ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Reduced-intensity allogeneic transplants are promising, increasingly used treatments for hematologic malignancies, exploiting graft-versus-tumor effects for eradicating malignancies. This article reviews approximately 40 published reports of reduced-intensity allogeneic transplants in lymphomas. Overall, reduced-intensity allogeneic transplants have been well tolerated and have produced encouraging results despite a diversity of transplant approaches used largely in heavily pretreated and older patients. Of 368 lymphoma patients who underwent reduced-intensity allogeneic transplants, 66.3% had responses, most of which were complete. Many had chemotherapy-refractory lymphomas, including some that relapsed after autologous transplants. Although the short follow-up periods of many studies do not permit assessments of response duration, protracted remissions were reported in some studies. Additionally, some patients entered molecular remissions, suggesting that graft-versus-tumor effects could, by themselves, cure some lymphomas. Graft-versus-host disease is the major risk of reduced-intensity allogeneic transplants, and treatment methods need refinement to reduce transplant risks while preserving graft-versus-tumor effects. Controlled trials involving patients with earlier-stage disease appear warranted to define better the role of reduced-intensity allogeneic transplants in treating lymphomas.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Targeted therapy using monoclonal antibodies against a tumor-specific antigen is now an established mode of therapy in the management of malignant lymphomas. Radioimmunotherapy, a novel way of delivering systemic radiotherapy concurrently with immunotherapy, has finally appeared on the horizon, with promising results. Recent clinical trials have demonstrated the safety and efficacy of radioimmunoconjugates. Durable antitumor responses have been achieved, even in heavily pretreated patients. The optimal position that these novel agents should take in the algorithm of lymphoma therapy remains to be defined.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We review our current understanding of the molecular determinants and mechanisms of lymphocyte apoptosis and identify the key regulators of these death-signaling pathways. In addition, we describe the key molecular aberrations that underlie the resistance of lymphomas to conventional therapy, and highlight the enormous promise of potential therapeutic strategies that could circumvent or overcome these genetic impediments to apoptosis.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Survival rates for cancer of the uterine cervix have improved over the last 40 years largely because of the impact of screening measures such as the Pap smear. The ability to screen and treat women for preinvasive disease, cervical dysplasia, is the key factor leading to the reduction in the incidence of invasive cervical cancer. More recently, the ability to test women for the causative agent, the human papilloma virus, has emerged as a potential screening tool. New research has focused on new technologies for Pap smear screening such as thin layer technology, the appropriate intervals for screening, and the appropriate methods of incorporation of human papilloma virus testing into the screening protocols. Reviews of published studies evaluating the efficacy of new technologies suggest that there is still insufficient information to confirm improved outcome; however, results to date suggest that thin layer Pap smear technology may improve sensitivity in the detection of cervical dysplasia. Automated rescreening technologies in use may decrease the number of false-negative Pap smears and are an option for laboratories. Various professional groups and countries have differing recommendations on the interval for screening, primarily on the basis of cost-effectiveness. Some of the most important new information this year regarding cervical cancer screening includes the new Bethesda System for the reporting of Pap smears and the new guidelines for the management of the abnormal Pap smear by the American Society of Colposcopy and Cervical Pathology. These guidelines incorporate human papilloma virus testing based on a multicenter trial documenting its efficacy in the triage of women with atypical squamous cells on Pap smear. These recommendations are reviewed along with the current literature on cervical cancer screening.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Carcinoma of the uterine corpus is the most common malignancy in the female pelvis. Surgical resection and staging are now the accepted approach to therapy, with excellent survival compared with other gynecologic malignancies. Several controversies exist, however, regarding optimal surgical management. Some of these controversies are addressed in this article, with a review of their recent and historic literature.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In this era of advanced medical technology, recurrent ovarian cancer continues to be a therapeutic dilemma. Most of these patients will succumb to their disease process. For this reason, it is of paramount importance for all clinicians to recognize that the primary goal of salvage therapy is to maximize disease-free survival and quality of life. With this goal in mind, they can offer patients a variety of different modalities to control disease, including second-look surgery, secondary or interval cytoreduction, second-line chemotherapy, hormonal therapy, and immunotherapy. The role of second-look surgery has yet to be delineated, but the modality can be helpful in evaluating disease status and guiding further therapy in patients receiving first-line platinum-based chemotherapy or in research protocols. Interval cytoreductive surgery has been shown to confer a survival advantage in a small subset of patients with localized resectable disease proven to be platinum sensitive. The choice of chemotherapeutic agents and the prognosis depend directly on whether the patient is a platinum-sensitive responder. Many agents are approved for the treatment of recurrent ovarian cancer, and the treatment of each patient should be individualized depending on the cumulative toxicities and performance status. Extensive ongoing research trials are underway to elucidate the best salvage therapy.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The risk of developing non-Hodgkin lymphoma (AIDS lymphoma) is greatly increased in HIV infection. Disruption of immune function by HIV infection may contribute to lymphomagenesis by inducing (1) loss of immunoregulation of Epstein-Barr virus-infected B cells [immunoblastic and central nervous system (CNS) lymphoma] caused by loss of T-cell function, and (2) chronic B-cell hyperactivation enhancing the generation of genetic lesions (c-myc:immunoglobulin gene translocation,bcl-6 overexpression) associated with some forms of AIDS lymphoma (Burkitt lymphoma-like small noncleaved cell lymphoma and large noncleaved cell lymphoma). Also, the overproduction of B-cell–stimulatory cytokines (interleukin 10 and 6) has the potential to contribute to tumor development by supporting the growth and viability of nascent lymphoma cell clones. Therefore, HIV infection-associated B-cell hyperactivation, including direct activation of B cells by various mechanisms, and chronic overproduction of B-cell–stimulatory cytokines have the potential to contribute to the development and growth of AIDS lymphoma. Several recent reports are discussed in this review, including recent work relevant to understanding the potential of a virus-encoded cytokine-like molecule, HHV8 vIL6, to induce B-cell hyperactivation in HIV-infected people, work pointing to the potential role of a chemokine (stromal cell-derived factor 1) in lymphomagenesis, and studies on phenotypic changes in circulating B cells in HIV infection.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Advances in polymerase chain reaction technology have greatly simplified the ability to detect and monitor Epstein-Barr virus DNA copy number in a variety of settings. An initial focus on cell-associated viruses by many investigators has shown some interesting results regarding the dynamics of Epstein-Barr virus infection. Several findings are unexpected. A relation between HIV load or CD4 T-cell counts and Epstein-Barr virus copy number is not seen. Furthermore, highly active antiretroviral treatment therapy in HIV patients that results in a rise of CD4 T cells may sometimes be associated with a rise in cell-associated Epstein-Barr virus load. Detection of Epstein-Barr virus in spinal fluid is useful in the diagnosis of primary central nervous system lymphoma, and monitoring of Epstein-Barr virus DNA copy number in spinal fluid may be useful in assessing response. Cell-free DNA in serum or plasma is emerging as a useful diagnostic tool in several settings. Fetal DNA can be detected in maternal serum or plasma. Tumor DNA can be detected in serum or plasma in association with a variety of cancers. Epstein-Barr virus DNA in serum or plasma has been found in infectious mononucleosis, nasopharyngeal carcinoma, posttransplant lymphoma, and nasal lymphoma. In each of these malignancies, its detection or quantification has been shown to be of prognostic significance. The utility of Epstein-Barr virus DNA detection and quantification in the serum or plasma of patients with HIV malignancies has yet to be determined but holds great promise.

ISSN:1040-8746    

出版商:OVID    

年代:2002

数据来源: OVID