Malignant non-Hodgkin Lymphoma Research Articles

Salvage therapy with PROMACE in relapsed non-Hodgkin malignant lymphoma

Salvage therapy with PROMACE in relapsed non-Hodgkin malignant lymphoma

Épidémiologie des hémopathies malignes en Basse-Normandie

Background The study was designed to present the incidence of all the haematological malignancies in Basse-Normandie over the period 1997–2004. We extracted the data from the “Registre régional des hémopathies malignes de Basse-Normandie (RRHMBN)”, a French registry which belongs to the Association of the French Cancer Registries (FRANCIM). All the malignant haematological diseases were coded using the third edition of the International Classification for Oncologic Diseases (ICD-O-3) and the ADICAP classification, a special version adapted in 2001 for haematology. Five thousand five hundred and ten new cases of malignant haematological disorders were registered over the period 1997–2004. Whatever the department constituting the Basse-Normandie (Calvados, Manche and Orne), no significant difference of incidence was detected. In men, the more frequent malignant disorders were non-Hodgkin's malignant lymphomas (NHML) followed by chronic lymphocytic leukemia and other mature neoplasms, myelodysplastic syndromes (MDS), multiple myeloma (MM), myeloproliferative disorders (MPD), acute myeloid leukemias (AML), Hodgkin's lymphomas (HL), Waldenström's macroglobulinemia (WM) and acute lymphoblastic leukemia (ALL). In women, MM is the third more frequent haematological disorders after NHML and lymphocytic leukaemia and other mature neoplasms, MPD, MDS, AML, Hodgkin's lymphomas, WM and ALL. The other haematological disorders are very rare. We provide the incidence for the main haematological disorders and for the first time we also present the incidence of the different subtypes of the Hodgkin's and non-Hodgkin's malignant lymphomas, mature lymphoid neoplasms, MPD and also MDS. These results are useful for the organization and follow-up of medical care. The development of specialized haematology and active protocols can optimize the management of the older patients. A high quality of the collected data remains necessary for a continuous watching and research on patients with malignant haematological diseases.

Review: Primary CNS lymphoma

Primary CNS Lymphoma (PCNSL) accounts for 3% of all primary brain tumors with a median age at onset of about 62 years. In the vast majority of cases, PCNSL presents as unifocal or multifocal enhancing lesions on MRI, frequently adjacent to the ventricles. Stereotactic biopsy is the diagnostic procedure of choice revealing high-grade malignant non-Hodgkin's B-cell lymphoma in more than 90% of cases. Therapy is not evidence based. When eligible, patients should be included in clinical trials. In patients younger than 60 years cure is the aim. Polychemotherapy based on high-dose methotrexate (MTX) or alternatively high-dose chemotherapy with autologous stem cell rescue should be offered to patients eligible for this regimens. For patients over 60 years of age no curative regimen with acceptable toxicity has yet been established. An MTX-based chemotherapy, for example, in combination with temozolomide, is recommended. The role of radiotherapy as part of the initial treatment is not established; however, the combination of radiotherapy with MTX-based chemotherapy potentially leads to severe long-term neurotoxic sequelae. Therefore, radiotherapy as part of the initial therapy is not recommended by the author outside clinical trials. At relapse or in cases of refractory disease, patients will frequently benefit of salvage therapy, which depends on the initial treatment.

Lymphomes non hodgkiniens primitifs du testicule : pronostic à long terme associé au traitement combinant chimiothérapie systémique et intrathécale

To evaluate the long-term prognosis of a retrospective series of primitive malignant non-Hodgkin's lymphoma (MNHL) of the testicle treated by orchidectomy and combined systemic and intrathecal chemotherapy. From 1992 to 2006, eight consecutive patients were treated for a primitive MNHL of the testicle (stages : IA [n=1], IEA [n=5], IIEA [n=1], IVEA [n=1]) and retrospectively analyzed. All of these tumors were highly malignant. The average age of the patients at the time of diagnosis was 64 years old (46-78). All the patients benefited from an enlarged orchidectomy and received a combination of systemic and intrathecal CHOP and VACP chemotherapy. Six patients finished with some locoregional radiotherapy and three had cerebral radiotherapy. Patients were treated over an average period of 90.5 months (12 to 168 months). Five patients (62.5%) responded successfully, one patient had a cerebral relapse stabilized by a second course of chemotherapy. Three patients died, one from septic shock during chemotherapy (IVEA stage), another from mesenteric infarction (IAE stage) and the third from acute coronary thrombosis while in complete remission. In spite of a reputedly bleak prognosis, primitive MNHL of the testicle treated with a combination of systemic and intrathecal chemotherapy would seem to be associated with a good specific long-term survival. Unfortunately, the rate of mortality linked to chemotherapy is significant (close to 12.5% in our series) and would not appear to entirely protect against cerebral recurrence.

Primary central nervous system lymphoma: A profile of 26 cases from western India

Primary central nervous system (CNS) lymphoma (PCNSL) is a rare malignant non-Hodgkin's lymphoma and it accounts for 1% of all intracranial tumors. Only a few PCNSL studies have been reported from India, and studies on prognostic factors determining outcome, or evaluation of the response to currently accepted treatment, are lacking. This study attempts to further delineate the clinical, radiological and pathological profile of PCNSL in India, to evaluate response to treatment and to assess usefulness of the International Extranodal Lymphoma Study Group (IELSG) score. All patients with pathologically proven PCNSL admitted over three years at a large tertiary care institution were studied. Clinical features, IELSG prognostic score, imaging and pathological features, and response to treatment were evaluated. Results were analyzed using chi 2 test. Of 26 patients found, all except two were immunocompetent. Median age at diagnosis was 59 years. Focal deficits (76.9%) and neuropsychiatric symptoms (57.6%) were the commonest presenting complaints. Except for one case, at least some contrast enhancement was seen in brain lesions of all patients. Pathological studies showed high grade diffuse large B-cell (DLBCL) histology in 96.2% of patients. Of 22 patients who received methotrexate (MTX) based chemotherapy with/without radiotherapy; six died, with a response rate of 72.7%. Median survival was 10 months. Median follow-up duration was 14.5 months. Four patients developed treatment-related cognitive decline. All six patients with IELSG score of 4/5 died, while all 16 patients with a score of 0-3 survived. PCNSL presents most commonly in the sixth decade with focal neurological deficit, behavioral symptoms and cognitive decline. High grade DLBCL is the commonest histological subtype. Steroids should ideally be withheld until biopsy as they may confound the diagnosis. Most immunocompetent patients respond well to high dose MTX-based chemotherapy with/without radiation. High IELSG scores correlate with worse prognosis in patients with PCNSL.

Un cas rare de lymphome B diffus primitif de la prostate et revue de la littérature

Primary malignant non-hodgkin lymphoma involving the prostate is rare. Most of the time, it is associated with extraprostatic disease. We report a case of a 72-year-old patient presenting with acute lower urinary tract irritative symptoms, due to large B-cell lymphoma limited to the prostate. Combination of chemotherapy with extern beam radiotherapy provided long-term local control.

A case of malignant primary non-Hodgkin's lymphoma in skeletal muscle treated by exclusive chemotherapy

Malignant non-Hodgkin's lymphoma (MNHL) is a frequent tumour but a primary intra-muscular location is exceptional. Standard treatment combines wide surgical removal with chemotherapy and radiotherapy. The functional consequences of this large excision are sometimes very unsatisfactory. We report the case of an intra-muscular MNHL of the posterior and internal part of the thigh. The diagnostic was established thanks to selective biopsies. The treatment was purely medical and conservative with chemotherapy after a multidisciplinary oncological discussion. Three years after the treatment, the general state of health is excellent with no signs of local or remote recurrence.

Immunotherapy of recurrent B-cell malignancies after allo-SCT with Bi20 (FBTA05), a trifunctional anti-CD3 × anti-CD20 antibody and donor lymphocyte infusion

Donor lymphocyte infusions (DLIs) after allo-SCT displayed limited use in CLL and highly malignant non-Hodgkin's lymphoma (NHL). Here we studied whether Bi20 (FBTA05), a novel trifunctional bispecific antibody targeting CD20 on lymphoma cells and CD3 on T cells, could induce GVL responses in combination with DLI or mobilized PBSCT after allogeneic transplantation in these diseases. Six patients (three cases with p53-mutated CLL and three with high-grade NHL (HG-NHL)) refractory to standard therapy were treated with escalating doses of Bi20 (range 10-2000 microg) followed by DLI or SCT. Thereby, all CLL patients showed a prompt but transient clinical and hematological response. In one patient with HG-NHL, we observed a halt in progression for almost 4 months. Side effects (fever, chills and bone pain) were tolerable and appeared at antibody dose levels between 40 and 200 microg. The cytokine profile was characterized by transient increases of IL-6, IL-8 and IL-10. Neither human anti-mouse antibodies nor GVHD developed, allowing repeated treatment courses. In summary, the trifunctional antibody Bi20 induced prompt antitumor responses in extensively pretreated, p53-mutated alemtuzumab and rituximab refractory patients indicating its therapeutic potential.

Occupation/industry and risk of non-Hodgkin’s lymphoma in the United States

Aims: To identify occupations and industries associated with non-Hodgkin’s lymphoma (NHL) in a large population-based, case-control study in the USA. Methods: Cases (n = 1189) of histologically confirmed malignant NHL...

Malignant lymphoma of the tonsil in a patient with Behçet's disease

Several connective tissue diseases such as rheumatoid arthritis and polymyositis are associated with cancer. In contrast, cancer is rarely reported in patients with Behçet disease. We report a case of lymphoma during the course of Behçet disease. Etiopathogenic factors are discussed. A 46-year-old man with a 14-year history of Behçet disease was diagnosed with non-Hodgkin malignant lymphoma of the right tonsil. He met international criteria for Behçet disease, which manifested as refractory oral ulcers requiring dapsone treatment. He achieved a complete remission of the lymphoma after three chemotherapy courses and local radiation therapy (45 Gy). At last follow-up 4 years later, he was still in complete remission.

Malignant non-Hodgkin's lymphoma (NHL) of the jaws: A review of 16 cases

Non-Hodgkin's lymphoma (NHL) is rarely found in the jaw. We present 16 cases and the purpose of this study was to analyze the clinical signs and symptoms. The treatment and the progression evolution are also mentioned. The diagnosis was usually difficult and was often misleading and so delays before the first bone biopsy were frequent. The therapy of this rare, diffuse, large cell lymphoma was very variable from one case to another but the majority of the patients were treated with a combination of chemotherapy and radiotherapy.

Flutter atrial révélateur de l’extension cardiaque d’un lymphome malin non hodgkinien

Primary or secondary cardiac lymphomas are not frequent. Their clinical expression is unusual and the diagnosis is rarely made during the patient's life. Our case report, which is a slow atrial flutter with a pericardial effusion, is an uncommon discovery mode for a malignant lymphoma. Their diagnosis and the mechanism of the arythmia were allowed by non-invasive cardiac imagery (transesophageal echography and magnetic resonance imaging), which showed a tumour-like infiltration of the right atrium, of the right ventricle posterior wall, and of the atrioventricular junction. The diagnosis of a high grade B cell malignant non-hodgkin lymphoma, involving the bone marrow, the liver and the kidneys was made by biopsies of lymph nodes, histological analysis of the bone marrow, and a body CT scan. Throughout the first chemotherapy sequence, we observed a spontaneous return to a sinusal rhythm, and the cardiac MRI showed a regression of the myocardial infiltration and of the pericardial effusion; moreover, the patient's state improved and the peripheral lymph nodes shrank back to a normal size. However, the patient passed away, due to neurological complications 13 months after the diagnosis of lymphoma, without recurrence of cardiac involvement.

Oral Candidiasis in Solid Organ Transplant Recipients

s of the 15th International Symposium on Infections in the Immunocompromised Host S17 Conclusions: The results demonstrate that, despite the generally naive CB lymphocytes, influenza HA-specific responses can be generated ex vivo and could be potentially be used to enhance immune reconstitution following allogeneic stem cell transplantation. 37 Harvest and Preparation Techniques of the Blood Stem Cells Dorel Vlad1, Carmen Calugaroiu1, Virginia Mirea1, Ramona Pasare1, Tatiana Puscariu2, Alexandra Dumitrescu2, Jeni Laura Vlad3, Simona Dima4, Irinel Popescu4. 1Transfusions and Medullar Graft Centre, 2Analysis Laboratory Central; 3Microbiology Department; 4General Surgery and Liver Transplantation Centre, Fundeni Clinical Institute Bucharest, Romania Background: The purpose of the study was to obtain a quality graft, which contained the minimum of 2.5x106/kg body stem cells CD34 viable and functional. Objectives: The principle was to base the separation of blood cells using the difference between density gradients. We compared the harvests on patients with: Hodgkin disease, multiple myloma, neuroblastoma, Ewing sarcoma, malignant non-Hodgkins lymphoma, and acute leukemia. Material and Methods: The study was undertaken between 2000 till November 2007 on 116 patients (97 patients and 19 donators) in the Medullar Graft and Transfusions Centre, collaborating with another department from Fundeni Clinical Institute. The total numbers of procedures was 188 (159 patients and 29 donators). The harvest of peripheral blood stem cells were made by: medullar aspiring puncture, citaferesys procedure, and/or umbilical vein puncture, after expelling the afterbirth from uterus. We used devices such as: Haemonetics MCS Plus and Cobe Spectra, and for harvests made for liver and pancreatic transplantation the Clinimacs Plus device system. Results: In the case of harvests for patients with hematological problems, we obtained 42 grafts CD34 5x106/KgC. For patients with diabetes, we obtained 2 grafts CD34 >5x106/KgC. For patients with liver problems we obtained 4 grafts CD34 500/mL on three consecutive measurements. Time to platelet engraftment (PLT_20) was defined as the number of days from stem cell infusion to date of maintaining platelet count (PLT) >20,000/mL for 3 consecutive measurements without any platelet transfusion for at least 7 days from the date of last PLT transfusion. Statistical analysis was done using Fisher' s exact test and the Wilcoxon rank sum test. Results: Thirty-five cases were compared to 35 controls. Demographics and transplant characteristics were similar between cases and controls. The median duration of treatment was 13 days for linezolid (range 5-28) and 18 days for vancomycin (6-43). The cumulative percentage of patients achieving ANC_500 and PLT_20 at each time point examined was similar for the two treatments groups. The p-values from the competing risk analysis were not significant (P=NS). The competing regression model confirmed this conclusion after adjustment for factors know to affect engraftment. WBC, ANC and PLT counts at 30 days after discontinuing treatment were similar between the two groups. Conclusions: Early linezolid administration did not have a negative impact on time to neutrophil or platelet engraftment post HSCT. Compared to controls cases had similar values of WBD, ANC and PLT 30 days after discontinuing treatment. A larger study is needed to validate our findings and assess the hematologic safety profile of linezolid in the period of greatest marrow vulnerability. 39 High Incidence of Human Herpesvirus 6 Reactivation in Adult Recipients of Double Cord Blood Transplants Vicky Kyriazi1, Eirini Grispou2, Aikaterini Manaka1, ConstantineGeorge Balotis1, Zoe Poulopoulou1, Eirini Bika1, Ioannis Baltadakis1, Dimitri Karakasis1, Mary Anagnostopoulou2, Ioannis Apostolidis1, Nicholas Harhalakis1, Olga Paniara2, Emmanuel NIikiforakis1. 1BMT Unit Evaggelismos Hospital, Athens Greece; 2Microbiology Laboratory, Evaggelismos Hospital, Athens Greece Introduction: Human herpesvirus 6 (HHV-6) reactivation may have significant consequences in cord blood transplant recipients (CBR). This study evaluates the incidence of HHV-6 reactivation, its manifestations and treatment in CBR at our center.

Coexistence of malakoplakia and multifocal diffuse large B cell lymphoma of colorectum

We report a case of concurrent multifocal diffuse large B cell lymphoma and malakoplakia of colorectum in a 36-year-old man presenting with recurrent bloody diarrhoea. Malakoplakia has been described in association with a variety of malignant and nonmalignant conditions. To the best of our knowledge, this is the third report of coexistence or association of malignant non-Hodgkin lymphoma and malakoplakia in the literature, and the first report ever in the colorectum.

Malignant non-Hodgkin lymphoma of the stomach (author's transl)

Between 1970 and 1978 467 malignant non-Hodgkin lymphomas were newly registered by the St. Gallen-Appenzell cancer registry. Among these 23 (4.9%) were primary gastric lymphomas. Among the necropsy material between 1970 and 1978 23 patients (15.6%) were observed with secondary gastric involvement among 147 generalised malignant non-Hodgkin lymphomas. Among the 23 patients whose malignant lymphomas were investigated by use of gastric resection specimens 10 were in clinical stage IE at the time of operation, the other 13 were in stage IIE. Macroscopically there was an uncharacteristic picture of these tumours which were frequently localised in the antrum and ulcerated in most cases. Histologically 19 cases had diffusely growing malignancy. Four tumours showed nodular or follicular structures. Histiocytic and immunoblastic (n = 14 and 13, respectively) forms were the most frequently occurring malignant lymphomas. The diagnosis of malignant lymphoma in biopsy material could only be verified in 4 out of 12 patients investigated preoperatively by gastroscopy. Histological typing of the lymphomas was not possible in most cases. When there is a suspicion of malignant lymphoma macroparticle biopsies should be performed.

Lungenfunktion nach Bestrahlung bei pädiatrisch-onkologischen Patienten

Lung function tests were performed in 22 children and juveniles who had received radiotherapy to the lungs, an average of 9.5 years previously, for tumour (14 with Hodgkin's disease [aged 7-22 years], 4 with malignant non-Hodgkin lymphoma [aged 6-14 years], 3 with Wilms tumour [4-6 years], and one with Ewing's sarcoma [aged 16 years]). All three patients who, as young children, had had radiotherapy to both lungs because of a Wilms tumour with multiple lung metastases had restrictive disorders of lung function. Four of 12 after treatment of Hodgkin's disease and one of two after malignant non-Hodgkin lymphoma and extensive thoracic irradiation developed a restrictive disorder of pulmonary function. But all four patients who had irradiation restricted to the mediastinum had normal lung functions.

Differential diagnosis of atypical plasma cells in the cerebrospinal fluid

2102 samples of lumbar cerebrospinal fluid (CSF) were examined by qualitative cytology for atypical plasma cells. Samples from seven patients contained such cells. Retrospective investigation of these patients revealed that four of them had had neuroborreliosis, one had multiple sclerosis, one herpes zoster and one malignant non-Hodgkin lymphoma. It is concluded that in a case of unexplained meningoradiculitis with lymphoplasmocytic reaction in the CSF, morphological analysis of the plasma cells can provide important diagnostic pointers.

Sinusitis in HIV infection

Case notes of 722 HIV-infected patients who had died between March 1986 and August 1993 were analysed to evaluate the prevention and characteristic features of sinusitis associated with HIV infection. In 73 patients (10%) sinusitis had been diagnosed at least once on the basis of radiological or clear-cut clinical criteria. In addition, 15 patients with sinusitis were identified among those attending an HIV out-patient clinic. There were altogether 126 episodes of sinusitis in 88 patients (62 men, 26 women; mean age 33 [19-69] years). In 62 patients the CD4 lymphocyte count was under 100/microliters. The most commonly affected site was the maxillary sinuses. Patients with mirror formation had a significantly longer duration of illness than those without (P = 0.021). In 58 patients the symptoms of fever, headache and rhinitis were predominantly caused by the sinusitis, in 49 only partially so, and in 19 sinusitis was a chance diagnosis. In 10 of 49 attacks of sinusitis the concurrent disease (e.g. cerebral toxoplasmosis, malignant non-Hodgkin lymphoma) had not been recognized by the referring doctor. There were 1-5 recurrences over an observation period of 11.8 (0-72) months in 23 patients.-These findings show that sinusitis frequently occurs in HIV-infected patients, takes a protracted course and is difficult to distinguish from concomitant diseases by its clinical presentation. If symptoms persist, possible concurrent respiratory infection or CNS involvement must be looked for. Sinus needle aspiration is of decisive importance to ascertain the causative organism.

Maligne lymphomatöse Polypose des Gastrointestinaltrakts

Two years after endoscopic excision of several polyps of the colon (histological examination revealing infiltration by a malignant non-Hodgkin lymphoma) a 67-year-old man was again found to have blood and mucus in his stool. Because local recurrence was suspected a coloscopy was performed. This revealed multiple polyps throughout the entire colon, predominantly in the sigmoid and rectum. Biopsy showed focal infiltration of the submucosa and mucosa with centrocytic non-Hodgkin lymphoma, compatible with the diagnosis of malignant lymphomatous polyposis of the gastrointestinal tract. Gastroduodenoscopy then demonstrated duodenal polyps and massive coarsening of the gastric folds due to infiltration. For the first time tumour masses were also found in the epipharynx. After 6 chemotherapy cycles according to the CHOP scheme (day 1: cyclophosphamide, 1500 mg, adriblastin, 100 mg and vincristine, 2 mg; days 1-5: prednisolone, 100 mg) all lymphoma infiltrates regressed completely. The patient has been symptom-free for 9 months.

The fine-needle aspiration cytology of lymph nodes suspected of malignancy. Its diagnostic value and capacity to predict the histogenesis

To examine the usefulness of fine needle aspiration cytology in the investigation of patients with enlarged lymph nodes, the authors made a retrospective evaluation of the results of 1158 aspirations in 838 patients (630 male, 208 female, mean age 44 [4-90] years). In these 1158 cases the diagnosis was verified histologically, serologically or by follow up extending over at least six months. In 94.6% (n = 1096) the aspirate gave an unequivocal diagnosis, in 4.2% (n = 48) the diagnosis was equivocal and in 1.2% (n = 14) no diagnosis was reached. There were 773 correct malignant results, 368 correct benign results and 16 false benign; in one case the assessment was false malignant. Sensitivity was 98% and specificity 99.7%. In benign lymphadenopathies the investigation achieved a specificity of 99.7%, and in metastases and malignant lymphomas the sensitivity was 97.8% and 98.2% respectively. In 211 out of 286 aspirations the cytological diagnosis correctly predicted the subsequent histological diagnosis; in 58 cases correct though imprecise expressions such as "highly malignant non-Hodgkin's lymphoma" were employed. No serious complications were encountered. Fine needle aspiration cytology enables the clinician to devise an exact diagnostic and therapeutic plan in nearly every patient with unexplained lymph node enlargement.