nizes the hallmarks of a good paper, he should be able to evaluate his own paper in this light before submitting it. This is, however, easier said than done, for it is extremely difficult to be objective about one's own paper. Review of a paper by a colleague is useful, if not essential, and this is particularly valuable if this colleague happens to be an experienced journal reviewer; and even more valuable is to subject the paper for institutional review if one's institution is fortunate enough to have an intramural reviewing system or, ideally, a department of publications. But even reviews of this type are not foolproof because an author's colleagues are not necessarily objective and, moreover, they may not take into account the considerations that are important to the journal editor. What should the author do then? One answer is for authors to become severely critical of their own papers, using as aids, because it is impossible to be totally objective, techijiques of evaluation that are used by editors and reviewers. Editors and reviewers all
have their own methods of operation but more formal methods of evaluating medical papers are available. Two that are useful are those of Colton3 and Freund.4 The outline presented by Colton is especially useful in inculcating a critical approach to the more formal papers, while that of Freund has more general application. Considerations such as these are important because the volume of the literature continues to expand unrelentingly - and moreover, the mass of papers published each year continues to comprise some that are good but also some that are poor. It is chastening to realize that a careful appraisal of the literature does, indeed, reveal so many papers of less than excellent quality..'6 Although editors and reviewers have some effect on the overall quality of papers published, their effect on the standard of the medical literature can only be small. Ultimately the standard can improve appreciably only if authors take an increasingly critical approach to their own papers. It is, of course, satisfying for an author to see
his paper in print, but it should be satisfying only if he or she knows that the paper is a superior product. Maybe when each author can produce a superior product and thus communicate clearly, editors will become redundant. Until then, editors will continue to exercise their fourfold responsibilities - to readers, to authors, to their journals and, sometimes, to their own occasionally inscrutable but, it is hoped, rational and constructive bases of editorial judgement. D.A.E.S. References 1. What the medical editor does (E). Can Med Assoc .1 93: 82, 1965 2. Official notice (E). Can Med Assoc 1 1: 57, 1911 3. COLTON T: Critical reading of the medical literature (chap 13), in Statistics in Medicine,
Boston, Little, 1974, pp 315-22 4. FREUND G: The profile of a publication: an aid in the critical evaluation of medical articles. Med Document 5: 2, 1961 5. ScHOR 5, KARTEr.J I: Statistical evaluation of medical journal manuscripts. JAMA 195: 1123, 1966 6 SCHOOLMAN HM, BECKTEL JM, BEST WR,
et al: Statistics in medical research: principles versus practices. I Lab Clin Med 71: 357, 1968
BCG and cancer The literature on the use of BCG (bacille Calmette-Gu6rin) in various types of cancer is now enormous, dating back to 1935, when Holmgren1 tried it intravenously, intralesionally and subcutaneously in 28 patients with cancer, without much success. The use of this vaccine received greater impetus when certain murine tumour cells were shown to have specific antigens, suggesting the possibility of an immunologic approach to therapy.2'3 A few scattered reports appeared of its clinical use during the next 10 years, but it was really a group of French workers4 who put BCG therapy on the map with their promising results in acute lymphoblastic leukemia. Since then the subject has snowballed, with chief emphasis on the leukemias and malignant melanomas. Those who wish to read recent reviews are referred in particular to that by Bast and colleagues5 and to several articles in the December 1974 issue of Seminars in Oncology. For the physicians with only marginal interest, I will summarize a few
recent developments and sketch in the general background, emphasizing that BCG therapy of cancer is still experimental, by no means without danger, possibly based on misconceptions, and needing much research into all sorts of basic problems. An early contribution to the study of BCG and human leukemias was Canadian. In a series of studies Davignon and colleagues64 showed that in the Province of Qu6bec death from leukemia was approximately half as common in BCG vaccinees as in the nonvaccinated. This view was confirmed by Rosenthal and associates' from a Chicago investigation but other studies in Scotland and Scandinavia have not yielded similar findings. If the work of Davignon and colleagues were to be confirmed, a means of preventing leukemia would appear to be at hand. The original work by Math. and colleagues,4 who treated patients with acute leukemia - mostly children and claimed a median survival of 30 months when BCG was used with
708 CMA JOURNAL/OCTOBER 18, 1975/VOL. 113
chemotherapy, has been criticized, but the disparity in results obtained by various observers may be due to the use of different strains of BCG. It now appears, however, that acute leukemia in adults may also be sensitive to BCG therapy. A Houston, Texas group led by Gutterman'0 have recently described encouraging results in the intensive use of BCG combined with intermittent chemotherapy. They have given 20 adults with acute leukemia intermittent chemotherapy with cytarabine, vincristine and prednisone, together with Pasteur strain BCG by scarification. The control group of 33 patients received chemotherapy alone. In the BCG group 11 of 20 had a remission of 91 weeks on the average, while 14 of the 33 controls had an average remission of only 50 weeks. Results were significant for acute myeloblastic leukemia but insignificant for acute lymphoblastic leukemia, probably because the leukemic lymphoblasts are less antigenic. The authors do not doubt the clinical efficacy of BCG in these cases, and note that immunocompetence was
NALFON
(Fenoprofen Calcium) Anti-Inflammatory Analgesic Agent DESCRIPTION Nalfon (fenoprofen calcium, Lilly) is a non steroidal antiinflammatory analgesic agent. Fenoprofen, the active moiety of the calcium salt is dI-2-(3-phenoxyphenyl) proponic acid.
ACTIONS Animal studies have demonstrated anti-inflammatory, analgesic, and antipyretic activities. tn clinical trials, 2.4 g Nalfon produced approximately the same clinical activity as 3.g A.S.A.
INDICATIONS Nalfon is indicated in the treatment of rheumatoid arthritis and osteoarthritis.
CONTRAINDICATIONS Nalfon should not be given to patients hypersensitive to this drug. Nalfon is contraindicated in patients with peptic ulcer or any inflammatory gastrointestinal tract disease.
WARNINGS Siiqce Nalfon reduces platelet aggregation and adhesiveness, its use with coumarin-type anticoagulants or heparin may cause bleeding complications. Use in Pregnancy - Safety of Nalfon during pregnancy and labour in humans has not been established. Reproductive studies in animals given Nalfon have not revealed teratogenic or embryocidal effects. Use in Children - Use in children is contraindicated under the age of fourteen years.
PRECAUTIONS There was less microbleeding from the gastro-intestinal tract with Nalfon than with salicylates. Patients with a history of peptic ulcer should be closely supervised during therapy with Nalfon. Abdominal discomfort which may occur with Nalfon can be minimized by the co-administration of antacid or by taking the drug with food. Sensitivity to Nalfon can develop. Patients with a history of allergy should be carefully supervised while receiving Nalfon.
ADVERSE REACTIONS Headache, dizziness, nervousness, confusion, insomnia, paresthesia and drowsiness have been reported. Abdominal discomfort or dyspepsia were reported. Nausea, vomiting and constipation have occurred. Skin rashes, pruritis and increased perspiration have been noted. Two instances of hypersensitivity were reported. Instances of blurred vision were reported during clinical trials. A few cases of lens opacity and subcapsular cataracts were reported in one year follow-up examinations. The relationship to the drug is not clear. Tinnitus and hearing loss have been noted. A few patients reported chest pains. Several instances of edema were reported.
DRUG INTERACTIONS When ASA. and Nalfon are administered together, plasma concentrations of fenoprofen, but not of salicylate, are reduced. The clinical significance of this finding is not known since the absorption of neither Nalfon nor ASA. is impaired.
TREATMENT OF OVERDOSAGE Standard procedures to evacuate gastric contents and symptomatic treatment should be employed.
DOSAGE AND ADMINISTRATION One capsule 4 times daily - osteoarthritis. Two capsules 4 times daily - rheumatoid arthritis.
HOW SUPPLIED Pulvules Nalfon 300mg (equivalent to Fenoprofen), Identi-Code H77, are supplied in bottles of 100.
Eli Lilly and Company (Canada) Limited, Toronto, Ontario
augmented by the treatment. Lack of immunocompetence is generally regarded as an unfavourable prognostic sign in a variety of cancers. It would seem that long-term control of acute myeloblastic leukemia is within reach. The poor results in some other reports may well be due to the use of doses of a less effective strain that were too small. Gutterman and colleagues make two suggestions: that chemotherapy and BCG may act synergistically, and that using a BCG preparation containing large numbers of living organisms to stimulate cell-mediated immunity plus large numbers of dead organisms to stimulate mainly humoral immunity may be important. Results of the use of BCG in malignant lymphoma have not been as striking, but a recent paper by Sokal, Aungst and Snyderman" reports significant differences in relapse rates between patients in stage Ia or ha treated with BCG and controls. In an editorial Frei and Schlossman" comment that, in spite of some reservations, the data from this study are impressive and further support the emerging evidence that BCG may be of therapeutic benefit in certain neoplastic diseases. Trials of BCG in malignant melanoma are in progress under the auspices of the Melanoma Reference Centre of the World Health Organization, the European Organization for Research on Treatment of Cancer, and various groups in the United States. In this tumour, wide local excision of lesions that have not metastasized can result in 60 to 70% 5-year survival, but when metastases are present there is little hope of cure, since radiotherapy offers only transient relief. It is here that BCG may help, for melanomas have some specific tumour-associated antigens to which antibodies have been identified, as well as lymphocytes that recognize the antigens. It may seem odd to use BCG to stimulate immunity together with chemical agents to depress immunity, but in practice there seems to be a case for alternating these techniques. One effective agent is dimethyl triazeno imidazole carboxamide (DTIC). In September 1974 Gutterman and colleagues13 reported some interesting figures when 89 patients with disseminated malignant melanoma were treated with a combination of DTIC administered intravenously and BCG administered by scarification. A control series of 111 received DTIC alone. Combined therapy in patients with lymph node metastases alone gave remission rates of 55%, as against 18% in controls. All patients, whether with visceral or nonvisceral metastases, had longer remissions when BCG was added. A good
710 CMA JOURNAL/OCTOBER 18, 1975/VOL. 113
prognosis was, as expected, associated with initial immunocompetence or with immunocompetence developing during therapy. The authors suggest that there is a case for regional immunotherapy, for example, directed intravenously to metastases in liver or lungs. They also plead that BCG be tried earlier. A Glasgow group14 reported a more modest series of 10 patients with disseminated malignant melanoma, in whom they stimulated immunity by BCG scarification, intralesional BCG or BCG used with irradiated autologous tumour cells. Six responded by tumour regression and one is still tumour-free 16 months after therapy (also including chlorambucil and antitumour antibodies). There are still many problems associated with BCG therapy. One relates to side effects. These are worst with intralesional injection, and include not only the commonplace local ulceration, but general reactions with fever and rigors and such distant effects as granulomatous hepatitis and mycobacterial lung lesions, fortunately responsive to antituberculosis therapy. Case selection is difficult and must ultimately depend on immunologic assessment. Meanwhile we need to know more about the most effective strains, the dose, the best route of administration, the optimum frequency of vaccination and the ratio of living organisms to dead ones that will give the best results. We also need to know whether different types of BCG or different schedules are needed for different tumours. The prospects are indeed exciting. References 1. HOLMOREN
I:
La tuberculine
et le BCG
chez les canc.reux. Schweiz Med Wochenschr
65: 1203, 1935 2. FOLEY EJ: Attempts to induce immunity against mammary adenocarcinoma in inbred
mice. Cancer Res 13: 578, 1953
3. PREHN RT, MAIN JM: Immunity to methylcholanthrene-induced sarcomas. J Nail Cancer Inst 18: 769, 1957 4. MATHJ2 G, AMIEI. JL, SCHWARZENBaRG L, et
al: Active immunotherapy for acute lymphoblastic leukaemia. Lancet 1: 697, 1969 5. BAST RC JR, ZBAR B, BoRsos T, et at: BCG
and cancer. N Engi J Med 290: 1413, 1458; 1974
6. DAVIGNON L, LEMONDE P, RosILLAito P. et al: BCG vaccination and leukaemia mor-
tality. Lancet 2: 638, 1970
7. DAVIGNON L, LEMONDE P, ST-PsasutE J, et al: BCG vaccination and leukaemia mortality (C). Lancet 1: 80, 1971 8. Idem: BCG vaccination and leukaemia mortality. Ibid, p 799 9. ROSENTHAL SR. CRISPEN RG, THORNE MG, et al: BCG vaccination and leukemia mortality. JAMA 222: 1543, 1972 10. GUTTERMAN JU, HaRSH EM, RODRIGUEZ V et al: Chemoimmunotherapy of adult acute leukaemia: prolongation of remission in myeloblastic leukaemia with BCG. Lancet
2: 1405, 1974
11. SOKAL JE, AUNOST CW, SNYDERMAN M: Delay in progression of malignant lymph-
oma after BCG vaccination. N Engi I Med
291: 1226, 1974
12. FREK E us, SCHLO55MAN S: BCG and lymph-
oma (E). Ihid, p 1255 13. GUTTERMAN JU, M.'.vLsosT G, GOrrLsEss JA, et al: Chemoimmunotherapy of disseminated malignant melanoma with dimethyl triazeno imidazole carboxamide and bacillus Calmette-
Gu.rin. N Engi I Med 291: 592, 1974
14. GRANT RM, MACKIE R, COCHRAN AJ, et al: Results of administering BCG to patients with melanoma. Lancet 2: 1096, 1974
have their own methods of operation but more formal methods of evaluating medical papers are available. Two that are useful are those of Colton3 and Freund.4 The outline presented by Colton is especially useful in inculcating a critical approach to the more formal papers, while that of Freund has more general application. Considerations such as these are important because the volume of the literature continues to expand unrelentingly - and moreover, the mass of papers published each year continues to comprise some that are good but also some that are poor. It is chastening to realize that a careful appraisal of the literature does, indeed, reveal so many papers of less than excellent quality..'6 Although editors and reviewers have some effect on the overall quality of papers published, their effect on the standard of the medical literature can only be small. Ultimately the standard can improve appreciably only if authors take an increasingly critical approach to their own papers. It is, of course, satisfying for an author to see
his paper in print, but it should be satisfying only if he or she knows that the paper is a superior product. Maybe when each author can produce a superior product and thus communicate clearly, editors will become redundant. Until then, editors will continue to exercise their fourfold responsibilities - to readers, to authors, to their journals and, sometimes, to their own occasionally inscrutable but, it is hoped, rational and constructive bases of editorial judgement. D.A.E.S. References 1. What the medical editor does (E). Can Med Assoc .1 93: 82, 1965 2. Official notice (E). Can Med Assoc 1 1: 57, 1911 3. COLTON T: Critical reading of the medical literature (chap 13), in Statistics in Medicine,
Boston, Little, 1974, pp 315-22 4. FREUND G: The profile of a publication: an aid in the critical evaluation of medical articles. Med Document 5: 2, 1961 5. ScHOR 5, KARTEr.J I: Statistical evaluation of medical journal manuscripts. JAMA 195: 1123, 1966 6 SCHOOLMAN HM, BECKTEL JM, BEST WR,
et al: Statistics in medical research: principles versus practices. I Lab Clin Med 71: 357, 1968
BCG and cancer The literature on the use of BCG (bacille Calmette-Gu6rin) in various types of cancer is now enormous, dating back to 1935, when Holmgren1 tried it intravenously, intralesionally and subcutaneously in 28 patients with cancer, without much success. The use of this vaccine received greater impetus when certain murine tumour cells were shown to have specific antigens, suggesting the possibility of an immunologic approach to therapy.2'3 A few scattered reports appeared of its clinical use during the next 10 years, but it was really a group of French workers4 who put BCG therapy on the map with their promising results in acute lymphoblastic leukemia. Since then the subject has snowballed, with chief emphasis on the leukemias and malignant melanomas. Those who wish to read recent reviews are referred in particular to that by Bast and colleagues5 and to several articles in the December 1974 issue of Seminars in Oncology. For the physicians with only marginal interest, I will summarize a few
recent developments and sketch in the general background, emphasizing that BCG therapy of cancer is still experimental, by no means without danger, possibly based on misconceptions, and needing much research into all sorts of basic problems. An early contribution to the study of BCG and human leukemias was Canadian. In a series of studies Davignon and colleagues64 showed that in the Province of Qu6bec death from leukemia was approximately half as common in BCG vaccinees as in the nonvaccinated. This view was confirmed by Rosenthal and associates' from a Chicago investigation but other studies in Scotland and Scandinavia have not yielded similar findings. If the work of Davignon and colleagues were to be confirmed, a means of preventing leukemia would appear to be at hand. The original work by Math. and colleagues,4 who treated patients with acute leukemia - mostly children and claimed a median survival of 30 months when BCG was used with
708 CMA JOURNAL/OCTOBER 18, 1975/VOL. 113
chemotherapy, has been criticized, but the disparity in results obtained by various observers may be due to the use of different strains of BCG. It now appears, however, that acute leukemia in adults may also be sensitive to BCG therapy. A Houston, Texas group led by Gutterman'0 have recently described encouraging results in the intensive use of BCG combined with intermittent chemotherapy. They have given 20 adults with acute leukemia intermittent chemotherapy with cytarabine, vincristine and prednisone, together with Pasteur strain BCG by scarification. The control group of 33 patients received chemotherapy alone. In the BCG group 11 of 20 had a remission of 91 weeks on the average, while 14 of the 33 controls had an average remission of only 50 weeks. Results were significant for acute myeloblastic leukemia but insignificant for acute lymphoblastic leukemia, probably because the leukemic lymphoblasts are less antigenic. The authors do not doubt the clinical efficacy of BCG in these cases, and note that immunocompetence was
NALFON
(Fenoprofen Calcium) Anti-Inflammatory Analgesic Agent DESCRIPTION Nalfon (fenoprofen calcium, Lilly) is a non steroidal antiinflammatory analgesic agent. Fenoprofen, the active moiety of the calcium salt is dI-2-(3-phenoxyphenyl) proponic acid.
ACTIONS Animal studies have demonstrated anti-inflammatory, analgesic, and antipyretic activities. tn clinical trials, 2.4 g Nalfon produced approximately the same clinical activity as 3.g A.S.A.
INDICATIONS Nalfon is indicated in the treatment of rheumatoid arthritis and osteoarthritis.
CONTRAINDICATIONS Nalfon should not be given to patients hypersensitive to this drug. Nalfon is contraindicated in patients with peptic ulcer or any inflammatory gastrointestinal tract disease.
WARNINGS Siiqce Nalfon reduces platelet aggregation and adhesiveness, its use with coumarin-type anticoagulants or heparin may cause bleeding complications. Use in Pregnancy - Safety of Nalfon during pregnancy and labour in humans has not been established. Reproductive studies in animals given Nalfon have not revealed teratogenic or embryocidal effects. Use in Children - Use in children is contraindicated under the age of fourteen years.
PRECAUTIONS There was less microbleeding from the gastro-intestinal tract with Nalfon than with salicylates. Patients with a history of peptic ulcer should be closely supervised during therapy with Nalfon. Abdominal discomfort which may occur with Nalfon can be minimized by the co-administration of antacid or by taking the drug with food. Sensitivity to Nalfon can develop. Patients with a history of allergy should be carefully supervised while receiving Nalfon.
ADVERSE REACTIONS Headache, dizziness, nervousness, confusion, insomnia, paresthesia and drowsiness have been reported. Abdominal discomfort or dyspepsia were reported. Nausea, vomiting and constipation have occurred. Skin rashes, pruritis and increased perspiration have been noted. Two instances of hypersensitivity were reported. Instances of blurred vision were reported during clinical trials. A few cases of lens opacity and subcapsular cataracts were reported in one year follow-up examinations. The relationship to the drug is not clear. Tinnitus and hearing loss have been noted. A few patients reported chest pains. Several instances of edema were reported.
DRUG INTERACTIONS When ASA. and Nalfon are administered together, plasma concentrations of fenoprofen, but not of salicylate, are reduced. The clinical significance of this finding is not known since the absorption of neither Nalfon nor ASA. is impaired.
TREATMENT OF OVERDOSAGE Standard procedures to evacuate gastric contents and symptomatic treatment should be employed.
DOSAGE AND ADMINISTRATION One capsule 4 times daily - osteoarthritis. Two capsules 4 times daily - rheumatoid arthritis.
HOW SUPPLIED Pulvules Nalfon 300mg (equivalent to Fenoprofen), Identi-Code H77, are supplied in bottles of 100.
Eli Lilly and Company (Canada) Limited, Toronto, Ontario
augmented by the treatment. Lack of immunocompetence is generally regarded as an unfavourable prognostic sign in a variety of cancers. It would seem that long-term control of acute myeloblastic leukemia is within reach. The poor results in some other reports may well be due to the use of doses of a less effective strain that were too small. Gutterman and colleagues make two suggestions: that chemotherapy and BCG may act synergistically, and that using a BCG preparation containing large numbers of living organisms to stimulate cell-mediated immunity plus large numbers of dead organisms to stimulate mainly humoral immunity may be important. Results of the use of BCG in malignant lymphoma have not been as striking, but a recent paper by Sokal, Aungst and Snyderman" reports significant differences in relapse rates between patients in stage Ia or ha treated with BCG and controls. In an editorial Frei and Schlossman" comment that, in spite of some reservations, the data from this study are impressive and further support the emerging evidence that BCG may be of therapeutic benefit in certain neoplastic diseases. Trials of BCG in malignant melanoma are in progress under the auspices of the Melanoma Reference Centre of the World Health Organization, the European Organization for Research on Treatment of Cancer, and various groups in the United States. In this tumour, wide local excision of lesions that have not metastasized can result in 60 to 70% 5-year survival, but when metastases are present there is little hope of cure, since radiotherapy offers only transient relief. It is here that BCG may help, for melanomas have some specific tumour-associated antigens to which antibodies have been identified, as well as lymphocytes that recognize the antigens. It may seem odd to use BCG to stimulate immunity together with chemical agents to depress immunity, but in practice there seems to be a case for alternating these techniques. One effective agent is dimethyl triazeno imidazole carboxamide (DTIC). In September 1974 Gutterman and colleagues13 reported some interesting figures when 89 patients with disseminated malignant melanoma were treated with a combination of DTIC administered intravenously and BCG administered by scarification. A control series of 111 received DTIC alone. Combined therapy in patients with lymph node metastases alone gave remission rates of 55%, as against 18% in controls. All patients, whether with visceral or nonvisceral metastases, had longer remissions when BCG was added. A good
710 CMA JOURNAL/OCTOBER 18, 1975/VOL. 113
prognosis was, as expected, associated with initial immunocompetence or with immunocompetence developing during therapy. The authors suggest that there is a case for regional immunotherapy, for example, directed intravenously to metastases in liver or lungs. They also plead that BCG be tried earlier. A Glasgow group14 reported a more modest series of 10 patients with disseminated malignant melanoma, in whom they stimulated immunity by BCG scarification, intralesional BCG or BCG used with irradiated autologous tumour cells. Six responded by tumour regression and one is still tumour-free 16 months after therapy (also including chlorambucil and antitumour antibodies). There are still many problems associated with BCG therapy. One relates to side effects. These are worst with intralesional injection, and include not only the commonplace local ulceration, but general reactions with fever and rigors and such distant effects as granulomatous hepatitis and mycobacterial lung lesions, fortunately responsive to antituberculosis therapy. Case selection is difficult and must ultimately depend on immunologic assessment. Meanwhile we need to know more about the most effective strains, the dose, the best route of administration, the optimum frequency of vaccination and the ratio of living organisms to dead ones that will give the best results. We also need to know whether different types of BCG or different schedules are needed for different tumours. The prospects are indeed exciting. References 1. HOLMOREN
I:
La tuberculine
et le BCG
chez les canc.reux. Schweiz Med Wochenschr
65: 1203, 1935 2. FOLEY EJ: Attempts to induce immunity against mammary adenocarcinoma in inbred
mice. Cancer Res 13: 578, 1953
3. PREHN RT, MAIN JM: Immunity to methylcholanthrene-induced sarcomas. J Nail Cancer Inst 18: 769, 1957 4. MATHJ2 G, AMIEI. JL, SCHWARZENBaRG L, et
al: Active immunotherapy for acute lymphoblastic leukaemia. Lancet 1: 697, 1969 5. BAST RC JR, ZBAR B, BoRsos T, et at: BCG
and cancer. N Engi J Med 290: 1413, 1458; 1974
6. DAVIGNON L, LEMONDE P, RosILLAito P. et al: BCG vaccination and leukaemia mor-
tality. Lancet 2: 638, 1970
7. DAVIGNON L, LEMONDE P, ST-PsasutE J, et al: BCG vaccination and leukaemia mortality (C). Lancet 1: 80, 1971 8. Idem: BCG vaccination and leukaemia mortality. Ibid, p 799 9. ROSENTHAL SR. CRISPEN RG, THORNE MG, et al: BCG vaccination and leukemia mortality. JAMA 222: 1543, 1972 10. GUTTERMAN JU, HaRSH EM, RODRIGUEZ V et al: Chemoimmunotherapy of adult acute leukaemia: prolongation of remission in myeloblastic leukaemia with BCG. Lancet
2: 1405, 1974
11. SOKAL JE, AUNOST CW, SNYDERMAN M: Delay in progression of malignant lymph-
oma after BCG vaccination. N Engi I Med
291: 1226, 1974
12. FREK E us, SCHLO55MAN S: BCG and lymph-
oma (E). Ihid, p 1255 13. GUTTERMAN JU, M.'.vLsosT G, GOrrLsEss JA, et al: Chemoimmunotherapy of disseminated malignant melanoma with dimethyl triazeno imidazole carboxamide and bacillus Calmette-
Gu.rin. N Engi I Med 291: 592, 1974
14. GRANT RM, MACKIE R, COCHRAN AJ, et al: Results of administering BCG to patients with melanoma. Lancet 2: 1096, 1974
