==================================CMR33================================== 33. Nodular poorly differentiated lymphocytic E cell. Non-Hodgkin's Lymphoma - adult. Stage 3-4. Investigative treatment. Standard treatment. 1 UI - 86271849 AU - Hainsworth JD ; Wolff SN ; Stein RS ; Greer JP ; Cousar JB ; Greco FA TI - Effects of Mega-COMLA (cyclophosphamide, cytarabine, vincristine, and methotrexate followed by leucovorin and prednisone) plus CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) in the treatment of lymphoid neoplasms with very poor prognosis. AB - Treatment results remain very poor for some clinical and histopathologic subsets of patients with aggressive non-Hodgkin's lymphoma. We treated 21 such patients with a high-dose combination chemotherapy regimen [Mega-COMLA (cyclophosphamide, cytarabine, vincristine, and methotrexate followed by leucovorin and prednisone) + CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)] in an attempt to improve disease-free survival. Neoplasms were classified using the Lukes-Collins system. Eight patients had T-cell lymphomas (convoluted lymphocytic lymphoma, four patients; T-cell lymphoma/leukemia, one; and peripheral T-cell lymphoma, three), eight had B-cell lymphomas (immunoblastic sarcoma, five patients; small noncleaved follicular center cell, one; and large noncleaved follicular center cell, two), and five had nontypable large noncleaved cell lymphomas. All patients were previously untreated; 18 of 21 patients had clinical stage III or IV disease. Following induction therapy (4-8 weeks' duration), 16 patients (76%) achieved complete remission, while three had partial remission. Two patients died of sepsis during induction therapy. Eleven of 16 complete responders (69%) remain in complete remission after a median follow-up of 35 months. The actuarial 3-year survival rate is 51% for the entire group. Myelosuppression with this regimen was severe and prolonged, with a median duration of neutropenia (less than 500 cells/microliter) of 14 days. Seven patients (33%) developed severe neuropathy following induction treatment. High-dose induction therapy with this regimen resulted in a high complete remission rate with manageable toxicity. Survival results are encouraging when compared retrospectively to our patients with similar poor-prognosis histologies treated with standard combination chemotherapy. However, the value of this intensive therapy, relative to newer ("third-generation:) regimens, can only be established by prospective randomized studies. MH - Actuarial Analysis ; Adult ; Aged ; Antineoplastic Agents, Combined/ADVERSE EFFECTS/*THERAPEUTIC USE ; Citrovorum Factor/ ADMINISTRATION & DOSAGE ; Cyclophosphamide/ADMINISTRATION & DOSAGE ; Cytarabine/ADMINISTRATION & DOSAGE ; Doxorubicin/ ADMINISTRATION & DOSAGE ; Drug Administration Schedule ; Female ; Human ; Lymphoma/*DRUG THERAPY/MORTALITY/PATHOLOGY ; Male ; Methotrexate/ADMINISTRATION & DOSAGE ; Middle Age ; Neoplasm Staging ; Neutropenia/CHEMICALLY INDUCED ; Peripheral Nerve Diseases/CHEMICALLY INDUCED ; Prednisone/ADMINISTRATION & DOSAGE ; Prognosis ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Thrombocytopenia/CHEMICALLY INDUCED ; Vincristine/ ADMINISTRATION & DOSAGE SO - Cancer Treat Rep 1986 Aug;70(8):953-8 2 UI - 86155597 AU - Gomez GA ; Barcos M ; Krishnamsetty RM ; Panahon AM ; Han T ; Henderson ES TI - Treatment of early--stages I and II--nodular, poorly differentiated lymphocytic lymphoma. AB - Twenty-nine patients with Stages I and II nodular, poorly differentiated lymphocytic lymphoma were treated with radiation therapy or radiation therapy plus chemotherapy. Twenty-two patients with Stage I received radiation to the involved field, the other seven with Stage II received total lymphoid radiation. Complete remission was achieved in all 29. There were no differences in remission duration or survival according to treatment modality. Five of 29 (17%) patients relapsed. No relapses were observed after 5 years. Ten patients died; one patient died of lymphoma, and nine others died in continuous complete remission of various other causes. Sixty-six percent of the patients were alive at 74-160 months (median 118 months). Involved field radiation with or without chemotherapy was well tolerated, producing acceptable toxicity. Substantially more toxicity was observed after total lymphoid irradiation and although cures were also achieved, less toxic treatment programs should be investigated. The low rate of relapse observed in early stages of this lymphoma in this and in other studies is suggestive that cures might be achieved in nearly one-half of the patients presenting in early stage. MH - Adult ; Aged ; Antineoplastic Agents, Combined/ADVERSE EFFECTS/ THERAPEUTIC USE ; Female ; Human ; Lymphoma, Giant Follicular/ DRUG THERAPY/*RADIOTHERAPY ; Male ; Middle Age ; Radiotherapy/ ADVERSE EFFECTS ; Radiotherapy Dosage ; Time Factors SO - Am J Clin Oncol 1986 Feb;9(1):40-4 3 UI - 86151735 AU - Cavallin-St~ahl E ; M:oller TR TI - Prednimustine v cyclophosphamide-vincristine-prednisolone in the treatment of non-Hodgkin's lymphoma with favorable histopathology: results of a national cancer care program in Sweden. AB - In a nationwide multicenter study, single-agent treatment with prednimustine (PM) was compared with combination chemotherapy with CVP (cyclophosphamide, vincristine, and prednisolone) in patients with stage III-IV non-Hodgkin's lymphoma (NHL) with favorable histology (Rappaport groups nodular lymphocytic poorly differentiated, nodular mixed, and diffuse lymphocytic poorly and well-differentiated). From January 1979 to May 1982, 217 evaluable patients were randomized, and at present analysis, the median follow-up time is 42 months. Overall response rate in the PM group was 63% (complete, 40%; partial, 23%) compared with 66% in the CVP group (complete, 32%; partial, 34%). There was no significant difference in relapse-free survival (RFS) or survival between the two groups, median RFS being 30 months and median survival being 42 months, respectively. Reclassification of the lymphomas according to the Kiel system (possible in 80%) revealed high-grade malignant NHL in 22 patients (12 in PM group, 10 in CVP group). Within this small group, there was a marked difference in survival in favor of CVP-treated patients. However, treatment with PM was less toxic and better tolerated than the CVP regimen. It was concluded that for patients with low-grade malignant NHL treatment with PM is equally effective and less toxic than the CVP regimen. MH - Adolescence ; Adult ; Aged ; Antineoplastic Agents, Combined/ *THERAPEUTIC USE ; Chlorambucil/*ANALOGS & DERIVATIVES ; Comparative Study ; Cyclophosphamide/ADVERSE EFFECTS/THERAPEUTIC USE ; Female ; Human ; Lymphoma/*DRUG THERAPY/MORTALITY/PATHOLOGY ; Male ; Middle Age ; Prednimustine/ADVERSE EFFECTS/*THERAPEUTIC USE ; Prednisone/ADVERSE EFFECTS/THERAPEUTIC USE ; Support, Non-U.S. Gov't ; Sweden ; Vincristine/ADVERSE EFFECTS/THERAPEUTIC USE SO - Semin Oncol 1986 Mar;13(1 Suppl 1):19-22 1 UI - 87127017 AU - Jensen JR ; Kaltoft K ; Bisballe S ; Thestrup-Pedersen K TI - Natural and concanavalin A-induced cytotoxic activity towards continuously growing B lymphocytes derived from patients with cutaneous T-cell lymphoma. AB - Continuously growing T- and B-cell lines were derived from peripheral blood, affected skin, and lymph nodes of patients with mycosis fungoides (MF) and S:ezary syndrome (SS). Two lymphoblastoid cell lines (MF-13 and SS-2) were Epstein-Barr virus (EBV)-transformed B cells evaluated by surface immunoglobulin, lack of E-rosette formation, positive EBV nuclear antibody test, and secretion of IgM antibody in a plaque-forming cell assay. Analysis of the natural-killer-cell activity using peripheral blood lymphocytes from patients with MF and healthy control persons towards MF-13 and SS-2 target cells suggested resistance to lysis even in tests supplemented with 1,000 IU/ml human gamma-interferon. However, the cell lines were not per se completely resistant to lysis because lymphocytes from control persons showed significant cytotoxicity in an 18-h assay supplemented with 2 micrograms/ml concanavalin A. MH - Adult ; Aged ; B Lymphocytes/*IMMUNOLOGY ; Cell Line ; Concanavalin A/*IMMUNOLOGY ; *Cytotoxicity, Immunologic/DRUG EFFECTS ; Female ; Human ; Interferon Type II/PHARMACODYNAMICS ; Killer Cells, Natural/IMMUNOLOGY ; Male ; Middle Age ; Mycosis Fungoides/*IMMUNOLOGY ; Sezary Syndrome/*IMMUNOLOGY ; Skin Neoplasms/*IMMUNOLOGY ; Support, Non-U.S. Gov't ; T Lymphocytes/ *IMMUNOLOGY SO - Arch Dermatol Res 1986;279(1):12-5 2 UI - 87079968 AU - Das DK ; Gupta SK ; Datta U ; Sharma SC ; Datta BN TI - Malignant lymphoma of convoluted lymphocytes: diagnosis by fine-needle aspiration cytology and cytochemistry. AB - The technique of fine-needle aspiration cytology (FNAC) was utilized in the diagnosis of 31 cases of malignant lymphoma of convoluted lymphocytes. The age of the patients ranged from 5 to 70 yr (median, 24 yr). Clinical history was available in 29 cases. All patients had peripheral lymphadenopathy. There was radiological evidence of mediastinal adenopathy in 62% of the cases, and 41% had pleural effusion; 52% of the patients presented with mediastinal compression syndrome. The diagnostically crucial convoluted cells comprised 47.3 +/- 23.73% of all lymphoid cells. Nuclear convolutions were appreciated in a significant number of cells in paraffin sections of 17 of 21 cases (85.7%) having subsequent histopathology. Cytochemical and E-rosette tests performed in 17 cases confirmed the T cell nature of the neoplasms. On an average, 72.3% of cells showed focal positive reaction for acid phosphatase, and 73.8% of cells formed E-rosettes. MH - Adolescence ; Adult ; Aged ; Biopsy, Needle ; Child ; Child, Preschool ; Female ; Histocytochemistry ; Human ; Lymphocytes/ *PATHOLOGY ; Lymphoma/ENZYMOLOGY/IMMUNOLOGY/*PATHOLOGY ; Male ; Middle Age ; Rosette Formation ; T Lymphocytes/IMMUNOLOGY SO - Diagn Cytopathol 1986 Dec;2(4):307-11 3 UI - 87044904 AU - Pascali E ; Pezzoli A TI - Serum and urine monoclonal immunoglobulins in malignant non-Hodgkin's lymphoma. AB - 62 consecutive patients with newly diagnosed malignant non-Hodgkin's lymphoma (NHL) were investigated for the presence, type, and amount of serum and urine monoclonal immunoglobulin abnormalities. The overall incidence of monoclonal gammopathy (MG) was 81%. M components of the IgM and IgG classes were found in the serum of 52% of the patients. Their concentration was below 10 g/l in 54% of cases and above 20 g/l in 26% of cases. The highest incidence of serum M components (75%) was seen in plasmacytoid lymphocytic lymphoma (PLL) and the lowest (38%) in follicular center cell lymphoma. A monoclonal free light chain, i.e., Bence Jones protein (BJP), was documented in the urine of 61% of cases with a daily excretion comprised between 0.01 and 9.24 g. The isolated urinary excretion of BJP was a major finding accounting for 36% of all MG found in association with NHL. It occurred in all histopathological subtypes with a frequency ranging from 17% of PLL to 37% of small lymphocytic lymphoma. MH - Adult ; Aged ; Bence Jones Protein/URINE ; Female ; Human ; IgG/ *ANALYSIS ; IgM/*ANALYSIS ; Lymphoma, Non-Hodgkin's/ *COMPLICATIONS/IMMUNOLOGY/URINE ; Male ; Middle Age ; Paraproteinemias/*COMPLICATIONS/IMMUNOLOGY/URINE ; Paraproteins/ *ANALYSIS SO - Acta Haematol (Basel) 1986;75(4):193-8 4 UI - 87006473 AU - Gaulard P ; Zafrani ES ; Mavier P ; Rocha FD ; Farcet JP ; Divine M ; Haioun C ; Pinaudeau Y TI - Peripheral T-cell lymphoma presenting as predominant liver disease: a report of three cases. AB - Three cases of a peculiar form of peripheral T-cell lymphoma presenting as predominant hepatic disease with splenomegaly are reported. The three patients had marked liver enlargement without lymphadenopathy; white blood cell count was normal, and modifications of hepatic tests were mild. In the three cases, the diagnosis of the lymphoma was mainly based on the results of hepatic morphological changes. Liver involvement was histologically characterized by a predominantly sinusoidal infiltration by tumor cells in the three cases, associated with perisinusoidal fibrosis in two of them; portal infiltration was noted in two patients. Immunopathological study showed that tumor cells were T-lymphoid cells that were different from normal T-lymphocytes by the lack of expression of one T-cell membrane antigen, i.e., Leu-1. These findings suggest that a distinct clinical, pathological and immunopathological entity might be individualized within the large group of T-cell lymphomas. MH - Adult ; Antigens, Surface/ANALYSIS ; Antineoplastic Agents/ THERAPEUTIC USE ; Bone Marrow/PATHOLOGY ; Diagnosis, Differential ; Follow-Up Studies ; Hepatomegaly/PATHOLOGY ; Histocytochemistry ; Human ; Immunoenzyme Technics ; Liver Diseases/*PATHOLOGY ; Liver Neoplasms/PATHOLOGY ; Lymphoma/DRUG THERAPY/*PATHOLOGY ; Male ; Phenotype ; Splenomegaly/PATHOLOGY ; T Lymphocytes/ IMMUNOLOGY/*PATHOLOGY SO - Hepatology 1986 Sep-Oct;6(5):864-8 5 UI - 86289969 AU - Inoue T ; Masaoka T ; Shibata H TI - Risk factors associated with interstitial pneumonia following allogeneic bone marrow transplantation for acute leukemia in Japanese experience. AB - Records of 101 patients with acute leukemia who received allogeneic bone marrow transplantation (BMT) with preparation using cyclophosphamide and total body irradiation (TBI) from September 1975 through July 1984 were collected into Japanese Bone Marrow Transplant Registry from 15 of the participating hospitals. These patients were divided into two groups by year of BMT. Group I included nine acute lymphocytic leukemia (ALL) and nine acute non-lymphocytic leukemia (ANL) patients who received BMT before 1980. Group II consisted 39 ALL and 44 ANL patients who were treated after 1981. One-year survivals were 11% and 58% in groups I and II, respectively (p less than 0.001). Probabilities of developing interstitial pneumonia at one year were 93% and 37% in groups I and II, respectively (p less than 0.001). Of 14 patients who developed interstitial pneumonia in group I, twelve (86%) died of interstitial pneumonia. Fifteen of 22 (68%) were fatal in group II. Using proportional hazard regression model, year of BMT (p = 0.0001) and selection of platelet donor with negative cytomegalovirus (CMV) titer (p = 0.0215) were found to be significant risk factors associated with interstitial pneumonia. The present analysis indicated that change in the selection of patients, e.g., in remission without infection at the time of BMT, as well as treatment modality, e.g., fractionated TBI, and selection of platelet donor with negative CMV titer, resulted in the significant improvement in the survival and decreased incidence of interstitial pneumonia. MH - Acute Disease ; Adult ; Anemia, Aplastic/THERAPY ; Bone Marrow/ *TRANSPLANTATION ; Comparative Study ; Cyclophosphamide/ THERAPEUTIC USE ; Cyclosporins/THERAPEUTIC USE ; Female ; Graft vs Host Disease/ETIOLOGY ; Histocompatibility Testing ; Human ; Leukemia/MORTALITY/*THERAPY ; Leukemia, Lymphoblastic/THERAPY ; Leukemia, Myelocytic/THERAPY ; Lymphoma/THERAPY ; Male ; Postoperative Care ; Postoperative Complications ; Pulmonary Fibrosis/*ETIOLOGY ; Radiotherapy Dosage ; Risk ; Support, Non-U.S. Gov't ; Transplantation, Homologous ; Whole Body Irradiation SO - Strahlenther Onkol 1986 Jun;162(6):368-73 6 UI - 86243039 AU - Bataille R ; Chappard D ; Alexandre C ; Dessauw P ; Sany J TI - Importance of quantitative histology of bone changes in monoclonal gammopathy. AB - Quantitative histology of bone changes, using undecalcified transiliac bone biopsies (UTBB), was performed blindly in 46 individuals with monoclonal gammopathy (MG), including 17 with MG of undetermined significance (MGUS) and 29 with overt multiple myeloma (MM). Three MGUS presented an excess of osteoclastic resorption (OR) in the vicinity of clusters of tumour cells and developed overt B cell malignancies, chronic lymphocytic leukaemia, Waldenstr:om's disease and MM respectively. On the other hand, MGUS with normal OR remained stable (median follow-up = 28 months), with one exception who developed a systemic amyloidosis. In MM, excessive OR was only observed in areas invaded by myeloma cells. OR was frequently normal in active MM lacking myeloma cells in UTBB. Active MM without lesions on radiography had excessive OR. IgA and pure Bence Jones MM appeared more osteoclastic than IgG cases (P less than 0.05). Of major interest was the finding that one third of MM presented histological bone changes similar to osteoporosis, osteosclerosis or osteoblastic metastasis. Two major findings must be emphasized from the current data: UTBB could be of major interest for the early detection of a B cell malignancy; heterogeneity of myeloma bone condition is unexpected. If some changes appear directly related to the tumour (i.e. excessive OR or osteoblastic dysfunction), some others are probably accidentally associated with it (i.e. osteoporosis), both needing treatment other than chemotherapy. MH - Aged ; Biopsy ; Bone and Bones/*PATHOLOGY ; Bone Resorption/ ETIOLOGY ; Diagnosis, Differential ; Female ; Human ; Male ; Middle Age ; Monoclonal Gammopathies, Benign/DIAGNOSIS ; Multiple Myeloma/DIAGNOSIS/PATHOLOGY ; Paraproteinemias/COMPLICATIONS/ DIAGNOSIS/*PATHOLOGY ; Prospective Studies ; Support, Non-U.S. Gov't SO - Br J Cancer 1986 Jun;53(6):805-10 7 UI - 86207932 AU - Oscier DG ; Mufti GJ ; Hamblin TJ ; Jones DB ; Smith JL TI - Evolution of a terminal deoxynucleotidyl transferase-positive lymphoma from a chronic T cell lymphocytosis. AB - A 56-yr-old Caucasian man presented with a generalised scaly rash and a peripheral blood lymphocytosis of 5.6 X 10(9)/l. 5 yr later he developed cutaneous nodules, lymphadenopathy and hepatosplenomegaly. Cells with convoluted nuclei and prominent nucleoli were seen in the peripheral blood. He underwent splenectomy and received intensive chemotherapy but died 6 months later with CNS infiltration. At presentation the peripheral blood lymphocytes were E-ve, UCHT1 + ve, and OKT8 + ve. Following transformation, cells in blood, spleen and CSF were E-ve, OKT11 + ve, DR + ve and Tdt + ve. A proportion of these cells had a S:ezary-like appearance at E/M. The splenic cells showed functional suppressor activity. This is the first reported case of the evolution of a Tdt + ve lymphoma from a post-thymic T cell lymphocytosis. MH - Case Report ; DNA Nucleotidylexotransferase/*BLOOD ; DNA Nucleotidyltransferases/*BLOOD ; Human ; Lymphocytes/CYTOLOGY/ *ENZYMOLOGY/IMMUNOLOGY ; Lymphoma/BLOOD/*ENZYMOLOGY/IMMUNOLOGY/ PATHOLOGY ; Male ; Microscopy, Electron ; Middle Age ; Suppressor Cells/IMMUNOLOGY SO - Scand J Haematol 1986 Feb;36(2):221-8 8 UI - 86100437 AU - Witzig TE ; Phyliky RL ; Li CY ; Homburger HA ; Dewald GW ; Handwerger BS TI - T-cell chronic lymphocytic leukemia with a helper/inducer membrane phenotype: a distinct clinicopathologic subtype with a poor prognosis. AB - T-cell chronic lymphocytic leukemia (T-CLL) accounts for about 2% of the various types of CLL and can be subtyped into helper/inducer (h/i) and cytotoxic/suppressor (c/s) cell membrane phenotypes. Seven patients with CLL were shown to have T-CLL with a h/i cell membrane phenotype; four with monoclonal antibody reagents and three by demonstration of the E-rosette receptor and focal acid alpha naphthyl acetate esterase activity. The clinical courses, treatment responses, and laboratory findings of these seven patients were reviewed to determine the prognosis and unique clinicopathologic features of this subtype. Two patients presented with skin rashes, and five were diagnosed during evaluation for other medical problems. Initially, four patients had splenomegaly and two had lymphadenopathy, but none of the patients had hepatomegaly. Morphologic examination revealed uniform, small lymphocytes in three patients, and the lymphocytes had nuclear indentations in four patients. Sera from the three patients tested were negative for antibody to the human T-cell leukemia/lymphoma virus I. Peripheral blood mononuclear cells from one patient showed normal interleukin-2 production and lacked antibody-dependent cell-mediated cellular cytotoxicity and natural killer activity. Cytogenetic analysis was done on one patient, revealing an abnormal clone with several chromosomal abnormalities, including an X;14 translocation with a break point at 14q11. All patients required chemotherapy, and all died a median of 21 months from the time of diagnosis. The findings in these patients, in addition to those in 31 patients described in the literature, indicate that h/i T-CLL is associated with a poor prognosis and has distinct clinical and pathologic features that separate it from c/s T-CLL, adult T-cell leukemia/lymphoma, the cutaneous T-cell lymphomas, and B-CLL. MH - Adult ; Antigens, Surface/ANALYSIS ; B Lymphocytes/PATHOLOGY ; Blood Cell Count ; Comparative Study ; Female ; Helper Cells/ CLASSIFICATION/*IMMUNOLOGY ; Human ; Karyotyping ; Leukemia, Lymphoblastic/PATHOLOGY ; Leukemia, Lymphocytic/BLOOD/ CLASSIFICATION/*IMMUNOLOGY ; Lymphocytes/PATHOLOGY ; Lymphoma/ PATHOLOGY ; Male ; Middle Age ; Prognosis ; Rosette Formation ; T Lymphocytes/CLASSIFICATION/*IMMUNOLOGY SO - Am J Hematol 1986 Feb;21(2):139-55