The use of adrenocorticotropic hormone and cortisone in the treatment of leukemia and leukosarcoma.

By MARTIN C. ROSENTHAL, M.D.,* RICHARD H. SAUNDERS, M.D.,* LAWRENCE I. SCHWARTZ, M.D., LEDA ZANNO5, i vI.D., ENRIQUE PEREZ SANTIAGO, M.D. AND WILLIAM DAMESHEK, M.D. D URING THE PAST EIGHTEEN MONTHS, interest in the clinical use of adrenocorticotropic hormone (ACTH) and cortisone has become quite general. For some time, the limited supply of these hormones, together with a lack of knowledge as to their ultimate effects on the organism, necessitated their use as investigational tools only. As knowledge of their action was gained and the supply increased, clinicians in many fields were quick to seize upon these hormones as possible therapeutic agents in the treatment of diseases which had hitherto been unresponsive to most methods of treatment. The beneficial results obtained in certain cases has, in some measure, justified this hope although the rationale for use of the hormones has not always been clear. The work of Dougherty and White” 2 focused attention anew’ on the reciprocal relationship between the adrenal cortex and lymphoid tissue. Their observations on the morphologic changes which occurred in lymphoid tissue and lymphocytes following adrenal cortical stimulation suggested that the adrenal glands might have an effect on leukemic proliferation. At their suggestion, one of treated 2 cases of chronic lymphocytic leukemia in 1943 with crude pituitary adrenotropic hormone extract daily for two weeks but since negative results were obhoned, further studies were not carried out. In 1944, Murphy and Sturm3 gave intraperitoneal injections of leukemic cells followed “some hours later” by injections of a hormonal preparation to rats of a strain highly susceptible to transmitted lymphocytic leukemia. When crude pituitary adrenotropic hormone was used, the survival rate was increased from the control rate of 5 to 10 per cent to more than 40 per cent. With adrenal cortical extracts, the survival rate was 20 to 60 per cent. In the same year, these authors showed that adrenalectomv greatly increased the susceptibility of rats to transplantable lymphocytic leukemia .