NOTES AND LETTERS AmvotroDhic Lateral Scl&rosisLFailure of Transfer Factor Therapy Saran Jonas, MD, Melvin Wichter, MD, and Lynn Spitler, M D Amyotrophic lateral sclerosis ( ALS) typically progresses relentlessly to death. The cause is unknown; current speculations include persistent poliovirus infection and impaired cell-mediated immunity [ I , 31. Recently, chronic fungal infection associated with defective cell-mediated immunity and resistant to conventional therapy has been treated, possibly with benefit 121, by the addition of transfer factor (TF), a dialyzable extract of leukocytes. W e attempted to treat ALS, for which no effective therapy exists, in a similar manner. The subjects were 7 male and 3 female ALS patients ranging in age from 34 to 63 (average, 54.4) years. All had given informed consent. They had had their disease 7 to 28 months (average, 13.4). All had limb weakness (9 with fasciculations, 7 with muscle atrophy). Two had spasticity. Another had dpsphagia, dysarthria, and tongue atrophy and fasciculations. T F was prepared 141 from normal donors. In vitro tests showed it to be active in enhancing the lymphocyte proliferative response to phytohemagglutinin. O u r patients began weekly treatment (subcutaneous injection of 0.75 ml of TF, the amount derived from 1.25 X 10’ lymphocytes) between September, 1976, and March, 1977. Immune responses were not tested. By the end of May, 1978, the patients had received an average of 2.87 (range, 2.1 to 4.0) monthly injections for 3 to 2 0 months (average, 11.3 months). Two had died. Six survivors, who initially had been walking, were in bed or in a wheelchair; 1 other had become aphonic; the eighth had become dysarthric and dysphagic. TF, as used, had no apparent benefit as therapy for ALS. Supported by Research Grant A1 10686 from the National Institutes of Health. Ref t-ences virus in motor-neurone disease. Lancet 2: 1176, 1977 2. Gross PA, Patel C, Spitler LE: Disseminated cryptococcus treated with transfer factor. JAMA 240:2460-2462, 1978 3. Kott E, Livni E, Zarnir R, et al: Amyotrophic lateral sclerosis: cell-mediated immunity to poliovirus and basic myelin protein in patients with high frequency of HLA-BW35. Neurology (Minneap) 26:376-377, 1976 1. Behan PO, Behan WM, Bell E, et ak Possible persistent From the Department of Neurology, New York University School of Medicine, New York, NY, and the Department of Medicine, Children’s Hospital and the University of California Medical Center, San Francisco, CA. Accepted for publication Jan 2, 1979. Address reprint requests to Dr Jonas, New York University Medical Center, 566 First Ave, New York, N Y 10016. 84 4. Spitler LE, Levin AS, Fudenberg HH: Human lymphocyte transfer factor, in Busch H (ed): Methods in Cancer Research. New York, Academic, 1973, vol 8, pp 59-106 Cerebellar Hemorrhage: Nonsurgical Forms - M. Feijoo De Freixo, MD, M. Jimenez Garcia, MD, and L. Galdos Alcelay, M D In keeping with the experience of Drs Heiman and Satya-Murti , we have recently treated cerebellar hemorrhages nonsurgically in 2 women 64 and 78 years old, respectively. in whom the diagnosis was proved by C T scan. Both patients had a good outcome without significant neurological sequelae 131. W e believe that two clinical variables indicate a surgical approach to the problem: the presence of hydrocephalus or deterioration in the level of consciousness, or both. Hydrocephalus, which was absent in our 2 patients as well as in Heiman and Satya-Murti’s, would be produced by block of the fourth ventricle or the aqueduct. This could result from blood clot 141, compression produced by the parenchymatous cerebellar hemorrhage and its surrounding edema, or both. T h e degree of hydrocephalus and the effect of the mass compressing the brainstem would affect the level of consciousness. T h e letter by Freeman et a1 [ 11does not contradict either Heiman and Satya-Murti’s conclusions or the idea of “benign hemorrhage” as a nonsurgical lesion. T h e availability of CT scanning allows a new approach to treating these lesions. Refwences 1. Freeman JW, Kennedy RM, Petty SS: Prognosis of nonoperated cerebellar hemorrhage. Ann Neurol 4389-390, 1978 2. Heiman TD,Satya-Murti S: Benign cerebellar hemorrhages. Ann Neurol 3:366-368, 1978 3. Jimenet h*, Galdos L, Feijoo M:Hematoma de cerebelo. Formas no qulrurgicas. Med Clin (Barcelona) (in press) 4. Richardson A: Spontaneous intracerebral and cerebellar hemorrhage, in Ross Russell RW (ed): Cerebral Arterial Diseases. Edinburgh and London, ChurchilULivingstone, 1976, p 223 From the Secciones de Neurologia, Residencia Sanitaria S. Social, Burgos, and Ciudad Sanitaria S. Social, Barcelona, Spain. Accepted for publication Feb 9, 1970. Address reprint requests to Dr Feijoo, Seccion de Neurologia, Residencia Sanitaria S. Social, Burgos, Spain.