Non-Hodgkin's lymphomas in Jordanians: a histopathological study of 231 cases

Our hospital admitted 231 patients with non-Hodgkin's lymphomas between June 1976 and November 1984. Review of these cases revealed the following profile: ages ranged from 1 to 70 years (median: 30 years), 156 males, predominantly children and adolescents, and 75 females. Diffuse histiocytic lymphoma accounted for 40.6 per cent of all cases. Seventeen patients (7 per cent) had nodular lymphomas. Fifteen patients, predominantly male children and adolescents, had lymphoblastic lymphomas and showed high association with mediastinal mass (47 per cent). Extranodal lymphomas mostly of the diffuse histiocytic subtype were diagnosed in 100 cases (43.3 per cent) and most frequently situated in the small intestine (59 cases). Burkitt's lymphoma--32 patients (14 per cent)--presented most often in male patients during the first decade of life and as an abdominal intestinal disease (19 cases). There were four cases of Mediterranean abdominal lymphoma (IPSID). Non-Hodgkin's lymphomas in Jordanians are mostly of the diffuse histiocytic type, are rarely nodular, have a high frequency of extranodal involvement and tend to occur in younger age groups. Mediterranean abdominal lymphoma is less frequent than previously thought. The use of both of the Rappaport and Lukes-Collins classifications demonstrated a high degree of reproducibility.     

A phase II trial of ProMACE-CytaBOM in previously untreated non-Hodgkin's lymphoma of intermediate- or high-grade histology.

Between November 1985 and June 1989 the aggressive combination chemotherapy programme ProMACE-CytaBOM was used at a community-based hospital as primary treatment for non-Hodgkin's lymphoma (NHL) of intermediate or high-grade histology in Ann-Arbor stages IB-IV. The 53 patients entering the study represented 90 per cent of all consecutive eligible patients with NHL diagnosed during the time period considered. Their median age was 54 years and median observation time was 36 months. Of 50 patients evaluable for response, 35 (70 per cent) achieved complete remission (CR), seven (14 per cent) partial remission, and five (10 per cent) were refractory. Treatment was given on an outpatient basis. Actually delivered drug doses ranged from 88 per cent to 97 per cent of the theoretical doses. Life-threatening toxicity was experienced by four patients. Treatment was stopped in three cases (6 per cent) because of toxicity and there was one treatment-related death. Actuarial 2-year disease-free survival of patients in CR was 73 per cent. Overall actuarial 3-year survival and disease-free survival were 67 per cent and 51 per cent respectively. High LDH level was a significant adverse prognostic factor both for achievement of CR (P less than 0.005) and for survival (P less than 0.0002). Age was of no prognostic importance. We conclude that ProMACE-CytaBOM is an effective, easy to administer and well-tolerated regimen for patients with aggressive NHL.     

Prognostic significance of DNA-analysis by flow cytometry in non-Hodgkin's lymphoma

DNA analysis by flow cytometry was performed on lymph node cells obtained from 65 untreated patients with non-Hodgkin's lymphoma. According to the Kiel classification 41 cases were of low grade malignancy and 24 cases belonged to the high grade malignancy group. 47 out of 61 evaluable cases were diploid/near-diploid, 12 were aneuploid and 2 cases showed polyploidy. No difference in survival was found between diploid/near-diploid and aneuploid cases. The percentage of S-phase cells was found to be a valuable prognostic parameter. Using a cut point at 4 per cent S-phase cells between low and high S-phase lymphomas a highly significant difference in survival was demonstrated (p = 0.0004). The actuarial survival up to 3 years was about 77 per cent for lymphomas with less than 4 per cent S-phase cells to be compared with 20 per cent for patients with high S-phase (greater than or equal to 4 per cent) lymphomas. Subdivision according to the percentage of S-phase cells seemed to be a better prognostic predictor than morphologic subclassification.     

Secondary central nervous system involvement by non-Hodgkin's lymphoma: the risk factors

The risk of secondary central nervous system (CNS) was estimated in 833 cases of non-Hodgkin's lymphoma diagnosed between January 1975 and December 1988. Fifty-one of them had CNS disease (51/833, 6.1 per cent). No case of low grade lymphoma developed CNS disease. However, 6.5 per cent and 16.7 per cent of patients with intermediate and high grade lymphomas, respectively, had secondary CNS involvement. Stage IV disease and the presence of B symptoms were also associated with an increased risk of CNS disease. Significantly higher incidence of CNS disease was seen in patients with lymphoma involving orbit (43 per cent), testis (40 per cent), peripheral blood (33 per cent), bone (29 per cent), nasal/paranasal sinuses region (23 per cent) and bone marrow (20 per cent). CNS prophylaxis is recommended to patients with an increased risk of CNS disease.     

Adding high-dose tamoxifen to CHOP does not influence response or survival in aggressive non-Hodgkin's lymphoma: an interim analysis of a randomized phase III trial

Purpose CHOP is the standard regimen currently used in the management of the majority of patients with aggressive non-Hodgkin's lymphoma (NHL). However, CHOP only produces 30–35% long-term survival. We hypothesized that adding high-dose tamoxifen, which is known to have multiple drug resistance-modulatory effects, to the CHOP regimen could increase the response rate, and consequently enhance the survival of patients with NHL. Patients and Methods In a prospective, controlled, and randomized study, eligible adult patients with aggressive NHL were randomized between CHOP only (Group I), or CHOP plus high-dose tamoxifen (Group II). The primary aim was to assess the effect of tamoxifen on complete response (CR) rate, with the secondary evaluation of tamoxifen potential impact on survival. The interim analysis of this study is presented. Results Fifty-one and forty-seven evaluable patients were randomized to Group I and Group II, respectively. The median age of all patients was 53y (range 18–78y). The two groups had comparable distributions of the pretreatment prognostic variables. The CR for patients in Group I was 80% (41 patients) as compared with 74% (35 patients) in Group II (P=0.48). Likewise, there was no apparent difference in the partial remission rates between the two groups (6% vs 15%, respectively). Of patients who initially attained CR, 15 (37%) and 10 (29%) subsequently relapsed in Groups II and I respectively (P=0.45). The NHL International Prognostic Index (IPI) was the only factor that predicted attaining CR. At the time of this interim analysis, the actuarial-estimated overall survival (OS) probability (±S.E.) for the entire population at 5 y was 58% (±6) with no survival difference between the two groups (P=0.51). Only attaining CR and the IPI predicted OS probability. The probability of remaining event-free at 5 y (±SE) for those achieving CR was 72% (±9), and there was no significant difference between the two treatment groups (P=0.68). Toxicity profile was similar in the two groups. Conclusion Based on this interim analysis, combining high-dose tamoxifen, as used in this study, with the CHOP regimen has failed to have any favorable effect on the outcome of patients with aggressive NHL, and therefore cannot be recommended for future trials.     

Curability of gastrointestinal lymphoma with combined surgery and radiation

Of a total of 1394 patients with non-Hodgkin's lymphomas seen at the Princess Margaret Hospital between January 1, 1967 and December 31, 1978, 150 presented with gastrointestinal involvement. One hundred-thirteen of those patients had localized (Stage I & II) disease. Prognostic factors affecting outcome included hulk of residual disease after initial surgery and presence of B-symptoms. Patients with Stage IA and IIA with gross residual lysphoma less than $\text{2}\text{1}\text{2}$ em in diameter treated with post-operative abdominal irradiation achieved 85% 10 years failure-free rate and 88% 10 year actuarial cause specific survival. The above group is considered curable with surgery and low dose adjuvant radiation.     

Peripheral T-cell lymphoma: a clinicopathologic study of 42 cases

We analysed the clinical and pathologic features of 42 patients with immunologically confirmed peripheral T-cell lymphoma. The median age was 60 years and the male to female ratio was 1:1. A prior lymphoproliferative or autoimmune disorder was present in 14 per cent of the patients. Signs of advanced disease were usually present from the onset, such as B symptoms (55 per cent), generalized lymphadenopathy (57 per cent), stage III/IV disease (62 per cent), and elevated levels of serum lactate dehydrogenase (68 per cent). Primary extranodal disease (14 per cent), hepatomegaly (12 per cent), splenomegaly (12 per cent), lung/pleural involvement (12 per cent), skin involvement (21 per cent), and bone marrow involvement (28 per cent) were uncommon. Lymphocytopenia was present in 64 per cent of the patients, and none of nine patients tested were serologically positive for human T-cell leukemia/lymphoma virus (HTLV-I) infection. Among 38 patients receiving combination chemotherapy, 20 (53 per cent) achieved a complete remission. The actuarial median survival of all patients was 17 months. Age greater than 60 years and stage III/IV disease predicted a poor clinical outcome, whereas the large cell histological subtype predicted a favourable outcome. Prospective clinical studies using uniform treatments and a uniform histologic classification scheme are needed to confirm these findings.     

Non-Hodgkin's lymphomas involving the female genital tract.

Thirteen female patients with lymphomas involving the genital tract were studied. Their median age was 50 years. There were three cases of stage I disease, one stage II and nine stage IV. The gastrointestinal tract was commonly involved in patients with disease in the ovary. The histology was mostly intermediate or high grade according to the Working Formulation. Immunophenotyping was performed in six patients and they were all B-cell tumours. There appeared to have a strong association between gastrointestinal involvement and ovarian disease. All patients received combination chemotherapy with or without additional radiotherapy and the survival of patients with stage I and II disease appeared to be superior to those with stage IV disease. However, the difference observed did not reach statistical significance because of small patient number. It remains uncertain whether lymphomas of the female genital tract by itself carries a poorer prognosis than the nodal lymphomas of comparable stage and histology.     

Primary lymphoma of Meckel diverticulum: a case report

A case of a primary lymphoma of Meckel's diverticulum in a 6-year-old Iraqi boy presenting clinically as acute appendicitis is reported. Exploration revealed a ruptured gangrenous Meckel's diverticulum with an ileo-ileal intussusception at the diverticulum origin. A fairly comprehensive search through the English language literature has failed to reveal any other report of a primary lymphoma of Meckel's diverticulum leading to acute intestinal obstruction.     

Non-Hodgkin's malignant lymphomas of upper digestive and respiratory tracts

The history of 102 patients with primary Non-Hodgkin's lymphoma of the upper digestive and respiratory tract is reviewed. An analysis is presented of the histopathologic, clinical and prognostic features of these patients, who presented to the Antoni van Leeuwenhoek Hospital in Amsterdam between 1958–1976. The histological slides were reviewed in 91 patients. Ilio-lumbar lymphography and bone marrow examination were performed in 44 and 66 patients respectively:4 lymphograms and 4 bone marrows were found to be abnormal. Of 82 patients with Stage I and II disease, there were 72 remissions with locoregional irradiation. Among these patients 36 suffered a relapse, 27 (75%) during the first year after treatment. The median survival was 14 months for all stages. The survival at 5 years was 28% for Stage I and 12% for Stage II patients. Prognosis was influenced by follicular cb/cc lymphomas, histiocytic poorly differentiated cell type, stage, size of primary tumor, and the radiation dose. We recommend adjuvant chemotherapy in Stage I and II patients after primary radiation treatment because of the high rate of primary relapse in distant sites.     

Primary Non-Hodgkin's Lymphoma of the Terminal Ileum with Enterovesical Fistula : A Case Report

A case of primary non-Hodgkin's lymphoma of the terminal ileum with enterovesical fistula is reported. A 50-year-old Malay man presented with haematuria, dysuria and per-rectal bleeding. Intravenous urogram, double contrast enema and an MDP bone scintigram showed a fistulous communication between the bladder and distal ileum. At laparotomy, a large tumour attaching the terminal ileum to the dome of the bladder was found. Histopathological examination of resected small bowel revealed a diffuse histiocytic non-Hodgkin's lymphoma of the small bowel. The bladder mucosa was shown to be normal.     

利妥昔单抗联合CHOP综合治疗B细胞性非霍奇金淋巴瘤的临床研究

目的:评价利妥昔单抗与CHOP联合治疗B细胞性非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHI.)的临床效果及不良反应.方法:用同期对照的前瞻性研究方法,将60例B细胞性NHL患者分为研究组(利妥昔单抗组)和对照组,研究组30例用CHOP方案联合利妥昔单抗治疗;对照组30例单用CHOP方案.CHOP方案:环磷酰胺600mg/m~2,静脉注射,d1;吡喃阿霉素或阿霉素50mg/m~2,静脉注射,d1;长春新碱1.4m/m~2,静脉注射,d1;强的松100mg,口服,d1～d5,每2l天为1个周期.RCHOP方案:美罗华375mg/m~2,静脉滴注,每1个周期第1天(d1);第3天开始CHOP方案,每21天为1个周期.全部60例患者完成3～6个周期化疗后进行疗效评价.结果:利妥昔单抗组完全缓解率(CR)达66.7%(20/30),总有效率90.0%(27/30);对照组CR为40.0%(12/30),总有效率为56.7%(17/30),两组疗效差异有统计学意义,P＜0.05.结论:利妥昔单抗联合CHOP方案治疗CD20阳性的B细胞性NHL的疗效显著,不良反应与单纯化疗相似,可作为该病目前的首选方案.     

A phase III trial comparing CHOP to PMitCEBO with or without G-CSF in patients aged 60 plus with aggressive non-Hodgkin's lymphoma

The management of older patients with aggressive non-Hodgkin's lymphoma presents a challenge to the physician. Age is a poor prognostic indicator, due to reduced ability to tolerate and maintain dose-intensive chemotherapy. Generally, older patients demonstrate a lower response rate, reduced survival and increased toxicity, although the majority of large randomised trials exclude older patients. This randomised trial was conducted in patients 60 years or over to compare CHOP (cyclophosphamide 750 mg m(-2), doxorubicin 50 mg m(-2), vincristine 1.4 mg m(-2), prednisolone 100 mg) with PMitCEBO (mitoxantrone 7 mg m(-2), cyclophosphamide 300 mg m(-2), etoposide 150 mg m(-2), vincristine 1.4 mg m(-2), bleomycin 10 mg m(-2) and prednisolone 50 mg). Due to the myelosuppressive nature of these regimens, patients were also randomised to the addition of G-CSF. The formal results of this trial with long-term follow-up are now reported. Data were analysed to assess efficacy and toxicity. Overall response rate was 84% in the CHOP arm and 83% in the PMitCEBO arm, with overall response rates of 83% for the use of G-CSF and 84% for no G-CSF. At median 44 months follow-up, there was no significant difference in failure-free, progression-free or overall survival between the CHOP and PMitCEBO arms. At 3 years, the actuarial failure-free survival was 44% in CHOP recipients and 42% in PMitCEBO recipients and the 3-year actuarial overall survival was 46% and 45% respectively. There was no significant difference in the failure-free, progression-free or overall survival with the addition of G-CSF.     

利妥昔单抗联合CHOP方案治疗B细胞非霍奇金淋巴瘤的疗效分析

目的：探讨利妥昔单抗联合CHOP方案治疗B细胞型非霍奇金淋巴瘤（NHL）的临床效果和不良反应。方法选择96例CD20阳性的B细胞NHL患者分为研究组49例和对照组47例,研究组采用利妥昔单抗与CHOP方案联合治疗方案,对照组只采用CHOP化疗方案。应用4个疗程后评价两组疗效及不良反应。结果研究组治疗有效率为90.0%,高于对照组的72.3%,差异有统计学意义（P﹤0.05）。而且两组的白细胞下降、脱发、恶心呕吐、便秘、血小板减少、贫血、肺部感染等不良反应比较,差异无统计学意义（P﹥0.05）。研究组1年、3年、5年无进展生存率（PFS）分别为81.6%、61.2%、26.5%,生存率分别为89.8%、65.3%、30.6%,均高于对照组,差异均有统计学意义（P﹤0.05）。结论采用利妥昔单抗与CHOP联合方案治疗B细胞非霍奇金淋巴瘤,可以提高临床疗效和远期生存率,且不因联合化疗而增加不良反应。     

Second malignant neoplasms in patients with non Hodgkin's lymphoma

A retrospective review of the records of 3886 patients with non-Hodgkin's lymphoma registered at the Princess Margaret Hospital between 1970 and 1985 was undertaken to determine the incidence of second malignant tumours. Three thousand and twenty-one patients with a minimum documented follow-up of 6 months from referral were identified for analysis. The overall observed/expected ratio for all cancers in patients with malignant lymphoma was 1, suggesting no increased risk of developing a second malignant neoplasm compared to the general population. When the data were analyzed independently for each tumour site, statistically significant increased risk of developing acute non lymphocytic leukemia (ANLL) (p less than 0.001) and carcinoma of the tongue (p less than 0.05) were found. An increased risk of lung cancer following lymphoma was detected but was not statistically significant. Survival following diagnosis of ANLL and lung cancer was similar and significantly shorter than that following the diagnosis of other second malignancies. The risk of developing a second primary cancer was significantly related to increasing patient age.     

利妥昔单抗联合CHOP方案对弥漫型大B细胞淋巴瘤的疗效及影响因素

目的探讨利妥昔单抗联合CHOP方案对弥漫型大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的疗效,观察影响化疗疗效的相关因素。方法本组选择我院2006年1月至2011年1月收入的DLBCL患者17例,患者给予利妥昔单抗联合CHOP方案治疗。观察化疗后疗效及淋巴结亚群改变情况,收集患者的性别、年龄、PS评分、Ann Arbor分期、结外浸润情况、LDH水平、体力状态(PS)评分、B症状、血红蛋白及T细胞浸润等相关情况,观察其对化疗的相关影响。结果本组所有17例患者完成治疗,治疗后疗效评估显示CR7例,PR6例,SD3例,PD1例,治疗有效率为76.4%(13/17)。影响化疗疗效相关因素分析中显示,血清LDH水平、PS评分、AnnArbor分期为影响患者化疗疗效的相关因素,P0.05。结论利妥昔单抗联合CHOP对弥漫型大B细胞淋巴瘤疗效显著,其中PS评分低、Ann Arbor分期低、血清LDH水平正常的患者化疗疗效相对较好。     

Total body irradiation in non-Hodgkin's lymphoma.

Between October 1972 and August 1977, low-dose fractionated total body irradiation (TBI), 150–300 rad, was selected for 48 patients with previously untreated non-Hodgkin's lymphoma staged II, III and IV. In 63% of the patients the disease had a nodular pattern; there were no patients with diffuse histiocytic lymphoma.All but 2 patients responded to TBI. The 4-year actuarial survival was 71% for the nodular group and 57% for the diffuse group.There were no acute symptoms during the course of treatment and no mortality associated with the treatment. Seventeen per cent of the patients developed transient platelet counts less than 30,000/mm³. Four required hospitalization for correction of thrombocytopenia and/or infection.The majority of patients who failed more than 3 months after initial complete remission were placed back in remission with either chemotherapy, TBI, or local irradiation. Patients with persistent disease after TBI showed a less favorable response with chemotherapy.A selected group of 15 patients in relapse after chemotherapy or localized radiotherapy were treated with TBI. Eleven responded to treatment, while 4 showed no useful response. The median survival for this group was slightly over 2 years. Twenty per cent developed transient platelet counts less than 30,000/mm³.     

Angiotropic large cell lymphoma (ALCL): morphological, immunohistochemical and genotypic studies with analysis of previous reports

The entity 'angioendotheliomatosis proliferans systemisata' was first described 28 years ago as a cutaneous small vessel neoplasm of presumed endothelial origin. Since then, 101 similar cases have been reported under a variety of different names, most with systemic as well as cutaneous lesions, and a lymphoid histogenesis of the tumour cell is now favoured. Review of these cases has shown a characteristic clinical presentation with predominant neurological and dermatological features, although the diagnosis was made at autopsy in 53 per cent of patients. Most therapeutic regimens have proved ineffective with a median survival of 5 months from date of clinical presentation. Aggressive combination chemotherapy can produce complete and lasting remission and a partial response to steroids is sometimes seen. We have examined a case of this condition showing unusual clinical features. Immunohistochemical studies confirm the lymphoid origin of the tumour cells with B cell phenotype. Antigen receptor gene rearrangement studies indicate the presence of the same clonal population of B cells in multiple sites. We suggest that the term 'angioendotheliomatosis proliferans systemisata' should be dropped and support the use of 'angiotropic large cell lymphoma' to describe this unusual condition.     

CHOP与CHOP-L方案治疗45例血管免疫母细胞性T细胞淋巴瘤的疗效及其预后分析

目的:评价应用CHOP与CHOP-L方案治疗血管免疫母细胞性T细胞淋巴瘤（AITL）的疗效及其预后影响因素。方法:对2005年1月-2012年1月经中国医科大学附属盛京医院病理及免疫组化结果确诊的45例AITL患者的临床资料及随访信息进行回顾性分析,分析CHOP与CHOP-L方案的治疗效果及其预后影响因素。结果:18例应用CHOP方案治疗,总有效率（OR）为50%,其中完全缓解率（CR）5例（27.8%）,部分缓解率（PR）4例（22.2%）;1、2、3年的总生存率（OS）分别为66.7%、44.4%及33.3%,无病生存率（DFS）分别为33.3%、22.2%、22.2%。27例应用CHOP-L方案化疗,OR为74%,其中CR 9例（33.3%）,PR 11例（40.7%）;1、2、3年的OS分别为81.4%、62.9%及37%,DFS分别为40.7%、33.3%、25.9%。应用CHOP-L方案化疗、Ann Arbor分期I-II期、结外侵犯0~1个、Ki-67≤50%、无巨大包块、无皮疹的患者疗效较好,且差异有统计学意义（P<0.05）。Ann Arbor分期I-II期、ECOG评分0~1分、Ki-67≤50%、无巨大包块（＞10cm）、结外侵犯0~1个及应用CHOP-L方案化疗的患者均较对照组有较高的3年OS与DFS,且差异有统计学意义（P<0.05）;女性患者及无B症状患者生存期优于男性及合并B症状患者（P<0.05）,但DFS差异无统计学意义（P>0.05）。多因素分析显示ECOG评分是影响本组患者生存的独立预后因素（P<0.05）。结论:AITL以老年、晚期患者多见,预后较差,左旋门冬酰胺酶（L-ASP）联合CHOP方案化疗提高了其治疗的有效率、3年生存率及DFS,且安全性好,不良反应可耐受。Ann Arbor分期、结外侵犯、Ki-67≤50%、巨大包块、皮疹及化疗方案是影响近期疗效的重要因素。患者的Ann Arbor分期、ECOG评分、Ki-67、巨大包块、结外侵犯的程度及化疗方案的选择是影响预后的重要因素。