Material and Methods: 1,654 non-Hodgkin lymphoma (NHL) patients defined according to the modified Kiel classification and treated at the 3rd Medical Depart -ment/Hanusch Hospital between 1.1.1975 and 31.12.1989 were analysed with regard to clinical presentation and outcome. Results: The median follow-up in our collective was 112 months. Survival of patients with B-cell NHL differed significantly between the subgroups of patients with low-grade and those with high-grade malignancy (p = 0.001). No such difference was seen in patients with T-cell lymphomas (p = 0.7). Symptoms at presentation and outcome were evaluated, and significant differences between the entities were found. Aggressive therapy failed to improve prognosis in patients with low-grade NHL, whereas early aggressive chemotherapy was found to ameliorate the outcome of high-grade NHL (p = 0.008). Improvement in low-grade NHL (p = 0.02) comparing the same periods might be attributable to early diagnosis in CLL (chronic lymphocytic leukaemia) and better supportive care. Conclusions: Late relapse, development of secondary high-grade NHL (1.4% in CLL, 9% in IC: immunocytoma, 11% in CBCC: centroblastic centrocytic lymphoma, and 40% in AILD: angioimmunoblastic lymphoma) as well as development of secondary non-lymphatic neoplasia (12% in our collective) emphasize the necessity of long-term observation in NHL patients.
In a 59-year-old man with multiple myeloma (kappa-light chain paraproteinaemia) in stage IIIB, bone marrow infiltration with atypical plasma cells was reduced by five cytostatic treatment courses with vincristine, melphalan, cyclophosphamide and prednisone (VMCP protocol), but anaemia requiring blood transfusion persisted (haemoglobin concentration 5.3 g/dl). Even administration of interferon alpha-2b (5 million units s.c. every other day) failed to alter this. Only a combination of interferon and erythropoietin (150 U/kg i.v. every other day) achieved lasting regression of the anaemia (haemoglobin concentration up to 14 g/dl). In four other anaemic patients with multiple myeloma, stage III, treated according to the VMCP protocol but without additional interferon, erythropoietin did not improve erythropoiesis.
After a 48-hour rehydration period 28 of 31 patients with cancer-associated hypercalcemia (serum calcium greater than or equal to 2.8 mmol/l) were treated intravenously with the bisphosphonate pamidronate. In three patients fluid repletion with 0.9% saline solution had already normalized serum calcium levels. Pamidronate was given in a single infusion on day 0, the dose of pamidronate adapted to the severity of hypercalcemia. If the serum calcium concentration was greater than or equal to 2.8 mmol/l on day 3, application of pamidronate was repeated. In all patients normocalcemia was restored; mean serum calcium decreased from 3.2 +/- 0.35 on day 0 to 2.15 +/- 0.32 on day 12. Hypercalcemia recurred in 11 patients, seven of these underwent pamidronate treatment according to the same therapeutical regimen. Normal calcium levels were attained in five cases. Side effects were of minor gravity: brief hyperthermia occurred in four patients and transient, asymptomatic hypocalcemia was noticed in nine cases.
Nine adult patients with Ki-1-positive large-cell anaplastic lymphoma were treated with MACOP-B. Two suffered from relapsed disease and had previously received chemotherapy; a third patient had received a single dose of 100 mg/m2 cisplatin before initiation of MACOP-B. The stage of lymphoma was determined according to the Ann Arbor Conference criteria and was II in one, III in two and IV in six patients. All patients had constitutional symptoms. Five patients had achieved complete remission 4 weeks after termination of the protocol and there were two partial remissions. One patient died of massive pulmonary embolism during the 4th week of treatment; another patient, who had received MACOP-B as salvage therapy, died of progressive lymphoma 1 month after completion of the regimen. Maximal observed toxicities according to WHO were mucositis grade 3 (n = 3) and there were three cases with thromboembolic complications, including a fatal pulmonary embolism in a young patient. However, MACOP-B appears an effective, fairly well-tolerated and feasible therapy for patients with Ki-1-positive large-cell anaplastic lymphoma.
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