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16 patients with relapsing non-Hodgkin’s malignant lymphomas considered as clinical stage I or II were treated by an association of chemo + radiotherapy and thereafter by maintenance BCG therapy. 5 of them were included in a randomized trial and have a significantly different disease-free survival from patients receiving the same treatment but without BCG. 11 were systematically treated by BCG and they also have a fairly good disease-free survival. Such a treatment appears to be of value in treating these patients and even probably of curing some of them.

The 3H-proline release test was used to measure spontaneous cytolytic activity of lymphocytes (CMC) from 94 melanoma patients after resection of the primary tumor. This assay showing a remarkable sensitivity and reproducibility allowed the detection of a certain disease-related pattern defined as preferential lysis of tumor cells when patients with mammary carcinoma and bladder tumor were tested simultaneously against corresponding tumor cells.

A combined treatment modality imcorporating surgery plus BCG immunotherapy was administered to (C57Bl/6 X DBA/2)F1 mice grafted with EAkR lymphosarcoma. A single preoperative local or postoperative systemic BCG administration cured 20-30% of the animals, but did not prolong the survival time of these groups. Repeated s.c. injections of BCG resulted in a significant increase in survival time compared to the group submitted to surgery alone. In contrast, multiple i.v. injections of BCG before and after surgery were no more effective than surgery alone and were less effective than a single postsurgical i.v. injection in producing cures. We have concluded that for local BCG therapy, multiple injections before and after surgery are more effective than a single injection. However, for systemic therapy, multiple injections are less effective than a single injection applied postoperatively.

Many recurrent superficial bladder cancers cannot be controlled with current standard therapies. Transurethral resection of superficial bladder tumors is curative in only 30 to 40% of cases. Adjuvant topical chemotherapy for superficial tumors may increase the cure rate to 60%. Whether topical chemotherapy can prevent the progression of these lesions to higher grades and stages is yet to be determined. There remains a significant percentage of patients (40%) who will suffer from recurrent tumors and possible cancer progression.

Summary— Intravesical instillations of Tokyo 172 strain BCG were given to 56 patients with superficial bladder cancer during the 24-month period after transurethral tumour resection as a prophylaxis against tumour recurrence. The recurrence rate of tumours was compared with that of historical controls. Results were estimated by the person-years method and there were statistically significant decreases in recurrent tumours following BCG therapy. Our results suggest that the intravesical Tokyo 172 strain BCG is effective and safe as a prophylaxis against the recurrence of superficial bladder tumours.

The survival of patients with acute non-lymphoid leukaemias (ANLL) receiving chemotherapy (32 patients) or chemotherapy plus BCG (31 patients) has been compared in a randomized trial which started in Nov 1974. Fresh BCG (Institut Pasteur, Paris) was administered by Heaf gun in the interval of chemotherapy cycles. The overall survival was better in the chemo-immunotherapy group (median duration of survival of 25 months compared to 16 months in the chemotherapy group). However, the first remission duration did not differ (median duration of the 15 and 12 months, respectively). Plateau survival curves were not obtained in either group. A second complete remission was obtained in 7 out of 12 patients with bone marrow relapses in the chemo-immunotherapy group, and only in 2 out of 15 in the chemotherapy group (P less than 0.05). BCG seemed more efficient in patients older than 40 years; no difference was observed according to sex.

An evaluation of long-term results of BCG therapy for superficial bladder tumours is presented. In 12 patients treated with a curative aim, 41.7% complete regressions and 25% partial regressions were observed. Later on, 10 of these patients continued treatment with a prophylactic aim and 4 presented recurrences at 2, 3, 5 and 6 years, respectively. Another 29 patients were treated primarily with a prophylactic aim after TUR. On the whole, the percentage of patients with recurrences was 28% for the group a receiving instillations alone or combined with dermal scarifications, and 64% for the group receiving only dermal scarifications. Most of the recurrences occurred in patients with recurrent disease which failed to respond to other therapies, but even in this group the time to first recurrence was sharply prolonged and the rate of recurrences per 100 patients per month significantly diminished in patients treated intravesically, as single therapy or associated with dermal scarifications. Although side effects were usually of minor importance, 5 patients had severe complications, underscoring the necessity to find more appropriate treatment regimes in further trials.

• Since the introduction of BCG intralesional immunotherapy for melanoma, severe complications, including death, have been reported after treatment in hypersensitized individuals. This is a case report of BCG dissemination with ulceration, skin necrosis, lymphadenitis, and abscess formation following the first intralesional injection of a minimal dose of BCG in a PPD-negative patient. The case demonstrates that severe complications can occur in patients who are not hypersensitized, anergic, or debilitated or who have been treated multiple times. This patient's complication further suggests that migration of BCG after intralesional therapy may play a role in the regression of uninjected nodules seen in some patients. ( Arch Surg 113:893-896, 1978)

Excerpt To the editor: We are presently treating a patient who developed recurrent urticarial eruptions that were temporally related to the administration of BCG. This systemic reaction is not desc...