National Cancer Institute®
Last Modified: June 1, 2002
UI - 11785835
AU - Garnier JL; Stevenson G; Blanc-Brunat N; Touraine JL; Milpied N; Leblond
TI - V; Blay JY Treatment of post-transplant lymphomas with anti-B-cell monoclonal antibodies.
SO - Recent Results Cancer Res 2002;159():113-22
AD - Hjpital Edouard Herriot, Nephrology, Transplantation and Clinical Immunology Department, Lyon, France.
The treatment of post-transplant lymphomas still needs major improvements in order to put the patient in remission and to retain graft function. Chemotherapy is far too toxic in these patients. A more specific treatment such as anti-B-cell monoclonal antibody is very promising. The cytotoxic effect of antibody relies mainly on complement-induced and antibody-dependent cellular cytotoxicity; apoptosis may also induce tumor cell death. B-cell antigens expressed on the cell surface are the targets of antibody attack; some specificities may be chosen because of their level of expression or because of signaling induced within the cell. Anti-B-cell antibodies can be produced by genetic engineering in order to be humanized or to carry bispecific Fabs. The efficacy and safety of anti-B-cell monoclonal antibodies (mAbs) in transplant patients have been proven with different antibodies such as anti-CD21/CD24 mAb, anti-CD38 mAb and anti-CD20 mAb. In a retrospective analysis of different centers in France, rituximab (anti-CD20 mAb, Roche Products) achieved an overall 69% remission rate in 34 organ and bone-marrow transplant patients. But the conditions of use of antibody must be better defined, particularly with regard to the immunosuppressive therapy, the type of tumor and the dose of antibody. We must also improve our understanding of the in vivo mechanisms of action of antibody to develop more efficient antibody constructs.
UI - 11785838
AU - Straus DJ
TI - Prognostic factors in the treatment of human immunodeficiency virus-associated non-Hodgkin's lymphoma.
SO - Recent Results Cancer Res 2002;159():143-8
AD - Memorial Sloan-Kettering Cancer Center, Cornell University, New York, NY 10021, USA.
Chemotherapy regimens similar to those used for non-Hodgkin's lymphoma (NHL) not associated with human immunodeficiency virus (HIV) infection have been used for patients with HIV-associated NHL with less success. In a recent trial, patients with intermediate or high-grade NHL were randomized to either low-dose chemotherapy with methotrexate, bleomycin, doxorubicin, vincristine and dexamethasone (m-BACOD) or to standard-dose m-BACOD with sargramostim (granulocyte-macrophage colony-stimulating factor, GM-CSF). With low-dose m-BACOD 41% of patients achieved a complete remission and the median survival was 35 weeks. With standard-dose m-BACOD and sargramostim, the percentage of complete remissions was 52% with a median survival of 31 weeks (P=n.s.). Myelosuppression was greater with standard-dose chemotherapy. In univariate and multivariate analyses of 21 pretreatment features of patients in this trial, four factors emerged as adversely prognostic with respect to survival: age >35 years, intravenous drug use, CD4 counts < 100/mm3 and stage III/IV disease. In an analysis using the proportional hazards model, a "favorable" group was defined by patients with 0 or 1 adverse factor (median survival 46 weeks, survival at 144 weeks 29.5%) as compared with an unfavorable group with 3 or 4 adverse factors (median survival 18 weeks, survival at 144 weeks 0). The outcome of these patients may be improving with the use of highly active antiretroviral therapy (HAART), which seems to improve immune function and tolerance of chemotherapy. A recent trial of the AIDS Malignancy Consortium found that low-dose chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone: CHOP) and standard-dose chemotherapy had similar response rates, acceptable toxicity and minimal alterations in cyclophosphamide, doxorubicin and indinavir pharmacokinetics in HIV-associated lymphoma patients also on HAART (stavudine, lamivudine and indinavir). There is a suggestion that Burkitt-type lymphomas may tend to occur in HIV-infected patients with relatively well preserved immune function and CD4 cell counts. Recent results from our institution suggest that similar outcomes are achievable with intensive chemotherapy in patients with Burkitt's lymphomas with or without HIV infection. With improved immune status and improved bone marrow function with the use of HAART, it will probably become more possible to treat many patients with aggressive HIV-associated NHL with more intensive treatment regimens.
UI - 11785839
AU - Tirelli U; Spina M; Jaeger U; Nigra E; Blanc PL; Liberati AM; Benci A;
TI - Sparano JA Infusional CDE with rituximab for the treatment of human immunodeficiency virus-associated non-Hodgkin's lymphoma: preliminary results of a phase I/II study.
SO - Recent Results Cancer Res 2002;159():149-53
AD - National Cancer Institute, Aviano, Italy.
Infusional CDE (cyclophosphamide, doxorubicin, etoposide; iCDE) is one of the most effective chemotherapeutic regimen for human immunodeficiency virus (HIV)-associated non-Hodgkin's lymphoma (NHL), with a complete remission rate of 46% and a median overall survival of 8.2 months (Sparano JA, Blood 1993; 81:2810). Since the majority of HIV-associated NHL are CD20-positive we reasoned that the addition of rituximab to iCDE (R-iCDE) could also improve the poor outcome of these patients. As a first step we investigated the safety of R-iCDE in a phase I/II study. Thirty patients with aggressive HIV-associated NHL evaluable patients were: median age: 38 years (range 29-65 years); male sex 24/29; histology: DLCL 16 (55%), Burkitt 10 (35%), ALCL 2 (7%), unclassified 1 (3%); stage: I (35%), II (10%), III (10%), IV (45%); International Prognostic Index: 0, 1 (59%), 2 (24%), 3 (17%), 4, 5 (0); CD4 count: median 132/ mm3 (range 3-470/mm3). Patients received rituximab (375 mg/m2) in conjunction with iCDE (five or six cycles). All patients were treated with G-CSF and highly active antiretroviral therapy (HAART). Twenty-six of 29 patients received treatment as planned, while chemotherapy had to be discontinued in three patients (2 persistent thrombocytopenias, 1 cerebral hemorrhage). Grade 3 or 4 toxicity was observed as follows: neutropenia 79%, anemia 45%, thrombocytopenia 34%, bacterial infection 34%, opportunistic infection 7%, mucositis 17%. A dose reduction was necessary in 22%. Complete remission was achieved in 86% of the patients, partial remission in 4%. Ten percent had progressive disease. After a median follow-up of 9 months the median overall survival is not reached. The actuarial survival at 2 years is 80% and the actuarial progression-free survival is 79%. Four of 29 patients (14%) have died, three from NHL and one from cryptosporidiosis. These findings suggest that the combination of rituximab with iCDE in patients with HIV-associated NHL is safe and feasible and that the addition of the anti-CD20 antibody does not increase the risk for infections. The high complete remission rate also indicates a potential therapeutic benefit and warrants further randomized trials.
UI - 11971211
AU - Hahn JS; Lee ST; Min YH; Ko YW; Yang WI; Kim GE
TI - Therapeutic outcome of Epstein-Barr virus positive T/NK cell lymphoma in the upper aerodigestive tract.
SO - Yonsei Med J 2002 Apr;43(2):175-82
AD - Department of Internal Medicine, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul 120-752, Korea. email@example.com
Expression of the natural killer (NK) cell antigen CD56 is uncommon in malignant lymphoma, but when it is, it is almost exclusively of the non-B cell lineage and show a preference for the nasal and nasopharyngeal region. T/NK cell lymphoma is known to be aggressive and refractory to treatment. It is highly associated with the Epstein-Barr Virus (EBV), but clinical investigations are rarely reported, that is until recently. We report here, on the clinical features and therapeutic outcomes of patients with T/NK cell lymphomas and its association with EBV. We reviewed fifty-four cases with peripheral T cell lymphomas in the upper aerodigestive tract between Jan. 1987 and Aug. 1998 from the Severance Hospital, Yonsei University College of Medicine. The diagnosis of T/NK cell lymphoma was made according to the expression of the NK cell markers, CD56 antigen and cytoplasmic CD3epsilon, in tumor specimens, by immunohistochemistry. Epstein-Barr early region (EBER) RNA was detected using in situ hybridization on paraffin-embedded sections. Among the 54 cases with malignant lymphomas occurring in the upper aerodigestive tract, 20 had T/NK cell lymphoma (37%). The primary sites of T/NK cell lymphomas were the nasal cavity, 12 cases (60%), the tonsils, 4 cases (20%), the nasopharynx, 2 cases (10%), and the oropharynx, 2 case (10%). There were no differences between the features, at diagnosis or therapeutic modalities for patients with T/NK cell lymphoma and non-T/NK cell lymphoma. The complete remission rate of T/NK cell lymphomas was lower than non-T/NK cell lymphomas (65% vs 85%, p=0.02). The overall survival of T/NK cell lymphomas was 13 months (1-74 month), which was significantly lower than non-T/NK cell lymphomas [60.6% with a median follow up of 22 months (1-101 month, p=0.02)]. Disease free survival of T/NK cell lymphomas was 22 months (4-66 month), significantly lower than non-T/NK cell lymphomas [73.8% with a median follow up of 22 months (2-95 month), p=0.04]. The overall survival rates for T/NK cell lymphomas were significantly lower than for EBV positive non-T/NK cell lymphomas (p=0.018). EBER RNA was detected in the paraffin-embedded tissue sections of all T/NK cell lymphomas, compared to only 17.6% (6 of 34 cases) for non- T/NK cell lymphomas. In conclusion, as patients with T/NK cell lymphomas showed poor clinical outcomes, and a high association with EBV positivity, clinical trials with more investigational therapeutic strategies, and further research into the relationship of EBV infection with pathogenesis of T/NK cell lymphoma is warranted.
UI - 11437056
AU - Samuel J; Mullai N; Firfir B
TI - Intestinal tuberculosis after successful treatment of advanced high-grade non-Hodgkin's lymphoma and AIDS.
SO - Endoscopy 2001 Jun;33(6):557
AD - Division of Medical Oncology, Cook County Hosptial, Chicago, Illinois, 60612, USA. firstname.lastname@example.org
UI - 11939825
AU - Giuliani M; Mastroianni A; Di Carlo A; Donati P; Miceli M; Monini P;
TI - Rezza G Onset of non-AIDS Kaposi sarcoma during therapy with interferon alfa-2a in an 82-year-old man with concomitant cutaneous T-cell lymphoma.
SO - Arch Dermatol 2002 Apr;138(4):535-7
UI - 11980095
AU - Arimoto H; Shirotani T; Nakau H; Hashizume K; Sakai Y; Matsukuma S
TI - Primary malignant lymphoma of the cavernous sinus--case report.
SO - Neurol Med Chir (Tokyo) 2000 May;40(5):275-9
AD - Department of Neurosurgery, Japan Self Defense Forces Central Hospital, Tokyo.
A 59-year-old female presented with a very rare case of primary malignant lymphoma of the cavernous sinus manifesting as diplopia and right facial hypesthesia. Magnetic resonance (MR) imaging showed the tumor located in the right cavernous sinus as low intensity with marked enhancement by gadolinium. The tumor was partially removed by the transzygomatic extradural approach. The histological diagnosis was malignant lymphoma. Chest and abdominal computed tomography and gallium-67 scintigraphy revealed no other lesions in the body. The patient received conventional radiotherapy and her diplopia and right facial hypesthesia gradually improved. At 1 month after radiotherapy, MR imaging showed no evidence of residual tumor. Primary cavernous sinus malignant lymphoma is extremely rare, but should be considered in the differential diagnosis of cavernous sinus lesions. Histological confirmation of tumors in this region is essential for choosing the most appropriate treatment to achieve a better outcome.
UI - 12025224
AU - Vaishampayan U; Karanes C; Du W; Varterasian M; al-Katib A
TI - Outcome of relapsed non-Hodgkin's lymphoma patients after allogeneic and autologous transplantation.
SO - Cancer Invest 2002;20(3):303-10
AD - Division of Hematology and Oncology, Department of Internal Medicine, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA. email@example.com
A retrospective review of 58 patients with non-Hodgkin's lymphoma (NHL) relapse or progression after autologous bone marrow transplantation (auto BMT), peripheral stem cell transplantation (PSCT), or allogeneic transplant and 12 (21%) patients had allogeneic transplant. Median time to relapse post-transplant was 4.8 months with 49 relapses within 12 months after transplant. Overall 5-year survival was 22% (auto BMT or PSCT 25%, allo BMT 18%, p = 0.38) with a median survival of 10 months (auto BMT or PSCT 10.2 months, allo BMT 7 months, p = 0.38). Thirty-five patients received salvage therapy and, of these, 13 demonstrated objective response. The 3-year survival of responders and non-responders was 55 and 14% and median survivals were 27.8 and 8 months, respectively (p = 0.02). Interval between BMT and relapse (p = 0.0001), and response to salvage therapy (p = 0.02) were the only significant predictors of survival.
UI - 12011122
AU - Witzig TE; Gordon LI; Cabanillas F; Czuczman MS; Emmanouilides C; Joyce
TI - R; Pohlman BL; Bartlett NL; Wiseman GA; Padre N; Grillo-Lopez AJ; Multani P; White CA Randomized controlled trial of yttrium-90-labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma.
SO - J Clin Oncol 2002 May 15;20(10):2453-63
AD - Division of Internal Medicine and Hematology, Nuclear Medicine, Mayo Clinic and Mayo Foundation, 60 Stabile Building, Rochester, MN 55905, USA. firstname.lastname@example.org
PURPOSE: Radioimmunotherapy combines biologic and radiolytic mechanisms to target and destroy tumor cells, thus offering a needed therapeutic alternative for refractory non-Hodgkin's lymphoma (NHL) patients. This phase III randomized study compares the novel radioimmunotherapy yttrium-90 ((90)Y) ibritumomab tiuxetan with a control immunotherapy, rituximab, in 143 patients with relapsed or refractory low-grade, follicular, or transformed CD20(+) transformed NHL. PATIENTS AND METHODS: Patients received either a single intravenous (IV) dose of (90)Y ibritumomab tiuxetan 0.4 mCi/kg (n = 73) or rituximab 375 mg/m(2) IV weekly for four doses (n = 70). The radioimmunotherapy group was pretreated with two rituximab doses (250 mg/m(2)) to improve biodistribution and one dose of indium-111 ibritumomab tiuxetan for imaging and dosimetry. The primary end point, overall response rate (ORR), was assessed by an independent, blinded, lymphoma expert panel. RESULTS: ORR was 80% for the (90)Y ibritumomab tiuxetan group versus 56% for the rituximab group (P =.002). Complete response (CR) rates were 30% and 16% in the (90)Y ibritumomab tiuxetan and rituximab groups, respectively (P =.04). An additional 4% achieved an unconfirmed CR in each group. Kaplan-Meier estimated median duration of response was 14.2 months in the (90)Y ibritumomab tiuxetan group versus 12.1 months in the control group (P =.6), and time to progression was 11.2 versus 10.1 months (P =.173) in all patients. Durable responses of > or = 6 months were 64% versus 47% (P =.030). Reversible myelosuppression was the primary toxicity noted with (90)Y ibritumomab tiuxetan. CONCLUSION: Radioimmunotherapy with (90)Y ibritumomab tiuxetan is well tolerated and produces statistically and clinically significant higher ORR and CR compared with rituximab alone.
UI - 12011126
AU - Osterborg A; Brandberg Y; Molostova V; Iosava G; Abdulkadyrov K; Hedenus
TI - M; Messinger D; Epoetin Beta Hematology Study Group Randomized, double-blind, placebo-controlled trial of recombinant human erythropoietin, epoetin Beta, in hematologic malignancies.
SO - J Clin Oncol 2002 May 15;20(10):2486-94
AD - Department of Oncology (Radiumhemmet), Karolinska Hospital, S-17176 Stockholm, Sweden. email@example.com
PURPOSE: To investigate the effect of recombinant human erythropoietin (epoetin beta) on anemia, transfusion need, and quality of life (QOL) in severely anemic patients with low-grade non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL), or multiple myeloma (MM). PATIENTS AND METHODS: Transfusion-dependent patients with NHL (n = 106), CLL (n = 126), or MM (n = 117) and a low serum erythropoietin concentration were randomized to receive epoetin beta 150 IU/kg or placebo subcutaneously three times a week for 16 weeks. Primary efficacy criteria were transfusion-free and transfusion- and severe anemia-free survival (hemoglobin [Hb] > 8.5 g/dL) between weeks 5 to 16. Response was defined as an increase in Hb > or = 2 g/dL with elimination of transfusion need. QOL was assessed by the Functional Assessment of Cancer Therapy scale. RESULTS: Transfusion-free (P =.0012) survival and transfusion- and severe anemia-free survival (P =.0001) were significantly greater in the epoetin beta group versus placebo (Wald chi(2) test), giving a relative risk reduction of 43% and 51%, respectively. The response rate was 67% and 27% in the epoetin beta versus the placebo group, respectively (P <.0001). After 12 and 16 weeks of treatment, QOL significantly improved in the epoetin beta group compared with placebo (P <.05); this improvement correlated with an increase in Hb concentration (> or = 2 g/dL). A target Hb that could be generally recommended could not be identified. CONCLUSION: Many severely anemic and transfusion-dependent patients with advanced MM, NHL, and CLL and a low performance status benefited from epoetin therapy, with elimination of severe anemia and transfusion need, and improvement in QOL.
UI - 11966958
AU - Ely SA
TI - MALToma versus marginal zone lymphoma versus diffuse large B cell lymphoma.
SO - J Gastroenterol Hepatol 2002 Feb;17(2):226; discussion 226-7
UI - 11978942
AU - Cohen Y; Lossos A; Polliack A
TI - Neurotoxicity with leukoencephalopathy after a single intravenous high dose of methotrexate in a patient with lymphoma.
SO - Acta Haematol 2002;107(3):185-6
AD - Department of Hematology, Hadassah University Hospital, Jerusalem, Israel.
UI - 12011222
AU - Otieno MW; Banura C; Katongole-Mbidde E; Johnson JL; Ghannoum M; Dowlati
TI - A; Renne R; Arts E; Whalen C; Lederman MM; Remick SC Therapeutic challenges of AIDS-related non-Hodgkin's lymphoma in the United States and East Africa.
SO - J Natl Cancer Inst 2002 May 15;94(10):718-32
AD - Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi and the Kenyatta National Hospital, Nairobi, Kenya.
Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. As we enter the third decade of the acquired immunodeficiency syndrome (AIDS) epidemic, it is apparent that the evolution of antiretroviral therapy and the emergence of combination antiviral strategies have greatly affected the natural history of HIV infection and its neoplastic complications. For example, there may be a trend for declining incidence of AIDS-related lymphoma in the United States for the first time. However, in regions of the world where the burden of HIV infection is greatest, such as in East Africa, AIDS-related lymphoma is an increasing cause of morbidity and mortality. Treatment of lymphoma has evolved coincident with improvements in antiretroviral therapy. Infusional chemotherapy regimens may offer advantages over other regimens and schedules, but comparative trials have not been done. Clinical trial data are available on which to develop therapeutic strategies to treat this disease in East Africa where pragmatic approaches are needed. Both the differences in manifestations of HIV infection and the inherent difficulties in administering cytotoxic chemotherapy in this part of the world must be taken into consideration in planning therapeutic strategies. Improved understanding of the pathogenesis of HIV infection and lymphoma will likely yield improved therapeutic interventions as well.
UI - 11994970
AU - Oei ME; Kraft GH; Sarnat HB
TI - Intravascular lymphomatosis.
SO - Muscle Nerve 2002 May;25(5):742-6
AD - Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, USA. firstname.lastname@example.org
Intravascular lymphomatosis, also known as endovascular lymphoma or angiotropic large cell lymphoma, is a rare malignancy typically diagnosed at autopsy. We describe a case in which the diagnosis was made at an early stage. Specific electrodiagnostic findings suggested concomitant polyneuropathy and myopathy. Suspicion of a paraneoplastic syndrome during electrodiagnostic testing prompted muscle biopsy, which revealed myopathy due to the direct infiltration of neoplastic cells. Resultant treatment with a standard chemotherapy regimen not only increased the patient's survival, but also improved neurological function. Copyright 2002 Wiley Periodicals, Inc. Muscle Nerve 25:000-000, 2002
UI - 11984808
AU - Dormann S; Duffner U; Martini C; Bohm N; Korinthenberg R; Niemeyer C
TI - Brief report: chronic myelopathy after combined chemo-radiotherapy in a patient with relapsed mediastinal B-cell lymphoma.
SO - Med Pediatr Oncol 2002 Jun;38(6):442-4
AD - Division of Pediatric Hematology and Oncology, University Children's Hospital, Freiburg, Germany.
UI - 11899124
AU - Mimouni D; David M; Feinmesser M; Coire CI; Hodak E
TI - Vitiligo-like leucoderma during photochemotherapy for mycosis fungoides.
SO - Br J Dermatol 2001 Dec;145(6):1008-14
AD - Department of Dermatology, Rabin Medical Centre, Petah Tikva, Israel. email@example.com
We describe four patients with mycosis fungoides (MF) in whom depigmentation, and also leucotrichia in one, occurred following the resolution of the eruption during phototherapy (psoralen plus ultraviolet A treatment in three patients, climatotherapy in one). In all cases, the depigmentation was localized to the area of the pre-existing MF lesions. There was no clinically obvious phototoxicity. Biopsy study including S100 staining in all cases, and electron microscopy in one case, demonstrated the total absence of melanocytes, with no evidence of MF. It is suggested that the phototherapy may have activated a cell-mediated immunity leading to destruction of the melanocytes. We recommend that vitiligo-like leucoderma be added to the list of untoward effects of phototherapy in MF.
UI - 11941235
AU - Angioi-Duprez K; Taillandier L; Gerin M; Berrod JP; George JL; Maalouf T
TI - [Ocular involvement during primary central nervous system lymphoma]
SO - J Fr Ophtalmol 2002 Feb;25(2):147-53
AD - Service d'Ophtalmologie B, CHU de Nancy-Brabois, rue du Morvan, 54511 Vandoeuvre Cedex.
PURPOSE: The aim of our study was to assess and to characterize the ocular involvement in patients with primary central nervous system lymphoma. Population and methods: We conducted a prospective study patients affected by primary central nervous system lymphoma and who underwent a systematic ophthalmological examination before treatment. RESULTS: The study population comprised 24 patients (mean age, 57 years; 16 women and 8 men). Among these patients, 6 had ocular involvement (2 patients with ocular signs revealing the cerebral process, 2 evidenced at the time of the initial ocular examination, and 1 as the disease evolved). Ocular involvement was vitritis in all cases, anterior uveitis in 1 patient, obliterant vasculitis in 1 patient and yellowish subretinal lesions in 1 patient. In 1 case, a vitrectomy led to adequate diagnosis of the disease. CONCLUSION: Our study shows a 25% incidence of ocular involvement in patients with primary central nervous system lymphoma, with posterior uveitis as the most common manifestation. Because of the relatively high incidence of ocular involvement, a systematic ophthalmological examination of this subset of patients should be mandatory.
UI - 12014312
AU - Konturek PC; Konturek SJ; Pierzchalski P; Starzynska T; Marlicz K;
TI - Hartwich A; Zuchowicz M; Darasz Z; Papiez D; Hahn EG Gastric MALT-lymphoma, gastrin and cyclooxygenases.
SO - Acta Gastroenterol Belg 2002 Jan-Mar;65(1):17-23
AD - Department of Physiology, University College of Medicine, 16 Grzegorzecka str, 31-531 Krakow, Poland.
Malt-lymphoma, gastrin and COX-2 interaction. Low grade, mucosal associated lymphoid tissue (MALT)-lymphoma is an unique among gastric malignancies where causal involvement of Helicobacter pylori (H. pylori) infection has been proposed based on complete regression of the tumor following the eradication therapy. In this report ten primary, low-grade MALT-lymphomas have been examined before and 6 months after one week of successful eradication therapy (clarithromycin + amoxicillin + omeprazole). Gastric biopsy samples from tumor and intact antrum and corpus mucosa were obtained during endoscopy before and after eradication for assessment of expression of gastrin and gastrin receptor (CCKB-R) as well as cyclooxygenase (COX)-1 and COX-2 using RT-PCR. The gastric lumen and serum gastrin and mucosal and tumor tissue PGE2 biosynthesis were determined by RIA before and after H. pylori eradication. Eradication of H. pylori resulted in complete endoscopic and histological remission of MALT-lymphoma in 9 out of 10 patients as assessed 6 months after this eradication. Before eradication, the mRNA expression for gastrin and CCKB-R as well as mRNA expression for COX-1 and COX-2 were observed in tumor tissue and infected mucosa, while corpus mucosa expressed only CCKB-R and antrum mucosa only gastrin. Six months upon the eradication when MALT-lymphoma completely regressed both endoscopically and histologically in 9 of 10 tested subjects, the expression of gastrin and COX-2 disappeared from the former area of MALT-lymphoma tumor. Gastrin mRNA remained detectable only in antrum mucosa, CCKB-R mRNA in corpus mucosa and COX-1 mRNA both in antrum and corpus mucosa. Gastric luminal and serum gastrin levels and gastric mucosa and tumor PGE2, which were greatly elevated before eradication, became normalized after this procedure. This study demonstrates that low-grade MALT-lymphoma is linked to H. pylori infection which may promote the expression and excessive release of gastrin and COX-2 expression that could be involved in the pathogenesis of MALT-lymphoma.
UI - 11807147
AU - Coiffier B; Lepage E; Briere J; Herbrecht R; Tilly H; Bouabdallah R;
TI - Morel P; Van Den Neste E; Salles G; Gaulard P; Reyes F; Lederlin P; Gisselbrecht C CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma.
SO - N Engl J Med 2002 Jan 24;346(4):235-42
AD - Hospices Civils de Lyon and the Universite Claude Bernard, Lyons, France. firstname.lastname@example.org
BACKGROUND: The standard treatment for patients with diffuse large-B-cell lymphoma is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Rituximab, a chimeric monoclonal antibody against the CD20 B-cell antigen, has therapeutic activity in diffuse large-B-cell lymphoma. We conducted a randomized trial to compare CHOP chemotherapy plus rituximab with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. METHODS: Previously untreated patients with diffuse large-B-cell lymphoma, 60 to 80 years old, were randomly assigned to receive either eight cycles of CHOP every three weeks (197 patients) or eight cycles of CHOP plus rituximab given on day 1 of each cycle (202 patients). RESULTS: The rate of complete response was significantly higher in the group that received CHOP plus rituximab than in the group that received CHOP alone (76 percent vs. 63 percent, P=0.005). With a median follow-up of two years, event-free and overall survival times were significantly higher in the CHOP-plus-rituximab group (P<0.001 and P=0.007, respectively). The addition of rituximab to standard CHOP chemotherapy significantly reduced the risk of treatment failure and death (risk ratios, 0.58 [95 percent confidence interval, 0.44 to 0.77] and 0.64 [0.45 to 0.89], respectively). Clinically relevant toxicity was not significantly greater with CHOP plus rituximab. CONCLUSIONS: The addition of rituximab to the CHOP regimen increases the complete-response rate and prolongs event-free and overall survival in elderly patients with diffuse large-B-cell lymphoma, without a clinically significant increase in toxicity.
UI - 11949261
AU - Peshikova MV; Dolgushin II; Rusanova NN
TI - [Etiology and structure of infectious complications of cytostatic therapy in children with acute lymphoblastic leukemia and non-B-cell non-Hodgkin lymphomas]
SO - Zh Mikrobiol Epidemiol Immunobiol 2002 Jan-Feb;(1):70-1
AD - State Medical Academy, Chelyabinsk, Russia.
A retrospective analysis of medical histories with acute lymphoblast leucosis and non-B-cell non-Hodgkin lymphomas made it possible to reveal infectious complications of cytostatic therapy in 100% of children, namely: sepsis (0.3%), unidentified infection (12%), local infection (87.7%). Infectious complications of the cytopenic nature were localized mainly in the upper sections of the gastrointestinal tract and in upper respiratory tract. Bacterial infectious complications caused by opportunistic microorganisms with the prevalence of Gram positive flora, resistant to cephalosporins of generations I and II, occurred most frequently.
UI - 11994984
AU - Nakagawa M; Simizu Y; Suemura M; Sato B
TI - Successful long-term control with lamivudine against reactivated hepatitis B infection following intensive chemotherapy and autologous peripheral blood stem cell transplantation in non-Hodgkin's lymphoma: experience of 2 cases.
SO - Am J Hematol 2002 May;70(1):60-3
AD - Department of Medicine, Nissay Hospital, Nishi-ku Itachibori 6-3-8, Osaka, Japan. email@example.com
It is well documented that cytotoxic treatment in patients carrying the hepatitis B virus (HBV) enhances the risk of severe hepatic damage. Recently lamivudine has been reported to be effective in suppressing the replication of HBV under such conditions. Here we report two cases with HBV carrier status and with non-Hodgkin's lymphoma who were successfully treated with high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation with the administration of lamivudine to prevent HBV flare-up. The antiviral effect of lamivudine was fair, and no objective side effect was experienced during the transplant procedure. Both patients were followed carefully for more than a year without the appearance of the resistant virus. The rebound phenomenon in which HBV proliferates abruptly has not been experienced after withdrawal of lamivudine. We suggest that lamivudine is indicated both in the treatment of HBV viremia and in the prevention of proliferation of HBV in patients with HBV carrier status undergoing high-dose myeloablative chemotherapy.
UI - 12050349
AU - Akhtar S; Maghfoor I
TI - Rituximab plus CHOP for diffuse large-B-cell lymphoma.
SO - N Engl J Med 2002 Jun 6;346(23):1830-1; discussion 1830-1
UI - 11992182
AU - Abd-el-Baki J; Demierre MF; Li N; Foss FM
TI - Transformation in mycosis fungoides: the role of methotrexate.
SO - J Cutan Med Surg 2002 Mar-Apr;6(2):109-16
AD - Department of Dermatology, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA.
BACKGROUND: Large cell transformation in patients with mycosis fungoides (MF) has been well reported in the literature. Although the risk factors have not been clearly elucidated, advanced stage seems to be associated with a higher incidence of transformation. Because MF is a rare disorder, little is known about the influence of other factors such as immunosuppressive therapy in the occurrence of transformation. OBJECTIVE: We questioned the role of methotrexate (MTX) in the transformation of MF to large cell lymphoma (LCL). METHODS: We identified all patients with MF who were registered in our cutaneous lymphoma database. Transformation was defined by the presence of large cells exceeding 25% of the infiltrate in at least one skin biopsy. In one patient, we followed the histologic, immunophenotypic, and genotypic changes taking place as transformation occurred. Results: A total of 134 patients with MF were identified. Of 21 patients who received MTX, 3 transformed, and of the 113 patients in the non-MTX group, only 2 transformed. The incidence of transformation in the patients who received MTX was significantly higher than in those who did not receive the drug (14.3% vs. 1.8%; p = 0.03). This significance was maintained, even after controlling for stage and sex. For one patient who transformed, we demonstrated an identical dominant T-cell clone in all skin specimens, including the large cell lymphoma. CONCLUSION: Our results demonstrate a significant association between MTX exposure and transformation to LCL in patients with MF. In light of the small sample size, short followup of patients, and the inherent tendency of mycosis fungoides to transform, the role for MTX in transformation is unproven and needs to be confirmed in a multicenter study.
UI - 11911313
AU - De Sanctis V; Martelli M; Anticoli AP; Caronna R; Chirletti P;
TI - Giovannini M; Santarelli M; Enrici RM; Mandelli F Localized stage I-IE aggressive non-Hodgkin's lymphoma (NHL): results of prospective study with multimodality therapeutic approach.
SO - Anticancer Res 2001 Nov-Dec;21(6A):4169-72
AD - Istituto di Radiologia, Universita degli Studi di Roma La Sapienza, Italy. firstname.lastname@example.org
BACKGROUND: A brief course of chemotherapy followed by radiation therapy was considered the best treatment for localized high-grade Non-Hodgkin's Lymphoma (NHL). The purpose of this study was to determine the efficacy and feasibility of a brief-course of anthracycline-based chemotherapy (CHOP) and consolidation radiation therapy (CRT) in a series of 57 consecutive patients with stage I-IE intermediate-high grade NHL. consecutive patients, stage I=31 (55%) and stage IE=26 (45%), were treated with 3 cycles of CHOP regimen. Forty-four (77%) received a CRT and thirteen (23%) with primitive gastric and splenic NHL underwent radical surgery. Multivariate analysis was performed to evaluate age, lactate dehydrogenase (LDH), bulky, nodal versus extranodal localization, as prognostic factors of locoregional control and survival. RESULTS: After a median follow-up of 84 months (range 4-128 months) the 5-year overall survival (OS), disease-free survival (DFS) and event-free survival (EFS) rates were 88%, 87.5% and 84%, respectively. Risk factor analysis revealed that the LDH value was the most important adverse prognostic factor for OS and EFS. No differences were found regarding the age and or extranodal localization. The 5-year OS, DFS and EFS was 100% in thirteen patients with primitive gastric or splenic NHL treated with a radical surgical approach followed by chemotherapy without CRT. CONCLUSION: We confirm the efficacy and feasibility of a brief course of CHOP chemotherapy followed by CRT in localized I-IE intermediate-high grade NHL without adverse prognostic factors. Randomized studies are warranted in order to define the dose and the target volume of CRT (involved field or extended field) in this setting of patients.
UI - 11920261
AU - Bosly A; Lepage E; Coiffier B; Fillet G; Herbrecht R; Divine M; Dupriez
TI - B; Nouvel C; Deconninck E; Tilly H; Bordessoule D; Gaulard P; Gisselbrecht C; The GELA Outcome is not improved by the use of alternating chemotherapy in elderly patients with aggressive lymphoma.
SO - Hematol J 2001;2(4):279-85
AD - Cliniques Universitaires UCL de Mont-Godinne, Yvoir, Belgium. email@example.com
INTRODUCTION: A prospective randomised study involving 810 elderly patients was conducted in an attempt to compare alternating chemotherapy with conventional first-line chemotherapy in aggressive non-Hodgkin's lymphoma in order to improve prognosis with an acceptable toxicity for elderly patients. PATIENTS AND METHODS: Patients included were 55-69 years old and had at least one adverse prognostic factor. Patients were treated either with ACVBP followed by consolidation (n = 396) or with an alternating regimen (n = 414). This regimen was an association of active drugs in NHL relapsing patients, alternating VIMMM with ACVBP for induction and alternation of VIM and ACVM in consolidation. Eight hundred and sixty-six patients were randomised. After histological review, 810 patients met the inclusion criteria: 396 in arm A, 414 in arm B. RESULTS: The complete response rate after induction was superior for conventional first-line therapy (58.5% vs 48%, P = 0.003) but at the end of treatment, the CR rate was not statistically different (52% vs 48%, P = 0.19). Conventional chemotherapy had a better five-year event-free survival than alternating regimen (33% (95% CI: 30-36%) vs 28% (95% CI: 26-30%), P = 0.0289) but overall survival was not statistically different (40% (CI 95% 38-42%) vs 36% (CI 95% 34-38%), P = 0.068). In this elderly high risk population, the toxicity was very high: 19% in arm A and 26% in arm B died during treatment. CONCLUSION: Alternating regimen did not improve outcome, was less efficient and more toxic.
UI - 11978140
AU - Apisarnthanarax N; Talpur R; Duvic M
TI - Treatment of cutaneous T cell lymphoma: current status and future directions.
SO - Am J Clin Dermatol 2002;3(3):193-215
AD - Division of Internal Medicine, Department of Dermatology, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
The treatment of cutaneous T cell lymphoma (CTCL), which includes mycosis fungoides and Sezary syndrome, has been in a state of continual change over recent decades, as new therapies are constantly emerging in the search for more effective treatments for the disease. However, prognosis and survival of patients with CTCL remains dependent upon overall clinical stage (stage IA-IVB) at presentation, as well as response to therapy. Past therapies have been limited by toxicity or the lack of consistently durable responses, and few treatments have been shown to actually alter survival, especially in the late stages of disease. Even aggressive chemotherapy has not been shown to improve overall survival compared to conservative sequential therapy in advanced disease, and adds the risk of immunosuppressive complications. Over the last decade, extracorporeal photopheresis has been the only single treatment that has been shown to improve survival in patients with Sezary syndrome, although its true efficacy and place in combination therapy remain unclear. Much of the focus of current research has been on combinations of skin-directed therapies and biological response modifiers, which improve response rates. The results of various trials over the years have also brought into favor the use of post-remission maintenance therapy with topical corticosteroids, topical mechlorethamine (nitrogen mustard), interferon-alpha, or phototherapy to prevent disease relapse. Recent novel developments in CTCL therapy include oral bexarotene, a retinoid X receptor-selective retinoid that has activity in all stages of CTCL, and the topical gel formulation of bexarotene, which plays a role in treating localized lesions. US Food and Drug Administration (FDA)-approved, oral systemic bexarotene has the advantage of a 48% overall response rate at a dosage of 300 mg/m(2)/day, and avoids immunosuppression and risk of central line and catheter-related infectious complications that are associated with other systemic therapies. Monitoring of triglycerides and use of concomitant lipid-lowering agents and thyroid replacement is required in most patients. Also recently FDA-approved, denileukin diftitox is the first of a novel class of fusion toxin proteins and is selective for interleukin-2R (CD25+) T cells, targeting the malignant T cell clones in CTCL. Denileukin diftitox is associated with capillary leak syndrome in 20 to 30% of patients, which may be ameliorated by hydration and corticosteroids. Higher response rates are possible by combining bexarotene with "statin" drugs and active CTCL therapies. Studies are being conducted on combining bexarotene and denileukin diftitox with other modalities. Biological response modifier therapies that are in current or future investigational trials include topical tazarotene, pegylated interferon, interleukin-2, and interleukin-12. At the forefront of systemic chemotherapy development, pegylated liposomal doxorubicin, gemcitabine, and pentostatin appear to have the greatest potential for success in CTCL therapy. Bone marrow transplantation, which is currently limited by the risk of graft-versus-host disease, offers the greatest potential for disease cure. Further developments for CTCL may include more selective immunomodulatory agents, vaccines, and monoclonal antibodies.
UI - 12008655
AU - Aksentijevich I; Flinn IW
TI - Monoclonal antibody therapy with autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma.
SO - Cancer Control 2002 Mar-Apr;9(2):99-105
AD - Division of Hematologic Malignancies, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231, USA.
BACKGROUND: With the introduction of novel monoclonal antibody products into the clinic, significant new strategies are being developed to improve upon existing treatment for non-Hodgkin's lymphoma. METHODS: Monoclonal antibodies are being used alone, in combination with chemotherapy, or as adjuncts to autologous bone marrow transplantation for the purpose of purging bone marrow of neoplastic cells. RESULTS: Monoclonal antibodies when used in vivo in conjunction with autologous bone marrow transplantation have been relatively well tolerated. Results from several trials seem to demonstrate a therapeutic benefit for the use of such combinations. CONCLUSIONS: Before these agents can be included in standard bone marrow transplantation regimen, long-term survival outcomes need to be obtained from randomized trials. We review the results from recent trials using monoclonal antibodies in conjunction with autologous stem cell transplantation for the treatment of non-Hodgkin's lymphoma.
UI - 11929754
AU - Wilson WH; Grossbard ML; Pittaluga S; Cole D; Pearson D; Drbohlav N;
TI - Steinberg SM; Little RF; Janik J; Gutierrez M; Raffeld M; Staudt L; Cheson BD; Longo DL; Harris N; Jaffe ES; Chabner BA; Wittes R; Balis F Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy.
SO - Blood 2002 Apr 15;99(8):2685-93
AD - Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
We hypothesized that incremental improvements in the cyclophosphamide-doxorubicin-vincristine-prednisone (CHOP) chemotherapy regimen through optimization of drug selection, schedule, and pharmacokinetics would improve outcome in patients with large B-cell lymphomas. A prospective multi-institutional study of administration of etoposide, vincristine, and doxorubicin for 96 hours with bolus doses of cyclophosphamide and oral prednisone (EPOCH therapy) was done in 50 patients with previously untreated large B-cell lymphomas. The doses of etoposide, doxorubicin, and cyclophosphamide were adjusted 20% each cycle to achieve a nadir absolute neutrophil count below 0.5 x 10(9)/L. The median age of the patients was 46 years (range, 20-88 years); 24% were older than 60 years; and 44% were at high-intermediate or high risk according to International Prognostic Index (IPI) criteria. There was a complete response in 92% of patients, and at the median follow-up time of 62 months, the progression-free survival (PFS) and overall survival (OS) rates were 70% and 73%, respectively. Neither IPI risk factors nor the index itself was associated with response, PFS, or OS. Doses were escalated in 58% of cycles, and toxicity levels were tolerable. Significant inverse correlations were observed between dose intensity and age for all adjusted agents, and drug clearance of doxorubicin and free etoposide was also inversely correlated with age (r = -0.54 and P(2) =.08 and r = -0.45 and P(2) =.034, respectively). Free-etoposide clearance increased significantly during successive cycles (P(2) =.015). Lymphomas with proliferation of at least 80% had somewhat lower progression and those expressing bcl-2 had significantly higher progression (P(2) =.04). Expression of bcl-2 may discriminate the recently described activated B-like from germinal-center B-like large-cell lymphomas and provide important pathobiologic and prognostic information. Dose-adjusted EPOCH may produce more cell kill than CHOP-based regimens. Dynamic dose adjustment may overcome inadequate drug concentrations, particularly in younger patients, and compensate for increased