ISSN:1042-8194    

DOI:10.3109/10428199309149104

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Autologous Bone Marrow Transplant (ABMT), at this point, is an experimental procedure reserved for patients without cure potential with available conventional chemotherapy. Unfortunately, the Ann Arbor staging system has not been able to identify these cases since there are patients with Stage IV who do well and others who do not. We have reported on a risk model based on gender and tumor burden (TB) assessment that can stratify patients with uniform Ann Arbor stage IV follicular low-grade lymphoma (FLGL) into three prognostic groups: (a) a group of females with low TB who have achieved a plateau of failure free survival (FFS) and survival of 50% and 92%, respectively, and who should not receive frontline ABMT; (b) a group of males with high TB having a median FFS and survival of only 12 and 48 months, respectively, and who could potentially benefit from ABMT; (c) a large group of patients with other TB-sex combinations, who are continuously relapsing at ten year follow-up, and whose survival is dismal. Even some of these, who have at best a 50% ten year survival, have not reached a plateau in their survival curves. This large group of patients, like all stage IV patients, will have a median age of 60 years at the time of initial diagnosis and treatment, and will be probably over 60 years old by the time they relapse, at which time salvage therapy will have increased morbidity and mortality, more so if it includes ABMT. Therefore, until further data might select patients with better outcome among this last group, they should be offered the option of frontline ABMT as consolidation of a complete remission (CR).All patients who achieved a partial response to initial conventional chemotherapy in our study had poor FFS and survival curves, and should also be candidates for an experimental protocol containing consolidation therapy with ABMT.

ISSN:1042-8194    

DOI:10.3109/10428199309149105

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

ISSN:1042-8194    

DOI:10.3109/10428199309149106

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Although small non-cleaved cell lymphoma (SNCCL) is one of the more common lymphoma subtypes in children, in both Africa and the United States, it is rare in adults. Although it responds dramatically to chemotherapy in both children and adults, it is considered a high grade lymphoma in the International Working Formulation, and carries a much less favorable prognosis than does large cell lymphoma, the more common disease with which it is often grouped in treatment reports. Beginning in 1981, we treated patients with SNCCL with MCOP (methotrexate, cyclophosphamide, vincristine, prednisone) followed by IMVP-16 (ifosfamide, methotrexate, VP-16) followed by HOAP-Bleo (adri-amycin, vincristine, cytosine arabinoside, prednisone, bleomycin). From 1984 to 1988, this program was modified in that cytosine arabinoside was added to MCOP, and cyclophosphamide was substituted for ifosfamide in IMVP-16. Eighty percent of the patients entered complete remission (CR): the freedom from progression (FFP) result at five years was 60%. By multivariate analysis, Ann Arbor stage IV and age over 40 years were the most important adverse prognostic factors predicting CR and FFP results, with five-year FFP results of 24% and 40%, respectively. However, only two of the seven patients with marrow disease were free of progressive disease at five years. Central nervous system and bone marrow relapse occurred in 10 patients, nine of whom had stage IV disease, seven of whom had never attained CR. The five-year survival result was 52%, and was significantly affected by stage IV disease and age. From this study, it appears that most patients with stages I-III SNCCL may be cured with intensive therapy, and recent studies suggest that prolonged treatment is not necessary. However, patients with stage IV disease and those over the age of 40 may need early intensification with very high dose therapy in order to improve results for this subgroup.

ISSN:1042-8194    

DOI:10.3109/10428199309149107

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The therapeutic approach to patients with follicular low-grade non-Hodgkin's lymphoma is controversial and has varied over a wide spectrum. A“watch and wait”approach in asymptomatic patients has been taken in some studies. In other series, single agent therapy with alkylating agents as cy-clophosphamide or chlorambucil has been employed. Response rates including complete responses are high, but relapses inevitably occur. Three-drug combination chemotherapy regimens consisting of cyclophosphamide, vincristine, and prednisone (CVP) have been utilized, in addition to more intensive regimens consisting of four or more drugs. Although responses are commonly achieved, there is no consistent survival advantage conferred by these more aggressive regimens. However, the remission duration may be prolonged in some subsets of patients as those with follicular mixed lymphoma. Due to the prolonged natural history of follicular low-grade lymphoma, a long period of follow-up is necessary to adequately evaluate the impact of a therapeutic regimen on remission duration and overall survival. Future trials may employ more aggressive therapy in combination with growth factors or biologic response modifiers in an effort to improve the outcome of patients with follicular low-grade lymphoma.

ISSN:1042-8194    

DOI:10.3109/10428199309149108

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

ISSN:1042-8194    

DOI:10.3109/10428199309149109

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

From March 1991 to April 1992, 44 previously untreated patients with stage II to IV intermediate-grade non-Hodgkin's lymphoma (according to the Kiel classification) were entered in a phase III comparative trial. The objectives of the study were to compare the efficacy and safety of using idarubicin instead of doxorubicin in the combination chemo-therapeutic regimen CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone). Forty-four patients were randomly assigned to receive either CI(idarubicin)OP or CH(doxorubicin)OP. The study is ongoing and so far no significant differences in complete response rate and (non-)hematologic tox-icity have been observed.

ISSN:1042-8194    

DOI:10.3109/10428199309149110

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

ISSN:1042-8194    

DOI:10.3109/10428199309149111

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The B cell non-Hodgkin's lymphomas (NHL-B) are a common, but heterogeneous group of human lymphoid neoplasms, consisting of monoclonal populations of neoplastic B lymphocytes demonstrating non-random chromosomal abnormalities, often associated with proto-oncogene translocations. Clinically and pathologically, these lymphomas are classified as low, intermediate, or high grade, according to the clinical aggressiveness of the NHL-B subtype. The clinical behavior can also be correlated with biological function regarding proliferative capabilities of the tumor cells. Our studies have shown that the low grade B cell lymphomas have low constitutive proliferative capacity in vitro and do not respond to cytokine growth factors (CGF), while the high grade NHL-B respond to the B cell growth factor (BCGF) family of CGFs. The high grade NHL-B also secrete BCGFs both in vitro and in vivo, as autocrine growth factors that may provide a target for new therapeutic approaches to therapy.

ISSN:1042-8194    

DOI:10.3109/10428199309149112

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

A review of the most significant prognostic factors found in large cell lymphomas is presented. Prognostic factors are divided in four categories: (a) those related to the patient: age at diagnosis; (b) those related to the tumor: stage, tumor bulk, spreading of tumor, extranodal sites, LDH andβ2-microglobulin levels; (c) those related to the host-tumor relationship: performance status, presence of B symptoms, serum albumin level, and interleukin secretion; and (d) those related to the physicians: type of treatment, dose intensity of this treatment. Most of these parameters are related to each others and only a few of them keep statistically significant correlation with outcome in multi-parametric studies. New prospective studies with new therapeutic strategies should stratify patients before treatment on these most important prognostic factors.

ISSN:1042-8194    

DOI:10.3109/10428199309149113

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor