恶性B淋巴细胞性淋巴瘤克隆性重排检测研究

目的　对恶性 Ｂ淋巴细胞性淋巴瘤进行克隆性研究。方法　用免疫组化法标记筛选恶性 Ｂ淋巴细胞性淋巴瘤,用针对 Ｉｇ Ｈ 单轮扩增引物进行多聚酶链反应扩增检测克隆性基因重排。结果　在 １２６ 例恶性 Ｂ细胞性淋巴瘤中,免疫组化标记与 Ｉｇ Ｈ 基因克隆性重排符合率为 ９７％ ,其中, Ｉｇ Ｈ 基因克隆性重排阳性 ８３ 例（６６％ ）,３ 例见 Ｔ Ｃ Ｒβ交叉阳性,在 １ 例病理诊断为颈淋巴结反应性增生病例中出现 Ｉｇ Ｈ克隆性重排,在其它 ２２ 例非淋巴组织和良性淋巴组织疾患中均未见阳性。在 １８ 例临床诊断有争议的病例中１１ 例出现 Ｉｇ Ｈ 克隆性重排。结论　克隆性重排检测对恶性 Ｂ淋巴细胞性淋巴瘤有一定的辅助诊断作用。     

Carminomycin versus doxorubicin in advanced breast cancer,a randomized phase II study of the E.O.R.T.C. breast cancer cooperative group

Sixty-four patients with advanced progressive breast cancer resistant to conventional treatments were entered into the present study. They were randomized to receive either Carminomycin (CMM) 20 mg/m² or Doxorubicin (DOX) 75 mg/m², both drugs being administered by i.v. bolus every 3 weeks until progression of the disease. Five patients were not eligible and response could not be evaluated in another eight patients. Three patients had only one course due to disease-related early death. Among twenty-seven evaluable patients who received at least two courses of DOX one complete response and seven partial responses were observed for an overall response rate of 30%. CMM showed significantly lower (P = 0.04) antitumor activity with only one partial response (4%) among the 24 patients who received at least two courses of therapy.Median duration of response dating from the start of chemotherapy was 46 weeks on DOX (range 18–102+) and 30 weeks for the single partial response on CMM. Although the median time to progression for all patients receiving CMM (9 weeks) was significantly shorter (P = 0.04) than for those receiving DOX (30 weeks), patients on DOX had only a marginally longer duration of survival (P = .28) than those initially treated with CMM. Myelotoxicity was more severe in the GMM treated group than in the DOX group. Other toxicities such as alopecia, nausea and vomiting were slightly more severe in the DOX treated group. On the basis of this and other similar randomized studies, CMM cannot be recommended for further application in the treatment of advanced breast cancer.     

Five-year results of the E.O.R.T.C. randomized study of splenectomy and spleen irradiation in clinical stages I and II of Hodgkin's disease

A controlled clinical trial was carried out on patients with clinical stages I and II of Hodgkin's disease by the E.O.R.T.C. from 1972 to 1976. Three hundred patients with supradiaphragmatic presentation were assigned at random into two groups, one treated by spleen irradiation, the other by splenectomy. All patients received a mantle field irradiation as well as a para-aortic lymph node irradiation. The actuarial survival rates and relapse-free survival rates at five years were, respectively, 90 and 62% in the group treated by spleen irradiation and 90 and 67% in the group splenectomized. The efficiency of the two treatments is therefore identical. In the group submitted to staging laparotomy, all patients received the same treatment without taking into account the results of the splenectomy and of the lymph node biopsy. Of 107 patients without spleen or lymph node involvement 18 relapsed (17%); of 33 patients with spleen involvement 14 relapsed (42%). Relapse in non-irradiated lymph node territories (iliac and inguinal areas) were fifteen-fold more frequent in patients with spleen involvement, whereas extra nodal relapses were about twice as frequent in patients with spleen involvement than in patients without spleen involvement. Patients with mixed cellularity or lymphoid depletion histological types received long term adjuvant chemotherapy either by Vinblastine + Procarbazine or by Vinblastine alone. The 5-year relapse rate was 12% with both chemotherapeutic regimens.