National Cancer Institute®
Last Modified: September 1, 2002
UI - 11856597
AU - Philip T; Biron P
TI - High-dose chemotherapy and autologous bone marrow transplantation in diffuse intermediate- and high-grade non-Hodgkin lymphoma.
SO - Crit Rev Oncol Hematol 2002 Feb;41(2):213-23
AD - Bone Marrow Transplant Department, Centre Leon Berard, 28 rue Laennec, 69008, Lyon, France. email@example.com
This is a review of data published in the literature on the role of marrow ablative treatment and blood or marrow transplantation for high-grade and intermediate-grade lymphoma. Timing and epidemiology are reviewed before the various clinical situations (primary refractory partial responses, complete responses and relapses). The Lyon consensus conference held in 1998 has also extensively been used and quoted.
UI - 11856598
AU - Mounier N; Socie G; Gisselbrecht C
TI - High-dose therapy for indolent lymphoma.
SO - Crit Rev Oncol Hematol 2002 Feb;41(2):225-39
AD - Institut d'Hematologie, Hopital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 10, Paris Cedex, France.
Stem-cell transplantation (SCT) has become the treatment of choice for patients with relapsed aggressive non-Hodgkin's lymphoma (NHL). However, the role of SCT in the management of patients with indolent NHL remains controversial. Indolent follicular lymphomas are diseases which are generally incurable with conventional therapy. Although patients can survive for prolonged periods, the median duration of first remission is approximately 3 years, and subsequent remissions are progressively shorter with time. Emerging evidence suggests that high-dose chemotherapy with SCT leads to prolonged disease-free and overall survival in a subset of patients with indolent NHL. However, there is increasing concern regarding the toxicity of SCT, especially the long-term risk of developing myelodysplastic syndrome. It is still unclear as to when this approach should be used. Poorer outcomes have been obtained in heavily pretreated patients but encouraging results are being reported for patients undergoing SCT early during the course of their disease. Investigators are now focusing on how to improve SCT efficacy in order to eradicate minimal residual disease. Many ongoing studies are especially exploring the impact of stem-cell purging and novel ablative regimens combined with allogeneic transplantation.
UI - 12116714
AU - Jantunen E; Kuittinen T; Mahlamaki E; Nousiainen T
TI - [Autologous stem cell transplantations in non-Hodgkin lymphomas]
SO - Duodecim 2001;117(11):1151-7
AD - KYS:n sisatautien klinikka PL 1777, 70211 Kuopio. firstname.lastname@example.org
UI - 11852527
AU - Painemal Duarte C; Gallardo J; Valdebenito JP; Gamargo C; Rubio B;
TI - Harbst H [MALT lymphoma of the bladder. Report of a case]
SO - Arch Esp Urol 2001 Dec;54(10):1138-40
AD - Seccion de Oncologia, Departamento de Medicina Interna Hospital Clinico de la Universidad de Chile Santos Dumontt 999 Santiago, Chile. email@example.com
OBJECTIVE: To describe and discuss primary malignant lymphoreticular proliferative tumors of the bladder. METHODS: A case of a 70-year-old woman with hematuria, dysuria, malaise and 5-kg weight loss is presented. RESULTS: Pelvic ultrasound examination showed an 8 x 7 x 8 cm solid and cystic mass adjacent to the bladder and uterus. Cystoscopic biopsy disclosed a low grade B cell non-Hodgkin lymphoma. Disappearance of the mass was achieved with 6 cycles of chemotherapy and radiotherapy. Four years thereafter the patient remains free of disease. CONCLUSIONS: Primary malignant lymphoma of the bladder is uncommon. The anatomopathological study is essential to differential diagnosis from other diseases. The response to chemotherapy and radiotherapy are excellent and permits bladder preservation.
UI - 11862771
AU - Gimenez-Mesa E; Martinez-Salio A; Porta-Etessam J; Berbel Garcia A;
TI - Cedena Romero T; Salama Bendoyan P [Reversible posterior leukoencephalopathy in a patient with non-Hodgkin's lymphoma after treatment with CHOP]
SO - An Med Interna 2001 Nov;18(11):591-3
AD - Servicio de Neurologia, Hospital Universitario Doce de Octubre, Ctra de Andalucia km 5,400, 28041 Madrid.
Reversible posterior leukoencephalopathy syndrome is a newly characterised and increasingly recognized clinico-radiologic syndrome. Underlying conditions that reportedly trigger this syndrome include hypertensive encephalopathy, eclampsia, renal failure, and immunosuppressive drug therapy with cyclosporine, tacrolimus and interferon alpha. We describe a 51-year-old woman with non-Hodgkin's lymphoma treated with conventional CHOP chemotherapy. Eight days after this treatment she developed severe headache, bilateral visual loss and focal seizures with secondary generalization. Neurologic examination showed confusion, cortical blindness, and left hemiparesis with hyperreflexia and sensory loss. A cranial T2-weighted magnetic resonance imaging revealed increased signal intensity in the occipital and frontal lobes in both hemispheres and right parietal lobe. A diagnosis of reversible posterior leukoencephalopathy was made. She presented a favourable outcome with conservative treatment with mannitol and phenytoin. A new cranial scanning showed nearly complete resolution of the abnormalities. To the best of our knowledge, this is the first case of reversible posterior leukoencephalopathy in a patient treated with standard-dose CHOP. In this patient, we confirm the theoretical pathophysiologic mechanisms suggested explaining how these drugs can cause the syndrome.
UI - 11890335
AU - Waisberg J; Bromberg SH; Franco MI; Matheus CO; Zanotto A; Petrolino LF;
TI - Beltrami AM; Godoy AC Primary non-Hodgkin lymphoma of the right colon: a retrospective clinical-pathological study.
SO - Int Surg 2001 Jan-Mar;86(1):20-5
AD - Department of Digestive Surgery, Hospital do Servidor Publico Estadual, Sao Paulo, Brazil. jaqueswaisberguol.com.br
The objective of this study was to analyze the results of surgical treatment of primary non-Hodgkin lymphomas of the right colon. Ten patients were operated on with curative intention. Dawson's criteria were used to characterize the colonic lymphoma as a primary lymphomas. In the staging of the tumor, the Ann Arbor classification for gastrointestinal lymphomas modified by Musshoff and Schmidt-Vollmer was used. The histological classification was made by using the International Working Formulation Group system. All patients were submitted to radical right colectomy and 6 of them received postoperative chemotherapy. The overall average survival was 39.2 months. Four of the patients are still alive, without active disease, with an average survival of 85.2 months. Six patients died due to relapse in the abdomen, with an average survival of 8.2 months. These results suggest that it is advantageous to patient survival to have them submitted for resection of their lesions at an initial stage of the disease (IE and IIE1). Chemotherapy must be used as a complementary treatment in locally advanced lesions, in an attempt to control the residual microscopic disease.
UI - 12170430
AU - Rummel MJ; Mitrou PS; Hoelzer D
TI - Bendamustine in the treatment of non-Hodgkin's lymphoma: results and future perspectives.
SO - Semin Oncol 2002 Aug;29(4 Suppl 13):27-32
AD - Department of Hamatologie/Onkologie, Medizinische Universitatsklinik, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Bendamustine has clinical potential in the treatment of low-grade non-Hodgkin's lymphoma (NHL). As a single agent, bendamustine has been used in two studies in patients with relapsed or refractory low-grade NHL. When bendamustine 120 mg/m(2) was given on days 1 and 2, the overall response rate was 73% with complete responses in 11%. When bendamustine 50 to 60 mg/m(2) was given on days 1 through 5, the overall response rate was 82.5%, with 14.5% complete responses. Bendamustine shows only partial cross-resistance with other agents used in the treatment of NHL and combination regimens have been investigated. The combination of bendamustine/vincristine/prednisolone (BOP) has been compared with cyclophosphamide/vincristine/prednisolone (COP) in a phase III study involving 162 patients with low-grade NHL. No differences were seen between the treatment arms with regard to response rate or survival, but the BOP regimen was significantly better tolerated than the COP regimen. The combination of rituximab/bendamustine has shown encouraging activity in patients with relapsed/refractory NHL and a trial is ongoing in which this combination is used in patients with advanced low-grade NHL or mantle cell lymphoma. Preliminary results from this trial are presented. The 93% overall response rate attained in the patients presently evaluable indicates that this combination is very active in this poor-prognosis population. Optimal treatment regimens with bendamustine in the treatment of low-grade NHL are yet to be defined, but results obtained to date indicate that further studies are warranted. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 12177115
AU - Dillman RO
TI - Radiolabeled anti-CD20 monoclonal antibodies for the treatment of B-cell lymphoma.
SO - J Clin Oncol 2002 Aug 15;20(16):3545-57
AD - Clinical and Laboratory Cancer Research, Hoag Hospital, Hoag Cancer Center, Newport Beach, CA 92658, USA. firstname.lastname@example.org
UI - 12190227
AU - Morrow TJ; Volpe S; Gupta S; Tannous RE; Fridman M
TI - Anemia of cancer in intermediate-grade non-Hodgkin's lymphoma.
SO - South Med J 2002 Aug;95(8):889-96
AD - One Health Plan, Atlanta, GA, USA.
BACKGROUND: Current literature suggests that anemia at baseline is an important adverse prognostic factor for lymphoma-related outcomes. We evaluated the prevalence, risk factors, and prognostic value of anemia in patients with intermediate-grade non-Hodgkin's lymphoma (IGNHL) treated in a community-based practice. METHODS: The retrospective sample included 591 patients who had IGNHL diagnosed between 1993 and 1999 and who were subsequently treated with CHOP chemotherapy. Anemia was defined as a hemoglobin (Hb) value < 12 g/dL. RESULTS: Anemia was present in 193 of 546 patients (35.3%). Baseline anemia was significantly associated with age > 60, extranodal sites > or = 2, Ann Arbor stage III or IV, elevated lactate dehydrogenase (LDH) level, B symptoms, and histology type. Baseline Hb was also a significant predictor of nonresponse to chemotherapy. CONCLUSIONS: Our study results support previous findings of a high prevalence of anemia in cancer patients before cytotoxic therapy and the adverse impact that baseline anemia has on response to chemotherapy.
UI - 11878045
AU - Estes J
TI - New approaches to the management of Non-Hodgkin's lymphoma.
SO - Semin Oncol Nurs 2002 Feb;18(1 Suppl 1):1-2
AD - Comprehensive Cancer Care Center, University of Michigan Hospital, Ann Arbor, MI, USA.
UI - 11878046
AU - Hohenstein M
TI - Immunotherapy: a novel treatment for Non-Hodgkin's lymphoma.
SO - Semin Oncol Nurs 2002 Feb;18(1 Suppl 1):10-5
AD - Department of Oncology/Hematology, University of Nebraska Medical Center, Lied Transplant Center, 668 S 41st St, Omaha, NE 68198, USA.
OBJECTIVES: To provide an overview of the principles of immunology, including immunotherapy, and information about monoclonal antibody therapy in the treatment of non-Hodgkin's lymphoma. DATA SOURCES: Published literature. CONCLUSIONS: Immunotherapy is a form of disease treatment that enhances the immune system with the use of biologic agents. One such agent is the monoclonal antibody, which can be combined with a radioisotope (e.g., iodine-131 or yttrium-90) or chemotherapeutic drug to deliver treatment directly to tumor cells with less toxicity to normal cells. IMPLICATIONS FOR NURSING PRACTICE: As the field of monoclonal antibody therapy continues to grow, nurses will play an important role in treatment and patient education. Nurses need to become knowledgeable in this area of cancer treatment and gain a better understanding of basic principles involved in immunotherapy.
UI - 11878047
AU - Bush S
TI - Monoclonal antibodies conjugated with radioisotopes for the treatment of Non-Hodgkin's lymphoma.
SO - Semin Oncol Nurs 2002 Feb;18(1 Suppl 1):16-21
AD - Division of Medical Oncology, University of Washington Medical Center, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G6800, Seattle, WA 98109, USA.
OBJECTIVES: To describe the use of monoclonal antibodies labeled with iodine-131 tositumomab and yttrium-90 ibritumomab-tiuxetan as treatment for non-Hodgkin's lymphoma. DATA SOURCES: Literature review of trials of radioimmunotherapy. CONCLUSIONS: Radiolabeled monoclonal antibodies recognize and react with specific antigens to provide targeted therapy to tumor cells, particularly hematopoietic tumor cells. This therapy delivers greater amounts of radiation to malignant cells than normal cells and spares critical organs that do not express the antigen. Strict safety and patient precautions must be in place with the use of radiotherapy. IMPLICATIONS FOR NURSING PRACTICE: As the use of radiommunotherapy in the treatment of non-Hodgkin's lymphoma grows, the role of nursing in the care of these patients will also grow. Nurses will play an important part in patient and family education, as well as staff preparation.
UI - 11878048
AU - Hendrix C; de Leon C
TI - Establishing a radioimmunotherapy outpatient care clinic for Non-Hodgkin's lymphoma.
SO - Semin Oncol Nurs 2002 Feb;18(1 Suppl 1):22-9
AD - Cancer Center Outpatient Treatment Clinic, Hoag Cancer Center, 4000 W. Pacific Coast Hwy, Newport Beach, CA 92660, USA.
OBJECTIVES: To describe an outpatient treatment model for treating non-Hodgkin's lymphoma with radioimmunotherapy. DATA SOURCES: Experiences of The Hoag Cancer Canter (Newport Beach, CA) in developing an outpatient treatment model. CONCLUSIONS: The Hoag Cancer Center has put an outpatient radioimmunotherapy treatment model into place. Goals include providing coordinated, collaborative care, safe delivery of radioimmunotherapy in an outpatient setting, and establishing an education program for the medical team, patient, and patient's family. IMPLICATIONS FOR NURSING PRACTICE: In providing outpatient treatment for non-Hodgkin's lymphoma, nurses will have many functions, including educating patients and family, coordinating treatment schedules, adhering to radiation safety guidelines, and reviewing post-therapy and long-term side effects that might occur at home.
UI - 11878049
AU - O'Brien T
TI - Current therapeutic approaches in the treatment of Non-Hodgkin's lymphoma.
SO - Semin Oncol Nurs 2002 Feb;18(1 Suppl 1):3-9
AD - Section of Hematology, Rush, Presbyterian St. Luke's Medical Center, 1725 W Harrison, Suite 809, Chicago, IL 60612, USA.
OBJECTIVES: To review the causes, classification, treatment, and new treatment modalities of non-Hodgkin's lymphoma. DATA SOURCES: Published literature and experimental therapies. CONCLUSIONS: The increasing incidence of non-Hodgkin's lymphoma can be attributed to a growth in the number of immunodeficiency and autoimmune disorders, infectious agents, and human T-cell leukemia-lymphoma virus. Treatment options include watch-and-wait, radiation, chemotherapy, biologic therapy, and stem cell/bone marrow transplant. New therapies include the use of monoclonal antibodies and radioimmunotherapy. Experimental therapies include high-dose radioimmunotherapy and stem cell transplantation, vaccines, and antisense antiangiogensis agents. IMPLICATIONS FOR NURSING PRACTICE: Nurses will need to become versed in this modality, and will play an important part not only in therapy but also in patient education.
UI - 12149300
AU - Witzig TE; Flinn IW; Gordon LI; Emmanouilides C; Czuczman MS; Saleh MN;
TI - Cripe L; Wiseman G; Olejnik T; Multani PS; White CA Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma.
SO - J Clin Oncol 2002 Aug 1;20(15):3262-9
AD - Mayo Clinic, 620 Stabile Building, Rochester, MN 55905, USA. email@example.com
PURPOSE: Rituximab is commonly used as a single agent or in combination therapy for non-Hodgkin's lymphoma (NHL). Ibritumomab tiuxetan radioimmunotherapy targets the same antigen as rituximab and has demonstrated efficacy in rituximab-naive NHL. This study evaluated ibritumomab tiuxetan in the treatment of rituximab-refractory follicular NHL. PATIENTS AND METHODS: Eligible patients were refractory to rituximab; this was defined as no objective response to rituximab (375 mg/m(2) weekly for 4 weeks) or time to progression (TTP) of < or = 6 months. The ibritumomab tiuxetan treatment regimen consisted of pretreatment with rituximab (250 mg/m(2) intravenously on days 1 and 8) to deplete peripheral blood B cells, then yttrium-90 ibritumomab tiuxetan (0.4 mCi/kg; maximum, 32 mCi) intravenously on day 8, administered on an outpatient basis. An imaging/dosimetry dose of indium-111 ibritumomab tiuxetan (5 mCi) was injected after rituximab (day 1) in 28 patients. RESULTS: Fifty-seven patients were treated. The median age was 54 years, 74% had tumors > or = 5 cm, and all were extensively pretreated (median, four prior therapies; range, one to nine). The estimated radiation-absorbed doses to healthy organs were below the study-defined limit in all patients studied with dosimetry. The overall response rate for the 54 patients with follicular NHL was 74% (15% complete responses and 59% partial responses). The Kaplan-Meier-estimated TTP was 6.8 months (range, 1.1 to > or = 25.9 months) for all patients and 8.7 months for responders. Adverse events were primarily hematologic; the incidence of grade 4 neutropenia, thrombocytopenia, and anemia was 35%, 9%, and 4%, respectively. CONCLUSION: Ibritumomab tiuxetan radioimmunotherapy is effective in rituximab-refractory patients. The only significant toxicity is hematologic.
UI - 12044501
AU - Reiser M; Diehl V
TI - Current treatment of follicular non-Hodgkin's lymphoma.
SO - Eur J Cancer 2002 Jun;38(9):1167-72
AD - Klinik I fur Innere Medizin, University Hospital Cologne, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany. firstname.lastname@example.org
56200 new cases of NHL are expected to be diagnosed in the United States (US) per year. For reasons that are not fully understood, the number of new cases per year has nearly doubled in the past three decades. Most patients with follicular lymphoma are over 50 years of age and present with widespread disease at diagnosis. Nodal involvement is very common, often accompanied by splenic and bone marrow disease. Despite the advanced stage, the median survival ranges from 8 to 12 years. The vast majority of patients with advanced stage follicular lymphoma are not cured using the current therapeutic options. The rate of relapse is fairly consistent over time, even in patients who have achieved complete responses (CRs) to treatment. Therapeutic options in follicular NHL include watchful waiting, oral alkylating agents, purine nucleoside analogues, combination chemotherapy, interferon and monoclonal antibodies. Radiolabelled monoclonal antibodies, autologous or allogeneic bone marrow or peripheral stem cell transplantation are under current clinical evaluation. The approval of rituximab, an unconjugated chimeric antibody against the CD20 antigen for the treatment of relapsed follicular B-cell NHL marked a milestone in the development of antibody treatment. In addition, newer approaches like radioimmunoconjugates with myeloablative activity induced response rates of 80-100% in heavily pretreated patients. Various clinical trials combining monoclonal antibodies with conventional therapies are currently ongoing to determine whether these new biological agents will alter the natural history of follicular lymphoma.
UI - 8922192
AU - Betticher DC; Zucca E; von Rohr A; Egger T; Radford JA; Ambrosetti A;
TI - Burki K; Rufener B; Schmitz SF; Cerny T 2-chlorodeoxyadenosine (2-CDA) therapy in previously untreated patients with follicular stage III-IV non-Hodgkin's lymphoma.
SO - Ann Oncol 1996 Oct;7(8):793-9
AD - Institute of Medical Oncology, Inselspital, Berne, Switzerland.
PURPOSE: This phase II multi-institutional trial was designed to assess response and toxicity of 2-chlorodeoxyadenosine (2-CDA) in patients with previously untreated follicular lymphoma. The clinical significance of detecting cells carrying the t(14;18) translocation (bcl-2/JH rearrangement) in peripheral blood and bone marrow by polymerase chain reaction (PCR) before, during and after treatment was also examined. were accrued: male/female: 15/22, median age 51 years (range: 20-78), stage III/IV: 9/28. Patients received a total 2-CDA dose of 0.7 mg/kg as continuous s.c. or i.v. infusions over 7 days, every 28 days for a maximum of 5 cycles. A total of 165 cycles were administered. In 25 patients, blood and bone marrow before, during and after treatment were available for PCR analysis of the bcl-2/JH rearrangements. RESULTS: All 37 patients were evaluable for response and toxicity. The overall response rate was 84% (95% confidence interval, 68%-94%) with 14% CR (n = 5) and 70% PR (n = 26) and a median time to treatment failure of 15.7 months. bcl-2/JH rearrangement in peripheral blood and/or bone marrow was found in 10/25 of patients (40%) before treatment and 5 of these became repeatedly negative after 2-CDA therapy. There was no apparent association between bcl-2/ JH result and response. In 11 patients, 2-CDA was stopped because of progressive disease (n = 4), myelotoxicity (grade 2-3, n = 4), and other causes (n = 3, pulmonary embolism, metabolic disorder, and patient's decision). Four patients (11%) suffered from infections (grade 2-3). In 6 patients, persistent thrombocytopenia of 7.5 months (range: 3-21) occurred after completion of the 5 cycles. CONCLUSION: 2-CDA is active in untreated follicular lymphomas, but time to treatment failure suggests no advantage compared with standard treatment and toxicity on haematopoietic stem cells appears to be more pronounced. Molecular remission is induced in a considerable proportion of patients with disappearance of the bcl-2/JH rearrangement, and its possible significance as a predictive factor for quality of response and relapse warrants further study.
UI - 10871932
AU - Zhou Y; Barnett MJ; Rivers JK
TI - Clinical significance of skin biopsies in the diagnosis and management of graft-vs-host disease in early postallogeneic bone marrow transplantation.
SO - Arch Dermatol 2000 Jun;136(6):717-21
AD - Department of Medicine, Vancouver General Hospital and University of British Columbia.
OBJECTIVE: To determine the value of skin biopsies in the management of suspected graft-vs-host disease (GVHD) within 30 days of allogeneic bone marrow transplantation (BMT). DESIGN: Retrospective study based on review of a BMT database. SETTING: Leukemia/BMT ward of a tertiary care, university teaching hospital. PATIENTS: One hundred and eighty-seven consecutive patients who received allogeneic BMT between January 1, 1994, and June 30, 1997, at Vancouver General Hospital, Vancouver, British Columbia. MAIN OUTCOME MEASURES: (1) Skin biopsy frequency for patients with rashes suggestive of acute GVHD; (2) clinical significance of skin biopsy in the management of patients with suspected acute GVHD after BMT; (3) relationship between severity of clinical GVHD and the likelihood to receive GVHD therapy; and (4) relationship between biopsy status or biopsy result and outcome of BMT (acute and chronic GVHD, transplant-related mortality, and overall and event-free survival). RESULTS: During the early post-BMT period (<30 days after BMT), 88 patients had rashes suggestive of acute GVHD; of these, 51 (58%) underwent skin biopsy to confirm the diagnosis. Skin biopsies were performed more often for higher clinical stages of cutaneous GVHD. There was no significant difference between the patients with positive biopsy findings and those with negative findings, either in the clinical severity of acute GVHD or in likelihood to receive treatment for GVHD. Most (85%) of the patients who underwent biopsies and received GVHD therapy had treatment initiated before skin biopsies were performed or before the results were available. The higher the clinical grade of overall acute GVHD, the more likely it was that the patients were treated for GVHD (P<.001). The outcome of BMT was not influenced by the skin biopsy status or biopsy result. CONCLUSIONS: The biopsy findings correlated poorly with the clinical severity of skin rash suggestive of acute GVHD soon after BMT. The decision to treat suspected acute GVHD depended not on skin biopsy findings but rather on clinical severity of acute GVHD. In this regard, skin biopsy has a limited role in the management of patients early after allogeneic BMT.
UI - 11049969
AU - Press OW; Eary JF; Gooley T; Gopal AK; Liu S; Rajendran JG; Maloney DG;
TI - Petersdorf S; Bush SA; Durack LD; Martin PJ; Fisher DR; Wood B; Borrow JW; Porter B; Smith JP; Matthews DC; Appelbaum FR; Bernstein ID A phase I/II trial of iodine-131-tositumomab (anti-CD20), etoposide, cyclophosphamide, and autologous stem cell transplantation for relapsed B-cell lymphomas.
SO - Blood 2000 Nov 1;96(9):2934-42
AD - Departments of Medicine, Pathology, Pediatrics, Radiology, Biological Structure, and Biostatistics, the University of Washington, Seattle, WA 98195, USA.
Relapsed B-cell lymphomas are incurable with conventional chemotherapy and radiation therapy, although a fraction of patients can be cured with high-dose chemoradiotherapy and autologous stem-cell transplantation (ASCT). We conducted a phase I/II trial to estimate the maximum tolerated dose (MTD) of iodine 131 ((131)I)-tositumomab (anti-CD20 antibody) that could be combined with etoposide and cyclophosphamide followed by ASCT in patients with relapsed B-cell lymphomas. Fifty-two patients received a trace-labeled infusion of 1.7 mg/kg (131)I-tositumomab (185-370 MBq) followed by serial quantitative gamma-camera imaging and estimation of absorbed doses of radiation to tumor sites and normal organs. Ten days later, patients received a therapeutic infusion of 1.7 mg/kg tositumomab labeled with an amount of (131)I calculated to deliver the target dose of radiation (20-27 Gy) to critical normal organs (liver, kidneys, and lungs). Patients were maintained in radiation isolation until their total-body radioactivity was less than 0.07 mSv/h at 1 m. They were then given etoposide and cyclophosphamide followed by ASCT. The MTD of (131)I-tositumomab that could be safely combined with 60 mg/kg etoposide and 100 mg/kg cyclophosphamide delivered 25 Gy to critical normal organs. The estimated overall survival (OS) and progression-free survival (PFS) of all treated patients at 2 years was 83% and 68%, respectively. These findings compare favorably with those in a nonrandomized control group of patients who underwent transplantation, external-beam total-body irradiation, and etoposide and cyclophosphamide therapy during the same period (OS of 53% and PFS of 36% at 2 years), even after adjustment for confounding variables in a multivariable analysis.
UI - 12091059
AU - Basso U; Brandes AA
TI - Diagnostic advances and new trends for the treatment of primary central nervous system lymphoma.
SO - Eur J Cancer 2002 Jul;38(10):1298-312
AD - Department of Medical Oncology, Azienda Ospedale-Universita, Via Giustiniani 2, 35100 Padova, Italy.
Primary central nervous system lymphoma (PCNSL) is a rare non-Hodgkin's lymphoma arising in the brain. Recent increase in its incidence has been noted both in immunocompetent individuals and patients with immunodeficiency. This review will focus on the epidemiology, pathogenesis, diagnosis and treatment of this aggressive extranodal lymphoma in immunocompetent patients. Stereotactic biopsy is usually required for diagnosis, while molecular biology and/or cytofluorimetric analysis may confirm the presence of clonal proliferation in the cerebrospinal fluid (CSF). Methotrexate-based chemotherapy plus whole-brain radiotherapy are the standard treatment for PCNSL and achieve a high rate of complete remissions (CR), but long-term neurotoxicity may heavily compromise the patient's quality of life. The metabolic rate of controversial gadolinium-enhancing lesions on magnetic resonance (MR) scans may be assessed with positron emission tomography (PET), which discriminates radiation necrosis from true recurrence. Withholding radiotherapy in patients achieving CR after first-line chemotherapy is a new and interesting treatment option, while the role of high-dose chemotherapy with stem cell rescue is still uncertain.
UI - 12117868
AU - Wotherspoon AC
TI - Extragastric MALT lymphoma.
SO - Gut 2002 Aug;51(2):148-9
AD - Department of Histopathology, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK. Andrew.Wotherspoon@rmh.nthames.nhs.uk
UI - 12117895
AU - Hosaka S; Nakamura N; Akamatsu T; Fujisawa T; Ogiwara Y; Kiyosawa K;
TI - Hidaka E; Ota H; Katsuyama T; Inagaki H A case of primary low grade mucosa associated lymphoid tissue (MALT) lymphoma of the oesophagus.
SO - Gut 2002 Aug;51(2):281-4
AD - Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
We report a very rare case of primary low grade mucosa associated lymphoid tissue (MALT) lymphoma of the oesophagus. An 83 year old woman treatment of oesophageal tumour. Although a physical examination and laboratory data showed no significant abnormalities, endoscopic observation revealed two slightly elevated submucosal tumour-like lesions of the oesophagus. Tissue specimens were obtained by endoscopic mucosal resection of the oesophagus using a cap fitted panendoscope. The lesions were composed of diffuse small atypical lymphoid cells--that is, centrocyte-like cells--which were stained with CD20, L26, BCL-2, and kappa, but not with CD3, CD5, CD10, or cyclin D1. Monoclonality was detected by polymerase chain reaction analysis using the primer for CDR-3 of immunoglobulin H and diagnosed as low grade MALT lymphoma of the oesophagus. The tumours were considered to be completely resected and therefore additional treatment was not administered. The patient is alive and well 22 months after treatment and diagnosis.
UI - 12060115
AU - Williams DM; Hobson R; Imeson J; Gerrard M; McCarthy K; Pinkerton CR;
TI - The United Kingdom Children's Cancer Study Group Anaplastic large cell lymphoma in childhood: analysis of 72 patients treated on The United Kingdom Children's Cancer Study Group chemotherapy regimens.
SO - Br J Haematol 2002 Jun;117(4):812-20
AD - Department of Paediatric Oncology, Addenbrookes NHS Trust, Hills Road, Cambridge CB2 2QQ, UK. email@example.com lymphoma (ALCL) were treated with short intensive multi-agent regimens [non-Hodgkin's lymphoma (NHL) 9000 and 9602]. Diagnosis was based on morphological and immunophenotypic criteria. Treatment for stage I disease consisted of eight courses (2 x vincristine, doxorubicin, prednisolone; 2 x methotrexate; 2 x cytarabine, thioguanine; and 2 x methotrexate etoposide). For stage II, III and non-central nervous system (CNS) stage IV, two COPADM (cyclophosphamide, doxorubicin, prednisolone, methotrexate, vincristine), two CYM (cytarabine methotrexate) and a COPADM was given. For CNS-positive disease, treatment was intensified and contained methotrexate 8 g/m(2) and cytarabine 3 g/m(2). Fifty-nine patients (82%) achieved a remission. Thirteen of these relapsed, with a median time to relapse from the start of treatment of 5 months (range 3-14). Relapse included a new site in 9/13 patients. The probabilities of overall and event free survival at 5 years were 65% (53-76%) and 59% (47-70%), respectively, with a median follow up of 4.3 years. Mediastinal and visceral involvement at presentation were found to be predictive of an increased risk of failure.
UI - 12060117
AU - Friedberg JW; Neuberg D; Gribben JG; Fisher DC; Canning C; Koval M; Poor
TI - CM; Green LM; Daley J; Soiffer R; Ritz J; Freedman AS Combination immunotherapy with rituximab and interleukin 2 in patients with relapsed or refractory follicular non-Hodgkin's lymphoma.
SO - Br J Haematol 2002 Jun;117(4):828-34
AD - Department of Adult Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. firstname.lastname@example.org
Rituximab has significant activity as a single agent in the treatment of follicular non-Hodgkin's lymphoma (NHL). Interleukin 2 (IL-2) is a lymphokine that increases effector cell number. In an effort to augment antibody-dependent cell-mediated cytotoxicity (ADCC) associated with rituximab therapy, low-dose IL-2 was added to a standard rituximab regimen and patients were evaluated for safety and efficacy. Twenty patients with relapsed or refractory follicular NHL were treated with IL-2 (1.2 MIU/m(2)/d for 56 d subcutaneously) as outpatients. Rituximab (375 mg/m(2)) was given on d 15, 22, 29 and 36. The regimen was well tolerated and only three patients required dose adjustments in IL-2. Infusional toxicity associated with rituximab was not exacerbated by IL-2. Peripheral blood immunophenotyping demonstrated significant increases in circulating CD8+ and CD56+ lymphocytes in all evaluable patients (P = 0.0002). Increases in total eosinophil number were observed in all patients. Eleven patients responded to therapy, for an overall response rate of 55%. Four additional patients had stable disease. For these 15 patients, the median time to progression exceeded 13 months. We conclude concomitant cytokine therapy to enhance ADCC with monoclonal antibody therapy was well tolerated and did not exacerbate antibody-related infusional toxicity. Further studies of this rational combination are warranted and ongoing.
UI - 12060145
AU - Iannitto E; Barbera V; Quintini G; Cirrincione S; Leone M
TI - Hepatosplenic gammadelta T-cell lymphoma: complete response induced by treatment with pentostatin.
SO - Br J Haematol 2002 Jun;117(4):995-6
UI - 12163626
AU - Kostakoglu L; Coleman M; Leonard JP; Kuji I; Zoe H; Goldsmith SJ
TI - PET predicts prognosis after 1 cycle of chemotherapy in aggressive lymphoma and Hodgkin's disease.
SO - J Nucl Med 2002 Aug;43(8):1018-27
AD - Division of Nuclear Medicine, Department of Radiology, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, New York 10021, USA. email@example.com
Early identification of chemotherapy-refractory lymphoma patients provides a basis for alternative treatment strategies. Metabolic imaging with (18)F-FDG PET offers functional tissue characterization that is useful for assessing response to therapy. Our objective was to determine the predictive value of (18)F-FDG PET early during chemotherapy (after 1 cycle) and at the completion of chemotherapy for subsequent progression-free survival (PFS) in patients with aggressive non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD). METHODS: (18)F-FDG PET (dual-head coincidence camera with attenuation correction) was performed before and after 1 cycle of chemotherapy on 30 patients (17 NHL, 13 HD; mean age, 52.3 +/- 16.0 y). For 23 of the 30 patients, (18)F-FDG PET data were also obtained after the completion of chemotherapy. The patients had a median follow-up of 19 mo (range, 18-24 mo). Follow-up of PFS was compared between patients with positive and negative (18)F-FDG PET results obtained after the first cycle of chemotherapy and at the completion of chemotherapy. RESULTS: Positive (18)F-FDG PET results obtained both after the first cycle and at the completion of therapy were associated with a shorter PFS (median, 5 and 0 mo, respectively) than were negative (18)F-FDG PET results (PFS medians not reached). A statistically significant difference in PFS between positive and negative (18)F-FDG PET results was obtained both after the first cycle and at the completion of chemotherapy (P < or = 0.001). The PFS and (18)F-FDG PET results obtained after the first cycle correlated better than those obtained after the completion of chemotherapy (r(2) = 0.45 vs. 0.17). (18)F-FDG PET had more false-negative results after the last cycle (6/17 cases, or 35%) than after the first cycle (2/13 cases, or 15%). Thus, (18)F-FDG PET had greater sensitivity and positive predictive values after the first cycle (82% vs. 45.5% and 90% vs. 83%, respectively) than after the last cycle. CONCLUSION: (18)F-FDG PET after 1 cycle of chemotherapy is predictive of 18-mo outcome in patients with aggressive NHL and HD and may earlier identify patients who would benefit from more intensive treatment programs.
UI - 12195750
AU - Linden O; Tennvall J; Hindorf C; Cavallin-Stahl E; Lindner KJ; Ohlsson
TI - T; Wingardh K; Strand SE 131I-labelled anti-CD22 MAb (LL2) in patients with B-cell lymphomas failing chemotherapy. Treatment outcome, haematological toxicity and bone marrow absorbed dose estimates.
SO - Acta Oncol 2002;41(3):297-303
AD - Department of Oncology, Lund University Hospital, SE-221 85 Lund, Sweden. firstname.lastname@example.org
The experience with radioimmunotherapy in B-cell lymphomas using the rapidly internalizing antibody, anti-CD22 (LL2), is limited. In this study we investigated the efficacy and toxicity of 131I-labelled-LL2 for radioimmunotherapy in patients with B-cell lymphomas that failed one or two cytostatic regimens. Eleven patients were treated with one or repeated cycles of 131I-anti-CD22 antibody, 1330 MBq/m2 (36 mCi/m2). Six of the 11 treated patients demonstrated an objective response, three of them with complete remission. All follicular (3 patients) and transformed lymphomas (2 patients) responded compared to one of four diffuse large B-cell lymphomas. Two out of six responders exhibited event-free survival (EFS), which was comparable with or longer than the EFS following primary anthracycline-containing chemotherapy. Non-haematological toxicity was mild. Haematological toxicity was associated with pretreatment clinical characteristics but not with estimated absorbed bone marrow doses. Objective remission following treatment with 131I-anti-CD22 can be achieved in patients with various subtypes of B-cell lymphomas, failing standard chemotherapy. Follicular or transformed lymphomas seem particularly responsive. Haematological toxicity seems to be dependent on the functional status of the bone marrow before radioimmunotherapy.
UI - 12151696
AU - Pranesh N
TI - Lymphoma in an ileostomy.
SO - Postgrad Med J 2002 Jun;78(920):368-9
AD - Department of Surgery, Milton Keynes General Hospital, Standing Way, Eaglestone, Milton Keynes MK6 5LD, UK. email@example.com
Lymphoma developing in an ileostomy is an extremely rare complication. The presentation is similar to the commoner, yet still rare, adenocarcinoma but the staging and management of the condition differs.
UI - 12100137
AU - Mitterbauer M; Kalhs P; Keil F; Prinz E; Moser K; Mannhalter C;
TI - Mitterbauer G; Brugger S; Gisslinger H; Lechner K; Greinix HT Continuous complete clinical and molecular remission in two patients with refractory lymphoid malignancies after autografting followed by allogeneic stem cell transplantation with reduced intensity conditioning.
SO - Br J Haematol 2002 Jul;118(1):132-5
AD - Department of Medicine I, Bone Marrow Transplantation, University Hospital of Vienna, Vienna, Austria. Margit.Mitterbauer@akh-wien.ac.at
We present a 60-year-old patient with primary refractory non-Hodgkin's lymphoma and a 58-year-old patient with multiple myeloma with relapse after first autologous stem cell transplantation (ASCT), who underwent ASCT followed by allogeneic stem cell transplantation (alloSCT) with reduced intensity conditioning consisting of fludarabine and a single dose of total body irradiation. For graft-versus-host disease prophylaxis cyclosporine and mycophenolate mofetyl were given. Complete donor chimaerism was observed on d 28 after SCT. Both patients achieved sustained complete haematological and molecular remission of the immunoglobulin kappa light chain (Igkappa) rearrangement and are alive and well 17 and 16 months after SCT respectively.
UI - 12100150
AU - Dumontet C; Mounier N; Munck JN; Bosly A; Morschauser F; Simon D; Marit
TI - G; Casasnovas O; Reman O; Molina T; Reyes F; Coiffier B Factors predictive of early death in patients receiving high-dose CHOP (ACVB regimen) for aggressive non-Hodgkin's lymphoma: a GELA study.
SO - Br J Haematol 2002 Jul;118(1):210-7
AD - Hematology Department, Centre Hospitalier Lyon Sud, Pierre Benite, France. firstname.lastname@example.org
Death during the induction phase of chemotherapy remains a common event in patients with aggressive non-Hodgkin's lymphoma (NHL). In a series of patients with aggressive NHL homogeneously treated with intensive induction chemotherapy [ACVB (doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone) regimen], we determined the clinical and biological parameters that were predictive of early death. Early death was defined as death, for whatever reason, occurring within 100 d of randomization. Predictive factors were identified by logistic regression and an index predictive for individual risk of early death was designed. Among the 2210 patients treated with ACVB, there were 162 (7.3%) early deaths. There was no significant reduction in the