The role of nitrogen mustard therapy in the treatment of lymphomas and leukemias

The clinical course of ninety-five cases of lymphomas and leukemias following therapy with methyl bis β-chloroethyl amine hydrochloride has been reviewed. These included fifty-seven cases of Hodgkin's disease, ten cases each of lymphosarcoma and chronic lymphatic leukemia, five cases of follicular lymphoblastoma, six cases of chronic myeloid leukemia and nine cases of other related diseases. The response of each case is classified according to criteria based on the period of amelioration of symptoms and duration of effective nitrogen mustard therapy. The clinical improvement and marked palliation in cases, even those responding only briefly, indicates the value of this method of therapy in Hodgkin's disease, lymphosarcoma and chronic lymphatic leukemia. The survival of forty patients with Hodgkin's disease averaged 40 months with a response to nitrogen mustard of twelve months. The seventeen patients still alive have responded 22.4 months and have an average duration of 65 months. This compares well with the best results reported for x-ray therapy and is especially encouraging in view of the terminal status of 50 per cent of the patients at the onset of nitrogen mustard therapy. Roentgen-resistant cases survived slightly longer but had a shorter response to nitrogen mustard than when irradiation was interrupted. Irradiation should be continued as long as feasible in controlling local tumor masses, with nitrogen mustard as adjunctive therapy in suppressing multicentric dissemination of the disease. Nitrogen mustard cannot be recommended as the sole therapeutic agent in lymphomas. As a rule the patient who responds well to irradiation will also respond well to nitrogen mustard. Toxic manifestations of nitrogen mustard therapy were of significance only in five terminal cases which developed anemia, leukopenia and purpura. However, these symptoms as the presenting toxic features of lymphoma prior to nitrogen mustard therapy were frequently controlled for considerable periods. The response of lymphosarcoma and chronic lymphatic leukemia is of sufficient promise to suggest continued use of nitrogen mustard therapy in cases selected according to certain clinical features.