Bronchial-Associated Lymphoid Tissue (BALT) Lymphoma: A Multicenter Retrospective Analysis.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4583-4583
Author(s):  
Daniele Laszlo ◽  
Sara Steffanoni ◽  
Giovanna Andreola ◽  
Rosaria Balzano ◽  
Giancarlo Pruneri ◽  
...  
Keyword(s):  
Systemic Treatment ◽  
Radical Surgery ◽  
Wedge Resection ◽  
Bone Marrow Involvement ◽  
Definitive Treatment ◽  
Hematological Toxicity ◽  
Low Grade ◽  
Symptomatic Disease ◽  
Balt Lymphoma

Abstract Surgery has been the treatment of choice in patients affected by BALT NHL; however, radical surgery is not always possible and does not avoid the risk of relapse. Systemic treatment is recommended for symptomatic patients who relapse after surgery or cannot undergo such procedure; nevertheless, there is no standard systemic chemotherapy which could be recommended for such indolent disease. Here we report clinical data of 16 patients (9 men and 7 female) with biopsy-proven low grade BALT lymphoma followed at EIO and IOSI from 1992 to 2004. Median age was 62 years (range 50–77); 8 patients presented symptomatic disease at diagnosis. Thoracotomy was necessary to obtain histological material in eight patients, while in the other 8 no-invasive procedures were performed. Thirteen patients were considered in stage IE and 3 in stage IV (bone marrow involvement in 2 patients, gastric in 1), according to Ann Arbor. Five patients received upfront aggressive surgery: 1 underwent wedge resection and 4 lobectomy. Surgery was the definitive treatment for 3 patients. With a median follow-up of 17 months (range 9–31), all these patients are still alive with no evidence of disease. Twelve patients received systemic treatment: two because of non-radical surgery and ten because of advanced stage, symptomatic disease or psychosocial reasons. The majority of them (7 patients) received alkylating containing regimen (Chlorambucil ± PDN), alone or in combination with Rituximab (Mabthera) (2 patients). Three additional patients, refusing CT, received Rituximab alone in a standard schedule. Hematological and non-hematological toxicity was in general mild: transient G3 neutropenia occurred in only one patient. No patient discontinued treatment because of treatment-related toxicity and no toxic death was recorded. All patients responded to systemic therapy with five patients achieving CR. Four of them are still alive and free of disease after 24, 65, 27, 42 months respectively. One patients still in CR died for reasons different from lymphoma after 54 months. With a median follow-up of 60 months (range 31 – 63), only four patients developed progressive disease or relapse after 67, 5, 63, 18 months respectively (median TTP=40 months). Our experience suggests that systemic treatment, when appropriate, is able to achieve an high response rate in this relative uncommon disease. Considering the clinical results and the low degree of toxicity observed, alkylating containing regimen (Chlorambucil ± PDN) alone or in combination with monoclonal antibody could be considered as first line treatment for patients with BALT lymphoma.

Bronchial-associated lymphoid tissue (BALT) lymphoma: a retrospective analysis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17547-17547
Author(s):  
S. Steffanoni ◽  
G. Pruneri ◽  
L. Spaggiari ◽  
L. Preda ◽  
D. Laszlo ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Systemic Treatment ◽  
Wedge Resection ◽  
Bone Marrow Involvement ◽  
Subsequent Treatment ◽  
Disease Stage ◽  
Definitive Treatment ◽  
Major Surgery ◽  
Symptomatic Disease ◽  
Balt Lymphoma

17547 Background: Systemic CT in BALT lymphoma is the accepted therapy for those pts where surgery isn’t radical or possible. There is not a standard systemic treatment for this uncommon lymphoma however its indolent behavior and the relative asymptomatic outcome, allows on systemic therapy delay and may justify the use of less toxic CT agents. Methods: Here we reported our experience on 19 pts (10 men and 9 women) with biopsy-proven BALT lymphoma, median age was 61 yrs; 8 pts presented a symptomatic disease at diagnosis. 15 pts had a localized pulmonary disease (stage IE); 4 pts had stage IVE disease for peripheral blood and bone marrow involvement (3 pts) and gastric involvement (1 pt). Of 16 pts valuable for response, 3 pts received radical surgery (1 wedge resection and 2 lobectomy) as definitive treatment and 13 pts received systemic treatment (Chl containing regimen in 6, Rituximab ± Chl in 6; CVP regimen in 1) because of symptomatic disease or relapse after major surgery. Results: 6/13 pts achieved CR: 5/6 are still alive and disease free: 1 pt in CR died for other causes. 3 pts in asymptomatic PR don’t need further therapy while the additional 4 pts in PR need subsequent treatment because of symptomatic progression after a median TTP of 40 months. With a median follow up of 39 months, the OS and RFS observed are 85% and 63% respectively. Hematology and non-hematology toxicity was in general mild: transient G3 neutropenia occurred in only two pts; no pt discontinued the treatment because of treatment-related toxicity and no toxic death was recorded. Conclusions: Our analysis seem to confirm that surgery could be considered as unique treatment only for minority of pts with BALT lymphoma. Systemic chemotherapy with Chl containing regimen may achieve a clinical control of disease with about 50% of CR as well as other reported with more aggressive CT regimen. A larger retrospective analysis on pathological figure and clinical outcome is planned on behalf of IELSG. No significant financial relationships to disclose.

Phase I Study of Fludarabine Plus Cyclophosphamide in Patients With Previously Untreated Low-Grade Lymphoma: Results and and Long-Term Follow-Up—A Report From the Eastern Cooperative Oncology Group

2000 ◽  
Vol 18 (5) ◽  
pp. 987-987 ◽  
Author(s):  
Howard S. Hochster ◽  
Martin M. Oken ◽  
Jane N. Winter ◽  
Leo I. Gordon ◽  
Bruce G. Raphael ◽  
...  
Keyword(s):  
Phase Ii ◽  
Bone Marrow Involvement ◽  
Survival Rates ◽  
Eastern Cooperative Oncology Group ◽  
Disease Free Survival ◽  
Low Grade ◽  
Survival Times ◽  
Free Survival ◽  
Disease Free

PURPOSE: To determine the toxicity and recommended phase II doses of the combination of fludarabine plus cyclophosphamide in chemotherapy-naive patients with low-grade lymphoma. PATIENTS AND METHODS: Previously untreated patients with low-grade lymphoma were entered onto dosing cohorts of four patients each. The cyclophosphamide dose, given on day 1, was increased from 600 to 1,000 mg/m2. Fludarabine 20 mg/m2 was administered on days 1 through 5. The first eight patients were treated every 21 days; later patients were treated every 28 days. Prophylactic antibiotics were required. RESULTS: Prolonged cytopenia and pulmonary toxicity each occurred in three of eight patients treated every 3 weeks. The 19 patients treated every 28 days, who were given granulocyte colony-stimulating factor as indicated, did not have undue nonhematologic toxicity. Dose-limiting toxicity was hematologic. At the recommended phase II/III dose (cyclophosphamide 1,000 mg/m2), grade 4 neutropenia was observed in 17% of all cycles and 31% of first cycles. Grade 3 or 4 thrombocytopenia was seen in only 1% of all cycles. The median number of cycles per patient was six (range, two to 11) for all patients enrolled. The response rate was 100% of 27 patients entered; 89% achieved a complete and 11% a partial response. Nineteen of 22 patients with bone marrow involvement had clearing of the marrow. Median duration of follow-up was more than 5 years; median overall and disease-free survival times have not been reached. Kaplan-Meier estimated 5-year overall survival and disease-free survival rates were 66% and 53%, respectively. CONCLUSION: The recommended dosing for this combination in patients with previously untreated low-grade lymphoma is cyclophosphamide 1,000 mg/m2 day 1 and fludarabine 20 mg/m2 days 1 through 5. The regimen has a high level of activity, with prolonged complete remissions providing 5-year overall and disease-free survival rates as high as those reported for other therapeutic approaches in untreated patients.

Long-term outcome of hypothalamic/chiasmatic astrocytomas in children treated with conservative surgery

1995 ◽  
Vol 83 (4) ◽  
pp. 583-589 ◽  
Author(s):  
Leslie N. Sutton ◽  
Patricia T. Molloy ◽  
Heidi Sernyak ◽  
Joel Goldwein ◽  
Peter L. Phillips ◽  
...  
Keyword(s):  
Radical Surgery ◽  
Conservative Surgery ◽  
Low Grade ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Content Type ◽  
Fine Print

✓ The feasibility of radical surgery for astrocytomas of the optic chiasm/hypothalamus has been reported by several groups. Such surgery carries significant risks, however, including permanent damage to the pituitary gland, optic apparatus, hypothalamic structures, and carotid arteries. The benefits of radical surgery, both in terms of efficacy and toxicity, should, therefore, be evaluated against standard therapy, as is usually done for new chemotherapeutic protocols. To this end, a retrospective review was performed of 33 patients treated at Children's Hospital of Philadelphia between 1976 and 1991 who met criteria that would have made them eligible for radical surgery in many centers today, but were treated with either no surgery or conservative surgery (< 50% resection) or biopsy followed by adjuvant therapy with local radiation therapy (29 patients) and/or chemotherapy with actinomycin-D and vincristine (18 patients). The review encompassed all children with a globular enhancing mass of at least 2 cm in the hypothalamic/chiasmatic region, no evidence of optic nerve involvement or involvement of the optic radiations by computerized tomography or magnetic resonance imaging, and follow up of at least 3 years. All but one patient had tissue confirmation of a low-grade or pilocytic astrocytoma. Thirteen of the patients were 2 years of age or younger at diagnosis. Five individuals died: three of tumor progression, one of acute shunt malfunction, and one of intercurrent infection. The remaining 28 were alive at last follow up, a mean of 10.9 years from diagnosis. Twenty-three surviving patients have functional vision in at least one eye, 12 require no endocrine replacement, and 16 are in or have completed schooling with regular academic requirements. If radical surgery is to become standard care for children with low-grade astrocytomas of the hypothalamic/chiasmatic region, long-term survival and functional outcome will have to equal or surpass those of historical controls who were treated conservatively.

Splenic Marginal Zone Lymphoma (SMZL): Clinical Course after Splenectomy. A Single Institution Experience

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3993-3993
Author(s):  
Susanna S Gaykazyan ◽  
Nalini Janakiraman ◽  
Philip Kuriakose ◽  
Koichi Maeda ◽  
Tareq Hammour
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Systemic Therapy ◽  
Marginal Zone ◽  
Clinical Course ◽  
Bone Marrow Involvement ◽  
Marginal Zone Lymphoma ◽  
Low Grade ◽  
Splenic Marginal Zone Lymphoma ◽  
Symptomatic Disease

Abstract SMZL is an indolent B-cell malignancy accounting for 1–2% of chronic lymphoid leukemia found on bone marrow examination and up to 25% of low-grade B-cell neoplasms in splenectomy patients. Aggressive transformation of SMZL rarely occurs. It usually presents as an incidental finding or with symptoms of splenomegaly and anemia. There is still no reliable clinical or biological scoring system for prognostic stratification. We reviewed pathology reports of 41 splenectomized patients at HFHS from 1994 to 2007 and identified 14 patients with splenic marginal zone lymphoma (SMZL). The reasons for splenectomy were symptoms of splenomegaly in all 14 patients, anemia in 13 patients, thrombocytopenia in 12 patients, AIHA in 4 patients, splenic laceration in one patient. We report here the demographics, clinical course and pathology review of these patients. The median age of patients was 77.8 years. There were 7 male and 7 female patients. ECOG performance status was 0–1 in 12(86%), and 2 in 2(14%). Of the 14 patients, 8(57%) were at Ann Arbor stage IV, 1(7%) was at stage III, 4(29%) were at stage II, and 1(7%) at stage I. LDH was above normal in 9(64%) patients B-symptoms were observed in 1(7%). Bone marrow involvement was documented in 8(57%) of the patients. Anemia in 13(93%), thrombocytopenia in 12(86%), AIHA in 4(29%). IPI score was 1–2 in 5(36%), and score 3–4 in 9(64%) of the patients. Median weight of the spleen was 1235 gm. Bone marrow cytogenetics were abnormal in 4(29%) cases. Following splenectomy, cytopenias resolved completely or partially (CR/PR) in 13(93%) patients. Bacterial infections were observed in 4(29%) patients and 2(14%) died of infectious complications. Progressive disease requiring additional systemic therapy was documented in 5(36%) patients. Total of 5(36%) patients died. One secondary to NSLC, 1(7%) of urothelial carcinoma, 1(7%) secondary to hypercalcemia, 2(14%) due to bacterial sepsis. Patients were followed up to 139 months (with median follow-up time of 42 months). The estimated median overall survival (OS) for this group was 116.5 months (9.7 years), the median progression-free survival (PFS) was 91 months (7.6 years). The Kaplan Meier method was used to calculate these estimates. A simple median was calculated for the sample median. In summary, we report the course of 14 patients with SMZL who underwent splenectomy for symptomatic disease. Only 5(36%) required systemic therapy following splenectomy. No death was attributed to progressive SMZL. Overall course was indolent even after splenectomy. Estimated OS was 116.5 months (9.7 years), PFS - 91 month (7.6 years).

Outcome and Long Term Toxicity of the LNH- PRO Trial after 12 Year Median Follow-up, in Patients with Indolent Non Hodgkin's Lymphoma Who Received Immunochemotherapy with CVP and Interferon-alfa2b (IFNα2b)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4465-4465 ◽  
Author(s):  
Jimena Cannata-Ortiz ◽  
Concepción Nicolás ◽  
Ana García-Noblejas ◽  
Javier Lopez ◽  
Pilar Sabin ◽  
...  
Keyword(s):  
Bone Marrow Involvement ◽  
Long Term Results ◽  
Low Grade ◽  
Secondary Malignancies ◽  
Bulky Disease ◽  
Long Term Outcome ◽  
Number Of Patients ◽  
Number Of Cycles

Abstract Introduction: Indolent B cell non-Hodgkin lymphomas are entities without curative treatment nowadays. However, survival has significantly improved since the incorporation of immunomodulatory agents and now immunochemotherapy has become the gold standard. Most treatment strategies use progression free survival (PFS) as a surrogate marker for overall survival (OS), although updated long term results are frequently lacking. Since 1990 our group introduced IFNα-2b to Bagley’s CVP induction regimen, for naïve indolent NHL (LNH-pro study). Herein we report our long term results. Aim: To evaluate long term outcome and late toxicities of patients who received immunochemotherapy with IFN α-2b plus CVP. Patients and Methods: From February 1990 to November 2001, patients from 7 Spanish institutions were included. Induction therapy consisted of Cyclophosphamide (400 mgs/m2 po) and Prednisone (100 mg/m2 po) daily for 5 days, Vincristine (1.4mg/m2 iv) on day 1, and subcutaneous IFN α-2b (3 MU/m2, three times a week, for a total of 36 doses). Patients received the number of cycles necessary to achieve maximum response. Updated clinical data were retrieved from participating centres up to March 2012. Results. A hundred and seventy patients with low-grade NHL were analyzed. Included entities were: 65% grade 1-2 follicular lymphoma (FL), 21% lymphocytic lymphoma and 14% marginal zone lymphoma. Median age was 56 yo (range 22-78 yo), elevated LDH and β2-microglobuline were 13.6% and 26% respectively, 57.6% had bone marrow involvement and 7.6% bulky disease (>7cm). According to FLIPI, 33% were high risk, 40% intermediate and 27% low risk FL. Median number of cycles was 6, and overall response rate achieved was 90%, with 68% complete remissions. Median follow up of surviving patients was 12.5 years (range 3-21 ys), with only 14.7% of patients lost to follow-up. Median PFS for all patients was 12.5 years (95% CI 10.5 – 14.5 years) and not reached for FL patients (20-year PFS of 63%; 95%CI: 54-72%). Median OS has not been reached, with a 20-year OS of 59.7% (CI 95%, 50.5-69%) for all low-grade NHL patients and 62% (IC 95%, 50-74%) for FL patients. Long-term toxicity is detailed in table 1. Incidence of secondary malignancies is 13.5%. At time of analysis, 57 out of 170 patients have died (33.5%), mainly due to lymphoma (58% of patients) and other non-lymphoma events (42%). Table Secondary malignancies 23 cases (13.5%) - MDS / AML 3 cases - Solid tumors 18 cases - Dermatologic neoplasia 2 cases Causes of death Number of patients (%) Induction toxicity events 4 (7%) Lymphoma progression / relapse 29 (51%) Secondary malignancies 9 (16%) Other non-lymphoma events 15 (26%) - Miocardiopathy 4 - Chronic Pulmonary disease 3 - Hepatic failure 2 - Brain traumatic injury 1 - Unknown cause 5 Figure 1 Figure 1. Conclusions: Our results confirm that immunochemotherapy with IFN α-2b plus CVP regimen induces a median PFS of 12.5 years and a 20-year OS of 59.7% (median not reached). With a median follow-up of 12.5 years, 58 % died due to lymphoma, 16% from secondary malignancies and 26% for non-lymphoma events. These results highlight the importance of performing long term follow-up in order to assess the real survival benefit of any treatment. Disclosures No relevant conflicts of interest to declare.

Orbital Non Hodgkin’s Lymphoma (NHL): A Large Monocentric Study of Initial Characteristics, Natural History and Prognostic Factors.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1378-1378
Author(s):  
Meunier Jerome ◽  
Lumbroso Livia ◽  
Dendale Remy ◽  
Vincent-Salomon Anne ◽  
Asselain Bernard ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Natural History ◽  
Cell Lymphoma ◽  
Malignant Tumors ◽  
Univariate Analysis ◽  
Bone Marrow Involvement ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
High Grade

Abstract Orbital NHL (ocular and/or adnexal involvement) represents less than 1% of all lymphomas but about half of malignant tumors of the eye and/or ocular adnexae. We therefore reviewed all patients treated at the Institut Curie between 1970 and 2003 for a NHL exhibiting initial orbital localization to define their initial characteristics, natural history and prognostic factors. Among 172 patients, 145 cases with completed datas were selected for the study. Pathological review according to the WHO classification showed 52 cases of MALT-type lymphoma (36%), 32 lymphoplasmocytic lymphomas (22%), 14 patients with lymphocytic lymphoma, 7 cases of follicular lymphoma, 13 unspecified low grade lymphomas [namely, 118 cases (82%) of low grade NHL], 22 patients with diffuse large B-cell lymphoma (15%), 2 cases of mantle cell lymphoma, 2 Burkitt’s lymphomas and one T-lymphoblastic lymphoma [namely, 27 cases (18%) of high-grade NHL]. Initial characteristics were: median age 66 years (range 3–96), sex ratio M/F 0.6, B symptoms 6%, PS≥2 in 4% of patients, stages III–IV 31.7%, bone marrow involvement 12%, elevated LDH in 18% and IPI 0-1/2/3/4-5 in 92/28/13 and 1 cases, respectively. Anatomic localizations were intra-orbital in 39 patients (27%), conjunctival in 38 (26%), eyelid in 9 cases, lachrymal in 8 and other in 8 cases. Treatment of selected patients consisted of abstention in 2 cases, surgical complete resection in 5 cases, mono or polychemotherapy alone (CT) in 4 cases, and radiotherapy alone in 98 cases (68%) or with CT in 36 cases (25%). With a median follow-up of 90 months (range 3–314), the 5-year relapse-free (RFS) and overall (OS) survivals were 64% and 79% for the low-grade NHL, and 43% and 50% for the high-grade NHL. Prognostic factors were determined for the 118 low-grade patients. In univariate analysis, age greater than 59 years, elevated IPI score and elevated LDH level were prognostic for lower RFS and OS. In multivariate analysis, age greater than 59 years was the only prognostic factor for both lower RFS and OS (Figure 1). In conclusion, with a median follow-up of 7.5 years, our large monocentric cohort of patients represents one of the most important series that defines the initial characteristics, natural history and prognostic factors of NHL with initial orbital localization. Figure Figure

Intensive Chemotherapy (High-Dose CHOP/ESHAP Regimen) Followed by Autologous Stem-Cell Transplantation (ASCT) in Previously Untreated Patients with Peripheral T-Cell Lymphoma (PTCL). Results of a Prospective Phase II Study from the GELCAB.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2077-2077 ◽  
Author(s):  
Armando Lopez-Guillermo ◽  
Santiago Mercadal ◽  
Javier Briones ◽  
Blanca Xicoy ◽  
Carme Pedro ◽  
...  
Keyword(s):  
Stem Cell ◽  
Phase Ii ◽  
Lymphoblastic Leukemia ◽  
Bone Marrow Involvement ◽  
Disease Free Survival ◽  
Severe Infection ◽  
Hematological Toxicity ◽  
High Dose ◽  
Free Survival

Abstract The outcome of patients (pts) with PTCL receiving conventional therapy is dismal. Because of this, there is an increasing interest to investigate intensive treatments in these pts. The aim of the study is to analyze the interim results, in terms of toxicity, response and outcome, of a phase II trial that includes high-dose chemotherapy (CT) plus ASCT as 1st-line treatment for pts with PTCL. Thirty-four pts (23M/11F; median age: 47 yrs.) diagnosed with PTCL (excluding cutaneous and anaplastic ALK+), in stages II–IV and ≤65 yrs, who have already finished planned therapy, are the subject of this analysis. Nine pts (26%) presented with primary extranodal disease, 24 (71%) were in stage IV, and 13 (38%) had bone marrow involvement. Fifty percent of the pts had high/intermediate or high-risk IPI, whereas 53% were in the groups 3 or 4 according to the Italian Index for PTCL. Pts received intensive CT (3 courses of high-dose CHOP [cyclophosphamide 2000 mg/m2 day 1, adriamycin 90 mg/m2 day 1, vincristine 2 mg day 1, prednisone 60 mg/m2/day, days 1 to 5, with mesnum and G-CSF], alternating with 3 courses of standard ESHAP). Responders (CR or PR) were submitted to ASCT. Median follow-up of surviving pts was 3.9 yrs (range, 0.5–7.6). Twenty four pts (71%) received the planned 6 courses of CT. Response rate after CT was: CR, 12 cases (35%); PR, 8 (23%); failure, 14 (42%), including one pt who died because of sepsis. Hematological toxicity of CT mainly consisted of neutropenia (grades 3–4 in 87 and 62% after high-dose CHOP and ESHAP, respectively) and thrombocytopenia (grades 3–4 in 63 and 68%, respectively). Severe infection requiring hospitalization was observed in 38 and 15% of courses of high-dose CHOP or ESHAP, respectively. Only 14 of the 20 candidates (70% of all candidates and 41% of all pts) received ASCT due to lack of stem-cell mobilization (3 cases), previous toxicity (2) and pt decision (1). No differences in the outcome were seen among these 20 pts according to whether or not they could eventually receive ASCT. No major toxicity was observed after ASCT. The overall response after the whole treatment was: CR, 14 cases (41%), PR, 5 (15%), failure, 15 (44%). Two of 14 pts in CR and the 5 pts in PR eventually progressed. Four-year failure-free survival (FFS) was 30%, whereas 4-year disease-free survival for pts achieving CR was 63%. Nineteen pts have died during follow-up, with a 4-yr overall survival (OS) of 38% (95%CI: 21–55%). Most patients died because of PTCL progression, but 2 pts died in CR due to a secondary acute lymphoblastic leukemia and to a lung cancer, respectively. IPI and Italian Index for PTCL were able to predict FFS and OS. In summary, in this series of patients with PTCL a relatively high CR rate was obtained with high-dose CHOP/ESHAP followed by ASCT. Toxicity was manageable. However, the prognosis of patients with PTCL, particularly of those not achieving CR, is still very unfavorable. Figure Figure

Complex Hydatid Cysts of the Liver: A Single Center's Evolving Approach to Surgical Treatment

2010 ◽  
Vol 76 (9) ◽  
pp. 1011-1015 ◽  
Author(s):  
Ivan Botrugno ◽  
Salvatore Gruttadauria ◽  
Sergio Li Petri ◽  
Davide Cintorino ◽  
Marco Spada ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radical Surgery ◽  
Wedge Resection ◽  
Left Hepatectomy ◽  
Right Hepatectomy ◽  
Hydatid Cysts ◽  
Risk Factors For Recurrence ◽  
The Mean ◽  
Over Time

In our study, we arbitrarily define complex hydatid cysts of the liver as either cysts with a diameter ≥ 10 cm, or as multiple and recurrent cysts. These types of cysts were then divided into two subgroups: giant cyst identified as a cyst with a diameter ≥ 10 cm, and complicated cyst as multiple, recurrent, abscessed cysts, or those resistant to conservative treatment. The aim of this study was to retrospectively analyze a series of 38 consecutive patients who underwent surgery for complex hydatid cysts over a period of 9 years at the same institute to determine the evolution of the surgical treatment and the risk factors for recurrence. Fourteen (36.8%) of these patients were women and 24 (63.2%) men (median age 48.1; range 16-71 years). The mean postoperative follow-up was 24 ± 10.8 months. All patients were treated prophylactically with albendazole (10 mg/Kg/day) for 15 days preoperatively and for 2 months postoperatively. Partial cystectomy was performed in two cases (5.26%) and radical pericystectomy in 20 cases (52.63%). In 15 cases the patients underwent liver resection (39.47%): left hepatectomy was performed in eight cases (21.05%), and right hepatectomy in seven cases (18.42%). In one case, both wedge resection and pericystectomy were performed. There were no deaths and only one patient (2.63%) showed signs of recurrence at follow-up. Radical surgery is the most effective treatment for complex hydatid cysts. In our experience, partial or total pericystectomy virtually eliminated, over time, the need for hepatic resection.

scholarly journals Active surveillance of primary extranodal marginal zone lymphoma of bronchus-associated lymphoid tissue

2021 ◽  
Vol 5 (2) ◽  
pp. 345-351
Author(s):  
Erel Joffe ◽  
Yan Leyfman ◽  
Esther Drill ◽  
Sridevi Rajeeve ◽  
Andrew D. Zelenetz ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Active Surveillance ◽  
Lymphoid Tissue ◽  
Systemic Chemotherapy ◽  
Marginal Zone ◽  
Systemic Treatment ◽  
Marginal Zone Lymphoma ◽  
Complete Surgical Resection ◽  
Balt Lymphoma

Abstract Although patients with bronchus-associated lymphoid tissue (BALT) lymphoma show an indolent clinical course, appropriate disease management at diagnosis is not well defined. This study aimed to compare 3 treatment strategies for patients with BALT lymphoma: active surveillance, systemic chemotherapy or immunotherapy at diagnosis, or complete surgical resection at diagnosis. We conducted a retrospective study of all patients with new diagnoses of marginal zone lymphoma (MZL) involving the lung who were treated at the Memorial Sloan Kettering Cancer Center between 1995 and 2017. Primary BALT lymphoma was defined as disease confined to the lungs and adjacent lymph nodes. Active surveillance was defined as a documented observation plan and ≥3 months of follow-up before initiating treatment. Overall survival (OS) and event-free survival (EFS) were compared between treatment groups. We reviewed 200 consecutive patients with MZL involving the lung; 123 met the inclusion criteria and were managed by active surveillance (47%), complete surgical resection (41%), or systemic chemotherapy or immunotherapy (11%). With a median follow-up of &gt;60 months, surgical resection was associated with a superior EFS compared with active surveillance and systemic treatment (6-year EFS: 74% vs 65% vs 62%, respectively; P = .013). Larger lesions and thrombocytopenia were associated with shorter EFS. All groups had excellent OS at 6 years (93%), albeit with a slight superiority for surgical resection (100%) over active surveillance (91%) and systemic treatment (76%) (P = .024). BALT lymphoma is an indolent disease that can often be managed expectantly and not require therapy for many years.

Radioimmunotherapy with I131 Tositumomab in Relapsed and Transformed Low-Grade (LG) Non-Hodgkin’s Lymphoma (NHL): Long-Term Follow-Up of a Single Institution Experience.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4641-4641
Author(s):  
Huma Qawi ◽  
Teresa M. O’Brien ◽  
Parameswaran Venugopal ◽  
Jamile Shammo ◽  
Elena Bogdanova ◽  
...  
Keyword(s):  
Median Time ◽  
Medical Center ◽  
Bone Marrow Involvement ◽  
Low Grade ◽  
Cell Transplant ◽  
Patient Response ◽  
Median Response ◽  
Alive With Disease ◽  
Duration Of Response

Abstract Background: Tositumomab and Iodine I 131 Tositumomab (BEXXAR®) is approved for the treatment of recurrent LG or transformed CD20+ NHL refractory to Rituximab or relapsed after chemotherapy. In 5 trials and an expanded access program (>995 pts), response rates were 47%–68% (durable CRs in up to 30%) with median response durations of 12–18 months. Most pts who relapsed post-BEXXAR tolerated subsequent cytotoxic regimens, stem cell transplant, localized radiation, Rituximab, and Bexxar re-treatment. Methods: A retrospective analysis of 49 pts with relapsed/refractory LG NHL and transformed NHL treated at Rush U. Medical Center (1998–2001) evaluated treatments pre-Bexxar, responses to BEXXAR, and treatments post-BEXXAR. All pts received BEXXAR as previously described (JCO. 19:3918). Median age was 57 yrs (range, 28–88 yrs); 88% had stage III/IV disease, and 49% had bone marrow involvement. Median time from diagnosis to Bexxar treatment was 31 mo (range, 8–204 mo); median prior treatments was 3 (range, 1–7). Prior therapies included anthracycline/ anthracenedione-based therapy in 36 (73%) pts, fludarabine in 22 (45%) pts, both in 16 (33%) pts, and Rituximab in 22 (45%) pts. Median time from last treatment failure or relapse was 3 mo (range, 1–15 mo). Results: Overall response rate to BEXXAR was 63%, with CR in 16 (33%) pts, and PR in 15 (30%) pts. Four (8%) pts had SD. Median duration of response was 11 mo (range, 3–41 mo). Of 16 CRs, 12 (75%) were durable (TTF >12 mo). After a median follow-up of 5.3 yrs (range, 2.7–6.1 yrs), 24 (77%) of 31 responders were alive. Of the 18 nonresponders, 14 died within 1 year, and 4 pts were alive after subsequent therapy. Overall, 19 pts died from progressive disease and 2 from other causes (lung cancer and MDS/AML). Relapse After BEXXAR. 17 pts relapsed after BEXXAR and received other therapies: 11 of 12 patients who received monoclonal antibodies (Rituximab or BEXXAR) have responded and were alive at last follow up (Table 1). Retreatment With BEXXAR. After a median follow-up of 3.4 yr since BEXXAR re-treatment, 3 pts remained in CR (2 with no further therapy); 2 were alive with disease. Interestingly, CR duration after Bexxar re-treatment compared favorably with the first Bexxar treatment in 3 pts (Table 2). Conclusion: Radioimmunotherapy (RIT) is one of the most efficacious treatments for relapsed LG NHL and is delivered over a single week with tolerable toxicity, most of which is hematologic and reversible. Our results suggest that pts who relapse after RIT can be safely and effectively treated with various therapies and responses comparable to pts without prior RIT. We have shown that BEXXAR re-treatment may lead to significantly longer duration of remission compared to initial BEXXAR therapy. Table 1. Relapsed Patients:Treatment After BEXXAR Treatment Alive Dead No Further Treatment 2 0 Rituxan alone 3 0 BEXXAR 5 0 RT only 1 0 Rituximab/Chemo/RT 2 1 Rituximab/Chemo/BMT 1 0 Chemo 0 1 Chemo for Lung Ca 0 1 Table 2. Response to Retreatment With BEXXAR (All Received Fludarabine Prior to Bexxar) Patient Response, Bexxar #1 # Treatments Response, Bexxar #2 1 CR 7 mo 0 CR 3.5 years to date 2 CR 13 mo 0 CR 3 years to date 3 CR 6 mo 1 CR 3 years, alive with disease 4 CR 12 mo 2 CR 9 mo, alive with disease 5 CR 10 mo 2 PR 3 mo, alive with disease

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