National Cancer Institute®
Last Modified: July 1, 2002
UI - 11553063
AU - Bowles KM; Tooze R; Marcus RE
TI - Large-cell lymphoma. An unusual late relapse.
SO - Clin Lab Haematol 2001 Jun;23(3):197-9
AD - Department of Haematology, Addenbrookes Hospital, Cambridge, UK.
We report a case of a 40-year-old man with a stage 4, anaplastic, large-cell lymphoma. He had been diagnosed 13 years before as having a liposarcoma, at which point he was treated with combination chemotherapy, which included anthracycline. On review of the histopathology from 13 years before, the original diagnosis of liposarcoma was revised to that of an anaplastic large-cell lymphoma. A diagnosis of relapsed anaplastic large-cell lymphoma was made. A MUGA scan showed a reduced ejection fraction of 46%. Our patient responded initially to combination chemotherapy, which included anthracycline, without further reduction in his ejection fraction. This was followed by high-dose chemotherapy and peripheral blood stem-cell transplantation. Twenty months later he is well and remains in complete remission.
UI - 12056952
AU - McGinnis KS; Shapiro M; Junkins-Hopkins JM; Smith M; Lessin SR; Vittorio
TI - CC; Rook AH Denileukin diftitox for the treatment of panniculitic lymphoma.
SO - Arch Dermatol 2002 Jun;138(6):740-2
AD - email@example.com
UI - 12057122
AU - Westin EH; Longo DL
TI - T-small cell disorders.
SO - Curr Treat Options Oncol 2001 Jun;2(3):225-35
AD - National Institute on Aging/NIH, 5600 Nathan Shock Drive, Baltimore, MD 21224-6825, USA.
A minority (less than 2%) of all lymphoproliferative disorders are derived from small T cells. These include T-cell prolymphocytic leukemia, T-cell granular lymphocytic leukemia, and mycosis fungoides/Sezary syndrome. With the possible exception of early-stage, skin-localized mycosis fungoides, all are considered incurable, although palliation can be achieved with radiation therapy, chemotherapy, biologic therapy, and combinations of these modalities. Of these disorders, mycosis fungoides is the most common; it follows an indolent, though gradually progressive, course that spans years. The T-cell prolymphocytic leukemias, in contrast, are generally refractory to treatment, with a median survival of typically less than 1 year. Although effective therapy remains elusive in most cases, the development of nucleosides as a class of chemotherapeutic agents and biologics, including interferon, monoclonal antibodies, and vitamin A derivatives, offers new hope for at least more effective palliation of these progressive lymphoproliferative disorders. However, rapid improvement in the treatment of these disorders remains hampered by the rarity of these individual entities. More rapid progress in treatment depends on national and international cooperation to accrue patients for definitive trials of sufficient size to evaluate new treatment options quickly.
UI - 12065554
AU - Spreafico F; Massimino M; Luksch R; Casanova M; Cefalo GS; Collini P;
TI - Ferrari A; Polastri D; Terenziani M; Gasparini M; Fossati-Bellani F Intensive, very short-term chemotherapy for advanced Burkitt's lymphoma in children.
SO - J Clin Oncol 2002 Jun 15;20(12):2783-8
AD - Department of Pediatric Oncology, Istituto Nazionale Tumori, Milan, Italy. firstname.lastname@example.org
PURPOSE: To improve the 63% event-free survival (EFS) achieved before 1986 in Murphy's stage III to IV Burkitt's lymphoma (BL), both chemotherapy and supportive care were intensified. PATIENTS AND METHODS: 2.1 to 17 years), with advanced BL were enrolled onto two sequential institutional studies. From 1987 to 1992, 30 patients were stratified according to the absence (regimen IA, n = 19) or presence (regimen IB, n = 11) of bone marrow (BM) or CNS involvement. After 5-week cytoreductive chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin, high-dose (HD) methotrexate (MTX), and intrathecal MTX or cytarabine, HD cytarabine and cisplatin were provided as a 4-day continuous infusion. Regimen IB was intensified by adding etoposide and HD ifosfamide and escalating MTX doses. Since 1992, regardless of BM or CNS status, 30 patients have been placed on regimen II, which is identical to IB but without ifosfamide. The scheduled duration of regimen II was 45 days. RESULTS: EFS and disease-free survival at 5 years are 81% +/- 5% and 87% +/- 5%, respectively, for 59 assessable patients (73% +/- 8% and 85% +/- 7% for regimen IA + IB, 89% +/- 6%, EFS and disease-free survival, for regimen II; median follow-up, 6.7 years; range, 0.6 to 13.5 years). Six patients, two of whom were receiving regimen II, died as a result of initial treatment failure or relapse, and five patients, none receiving regimen II, died as a result of treatment-related complications. CONCLUSION: This 45-day intensive chemotherapy program is the shortest schedule for disseminated BL and overcomes previously recognized risk factors such as BM and CNS infiltration.
UI - 12065565
AU - Sarris AH; Phan A; Duvic M; Romaguera J; McLaughlin P; Mesina O; King K;
TI - Medeiros LJ; Rassidakis GZ; Samuels B; Cabanillas F Trimetrexate in relapsed T-cell lymphoma with skin involvement.
SO - J Clin Oncol 2002 Jun 15;20(12):2876-80
AD - Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. email@example.com
PURPOSE: Methotrexate (MTX) is active against lymphomas, but transport or polyglutamylation mutations confer MTX resistance. Because trimetrexate (TMTX) enters cells by passive diffusion and is not polyglutamylated, its activity in relapsed T-cell lymphoma was investigated. PATIENTS AND METHODS: Eligible patients had histologically confirmed relapsed T-cell lymphoma involving the skin, had received more than one previous regimen, were older than 16 years, had normal organ function, and had no CNS disease or serious infections, including human immunodeficiency virus. TMTX (200 mg/m(2)) was given intravenously every 14 days without topical or systemic corticosteroids. Patients who responded received up to 12 doses. RESULTS: Twenty patients were assessable for response. Median age was 59 years (range, 45 to 87 years); 13 patients were men. Three patients had anaplastic large-cell lymphoma, 15 had mycosis fungoides or Sezary syndrome (14 with large-cell transformation), and two had peripheral T-cell lymphoma. Serum lactate dehydrogenase was high in 35%, and beta-2 microglobulin was more than 3.0 mg/L in 35% of patients. The median number of previous regimens was three (range, two to 15) and included MTX in five patients. Disease was refractory to the regimen immediately preceding TMTX in 85% of patients. Responses were complete in one and partial in eight patients (overall response rate, 45%). Two of five patients previously treated with MTX responded. Grade 3 or 4 mucositis was observed after 4%, infection after 3%, neutropenic fever after 6%, neutrophils less than 100/microL after 4%, and platelets less than 10,000/microL after 3% of TMTX doses. CONCLUSION: TMTX is active with acceptable toxicity in this population and merits further investigation.
UI - 11896424
AU - Pavone V; Gaudio F; Guarini A; Perrone T; Zonno A; Curci P; Liso V
TI - Mobilization of peripheral blood stem cells with high-dose cyclophosphamide or the DHAP regimen plus G-CSF in non-Hodgkin's lymphoma.
SO - Bone Marrow Transplant 2002 Feb;29(4):285-90
AD - Haematology, University of Bari, Medical School, Policlinico Bari, Italy.
Our study analyzes the mobilization of hematopoietic stem cells after two chemotherapeutic regimens in non-Hodgkin's lymphoma (NHL) patients. The study included 72 patients with NHL (42 follicular and 30 large cells). The mean age was 37 years (range 17-60). Sixty-four patients (88.9%) had stage III-IV disease. Forty-eight patients (66.7%) had bone marrow involvement. Systemic B symptoms were present in 42 patients (58.3%). Mobilization chemotherapy regimens were randomly assigned as DHAP in 38 patients (52.7%) or cyclophosphamide (CPM) (5 g/m(2)) in 34 (47.2%) and the results of 132 procedures were analyzed. At the time of PBSC mobilization, 46 patients (63.9%) were considered to be responsive (complete remission, partial remission or sensitive relapse) and 26 (36.1%) not responsive (refractory relapse or refractory to therapy). Pre-apheresis CD34+ blood cell count and number of previous chemotherapy treatments were used to predict the total number of CD34+ cells in the apheresis product. The mobilizing regimens (CPM or DHAP) were similar in achieving the threshold CD34+ cell yield, for optimal engraftment. Since DHAP was very effective as salvage treatment, we suggest using DHAP as a mobilizing regimen in patients with active residual lymphoma at the time of stem cell collection.
UI - 11896427
AU - Rapoport AP; Meisenberg B; Sarkodee-Adoo C; Fassas A; Frankel SR;
TI - Mookerjee B; Takebe N; Fenton R; Heyman M; Badros A; Kennedy A; Jacobs M; Hudes R; Ruehle K; Smith R; Kight L; Chambers S; MacFadden M; Cottler-Fox M; Chen T; Phillips G; Tricot G Autotransplantation for advanced lymphoma and Hodgkin's disease followed by post-transplant rituxan/GM-CSF or radiotherapy and consolidation chemotherapy.
SO - Bone Marrow Transplant 2002 Feb;29(4):303-12
AD - Greenebaum Cancer Center and Stem Cell Transplantation Program, University of Maryland School of Medicine, Baltimore, MD, USA.
Disease relapse occurs in 50% or more of patients who are autografted for relapsed or refractory lymphoma (NHL) or Hodgkin's disease (HD). The administration of non-cross-resistant therapies during the post-transplant phase could possibly control residual disease and delay or prevent its progression. To test this approach, 55 patients with relapsed/refractory or high-risk NHL or relapsed/refractory HD were enrolled in the following protocol: stem cell mobilization: cyclophosphamide (4.5 g/m(2)) + etoposide (2.0 g/m(2)) followed by GM-CSF or G-CSF; high-dose therapy: gemcitabine (1.0 g/m(2)) on day -5, BCNU (300 mg/m(2)) + gemcitabine (1.0 g/m(2)) on day -2, melphalan (140 mg/m(2)) on day -1, blood stem cell infusion on day 0; post-transplant immunotherapy (B cell NHL): rituxan (375 mg/m(2)) weekly for 4 weeks + GM-CSF (250 microg thrice weekly) (weeks 4-8); post-transplant involved-field radiotherapy (HD): 30-40 Gy to pre-transplant areas of disease (weeks 4-8); post-transplant consolidation chemotherapy (all patients): dexamethasone (40 mg daily)/cyclophosphamide (300 mg/m(2)/day)/etoposide (30 mg/m(2)/day)/cisplatin (15 mg/m(2)/day) by continuous intravenous infusion for 4 days + gemcitabine (1.0 g/m(2), day 3) (months 3 + 9) alternating with dexamethasone/paclitaxel (135 mg/m(2))/cisplatin (75 mg/m(2)) (months 6 + 12). Of the 33 patients with B cell lymphoma, 14 had primary refractory disease (42%), 12 had relapsed disease (36%) and seven had high-risk disease in first CR (21%). For the entire group, the 2-year Kaplan-Meier event-free survival (EFS) and overall survival (OS) were 30% and 35%, respectively, while six of 33 patients (18%) died before day 100 from transplant-related complications. The rituxan/GM-CSF phase was well-tolerated by the 26 patients who were treated and led to radiographic responses in seven patients; an eighth patient with a blastic variant of mantle-cell lymphoma had clearance of marrow involvement after rituxan/GM-CSF. Of the 22 patients with relapsed/refractory HD (21 patients) or high-risk T cell lymphoblastic lymphoma (one patient), the 2-year Kaplan-Meier EFS and OS were 70% and 85%, respectively, while two of 22 patients (9%) died before day 100 from transplant-related complications. Eight patients received involved field radiation and seven had radiographic responses within the treatment fields. A total of 72 courses of post-transplant consolidation chemotherapy were administered to 26 of the 55 total patients. Transient grade 3-4 myelosuppression was common and one patient died from neutropenic sepsis, but no patients required an infusion of backup stem cells. After adjustment for known prognostic factors, the EFS for the cohort of HD patients was significantly better than the EFS for an historical cohort of HD patients autografted after BEAC (BCNU/etoposide/cytarabine/cyclophosphamide) without consolidation chemotherapy (P = 0.015). In conclusion, post-transplant consolidation therapy is feasible and well-tolerated for patients autografted for aggressive NHL and HD and may be associated with improved progression-free survival particularly for patients with HD.
UI - 12036859
AU - Wiseman GA; Gordon LI; Multani PS; Witzig TE; Spies S; Bartlett NL;
TI - Schilder RJ; Murray JL; Saleh M; Allen RS; Grillo-Lopez AJ; White CA Ibritumomab tiuxetan radioimmunotherapy for patients with relapsed or refractory non-Hodgkin lymphoma and mild thrombocytopenia: a phase II multicenter trial.
SO - Blood 2002 Jun 15;99(12):4336-42
AD - Division of Nuclear Medicine, Mayo Clinic, Rochester, MN 55905, USA. firstname.lastname@example.org
Mildly thrombocytopenic patients with relapsed or refractory low-grade non-Hodgkin lymphoma (NHL) have an increased risk of chemotherapy-induced myelosuppression following treatment. The safety and efficacy of radioimmunotherapy with a reduced dose of (90)Y ibritumomab tiuxetan (0.3 mCi/kg [11 MBq/kg]; maximum 32 mCi [1.2 GBq]) was evaluated in 30 patients with mild thrombocytopenia (100-149 x 10(9) platelets/L) who had advanced, relapsed or refractory, low-grade, follicular, or transformed B-cell NHL. The ibritumomab tiuxetan regimen included an infusion of rituximab (250 mg/m(2)) and injection of (111)In ibritumomab tiuxetan (5 mCi [185 MBq]) for dosimetry evaluation, followed 1 week later with rituximab (250 mg/m(2)) and (90)Y ibritumomab tiuxetan (0.3 mCi/kg [11 MBq/kg]). Patients (median age, 61 years; 90% stage III/IV at study entry; 83% follicular lymphoma; and 67% with bone marrow involvement) had a median of 2 prior therapy regimens (range, 1-9). Estimated radiation-absorbed doses were well below the study-defined maximum allowable for all 30 patients. With the use of the International Workshop criteria for NHL response assessment, the overall response rate was 83% (37% complete response, 6.7% complete response unconfirmed, and 40% partial response). Kaplan-Meier estimated median time to progression (TTP) was 9.4 months (range, 1.7-24.6). In responders, Kaplan-Meier estimated median TTP was 12.6 months (range, 4.9-24.6), with 35% of data censored. Toxicity was primarily hematologic, transient, and reversible. The incidence of grade 4 neutropenia, thrombocytopenia, and anemia was 33%, 13%, and 3%, respectively. Reduced-dose ibritumomab tiuxetan is safe and well tolerated and has significant clinical activity in this patient population.
UI - 12036865
AU - Hoelzer D; Gokbuget N; Digel W; Faak T; Kneba M; Reutzel R;
TI - Romejko-Jarosinska J; Zwolinski J; Walewski J Outcome of adult patients with T-lymphoblastic lymphoma treated according to protocols for acute lymphoblastic leukemia.
SO - Blood 2002 Jun 15;99(12):4379-85
AD - Medical Clinic III, Department of Hematology, University of Frankfurt, Germany. email@example.com
We treated 45 adult patients with T-lymphoblastic lymphoma (T-LBL) (age range 15-61 years) with 2 protocols designed for adult acute lymphoblastic leukemia (ALL). An encouraging cure rate of 90% was recently reported for T-LBL in children treated with a similar approach. In our study, an 8-drug standard induction was administered over 8 weeks including prophylactic cranial (24 Gy) and mediastinal irradiation (24 Gy) followed by consolidation and reinduction therapy. At diagnosis, 91% of the 45 patients showed a mediastinal tumor and 40% had pleural/pericardial effusions; 73% of the patients had stage III/IV disease. Overall, 42 patients (93%) achieved a complete remission (CR), 2 patients (4%) achieved a partial remission, and 1 patient (2%) died during induction. In patients with stage I-III disease (n = 18) the CR rate was 100% compared with 89% in stage IV (n = 27). There were 15 patients who relapsed (36%) within 12 months. The majority of relapses (47%) occurred in the mediastinum (n = 7) despite mediastinal irradiation with 24 Gy in 6 out of 7 patients. The estimates for overall survival, continuous CR, and disease-free survival at 7 years are 51%, 65%, and 62%, respectively. Stage, age, lactate dehydrogenase, and all other parameters had no influence on achievement of CR or outcome. This study demonstrates in a large cohort of patients with adult T-LBL that a high CR rate and a favorable outcome can be achieved with an ALL-type regimen. Mediastinal recurrence was the major obstacle and further improvement by intensification of chemotherapy, increased dose of mediastinal irradiation (36 Gy), and extended indications for stem cell transplantation seem to be required.
UI - 12042983
AU - Moskowitz C
TI - Risk-adapted therapy for relapsed and refractory lymphoma using ICE chemotherapy.
SO - Cancer Chemother Pharmacol 2002 May;49 Suppl 1():S9-12
AD - Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. firstname.lastname@example.org
At Memorial Sloan Kettering Cancer Center, New York, we have treated over 400 patients with ICE chemotherapy after failure of upfront anthracycline-based therapy with a response rate of 72% in aggressive non-Hodgkin's lymphoma (NHL) and 84% in Hodgkin's disease. Utilizing this database, we have identified pretreatment prognostic markers capable of predicting the quality of response (complete response vs partial response vs failure) to second-line cytoreductive ICE chemotherapy and consequently autologous stem cell transplantation. We have shown that in aggressive NHL, patients achieving a complete response have superior survival when compared to those achieving only a partial response. By identifying a priori those patients destined to have only a partial response to ICE, we will be able to target a group of chemosensitive patients who are most likely to benefit from improved treatment. Novel treatment strategies designed to increase their complete response rate would be anticipated to improve their long-term survival.
UI - 11940484
AU - Barrios Y; Cabrera R; Yanez R; Briz M; Plaza A; Fores R; Fernandez MN;
TI - Diaz-Espada F Anti-idiotypic vaccination in the treatment of low-grade B-cell lymphoma.
SO - Haematologica 2002 Apr;87(4):400-7
AD - Departments of Immunology, Clinica Puerta de Hierro, Madrid, Spain.
BACKGROUND AND OBJECTIVES: Patients with B-cell lymphoma can be induced to mount a specific immune response against the individual idiotypic determinants expressed in their tumor cells. This form of active immunotherapy is now under evaluation in the clinical setting. We evaluated the feasibility and effectiveness of this kind of immunotherapy in a group of patients with low-grade lymphoma, which included two cases of bi/triclonal lymphoma. DESIGN AND METHODS: Nine patients with a histopathologic diagnosis of follicular non-Hodgkin's (NHL) low-grade B-cell lymphoma were initially selected for this disease-free survival study. Idiotypic proteins were recovered by somatic fusion of the tumor cells and their identity with the tumor idiotype determined by molecular methods. The patients received the vaccine consisting of their tumor Ig protein coupled to keyhole limpet hemocyanine and were observed for toxicity, anti-idiotypic immune response, clinical outcome and circulating t(14;18)+ tumor cells. RESULTS: The median duration of follow-up was 40 (10-64) months from the initiation of immunotherapy. Tumor regression was detected in two patients. No tumor progression was observed in the other patients. Eight patients generated specific anti-idiotypic antibodies and 3 out of five were cleared of circulating t(14;18)+ cells. INTERPRETATION AND CONCLUSIONS: Induction of tumor-specific anti-idiotypic immune responses may be of benefit to patients affected by low-grade B-cell NHL. Our results are in line with those previously reported and call attention to the issue of tumor clonality in this kind of treatment.
UI - 11940500
AU - Bassan R; Reseghetti A; Cortelazzo S; Rossi A; Buelli M; Viero P; Barbui
TI - T Gigantic cutaneous lymphoma following Di Bella's therapy.
SO - Haematologica 2002 Apr;87(4):EIM13
AD - U.O. Ematologia, Ospedali Riuniti, largo Barozzi 1, 24100 Bergamo, Italy. email@example.com
UI - 11940507
AU - Magagnoli M; Balzarotti M; Castagna L; Bertuzzi A; Nozza A; Santoro A
TI - Combined systemic and intrathecal chemotherapy plus radiotherapy in testicular lymphoma: a report of two cases.
SO - Haematologica 2002 Apr;87(4):ELT22
AD - Departmenti of Medical Oncology and Hematology, Istituto Clinico Humanitas- Via Manzoni 56, 20089 Rozzano, Italy. firstname.lastname@example.org
UI - 11982647
AU - Bassiri-Tehrani S; BA BA; Cohen DE
TI - Treatment of cutaneous T-cell lymphoma with alitretinoin gel.
SO - Int J Dermatol 2002 Feb;41(2):104-6
AD - Department of Dermatology, New York University School of Medicine, New York 10016, USA.
UI - 12028061
AU - Imashuku S; Naya M; Tamura S; An B; Teramura T; Kobayashi M; Nomura K;
TI - Taniwaki M Effectiveness of rituximab for chemotherapy-resistant multiple tumoral B-LPD in a haemopoietic stem cell recipient.
SO - Br J Haematol 2002 Jun;117(3):771-3
UI - 12090049
AU - Okumoto T; Tomiyama K; Ino H; Kanaya Y; Maruyama S; Otani J; Yokoyama N;
TI - Soda M [A case of malignant lymphoma of the stomach in which preoperative chemotherapy provided a complete response]
SO - Gan To Kagaku Ryoho 2002 Jun;29(6):943-7
AD - Dept. of Surgery, Himeji St. Mary's Hospital.
We have encountered a case of malignant lymphoma of the stomach in which a complete remission was confirmed in a resected specimen after chemotherapy. A 75-year-old woman complained of vomiting blood. A biopsy from gastric endoscopy indicated malignant lymphoma of diffuse large B-cell type. The patient was assumed to be inoperable due to enlargement of the tumor and lymph node metastasis, and THP-COP chemotherapy was carried out. After four courses of the THP-COP regimen, endoscopic examination revealed a significant tumor reduction. Total gastrectomy and splenectomy with lymph node dissection (D2) were performed after chemotherapy. No tumor cells were detected in any sections of the specimen or regional lymph nodes.
UI - 12090052
AU - Sato T; Yanagihara M; Sato K; Nozawa T; Furukawa Y; Imanishi H; Kouzuma
TI - T [Effectiveness of prolonged oral administration of low-dose etoposide in a case of malignant lymphoma in the mesenterium]
SO - Gan To Kagaku Ryoho 2002 Jun;29(6):959-62
AD - Dept. of Surgery, Yokohama Seamens' Insurance Hospital.
Malignant lymphoma in the mesenterium is rare and carries a poor prognosis, although curative resection cases have been reported. A 39-year-old woman with non-resectable mesenteric malignant lymphoma obtained a better QOL and outcome from prolonged oral administration of low-dose etoposide as a maintenance therapy after CHOP therapy.
UI - 12089234
AU - Dourakis SP; Sevastianos VA; Alexopoulou A; Deutsch M; Stavrianeas N
TI - Treatment side effects. Case 2. Toxic, epidermal, necrolysis-like reaction associated with docetaxel chemotherapy.
SO - J Clin Oncol 2002 Jul 1;20(13):3030-2
AD - Hippokration General Hospital and Sigrou Hospital, Athens, Greece.
UI - 12057111
AU - DeAngelis LM
TI - Primary central nervous system lymphomas.
SO - Curr Treat Options Oncol 2001 Aug;2(4):309-18
AD - Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021-6700, USA. email@example.com
Primary central nervous system lymphoma (PCNSL) is widely regarded as one of the primary brain tumors most amenable to treatment. Although whole brain radiotherapy was the cornerstone of therapy for decades, recent work clearly indicates that chemotherapy has become the primary focus of treatment for this disease. The initial treatment of PCNSL for all patients, including the elderly, should be chemotherapy using a high-dose methotrexate-based regimen. Although cranial irradiation has often been combined with methotrexate, the unacceptably high incidence of late neurotoxicity, particularly in older patients, has caused many to eliminate radiotherapy, especially in those older than age 60 years. Emerging data support the validity of this approach, and the development of more efficacious chemotherapeutic regimens has been the focus of recent research.
UI - 11722986
AU - Press OW; Leonard JP; Coiffier B; Levy R; Timmerman J
TI - Immunotherapy of Non-Hodgkin's lymphomas.
SO - Hematology (Am Soc Hematol Educ Program) 2001;():221-40
AD - Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
Recent years have witnessed the development of a variety of promising immunotherapies for treating patients with non-Hodgkin's lymphomas. Foremost among these advances is the exciting success of monoclonal antibodies directed against lymphocyte surface antigens. Rituximab is a chimeric (human-mouse) anti-CD20 antibody that induces responses in approximately half of the patients with relapsed indolent lymphomas and a third of patients with relapsed aggressive lymphomas when used as a single agent. Response rates appear even higher (up to 70%) for newly diagnosed patients treated with Rituximab monotherapy. Other promising antibodies for treatment of B cell malignancies include epratuzumab (anti-CD22), CAMPATH-1H (anti-CD52w), and Hu1D10 (anti-class II HLA). Even more exciting than antibody monotherapy is the prospect of combination antibody therapy (e.g. rituximab + epratuzumab) or combination chemotherapy and antibody therapy. In this regard, a recent phase III randomized trial from the GELA group in France demonstrated statistically significantly superior complete and overall response rates and superior event-free and overall survivals for elderly patients with newly diagnosed diffuse aggressive B cell lymphomas treated with CHOP + rituximab compared with CHOP alone. Confirmatory cooperative group trials combining chemotherapy with antibody therapies are currently underway. Another approach to augment the efficacy of antibodies is to deploy them in radiolabeled form. Iodine-131, Yttrium-90, and Copper-67 labeled monoclonal antibodies targeting CD-20, CD-22, HLA class II, and other cell surface antigens have been tested and demonstrate higher overall response rates (50-80%) and complete response rates (20-40%) than unlabeled antibodies. Pilot studies combining radiolabeled antibodies with either standard dose chemotherapy or myeloablative chemoradiotherapy with stem cell transplantation also appear very promising. Lymphoma vaccines have also produced very encouraging results in single institution studies at Stanford and the National Cancer Institute, with responding patients demonstrating superior event-free and overall survival than historical controls. Phase III randomized trials of idiotype vaccines are currently underway and novel new vaccine approaches are also being tested.
UI - 11722987
AU - Cavalli F; Isaacson PG; Gascoyne RD; Zucca E
TI - MALT Lymphomas.
SO - Hematology (Am Soc Hematol Educ Program) 2001;():241-58
AD - Oncology Institute of Southern Switzerland, Department of Medical Oncology.
This review addresses the biology and the treatment of lymphomas arising from mucosa-associated lymphoid tissue (MALT). This entity, first described in 1983, represents about 8% of all non-Hodgkin's lymphomas and was recently re-classified as "extranodal marginal zone lymphomas of MALT-type." The term marginal zone lymphoma (MZL) encompasses the three closely related lymphoma subtypes of nodal, primary splenic and extranodal lymphomas of MALT type: the latter represent the vast majority of MZL. These lymphomas arise at different anatomic sites, are composed of mature B-cells lacking expression of CD5 and CD10, often present with overlapping morphologic features, but typically quite distinct clinical behaviors. Only very recently cytogenetic/molecular genetic observations have underlined the distinctiveness of these three lymphoid neoplasms, which in both the R.E.A.L. and WHO-classifications are included in the general term of MZL. MALT lymphomas arise in numerous extranodal sites, but gastric MALT lymphoma is the most common and best studied and is, therefore, the paradigm for the group as a whole. Dr. Isaacson describes the principal histological features of these lymphomas, including criteria to distinguish this entity from other small B-cell lymphomas. Several lines of evidence suggest that gastric lymphoma arises from MALT acquired as the result of aH. pyloriinfection. However, at least 1/3 of cases do not respond to eradication ofH. pylori. Very recent data suggest that both t(11;18) (q21;q21) and bcl10 nuclear expression are associated with failure to respond to this treatment. Dr. Gascoyne discusses the biologic function of proteins deregulated through the different translocations, which play a role in pathogenesis of MALT lymphomas, emphasizing particularly their influence in disrupting the apoptotic pathway. Dr. Zucca reviews findings suggesting that MALT lymphoma is an antigen driven neoplasm. He also presents specific guidelines for treatment of gastric lymphomas trying to shed some light on the amazingly inconsistent and confusing data in the literature. Taking advantage on the more than 300 non-gastric MALT lymphomas collected by the International Extranodal Lymphoma Study Group (ILESG), Dr. Cavalli compares gastric lymphomas with those arising in many other sites. Overall, the data presented in this session will underline the fact, that MALT lymphomas are characterized by some unique biological properties.
UI - 12082683
AU - Ott M; Schmidberger H; Wormann B; Albrecht CF; Pradier O; Hess CF
TI - Involved-field irradiation in combination with total-body irradiation (TBI) does not increase short-term toxicity compared to TBI alone in patients with advanced-stage low-grade non-Hodgkin lymphoma.
SO - Strahlenther Onkol 2002 May;178(5):245-51
AD - Department of Radiotherapy, University of Goettingen, Germany.
PURPOSE: High-dose therapy (HDT) is currently under investigation for patients with advanced low-grade non-Hodgkin lymphoma (NHL). We report on the toxicity of a modified HDT that combines total-body irradiation (TBI) with involved-field irradiation (IF-RT) for patients with bulky disease or residual lymphomas > 2 cm after induction chemotherapy. PATIENTS AND METHODS: 41 patients received HDT which consisted of high-dose cyclophosphamide and fractionated TBI (6 x 2 Gy) followed by autologous stem cell transplantation. Eleven patients received IF-RT prior to TBI, three patients had already received another radiotherapy treatment prior to HDT. RESULTS: After a medium follow-up of 19 months we observed an overall survival rate of 100%, and a relapse-free survival rate of 78%. Severe toxicity was observed only in one patient who developed a myelodysplastic syndrome, and another patient who showed signs of pneumonitis. About two thirds of the patients claimed minor toxicity of grade I-II according the LENT-SOMA scale, predominantly as a decrease in concentration, reduced sexual functioning, and musculo-skeletal pain. Correspondingly, laboratory tests showed grade I-II changes of blood counts, liver enzymes, hormone levels, and lung function. There was no excess toxicity in the patients who received IF-RT additional to TBI. CONCLUSIONS: HDT including TBI and prior IF-RT is feasible without excess morbidity. Careful follow-up is required to detect myelodysplastic syndrome or endocrine changes of ovarian or testicular function.
UI - 12077596
AU - Masood N; Russell KJ; Olerud JE; Sabath DE; Sale GE; Doney KC; Flowers
TI - ME; Fefer A; Thompson JA Induction of complete remission of advanced stage mycosis fungoides by allogeneic hematopoietic stem cell transplantation.
SO - J Am Acad Dermatol 2002 Jul;47(1):140-5
AD - Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA 98109-1023, USA.
Advanced mycosis fungoides (MF) is incurable with conventional treatments. High-dose chemoradiotherapy with autologous bone marrow transplantation has induced remissions in a small number of patients with MF, but this modality is limited by a high relapse rate. We report induction of complete remission in a 37-year-old woman with rapidly progressive stage IV MF with allogeneic stem cell transplantation (Allo SCT). She remains in continuous complete remission 2 years after transplant. Allo SCT for MF is theoretically attractive, because there is no contamination of the graft by malignant cells, and because of the possibility of graft-versus-tumor effect. Although the results in this patient are encouraging, more patients and longer follow-up are needed to define the usefulness of Allo SCT in the treatment of MF.
UI - 11998607
AU - Hendrix CS; de Leon C; Dillman RO
TI - Radioimmunotherapy for non-Hodgkin's lymphoma with yttrium 90 ibritumomab tiuxetan.
SO - Clin J Oncol Nurs 2002 May-Jun;6(3):144-8
AD - firstname.lastname@example.org
The increasing incidence of non-Hodgkin's lymphoma (NHL), coupled with the lack of optimal treatment options, has prompted the development of novel treatments. Of these, radioimmunotherapy is one of the most promising. Two of the radiolabeled monoclonal antibody therapies being studied in the treatment of NHL are yttrium 90 (90Y) ibritumomab tiuxetan and iodine 131 (131I) tositumomab. The radionuclides 90Y and 131I emit beta radiation; 131I also emits gamma radiation, thus requiring more elaborate precautionary measures to limit radiation exposure. The monoclonal antibody portions of the drugs target the CD20 surface antigen that is present on the majority of B-cell lymphomas, resulting in direct radiation to the targeted cells, as well as indirect targeting of adjacent cells (known as the crossfire effect). Clinical trials of 90Y ibritumomab tiuxetan in patients with NHL have produced promising results. The safe and effective use of radioimmunotherapy requires a multidisciplinary team approach in which nurses play a central role.
UI - 12065794
AU - McLaughlin P
TI - Progress and promise in the treatment of indolent lymphomas.
SO - Oncologist 2002;7(3):217-25
AD - University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. email@example.com
In the era of conventional alkylating agent-based chemotherapy, advanced stage indolent lymphoma has been considered incurable. The failure of our traditional therapies to cure these patients, coupled with the indolent course of the disease and the elderly population affected, has fostered a nihilistic attitude about the treatment of these diseases. Twenty years ago, in the absence of interesting alternatives to alkylating agents, judicious use and reuse of alkylators was perhaps the best we could do. There are now many reasons for optimism and excitement in the treatment of these diseases, including the availability of promising agents such as interferon-alpha, the nucleoside analogues, and rituximab. Radioimmunotherapy will also likely play a role in future therapy programs. Allogeneic stem cell transplantation is a high-risk approach that is not an option for all patients, but it has the potential to cure patients, even in the setting of relapse. Mini-allogeneic transplantation may permit an approach to allogeneic transplantation that is better tolerated than standard transplant strategies. In addition to these therapy options, biological insights have provided new options for monitoring patients. Molecular monitoring (polymerase chain reaction for bcl-2) is a stringent measure of short-term treatment efficacy, and one that correlates with durability of remission, i.e., it is a surrogate marker by which to judge treatment efficacy. There used to be a limited number of conventional treatment approaches, which consistently failed. The pendulum has swung. There are now many promising new options. It is time to plan and conduct trials that are geared for success.
UI - 12082652
AU - Voliotis D; Diehl V
TI - Challenges in treating hematologic malignancies.
SO - Semin Oncol 2002 Jun;29(3 Suppl 8):30-9
AD - Clinic I for Internal Medicine, University of Cologne, Cologne, Germany.
During the past 40 years substantial progress has been made in the treatment of hematologic malignancies, particularly in some subgroups of patients. Today, cure is attainable for patients with Hodgkin's disease and a considerable proportion of patients with high-grade non-Hodgkin's lymphoma. Prognosis is improving in patients with acute promyelocytic leukemia and, to some extent, those with acute lymphoblastic and myeloid leukemias. However, the majority of patients who suffer from a hematologic malignancy live with incurable disease. In CLL, outside the setting of a clinical trial, it is advisable to postpone treatment until the manifestation of clinical symptoms. It is yet to be determined whether treatment strategies based on new prognostic parameters such as cytogenetics can change the course of disease. In indolent lymphomas, cure is not attainable for the vast majority of patients; the median survival of 9 to 10 years has remained unchanged for several decades. Nevertheless, there has been a dramatic change in therapeutic paradigms in the past few years. For the first time, with the use of new cytostatic drugs and recombinant monoclonal antibodies, it is possible to achieve molecular remissions. Whether this will translate into cure or prolonged survival is still to be determined. In Hodgkin's disease, which is curable when treated with radiotherapy, chemotherapy, or combined therapy, depending on the stage of disease, the focus of future studies must be on prevention of early relapse and on primary resistant disease, both of which present a very poor prognosis. Finally, regardless of underlying malignancy and prognosis, the preservation of quality of life is of major consideration in the setting of hematologic malignancies. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 12057060
AU - Siegel RS; Kuzel TM
TI - Cutaneous T-cell lymphoma/leukemia.
SO - Curr Treat Options Oncol 2000 Apr;1(1):43-50
AD - Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical School, 676 N. St. Clair, Suite 850, Chicago, IL 60611, USA.
Effective treatment for cutaneous T-cell lymphomas (CTCL) requires an accurate and specific diagnosis based on the clinical presentation combined with evaluation of the histopathology, immunophenotyping, and gene rearrangement studies. Careful clinical and pathologic evaluation in centers familiar with the diverse forms of CTCL is most valuable for determining treatment options. The goals of treatment in mycosis fungoides (MF), which afflicts more than 50% of patients with CTCL, are the relief of symptoms and improvement in cosmetics. Despite some uncontrolled clinical trial results that have been reported to suggest "cures" in this disease, the general perception remains that this disease is not curable with standard therapies available today. Treatment is divided into topical (skin-directed) and systemic therapy. The most active systemic agent for the treatment of MF remains interferon-alpha, although many new modalities have recently been approved for the treatment of CTCL.
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 - 11837584
AU - Komatsu T; Kikuchi Y; Nisijima H; Takanaka T; Terayama N; Matsui O
TI - Experience of two orbital MALT lymphomas treated with radiotherapy, and review of the literature.
SO - Radiat Med 2001 Nov-Dec;19(6):317-20
AD - Department of Radiology, Kanazawa University School of Medicine, Japan.
Orbital MALT lymphoma is a relatively rare malignant disease, for which radiation therapy is effective. However, the optimal dose has not been determined. We experienced two cases of orbital MALT lymphoma. One patient was successfully treated, but the other developed a severe complication. We conclude that for safe treatment of orbital MALT lymphoma, a dose in excess of 40 Gy must not be delivered.
UI - 12111762
AU - Rohatgi N; LaRocca RV; Bard V; Sethuraman G; Foon KA
TI - Phase II trial of sequential therapy with fludarabine followed by cyclophosphamide, mitoxantrone, vincristine, and prednisone for low-grade follicular lymphomas.
SO - Am J Hematol 2002 Jul;70(3):181-5
AD - The Barrett Cancer Center and the Division of Hematology/Oncology, Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Advanced follicular lymphomas, grades I and II, are indolent tumors but are not considered curable with standard therapy. Fludarabine has the highest single-agent response rates in this disease. However, fludarabine-based combination chemotherapy regimens have been associated with significant myelotoxicity. Data exist suggesting that the best way to combine partially non-cross-resistant agents may be to use them sequentially. Patients with bulky stage II, stage III, or stage IV follicular lymphoma (grade I or II) were entered on this protocol. Patients were treated with 3 cycles of fludarabine followed by 6-8 cycles of cyclophosphamide, mitoxantrone, vincristine, and prednisone (CNOP). Response was assessed after the 3(rd) cycle of fludarabine and after the 4(th), 6(th), and 8(th) cycles of CNOP. Twenty-seven patients were entered on the protocol. Median follow-up was 50 months. Eighteen patients (67%) attained a complete response (CR), and eight patients (30%) attained a partial response (PR), for an overall response rate of 97%. Median relapse-free survival was 34 months, and median overall survival was not reached for the entire cohort. While all patients who achieved only PR progressed, more than half of those in CR remain free of progression at 39-84 months of follow-up. The regimen was well tolerated. The sequential combination of fludarabine and CNOP appears to be active and well tolerated in patients with grade I and II follicular lymphoma. Patients who achieve CR fare best, and many remain disease-free long term. While these results are encouraging, the addition of other active agents such as rituximab to this regimen may further enhance efficacy and is under investigation. Copyright 2002 Wiley-Liss, Inc.
UI - 12111776
AU - Nakabe N; Kobayashi Y; Nakajima T; Hattori T; Kuroda J; Kimura S;
TI - Yoshikawa T Successful treatment of non-Hodgkin's lymphoma complicated with autoimmune neutropenia.
SO - Am J Hematol 2002 Jul;70(3):264-5
UI - 12102166
AU - Baiocchi OC; Colleoni GW; Navajas EV; Duarte LC; Alves AC; Andrade AL;
TI - Kerbauy J; Oliveira JS Impact of highly active antiretroviral therapy in the treatment of HIV-infected patients with systemic non-Hodgkin's lymphoma.
SO - Acta Oncol 2002;41(2):192-6
AD - Hematology and Transfusion Service, Universidade Federal de Sao Paulo, Brazil.
Twenty cases of systemic non-Hodgkin's lymphoma (NHL) in HIV-infected patients were reviewed over a 10-year-period, divided into Group A, including 13 NHL cases treated before the highly active antiretroviral therapy (HAART) era, and Group B, including 7 patients who received HAART. A Kaplan-Meier survival curve was performed and log-rank was applied to assess statistical differences between the groups. In group A, the median CD4 count was 36 cells/mm3. No complete remission was found. In group B, the median CD4 count was 137 cells/mm3. Four patients (57.0%) are still alive and in complete remission. Group A had a median survival of 5 months and group B 31 months (p = 0.0032). Our results are in agreement with recent reports in that a higher CD4 count and better immune status achieved with HAART is predictive of a better outcome. We found that HAART in combination with chemotherapy improves overall survival of NHL patients without increasing adverse effects.
UI - 12060818
AU - Chrischilles E; Delgado DJ; Stolshek BS; Lawless G; Fridman M; Carter WB
TI - Impact of age and colony-stimulating factor use on hospital length of stay for febrile neutropenia in CHOP-treated non-Hodgkin's lymphoma.
SO - Cancer Control 2002 May-Jun;9(3):203-11
AD - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City 52242, USA. firstname.lastname@example.org
BACKGROUND: In intermediate-grade non-Hodgkin's lymphoma (NHL) patients, full-dose CHOP improves survival but increases myelosuppression, causing febrile neutropenia hospitalization (FNH) in 28% of patients