National Cancer Institute®
Last Modified: April 1, 2002
UI - 11854211
AU - Marcato P; Mulvey G; Armstrong GD
TI - Cloned Shiga toxin 2 B subunit induces apoptosis in Ramos Burkitt's lymphoma B cells.
SO - Infect Immun 2002 Mar;70(3):1279-86
AD - Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta T6G 2H7, Canada.
The Shiga toxins (Stx1 and Stx2), produced by Shigella dysenteriae type 1 and enterohemorrhagic Escherichia coli, consist of one A subunit and five B subunits. The Stx1 and Stx2 B subunits form a pentameric structure that binds to globotriaosylceramide (Gb3-Cer) receptors on eukaryotic cells and promotes endocytosis. The A subunit then inhibits protein biosynthesis, which triggers apoptosis in the affected cell. In addition to its Gb3-Cer binding activity, the data in the following report demonstrate that the Stx2 B pentamer induces apoptosis in Ramos Burkitt's lymphoma B cells independently of A subunit activity. Apoptosis was not observed in A subunit-free preparations of the Stx1 B pentamer which competitively inhibited Stx2 B pentamer-mediated apoptosis. The pancaspase inhibitor, Z-VAD-fmk, prevented apoptosis in Ramos cells exposed to the Stx2 B subunit, Stx1 or Stx2. Brefeldin A, an inhibitor of the Golgi transport system, also prevented Stx2 B subunit-mediated apoptosis. These observations suggest that the Stx2 B subunit must be internalized, via Gb3-Cer receptors, to induce Ramos cell apoptosis. Moreover, unlike the two holotoxins, Stx2 B subunit-mediated apoptosis does not involve inhibition of protein biosynthesis. This study provides further insight into the pathogenic potential of this family of potent bacterial exotoxins.
UI - 11788819
AU - Spaepen K; Mortelmans L
TI - Evaluation of treatment response in patients with lymphoma using [18F]FDG-PET: differences between non-Hodgkin's lymphoma and Hodgkin's disease.
SO - Q J Nucl Med 2001 Sep;45(3):269-73
AD - Department of Nuclear Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Fluorine-18fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) has become a very useful technique for the therapy monitoring of patients with lymphoma. It provides unique information about the metabolic behavior of the disease independent of morphological criteria. In recent years, [18F]FDG-PET has proven to be a technique with high sensitivity for the detection of residual tumor. Therefore, [18F]FDG-PET seems to be the ideal tool for the evaluation of treatment response. However, most recent published studies included both HD and NHL, although [18F]FDG-PET scan results in Hodgkin's disease (HD) has a different impact than in Non Hodgkin's Lymphoma (NHL). In this paper, we summarize our findings on the role of [18F]FDG-PET in the therapy evaluation of lymphoma patients in a large group of patients and highlight the differences between the interpretations of the results of HD and NHL patients. Finally, a strategy for the implementation of [18F]FDG-PET in the management of lymphoma patients is proposed.
UI - 11862427
AU - Hempel G; Flege S; Wurthwein G; Boos J
TI - Peak plasma concentrations of doxorubicin in children with acute lymphoblastic leukemia or non-Hodgkin lymphoma.
SO - Cancer Chemother Pharmacol 2002 Feb;49(2):133-41
AD - Institut fur Pharmazeutische Chemie, Westfalische Wilhems-Universitat, Munster, Germany. email@example.com
PURPOSE: The peak plasma concentrations seem to play an important role in the toxicity of the anthracyclines. As there are only limited data in the literature about the distribution of doxorubicin in children, we assessed the peak plasma concentrations of doxorubicin in pediatric patients. PATIENTS AND METHODS: We collected 87 plasma samples at the end of infusion from 27 children with acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL) treated with 30 mg/m(2) doxorubicin as a 1- or 2-h infusion once weekly for four weeks in the ALL-BFM 95 or NHL-BFM 95 protocol. Plasma concentrations of doxorubicin were quantified by capillary electrophoresis, and the peak plasma levels for a uniform 2-h infusion were calculated. RESULTS: The geometric mean of all samples was 273 microg/l with a geometric coefficient of variation of 46.0%. This is in accordance with the peak plasma concentrations expected from simulations based on literature data from adults. High inter-individual as well as substantial intra-individual variability was observed. Girls had slightly higher peak plasma levels than boys. Age, weight, and body mass index as well as laboratory parameters had no influence on the peak plasma concentrations. No cumulation of doxorubicin during therapy was observed. CONCLUSION: The peak plasma concentrations are similar in adults and children for both the absolute values as well as the variability; this indicates that there are no major differences in the distribution of doxorubicin in children and adults.
UI - 11862429
AU - Muller HJ; Beier R; da Palma JC; Lanvers C; Ahlke E; von Schutz V;
TI - Gunkel M; Horn A; Schrappe M; Henze G; Kranz K; Boos J PEG-asparaginase (Oncaspar) 2500 U/m(2) BSA in reinduction and relapse treatment in the ALL/NHL-BFM protocols.
SO - Cancer Chemother Pharmacol 2002 Feb;49(2):149-54
AD - Department of Pediatric Hematology/Oncology, University of Munster, Germany. firstname.lastname@example.org
PURPOSE: As previous data had shown that only two-thirds of patients had the predicted activity time courses when PEG-asparaginase 1000 U/m(2) was used in reinduction after native E. coli asparaginase in induction treatment of acute lymphoblastic leukaemia (ALL), drug monitoring was performed with the use of a higher dose. METHODS: Because one-third of patients had insufficient serum asparaginase activity time courses after a single dose of 1000 U/m(2) PEG-asparaginase during reinduction treatment, a dose of 2500 U/m(2) PEG-asparaginase, which is the approved dosage in Germany, was used in 39 reinduction and 20 relapse patients to determine whether prolongation of the activity time course may be possible with this higher dose, and to look for significant differences between reinduction and relapse patients. RESULTS: After 1, 2 and 3 weeks, the mean activities were 1113 +/- 699 U/l, 231 +/- 259 U/l, and 13 +/- 35 U/l in the reinduction patients, and 1078 +/- 649 U/l, 165 +/- 195 U/l and 19 +/- 28 U/l in the relapse patients, respectively. There were a considerable number of patients with a substantially shortened activity time course in both groups. In 10 of 39 reinduction patients and in 7 of 24 doses during relapse treatment, only activities <100 U/l were found after 1 week with a further fast decline. No statistically significant differences between the two patient groups could be shown at any time-point. CONCLUSIONS: Comparison of these data with activities after 1000 U/m(2) PEG-asparaginase showed no prolongation of the time with activity in the therapeutic range with the higher dose. Therefore, for a longer duration of therapeutic activity, administration of further doses is mandatory.
UI - 11889454
AU - Kollmar O; Becker S; Schilling MK; Maurer CA
TI - Intestinal lymphoma perforations as a consequence of highly effective anti-CD20 antibody therapy.
SO - Transplantation 2002 Feb 27;73(4):669-70
UI - 11899688
AU - el Mrabet F; Ferhati D; Berkhli S; el Hanchi Z; Rhrab B; Lakhdar A;
TI - Baidada A; Kettani F; Kharbach A; Chaoui A [Primary malignant non-Hodgkin's lymphoma of the cervix uteri]
SO - Presse Med 2002 Feb 23;31(7):318
UI - 11899679
AU - el Omari-Alaoui H; Kebdani T; Benjaafar N; el Ghazi E; Erriahni H; el
TI - Gueddari BK [Non-Hodgkin's lymphoma of the uterus: apropos of 4 cases and review of the literature]
SO - Cancer Radiother 2002 Feb;6(1):39-45
AD - Service de radiotherapie, Institut national d'oncologie, Rabat, Maroc.
The primary non hodgkin's lymphoma of the uterus is rare. This rarity explains of one part certain difficulties of the histological diagnosis and on the other hand the absence of a therapeutic strategy clearly established. We report 4 cases of primary non-hodgkin lymphoma of the uterus. Two patients had a cervical location, the two other had corpus location. The average age of our patients is of 59 years (extremes: 54-68). Histological diagnosis was confirmed by biopsy for the cervical location. For the corpus location, it is study of the uterus after hysterectomy which retained the diagnosis of lymphoma. The type of the lymphoma was low grade in two cases and high grade in the two other cases. The disease was limited to the pelvis for all our patients (stage IE according to Ann-Arbor's classification). The treatment consisted of an association of chemotherapy and radiotherapy in both cases of lymphoma of the cervix and in a radical hysterectomy followed by chemotherapy for the two cases of lymphoma of the corpus. Our patients are regularly followed, with an average follow-up of 56 months. Two patients are in disease free, the third patient presented a dissemination of the disease and the fourth patient presented a squamous cell carcinoma of the lung.
UI - 11915743
AU - Tobinai K
TI - [Rituximab, a chimeric anti-CD20 monoclonal antibody, in the treatment of B-cell lymphoma]
SO - Gan To Kagaku Ryoho 2002 Mar;29(3):473-80
AD - Hematology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. monoclonal antibody, was approved for the treatment of B-cell lymphoma by the Japanese government. Rituximab is the first monoclonal antibody that was approved for the treatment of malignant neoplasms by the U.S. Food and Drug Administration (FDA). Several clinical trials of rituximab conducted in USA, Europe and Japan revealed its promising therapeutic efficacy for B-cell lymphoma. Its minimal myelotoxicity allows rituximab to be combined with full doses of anticancer agents. Ongoing clinical trials will define the future role of rituximab in the treatment of B-cell lymphoma.
UI - 11760551
AU - Zelenetz AD; Hoppe RT; NCCN Non-Hodgkin's Lymphoma Practice Guidelines
TI - Panel NCCN: Non-Hodgkin's lymphoma.
SO - Cancer Control 2001 Nov-Dec;8(6 Suppl 2):102-13
AD - Stanford University Medical Center.
UI - 11868363
AU - Yanagiya N; Takahashi N; Nakae H; Kume M; Chubachi A; Miura I
TI - [Plasma exchange and continuous hemodiafiltration as an initial treatment for diffuse large B-cell lymphoma-associated hemophagocytic syndrome]
SO - Rinsho Ketsueki 2002 Jan;43(1):35-40
AD - Third Department of Internal Medicine, Akita University School of Medicine.
A 68-year-old man was admitted to our hospital because of fever, jaundice and hepatosplenomegaly. A diagnosis of diffuse large cell, B-cell type malignant lymphoma, associated with hemophagocytic syndrome (LAHS), was made. CT scan revealed lymphadenopathy in the abdominal cavity and multiple tumors in the spleen. Performance status and hepatic coma grade were 4 and II, respectively. Laboratory findings showed bicytopenia (Hb 9.9 g/dl, platelet 35 x 10(3)/microliter), severe liver dysfunction (ALP 1,115 U/l, gamma-GTP 437 U/l, T.Bil 15.4 mg/dl, D.Bil 12.8 mg/dl) and elevated levels of beta 2 microglobulin (12.9 mg/dl), ferritin (2,300 ng/ml) and sIL-2 receptor (36,900 U/ml). Plasma exchange (PE) and continuous hemodiafiltration (CHDF) enabled the patient to undergo diagnostic procedures, irradiation (total 34 Gy) and chemotherapy. Biopsy specimens revealed infiltration of lymphoma cells into the liver and bone marrow. We measured the blood concentrations of TNF-alpha, IL-6, and IL-8 before and after PE and CHDF by the ELISA method, and found normalization of hypercytokinemia after the procedure. It was suggested that initial treatment with PE and CHDF was effective for control of HPS, enabling us to perform chemotherapy for the lymphoma.
UI - 11790067
AU - Kouroukis CT; Browman GP; Esmail R; Meyer RM
TI - Chemotherapy for older patients with newly diagnosed, advanced-stage, aggressive-histology non-Hodgkin lymphoma: a systematic review.
SO - Ann Intern Med 2002 Jan 15;136(2):136-43
AD - Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada.
PURPOSE: To conduct a systematic review assessing chemotherapeutic regimens in patients at least 60 years of age with previously untreated, advanced-stage, aggressive-histology non-Hodgkin lymphoma. DATA SOURCES: Computerized databases were searched for reports from 1966 to April 2000. Relevant journals, textbooks, and reference lists of published articles were hand searched. Abstract reports were not considered. STUDY SELECTION: Randomized trials comparing different chemotherapy regimens were selected. Two independent assessors, who were blinded to authors, institution, and results of the report, reviewed the retrieved citations. DATA EXTRACTION: One author abstracted data on patient characteristics, study quality score, survival, disease response and control, toxicity, and quality of life; pooling was not done because of study heterogeneity. DATA SYNTHESIS: 12 randomized trials that compared chemotherapeutic regimens were reviewed. Progression-free and overall survival were improved when anthracycline-containing regimens, such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CTVP (cyclophosphamide, pirarubicin, vincristine, and prednisone), were compared with other regimens. CONCLUSIONS: For treatment of older patients with advanced-stage, aggressive-histology lymphoma who do not have significant comorbid illnesses, an anthracycline-containing regimen, such as CHOP, given in standard doses and schedule, provides for superior outcomes compared with other regimens.
UI - 11779292
AU - Godwin JE; Fisher RI
TI - Diffuse large-cell lymphomas: a review of therapy.
SO - Clin Lymphoma 2001 Dec;2(3):155-63
AD - Department of Medicine and Pathology, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA. email@example.com
In this review, the historical and modern classification schemes of non-Hodgkin's lymphoma (NHL) will be briefly summarized, with a critical review of the evolution and current state of treatment strategies for diffuse large-cell lymphoma (DLCL). We provide current treatment recommendations for newly diagnosed disease and indicate the areas of active clinical investigation. In the past, many of the promising phase II studies in DLCL have appeared beneficial based on patient selection criteria and not the therapeutic result. Lessons learned in clinical trials in NHL may serve as a paradigm for other cancer investigations.
UI - 11779293
AU - Rutar FJ; Augustine SC; Kaminski MS; Wahl RL; Siegel JA; Colcher D
TI - Feasibility and safety of outpatient Bexxar therapy (tositumomab and iodine I 131 tositumomab) for non-Hodgkin's lymphoma based on radiation doses to family members.
SO - Clin Lymphoma 2001 Dec;2(3):164-72
AD - University of Nebraska Medical Center, Omaha 68198-5480, USA. firstname.lastname@example.org
Radioimmunotherapy with anti-CD20 antibodies is a promising treatment approach for relapsed low-grade non-Hodgkin's lymphoma. Under revised released following treatment provided the maximum dose to any individual is not likely to exceed 500 mrem. Non-Hodgkin's lymphoma patients have been studied to evaluate radiation exposure to caregivers/family members after outpatient treatment with tositumomab and iodine I 131 tositumomab (Bexxar therapy). Estimates of total radiation doses to individuals expected to be maximally exposed to patients posttreatment have revealed that the doses should be within revised guidelines. In a University of Nebraska Medical Center study, the predicted total radiation doses (based on patient dose rate at 1 meter) ranged from 95-423 mrem. Family members were provided radiation-monitoring devices to directly monitor radiation exposure. Measured doses ranged from 10-409 mrem. In this and other studies, estimated and measured dose equivalents to maximally exposed individuals were below 500 mrem. Measured doses were, in most instances, lower than those predicted by patient-specific calculations, thus confirming the validity of the calculated dose predictions. Therefore, radioimmunotherapy with tositumomab and iodine I 131 tositumomab can be safely conducted on an outpatient basis.
UI - 11779297
AU - Natkunam Y; Stanton TS; Warnke RA; Horning SJ
TI - Durable remission in recurrent T-cell-rich B-cell lymphoma with the anti-CD20 antibody rituximab.
SO - Clin Lymphoma 2001 Dec;2(3):185-7
AD - Department of Pathology, Stanford University Medical Center, Stanford, CA 94305, USA. email@example.com
A diagnostic continuum exists between lymphocyte-predominant Hodgkin's disease, T-cell-rich B-cell lymphoma (TCRBCL), and diffuse large B-cell lymphoma. While TCRBCLs are uncommon, their clinical and morphologic presentation can mimic other Hodgkin's and non-Hodgkin's lymphomas from which they must be distinguished for diagnosis and treatment. We present an unusual case of a 30-year-old man with recurrent TCRBCL arising from lymphocyte-predominant Hodgkin's disease with remarkable response to treatment with the anti-CD20 antibody, rituximab.
UI - 11779298
AU - Brown KS; Levitt DJ; Shannon M; Link BK
TI - Phase II trial of Remitogen (humanized 1D10) monoclonal antibody targeting class II in patients with relapsed low-grade or follicular lymphoma.
SO - Clin Lymphoma 2001 Dec;2(3):188-90
AD - Division of Hematology, Oncology, and Blood and Marrow Transplant, Department of Internal Medicine and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, 52242, USA.
UI - 11902529
AU - Du MQ; Isaccson PG
TI - Gastric MALT lymphoma: from aetiology to treatment.
SO - Lancet Oncol 2002 Feb;3(2):97-104
AD - Department of Histopathology, Royal Free and University College Medical School, University College London, UK. firstname.lastname@example.org
The development of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is dependent on Helicobacter pylori infection. Bacterial colonisation of the gastric mucosa triggers lymphoid infiltration and the formation of acquired MALT. The bacterial infection induces and sustains an actively proliferating B-cell population through direct (autoantigen) and indirect (intratumoral T cells specific for H. pylori) immunological stimulation. Moreover, the bacterial infection provokes a neutrophilic response, which causes the release of oxygen free radicals. These reactive species may promote the acquisition of genetic abnormalities and malignant transformation of reactive B cells. A transformed clone carrying the translocation t(1;18)(q21;q21) forms a MALT lymphoma, the growth of which is independent of H. pylori and will not respond to bacterial eradication. Malignant clones without t(11;18)(q21;q21), but with other genetic abnormalities, such as trisomy 3 or microsatellite instability, depend critically on immune stimulation mediated by H. pylori for their clonal expansion. In the early stages, the tumour can be successfully treated by eradication of the bacterium, whereas at later stages the tumour may escape its growth dependency through acquisition of additional genetic abnormalities such as t(1;14)(p22;q32) and t(1;2)(p22,p12) involving the BCL-10 gene. Finally, further genetic abnormalities, such as inactivation of the tumour suppressor genes, p53 and p16, can lead to high-grade transformation. Detection of these abnormalities may help with the clinical management of patients with gastric MALT lymphoma.
UI - 11533100
AU - Rodriguez J; Munsell M; Yazji S; Hagemeister FB; Younes A; Andersson B;
TI - Giralt S; Gajewski J; de Lima M; Couriel D; Romaguera J; Cabanillas FF; Champlin RE; Khouri IF Impact of high-dose chemotherapy on peripheral T-cell lymphomas.
SO - J Clin Oncol 2001 Sep 1;19(17):3766-70
AD - Department of Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
PURPOSE: To evaluate the outcome of high-dose chemotherapy (HDCT) and autologous or allogeneic hematopoietic transplantation in patients with peripheral T-cell lymphoma (PTCL) who experienced disease recurrence after prior conventional chemotherapy. PATIENTS AND METHODS: We performed a retrospective analysis of 36 PTCL patients from the University of Texas M.D. Anderson Cancer Center treated between 1989 and 1998 with HDCT and autologous or allogeneic hematopoietic transplantation. RESULTS: A total of 36 patients were studied (29 received autologous transplantation, and seven received allogeneic transplantation). The overall survival rate at 3 years was 36% (95% confidence interval [CI], 23% to 59%), and the progression-free survival (PFS) rate was 28% (95% CI, 16% to 49%). The pretransplant serum lactate dehydrogenase level was the most important prognostic factor for both survival and PFS rates (P < .001). A Pretransplant International Prognostic Index score of < or = 1 indicated a superior survival rate (P = .036) but not an improved PFS rate. A median follow-up of 43 months (range, 13 to 126 months) showed 13 patients (36%) were still alive with no evidence of disease. CONCLUSION: Our results are comparable to the published data on HDCT in B-cell non-Hodgkin's lymphoma (NHL) patients despite the fact that patients with PTCL are known to have a worse outcome compared with B-cell NHL patients. Considering the dismal outcome of conventional chemotherapy in PTCL patients, these data suggest the hypothesis that the poor prognostic implication of T-cell phenotyping in NHL might be overcome by frontline HDCT and transplantation.
UI - 11866264
AU - Levy M; Copie-Bergman C; Traulle C; Lavergne-Slove A; Brousse N; Flejou
TI - JF; de Mascarel A; Hemery F; Gaulard P; Delchier JC; Groupe d'Etude des Lymphomes de l'Adulte (GELA) Conservative treatment of primary gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue: predictive factors of response and outcome.
SO - Am J Gastroenterol 2002 Feb;97(2):292-7
AD - Service d'Hepatologie et de Gastroenterologie, Departement de Pathologie et EA 2348, and Service de Biostatistiques et d'Informatique, Hjpital Henri Mondor, Creteil, France.
OBJECTIVES: Primary gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue may regress with conservative treatment such as anti-Helicobacterpylori therapy or monochemotherapy. The aims of the present study were to analyze the predictive factors of response to anti-H. pylori treatment, to assess the effects of an adjuvant therapy in responding patients, and to evaluate an alternative therapy in nonresponding patients. METHODS: From 1995 to 2000, 48 H. pylori-infected patients with localized primary gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue were treated with anti-H. pylori therapy. Endoscopic and endoscopic ultrasonography features and histological grading of large cells' proportion were analyzed. Eradication of H. pylori and tumoral response were assessed at 2 and 6 months, respectively. From 1996, patients in remission at 6 months were randomized to receive either chlorambucil p.o. for 6 months or no treatment. Patients who did not respond to H. pylori eradication received chlorambucil p.o. for 1 yr. RESULTS: Among the 48 treated patients, 33 (69%) were in complete (n = 28) or in partial (n = 5) remission, and 15 (31%) were in treatment failure at 6 months. H. pylori was eradicated in 47 patients. The response was not correlated with the endoscopic features or with the histological grade. In contrast, it was related to ultrasonographic features: remission was achieved in 76% of patients when no perigastric lymph node was detected versus only 33% when endoscopic ultrasonography showed presence of lymph nodes (p = 0.025). All responding patients remained in remission (median 34 months) whatever the treatment they received (no treatment or chlorambucil). Remission could be achieved with chlorambucil in 58% of the nonresponding patients to anti-H. pylori treatment. CONCLUSIONS: The major negative predictive factor of the tumoral response to anti-H. pylori treatment in patients with primary gastric low-grade B-cell lymphoma of mucosaassociated lymphoid tissue was the presence of perigastric lymph nodes on endoscopic ultrasonography. In responding patients, remission remained stable, suggesting that adjuvant chemotherapy was not useful. In patients who failed to respond to H. pylori eradication, monochemotherapy with chlorambucil proved to be efficient, but new therapeutic modalities should be evaluated to improve the control of the tumoral process.
UI - 11870175
AU - Wang XS; Giralt SA; Mendoza TR; Engstrom MC; Johnson BA; Peterson N;
TI - Broemeling LD; Cleeland CS Clinical factors associated with cancer-related fatigue in patients being treated for leukemia and non-Hodgkin's lymphoma.
SO - J Clin Oncol 2002 Mar 1;20(5):1319-28
AD - Department of Symptom Research, Division of Anesthesiology and Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. email@example.com
PURPOSE: To describe fatigue severity, fatigue interference, and associated factors in hematologic malignancies. PATIENTS AND METHODS: Patients being treated for leukemia and non-Hodgkin's lymphoma (n = 228) completed the Brief Fatigue Inventory to rate fatigue severity and functional interference caused by fatigue. Data on patient demographics, Eastern Cooperative Oncology Group performance status, other physical symptoms, current treatments, and laboratory values were also collected. Descriptive statistics, bivariate correlation, and logistic regression were used for data analysis. RESULTS: Fifty percent of the sample reported severe fatigue, which was defined as a "fatigue worst" rating of 7 or greater. More patients with acute leukemia (61%) reported severe fatigue compared with those with chronic leukemia (47%) and non-Hodgkin's lymphoma (46%). Increased fatigue severity significantly compromised patients' general activity, work, enjoyment of life, mood, walking, and relationships with others. Fatigue severity was strongly associated with performance status, use of opioids, blood transfusions, gastrointestinal symptoms, and sleep disturbance items, as well as with low serum hemoglobin and albumin levels. Regression analysis indicated that nausea was the significant clinical predictor of severe fatigue (odds ratio, 13), and low serum albumin was the significant laboratory value predictor (odds ratio, 3.8). CONCLUSION: Disabling fatigue occurs with high frequency in hematologic malignancy, supporting a need to develop better methods of fatigue management. Better control of gastrointestinal and other symptoms may be of benefit. The mechanism and relationship between low albumin and severe fatigue needs to be investigated further, and longitudinal studies of the effects of treatment, host factors, and other symptoms are needed.
UI - 11884495
AU - Siegel JA; Kroll S; Regan D; Kaminski MS; Wahl RL
TI - A practical methodology for patient release after tositumomab and (131)I-tositumomab therapy.
SO - J Nucl Med 2002 Mar;43(3):354-63
AD - Nuclear Physics Enterprises, Cherry Hill, New Jersey 08003, USA. firstname.lastname@example.org
A methodology was developed determining patient releasability after radioimmunotherapy with tositumomab and (131)I-tositumomab for the treatment of non-Hodgkin's lymphoma. METHODS: Dosimetry data were obtained and analyzed after 157 administrations of (131)I-tositumomab to 139 patients with relapsed or refractory non-Hodgkin's lymphoma. Tositumomab and (131)I-tositumomab therapy included dosimetric (low activity) and therapeutic (high activity) administrations. For each patient, the total-body residence time was calculated after the dosimetric administration from total-body counts obtained over 6 or 7 d and was then used to determine the appropriate therapeutic activity to deliver a specific total-body radiation dose. Patient dose rates at 1 m were measured immediately after the therapeutic infusion. Patient-specific calculations based on the measured total-body residence time and dose rate for (131)I-tositumomab were derived to determine the patient's maximum releasable dose rate at 1 m, estimated radiation dose to maximally exposed individuals, and the amount of time necessary to avoid close contact with others. RESULTS: The mean administered activity (+/-SD), determined by dosimetry studies for each patient before therapy, was 3,108 +/- 1,073 MBq (84 +/- 29 mCi) (range, 1,221 +/- 5,957 MBq [33--161 mCi]). Immediately after treatment, the mean measured dose rate (+/- SD) at 1 m was 0.109 +/- 0.032 mSv/h (10.9 +/- 3.2 mrem/h; range, 0.04--0.24 mSv/h [4--24 mrem/h]). The measured dose rates were 60% (range, 37%--90%; P < 0.0001) of the theoretic dose rates from a point source in air predicted using the dose equivalent rate per unit activity of (131)I (5.95 x 10(-5) mSv/MBq h [0.22 mrem/mCi h] at 1 m). The mean estimated radiation dose to the maximally exposed individual was 3.06 mSv (306 mrem) (range, 1.95--4.96 mSv [195--496 mrem]). On the basis of current regulatory patient-release criteria, all (131)I-tositumomab--treated patients were determined to be releasable by comparing the dose rate at 1 m with a predetermined maximum releasable dose rate. Detailed instructions were provided to limit family members' exposure. CONCLUSION: A methodology has been developed for the release of patients administered radioactive materials based on the new Nuclear Regulatory Commission regulations. This approach uses a patient-specific dose calculation based on the measured total-body residence time and dose rate. This analysis shows the feasibility of outpatient radioimmunotherapy with tositumomab and (131)I-tositumomab.
UI - 11801488
AU - Cohen Y; Amir G; Rachmilewitz EA; Polliack A
TI - Sustained complete remission following a combination of very low intensity chemotherapy with rituximab in an elderly patient with Burkitt's lymphoma.
SO - Haematologica 2002 Jan;87(1):ELT04
AD - Department of Hematology, Hadassah University Hospital, Jerusalem, Israel 91120.
UI - 11849235
AU - Straka C; Oduncu F; Drexler E; Mitterer M; Schnabel B; Konig A; Brack N;
TI - Nerl C; Emmerich B The CD19+ B-cell counts at peripheral blood stem cell mobilization determine different levels of tumour contamination and autograft purgability in low-grade lymphoma.
SO - Br J Haematol 2002 Mar;116(3):695-701
AD - Medizinische Klinik-Innenstadt, University of Munich, Munich, Germany. email@example.com
The tumour load of peripheral blood stem cell (PBSC) harvests and the outcome of ex vivo immunomagnetic B-cell purging was investigated in 19 patients with low-grade lymphoma. To quantify the tumour load, we combined fluorescence-activated cell sorting measurement of CD19+ B-cells and determination of the B-cell light chain ratio (LCR) with consensus complementarity-determining region III-polymerase chain reaction (CDRIII-PCR) and gene scan analysis. The number of tumour cells was calculated using B-cell extracts from the PBSCs. Two different patterns were distinguished. In eight patients (42%) with CD19+ B cells >1% in the apheresis product, a high tumour load was found, characterized by a monoclonal LCR, positive PCR in seven out of eight cases, >5 x 10(7) extracted lymphoma cells in six out of seven PCR-assessable cases, and the presence of residual lymphoma after purging in six of seven cases. In 11 patients (58%) with <1% CD19+ B-cells in the product, a low tumour load was indicated by a polyclonal LCR, positive PCR in only 4 out of 11 cases, >5 x 10(7) extracted lymphoma cells in zero out of four PCR-assessable cases, and the presence of residual lymphoma after purging in zero out of four of these cases. The level of residual lymphoma following purging largely depended on the level of tumour contamination. CD19+ B-cells >50/microl in the peripheral blood at mobilization predicted a high tumour load in the apheresis product.
UI - 11054376
AU - Fischbach W; Dragosics B; Kolve-Goebeler ME; Ohmann C; Greiner A; Yang
TI - Q; Bohm S; Verreet P; Horstmann O; Busch M; Duhmke E; Muller-Hermelink HK; Wilms K; Allinger S; Bauer P; Bauer S; Bender A; Brandstatter G; Chott A; Dittrich C; Erhart K; Eysselt D; Ellersdorfer H; Ferlitsch A; Fridrik MA; Gartner A; Hausmaninger M; Hinterberger W; Hugel K; Ilsinger P; Jonaus K; Judmaier G; Karner J; Kerstan E; Knoflach P; Lenz K; Kandutsch A; Lobmeyer M; Michlmeier H; Mach H; Marosi C; Ohlinger W; Oprean H; Pointer H; Pont J; Salabon H; Samec HJ; Ulsperger A; Wimmer A; Wewalka F Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group.
SO - Gastroenterology 2000 Nov;119(5):1191-202
AD - Medizinische Klinik II, Klinikum Aschaffenburg, Aschaffenburg, Germany.
BACKGROUND & AIMS: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. METHODS: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori-positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. RESULTS: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P < 0.001). CONCLUSIONS: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori-positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed.
UI - 11163492
AU - Murtha AD; Rupnow BA; Hansosn J; Knox SJ; Hoppe R
TI - Long-term follow-up of patients with Stage III follicular lymphoma treated with primary radiotherapy at Stanford University.
SO - Int J Radiat Oncol Biol Phys 2001 Jan 1;49(1):3-15
AD - Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA. firstname.lastname@example.org
PURPOSE: To report the long-term survival and late toxicity data of Stage III follicular lymphoma patients treated with primary radiotherapy.METHODS AND MATERIALS: Sixty-six patients with Stage III follicular small cleaved (FSC) or follicular mixed (FM) non-Hodgkin's lymphoma were treated with total lymphoid irradiation (61 patients) or whole body irradiation (5 patients) as their primary treatment modality from 1963 to 1982 at Stanford University. Adjuvant chemotherapy was given to 13 patients. RESULTS: Median follow-up was 9.5 years with a range of 0.5-24.3 years. Median overall survival, cause-specific survival, freedom from relapse, and event-free survival were 9.5, 18.9, 7.1, and 5.1 years, respectively. Few initial relapses or lymphoma-related deaths were seen beyond the first decade of follow-up. Patient age and number of disease sites were the two strongest predictors of overall survival. The cohort of patients with limited Stage III disease demonstrated an 88% freedom from relapse and a 100% cause-specific survival with up to 23.5 years follow-up. CONCLUSION: The long-term survival data for Stage III FSC or FM non-Hodgkin's lymphoma treated with primary radiotherapy are at least comparable and possibly better than results achieved with other therapeutic approaches. Patients with limited Stage III disease do particularly well. Whether these results are superior to an initial approach of deferred therapy until clinically indicated is currently unknown.
UI - 11762817
AU - Machover D; Delmas-Marsalet B; Misra SC; Gumus Y; Goldschmidt E; Schilf
TI - A; Frenoy N; Emile JF; Debuire B; Guettier C; Farrokhi P; Boulefdaoui B; Norol F; Parquet N; Ulusakarya A; Jasmin C Dexamethasone, high-dose cytarabine, and oxaliplatin (DHAOx) as salvage treatment for patients with initially refractory or relapsed non-Hodgkin's lymphoma.
SO - Ann Oncol 2001 Oct;12(10):1439-43
AD - Department of Hematology and Oncology and the Institut du Cancer et d'Immunogenetique (ICIG), Hospital Paul Brousse, Villejuif, France. email@example.com
BACKGROUND: Dexamethasone. cytarabine (ara-C), and cisplatin (DHAP) can be used effectively to treat patients with non-Hodgkin's lymphoma (NHL). We hypothesized that substitution of cisplatin by oxaliplatin (L-OHP) could result in less toxicity and greater efficacy. L-OHP is active in patients with lymphoma. It produces mild myelosuppression and is devoid of renal toxicity. We report on a phase II study of dexamethasone, high-dose ara-C, and L-OHP (DHAOx) used to treat patients with NHL who were previously treated with chemotherapy. PATIENTS AND METHODS: Fifteen patients were given DHAOx. They had failed to achieve a CR with initial chemotherapy or had recurrent disease. DHAOx consisted of dexamethasone, 40 mg/day (days 1 to 4): L-OHP, 130 mg/m2 (day 1); and ara-C, 2,000 mg/m2 every 12 h (day 2). Treatment was repeated every 21 days. RESULTS: Patients received a median of four courses of DHAOx. Myelosuppression and transient sensory peripheral neuropathy were the most prominent toxic effects. Serum creatinine levels did not increase in patients with normal renal function, nor in patients who had renal impairment before DHAOx. The median follow-up time from the start of DHAOx treatment was 17 months. Eight patients (53%) achieved a CR, and three patients (20%) had a PR. Responses were achieved by patients with lymphomas of various histologies that included mainly the follicular subtype, and by patients with and without resistance to prior chemotherapy. None of the eight responders have relapsed from CR at 4+. 6+, 14+, 15+, 19+, 20+, 24+, and 24+ months. They had various types of therapy after DHAOx. Disappearance of molecular markers was observed in all four patients who achieved a CR and whose tumor cells carried molecular abnormalities. CONCLUSION: DHAOx possesses characteristics of toxicity which compare favorably to those reported with DHAP, and it is useful as a salvage treatment for patients with NHL. Larger studies are required to establish the therapeutic potential of the regimen.
UI - 11762819
AU - Seymour JF; Grigg AP; Szer J; Fox RM
TI - Fludarabine and mitoxantrone: effective and well-tolerated salvage therapy in relapsed indolent lymphoproliferative disorders.
SO - Ann Oncol 2001 Oct;12(10):1455-60
AD - Department of Haematology, The Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia. firstname.lastname@example.org
BACKGROUND: Prior studies of the combination of fludarabine, mitoxantrone and dexamethasone have yielded high response rates but are associated with a significant risk of opportunistic infections, predominantly Pneumocystis Carinii pneumonia (PCP) requiring routine prophylaxis. PATIENTS AND METHODS: We evaluated the combination of fludarabine (25 mg/m2/day x 3) and mitoxantrone (10 mg/m2 x 1) without corticosteroids or PCP prophylaxis in 29 patients with relapsed or refractory indolent lymphoproliferative disorders; median age 56 years, 62% refractory to preceding chemotherapy. RESULTS: A median of four cycles was administered without cumulative myelosuppression. Neutropenia <0.5 x 10(9/)l was seen in 16% of cycles. Infections complicated 10.4% of cycles. with impaired performance status (> or = ECOG 2) and increased age ( > 56 years) significant risk factors (P < or = 0.01). No cases of PCP were encountered. The response rate was 90%, median remission duration 11.9 months and the median survival 57 months. Peripheral blood progenitor cell mobilization was attempted in 11 patients and yielded > or = 2 x 10(6) CD34+ cells/kg in only 5 cases (45%). CONCLUSIONS: High response rates can be attained with fludarabine and mitoxantrone in combination without corticosteroids, and routine PCP prophylaxis can safely be omitted. Peripheral blood progenitor collections are problematic in these heavily pretreated patients.
UI - 11762825
AU - Saikia TK; Menon H; Advani SH
TI - Prolonged neutropenia following anti CD20 therapy in a patient with relapsed follicular non-Hodgkin's lymphoma and corrected with IVIG.
SO - Ann Oncol 2001 Oct;12(10):1493-4
UI - 11902983
AU - Breneman D; Duvic M; Kuzel T; Yocum R; Truglia J; Stevens VJ
TI - Phase 1 and 2 trial of bexarotene gel for skin-directed treatment of patients with cutaneous T-cell lymphoma.
SO - Arch Dermatol 2002 Mar;138(3):325-32
AD - Department of Dermatology, University of Cincinnati, OH, USA.
OBJECTIVE: To evaluate the safety, dose tolerance, and efficacy of topical bexarotene gel in patients with early-stage cutaneous T-cell lymphoma (CTCL). DESIGN: Phase 1 and 2, open-label, dose-escalation clinical trial of bexarotene gel. SETTING: Three university-based clinics. PARTICIPANTS: Sixty-seven adults with early-stage (TNM stages IA-IIA) CTCL. INTERVENTIONS: Bexarotene gel, 0.1%, 0.5%, and 1.0%, applied in incremental dose adjustments from 0.1% gel every day to 1.0% gel 4 times daily or the maximal tolerated dose. MAIN OUTCOME MEASURES: Patients were followed for efficacy and safety, and treatment continued as long as they benefited. Response (> or =50% improvement) was evaluated by the Physician's Global Assessment of cutaneous disease and by an overall severity assessment of cutaneous disease, including signs of CTCL and area involved. RESULTS: Most patients tolerated topical bexarotene at 1% gel twice daily for routine use. Adverse events were