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Solitary bone plasmacytomas account for 5-7% of multiple myeloma cases and are assumed to have a fairly good prognosis, with a long duration of relapse-free survival after primary local treatment. Isolated phalanx plasmacytoma is a very rare entity, because involvement of extremities is seen in less than 1% of all solitary bone plasmacytomas, where they are usually localized centripedally, often in the axial skeleton. A 68 year old patient with a lytic lesion involving 5th phalanx was diagnosed as having a biopsy-proven solitary plasmacytoma, with a negative work-up for coexisting plasma cell dyscrasia. Three and a half months after completion of radiotherapy of the involved phalanx, the patient was readmitted with hypercalcemia, renal insufficiency and subsequently diagnosed as having atypical plasma cell infiltration of marrow, and plasmacytomas involving the right vocal cord and the premaxillary region, as well as pathological ulna fracture. Plasmacytoma of the phalanx, with extreme short duration of remission and an aggressive type of clinical relapse, is in sharp contrast with the natural stable course of a solitary plasmacytoma where the use of systemic treatment is subject to intense debate.

Although the smoking epidemic is decreasing steadily in other parts of the world, it continues to spread at an accelerated rate in underdeveloped and developing countries. Turkey, among other developing countries, faces the increasing threat of tobacco-related cancers, particularly lung cancer, which is the leading cause of cancer death in both sexes. We investigated the relationship between cigarette consumption and the relative mortality rates due to lung cancer in men and women between 1965 and 1992. We found a parallelism between the increasing total and per capita cigarette consumption and the rising relative mortality from lung cancer in both sexes. Total per capita cigarette consumption rose from 1230 cigarettes per year in 1985 to 1495 in 1991, and the per capita yearly cigarette consumption over the age of 15 increased from 1850 in 1965 to 2600 in 1992. During the same period, the relative mortality from lung cancer increased from 25 to 40% in men and from 11 to 16% in women. The tar, nicotine, and carbon monoxide determinations of locally produced and imported cigarettes suggested that the high tar and carbon monoxide content of most locally produced cigarettes smoked over many years could also be a contributory factor to the increased mortality rates due to lung cancer. Only two brands of locally produced cigarettes contained lower than 12 mg of tar per cigarette as allowed in European community states, whereas half of the imported brands of cigarettes met this standard. Four of the six imported brands of cigarettes contained higher tar and carbon monoxide compared with the same brands sold in England. These findings indicate that urgent measures are necessary not only to ban all activities promoting the sale of cigarettes but also to establish standards for both national and foreign brands of cigarettes while making a greater effort to reduce active and passive smoking in the Turkish population.

This study was aimed to evaluate the efficacy of G-CSF (Granulocyte colony stimulating factor) administration to 37 patients with neutropenia following intensive combination chemotherapy. The patients were divided into two subgroups including solid tumors given ifosfamide and etoposide combination chemotherapy (IMET subgroup) and acute myeloid leukemia (AML) patients treated with mitoxantrone and cytarabine. Control group consisted of 31 acute myeloid leukemia patients. G-CSF was started on the first day of absolute neutropenia until the absolute neutrophil count was above 1000/mm(3) for two consecutive days. G-CSF was found to be effective for early recovery of neutrophil count. Expected response was achieved within 14 days in 91.5% of the courses with a median of fifth day of G-CSF treatment. In conclusion, this study showed the efficacy of G-CSF in early recovery of neutrophil count without any reduction in the incidence of febrile episodes and documented rates of bacterial and fungal infections in patients with acute myeloid leukemia.

We report here a 16-year-old boy with pre-B-type acute lymphoblastic leukemia who developed acute tumor lysis syndrome (TLS) following 12 h mitoxantrone infusion. TLS is a distinct clinical entity which has been recognized most frequently with aggressive combination chemotherapy of rapidly proliferating hematologic neoplasms. There have been a few reports of single-agent-induced tumor lysis, but to our knowledge, this is the first case reported with mitoxantrone alone.

In this study, we developed a reliable scale to measure the quality of life (QOL), which would reflect the cultural characteristics of cancer patients in Turkey. We used the Rolls-Royce model and determined a form with 49 items in eight dimensions such as general well-being, physical symptoms and activity, sleep dysfunctions, appetite, sexual dysfunction, cognitive functions, medical interaction, social participation and work performance. The forms were used for assembling data from 100 subjects (10 physicians, 19 healthy volunteers, 18 patients relatives, 28 patients on chemotherapy, 25 patients off chemotherapy). Half-split reliability and the signal effect were used to demonstrate reliability and responsiveness. After demonstrating the validity of the test, the final form was constructed. When these eight dimensions were factor analysed, it was found that the general well-being and sexual dysfunction were the most important determinants of QOL.

Aims: To analyze the clinical and therapeutic aspects of patients with primary tonsillary non-Hodgkin's lymphoma., Methods: Twenty-eight patients with primary tonsillary non-Hodgkin's lymphoma who had been followed in the Hacettepe Oncology Institute between 1974 and 1992 were retrospectively analyzed. Fifteen patients were male, 13 were female. Median age was 55 years., Results: Constitutional symptoms were present in 10 patients (35.7%). Stages according to the Ann Arbor classification were I and II in 12 and 16 patients, respectively. According to the Rappaport classification, poorly differentiated lymphocytic was the most common pathologic subgroup (42.9%). Grades according to the Working Formulation were low, intermediate and high in 3, 22 and 3 patients, respectively. Twenty-two patients had received chemotherapy. Cyclophosphamide, vincristine and prednisone (CVP), and cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) were the regimens most commonly employed. Eighteen patients received radiotherapy to Waldeyer's ring and neck. Eight patients achieved remission with chemotherapy plus radio-therapy, 7 patients with chemotherapy alone, and 5 patients with radiotherapy alone. In addition to the 20 patients who achieved complete remission, 3 patients achieved partial remission; the overall response rate was 82.1%. The response rates and survival attained with the combined modality, chemotherapy, or radiotherapy alone were not statistically different (P > 0.05). The median follow-up was 14 months. Overall and disease-free survival at 5 years were 62.6% and 77.6%, respectively. Pathologic grade was the most important prognostic factor influencing overall survival in the Cox multivariate model., Conclusions: Poorly differentiated lymphocytic lymphomas were the most common pathologic subtype, and pathologic grade was the most important prognostic factor to influence survival in the present study. Although combined modality treatment did not appear to be superior to chemotherapy or radiotherapy alone, a larger number of patients is needed to draw definite conclusions.

In this retrospective study, 470 patients with non-Hodgkin's lymphoma (NHL) who had been followed in the Hacettepe University Medical Oncology Department between 1973 and 1990, were evaluated to establish their epidemiologic, clinical and therapeutic characteristics. Out of 470 patients, 302 (62.2%) were male and 168 (37.8%) were female. The ages ranged from 16 to 85, with a median of 44 years. Constitutional symptoms were present in 46.4% of the patients. According to the Working Formulation, low, intermediate, and high-grade lymphomas comprised 33.4%, 54.9%, and 12.7%, respectively. The most common extranodal presentation was gastrointestinal. The chemotherapy regimens most commonly used were CVP (cyclophosphamide, vincristine, prednisone), BCNOP (bleomycin, cyclophosphamide, mitoxantrone, vincristine, prednisone), CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and CHOP-Bleo (cyclophosphamide, doxorubicin, vincristine, prednisone, bleomycin). The response rates and the survival figures attained with these regimens were not statistically significantly different (P > 0.05). In the Cox multivariate model, pathologic grade, leukopenia, responsiveness to chemotherapy, bone marrow involvement and age were the important factors influencing the disease-free survival, while responsiveness to chemotherapy, age, presence of constitutional symptoms, pathologic grade, extranodal presentation and stage were the important factors influencing the overall survival. The distribution of NHL according to grade and stage was similar to that in western societies, while constitutional symptoms and lymphomas of the small intestine including immunoproliferative small intestinal disease were more common in Turkey.

The average ceruloplasmin levels of 29 patients with active breast cancer and 22 patients in remission were 824 +/- 61 mg/l and 630 +/- 18 mg/l respectively. The average ceruloplasmin level of 17 patients with benign breast diseases was 555 +/- 29 mg/l and of 18 healthy women in a control group 584 +/- 17 mg/l. Breast cancer patients not in remission had ceruloplasmin levels which were significantly increased when compared to the other 3 groups. The CA 15-3 levels and ceruloplasmin levels were positively correlated. We propose that ceruloplasmin may be used as a tumour marker in the follow-up of patients with breast cancer.

Susceptibility to infection is widely recognized as the major cause of morbidity and mortality in patients with CLL and MM. The present study was designed to investigate the serum bactericidal (SBA) and serum opsonic activities (SOA) in 12 CLL and 12 MM patients, and results were compared to 20 normals. SBA and SOA were measured by a new radiometric assay. SBA was found to be normal in 11 patients with CLL and in all 12 patients with MM. In contrast, SOA was significantly lower in 11 out of 12 patients with CLL. Ten of twelve patients with MM also had significantly lower SOA compared to those of controls. No correlation was detected between the serum immunoglobulin and complement levels of the patients or between the degree of the opsonic defect and the incidence of infection. In mixture experiments, untreated normal serum partially corrected the opsonic activity of CLL and MM serum. The results suggest the presence of a possible inhibitor in the serum of patients with two well-known B-lymphocyte-derived disorders.

The haemoglobin-F levels and F-cell numbers were assessed in 19 patients with different urogenital cancers. Alpha-fetoprotein (AFP), beta human chorionic gonadotrophin (beta HCG), total and prostatic acid phosphatase levels were also measured. HbF levels were found to be elevated in patients with testicular and prostatic cancer. No significant correlation was observed between HbF, AFP and beta HCG levels. The findings suggest that HbF production could be enhanced in patients with testicular and prostatic carcinomas and might be a useful marker to the disease activity.

A vital dye exclusion method following a 4 day tumor sensitivity assay was used to predict clinical response to chemotherapeutics in 16 patients with acute nonlymphoblastic leukemia (n = 12), acute lymphoblastic leukemia (n = 2), diffuse poorly differentiated lymphoma (n = 1) and oat cell carcinoma (n = 1). After 4 days of incubation, controls and drug-supplied cells were stained with fast green and hematoxylin-eosin. A tumor cell survival of 30% was used to distinguish in vitro resistance and in vitro sensitivity. Eight patients responded and five did not respond to the chemotherapy protocol. This agreed with the in vitro results. Two patients who were sensitive in vitro responded only partially in vivo but two additional patients sensitive in vitro did not respond. These results indicate that this short-term method may give a simple estimation of drug resistance.

A 27-year-old woman with Hodgkin's disease, nodular sclerasing type, having received two courses of radiation therapy with one year and nine months interval and a prolonged course of chemotherapy with combinations of COPP, MOPP and CVPP, developed oat cell carcinoma of the lung, four years after the initial diagnosis.