The influence of nitrogen mustard on mycosis fungoides; observations relating its effect to the reticulo-endothelial system.

By HENRY H. HENSTELL, M.D., JEROME N. TOBER, M.D., AND BEN A. NEWMAN, M.D. T HIS report deals with the therapeutic effect of nitrogen mustard on 6 patients with mycosis fungoides. The nitrogen mustards, i.e., the B-chloroethylamines, of which the methyl-bis form is being studied clinically, has been shown to be effective in the control of certain types of malignancies.’4 The effects of this group of chemicals, which appear to be on the nuclear structure of the cell, resemble most closely the action of short wave radiation rather than that of any known chemical reaction.’ 6 The cellular susceptibility to nitrogen mustard is related to the proliferative activity of the tissue. Thus malignant tissue is more susceptible to its action than is normal tissue; while in the normal, the bone marrow elements, the lymph nodes, and probably the liver reflect the cytotoxic action of the mustards. This action may result in lymphopenia, granulocytopenia, thrombocytopenia and moderate anemia as well as nausea and vomiting. Preliminary clinical experience with the methyl-bis-nitrogen mustard also indicates that a specific effect is exerted upon lymphatic tissues and upon malignancies of lymphatic origin. Nitrogen mustard has been found to be most effective in the treatment of Hodgkin’s disease and lymphosarcoma, and less satisfactory in the treatment of the leukemias. Preliminary trials of the chemical in