Hematology

Introduction
The Hematology Group is a part of the Division of Oncology/ Hematology. Accordingly, all six staff physicians and three residents are combined with chemotherapeutic clinical and research activities for patients with both hematological and non-hematological tumors in this division. Bone marrow transplantation is also performed by the same physicians. The number of patients with hematological malignancies has been increasing annually as shown in the table.

Routine Activities
We manage various kinds of hematological malignancies including non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, acute leukemia, and chronic myeloid leukemia. We also manage almost all patients treated with aggressive chemotherapy in the 8F ward in which we have 8 laminar air flow rooms. Our clinical practice consists of not only the treatment of patients but also consultation on hematological abnormalities.
There is a weekly case conference on Tuesday afternoon in the Division of Oncology/Hematology and a monthly joint conference of malignant lymphoma with gastrointestinal oncologists and pathologists.

Research Activities
The following clinical trials were conducted in this year.

Phase I and I/II trials
1. CPT-11/etoposide for relapsed non-Hodgkin’s lymphoma
2. dose escalated CHOP for aggressive non-Hodgkin's lymphoma

Phase II trials
1. IDEC-C2B8 (monoclonal antibody against CD20) for low grade non-Hodgkin's lymphoma
2. NS-075 (high dose cytarabine) for acute myeloid leukemia
3. J COG-LSG 16 for lymphoblastic lymphoma or acute lymphoblastic leukemia
4. JCOG-LSG 14 for Hodgkin's disease
5. JCOG-LSG 17 for standard-risk non-Hodgkin's lymphoma
6. JCOG-LSG 19/20 randomized study for high-risk non-Hodgkin's lymphoma
7. auto BMT for relapsed malignant lymphoma

Phase III trials
1. JCOG-LSG 13/mLSG 8 for multiple myeloma
2. JALSG (Japan Adult Leukemia Study Group) AML 75 for acute myeloid leukemia
3. JCOG-randomized study of autoBMT/ conventional dose chemotherapy for breast cancer

The NCCHE has more cases enrolled into JCOG-LSG trials than the NCCH, Tokyo, and we rank first among the institutions holding membership in the fields of HodgkinÕs disease (LSG14), non-HodgkinÕs lymphoma (LSG17 and LSG19/20) and multiple myeloma (LSG13/mLSG8).

New Developments
In chemotherapy of patients with non-HodgkinÕs lymphoma (intermediate or high grade), the third generation therapy consists of a number of active drugs (MACO-P, PROMACE-CYTABOM, etc.) was not found to be therapeutically effective, and CHOP therapy (the first generation chemotherapy) was still assessed to be the standard treatment, indicating the importance of developing new regimens. As a result, we conducted a single institutional phase I, II trial of high dose CHOP therapy and determined the maximum tolerated dose of doxorubicin (DOX) and cyclo-phosphamide (CPM), i.e., 70 mg/m2 of DOX and 1250 mg/m2 of CPM without G-CSF administration, and 70 mg/m2 and 2250 mg/m2 of CPM with administration of G-CSF. Based on this result, JCOG-LSG started a new randomized phase II study (LSG19/20: biweekly CHOP vs. high CHOP).

Statistics
Number of patients enrolled into clinical trials in 1997

ProtocolNo. of pts
Hodgkin's DiseaseLSG 143
non-Hodgkin's LymphomaLSG 161

LSG 1714

LSG 19/204
Multiple MyelomaLSG 13/mLSG 83
Acute Myeloid LeukemiaJALSG AML 952
Bone Marrow Transplantation
4

(K. Ito)

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