老年非霍奇金淋巴瘤R-CHOP14治疗方案疗效评价

目的对利妥昔单克隆抗体联合CHOP方案(R-CHOP14)治疗老年非霍奇金淋巴瘤(NHL)的临床疗效、不良反应进行研究和分析,并了解其对免疫功能的影响。方法采用回顾性研究分析方法,将70例老年非霍奇金淋巴瘤患者分为R-CHOP14组24例、CHOP14组23例及CHOP21组23例,6个疗程后,观察3组的临床疗效及不良反应的发生情况。结果R-CHOP14组患者的完全缓解率为70.8%,总有效率为83.3%;CHOP14组患者的完全缓解率为39.2%,总有效率为65.2%;CHOP21组患者的完全缓解率为34.8%,总有效率为56.6%;RCHOP14组患者的完全缓解率高于CHOP14组及CHOP21组;疗效差异有统计学意义(P<0.05);3组患者间不良反应发生率差异无统计学意义(P>0.05)。结论R-CHOP方案治疗老年非霍奇金淋巴瘤疗效好,不良反应小,效价比高,耐受好,但会使免疫功能受损,感染发生率增加。     

Experience with surgical treatment of osteosarcoma]

The authors treated 79 patients with osteosarcoma by surgery and chemotherapy 1975 through 1991. The appearance, localization and differential diagnosis are discussed. Attention is called to the doctor's delay. The effective pre- and postoperative chemotherapy decreased the incidence of the lung metastases and increased the survival rate (71% 3 years overall survival and 41% 5 years survival) and made the limb-sparing surgery possible. The development of the reconstructive surgical technique and new designs of tumor endoprostheses enabled us to perform limb-sparing surgery in more than one third of the cases at the same survival chance. The limb-sparing means a decisive change in the quality of the rehabilitation of the osteosarcoma patients.     

Experience with surgical treatment of ascendant varicophlebitis]

In ascendant varicophlebitis, the authors suggest not only crossectomy, but also radical removal of the dilated part of the great saphenous vein and of all thrombosed and non-thrombosed varicose veins in one session. They consider it important to clear the extension of the thrombosis by using an ultrasonic doppler flowmeter or the duplex scan technique; phlebography is needed only if deep venous affection is suspected. Cardinal questions of the operative technique are discussed. In cases of deep venous affection, thrombectomy is performed with Fogarty catheter. Antibiotics are generally held to be unnecessary, but early mobilisation and postoperative low-dose heparin prophylaxis are of great importance. No significant complications were detected after 37 interventions. Every patient was controlled one year after surgery. Residual complaints were found more rarely in the radically treated group. As concerns the quick and definitive recovery, mention is made of favourable economic consequences of the active surgical treatment.     

Agricultural exposures and non-Hodgkin's lymphoma

Farmers have an increased risk of non-Hodgkin's lymphoma (NHL), several studies have found increased risks of NHL among producers or sprayers of pesticides. The findings are markedly inconsistent across countries and studies, but overall there is evidence of an increased risk among production workers and professional pesticide sprayers with heavy exposures. However, this increased risk does not appear to be confined to workers exposed to phenoxy herbicides containing 2,3,7,8-tetrachlorodibenzo-p-dioxin, and it may be due to phenoxy herbicide exposure itself rather than to the dioxin contaminants. Other pesticide exposures, including organochlorine and organophosphorous insecticides, have also been associated with NHL in some studies, as have nitrates in drinking water. Farmers may also have exposure to oncogenic viruses carried by farm animals, and studies of slaughterhouse workers and meat inspectors have found increased risks of NHL.     

Pretreatment with rituximab enhances radiosensitivity of non-Hodgkin's lymphoma cells

The present study examines the effects of ionizing radiation in combination with rituximab (RTX), a chimeric human anti-CD20 monoclonal antibody, on proliferation, cell cycle distribution and apoptosis in B-lymphoma RL and Raji cells. Exposure to ionizing radiation (9 Gy) induced cell growth delay and apoptosis in RL cells, whereas Raji cells showed moderate radio-resistance. The simultaneous exposure of lymphoma cells to ionizing radiation and RTX (10 microg/mL) markedly enhanced apoptosis and cell growth delay in RL and Raji cells. Cooperative antiproliferative and apoptotic effects of RTX and radiation were achieved through the inhibition of c-myc and bcl-XL expression. Furthermore, RTX-modulated expression of cell cycle regulating proteins, such as p53, p21/WAF1, p27/KIP1, contributed to the development of radiation-induced cell killing and growth arrest. Each NHL cell line that underwent apoptosis induced by combination treatment revealed enhanced caspase-3 and poly (ADP-ribose) polymerase (PARP) cleavage as compared to only irradiated cells. These findings show that rituximab synergistically enhances radiation-induced apoptosis and cell growth delay through the expression of proteins involved in the programmed cell death and cell cycle regulation pathways.     

Prescription medications associated with a decreased risk of non-Hodgkin's lymphoma

Earlier epidemiologic studies have suggested an inverse association between non-Hodgkin's lymphoma and exposure to histamine(2) (H(2)) blockers, nonsteroidal anti-inflammatory drugs, cholesterol-lowering drugs, and antibiotics. Data from the PHARMO database were used to conduct a nested, population-based case-control study that included 1985-1998 drug-dispensing records for 300,000 residents of six Dutch cities. Included were those subjects without a previous history of cancer who were aged >/=20 years and were registered with an incident primary discharge diagnosis of non-Hodgkin's lymphoma between 1991 and 1998. This paper includes data on 211 cases and 800 controls individually matched on sex, age, community pharmacy, calendar time, and duration of follow-up. Conditional logistic regression analysis was used to evaluate the association between non-Hodgkin's lymphoma and categories of cumulative drug use in days. In multivariate analyses, nonsignificant risk reductions were found for all drugs tested, and the negative association tended to increase with increasing duration of use. For women, the odds ratio for H(2) blockers was 0.29 (95% confidence interval: 0.12, 0.69) and for analgesics was 0.40 (95% confidence interval: 0.22, 0.71). Results support an inverse association between occurrence of non-Hodgkin's lymphoma and use of H(2) blockers and analgesics among women, and they warrant confirmation in larger studies.     

Diagnosis and treatment of primary gastric non-Hodgkin's lymphoma: analysis of 157 patients

OBJECTIVE: To seek the optimum treatment for patients with primary gastric non-Hodgkin's lymphoma and factors associated with prognosis. METHODS: A retrospective study was conducted on 157 primary gastric non-Hodgkin's lymphoma patients who had received operation for 45 years. RESULTS: The X-ray diagnosis rate was 39.4% before operation. The diagnosis rate by gastroscopy was 52.7%. Among the 157 patients, 32 belonged to stage I(E), 40 stage II(E), 29 stage III(E), and 56 stage IV(E). All of the patients were received chemotherapy or radiation. The 3-, 5-, 10-, 15-year survival rates were 51.1% (69/135), 42.3% (55/130), 20.7% (23/111), and 13.5% (14/104). CONCLUSIONS: The 3-, 5-year survival rates in stage I(E) and stage II(E) were 2 to 5 times higher than those in stage III(E) and IV(E) (P < 0.01). The 3-, 5-year survival rates of primary gastric non-Hodgkin's lymphoma were 60.2% (65/108) and 50.0% (52/104) respectively. The prognosis was better than the 5-year survival rate of gastric cancer patients with D(2) lymphodenectomy (33.3%). Early diagnosis and treatment are effective to prevent complications, enhance quality of patient's life, and prolong the survival.     

Occupational chlorophenol exposure and non-Hodgkin's lymphoma

Occupational exposure to chlorophenols is suspected to increase non-Hodgkin's lymphoma (NHL) risk. This association was examined using data on 995 NHL cases and 1783 controls from the Selected Cancers Study, a population-based case-control study of men aged 32 to 60 years from eight population-based cancer registries conducted from 1984 to 1988. Potential chlorophenol exposure was characterized by an industrial hygienist using intensity estimates and confidence ratings, based upon review of verbatim job histories. Cases with substantial chlorophenol exposure had a significantly greater number of years of chlorophenol exposure (median years: cases, 4.0; controls, 2.0; P = 0.046); however, in conditional logistic regression models, the odds ratio for more than 8 years of substantial exposure was 1.51 (95% CI, 0.88 to 2.59). Overall, the findings do not provide strong support for an association with NHL risk. Chlorophenol exposure in this study is not based upon measured values and, therefore, may fail to characterize actual chlorophenol exposures accurately. Because of the large presence of machinists in the potentially chlorophenol-exposed group, these results may be underestimated by exposure misclassification if these subjects were not exposed to chlorophenolic biocides. However, these results are consistent with other findings, which suggest that chlorophenol exposure is not likely to be a strong risk factor for NHL.     

Nutrient intake and risk of non-Hodgkin's lymphoma

The mechanisms through which diet may influence the development of non-Hodgkin's lymphoma (NHL) are unclear but can be better understood by examining associations between nutrient consumption and NHL risk. Between 2000 and 2002, 591 NHL cases and 460 population-based controls in Sweden completed a semiquantitative food frequency questionnaire. Unconditional logistic regression was performed to estimate odds ratios and 95% confidence intervals for associations with nutrient intake; all statistical tests were two sided. Dietary intake of most macronutrients was not associated with risk of NHL or its common subtypes. Consumption of omega-3 or marine fatty acids was associated with decreased risk of NHL and chronic lymphocytic lymphoma, and dietary fiber was associated with lower risk of all subtypes examined. When the highest and the lowest quartiles of marine fat intake were compared, the odds ratio for NHL risk was 0.6 (95% confidence interval: 0.4, 0.9), ptrend=0.03; for dietary fiber intake, the corresponding odds ratio was 0.5 (95% confidence interval: 0.3, 0.7), ptrend<0.001. Dietary consumption of beta-carotene or alpha-tocopherol was associated with lower NHL risk, whereas intake of calcium or retinol was associated with increased NHL risk. Nutrients that affect inflammation, vitamin D activity, oxidative DNA damage, or DNA methylation may be associated with risk of NHL.