Document 0004
 DOCN  M9490004
 TI    Systemic hyperthermia in the treatment of HIV-related disseminated
       Kaposi's sarcoma. Long-term follow-up of patients treated with low-flow
       extracorporeal perfusion hyperthermia.
 DT    9411
 AU    Alonso K; Pontiggia P; Sabato A; Calvi G; Curto FC; de Bartolomei E;
       Nardi C; Cereda P; Laboratory Atlanta, Riverdale, Georgia.
 SO    Am J Clin Oncol. 1994 Aug;17(4):353-9. Unique Identifier : AIDSLINE
       MED/94324355
 AB    Treatment of HIV and related malignancies with pharmacologic and
       biologic agents has not appreciably modified the course of disease.
       Immunologic impairment remains the critical factor in response. We
       report the long-term results of a single session of low-flow (0.3 L/min)
       extracorporeal perfusion hyperthermia on 29 men and 2 women with
       disseminated Kaposi's sarcoma and profound immunologic impairment. Any
       antiretroviral drug employed by the patient was stopped 72 hours prior
       to treatment and withheld during the period of follow-up. Core
       temperature was raised to 42 degrees C and held for 1 hour with
       extracorporeal perfusion and ex vivo blood heating to 49 degrees C as
       the means of temperature control. Of 31 patients, 2 died of
       complications secondary to treatment (cardiac arrhythmia; CNS bleed).
       There were two cases of intravascular coagulopathy. Pressure point skin
       damage may occur despite adequate cushioning. At 30 days posttreatment
       complete or partial regressions were seen in 20/29 of those treated,
       with regressions persisting in 14/29 of those treated by 120 days
       posttreatment. At 360 days, 4/29 maintain tumor regressions with 1 in
       complete remission (at 26 months). The patient in complete remission
       remains culture-negative and PCR-negative for HIV. CD4+ counts rose from
       around 250 to, and remain around, 800 in this man. Selected healed
       lesions were biopsied to demonstrate tumor absence. Patients were
       selected for treatment if pretreatment testing of the tumor showed
       regression in vitro with heat exposure. Analysis of the early and
       midterm failures showed little sustained rise of the CD4+ cells if
       presenting total CD4+ counts were below 50 and had been at such low
       levels for extended periods, although other surrogate markers of HIV
       activity declined (semiquantitative PCR) during this period and is felt
       to support the hypothesis of apoptosis proposed in this illness.
       Analysis of the tumors of the few men not responding demonstrated
       elevated levels of IL-6 as compared to responders (12 vs < 1 pg/ml). At
       120 days 29/31 patients remained alive (expected, 20). At 360 days,
       21/31 remained alive (expected, 11). In no patient was HIV activity
       stimulated with heat exposure. CMV retinitis did clear in some patients
       treated (both techniques), but treatment alone did not prevent later
       development of retinopathy. EBV parameters were markedly altered in the
       short term with heat exposure in some patients. Few patients showed
       herpes simplex activation. Varicella-zoster virus remitted in some
       patients. There is utility in the use of systemic hyperthermia to
       control HIV and related malignancy.(ABSTRACT TRUNCATED AT 400 WORDS)
 DE    Adult  *Extracorporeal Circulation/METHODS  Female  Follow-Up Studies
       Human  *Hyperthermia, Induced/METHODS  HIV/ISOLATION & PURIF  HIV
       Infections/BLOOD/*COMPLICATIONS/MICROBIOLOGY  Leukocyte Count  Male
       Polymerase Chain Reaction  Remission Induction  Sarcoma,
       Kaposi's/ETIOLOGY/*THERAPY  Support, Non-U.S. Gov't  T4 Lymphocytes
       CLINICAL TRIAL  CLINICAL TRIAL, PHASE I  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).