Treatment outcome of radiotherapy alone versus radiochemotherapy in early stage nasal natural killer/T-cell lymphoma

This study aims to investigate the prognostic factors and long-term treatment outcome in patients with early stage nasal natural killer (NK)/T-cell lymphoma. Sixty-four patients were recruited in this study, whose clinical and laboratory data were collected from hospital records. Early stage (stage IE: 51, stage IIE: 13) nasal NK/T-cell lymphoma (NNTCL) was established according to Ann Arbor staging classification. Among these patients, 23 received radiotherapy (RT) alone, the remaining 41 cases were treated with radiochemotherapy (RCT) comprised of 1–6 cycles of anthracycline-based chemotherapeutic regimens. Results show that the median overall survival (OS) time was 41 months. The 5-year OS and progression-free survival rates were 59.2 and 52.3%, respectively. The 5-year OS rate for patients who received RT alone was 57.9%, whereas that for patients who received RCT was 61.5% (P = 0.47). There is no significant difference between two treatment modalities. Multivariate analysis showed that Eastern Cooperative Oncology Group performance status (PS) score ≥ 2, local tumor invasion out of nasal cavity, and lower complete remission (CR) rates in the initial treatment were significant unfavorable independent prognostic factors. Taken together, our study suggests that RCT did not improve the survival rate of patients with early stage NNTCL. PS score before treatment, local tumor invasion out of nasal cavity, and CR rate of the primary treatment may be independent prognostic factors among the subtype lymphoma entity.     

原发性肠道非霍奇金淋巴瘤 53例临床预后分析

背景与目的：胃肠道是淋巴瘤最常见的结外侵犯部位。本文对原发性肠道非霍奇金淋巴瘤的临床及病理特征进行分析,探讨各种临床指标与预后的关系。方法：选择1980年1月至2000年1月我院治疗的原发性肠道非霍奇金淋巴瘤共53例,均在我院腹部外科或内科接受手术治疗或化疗并进行随访。应用SPSS10．0软件行生存分析并对各临床指标与预后的关系进行Cox单因素和多因素分析。结果：5年总生存率为49．59％,10年预期总生存率为41．33％。log—rank单因素分析显示病理免疫表型(T／B)、有无B症状、血清乳酸脱氢酶(lactate dehydrogenase,LDH)是否升高、临床分期(包括Musschoff和Rohitiner两种分期法)、PS状态、能否完全切除、肠病灶数等因素都与生存密切相关。而年龄、性别、肿瘤大小和治疗模式与总生存期无关。Cox模型进行多因素分析发现仅病理免疫表型(T或B细胞型)与总生存期有关。结论：原发性肠道非霍奇金淋巴瘤的病理免疫表型是独立的预后危险因素,T细胞性淋巴瘤其临床进程快、疗效及预后差。     

Patterns of failure and influence of potential prognostic factors after surgery in transitional cell carcinoma of the upper urinary tract

Background  We investigated the long-term outcome of upper urinary tract transitional cell carcinoma (TCC) after surgery. Methods  The study population comprised 114 surgically treated patients with upper urinary tract TCC treated at Jikei University Hospital between March 1990 and December 2004. All these patients underwent radical surgery without any type of neoadjuvant therapy. Patterns of failure and patient survival were compared with clinicopathological parameters. Results  The 5- and 10-year overall survival (OAS) rates for the patients were 85% (95% confidence interval [CI], 81%–89%) and 76% (95% CI, 69%–83%). To date, 19 patients (16.7%) have experienced distant or lymph node metastasis at a mean of 13.3 months following surgery (range, 1 to 50 months). The site of the primary tumor did not affect patient survival (P > 0.05). Both lymphovascular involvement (LVI) and positive lymph nodes were found to have poor prognosis in univariate analysis (P = 0.004 and P < 0.0001). Multivariate analysis indicated pathological stage and bladder recurrence (bladder recurrence being a better prognostic factor) to be independent predictors of metastasis-free survival, but not of OAS or cause-specific survival (CSS). Conclusion  Pathological stage and bladder recurrence were found to be the predictors of metastasis-free survival in this study. Further searching for reliable biomarkers is needed to accurately predict the prognosis of this malignancy.     

Primary gastric lymphoma of T-cell origin: clinicopathologic features and treatment outcome

We conducted a retrospective analysis to investigate the natural history and the clinical outcome after treatment of primary gastric lymphoma of T-cell origin. Seventeen cases of T-cell origin among 444 primary gastric lymphoma patients were analyzed. The median age of the 14 male and 3 female patients was 49 years (range 22-76 years). The median progression-free survival (PFS) and overall survival (OS) were only 10 months (95% CI; 0-20 months), and 12 months (95% CI; 4-21 months), respectively. This study showed that the incidence of this subtype of T-cell gastric lymphoma was very rare, and had poor prognosis.     

Secondary intramedullary spinal cord non-Hodgkin’s lymphoma

Intramedullary spinal cord metastases of solid neoplasms are associated with poor long-term survival. As the characteristics of secondary intramedullary spinal cord non-Hodgkin’s lymphoma (NHL) are not well understood, we sought to describe its clinical features and outcome. We retrospectively reviewed the Mayo Clinic patient database, lymphoma database, and pathology records from 1996 to 2010 and identified patients with clinical myelopathy and neuroimaging evidence of secondary intramedullary spinal cord involvement from pathologically confirmed systemic NHL. Seven patients were included in this study. The median age was 61 years (range, 41–81). Symptom onset was subacute (≤8 weeks) in six. Four patients were wheelchair-dependent at diagnosis. Spinal cord NHL was diagnosed by cerebrospinal fluid cytology in four; Positron emission tomography hypermetabolism in two; or MRI features alone. Myelopathy developed in five patients at a median 8 months (range, 1–58) following systemic NHL diagnosis, while myelopathy was the heralding symptom of NHL in two patients. Spinal cord MRI lesions were characteristically gadolinium enhancing and expansile. Four patients had co-existing MRI brain lesions. Six patients had B-cell NHL and one patient T-cell NHL. Six of the seven were treated (high dose intravenous methotrexate in three; radiation therapy in two; and R-CHOP in one). Median survival was 11.5 months (range, 1–28) with a 33% 2-year survival compared to historical median survival estimates of spinal cord metastases due to solid tumors of 3 months. In secondary intramedullary spinal cord involvement of NHL early neurological morbidity is common, but overall survival compares favorably to previously reported survival in spinal cord metastases from solid tumors.     

T-cell non-Hodgkin's lymphoma in adults: clinicopathological characteristics,response to treatment and prognostic factors

T-cell NHL represent 10-15% of all malignant lymphomas making systematic prospective clinical trials difficult. Therefore, the prognostic significance of the T-cell phenotype has been a matter of controversy in recent years. In a retrospective analysis of 681 patients (pts) with NHL accrued from 1992 to 1997 at a single institution, 66 patients with T-cell NHL were identified. According to the REAL classification, histologies were as follows: 28 peripheral T-cell lymphomas (PTCL), 19 large cell anaplastic lymphoma (LCAL), 12 precursor lymphoblastic lymphoma (Lb), and seven AILD. Multiagent anthracycline containing regimens were used as initial therapy in 91% of cases. T-cell NHL represent 9.8% of all NHL patients at our institution accrued over a 6-year period. Overall response rate was 76%, 21% had progressive disease and 3% died during first line treatment. Mean overall survival (OS) was 8.22 +/- 0.94 years. There was a significant difference in OS between the four different histological subgroups (log rank P=0.0288). LCAL: mean OS 11.05 +/- 1.55 years (95% CI 8.00-14.09); LB: mean OS 7.09 +/- 1.40 years (95% CI 4.33-9.84); PTCL: mean 6.62 +/- 1.17 years (95% CI 4.33-8.90); AILD: 1.54 +/- 0.44 years (95% CI 0.67-2.40). OS was also significantly different for patients classified according to the International Prognostic Index (IPI)-score (log rank P = 0.002). Mean OS for patients with low risk, intermediate low risk, intermediate high risk and high risk was 10.46 +/- 1.02, 6.46 +/- 1.79, 4.50 +/- 1.20 and 1.15 +/- 0.46 years, respectively. Univariate analysis (log-rank test) for prognostic factors also revealed elevated LDH, B-symptoms and extranodal involvement as significant factors for OS. The presence of bulky disease (>7.5 cm), advanced stage III/IV and bone marrow involvement did not influence OS. In conclusion, it is evident that histological subtype and IPI-score have a strong prognostic impact on OS in pts with T-cell NHL. Thus, the distribution of risk factors in patients with T-cell NHL may be more important for OS than T-cell histology per se.     

Prognostic significance of the immunophenotype versus the International Prognostic Index in aggressive non-Hodgkin's lymphoma

The International Prognostic Index (IPI) is currently the most widely accepted prognostic factor system for patients with aggressive non-Hodgkin's lymphoma (NHL). However, in constructing the model, the immunophenotype of the disease was not used as an independent variable. The purpose of the present study was to assess and compare the prognostic significance of the immunophenotype (B-cell vs. T-cell) of aggressive NHL with other well-established prognostic determinants, in particular the IPI. Between January 1995 and December 2000, a retrospective analysis was conducted of clinical and pathological data on 181 patients aged = 15 years who had been newly diagnosed with aggressive NHL. All pathology slides were reviewed and defined according to the Revised European-American Lymphoma classification. Forty-one patients (23%) had T-cell lymphoma and 140 patients (77%) had B-cell lymphoma. Diffuse large B-cell lymphoma and unspecified peripheral T-cell lymphoma were the 2 most common entities, comprising 63% and 14% of patients, respectively. Most of the pretreatment characteristics, including IPI risk groups, were not significantly different between B-cell and T-cell lymphomas. The rates of complete remission (71% vs. 54%, P = 0.038) and progressive disease (39% vs. 63%, P = 0.023) significantly favored patients with B-cell lymphoma. With a median follow-up time of 31 months (range, 10-81 months), the 5-year overall survival (49% vs. 27%; P < 0.001) and event-free survival (35% vs. 10%; P < 0.001) were significantly better in B-cell lymphoma. The 5-year disease-free survival was also in favor of the B-cell group (48% vs. 21%; P = 0.086). Patients with T-cell lymphoma yielded inferior survival in all IPI risk groups. Multivariate analysis revealed T-cell lymphoma as the most significant factor associated with short overall survival (relative risk [RR], 3.4; 95% CI, 1.9-5.9) and event-free survival (RR 2.7, 95% CI, 1.7-4.3). When a second multivariate analysis was done using IPI (age, stage, performance status, number of extranodal sites, and serum lactate dehydrogenase) as one independent variable, T-cell phenotype remained the strongest factor affecting the survival of patients (P < 0.001). T-cell lymphoma is an independent prognostic factor, the significance of which is at least comparable to the IPI for patients with aggressive NHL.     

原发扁桃体非霍奇金淋巴瘤89例临床分析

背景与目的：扁桃体是原发头颈部非霍奇金淋巴瘤（non-Hodgkin’s lymphoma,NHL）的最常见部位。本研究主要分析和总结原发扁桃体NHL的临床特点及治疗预后,探讨进一步改善预后和治疗后生存质量的可能途径。方法：回顾性分析1990年5月至2003年1月,89例初治原发扁桃体NHL患者的临床资料。按照改良的欧洲．美国淋巴瘤和WHO淋巴瘤分类原则进行病理分类。根据AnnArbor标准进行分期。Ⅰ期和Ⅱ期患者主要接受放化疗联合治疗,Ⅲ期和Ⅳ期患者以化疗为主。结果：89例患者中弥漫大B细胞型60例（67％）,外周T细胞型11例（12％）,惰性淋巴瘤5例（6％）,间变大T细胞型和T淋巴母细胞型各1例,未明确分类11例（12％）。Ⅰ期和Ⅱ期患者8l例（91％）,其中58例（72％）为放化疗联合治疗,19例（23％）为单纯放疗,3例（4％）为单纯化疗,1例（1％）为放化疗联合美罗华治疗。全组患者5年总生存率和无病生存率均为80％,Ⅰ期和Ⅱ期患者的5年生存率为84％。早期患者的生存率与原发耐药、复发和国际预后指数（internationalprognostic index,IPI）评分有显著性相关;而性别、年龄、病理类型、B症状、是否有巨块等对生存率均无显著性影响。结论：原发于扁桃体的NHL绝大部分为Ⅰ期和Ⅱ期的早期患者．因此预后较好。病理类型以弥漫大B细胞型最为多见。Cox回归分析显示在早期患者中原发耐药、复发和IPI〉1是影响预后的主要因素。     

Risk of non-Hodgkin lymphoma and nitrate and nitrite from the diet in Connecticut women

It has been estimated that 65,980 individuals were diagnosed with non-Hodgkin lymphoma (NHL) and 19,500 died from NHL in the United States in 2009. Although established risk factors such as immunodeficiency and viral infections may be responsible for a portion of the cases, the majority of NHL cases remain unexplained. Dietary nitrate and nitrite intake are exposures of particular interest for NHL risk as they are precursors in the endogenous formation of N-nitroso compounds, which cause lymphomas in animal studies. We investigated NHL risk overall and by histologic type in relation to dietary nitrate and nitrite intake in a population-based case–control study of 1,304 women in Connecticut. Nitrate and nitrite intake were assessed using a 120-item food frequency questionnaire. We found no association between risk of NHL overall and dietary nitrate and a slightly increased risk of NHL with higher dietary nitrite intake (highest vs. lowest intake quartile OR = 1.4; 95% CI: 0.9–2.2). When we evaluated intake by subtype, a significant positive trend was observed for follicular lymphoma and nitrate (p-trend = 0.04) and nitrite (p-trend < 0.01) with an over twofold risk in the highest nitrite intake quartile (OR = 2.3; 95% CI: 1.1–4.9). An increased risk in the highest quartile of nitrite intake was also observed for T-cell lymphoma (OR = 3.4; 95% CI: 1.0–11.9). Animal products containing nitrite were more strongly associated with risk of follicular lymphoma; whereas, both animal and plant sources of nitrite were associated with elevated ORs for T-cell lymphoma. Our results confirm a previous finding for nitrite intake and NHL risk and highlight the importance of evaluating histologic type. We conclude that these results should be replicated in a larger study with data on drinking water as well as dietary sources of nitrate intake.     

Basal vs. luminal a breast cancer subtypes: a matched case-control study using estrogen receptor,progesterone receptor,and HER-2 as surrogate markers

Breast cancer is a heterogeneous disease that encompasses several distinct entities with different biological characteristics and clinical behavior. Basal subtype is considered as a prognostically unfavorable subset. The purpose of this study is to compare the clinico-pathological characteristics and outcome of basal vs. luminal A subtype, as approximated by ER, PR, and HER-2. Sixty-four patients with basal breast cancer were matched for age, stage, and year of diagnosis with 64 patients having luminal A disease. Basal tumors were immunohistochemically defined by a lack of expression of estrogen receptor (ER), progesterone receptor (PR), and HER-2, while luminal A cancers were ER+ or PR+, and HER-2−. As compared with luminal A, basal subtype patients had significantly larger primary tumor size, higher percentage of grade III tumor, more tumor that showed lymphovascular invasion, less presence of non-invasive disease, and higher proportion of extranodal extension. There was no statistically significant difference in metastatic sites, pathology type, or in the axillary lymph nodal status. A few patients received neoadjuvant chemotherapy—13 and 9 patients in basal and luminal A groups, respectively). The complete pathological response was 20% and 14%, respectively (not significant). At a median follow-up of approximately 2 years, there was no statistically significant difference in the overall survival rate between basal and luminal A patients. Analysis of disease-free survival (DFS) for stage I–III (53 patients in each group) showed that the median DFS for basal patients was 41.4 months (95% CI, 26.5–55.3 months), whereas the DFS for the luminal A patients was not reached (P = 0.014). After adjusting for several significant prognostics variables identified in a univariate analysis, a multivariate conditional logistic regression analysis identified the negative effect of lymphovascular invasion and the favorable influence of the use of neoadjuvant and/or adjuvant chemotherapy. This matched case–control study confirmed the poor clinical and pathological characteristics of patients with basal subtype and their unfavorable outcome compared with luminal A disease. Management of basal tumors remains a challenging task, and new therapeutic strategies are warranted.     

Localised extranodal non-Hodgkin's lymphoma of the gastrointestinal tract: Sheffield Lymphoma Group experience (1989-1998)

Extranodal non-Hodgkin's lymphoma (NHL) of the gastrointestinal tract accounts for about one third of all extranodal NHL. We retrospectively reviewed the clinical and histopathologic records of 71 patients with stage IE and IIE primary gastrointestinal NHL referred to the Sheffield Lymphoma Group (SLG) from 1989 to 1998. Cross-referencing with the Hospital Histopathology Department database revealed that only two-thirds of all cases were seen by the Group. The most common primary site was the stomach (45 patients, 63% of all cases), followed by the small intestine (16, 23%) and large intestine (9, 13%). The median age of patients was 62 years; the majority of patients presented with stage I (61%) and/or grade (65%) NHL. Mucosa-associated lymphoid tissue (MALT) lymphomas were the largest histologic subtype seen (57%), with 87% of these arising from the stomach; next most frequent was the diffuse large B-cell subtype (21% of all cases) most frequently arising from the intestine (60%). For treatment of gastric MALT lymphoma, a combined approach (surgery followed by chemotherapy, antihelicobacter therapy followed by chemotherapy) was favoured (22 cases). Five-year and 10-year overall survivals were 52% and 45% respectively. Knowledge of the Revised European American Lymphoma classification and the Helicobacter pylori/MALT association has influenced treatment approaches over the 10-year study period. For small intestinal lymphoma, surgery (with or without chemotherapy) gave 5- and 10-year survivals of 60%. Overall survival of patients with primary gastrointestinal lymphoma managed by the SLG is similar to that reported from other large series.     

非霍奇金淋巴瘤1012例临床病理分析

目的:了解我院近10年来非霍奇金淋巴瘤(NHL)的发病特点,分析影响NHL预后的相关因素.方法:回顾性分析了近10年来我院收治的1012例NHL患者的临床病理特点,对影响新疆地区NHL生存率及预后的临床病理因素进行分析.结果:1012例NHL中以40～60岁汉族男性发病多见,最主要病理类型依次为弥漫性大B细胞淋巴瘤(DLBCL)346例(34.1%),外周T细胞淋巴瘤(PTCL)185例(18.3%),滤泡淋巴瘤(FL)97例(9.6%),黏膜相关淋巴组织淋巴瘤(MALT)94例(9.3%),NK/T细胞淋巴瘤62例(6.1%),T-淋巴母细胞淋巴瘤(T-LBL)47例(4.6%).结性起病的淋巴瘤619例(61.2%),结外起病的淋巴瘤393例(38.8%).本组维吾尔族女性FL淋巴瘤患者人数比例较汉族女性患者高(P=0.002),汉族男性PTCL患者人数比例高于维吾尔族男性患者(P=0.015).5年总生存率为45.8%.单因素分析显示临床分期,行为状态评分(PS),B症状,年龄,肿块大小,血清乳酸脱氢酶(LDH),结外器官受侵数目及IPI是NHL的预后因素(P＜0.05).多因素分析提示T细胞来源,Ⅲ～Ⅳ临床分期,IPI评分3～5分及LDH增高是NHL独立的预后不良因素(P＜0.05).结论:新疆地区NHL发病以中年多见,结性起病者多于结外起病,B细胞淋巴瘤多于T细胞淋巴瘤.免疫分型、临床分期、IPI、血清LDH水平与NHL预后相关.     

Analysis of Clinical Manifestations and Prognosis of 92 Cases with Non-Hodgkin＇s Lymphoma

Objective  To analyze the risk factors and influence of various treatments on the prognosis of non-Hodgkin’s lymphoma (NHL). Methods  Clinical data of 92 patients with NHL from our hospital were retrospectively reviewed. Kaplan-Meier statistics were used to analyze the differences in survival times of the patients receiving various treatments. Cox regression model was employed for analyzing the prognostic factors. Results  Among our patients, the 2 and 5-year disease-free survivals (DFS) were respectively 68% and 51%. The 5-year cancer-specific survival (CSS) was 55%. Mono-factorial analysis showed that the main independent prognostic factors included Ann Arbor Staging, B symptoms, lactate dehydrogenase (LDH), the international prognostic index (IPI) and age. Concerning the IPI, the 5-year CSS for the low-risk factors (0–1), lower-moderate risk (2), higher-moderate (3) and high-risk (4–5) were respectively 60%, 62%, 42% and 33%. Analysis of the prognoses, based on treatment of the patients with different stages, was as follows: the 5-year survival rates of the Stage-I and II patients, receiving surgery or chemotherapy alone, or a combined therapy, were respectively 19%, 72% and 68%, showing that the survival rates of the group with a combined therapy and the chemotherapy alone were superior to the group with surgery alone; the 5-year survival rates of the Stage-III and IV patients, receiving surgery or chemotherapy alone or a combined therapy, were respectively 50%, 35% and 60%, indicating that the survival rate of the group with a combined therapy was superior compared to the group with chemotherapy alone. Conclusion  Long-term survival of non-Hodgkin’s lymphoma patients is closely related with multiple factors. Rational detection and assessment of the risk factors may prolong the living time of the patients. Different methods of treatment can influence the patient’s prognosis. Correct evaluation of the prognostic factors, and rational and effective therapy can prolong the patient’s survival.     

Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome

Background: Malignant small intestine tumor accounts for 0.1–0.3%of all malignancies. Although primary adenocarcinoma is themost common histologic subtype, there is no report of the clinicalcharacteristics and natural history in the Asian population. Methods: We conducted retrospective analysis for the patients with thesmall intestine adenocarcinoma to explore the clinical characteristicsand prognosis. All patients with adenocarcinoma of small intestinediagnosed between March 1997 and March 2007 in the CatholicMedical Center in Korea were identified through the cancer registry.The medical records were reviewed for patient characteristics,treatment and outcome data. Results: Data on 53 patients were available. Twenty-six patients (49.0%)underwent curative resection and 13 patients receiving adjuvantchemotherapy. Fifteen patients received palliative chemotherapy.Median of overall survival of all patients was 12 months (95%confidence interval (CI): 8.5–15.1 months). Three-yearsurvival and relapse-free survival rates after curative resectionwas 66.1 and 50.8%, respectively. Median survival of patientsreceived palliative chemotherapy was 8.0 months (95% CI: 3.5–12.4). Conclusions: The prognosis of primary adenocarcinoma of small intestine waspoor, especially in cases where curative resection could notto be performed. Further study on the methods for early detectionand effective systemic chemotherapy should be investigated.     

Clinical and Pathological Features of Primary Gastrointestinal Non-Hodgkin＇s Lymphoma

OBJECTIVE The study was initiated to obtain histologic distribution, clinical features, and treatment results in patients with primary gastrointestinal non-Hodgkin‘s lymphomas.METHODS Between January 1990 and January 2000, 89 PGI NHL patients were eligible to evaluate clinical features. Histological and immunohistological studies were routinely used and all the specimens were reclassified according to the recently published WHO classification system.RESULTS (1)Clinically, among the 89 patients, there were 24 patients in stage IE,33 in stage IIE,19 in stage IIIE,and 13 in stage IVE. (2)Immunohistological studies revealed 72 patients were with B-cell type and only 17 with T-cell type. (3)Altogether, 15 MALT lymphoma were diagnosed among 89 PGI NHL patients, and 14/15 were found primary in the stomach.(4)The 3-year and 5-year overall survival were 77.0% (57/74) and 53.6% (30/56)for the total group.CONCLUSION No clinical symptoms and signs were found to be specific for the diagnosis of PGI NHL. Most patients were in stage IE and liE when diagnosed and the intermediate grade and B-cell type were more common than the others. Surgical resection of the tumor and standard combined chemotherapy post surgery were suggested to be the most effective measures for the long term survival of the PGI NHL patients.     

High incidence of hepatitis B virus infection in B-cell subtype non-Hodgkin lymphoma compared with other cancers

BACKGROUND: The authors investigated the prevalence of hepatitis B virus (HBV) infection by using serologic markers in non-Hodgkin lymphoma (NHL) compared with other types of cancers in Chinese patients. METHODS: In this case-control study, HBV and other hepatitis markers were compared between a study group and a control group. The study group included 587 patients with NHL (age range, 16-86 years), and the control group included 1237 patients (age range, 16-89 years) who were diagnosed with other cancers except liver cancer. An enzyme-linked immunosorbent assay was used to test serum samples from both groups for HBV markers and other hepatitis markers. RESULTS: Logistic regression analysis showed that there was a higher prevalence of HBV infection in patients with the B-cell subtype of NHL (30.2%) than in patients with other cancers (14.8%; odds ratio [OR], 2.6; 95% confidence interval [95% CI], 2.0-3.4); however, in patients with the T-cell subtype of NHL, the HBV infection rate (19.8%) was similar to that among patients with other cancers (OR, 1.2; 95% CI, 0.8-1.8). A significant difference in HBV prevalence was found between B-cell and T-cell NHL (OR, 2.3; 95% CI, 1.4-3.6). In the patients with B-cell NHL, those who were infected with HBV had a significantly earlier disease onset (9.5 years) than those who were not infected with HBV. CONCLUSIONS.: The current results demonstrated that patients with B-cell NHL, but not patients with T-cell NHL, had a higher prevalence of HBV infection. HBV infection was associated with a significantly earlier disease onset (P < .001), a finding that suggested the possibility that HBV may play an etiologic role in the induction of B-cell NHL.     

Treatment of T-cell non-hodgkin’ lymphoma

Opinion statement T-cell non-Hodgkin’s lymphoma (NHL) represents approximately 10% to 15% of all lympho-mas in Western countries. Patients with T-cell NHL are often treated similarly to patients with intermediate grade B-cell NHL, although many reports have demonstrated lower overall survival rates in patients with T-cell NHL compared to patients with B-cell NHL. Updated classifications have recognized specific clinical and pathologic T-cell entities, such as peripheral T-cell lymphoma, not otherwise characterized, angioimmunoblastic lymphoma, systemic anaplastic T-cell lymphoma, adult T-cell leukemia/lymphoma, subcutaneous panniculitis-like T-cell lymphoma, hepatosplenic T-cell lymphoma, extranodal natural killer (NK)/T-cell lymphoma nasal type, and enteropathy-type intestinal T-cell lymphoma. Furthermore, these distinct T-cell NHL subtypes often warrant individual-ized diagnostic and therapeutic strategies, such as the associated cytophagic histiocytic panniculitis and hemophagocytic syndrome with subcutaneous panniculitis-like T-cell lymphoma, the chromosomal translocation t(2;5), leading to the nucleophosmin anaplastic lymphoma kinase fusion protein, viral pathogenesis of Epstein-Barr virus, human T-cell lymphotropic virus type-1 associated with extranodal NK/T-cell lymphoma nasal type and adult T-cell leukemia/lymphoma, respectively, and the role of radiation therapy in extra-nodal NK/T-cell lymphoma nasal type. Other active therapeutic agents in T-cell NHL include purine and pyrimidine antimetabolite agents eg, nucleoside analogues and gemcitabine, respectively), denileukin diftitox, and antinucleoside or retinoic acid with interferon-α combination treatment. The exact role of transplantation in patients with T-cell NHL is unknown, but several case series have documented the feasibility of autologous and allogeneic transplant with reported long-term survival rates similar to transplanted B-cell NHL. Identification of relevant proto-oncogenes and tumor suppressor genes involved in the pathogenesis of T-cell NHL, such as the nucleophosmin anaplastic lymphoma kinase fusion protein, p53 and retinoblastoma gene, cyclin-dependent kinase inhibitors, histone deacetylation inhibitors, and infectious etiologies (eg, Epstein-Barr virus and Helicobacter pylori), in addition to their interplay with the various regulatory pathways of cell-cycle progression and apoptosis, represent potential candidates for molecular-based therapy. Prospective multi-institution clinical trials are critically important to determine the most effective treatment regimens that will continue to improve cure rates in these aggressive, yet treatable and often curable, diseases.     

Bone marrow involvement by non-Hodgkin's lymphoma: the clinical significance of morphologic discordance between the lymph node and bone marrow. Nebraska Lymphoma Study Group.

Bone marrow specimens from 317 patients with non-Hodgkin's lymphoma (NHL) obtained at initial staging were evaluated for the presence of lymphoma or benign lymphoid aggregates. Thirty-two percent (102 patients) had lymphoma in their bone marrow, and 9% had benign lymphoid aggregates. Bone marrow lymphoma was present in 39% of low-grade, 36% of intermediate-grade, and 18% of high-grade lymphomas. The bone marrow was involved in 25% of patients with diffuse large-cell or immunoblastic NHL (ie, diffuse histiocytic lymphoma of Rappaport). Bone marrow involvement did not affect survival of patients with low-grade NHL, but survival was significantly shorter (P = .03) for patients with intermediate- and high-grade NHL with bone marrow involvement. Bone marrow involvement was equally common in B-cell and T-cell NHL (31% v 32%). However, patients with T-cell NHL and bone marrow involvement had shorter survival than B-cell NHL with marrow involvement (P = .02) or T-cell NHL without marrow involvement (P = .05). A high incidence of morphologic discordance between lymph node and bone marrow was observed (ie, 40%), always with a more aggressive subtype in the lymph node than in the bone marrow. Presence of large-cell lymphoma in the bone marrow predicted for short survival. Survival for patients with small-cell lymphoma in their bone marrow did not differ significantly from patients with negative bone marrows. We conclude that bone marrow involvement in large-cell NHL, especially in those of T-cell origin, portends a poor prognosis. However, the subgroup of patients with an aggressive histologic subtype of NHL in a lymph node biopsy and small-cell NHL in the bone marrow do not have a poorer outlook than those without bone marrow involvement.     

THE RELATIONSHIP BETWEEN NON-HODGKIN'S LYMPHOMA AND THE GENE REARRANGEMENT

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Surgery and chemotherapy versus chemotherapy as treatment of high-grade MALT gastric lymphoma

Background and Objectives Treatment of high-grade MALT (mucosa-associated lymphoid tissue) gastric lymphoma remains uncertain. To assess efficacy and toxicity of the most common therapies—surgery followed by chemotherapy or chemotherapy alone—we began a controlled clinical trial in patients in early stage (I and II). Methods One hundred and two patients were randomized to be treated with surgery followed by six cycles of CEOP-Bleo (cyclophosphamide, epirubicin, vincristine, prednisone, and bleomycin at standard doses) (52 cases) or with chemotherapy alone (49 cases). Results Complete response rates were 94% [95% confidence interval (CI): 88–99%] and 96% (93–100%), respectively. Actuarial curves at 5 yr showed that event-free survival were 70% (95% CI: 59–74%) in patients treated with surgery and chemotherapy, that were not statistically significant to 67% (95% CI: 51–69%) in the patients who received chemotherapy (p=0.5). Also, overall survival that was not statistically significant: 78% (95% CI: 70–88%) in the combined treatment and 76% (95% CI: 70–87%) in chemotherapy (p=0.8). Acute and late toxicity were mild and well controlled. No acute leukemia or second neoplasm has been observed. Conclusions The use of surgery and chemotherapy did not improve outcome in patients with early-stage high-grade gastric MALT lymphoma. It is apparent that chemotherapy alone is sufficient treatment in this select group of patients.