Diffuse small noncleaved-cell, non-Burkitt's lymphoma in adults: a high-grade lymphoma responsive to ProMACE-based combination chemotherapy.

1994 ◽  
Vol 12 (10) ◽  
pp. 2153-2159 ◽  
Author(s):  
D L Longo ◽  
P L Duffey ◽  
E S Jaffe ◽  
M Raffeld ◽  
S M Hubbard ◽  
...  
Keyword(s):  
Overall Survival ◽  
Combination Chemotherapy ◽  
Survival Rates ◽  
Large Cell ◽  
Complete Response ◽  
Burkitt’S Lymphoma ◽  
Burkitt's Lymphoma ◽  
Advanced Stage ◽  
Stage Disease ◽  
Localized Disease

PURPOSE To review the efficacy of cyclophosphamide, doxorubicin, etoposide, methotrexate with leucovorin, and prednisone (ProMACE)-based combination chemotherapy programs in the treatment of patients with diffuse small noncleaved-cell non-Burkitt's lymphoma. PATIENTS AND METHODS Thirty-three patients with diffuse small noncleaved-cell non-Burkitt's lymphoma were accrued: eight with localized disease were treated with modified ProMACE-mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) plus involved-field radiation therapy, and 25 with advanced-stage disease were treated with ProMACE/MOPP flexitherapy (n = 8), ProMACE-MOPP (n = 9), or ProMACE-cytarabine, bleomycin, vincristine, and methotrexate with leucovorin (CytaBOM) (n = 8). The median follow-up duration is 10 years. RESULTS All eight patients with localized disease achieved a complete response, none have relapsed, and one died of intercurrent illness. Among patients with advanced-stage disease, five of eight (63%) flexitherapy-treated patients, six of nine (67%) ProMACE-MOPP-treated patients, and eight of eight (100%) ProMACE-CytaBOM-treated patients achieved a complete response. If the two ProMACE-MOPP-based groups are considered together, disease-free and overall survival rates at 15 years are projected at 61% and 35%, respectively. In contrast, only one patient has relapsed from a ProMACE-CytaBOM-induced complete remission, and overall survival of ProMACE-CytaBOM-treated patients (88%) is significantly higher than that for flexitherapy and ProMACE-MOPP (P2 = .04). CONCLUSION Adult patients with diffuse small non-cleaved-cell non-Burkitt's lymphoma may be effectively treated with regimens that are effective in other aggressive lymphomas (eg, diffuse large-cell lymphoma).

scholarly journals Primary Cutaneous Anaplastic Large Cell Lymphoma: The British Columbia Cancer Agency Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3076-3076
Author(s):  
Greg Hapgood ◽  
Laurie H. Sehn ◽  
Diego Villa ◽  
Richard Klasa ◽  
Alina S. Gerrie ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cell Lymphoma ◽  
Combined Modality Therapy ◽  
Large Cell ◽  
Advanced Stage ◽  
Limited Stage ◽  
Stage Disease ◽  
Cancer Agency ◽  
First Relapse

Abstract Background: Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare T-cell cutaneous lymphoma consisting of CD30 positive typically anaplastic-appearing cells and was distinguished from systemic ALCL and lymphomatoid papulosis in the World Health Organization classification of lymphoid neoplasms. Previous studies have shown PCALCL has an excellent overall survival with few patients dying from disease. Over-treatment should be avoided. Methods: The British Columbia Cancer Agency Lymphoid Cancer Database was searched to identify all adults (>18 years) diagnosed with PCALCL from 1993 to 2013 with complete clinical information. Pathologic records were reviewed to confirm the diagnosis and correlate with presenting clinical features. Before 2005, patients with limited stage disease commonly received combined modality therapy using CHOP-like chemotherapy. After 2005, the Lymphoma Tumor Group endorsed treatment with radiotherapy (RT) alone due to emerging data failing to support a role for chemotherapy. Results: 46 patients (31 males (67%); M:F ratio 2) with a median age of 64 y were identified (Table 1). 39 patients had limited stage disease (stage 1A, n=38; stage 2A n=1) and 7 patients had advanced stage disease (multiple distant cutaneous sites). For the limited stage patients 18 were treated with radiotherapy (RT) alone, 8 with combined modality therapy (CMT) consisting of CHOP-like chemotherapy for 3 cycles followed by involved field RT, 4 with chemotherapy alone, 5 with surgical resection alone and 4 patients refused or were too frail to be treated due to unrelated comorbidities. For the 7 patients with advanced stage disease, 2 received local therapy alone (RT n=2; surgery n=1) and 4 received CHOP-like chemotherapy. The median follow-up for living patients was 54.5 months (range 4 to 241 months). Overall, 18 (39%) patients relapsed, of which, only 2 (11%) had progressed to advanced stage at first relapse. The majority of relapses were cutaneous; however, 4 patients ultimately developed systemic disease with biopsy proven ALK-negative ALCL. 4 patients (9%) died from PCALCL and none had had advanced stage disease at diagnosis. For the whole cohort, the 5-y time to progression (TTP) was 53% (59% for limited stage and 21% for advanced stage patients), the 5-y disease specific survival (DSS) was 83% and the 5-y overall survival (OS) was 73%. In an as-treated analysis, the 5-y DSS for limited stage patients was similar comparing RT to CMT or CHOP-like chemotherapy alone (Figure 1) but the 5-y TTP for limited stage patients favored RT alone compared to CMT or CHOP-like chemotherapy (76% vs 33%, p=0.02)(Figure 2). Furthermore, limited stage patients treated after the 2005 policy change endorsing RT alone had a similar TTP compared to patients treated prior to 2005 (5-y TTP 61% vs 50%, respectively, p= 0.860). The 5-y DSS and OS rates for all patients with limited stage disease were 80% and 68%, respectively. For all patients, the five year risk of systemic recurrence was 9%. Conclusion: Limited stage is typical of PCALCL and few patients present with advanced disease. We confirm the favorable prognosis in PCALCL and the effectiveness of RT alone, without systemic treatment, at minimizing the risk of relapse. A small proportion of patients developed systemic ALCL. Stage at diagnosis did not predict the rare event of death in this series. Table 1. Patient characteristics and clinical follow-up Characteristic N (%) Total 46 (100%) Gender Males 31 (67%) Stage at diagnosis I/II 39 (85%) IV 7 (15%) Initial treatment Radiotherapy (RT) alone 20 (44%) CHOP-like + RT 8 (17%) CHOP-like 8 (17%) Surgery 6 (13%) Refused 1 (2%) Too frail 3 (7%) Response rate Complete 40 (87%) Partial 5 (11%) Uncertain 1 (2%) Site of first relapse Skin only 14 (78%) Regional lymph node 0 (0%) Systemic* 4 (22%) Follow-up (months) Median (range) 54.5 (4 to 241) Status at last follow-up No evidence of disease 28 (61%) Alive with disease 6 (13%) Died of lymphoma 4 (9%) Died of other cause 9 (19.5%) Disease-specific survival 5 y (all patients) (83%) Overall survival 5 y (all patients) (73%) Progression-free survival 5 y (all patients) (42%) * Two patients initially relapsing in the skin subsequently developed a systemic relapse. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Differences in Outcome of Patients with Syncytial Variant Hodgkin Lymphoma (HL) Compared with Typical Nodular Sclerosis HL

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1441-1441
Author(s):  
Tarsheen K. Sethi ◽  
Van T Nguyen ◽  
Shaoying Li ◽  
David S Morgan ◽  
John P. Greer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Progression Free Survival ◽  
Complete Response ◽  
Disease Stage ◽  
Cell Transplant ◽  
Advanced Stage ◽  
Bulky Disease ◽  
Free Survival ◽  
Nodular Sclerosis ◽  
Stage Disease

Abstract Introduction: Syncytial variant of nodular sclerosis HL (SV) is a well-described distinct pathologic entity characterized by prominent aggregates of Hodgkin/Reed- Sternberg cells in nodules separated by fibrous collagen bands. Despite its well-known morphologic description, little is known regarding the clinical behavior of the SV. Previous reports suggest that patients with SV often presented with B symptoms and advanced stage disease, however, large series defining the clinical outcome have not been reported so far. We systematically studied the clinical features and outcome of patients with SV and further compared them with patients with typical nodular sclerosis HL (t-NS). Patients and Methods: 167 adult patients (pts.) with Nodular Sclerosis HL were included in our analysis following institutional IRB approval. Differences between the two groups (SV vs. t-NS) were analyzed using Chi- square and t -Student tests. Statistical significance was set at P <0.05. Kaplan Meier method was used to calculate the Progression-free survival (PFS) and overall survival (OS). Log-rank test was used to determine the differences in survival. Statistical analysis was performed using SPSS.22 software. Results: Of the 167 patients, 43 were confirmed as SV based on morphology and immunophenotype. The median age at diagnosis was 31 yrs. (range: 18-75 yrs.) and 85 patients were male (51%). At diagnosis, 100% patients had an ECOG status of 0-1; 39 % had advanced stage disease (stage III and IV); and 48% had B symptoms. 23 % patients presented with bulky disease defined as a mass > 10 cm or a mediastinal mass >1/3 of thorax at T5-T6. 90% patients received ABVD as their initial treatment. The remaining were treated with Stanford V, MOPP or on a clinical trial. 37 % patients received radiation therapy. Furthermore, 63% patients with SV and relapsed disease were treated with high dose therapy followed by stem cell transplant (ASCT). In the SV vs. t-NS comparison, no statistically significant differences were observed between the two groups with regards to age, gender, stage at presentation, B symptoms, bulky disease or favorable features. The rate of complete response (CR) in the SV group was 74% vs. 87% in the t-NS group (P=0.05). Moreover, at a median follow up of 49 months, the median progression free survival (PFS) was inferior in the SV group (17.02 months) compared with the t-NS group (not reached) (P<0.0001; HR = 3.695; 95% CI=3.0-11.07). The median overall survival (OS) was not reached in both groups and was not statistically different [Fig.1&2, P=0.32]. Significant differences in PFS and OS were observed based on stage of disease (early vs. advanced) and achievement of complete response at end of treatment by univariate analysis. In the corresponding multivariate analysis, achievement of CR following completion of treatment was the only independent predictor for OS. Discussion: In summary, our results suggest that SV was associated with a lower rate of complete response to standard ABVD chemotherapy +/- radiation and inferior PFS. Despite the high rate of relapse associated with SV, these patients can be salvaged with standard salvage regimens, ASCT or newer immunomodulatory agents and therefore not compromising OS. Our report suggests that patients with SV should be considered for novel combination immuno-chemotherapies to improve the rate of complete remission and subsequently avoid the need for ASCT. Figure 1. PFS in patients with SV vs. t-NS Figure 1. PFS in patients with SV vs. t-NS Figure 2. OS in patients with SV vs. t-NS Figure 2. OS in patients with SV vs. t-NS Disclosures Reddy: PCYC: Consultancy; ImmunoGen: Consultancy; Gilead: Other: Speaker; Seattle Genetics: Consultancy; Celgene: Consultancy, Research Funding.

Management of Classical Hodgkin's Lymphoma: Single Center Experience from Tawam Hospital, United Arab Emirates

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5363-5363
Author(s):  
Hani Y Osman ◽  
Amar Lal ◽  
Sabir Hussain ◽  
Arif Alam ◽  
Musab AbdAlrahman
Keyword(s):  
Combination Chemotherapy ◽  
Hodgkin’S Lymphoma ◽  
Complete Response ◽  
Hodgkin's Lymphoma ◽  
Disease Stage ◽  
Advanced Stage ◽  
Mixed Cellularity ◽  
Early Stage Disease ◽  
Nodular Sclerosis ◽  
Stage Disease

Abstract Classical Hodgkin's lymphoma (cHL) is an uncommon lymphoproliferative disorder. In general Hodgkin's lymphoma is a disease of the younger population affecting mostly patient of 15 to 30 years of age. There is second peak of incidence noticed among older population of 70 years of age or more. Histologically, Hodgkin's lymphoma is broadly classified into nodular lymphocyte predominant or classical Hodgkin's lymphoma which is further sub classified into 4 subtypes: lymphocyte-rich, lymphocyte-depleted, mixed cellularity and nodular sclerosis. The commonest subtype is the nodular sclerosis which accounts for 70% of the cases of classical HL, this is followed by the mixed cellularity subtype which account for 20 to 25% of the cases. cHL is characterized by the presence of the Reed Sternberg cells (HRS cells) within a background of non-malignant inflammatory cells. Most patient with advanced stage Hodgkin's lymphoma in general are managed with either the 6 to 8 cycles of ABVD combination chemotherapy or 6 cycles of escalated BEACOPP. In this retrospective study, we reviewed the cHL patient's demographics, management and their outcome in our center. The data base in this institution was searched over 5 year's period (January 2011 to December 2015). 29 patients were identified to be included in the study however one patient was lost to follow up so the outcome of his disease could not be traced. Data was collected regarding age, sex, stage, International prognostic index (IPI), treatment and outcome. The median age was 50 years (range 21 to 62 years). Out of the total number, 57% were males (N 16) and 43% were females (N 12). In terms of the histological subtypes of our cohort, the commonest was the nodular sclerosis subtype which occurred in 75% (N 21) followed by mixed cellularity 25 % (N 7) Most of the patients were diagnosed with early stage disease (stage 1-2) 71 % (N 20) while the rest had advanced stage disease. In terms of the international prognostic scoring stratification, the majority are of good risk group with IPI score 1 at 43% (N 12), IPI score 2 at 25% (N 7), while IPI score 3 is 14% (N 4), IPI score 4 is 11% ( N 3) and IPI score 5 is only in 7% ( N 2) of the patients. The majority of patients were managed with ABVD combination chemotherapy with excellent outcome as 85 % of our evaluated patients achieved complete response at the end of their treatment course. Only 15 % of the patients had residual disease at the end of their treatment. One patient received BEACOPP combination chemotherapy, his IPI scorewas 3 and he had persistent disease at the end of his treatment. Although the number of the patients included is small, our study confirmed that ABVD protocol is an excellent regimen for the treatment of classical Hodgkin's lymphoma. This is shown in a significant number of our patient achieving complete response after receiving 6 to 8 cycles of ABVD. Disclosures Osman: BMS: Honoraria. Lal:BMS: Honoraria. Hussain:BMS: Honoraria. Alam:BMS: Consultancy, Honoraria; Biologix: Honoraria.

scholarly journals Primary Cutaneous Anaplastic Large-Cell Lymphoma: A Surveillance, Epidemiology, and End Results Database Analysis from 2005-2016

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4022-4022
Author(s):  
Cesar Gentille Sanchez ◽  
Joe Ensor ◽  
Akshjot Puri ◽  
Jasleen K. Randhawa ◽  
Shilpan S. Shah ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck ◽  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
Large Cell ◽  
Seer Database ◽  
Skin Site ◽  
Large Cell Lymphoma ◽  
Overall Survival Rates

Introduction Primary cutaneous anaplastic large-cell lymphoma (PCALCL) is a rare T-cell lymphoma that presents as a solitary or grouped nodules. It is characterized by anaplastic-appearing cells that are usually ALK negative but have high expression of CD30. There is paucity of epidemiologic data on PCALCL. A prior analysis of the Surveillance, Epidemiology, and End Results (SEER) database by Yu et al. reported only 157 cases from 1973 to 2004. We are presenting an analysis of the patients diagnosed with PCALCL after 2004. Methods We used the SEER database to retrospectively identify patients diagnosed with PCALCL from 2005 to 2016. The database collects data from cancer registries covering approximately 26% of the US population and was used to estimate frequencies and overall incidence rate. Survival was analyzed using the Kaplan-Meier method and log-rank tests were used to compare survival distributions. We assessed the effect of primary skin site (head and neck) and increasing age on survival as they were suggestive of decreased overall survival on multivariate analysis of the 1973-2004 cohort. P < 0.05 was considered statistically significant for all analysis. Results There were 501 cases of PCALCL recorded from 2005 to 2016. Median follow-up was 52 months. The overall incidence rate was found to be 0.12/1,000,000 age adjusted to the 2000 US standard population. More than 50% of the cases were diagnosed after 2010. The median age at diagnosis was 61 years (2-97 years). It was seen most frequently in White (72.9%) patients followed by Hispanic (10.2%) and Black (9.4%) patients. The male to female ratio was 1.42. The most common primary sites affected were the skin of the lower limbs and hip (26.4%) and head and neck (21.3%). A 33.4% of patients required treatment which was mainly excisional (1 patient required amputation). Notably, PCALCL was diagnosed as a second or third malignancy in 19.2% of cases. Overall survival rates at 5 years and 10 years were found to be 80.6% (95% CI: 76.3%, 84.3%) and 61.5% (95% CI: 54.1%, 68.1%) respectively. Age greater than 60 years old was significantly associated with a lower survival (89.7% vs 54.4%, p<0.0001). Survival was not significantly different if head and neck was the site of the primary lesion (64.2% vs 60.8%, p = 0.4371). Conclusion Our analysis of the SEER database for PCALCL is the largest done to our knowledge. Although the number of cases has almost tripled since 2005, it is still a rare type of cutaneous T-cell lymphoma. Lower extremities and hips are the most frequent primary skin site. Only a third of the patients required treatment with overall survival rates of more than 80% by 5 years. Older age (more than 60 years old) is associated with a worse outcome. Head and neck as the primary skin site does not appear to be associated to lower survival as previously thought. Disclosures No relevant conflicts of interest to declare.

Stereotactic radiotherapy in patients with oligometastatic or oligoprogressive gynecological malignancies: a multi-institutional analysis

2020 ◽  
Vol 30 (6) ◽  
pp. 865-872 ◽  
Author(s):  
Cem Onal ◽  
Melis Gultekin ◽  
Ezgi Oymak ◽  
Ozan Cem Guler ◽  
Melek Tugce Yilmaz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Complete Response ◽  
Term Survival ◽  
Free Survival ◽  
Oligometastatic Disease

IntroductionData supporting stereotactic body radiotherapy for oligometastatic patients are increasing; however, the outcomes for gynecological cancer patients have yet to be fully explored. Our aim is to analyze the clinical outcomes of stereotactic body radiotherapy in the treatment of patients with recurrent or oligometastatic ovarian cancer or cervical cancer.MethodsThe clinical data of 29 patients (35 lesions) with oligometastatic cervical cancer (21 patients, 72%) and ovarian carcinoma (8 patients, 28%) who were treated with stereotactic body radiotherapy for metastatic sites were retrospectively evaluated. All patients had <5 metastases at diagnosis or during progression, and were treated with stereotactic body radiotherapy for oligometastatic disease. Patients with ≥5 metastases or with brain metastases and those who underwent re-irradiation for primary site were excluded. Age, progression time, mean biologically effective dose, and treatment response were compared for overall survival and progression-free survival.ResultsA total of 29 patients were included in the study. De novo oligometastatic disease was observed in 7 patients (24%), and 22 patients (76%) had oligoprogression. The median follow-up was 15.3 months (range 1.9–95.2). The 1 and 2 year overall survival rates were 85% and 62%, respectively, and the 1 and 2 year progression-free survival rates were 27% and 18%, respectively. The 1 and 2 year local control rates for all patients were 84% and 84%, respectively. All disease progressions were observed at a median time of 7.7 months (range 1.0–16.0) after the completion of stereotactic body radiotherapy. Patients with a complete response after stereotactic body radiotherapy for oligometastasis had a significantly higher 2 year overall survival and progression-free survival compared with their counterparts. In multivariate analysis, early progression (≤12 months) and complete response after stereotactic body radiotherapy for oligometastasis were the significant prognostic factors for improved overall survival. However, no significant factor was found for progression-free survival in the multivariable analysis. No patients experienced grade 3 or higher acute or late toxicities.ConclusionsPatients with early detection of oligometastasis (≤12 months) and with complete response observed at the stereotactic body radiotherapy site had a better survival compared with their counterparts. Stereotactic body radiotherapy at the oligometastatic site resulted in excellent local control rates with minimal toxicity, and can potentially contribute to long-term survival.

Long-term outcomes of patients with advanced-stage cutaneous T-cell lymphoma and large cell transformation

Blood ◽  
2008 ◽  
Vol 112 (8) ◽  
pp. 3082-3087 ◽  
Author(s):  
Suzanne O. Arulogun ◽  
H. Miles Prince ◽  
Jonathan Ng ◽  
Stephen Lade ◽  
Gail F. Ryan ◽  
...  
Keyword(s):  
De Novo ◽  
Cell Transformation ◽  
Early Stage ◽  
Large Cell ◽  
Tumor Stage ◽  
Advanced Stage ◽  
Long Term Outcomes ◽  
Stage Disease ◽  
Large Cell Transformation

Abstract Although mycosis fungoides (MF) is typically an indolent disease, patients with advanced-stage disease (stages IIB-IVB), including Sézary syndrome (SS), often have a poor outcome. A 31-year, retrospective analysis of our cutaneous lymphoma database, of 297 patients with MF and SS, was undertaken to study long-term outcomes and identify clinical predictors of outcome in patients with advanced-stage disease (ASD, n = 92) and large cell transformation (LCT, n = 22). Two-thirds of patients with ASD presented with de novo ASD. The median overall survival (OS) for ASD was 5 years with a 10-year predicted OS of 32%. Age at initial diagnosis (P = .01), tumor stage (P = .01), and clinical stage (P = .001) were found to be significant predictors of outcome. Patients who presented with de novo ASD demonstrated better outcomes that were not statistically significant than those with a prior diagnosis of early-stage MF (P = .25). Transformation developed in 22 of the 297 MF/SS patients (7.4%), with a transformation rate of only 1.4% in patients with early-stage disease, compared with stage IIB (27%) and stage IV (56%-67%) disease. The median OS from diagnosis of LCT was 2 years. We confirm that the incidence of LCT is strongly dependent on tumor stage at diagnosis, and we demonstrate a much lower overall risk of LCT than previously reported.

scholarly journals A CASE OF ILEOILEAL INTUSSUSCEPTIONS CAUSED BY BURKITT’S LYMPHOMA

2016 ◽  
Vol 7 (1) ◽  
Author(s):  
F. Molinaro ◽  
E. Bindi ◽  
M. Sica ◽  
F. Mariscoli ◽  
R. Angotti ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Histological Examination ◽  
Surgical Intervention ◽  
Burkitt’S Lymphoma ◽  
Burkitt's Lymphoma ◽  
World Health ◽  
Disease Stage ◽  
Metabolic Complications ◽  
Intestinal Occlusion ◽  
Stage Disease

<strong>Introduction</strong> Burkitt’s lymphoma is a high grade B-cell tumor described for the first time by the Irish surgeon Dennis Burkitt in 1958 in Africa. The most frequent of the clinical variants, in which it is classified by the World Health Organization (sporadic, endemic, HIV-associated), is the sporadic one, which usually involves the abdomen, in particular the ileocecal tract. Thus, a common clinical presentation is that of a child suffering from abdominal pain with nausea and vomit, until the dramatic case of an intestinal occlusion by an intussusceptions. According to this, the surgeon is the first who diagnoses and treats this tumor, playing an important role for the treatment, in terms of reduction of the metabolic complications of the medical therapy and of improvement of survival rate. In this work we present a case of a child operated for intestinal occlusion by ileoileal intussusception, caused by a Burkitt’s lymphoma, as it was diagnosed by histological examination few days after surgical intervention. <br /><strong>Case report</strong> A 12-years boy reached the emergency department for abdominal pain and vomit. Two weeks before he had a surgical intervention for a suspected appendicitis at another hospital. An ultrasound examination was performed and it revealed the presence of a complex mass in the right iliac fossa. The day after the patient felt worse and he had an episode of bilious vomit. An x-ray examination of the abdomen was performed and showed the presence of an intestinal obstruction. The patient underwent to surgical intervention. The obstruction was caused by an ileoileal intussusceptions, and it needed to perform a resection followed by anastomosis. Few day after surgical intervention, the result of histological examination indicated the presence of a Burkitt’s lymphoma within the tract resected. A CT scan was performed and showed the involvement of mesenteric lymph nodes. The bone marrow aspirate and the lumbar puncture showed no neoplastic presence. Then the patient started therapy according to protocol. <br /><strong>Discussion and Conclusions</strong> Burkitt’s lymphoma represents 3-5% of all non-Hodgkin lymphomas, and 40% in pediatric population. Children have an excellent prognosis with contemporary treatment regardless of the disease stage. Patients with limited stage disease are curable with limited treatment, avoiding complications associated with more intensive therapies. Nevertheless surgery is important in the management of this disease, the role of the surgeon has usually been controversial. A surgical intervention can be resolving in case of limited disease, or, in case of a high stage disease, it can be diagnostic or helpful, through the debulking of the mass. However, apart in case of intussusception, the diagnoses of Burkitt can be challenging and the presence of disease can revealed after a story of recurrent abdominal pain or after surgical interventions for appendicitis. In this work we show how a timely diagnosis can be difficult and how it can be an obstacle for treatment. In this case the sudden worsening of clinical conditions permitted an early diagnosis with a complete resection of the ileum involved by Burkitt’s lymphoma has improved the prognosis and reduced therapy’s complications.

COPBLAM III: infusional combination chemotherapy for diffuse large-cell lymphoma.

1988 ◽  
Vol 6 (3) ◽  
pp. 425-433 ◽  
Author(s):  
D B Boyd ◽  
M Coleman ◽  
S W Papish ◽  
A Topilow ◽  
S K Kopel ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Combination Chemotherapy ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Complete Response ◽  
The Elderly ◽  
Diffuse Large Cell Lymphoma ◽  
Large Cell Lymphoma ◽  
The Difference

COPBLAM III, a polychemotherapy regimen consisting of cyclophosphamide, infusional vincristine, prednisone, infusional bleomycin, doxorubicin, and procarbazine, was administered to 51 patients with diffuse large-cell lymphoma. Ninety-six percent of patients age 60 or younger achieved a complete response (CR); none have relapsed. Overall, 88% of patients are alive and well and potentially in the survival plateau. For patients greater than 60 years, CR was obtained in 73%, with 42% potentially in the survival plateau, the difference resulting in part from four relapses, three toxic deaths, and one presumed unrelated death. These results in the elderly were paralleled by a relatively reduced ability to tolerate therapy. Toxicity was primarily pulmonary, occurring in 39% of patients, two of whom died. With an overall CR rate of 84%, of which 92% are sustained at a median follow-up of 40 months, COPBLAM III represents a highly effective treatment in a sizeable cohort of patients.

Late relapse in patients with diffuse large-cell lymphoma treated with MACOP-B.

1997 ◽  
Vol 15 (5) ◽  
pp. 1745-1753 ◽  
Author(s):  
A Y Lee ◽  
J M Connors ◽  
P Klimo ◽  
S E O'Reilly ◽  
R D Gascoyne
Keyword(s):  
Overall Survival ◽  
De Novo ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Late Relapse ◽  
Advanced Stage ◽  
Overall Survival Rate ◽  
Diffuse Large Cell Lymphoma ◽  
Alive With Disease ◽  
Large Cell Lymphoma

PURPOSE To examine the clinical course of patients who experienced a late relapse after initial curative chemotherapy for advanced-stage diffuse large-cell lymphoma. PATIENTS AND METHODS Between April 1981 and June 1986, 127 patients with de novo advanced-stage diffuse large-cell lymphoma were treated with a 12-week chemotherapy program (methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin [MACOP-B]). The overall survival rate at 10 years is 52%. One hundred six patients (83%) entered a complete remission (CR) and 43 of them relapsed. With a median follow-up duration of 146 months, 26 patients relapsed early and 17 relapsed late, ie, after a continuous CR (cCR) of greater than 24 months. All late relapses occurred in patients with B-cell lymphoma. RESULTS After 24 months from diagnosis, the rate of late relapse averaged 2.2% per year and reached a projected 22% actuarial risk of late relapse after 10 years. The median time to late relapse was 69 months (range, 38 to 141). Ten patients relapsed with aggressive histologic subtypes and were treated with curative intent using anthracycline-based chemotherapy. Four remain in second CR, one is alive with disease, and five died of disease or while on treatment. The 6-year overall survival rate from the time of relapse (SFR) for these 10 patients is 42%. Six patients relapsed with low-grade follicular lymphoma. These patients received various treatments intended to control, but not necessarily cure disease. One is in second CR, one is alive with disease, and four died of disease or while on treatment. The 6-year overall SFR rate for these six patients is 40%. bcl-2 translocation and Bcl-2 protein expression at diagnosis did not predict for the type of late relapse. One patient did not undergo repeat biopsy at relapse and died 9 months later despite aggressive therapy. CONCLUSION Curative therapy should be attempted in patients who relapse late with aggressive-histology lymphoma and those who relapse with follicular histology may benefit from palliative treatment. The behavior of late-relapse lymphoma is similar to de novo lymphoma, with outcome dictated by the histologic subtype at relapse.

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