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M9490004.TXT
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1994-09-03
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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).