis. Bone marrow scanning with 99mTc-sulfur-minicolloid provided a noninvasive means to assess the extent of marrow damage. Our patient's condition improved clinically following cytotoxic chemotherapy demonstrating that marrow necrosis may be associated with a treatable disease.