Radioimmunotherapy for Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphoma (NHL) is the most common hematological malignancy in the United States with a rapidly increasing incidence. Most follicular NHL is indolent but incurable, whereas the more aggressive varieties do respond to therapy. Most patients with follicular NHL who transform to an aggressive NHL are very difficult to treat successfully. Treatment options have included chemotherapy, radiation, immunotherapy with monoclonal antibodies, alone or in combination, and hematopoietic stem cell transplantation. The efficacy of monoclonal antibodies is augmented when they are combined with a radioisotope like iodine-131 or yttrium-90. There have been a number of studies done in recent years studying the efficacy of this form of therapy, i.e., radioimmunotherapy (RIT) in patients with NHL. This review attempts to integrate the information from the various clinical trials done using RIT in patients with relapsed/refractory or newly diagnosed NHL and in hematopoietic stem cell transplantation. It also includes updates on the use of RIT in elderly patients and in patients with significant bone marrow involvement among other recent advances made in this field.     

Non-Hodgkin's lymphoma in pregnancy

Pregnancy in patients who have non-Hodgkin's lymphoma is unusual. We have reported a case of diffuse, poorly differentiated lymphocytic lymphoma, stage IIIa, in a patient whose disease went into remission after she received six courses of CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone). She became pregnant soon afterward and was delivered of a normal, full-term infant with a normal chromosomal pattern. Risk of teratogenicity appears to be negligible when chemotherapy is used during the third trimester of pregnancy.     

Lymphomas in solid organ transplantation

Background: The purpose of this investigation was to identify and characterize abdominal lymphomas as they occur in a large solid-organ-transplant population. Methods: A large transplant population was isolated, and all patients developing an abdominal lymphoma were identified. These patients were further characterized after review of their medical records and radiologic examinations. Results: Twenty-eight (1%) of 2925 patients developed lymphoma following transplantation. Of these 28 patients, 14 developed abdominal manifestations of disease. Examples of the wide variety of abdominal manifestations of posttransplant lymphoma are presented. Most of these patients had positive titers for Epstein-Barr virus and were treated with cyclosporin as a part of their immunotherapy. The majority of patients died secondary to this aggressive disease process. Conclusion: The development of lymphoma following solid organ transplantation is more common than in the general population. One-half of the patients in our study population developed abdominal manifestations of this disease. Received: 11 March 1997/Accepted after revision: 25 June 1997     

Intracranial Disease in Non-Hodgkin's Lymphoma

In an eighteen month period ending October 1978, nine casesof intracranial Non-Hodgkin's lymphoma were diagnosed in thiscentre. Eight patients had lymphomatous meningitis and one,multiple intracerebral lymphoma deposits. The commonest presentationwas with multiple cranial nerve palsies. Despite treatment fivepatients died within one month of diagnosis and at autopsy threepatients were found to have extensive lymphoma involving themeninges. Three patients remain in remission after combinationchemotherapy and radiotherapy. The incidence, clinical features,management and prognosis for this condition are discussed.     

Non-Hodgkin's lymphoma. Understanding the disease

An overview providing current knowledge about non-Hodgkin's lymphoma (NHL) is presented. The pathophysiology, epidemiology, clinical signs and symptoms, and the classification system of NHL are outlined. In addition, the staging of NHL, diagnostic procedures, treatment options, and recommendations related to follow-up care and managing recurrent disease are presented.     

利妥昔单抗联合CHOP化疗方案治疗非霍奇金淋巴瘤

目的：观察用利妥昔单抗联合CHOP化疗方案和单用CHOP化疗方案治疗B细胞系CD20阳性非霍奇金淋巴瘤患者的疗效及不良反应。方法：共23例B细胞系非霍奇金淋巴瘤患者,11例（R-CHOP组）采用利妥昔单抗联合CHOP化疗方案,12例（CHOP组）单用CHOP化疗方案。结果：在R-CHOP组中,完全缓解（CR）7例,部分缓解（PR）2例,有效率为81.8%;在CHOP组中,CR2例,PR3例,有效率为41.7%,两组有显著差异（P〈0.05）。胃肠道反应的发生率R-CHOP组为18.2%,CHOP组为16.7%,两组无显著差异（P〉0.05）;白细胞减少的发生率R-CHOP组为36.4%,CHOP组为41.7%,两组无显著差异（P〉0.05）;发热的发生率R-CHOP组为45.5%,CHOP组为8.3%,两组有显著差异（P〈0.05）。结论：用利妥昔单抗联合CHOP方案治疗B细胞系CD20阳性非霍奇金淋巴瘤患者疗效较好;化疗最明显的不良反应是发热,患者可以耐受,它可以做为临床一线治疗方案。     

Non-Hodgkin's Lymphoma Presenting with Isolated Cauda Equina Compression

A 50-year-old man, who had previously been well, presented withsymptoms and signs of progressive cauda equina compression.This was shown to be due to an extradural lesion which on biopsywas found to be a non-Hodgkin's lymphoma of the small cell lymphocytetype. There was no evidence of lymphoma deposits elsewhere.Non-Hodgkin's lymphoma rarely affects the central nervous systemexcept as a late feature of widely disseminated disease. Thiscase demonstrates that isolated spinal infiltration in the absenceof widespread disease can be a mode or presentation of a non-Hodgkin'slymphoma. Accordingly primary extradural non-Hodgkin's lymphomashould be considered in the differential diagnosis of spinalcord and root compression.     

Livin在非霍奇金淋巴瘤中表达的临床意义

本研究旨在探讨凋亡抑制因子Livin在非霍奇金淋巴瘤组织中的表达及其临床意义。应用免疫组织化学法检测Livin蛋白在30例非霍奇金淋巴瘤(non-Hodgkin′s lymphoma,NHL)患者及11例淋巴结反应性增生(reac-tive hyperplasia of lymph node)患者淋巴结中的表达,并应用real-time PCR对其中20例非霍奇金淋巴瘤、10例淋巴结反应性增生及4例正常人的淋巴结组织中Livin mRNA表达水平进行检测,分析livin蛋白和mRNA表达与NHL患者临床表现及其特征的相关性。结果表明,NHL患者淋巴结组织中Livin mRNA表达水平与正常淋巴结组织以及淋巴结反应性增生组织比较均显著增高(RQ中位数分别为12.4vs0.34和12.4vs0.61)(p0.01)。30例非霍奇金淋巴瘤中有16例Livin蛋白表达阳性,阳性率为53.3%;11例淋巴结反应性增生患者仅1例表达阳性,阳性率为9.1%;而且观察到Livin蛋白主要在细胞浆中表达,在胞核内极少见有表达。研究还显示,无论是LivinmRNA表达还是蛋白表达均与NHL的临床分期(p=0.023;p=0.009)、B症状(p=0.015;p=0.026)、血β2微球蛋白(β2-MG,p=0.031;p=0.012)及血清乳酸脱氢酶(LDH,p=0.037;p=0.007)密切相关,而两者的表达与年龄、性别及分型无明显相关性(p0.05)。结论:Livin mRNA及蛋白在NHL患者中表达增高,并与临床多项指标存在相关性,因此Livin表达水平对评价患者临床分期及预后可能具有重要的指导意义;对Livin在NHL中的作用机制的深入探讨将有助于揭示NHL的发生、发展及治疗的机理,并有望成为NHL未来治疗的重要突破点。     

非霍奇金淋巴瘤血清蛋白质质谱分析

目的：应用表面增强激光解析电离飞行时间质谱技术检测血清蛋白指纹图,通过差异蛋白组学筛选非霍奇金淋巴瘤（nonhodgkin’s lymphoma,NHL）特有的蛋白标记物,找出最佳的标志蛋白组合模式建立非霍奇金淋巴瘤诊断模型。方法：用Ciphergen公司生产的PBSII／C型蛋白质指纹图谱仪和AuChpi金芯片采集50例NHL患者（NHI。组）、50例淋巴结炎患者（淋巴结炎组）、50例健康志愿者（对照组）血清蛋白质指纹图谱,采用BiomakerWizard3．1版分析软件筛选差异蛋白,建立NHL诊断模型。结果：NHL患者、淋巴结炎患者、健康志愿者血清蛋白质指纹图谱之间有4个标志蛋白在NHL患者血清中高表达,3个标志蛋白在NHL血清中低表达。分析系统筛选出质荷比（M／Z）4966、9278、6633、4222、9216、9237和7714标志蛋白建立NHL诊断模型,该模型对NHL的诊断灵敏度和特异性分别为92％和98％。结论：NHL与淋巴结炎组、对照组比较血清蛋白质表达具有显著差异,筛选其中差异蛋白质可用于建立NHL预测模型。     

Non-Hodgkin's lymphoma presenting with isolated cauda equina compression

A 50-year-old man, who had previously been well, presented with symptoms and signs of progressive cauda equina compression. This was shown to be due to an extradural lesion which on biopsy was found to be a non-Hodgkin's lymphoma of the small cell lymphocyte type. There was no evidence of lymphoma deposits elsewhere. Non-Hodgkin's lymphoma rarely affects the central nervous system except as a late feature of widely disseminated disease. This case demonstrates that isolated spinal infiltration in the absence of widespread disease can be a mode of presentation of a non-Hodgkin's lymphoma. Accordingly primary extradural non-Hodgkin's lymphoma should be considered in the differential diagnosis of spinal cord and root compression.     

Correlating Metabolic Activity with Cellular Proliferation in Follicular Lymphomas

Purpose  The aim of this study was to correlate metabolic behavior of follicular lymphoma with proliferative index (Ki67). Materials and Methods  Pre-treatment 2-deoxy-2-[F-18]fluoro-d-glucose positron emission tomography–computed tomography scans of 23 patients with pathologic diagnosis of follicular lymphoma were retrospectively analyzed together with Ki67. The maximal standardized uptake value (SUV) was measured and corrected to glucose level of 100 mg/dl over the biopsy region (BxSUV100) and at the highest tumor activity of the body (BmSUV100). Results  BxSUV100 was significantly correlated with Ki67 (p = 0.037). There was an increasing trend of metabolic activity across the pathologic grades of follicular lymphomas. BmSUV100 and BxSUV100 were also significantly different (p < 0.0005), suggesting potential pitfalls of sampling error by histology. Conclusion  The increasing trend of metabolic activity across follicular lymphoma grades correlates with cellular proliferation. The metabolic information from positron emission tomography–computed tomography may offer another useful parameter in the management of follicular lymphomas.