摘要:

During the last few decades prognostic classification of Hodgkin's disease has been primarily according to the Ann Arbor classification. However, this does not include prognostic subgrouping of the various stages. Consequently, many studies have investigated the prognostic significance of other clinical and laboratory characteristics. Many prognostic factors have been identified, but recent studies have shown that the total tumour burden is by far the most important prognostic factor in Hodgkin's disease, and that most of the other known prognostic factors are related to tumour burden, without independent prognostic significance.Radiotherapy has been the standard treatment in the management of early stage disease. Adjuvant combination chemotherapy improves disease‐free but survival but until now no improvement in overall survival has been documented. Combination chemotherapy alone has been tested in too few trials to allow a final conclusion.Advanced disease is treated with combination chemotherapy. The MOPP regimen and its modifications seem equally effective. For MOPP failures ABVD and other supposedly non‐cross‐resistant combinations seem equally effective and able to produce prolonged disease‐free survival in only about 20% of these patients. In some studies alternating regimens such as MOPP/ABVD for previously untreated patients have produced better results than MOPP alone and are currently being evaluated in larger series of patients.For patients with disease resistant to standard chemotherapy the outlook is still poor. High dose chemotherapy and total body irradiation followed by bone marrow transplantation have shown some promise. Hopefully, in the future new biological techniques will make new types of treatment available or allow a more intensive therapy with the drug combinations current

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01234.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The non‐Hodgkin's lymphomas (NHL) is a heterogeneous group of tumors derived from B and T lymphocytes and their precursors. In this review we have used a classification scheme of 5 main categories: 1. Follicular lymphomas, 2a. small lymphocytic cell (CLL or immunocytomas), 2b. diffuse small cleaved cell including intermediate lymphocytic and mantle zone NHL, 3. large cell NHL, 4. early B cell (Burkitt's and non‐Burkitt's), 5. precursor cell (lymphoblastic lymphomas). Classification of non‐leukemic post‐thymic T cell NHL is still controversial. Prognostic factors are parameters of tumor burden, proliferative activity, and the condition of the patient. Actual step of tumor progression, the dose intensity of chemotherapy, and the rapidity of tumor regression may also be of importance for outcome. The optimal therapy for follicular NHL remains to be defined. However, the inevitable course of tumor progression and the fact that only achievement of CR offers the chance of a significant fraction of patients being disease‐free leads to the recommendation to treat all younger patients initially. Patients with large cell NHL regardless of stage should be treated with combination chemotherapy. The CR rates have increased with the use of more dose‐intensive regimens suggesting that prognosis for high‐risk subsets might be further improved using high‐dose chemotherapy with autologous bone marrow transplantation as fir

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01235.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The very varying length of survival in B cell chronic lymphocytic leukaemia (B‐CLL), has stimulated the development of a number of clinical staging systems based on clinical and haematological parameters. Especially the staging systems of Rai et al and of Binet et al have won acceptance, and a combination of these systems has been proposed by the International Workshop on CLL. This system, the International Workshop System, should be used as a reference in all CLL studies with prognostic aspects.The immunophenotype of the B cell in B‐CLL is characterized by expression of faint surface membrane immunoglobulin and a number of B cell differentiation antigens, of which CD5 and the mouse erythrocyte receptor are the most important. Normal counterparts have been identified as candidates for the leukaemic target cell. No definite prognostic value of surface membrane immunoglobulin class has yet been established in B‐CLL.Chromosome abnormalities have been found in 30 to 50% of B‐CLL cases, trisomy 12 being the most frequent finding, followed by 14q+. The prognostic role of trisomy 12 is debated, whereas a concensus is emerging of a poor prognosis associated with multiple cytogenetic abnormalities.In advanced B‐CLL, it has been shown that response to treatment is a prerequisite for prolonged survival. The effect of intensive therapy is currently being investigated in several studies by comparison with the effect of chlorambucil and prednisone, till now the primary standard therapy. In a Danish multicentre study, however, prolonged survival following initial treatment with CHOP has not yet been recorded, in spite of a much higher remission rate than with chlorambucil and p

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01236.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Although many cytostatic drugs have been shown to be both mutagenic and carcinogenic in experimental systems, only the alkylating agents have been demonstrated with certainty to induce malignancy in man. Thus, therapy with almost all alkylating agents in clinical use today results in a highly increased risk of acute nonlymphocytic leukaemia (ANLL). Other types of leukaemia are not observed in excess following cancer chemotherapy, and only one type of solid tumour has been convincingly related to treatment with cytostatic drugs: carcinoma of the urinary bladder following cyclophosphamide and the now abandoned alkylating agent chlornaphazine.Low dose total‐body irradiation, as in the atomic bomb explosions of World War II, is known to induce ANLL, acute lymphoblastic leukaemia and chronic myelogenous leukaemia, as well as various solid tumours and multiple myeloma in man. High voltage radiotherapy, by comparison, has been found to be followed by a moderately increased risk of ANLL in only a few studies. This phenomenon has been related to cell kill rather than to malignant transformation of haematopoietic stem cells within the fields of irradiation. A moderately increased risk of various solid tumours and of non‐Hodgkin's lymphomas has been observed with a long follow up, particularly in series of patients treated for Hodgkin's disease. This excess possibly represents both radiotherapy‐induced solid tumours and a general predisposition to development of solid tumours and non‐Hodgkin's lymphomas as part of the natural history of the primary malignancy.The risk of therapy‐related acute nonlymphocytic leukaemia (t‐ANLL) is dose‐dependent and possibly directly proportional to the total cumulative dose af alkylating agents. It increases with patient age, like the risk of de‐novo ANLL, and it levels out 7–8 years after cessation of therapy with alkylating agents. Most cases of t‐ANLL present in a preleukaemic phase with refractory cytopenia. Already at this early stage the characteristic chromosome abnormalities can be observed in the bone marrow, most often loss of the whole, or parts of the long arms, of chromosomes no 5 and/or no 7. The cytogenet‐ic abnormalities are of diagnostic, prognostic and perhaps also of pathogenetic si

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01237.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

VM26, teniposide, and VP16, etoposide, are semisynthetic derivatives of podophyllotox‐in, a derivative of podophyllin. Podophyllin is the crude extract from the roots of two related plants, the American mandrake or may apple (podophyllum peltatum) and podophyllum emodi from India, which have been used in folk medicine throughout the ages in both American and Asian cultures.VM26 and VP16 were introduced almost simultaneously clinically in the early 1970's but the subsequent development has differed greatly (1,2,3,4,5). VP16 has been widely studied alone and in combination in the majority of common tumour types and is highly effective in several, notably testicular and small cell lung cancers, lymphomas and acute leukaemias. Early indications of this activity focused investigator interest almost exclusively on VP16, with the result that clinical research on VM26 has lagged far behind. VM26 has tended to be used in paediatric oncology, especially for neuroblastoma, but is also active in acute leukaemias, lymphomas and in small cell carcinom

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01238.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Multidrug resistance involves cross‐resistance between some of the most important agents in cancer chemotherapy, including the anthracyclines and the vinca alkaloids. It is closely related to an active extrusion of the drugs from the resistant cells, which is related to an overexpression of the multidrug resistance gene encoding a membrane protein, the P‐glycoprotein, that has homologies with bacterial transport proteins. The extrusion mechanism is accessible to inhibition by several means, and particularly the use of competitive inhibition with non‐toxic analogues of the drugs has proved to be an effective way to reverse multidrug resistance in animal tumorsin

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01239.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

An integrated set of methods for routine flow cytometric DNA analysis are described. The methods consist of procedures for sample acquisition, storage, standardization, staining and statistical analysis. Our experience with the methods over the past ten years is reviewed. It is concluded that only with adequate solutions to all methodological steps involved, is it possible to produce reliable end‐point results. Flow cytometric DNA analysis is a valuable research tool in clinical and experimental oncology. Final evaluation of the prognostic significance of DNA analysis in neoplastic disease awaits the results of ongoing studie

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01240.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The use of semi‐solid cultures of bone marrow cells is briefly reviewed. In the last two decades this technique has greatly improved our understanding of the hierarchical structure of cell production and its regulatory factors. It is now well established that relatively few multipotent stem cells, with self‐renewing capacity, are feeding cells into the differentiating pool of all the different lineages of mature cells found in blood. The proliferation and differentiation in this system are controlled by specific haemopoeitic growth factors, which also regulate the function of the mature cells. Several of these factors are now produced in recombinant form, allowing further studies of their biological significance. Clinical trials with two of the factors have supported the experimental evidence for theirin vivofunction, and they can be administered without serious side effects. The clinical access to these factors is promising for future treatment of cancer patients and may possibly completely change the outcome of several haematological and infectious disea

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01241.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1989.tb01242.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY