Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies.
Summary
Stage I/IIA follicular lymphoma (FL) is considered a localised disease that can be adequately treated with radiotherapy alone. Bone marrow (BM) and peripheral blood (PB) involvement in FL was investigated by polymerase chain reaction (PCR) in a series of 24 consecutive patients with histologically revised diagnosis and treated with involved field radiotherapy. Despite the limited stage, Bcl‐2/IgH+ cells were found at diagnosis in PB and/or BM of 16 patients (66·6%). After treatment, in 9/15 Bcl‐2/IgH positive evaluable patients, a disappearance of Bcl‐2/IgH+ cells was observed, which persisted after a median follow‐up of 43·5 months (range 11–70) in all but one patient. Quantitative PCR demonstrated the feasibility of clearing PB and BM Bcl‐2+ cells after local irradiation of the primary site of the disease only when the basal number of lymphoma cells was <1:100 000. Patients with Bcl‐2/IgH+ cells at diagnosis or after treatment had a higher likelihood of relapse. Thus, despite a negative BM biopsy, the majority of localised FL Bcl‐2/IgH+ cells were found in the PB and BM. Lymphoma cells can reversibly spread from the affected lymph node to PB and BM and, in a proportion of cases, durably disappear after irradiation. The possibility of a persistent lymphoma cell clearance is proportional to the amount of cells detected at presentation by quantitative PCR.
Objectives: To evaluate the possibility that women affected by Hodgkin’s disease (HD) during their second or third trimester of pregnancy can safely carry their pregnancy to term. Methods: From 1986 to 1997, 6 women came to our Center during the second trimester of pregnancy and were diagnosed as having HD. Three of these 6 patients were treated with chemotherapy before delivery and 3 of them were kept under observation and started treatment after delivery. Results: All 6 women gave birth to a healthy female. Conclusions: The pregnancy does not worsen the course of the illness and does not compromise long-term clinical remission and recovery.
In diffuse large B-cell lymphoma (DLBCL), the response to first-line immunochemotherapy remains somewhat unpredictable. Interim [(18)F]fluorodeoxyglucose-positron emission tomography (FDG-PET) (PET-int) analysis could be an important tool in the prompt shift to intensified regimens. We prospectively evaluated the effectiveness of PET-int carried out at mid-treatment with standard immunochemotherapy in predicting relapse in a series of 85 consecutive patients with DLBCL. PET-int results were dichotomized as positive or negative using the recently validated five-point scale scoring system. This examination was also compared with interim computed tomography (CT-int) and final PET (PET-fin). End-points were: complete remission (CR), positive predictive value (PPV) of refractoriness and relapse, negative predictive value (NPV), overall survival (OS) and progression-free survival (PFS). Observation time was fixed to 24 months unless preceded by a DLBCL-related event. The PPV of PET-int was 58% and the NPV was 77%. CR was correlated with both PET-int and CT-int (p < 0.0001), but in multivariate analysis only CT-int was correlated with CR (p = 0.002). CT-int and PET-fin were predictive of both OS and PFS, whereas PET-int was predictive only of OS (p = 0.013). In Cox regression only PET-fin was predictive for both OS (p = 0.004) and PFS (p = 0.005). PET-int was unable to discriminate those chemosensitive patients who would later relapse. We therefore believe that the use of this expensive radioactive tool is not justified as an interim analysis.
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