New Cases Of non-Hodgkin Lymphoma Research Articles

Increasing incidence of non-Hodgkin lymphoma in England, 1985–2019

Abstract Background In the UK, non-Hodgkin lymphoma (NHL) is the most common hematological malignancy and 6th most common cancer overall - accounting for about 14,200 new cases and 4,900 deaths each year. After rising rapidly from the 1980s onwards, the incidence rates of NHL have broadly stabilised in several European and North American countries since the late 1990s. We conducted a retrospective population-based cohort study to examine whether similar changes in the incidence of NHL have also occurred in England from 1985-2019. Methods Individual-level data for patients diagnosed with NHL, and the corresponding national population (denominator) data were obtained from ONS/PHE. Average annual incidence rates (AAIR) were calculated by sex, three age categories (0-34, 35-64 and 65+ years) and seven five-year time periods (1985-89 to 2015-19). Results During the 35-year study period, a total of 304,994 new cases of NHL were registered in England (54% males, 46% females). In young people aged 0-34 years, the AAIRs increased by 33% in males and 60% in females (from 1.8/100,000 in 1985-89 to 2.4/100,000 in 2015-19 in males, and from 1.0/100,000 in 1985-89 to 1.6/100,000 in 2015-19 in females). In middle age (35-64 years), the AAIRs increased by 54% in males and 57% in females (from 13.3 to 20.5 in males, and from 9.6 to 15.1 in females). At older ages (65+ years), the AAIRs increased by 108% in males and 102% in females (from 47.6 to 99.1 in males, and from 34.1 to 68.7 in females). In both sexes and all age categories, the disease was most frequently diagnosed at the advanced Stage 4. With regards to the socioeconomic status, the disease was relatively more commonly diagnosed in the most deprived groups. Conclusions In contrast with many European and North American countries, there has been a steady and substantial increase in the incidence of NHL in England over the past four decades. Overall, the highest increase was observed in males (115%) and those aged 65+ years (109%). Key messages • The reasons behind this continued increase in incidence in England, which is in contrast with most European/North American populations, remain elusive and need further etiological investigation. • Considering that the large majority of cases were diagnosed at the advanced Stage 4, there is an urgent need for clinical guidance to facilitate early diagnosis of NHL.

Global patterns of non-Hodgkin lymphoma in 2020.

We evaluated the global patterns of non-Hodgkin lymphoma (NHL) in 2020 using the estimates of NHL incidence and mortality in 185 countries that are part of the GLOBOCAN 2020 database, developed by the International Agency for Research on Cancer (IARC). As well as new cases and deaths of NHL, corresponding age-standardized (world) rates (ASR) of incidence and mortality per 100 000 person-years were derived by country and world region. In 2020, an estimated 544 000 new cases of NHL were diagnosed worldwide, and approximately 260 000 people died from the disease. Eastern Asia accounted for a quarter (24.9%) of all cases, followed by Northern America (15.1%) and South-Central Asia (9.7%). Incidence rates were higher in men than in women, with similar geographical patterns. While the incidence rates were highest in Australia and New Zealand, Northern America, Northern Europe and Western Europe (>10/100 000 for both sexes combined), the highest mortality rates (>3/100 000) were found in regions in Africa, Western Asia and Oceania. The large variations and the disproportionately higher mortality in low- and middle-income countries can be related to the underlying prevalence and distribution of risk factors, and to the level of access to diagnostic and treatment facilities.

A Phase 1 Study of NKX019, a CD19 Chimeric Antigen Receptor Natural Killer (CAR NK) Cell Therapy, in Subjects with B-Cell Malignancies

A Phase 1 Study of NKX019, a CD19 Chimeric Antigen Receptor Natural Killer (CAR NK) Cell Therapy, in Subjects with B-Cell Malignancies

Circulating nucleosomes in hematological malignancy.

e20078 Background: There are over 700,000 new cases of non-Hodgkin lymphoma (NHL), acute myeloid leukaemia (AML) and acute lymphocytic leukaemia (ALL) diagnosed globally each year and approximately 415,000 deaths. The non-specific symptoms of lymphoma and leukemia often delay diagnosis. We investigated the circulating levels of intact nucleosomes containing the histone H3.1 isoform (Nu.Q-H3.1) in a variety of solid tumors, NHL, AML, ALL, and in healthy subjects. Methods: We measured levels of Nu.Q-H3.1 in plasma samples taken from 62 healthy volunteers (mean age = 45 yrs) and 329 patients diagnosed with cancer (mean age = 56 yrs), including 25 patients diagnosed with each of cancer of the bladder, bone, brain, oesophagus, cervix, skin, head & neck or melanoma, 21 patients diagnosed with uterine cancer as well as with NHL (n = 25), AML (n = 25) and ALL (n = 8). The cohort included samples taken from patients at diagnosis and at relapse. Whole blood samples were collected in EDTA plasma tubes, double-centrifuged at 1500 rcf for 15 minutes within 2 hrs of blood draw, after which plasma was transferred to a cryotube and frozen immediately until analysis. Plasma samples (20µl) were analyzed in duplicate for Nu.Q-H3.1 using an ELISA method developed and validated to CLSI guidelines. Results: We observed elevated levels of Nu.Q-H3.1 in the patients diagnosed with various cancers. Only 14 of 271 patients with a solid tumor had levels > 200ng/ml. In contrast the median Nu.Q-H3.1 levels observed for NHL, AML and ALL were 276, 284 and 585ng/ml respectively. The median nucleosome level in 62 healthy subjects was 40ng/ml; the highest level was 198ng/ml. The AUC for all patients diagnosed with NHL, AML or ALL (n = 54) vs healthy volunteers was 91% with a sensitivity of 74% at 95% specificity. The AUC for the subset of patients newly diagnosed with NHL, AML or ALL (n = 31) vs healthy volunteers was 92% with a sensitivity of 81% at 95% specificity. Conclusions: Elevated nucleosome levels have been reported for a number of diseases. Our early results indicate that levels of Nu.Q-H3.1 are particularly elevated in haematological malignancies and may be a useful diagnostic tool warranting further study.

LYMPHOMA: EXPLORING AWARENESS IN LEBANON

In 2012, 14.1 million patients were diagnosed with cancer worldwide of which 385,700 estimated new cases of non-Hodgkin lymphoma (NHL). Also, 81,080 new cases of lymphoma were reported in the United States (US) among both genders in 2016. In Lebanon, Lymphoma represents the fifth most frequent cancer, nonetheless, little is known regarding its epidemiological attributes. This study aims to determine the current knowledge of the Lebanese people living in Lebanon about Lymphoma. About 400 participants were approached in public places, universities, hospitals or work places in different regions across Lebanon. A survey including questions about lymph nodes, cancer and lymphoma as well as demographic characteristics was given to all eligible participants. The data was collected and analyzed using SPSS and p value < 0.05 was considered significant. When asked about the types of cancers they knew, the majority of participants (93.5%) were able to identify breast cancer, while less than half of (30.67%) identified lymphoma as a cancer. Enlargement of the lymph nodes (LN) was the most common recognized symptom (93.4%) whereas 76.42% thought that family history of lymphoma was the most frequent risk factor for lymphoma. Among those who claim to know about lymphoma (30%), true in-depth knowledge about lymphoma was still lacking. The results of this independently conducted survey reveal the lack of awareness about lymphomas among the Lebanese population and highlight the need for campaigns to increase the knowledge and awareness.

Advances in relapsed/refractory follicular lymphoma therapeutics

Of 75 000 new cases of Non-Hodgkin lymphoma (NHL) expected in 2018 in USA, World Health Organization (WHO) data suggest that follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) will be the two most common types. On average, each year, 15 000 new cases of FL are diagnosed in the United States alone. Despite dramatic improvements worldwide in the treatment of FL, such as the emergence of anti-CD20 agents, FL cannot be cured yet. There is no widely agreed standard of care for the first line therapy of FL. Current options include “watch and wait” strategies, rituximab monotherapy, multi-drug therapy of rituximab and bendamustine or CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), CVP (cyclophosphamide, vincristine, prednisones), or combinations with the new anti-CD 20 monoclonal antibody obinutuzumab. Even with average of 80% response rate to initial therapy 20% of patients relapse within 2 years and there is no clear consensus on further management. However, a diverse set of new drugs with different mechanisms of action are available in a relapse setting. These drugs have extended overall survival (OS) up to 12 years. An indolent course of FL is manifested by varying periods of remissions and relapses that can potentially progress to transformation into either other hematologic malignancy (eg, DLBCL) or become chemo-refractory. Considering the chronic nature of FL, physicians should strive for both efficacy of treatment and possible extended-length remissions, and for good patient quality of life and limited toxicity.

Population-based incidence of lymphomas in the French Nord-Pas-de-Calais region between 2001 and 2005: Annual estimations and spatial analysis.

Non-Hodgkin's lymphomas (NHL) are the seventh most commonly diagnosed cancer in France. Nord-Pas-de-Calais is ranked as the region with the highest incidence of cancers and deaths by cancer in France. With its rich industrial past and its contrasted population densities between urban and rural territories, Nord-Pas-de-Calais represents a geographic area of interest to study the overall incidence of NHL and examine spatial variation of NHL incidence between the 170 cantons of the region. LYMPHONOR was a population-based multicentre retrospective study of patients residing in the Nord-Pas-de-Calais region and diagnosed with NHL between January 2001 and December 2005. Spatial distribution of NHL incidence in Nord-Pas-de-Calais was explored using two complementary approaches: adjusted smoothed standardised incidence ratio (SIR) and spatial scan statistics (detection of atypical clusters). Between 2001 and 2005, 2132 new cases of NHL were diagnosed in the Nord-Pas-de-Calais region. In 2005, age-standardised NHL incidence rates were 10.2 and 7.0 cases per 100,000 person-years in male and female residents, respectively. No significant spatial disparities in NHL incidence were found within the Nord-Pas-de-Calais region. The age-adjusted smoothed SIR varied from 0.82 to 1.25 between cantons. Consistently, spatial scan statistics did not detect any significant atypical cluster of high NHL incidence. Comparison with national data collected during the same period does not show an overincidence of NHL in the Nord-Pas-de-Calais region. In addition, no evidence for spatial heterogeneity and clustering of NHL incidence was found within this region. Future epidemiological research using large-scale registries is needed to better appraise spatial variation of NHL incidence in France and to investigate possible reasons for significant clusters.

Radioimmunotherapy as the first line of treatment in non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy. The estimated deaths and new cases of NHL in the USA in 2018 have reached 19,910 and 74,680, respectively, with 5-year survival rate of 71%. Therapeutic interventions for NHL consist of chemotherapy, radiation therapy and immunotherapy. Radioimmunotherapy (RIT) is a potential alternative treatment for NHL that is currently used in different lines of treatment. Studies show that nuclear medicine physicians and radiation oncologists are not yet certain about the proper line for administration of RIT. Herein, we have reviewed the efficiency and toxicity of RIT as the first line of treatment, and discussed potential novel indications, and strategies such as modifying induction therapy and using rituximab maintenance to optimize the efficiency of RIT as the first line of treatment. Our review indicates that it is more logical to postpone conventional therapies to the second or third lines of treatment instead of RIT.

Minimal change nephrotic syndrome associated with non-Hodgkin lymphoid disorders: a retrospective study of 18 cases.

Few studies have examined the occurrence of minimal change nephrotic syndrome (MCNS) in patients with non-Hodgkin lymphoma (NHL). We report here a series of 18 patients with MCNS occurring among 13,992 new cases of NHL. We analyzed the clinical and pathologic characteristics of this association, along with the response of patients to treatment, to determine if this association relies on a particular disorder. The most frequent NHLs associated with MCNS were Waldenström macroglobulinemia (33.3%), marginal zone B-cell lymphoma (27.8%), and chronic lymphocytic leukemia (22.2%). Other lymphoproliferative disorders included multiple myeloma, mantle cell lymphoma, and peripheral T-cell lymphoma. In 4 patients MCNS occurred before NHL (mean delay, 15 mo), in 10 patients the disorders occurred simultaneously, and in 4 patients MCNS was diagnosed after NHL (mean delay, 25 mo). Circulating monoclonal immunoglobulins were present in 11 patients. A nontumoral interstitial infiltrate was present in renal biopsy specimens from 3 patients without significant renal impairment. Acute kidney injury resulting from tubular lesions or renal hypoperfusion was present in 6 patients. MCNS relapse occurred more frequently in patients treated exclusively by steroid therapy (77.8%) than in those receiving steroids associated with chemotherapy (25%). In conclusion, MCNS occurs preferentially in NHL originating from B cells and requires an aggressive therapeutic approach to reduce the risk of MCNS relapse.

Primary Diffuse Large B Cell Lymphoma of the Rectum Mimicking an Arteriovascular Malformation: A Case Report and Review

Introduction: Lymphomas are malignant neoplasms of the lymphocyte cell lines. They mainly involve lymph nodes, spleen, and other non-hemopoietic tissues, and are classified as either Hodgkin's or non-Hodgkin's lymphomas (NHL) of B-lymphocyte or T-lymphocyte origin. According to estimates, in 2008, 66,120 new cases of NHL occurred in the United States. Gastrointestinal NHL account for 4-20% of all NHL. Approximately 0.2-0.6% of malignant lymphomas arise in the colorectal tract. Primary rectal NHL is rare, accounting for 0.2% of all rectal malignancies. We present a patient with a history of multiple admissions with presumed rectal arteriovascular malformations (AVMs) who was ultimately diagnosed with primary diffuse large B cell lymphoma of the rectum (DLBCL). Case: An 84-year-old Chinese male with past medical history of Hepatitis B and BPH presented to the ER with recurrent episodes of hematochezia. He denied abdominal pain, nausea, or vomiting. Previous colonoscopy for evaluation of the same symptoms had revealed only internal hemorrhoids and AVMs. He subsequently underwent a repeat colonoscopy which revealed a 3-cm ulcerated lesion immediately above the anal verge with persistent, active bleeding from the distal margin of the mass. APC thermal therapy was applied with adequate hemostasis. Biopsy and immunochemistry report was positive for CD5, CD20, PAX-5, BCL-2, BCL-6, consistent with DLBCL of the rectum. He subsequently underwent combined R-CHOP and radiation therapy with good results. Discussion: A thorough search of Pubmed and MEDLINE revealed fewer than 75 reported cases of primary B cell lymphoma of the rectum. The lack of specific complaints makes the diagnosis difficult to establish. Typically, the mean age at diagnosis is 55 years. Men are affected twice as often as women. The most common symptoms in more than half of patients are abdominal pain, weight loss, or changes in bowel habits. Lower gastrointestinal bleeding can be found in 13-20% of patients. The CHOP chemotherapeutic regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) remains the first line therapy, with surgery or radiation in some cases. Recent studies suggest that the addition of rituximab may lead to improved overall survival as well as disease progression. Conclusion: We present the case of an 84-year-old male with a history of multiple admissions for lower GI bleeding secondary to presumed AVMs, with a subsequent diagnosis of DLBCL. This rare malignancy can grow rapidly and should be included in the differential for recurrent lower gastrointestinal bleeding.

Anti-CD22 Antibody Targeting of pH-responsive Micelles Enhances Small Interfering RNA Delivery and Gene Silencing in Lymphoma Cells

The application of small interfering RNA (siRNA) for cancer treatment is a promising strategy currently being explored in early phase clinical trials. However, efficient systemic delivery limits clinical implementation. We developed and tested a novel delivery system comprised of (i) an internalizing streptavidin-conjugated monoclonal antibody (mAb-SA) directed against CD22 and (ii) a biotinylated diblock copolymer containing both a positively charged siRNA condensing block and a pH-responsive block to facilitate endosome release. The modular design of the carrier facilitates the exchange of different targeting moieties and siRNAs to permit its usage in a variety of tumor types. The polymer was synthesized using the reversible addition fragmentation chain transfer (RAFT) technique and formed micelles capable of binding siRNA and mAb-SA. A hemolysis assay confirmed the predicted membrane destabilizing activity of the polymer under acidic conditions typical of the endosomal compartment. Enhanced siRNA uptake was demonstrated in DoHH2 lymphoma and transduced HeLa-R cells expressing CD22 but not in CD22 negative HeLa-R cells. Gene knockdown was significantly improved with CD22-targeted vs. nontargeted polymeric micelles. Treatment of DoHH2 cells with CD22-targeted polymeric micelles containing 15nmol/l siRNA produced 70% reduction of gene expression. This CD22-targeted polymer carrier may be useful for siRNA delivery to lymphoma cells.

Reassessing the Standard of Care in Indolent Lymphoma: A Clinical Update to Improve Clinical Practice

Non-Hodgkin's lymphoma (NHL) represents a diverse group of hematologic malignancies originating in B or T lymphocytes. Approximately 85% of NHLs are of B-cell origin, with the remainder mostly of T-cell origin. The most common NHL types are diffuse large B-cell lymphoma (31%) and follicular lymphoma (22%). More than 65,000 new cases of NHL develop each year, and approximately 20,000 people with NHL died of the disease 2009. NHL is the seventh most common cancer in the United States, contributes to approximately 4% to 5% of all cancer cases in the United States, and causes approximately 3% of all cancer-related deaths. Currently, nearly 500,000 people are living with the disease or are in remission. Several new and encouraging advances have been made in the treatment of indolent NHL. Although the watch and wait approach still has a role, combined immunochemotherapy remains the standard of care for both first-line and relapsed/refractory disease. As front-line treatment, bendamustine plus rituximab may become a new standard of care, especially for older patients. In contrast, rituximab in combination with chemotherapy followed by rituximab maintenance seems to be the optimal option in patients with relapsed disease.

131I-Tositumomab (Bexxar®) vs. 90Y-Ibritumomab (Zevalin®) Therapy of Low-Grade Refractory/Relapsed Non-Hodgkin Lymphoma

The American Cancer Society estimated 66,120 new cases of non-Hodgkin lymphoma (NHL) in the USA in 2008. Radioimmunotherapy has been shown in clinical trials to be an effective treatment for refractory/relapsed NHL. The available agents are Bexxar, a (131)I radiolabeled murine monoclonal antibody, and Zevalin, a (90)Y radiolabeled murine antibody. Both target CD20 receptors present on the surface of lymphocytes. We present our clinical experience with Bexxar and Zevalin in the management of low-grade refractory or relapsed NHL. This is a retrospective study (Jan 2000-Jul 2006) of 67 patients with NHL, who were treated with Bexxar (31 patients, group A) or Zevalin (36 patients, group B) for refractory/relapsed disease. Group A included 16 men and 15 women, 35-81 years old (average, 59.3 +/- 13.4). Group B included 27 men and nine women, 36-85 years old (average, 55.4 +/- 13.8). Therapeutic doses ranged 40-138 mCi (average, 78.1 +/- 28.2) for Bexxar and 17-34 mCi (average, 28.8 +/- 4.37) for Zevalin. Objective responses were induced in 22 of the 31 patients (70.9%) in group A and 28 of the 36 patients (77.8%) in group B. Complete response was noted in 11 patients (35.5%), partial response in seven patients (22.6%), and mixed response in four patients (12.9%) in group A. There were five patients (16.1%) with stable disease and four patients (12.9%) with disease progression in the same group. Complete response was noted in 15 patients (41.7%), partial response in nine patients (25%), and mixed response in four patients (11.1%) in group B. There were four patients (11.1%) with stable disease and another four patients (11.1%) with disease progression in the same group. The average decreases at posttherapy nadir were 36.9% +/- 0.33 (group A) and 52.6% +/- 0.32 (group B) for platelets, 27.8% +/- 0.27 (group A) and 34.2% +/- 0.38 (group B) for leukocytes, and 4.9% +/- 0.15 (group A) and 7.6% +/- 0.11 (group B) for hemoglobin. Grades 3 and 4 hematological toxicity occurred in 14 patients (45.2%) treated with Bexxar and 22 patients (61.1%) treated with Zevalin, but was reversible. Our study suggests that clinical practice of Bexxar and Zevalin radioimmunotherapy is an effective and safe adjunctive treatment for patients with NHL refractory/relapsed to conventional treatment. However, due to the small number of subjects, it was not possible to determine whether differences in the outcomes or toxicities from the two agents were statistically significant.

Non-Hodgkin Lymphoma: Diagnosis and Treatment

Non-Hodgkin lymphomas are a heterogeneous group of malignancies of the lymphoid system. Based on the World Health Organization classification of hematological and lymphoid tumors, these diseases have been classified as B-cell and T-cell neoplasms. B-cell lymphomas account for approximately 90% of all lymphomas, and the 2 most common histological disease entities are follicular lymphoma and diffuse large B-cell lymphoma. Approximately 55,000 to 60,000 new cases of non-Hodgkin lymphoma are diagnosed annually in the United States, a number that has nearly doubled during the past 3 decades. The Ann Arbor Staging Classification is used routinely to classify the extent of disease, and the International Prognostic Index has been used to define prognostic subgroups. Also, recent data have identified molecular and genetic markers of prognosis that may be used in the future to further refine treatment decisions. Treatment of these diseases is based on the histology and extent of disease. Patients with follicular lymphomas with early-stage disease generally are treated with radiation therapy, whereas those with stage III and IV disease requiring treatment usually are treated with chemotherapy, Immunotherapy, or radioimmunotherapy. These patients generally experience long survival, but only a minority are cured. For patients with diffuse large B-cell lymphoma, treatment of limited-stage disease generally includes doxorubicin-based chemotherapy combined with rituximab followed by involved field radiation therapy. Those with extensive disease are treated with rituximab combined with chemotherapy alone. Disease relapse is a problem, and high-dose therapy with stem cell support is the treatment of choice for chemosensitive relapsed aggressive lymphomas. Patients with chemoresistant disease or whose disease relapses subsequently should be treated with novel experimental therapies.

Descriptive epidemiology of non-Hodgkin lymphomas in a southwestern French hematology center: absence of significant relationship with hepatitis C virus infection.

From January 1995 to June 1998, 136 new cases of non-Hodgkin lymphomas (NHLs) were seen in our center which serves all the French Basque Country (300000 inhabitants). The crude and standardized incidence rates were respectively 13.2 and 7.6 cases/100000/year. The distribution of histologic subtypes according to the REAL classification showed a good correlation with the previous published data. Eleven patients (8%) were HIV-positive and two (1.4%) were HCV carriers. Hence, in our region, contrary to Italy, there is no evidence of relationship between HCV and NHLs.

Evaluation and management of the “New” lymphoma entities: Mantle cell lymphoma, lymphoma of mucosa-associated lymphoid tissue, anaplastic large-cell lymphoma, and primary mediastinal B-cell lymphoma

Non-Hodgkin's lymphomas (NHL) represent a major health problem worldwide, and incidence has been on the rise continuously for the last few decades. It is estimated that approximately 55,000 new cases of NHL will be diagnosed in the United States in 1998 and that slightly fewer than 25,000 patients will die of treatment failure or recurrent disease. The rising incidence of NHL is related not only to the acquired immunodeficiency syndrome epidemic but to also a steady increase in the number of cases diagnosed in older patients without immunosuppression. The new pathologic classification of NHL (revised European-American lymphoma classification, REAL) developed by the International Lymphoma Study Group (ILSG) is already resulting in more accurate disease-specific epidemiologic and clinical investigations. These studies have brought a new awareness of the existence and the relative prevalence of discrete NHL subtypes that appear to predominate among patients in different populations according to age, sex, geographic distribution, and predisposing conditions. This developing database has also the potential to result in the discovery of specific environmental causes, predisposing genetic factors, and therapeutic approaches. Some of the entities defined in the REAL classification, such as follicular lymphomas, diffuse B large-cell lymphomas, and T-cell lymphoblastic lymphomas, were already well described in the older classification systems (Kiel and Working Formulation). Others, such as mantle cell lymphoma, (MCL) anaplastic large-cell lymphoma (ALCL), lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), and primary mediastinal B-cell lymphoma (PMBCL) are relatively new members of the family, and accurate data on their clinicopathologic features and natural histories have only recently begun to emerge. This review presents in detail the most recent data on the clinical presentation of, diagnostic evaluation of, and treatment options for the most common of the new NHL entities: MCL, MALT lymphoma, CD30 + (Ki-1 +) ALCL, and PMBCL. These four entities combined represent approximately 20% of all cases of NHL and exemplify well the broad clinicopathologic spectrum of NHL and the diagnostic and therapeutic challenges facing those who care for patients affected by these conditions.

Diffuse lung uptake of Ga-67 citrate in treated lymphoma: another milestone on the road to understanding.

There are approximately 51,000 new cases of non-Hodgkin lymphoma and 7,800 new cases of Hodgkin disease reported yearly. Combined, these diseases account for 23,000 deaths. As medical oncology advances, the probability of curing cancer will increase because of improvements in diagnostic and therapeutic interventions. Anatomic diagnostic studies such as computed tomography (CT) and magnetic resonance (MR) imaging are generally used to identify and stage lymphoma; however, when the involved nodes are of normal size, CT and MR imaging are incapable of helping to distinguish between normal nodes and those involved with either Hodgkin or non-Hodgkin lymphoma. The problem of differentiating active lymphoma from scar or necrosis in residual masses after radiation therapy and/or chemotherapy, especially in the thorax, has been well documented in the medical literature. Whether gallium imaging is useful in this situation has been the subject of controversy over the years, and there have been many important detours and milestones on the road to our understanding of the role that gallium-67 scintigraphy should play. 22 refs.

Clinicopathological Features, Survival And Prognostic Factors Of Primary Central Nervous System Lymphomas: Trends in Incidence of Primary Central Nervous System Lymphomas and Primary Malignant Brain Tumors in A Well-Defined Geographical Area; Population-Based Data from the Danish Lymphoma Registry, Lyfo, And the Danish Cancer Reistry

It has been claimed that Primary Central Nervous System Lymphomas (PCNSL), a rare neoplasm accounting for only a small fraction of malignant brain tumors and extranodal non-Hodgkin lymphomas (NHL), occur with increasing frequency in immunologically normal as well as in immunocompromised individuals. In an attempt to characterize the clinicopathological features, outcome and prognostic factors of PCNSL we here report our experience in a large unselected series of patients from a well-defined region. In addition, we present data on trends in incidence of PCNSL and primary malignant brain tumors in a well-defined geographical area. In a Danish population-based NHL registry (LYFO) representing a population of 2.7 million all new cases of NHL were registered during the approximate 11-year period from 1st January 1983 to 31st May 1994. Incidence data of primary malignant tumors of the brain and central nervous system in western Denmark for the period 1971-1990 have been obtained from the Danish Cancer Registry. During the approximate 11-year period 3124 new cases of NHL were registered. Of these, 1152 (37%) were extranodal and 48 were non-AIDS related PCNSL accounting for 4.2% of extranodal NHL and 1.5% of all NHL, respectively. The average annual incidence rate of non-AIDS related PCNSL during the period was 1.56 cases per million population (age range: 15-85 yrs, median: 62 yrs, M/F ratio: 1). In a 23-year period there was no trend towards an increasing incidence of non-AIDS related PCNSL in a well-defined population. PCNSL accounted for 1.7% of all primary malignant brain tumors. Incidence of primary malignant brain tumors was stable, except for age ranges over 70 years. However, diagnostic artifacts might be responsible for this apparent increase. Histologically, 85% were high grade. Using the Kiel classification centroblastic diffuse (60%) and immunoblastic lymphoma (13%) were the most common subtypes. Forty-three patients had B-cell lymphoma and no T-cell lymphoma was detected. Forty-seven cases were diagnosed pre mortem. Treatment included surgical resection (26 patients), whole brain irradiation (WBRT) (43 patients) and chemotherapy (28 patients). Median survival for those receiving either WBRT or WBRT and chemotherapy was 8 months and 20 months, respectively (p = 0.78). Overall survival was 53%, 38% and 26% at 1, 2 and 5 years. Cox-regression analysis identified only one factor having independent impact on survival in PCNSL: performances score > or = 2 (p < 0.001, RR = 5.8).

Incidence, clinicopathological features and outcome of primary central nervous system lymphomas: Population-based data from a Danish lymphoma registry

Primary Central Nervous System lymphomas (PCNSL), a rare neoplasm accounting for only a small fraction of malignant brain tumors and extranodal non-Hodgkin's lymphomas (NHL), seems to occur with increasing frequency in immunologically-normal as well as immunocompromised individuals. In an attempt to characterize the clinicopathological features, incidence rate and outcome of PCNSL, we here report our experience in a large unselected group of patients from a well-defined region.In a Danish population-based NHL registry (LYFO) representing a population of 2.7 million, all new cases of NHL were registered during the 10-year period from 1st January 1983 to 31st December 1992. The number of malignant brain tumors reported to the Danish Cancer Registry from the region covered by LYFO, during the 7-year period from 1st January 1983 to 31st December 1989, is compared to the number of PCNSL.During the 10-year period 2687 new cases of NHL were registered. Of these, 1004 (37%) were extranodal and 42 were non-AIDS-related PCNSL, accounting for 4.2% of extranodal NHL and 1.6% of all NHL, respectively. The incidence rate for PCNSL during the ten-year period (age range: 21-85 yrs, median: 62 yrs, M/F ratio: 0.9) was 15.6 cases per million population. Eighteen and 24 cases were diagnosed during the first and the second 5-year period, respectively (p > 0.05). During the 7-year period 1866 primary malignant brain tumors were registered in the region covered by the LYFO study group. In the same period 30 cases of PCNSL were detected. Thus, PCNSL accounted for 1.6% of all primary malignant brain tumors diagnosed in Western Denmark. Histologically, 83% were high-grade. Using the Kiel classification centroblastic diffuse (62%) and immunoblastic lymphoma (12%) were the most common subtypes. Thirty-seven patients had B-cell lymphoma; no T-cell lymphomas were detected. Forty-one cases were diagnosed pre mortem. Treatment included surgical resection (23 patients), whole brain irradiation (WBRT) (37 patients) and chemotherapy (22 patients). Median survival for those receiving either WBRT or WBRT and chemotherapy was 7.5 months and 12 months, respectively (p > 0.05). Survival was 43.9%, 31.7% and 7.3% at 1, 2 and 5 years.

Epidemiology of non-Hodgkin's lymphoma: Recent findings regarding an emerging epidemic

Between 1973 and 1989, the incidence of non-Hodgkin's lymphoma (NHL) increased by nearly 60% in the United States, one of the largest increases of any cancer. In 1993, approximately 43,000 new cases of NHL will be diagnosed and over 20,000 deaths due to NHL will occur. The annual incidence rate of NHL per 100,000 persons in the US has risen from 5.9 in 1950 to 13.7 in 1989. This increase has occurred in both males and females, blacks and whites, and in all age groups except the very young. The largest increase has occurred in the elderly, and rates have increased more rapidly in rural areas. Most of the increase cannot be attributed to acquired immunodeficiency syndrome. Similar findings have been reported from other developed countries. Epidemiologic studies indicate that environmental factors may play an important role in the etiology of NHL. In this paper, current knowledge concerning the epidemiology of NHL is summarized, with special emphasis on environmental factors of possible etiologic importance, such as drugs, pesticides, solvents and other chemicals, dusts and particles, hair dyes, smoking, Helicobacter pylori infection, and diet. Many different environmental factors of low risk acting on large segments of the population could account for much of the increase in NHL.