Radio-Active Phosphorus in Leukaemia

Easson, Eric Craig (1958) Radio-Active Phosphorus in Leukaemia. PhD thesis, University of Glasgow.

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This thesis is concerned with the response to P32 of chronic leukaemia in humans. Section I outlines the historical basis of classification of the leukaemias, preference being given for a simple working system. The common clinical syndromes are described, followed by a brief account of the main clinical pathological features. Aetiology is also considered here, including incidence, the relationship of leukaemia to other diseases, and the aetiological importance of various external factors, chemical and physical. Section II is concerned with the principles of management of leukaemic patients, and outlines the evolution of modern therapeutic practice. Section III discusses the pharmacology of radioactive phosphorus, the anti-leukaemic agent with which this thesis is primarily concerned. The biochemical and the physical features are described, its absorption, distribution, and excretion, and finally the biological effects which follow its administration. Section IV describes the author's experience in treating 60 patients with P at the Christie Hospital and Holt Radium Institute in Manchester, England. The evolution of a dosage system is discussed, and it is shown that in more than 90% of selected cases of chronic leukaemia an exponential relationship exists between the falling white cell count and the Integral Body Dosage from P32. The logarithms of the WBC plotted against the cumulative IBD (most conveniently expressed in millicuries-destroyed) gives a straight line graph. Such a straight line can he extrapolated at an early stage in treatment and permits a prediction to he made of the Minimum Effective Dose for each patient. This method of treatment has provided satisfactory remissions both clinically and haematologically. This exponential relationship has held in all hut 12 of the 60 treated patients, hut in 7 of these there were obvious reasons for this non-exponential behaviour. Following recurrence of symptoms, 15 patients have received a second course of P32 , seven of these have had a third, and 1 a fourth course. The pattern of response has been remarkably similar to the first, but with a curious tendency to increasing sensitivity. Section V describes one of several possible applications of the exponential fall in the WBC - a quantitative study of white cell sensitivity. The HVD is a quantitative expression of leukopoietic sensitivity for each individual. Twenty seven cases of chronic myeloid and twenty one of chronic lymphatic leukaemia were tabulated in order of their white cell sensitivity, and various haematological and clinical data were similarly tabulated, but with none of these has any clear correlation been demonstrated. Section VI provides summaries of the case histories of the sixty patients treated by P32 . It is concluded that in addition to and in spite of much detailed and complex research, there is need for more clinical study of leukaemia, and especially for aetiological investigation. Management of patients is advocated in centres possessing all modern therapeutic techniques, and regret is expressed at the dilution of experience that has followed the introduction of chemotherapy. Therapeutic trials might be organised on a national scale to offset this loss of clinical material. The prediction method of P dosimetry is advocated when this isotopic treatment is appropriate. Much more work is seen to be necessary if even small questions are to be answered in this vast problem.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine, Nuclear physics and radiation, Oncology
Date of Award: 1958
Depositing User: Enlighten Team
Unique ID: glathesis:1958-79223
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 31 Mar 2020 09:09
Last Modified: 31 Mar 2020 09:09

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