The Use of Adrenocorticotropic Hormone and Cortisone in the Treatment of Leukemia and Leukosarcoma

Abstract

Abstract Forty-two patients with various diseases of leukocytic proliferation were treated with one or more courses of adrenocorticotropic hormone or cortisone. Of 13 patients with acute or subacute lymphocytic leukemia who received adequate courses of treatment, 9 (69 per cent) developed objective and hematologic evidence of well defined remissions. Remissions were, however, brief, lasting one to ten weeks. Retreatments produced further remissions but a state of refractoriness was eventually reached. Of 5 patients with acute granulocytic leukemia only 1 showed a slight clinical improvement with therapy. An actual acceleration of the process occurred in 2 cases. Two cases of monocytic leukemia showed no response and death seemed to be hastened. In 5 cases of chronic lymphocytic leukemia, distinct improvement occurred in 4, particularly in those showing terminal leukemia with anemia, exfoliative dermatitis, or symptomatic hemolytic anemia. All of 5 cases of lymphosarcoma showed some degree of improvement. Features benefited were organ enlargement, symptomatic hemolytic anemia and anemia. In 5 cases of Hodgkin’s disease, 3 were notably benefited particularly with respect to constitutional symptoms. There was, however, no fundamental alteration of the disease process. Only 1 case of 5 with multiple myeloma showed a favorable response. Hyperglobulinemia decreased to a variable extent in all cases, as did Bence-Jones proteinuria. The characteristics of remission including reticulocytosis, thrombocytosis, white cell response and marrow picture are detailed. The effect of ACTH on the level of serum globulins, the activity of abnormal hemagglutinins, and sedimentation rate are likewise discussed. The nonspecific effects of adrenocorticotropic therapy are indicated. Comment is made of the undesirable effects of ACTH therapy. These included psychoses, fluid retention, hypertension, convulsions, porcine, obesity, acne, hirsutes and diabetes mellitus. The therapeutic effectiveness of ACTH is compared with the existing available methods of therapy in the hematologic conditions under discussion.