Die Rolle der Strahlentherapie bei seltenen extranodalen Non-Hodgkin-Lymphomen

Extranodal non-Hodgkin lymphoma (NHL) accounts for approximately 30% of NHLs. Extranodal NHLs are mainly located in the skin (mainly T-cell NHL), stomach, small intestines, tonsils and central nervous system (CNS mainly B-cell lymphoma). Uncommon sites represent the orbit, salivary glands, nasal cavity, paranasal sinuses, thyroid gland, lungs, bladder, breast, female genital tract, testes, bone and extradural space. Stage, localization and histology are crucial for the decision of treatment modality. As, in contrast to nodal NHL, extranodal NHLs are more frequently diagnosed in stages I/II, radiotherapy (RT) plays a significant role in the treatment of extranodal NHLs. In general, in patients with low grade NHL involved-field radiotherapy (IF-RT) alone with 30?C40?Gy is recommended. Excellent local control is achieved by IF-RT resulting in high disease-free and overall survival rates. In cases of high grade lymphoma, induction chemotherapy is followed by consolidating IF-RT (36?C40?Gy). The localization and histology are predictors for local control, disease-free and overall survival.     

非霍奇金淋巴瘤中细胞凋亡与细胞增殖的研究

目的了解非霍奇金淋巴瘤(NHL)中细胞凋亡与细胞增殖间的关系,探讨两者在NHL发生与发展中的作用.方法利用TdT介导的dUTP缺口末端标记(TUNEL)法和PCNA免疫组化技术原位检测60例NHL中的细胞凋亡和增殖水平,计算凋亡指数(AI)和增殖指数(PI).结果B细胞性NHL中,随着恶性度增高,AI和PI均增高(P＜0.05),T细胞性NHL中高度恶性组PI明显高于低度恶性组(P＜0.05),而AI在两组之间无显著性差异(P＞0.05).AI和PI呈显著正相关(r=0.704,P＜0.01).结论在NHL中细胞凋亡与增殖之间可能存在密切的联系,共同参与了NHL的发生和恶性进展.对细胞凋亡和增殖水平的检测可能有助于NHL恶性度及预后的判断.     

Ga-67 scintigraphy for the localization and staging of malignant lymphoma

Thirty-eight Ga-67 scintigraphies have been evaluated in regard to patients with an untreated malignant lymphoma or a recurrent lymphoma after a complete remission. Thirty-four studies (89%) showed positive findings. Waldeyer's ring and lymph node involvement were detected in 66% of the cases. The recurrent type was detected less often than the untreated malignant lymphoma, and there was no significant difference in detectability between Hodgkin's disease and non-Hodgkin's lymphoma. Although the malignancy grade for NHL did not affect the detectability, the intermediate and high grade NHLs tended to show a greater uptake than the low grade NHLs. The detectability was particularly good for neck and intrathoracic lymph nodes. Ga-67 scintigraphy tended to downgrade a malignant lymphoma to a lower stage, especially if in recurrence.     

Serum soluble interleukin-2 receptor levels are associated with clinical disease status and histopathological grade in non-Hodgkin's lymphoma and chronic lymphocytic leukemia.

Serum soluble Interleukin-2 receptor levels (sIL-2R) were measured in 121 patients (pts) with non-Hodgkin's lymphoma (NHL) and in 30 patients with Chronic lymphocytic leukemia (CLL). Sera collected from 32 normal volunteers and 18 patients with infection or a variety of non malignant hematological disorders served as controls. A small number of patients with Hairy cell leukemia (HCL) and Hodgkin's disease (HD) were also studied. NHL patients were classified according to their clinical status as "active" (82 pts) or "non-active" (39 pts) and CLL according to the stage of their disease. NHL patients were also further classified as low (55 pts), intermediate (38 pts) and high grade malignancy (28 pts), according to the Working formulation scheme. A significant difference was found between the high levels of sIL-2R in patients with "active" disease and the lower levels in patients with quiescent or responsive disease. Significantly different high levels were found in patients with aggressive (intermediate and high grade) lymphoma as opposed to low grade lymphoma and CLL. In CLL itself higher levels of sIL-2R were seen in more advanced disease than in early disease. Thirteen patients with active Hodgkin's disease (HD) had moderately elevated sIL-2R levels, similar to those recorded for patients with infections and some non-malignant hematological disorders while another 13 HD patients in remission, had normal levels comparable to those recorded in normal controls. Extremely high levels of sIL-2R were seen in 2 patients with HD with severe viral infections and levels approaching those seen in HCL, were noted (20-30,000 u/ml).(ABSTRACT TRUNCATED AT 250 WORDS)     

IIVP salvage regimen induces high response rates in patients with relapsed lymphoma before autologous stem cell transplantation

Patients with relapsed lymphoma can be cured with high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT). New therapeutic approaches with better cytoreductive capacity are needed for relapsed patients to keep their chance for cure with transplantation. We report 30 patients with relapsed lymphoma, median age 43 years, treated with IIVP salvage regimen consisting of ifosfamide, mesna, idarubicin, and etoposide for 2 or 3 cycles. Seventeen patients had non-Hodgkin lymphoma (NHL) and 13 patients had Hodgkin disease (HD). Fourteen (47%) patients were at their first relapse. Overall response rate was 86.6% (n = 26) with 19 patients (63.3%) achieving complete response. Overall response rate was 92% in patients with HD and 82% in NHL. The most frequent side effects observed were grade III-IV neutropenia (87%) and thrombocytopenia (73%). IIVP regimen is a highly effective salvage therapy for patients with relapsed HD or NHL who are candidates for autologous HSCT. Close follow up is necessary because of the high incidence of grade III-IV hematologic toxicity.     

A PCR analysis of bcl-2 gene rearrangement in nodal and extranodal non-hodgkins-lymphoma (nhl) - some unusual observations in saudi patients

Non-Hodgkin's lymphoma (NHL) is the most common malignancy referred to our institute which is the largest tertiary referral cancer centre in Saudi Arabia, The proportion of follicular low grade NHL appears to be extremely small in this population (<5% of all NHL). To date, there is no data available regarding any correlation between bcl-2 gene rearrangement and different cell types of nodal and extranodal NHLs in Saudi patients. We used a sequential polymerase chain reaction (PCR) technique to determine the frequency of bcl-2/J(H) recombination occurring via the major breakpoint region (mbr) in 16 GI tract NHLs including 4 MALT lymphomas and 13 follicular (nodal) NHLs. The results showed only 2/13 (15%) nodal follicular NHLs with bcl-2/J(H) fusion DNA whereas 9/16 (56%) of the extranodal NHLs with at least 2 of them exhibiting MALT characteristics were positive for the bcl-2 gene rearrangement. A breakdown of the proportion of extranodal NHLs of different cell types showing bcl-2 rearrangement via mbr was as follows: 5/8 diffuse large non-cleaved cell (DLNCC), 1/3 diffuse small cleaved cell (DSCC), 1/1 follicular small cleaved cell (FSCC) and 2/4 MALTs. The PCR amplified bcl-2/J(H) fusion DNA from 5 randomly selected tumors (2 MALTs, 1 DLNCC, 1 DSCC and 1 nodal follicular lymphoma) were cloned and sequenced. All 5 of them showed different bcl-2/J(H) N-regions confirming the clonality of each tumor sample. The data indicating a very low incidence of bcl-2 translocation in nodal follicular NHLs and a surprisingly high incidence of it in extranodal NHLs are intriguing, and quite contrary to the findings in Western patients. These unusual observations warrant further studies and may suggest that different genetic events are involved in the development of extranodal NHLs including MALT and follicular center-cell NHLs in Saudi patients.     

Non-Hodgkin's lymphoma among people with AIDS: Incidence,presentation and public health burden

We describe the anatomic and histologic presentation and prognosis of non-Hodgkin's lymphoma (NHL) among people with AIDS (PWA) and determine their contribution to the NHL burden. We linked AIDS and cancer registries in selected areas of the United States and compared NHL sites and histologies in PWA and non-PWA, after adjusting for age, sex and ethnicity. Among 51,033 PWA, we found 2,156 cases of NHL (4.3%). Half of NHL cases occurring post-AIDS were not reported to AIDS registries. NHL was part of an AIDS-defining condition for 3.2% of all PWA; the relative risk of NHL with 3.5 years of another AIDS diagnosis was 165-fold compared to non-PWA within the cancer surveillance system. Of NHLs, 39% were high grade (vs. 12% among non-PWA), 60% were nodal (vs. 74% among non-PWA) and 15% had brain primaries (vs. 1% among non-PWA). Excluding brain sites, extranodal sites were still 20% more common than expected. Relative risk was elevated for all histologic types, with the risk ranging from 652-fold for high-grade diffuse immunoblastic tumors and 261-fold for Burkitt's lymphomas to 113 for intermediate-grade lymphoma to 14-fold for low-grade lymphoma. Survival among PWA with NHL was poor, and tumor grade had little impact. In high-risk AIDS areas, AIDS-related NHLs constitute a major share of the NHL burden. We conclude that NHL risk is considerably under-estimated in AIDS registry data. The major differences between PWA and non-PWA were the high frequency of brain lymphoma and the increase in high-grade lymphomas in PWA. However, the grade of NHL did not influence the prognosis among PWA with lymphoma. The increasing risk of NHL in PWA has contributed substantially to the general increase in NHL rates in the United States since 1981. Int. J. Cancer 73:645–650, 1997. © 1997 Wiley-Liss, Inc.     

淋巴组织增生性疾病组织中EB病毒的原位杂交检测

目的探讨ＥＢ病毒与我国各类淋巴组织增生性疾病的关系。方法以ＥＢ病毒ＬＭＰ基因为探针,对２１４例淋巴组织增生性疾病组织中ＥＢ病毒进行原位杂交检测,并用ＳＹＳＴＡＴ软件对实验结果进行分析。结果霍奇金淋巴瘤（ＨＤ）、非霍奇金淋巴瘤（ＮＨＬ）、淋巴组织良性增生（ＢＬＰ）组织中ＥＢ病毒阳性率分别为３０．０％（１５／５０）,１４．０％（１８／１２９）及２．９％（１／３５）。在ＮＨＬ中,高度恶性（ＨＮＨＬ）、中度恶性（ＭＮＨＬ）及低度恶性（ＬＮＨＬ）ＥＢ病毒阳性率分别为２８．１％（９／３２）、１０．５％（９／８４）及０％（０／９）。ＨＤ与ＨＮＨＬ间ＥＢ病毒阳性率均显著高于ＢＬＰ（Ｐ＜０．０１,Ｐ＜０．０５）,ＭＮＨＬ和ＬＮＨＬ与ＢＬＰ间ＥＢ病毒阳性率差异无显著性（Ｐ＞０．０５）。结论ＥＢ病毒与ＨＤ及ＨＮＨＬ的发生有关,而与ＭＮＨＬ及ＬＮＨＬ的发生关系不大。     

Malignant lymphoma in southern Taiwan according to the revised European-American classification of lymphoid neoplasms

BACKGROUND: The purpose of the current study was to determine the distribution and relative frequency of each subtype of malignant lymphoma in southern Taiwan according to the revised European-American classification of lymphoid neoplasms (REAL). METHODS: The pathology files of a regional hospital in southern Taiwan for 1989-1998 were searched for malignant lymphoma, lymphoproliferative disorder, and Hodgkin disease (HD). The results of light microscopy, immunohistochemistry, and in situ hybridization for Epstein-Barr virus-encoded RNA (EBER) were correlated with clinical findings, and all cases were classified according to REAL. RESULTS: A total of 205 cases were analyzed retrospectively. There were 197 cases (96.1%) of non-Hodgkin lymphoma (NHL) and 8 cases (3. 9%) of HD. Among the 197 NHL cases, 161 (81.7%) were of B-cell lineage and 36 (18.3%) were of T-/natural killer cell lineage. Diffuse large B-cell lymphoma, extranodal marginal zone lymphoma, and follicular lymphoma were the most common B-cell subtypes and represented 47.2%, 19.3%, and 6.1%, respectively, of all NHL cases. Among the 36 cases of T-/natural killer cell lineage, unspecified peripheral T-cell lymphoma (8.6%), T-/natural killer cell lymphoma (angiocentric lymphoma) (4.1%), and anaplastic large cell lymphoma (3.6%) were the most common subtypes. Seven of eight T-/natural killer cell lymphoma cases were positive for EBER. The eight cases of HD were classified as lymphocyte-rich classic (two cases), nodular sclerosis (two cases), and mixed cellularity (four cases) subtypes. Three of these eight cases were positive for EBER. CONCLUSIONS: To the authors' knowledge this study is the first in Taiwan using the REAL classification and it again confirms the different geographic distribution of the various subtypes of malignant lymphoma. The frequency of T-/natural killer cell lineage NHL in Taiwan is higher than that in Western countries but not as high as reported previously.     

A clinicopathologic study of lymphoid neoplasias associated with human immunodeficiency virus infection in Italy

The clinicopathologic features of 45 human immunodeficiency virus (HIV)-infected patients (mainly intravenous drug users [IVDU]) with lymphoid neoplasias seen from September 1984 through July 1990 at an Italian cancer center are reviewed. Thirty-five had systemic non-Hodgkin's lymphoma (NHL), and ten had Hodgkin's disease (HD). Histologically, 27 NHL cases were intermediate grade (five cases) or high grade (22 cases, 14 of the small noncleaved cell type), according to the Working Formulation. Eight NHL cases, including four anaplastic large cell (ALC) BerH2 (CD30)-positive lymphomas, were in the miscellaneous group. Immunohistologic and/or gene rearrangement analysis showed the B-cell origin of 20 of the 24 NHL cases studied. At presentation, 71% of NHL patients had advanced stages (Stage III or IV), and 85% had extranodal disease (predominantly gastrointestinal tract and marrow). Of the 23 patients evaluable for treatment, only seven had a complete clinical response after lymphoma therapy; the median survival of 34 evaluable patients was 22 months after the diagnosis of NHL. Fifteen patients died; most deaths were attributable to progressive lymphoma and opportunistic infections. As with NHL, advanced disease, extranodal involvement, aggressive histologic findings, and poor response to therapy were also observed in patients with HD. This study shows that lymphoid neoplasias occurring in Italian IVDU with HIV infection and those previously reported in North American homosexual men with HIV infection share similar clinicopathologic features. However, some features such as the absence of history of Kaposi's sarcoma at diagnosis, the lack of detection of primary brain and rectal NHL, and the occurrence of B-cell ALC BerH2 (CD30)-positive NHL were observed uniquely in this series of patients.     

Expression of p53 in pediatric lymphomas from Mexico

Eighty-five cases of pediatric non-Hodgkin's lymphomas (NHLs) from Mexico have been reviewed and classified according to histologic type and immunophenotype using a panel of markers which included CD20, CD45RO-(UCHLI), CD3 and Tdt. Twenty-five cases were classified as lymphoblastic lymphoma (LBL) of precursor cell origin and forty-nine cases as non-lymphoblastic lymphomas. Eleven cases could not be satisfactorily classified due to insufficient tissue or on technical grounds. All these lymphomas were subjected to immunohistochemistry (IHC) for detecting p53 expression. p53 was detectable in 7 (28%) lymphoblastic lymphomas, in 36 (73.4%) non-lymphoblastic lymphomas and in 4 (36.3%) of the lymphomas that could not be classified. Our results indicate that in contrast to adults with NHL and children with acute leukemia, p53 expression is relatively frequent in pediatric NHLs, although it is higher in lymphomas of B cell phenotype than in those of T cell type.     

HIV-testing and newly-diagnosed malignant lymphomas. The SAKK 96/90 registration study

The association of Non-Hodgkin Lymphoma (NHL) and HIV-infection was soon recognized and the Center of Disease Control (CDC) has classified some types of NHL as AIDS-defining illnesses (ADI). Hodgkin's disease (HD) represents the most common type of non ADI malignancy in HIV-infected cases. Commonly, data on malignant lymphoma in this population is collected in known HIV-positive patients or in autopsy-series. This registration study was designed to estimate the incidence of HIV-positivity in patients with newly diagnosed malignant lymphoma. A registration of all patients with newly diagnosed malignant lymphoma and their HIV-status was performed in every center of the Swiss Group for Clinical Cancer research (SAKK) from January 1, 1991 to July 31, 1993. Among 474 eligible patients, HIV-status was evaluated in 400 and 52 were tested positive (13%), 42 (81%) of them males. Three of them were newly detected cases (after lymphoma-diagnosis). Three hundred and forty patients (72%) presented with NHL, 42 (12.4%) of them HIV-positive; 33 out of these had aggressive lymphoma. B-symptoms were significantly more frequent in HIV-positive patients. In the 134 patients with HD, 10 (7.5%) tested HIV-positive, mostly presenting with stage IV disease (7), B-symptoms (9) and extranodal disease (7). In conclusion, 13% out of 400 evaluated patients with newly diagnosed malignant lymphoma tested HIV-positive. The study confirms the predominance of aggressive lymphoma histologies and frequent presentation with B-symptoms in HIV-positive patients with NHL. Male gender, young age (26-35 years) and B-symptoms are prognostic factors for HIV-positivity in NHL.     

Regional variation in the distribution of subtypes of lymphoid neoplasms in India

Lymphoid malignancies (LM) are a heterogeneous group of tumours. The relative frequencies of the various types of LMs vary across geographic regions. The pattern in India shows significant differences from the rest of the world. As India is a vast country, we set out to investigate whether there are regional differences in the relative frequencies of the various LMs. A total of 562 LMs from three different regions in India--Barshi (western India, 102 cases), Pondicherry (southern India, 156 cases) and Jaipur (northern India, 304 cases) were analysed according to the WHO classification. The non-Hodgkin lymphoma (NHL) to Hodgkin disease (HD) ratio was 6.28 in Barshi, 1.26 in Pondicherry and 2.27 in Jaipur. The frequency of HD's various subtypes did not significantly differ among the three regions. While T-cell NHLs constituted only 12.5% of NHLs at Barshi, they accounted for 31 and 27.5% of all NHLs at Pondicherry and Jaipur, respectively. There were also notable differences in the specific subtypes of NHL between the three different geographic regions in India.     

Epidemiology of the non-Hodgkin's lymphomas: Distributions of the major subtypes differ by geographic locations

Background: There has been no previous systematic study of the distribution of the major subtypes of non-Hodgkin's lymphoma (NHL) across geographic regions, although there have been isolated reports of such differences.Design: As part of a clinical evaluation of the International Lymphoma Study Group (ILSG) classification of NHL, we classified 1378 NHLs from eight different geographic sites (Omaha, NE, USA; Vancouver, BC, Canada; Capetown, South Africa; London, England; Würzburg/Göttingen, Germany; Lyon, France; Locarno/Bellinzona, Switzerland; and Hong Kong) using the ILSG classification.Results: Substantial differences were found in the distribution of the major subtypes of NHL across geographic regions (P < 0.0001). A greater percentage of follicular lymphoma was seen in North America, London and Capetown (31% versus 14% at other sites). Peripheral T-cell lymphoma was more common in London, Capetown and Hong Kong (9%) than elsewhere (3%). In Locarno/Bellinzona, higher percentages of mediastinal large B-cell lymphoma (9% versus 2% elsewhere) and mantle cell lymphoma (14% versus 6% elsewhere) were seen. Angiocentric nasal T-/NK-cell lymphoma was only seen in Hong Kong (8%) and Lyon (2%).Conclusions: Our study provides evidence that the distribution of NHL subtypes differs by geographic region. These findings suggest that geographical differences in etiologic or host factors may be responsible for the observed differences in the distribution of cases across NHL subtypes.     

Use of the World Health Organization (WHO) classification of non-Hodgkin's lymphoma in Mumbai, India: a review of 200 consecutive cases by a panel of five expert hematopathologists

This study aims to answer the question whether the World Health Organization (WHO) classification of non-Hodgkin's lymphoma (NHL) can be practised to international standards at the Lymphoma Registry (LR) established at the Tata Memorial Hospital, Mumbai, India. Furthermore, the study aims to identify differences in the distribution of NHL subtypes at this LR (likely to be representative of India) as compared to the rest of the world. A panel of 5 expert hematopathologists from the NHL Classification Project reviewed 200 consecutive NHL cases at the LR in January of 2001. These cases were accrued during August and September, 2000. On all cases, hematoxylin and eosin stains and appropriate immunostains were available for review. The diagnosis made by the host pathologist at the LR (KNN) and the initial diagnosis made by each of the expert hematopathologists was compared with the consensus diagnosis. A consensus diagnosis was made by the 5 experts in 197 cases. The agreement of the host pathologist with the consensus diagnosis was 82% and the agreement of the individual experts with the consensus diagnosis varied from 76-88% (mean 82%). According to the consensus diagnosis, 80% of NHLs were of B-cell type, 18% were of T-cell type, and the immunophenotype could not be determined in the remaining 2% of cases. In conclusion, the WHO classification of NHL was properly utilized at the Lymphoma Registry, Mumbai, India, and geographic differences were noted in the distribution of NHL subtypes at the LR as compared to the rest of the world. Precursor T lymphoblastic leukemia/lymphoma was more common in India (7%) than the rest of the world (1-4%), and indolent B-cell NHLs (29%) were less common than in the West. As compared to China and Japan, peripheral T-cell lymphoma (4.6%), extranodal NK/T cell lymphoma, nasal type (0.5%) and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT-lymphoma) (2.6%) were less common, but follicular lymphoma (15%) and chronic lymphocytic leukemia/small lymphocytic lymphoma (5%) were more common. This suggests that the distribution of the B-cell and T-cell lymphomas in the Indian population, except for lymphoblastic lymphoma, lies in between the Western world (mainly Caucasian) and the Orientals.     

Non-Hodgkin lymphoma among young adults with and without AIDS in Italy.

To compare the presentation and prognosis of non-Hodgkin lymphoma (NHL) in people with AIDS (PWA) and in the general Italian population, a record linkage study was carried out. The fraction of NHLs attributable to HIV/AIDS was also estimated. Information from the National AIDS Registry (RAIDS) was linked with records from 13 cancer registries (CR), covering about 15% of the Italian population. During the period 1985--94, among PWA ages 15--49, 136 NHLs were identified (8% of all NHLs) and were compared with 1,481 concurrent incident NHL cases of the same age group among non-PWA. Percentages above 13% of all NHLs were registered in the northern areas of Genoa and Varese, i.e., the most heavily affected by the AIDS epidemic. Between 1 year prior to and 3.5 years after AIDS diagnosis, PWA showed an overall standardised incidence ratio (SIR) for NHL of 302. SIR was particularly high (394) within 3 months after AIDS diagnosis and subsequently declined to 170. SIR was somewhat higher in females (428) than in males (280) but similar among intravenous-drug users (299) and other HIV-transmission groups (309). High-grade NHL, particularly immunoblastic and Burkitt's lymphoma, were twice as frequent among PWA than non-PWA. Conversely, low-grade NHL were less frequent. Except for the high proportion of brain localisation, no clear difference emerged in the pattern of NHL presentation site in PWA compared with non-PWA. At variance with NHL in the general population, among PWA histological grade had little impact on survival, which overall appeared to be very poor (2-year survival: 10%; 95% confidence interval: 3%--17%). Our present linkage of RAIDS and CRs represents an efficient tool for the surveillance of trends in incidence and survival of NHL among PWA in Italy.     

A review of childhood cases of malignant lymphoma in Osaka, Japan

Fifty-one cases of malignant lymphomas in patients under 20 years of age have been reviewed in Osaka, Japan. The breakdown of these cases revealed 6 cases (11.8%) of Hodgkin's disease (HD) and 45 cases (88.2%) of a non-Hodgkin's lymphoma (NHL). Both the HD and NHL cases were determined by using the Rye classification, as well as the Rappaport, Kiel, and LSG classifications, respectively. The results have shown that (1) the incidence of HD in childhood is the same as that seen in the adult in Japan; (2) that a NHL of the nodular type is rare in Japan as it is in Western countries; (3) that any significant differences were not present in the distribution of each histologic subtype in the cases of a NHL among Japan and Western countries, and that the lymphoblastic type was the most common. From this study it is concluded that geographical differences were not a factor in comparing cases of childhood malignant lymphomas in Japan and Western countries.     

Non-Hodgkin lymphoma in Chile: a review of 207 consecutive adult cases by a panel of five expert hematopathologists

The distribution of subtypes of non-Hodgkin lymphoma (NHL) in Latin America is not well known. This Chilean study included 207 consecutive cases of NHL diagnosed at five cancer centers in the capital, Santiago, and one center in Vi?a del Mar. All cases were reviewed and classified independently by five expert hematopathologists according to the 2001 World Health Organization classification of NHL. A consensus diagnosis of NHL was reached in 195 of the 207 cases (94%). B-cell lymphomas constituted 88% of NHL, and diffuse large B-cell lymphoma (DLBCL, 38.5%) and follicular lymphoma (25.1%) were the most common subtypes. There was a high frequency of marginal zone B-cell lymphoma (10.3%), as well as of extranodal natural killer (NK)/T-cell lymphoma, nasal type (2.6%) and adult T-cell leukemia/lymphoma (0.5%). Extranodal presentation was seen in 74 of the 195 cases (38%) and the most common extranodal presentation was in the stomach (37.6%). The most common gastric lymphoma was DLBCL (54.5%) followed by mucosa-associated lymphoid tissue (MALT) lymphoma (41%). Overall, the frequency of NHL subtypes in Chile is between that reported in Western and Eastern countries, which is probably a reflection of the admixture of ethnicities as well as the environment and socioeconomic status of its population.     

Frequent chromosome arm 13q deletion in aggressive non-Hodgkin's lymphoma.

To clarify the role of allelic loss on chromosome arm 13q in lymphomagenesis, we performed fluorescence in situ hybridization (FISH) analysis of a total of 43 primary lymphomas, including both indolent and aggressive non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD), using the specific probes at RB1 and D13S319 loci on the centromeric portion of chromosome arm 13q. Monosomy at either or both RB1 and D13S319 loci was detected in 15 of 43 (35%) lymphomas (14 of 43 cases at RB1 locus and seven of 43 cases at D13S319 locus); the 13q deletion was frequently detected in the aggressive NHLs (40%; 12 of 30 cases) compared with that in indolent NHL (17%; one of six cases) and a subset of HD (29%; two of seven cases). There are only six cases of 43 which have total monosomy 13q14, all aggressive NHL, 14% of total or 20% of this subgroup. In addition, we analyzed the loss of heterozygosity in 15 of the 43 primary lymphoma samples for several polymorphic microsatellite loci (D13S168, RB1 and D13S272) on the chromosome arm 13q, and confirmed the 13q deletion in four of five cases that were positive on FISH analysis. The subchromosomal region frequently altered in lymphoma on 13q14 is the region around RB1 locus and centromeric to D13S319 locus, which is an overlapped region frequently deleted in chronic lymphocytic leukemia. Together, our data indicate that the 13q alterations are present in a variety of types of lymphoma and occur in a significant proportion of aggressive NHLs, suggesting the possible presence of common candidate gene(s) on the 13q14 region, whose alteration may play an important role in the formation or development of a wide variety of mature lymphoid malignancies.     

Radiotherapy as salvage treatment in patients with Hodgkin's disease or non-Hodgkin's lymphoma relapsing after initial chemotherapy

The prognosis of relapsing Hodgkin's disease (HD) and high grade aggressive non-Hodgkin's lymphoma (NHL) is generally poor since many of these patients fail to respond to second line chemotherapy. Radiation therapy has been reported as an effective but seldom used, alternative treatment. We have observed very encouraging results with salvage radiotherapy in a highly selected group of eight lymphoma patients (six with HD and two with high grade NHL), suffering mainly from nodal relapse. The literature on the use of radiation therapy after chemotherapy failures in HD and NHL is reviewed.