Objectives: To evaluate the impact of pulmonary emphysema (PE) on the incidence and severity of radiation pneumonitis (RP) in patients with lung and mediastinal tumours. Methods: 92 patients were enrolled. Involved-field radiation therapy (non-small cell carcinoma or mediastinal tumours in 69 patients; median 70 Gy) and accelerated hyperfractionation (limited disease small cell carcinoma in 23 patients; median 45 Gy) were performed. Common Terminology Criteria for Adverse Events v.3.0 was used to evaluate RP and the relationship with the percentage of pulmonary volume irradiated to .20 Gy (V20) and PE. PE was diagnosed by the presence of low-attenuation areas (LAAs) on CT scans and was classified into Grades 0-4 according to the extent of the LAAs. Results: The median follow-up time was 16 months. The 6-month cumulative incidence of RP at Grade 3 or greater was 7.7% and 34.1% in patients with a V20 of ,25% and >25%, respectively (p50.017). In patients with PE Grades 0, 1, 2 and 3 or greater, the incidence of RP was 16.5%, 9.1%, 8.6% and 54.0%, respectively. As the PE Grade increased, the incidence of RP also increased significantly. Conclusion: The incidence and severity of RP are significantly higher in patients with a high V20 value as well as in those with severe PE.
Summary:Hepatitis B virus (HBV) reactivation, a well-known complication in immunosuppressed patients, can give rise to acute hepatitis and even fatal fulminant hepatitis. Three Japanese males with non-Hodgkin's lymphoma (NHL) who were carriers of HBV received high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT). To prevent HBV reactivation, all received oral lamivudine (150 mg/day), a nucleoside analogue, at the start of chemotherapy. All were treated at full-dose intensity, including corticosteroids, without modification of treatment regimens. All three patients completed the total course of chemotherapy and PBSCT, with no signs of HBV reactivation. Peripheral blood stem cell (PBSC) harvests and hematological recoveries after transplantation were not affected by lamivudine, which was continued for at least 16 weeks after transplantation. HBV-DNA and DNA polymerase levels remained negative/normal after discontinuation of lamivudine. Lamivudine effectively inhibits HBV replication and has few serious adverse effects, particularly those related to hematopoiesis. Thus, prophylactic use of lamivudine from initiation of chemotherapy deserves consideration in the treatment of HBV carriers who require immunosuppressive chemotherapy, and may prevent HBV reactivation. Bone Marrow Transplantation (2001) 27, 433-436. Keywords: non-Hodgkin's lymphoma; hepatitis B; lamivudine; peripheral blood stem cell transplantation (PBSCT) Recent studies have shown that an improved prognosis or even cure can be achieved by high-dose chemotherapy followed by stem cell transplantation for patients with aggressive non-Hodgkin's lymphoma (NHL).
Cytokeratin 19 fragment (CYFRA 21-1) level in serum have already been documented as a useful tumor marker for lung cancer. In the present study, we hypothesized that CYFRA 21-1 increases in the sera of patients with radiation pneumonitis, resulting from epithelial cell damage. We measured CYFRA 21-1 in the sera of patients with radiation pneumonitis and evaluated the correlation between CYFRA 21-1 level and severity of radiation pneumonitis as well as clinical course. We studied 16 patients diagnosed with radiation pneumonitis associated with primary lung cancer. CYFRA 21-1 levels in the sera of patients with diffuse radiation pneumonitis (n = 6) significantly increased compared to normal smokers (n = 10) or patients with local radiation pneumonitis (n = 10). CYFRA 21-1 values in sera changed according to the progression or improvement of the diffuse radiation pneumonitis. An immunohistochemical study using pulmonary tissues obtained from autopsied patients with radiation pneumonitis demonstrated that the hyaline membrane and proliferating type II pneumocytes were strongly stained by the anti-human cytokeratin 19 antibody. Our data demonstrated that CYFRA 21-1 was increased in patients with diffuse radiation pneumonitis. Since CYFRA 21-1 is widely used as a tumor marker for lung cancer, this evidence should be noted especially in irradiated patients.
Summary:Localized cutaneous nontender nodules appeared on the back of a 52-year-old Japanese woman. Skin biopsy revealed atypical large T-lymphocytes infiltrating the dermis. CD30 staining was negative in tumor cells. The diagnosis was CD30-negative cutaneous large T cell lymphoma. There was no evidence of peripheral lymphadenopathy or bone marrow involvement. Six cycles of induction chemotherapy were administered and a complete clinical remission (CCR) was attained. Local irradiation was not given. As the clinical course of CD30-negative cutaneous large T cell lymphoma is recurrent and often incurable with conventional chemoradiotherapy, she received high-dose chemotherapy without total body irradiation (TBI) followed by unpurged autologous peripheral blood stem cell transplantation (APBSCT). A relapse in the skin followed 40 days after APBSCT, but tumor cells transformed into a CD30-positive anaplastic large cell lymphoma (ALCL). We question the need for TBI in conditioning and for purged stem cells for APBSCT in patients with high risk cutaneous lymphomas. Keywords: CD30-negative cutaneous large T cell lymphoma; autologous peripheral blood stem cell transplantation (APBSCT); histological transformation Cutaneous T cell lymphoma (CTCL) other than mycosis fungoides (MF) represents a rare and heterogeneous group of lymphomas; the clinical behavior has seldom been described. [1][2][3][4] In 1997, the European Organization for Research and Treatment of Cancer (EORTC) reported a new classification for primary cutaneous lymphoma. 5 In their report, CTCL were subdivided into two categories: indolent and aggressive forms according to clinical behavior. CD30-negative large T cell lymphoma, classified as one of the aggressive CTCL, accounted for 5% (36/626) of all primary cutaneous lymphomas and the estimated 5-year survival was 15%.1,5 An effective and curative therapeutic strategy for CTCL with this histology has not been established. We describe the clinical features in a woman with CD30-negative large T cell lymphoma and the early recurrence after high-dose chemotherapy with APBSCT. Case reportA previously healthy 52-year-old Japanese woman presented with nontender localized cutaneous nodules on her back in August 1997. Systemic B symptoms were nil and all vital signs were normal. The major finding was several smooth cutaneous nodules, without ulceration, ranging in size from 1 to 3 cm on her left back, and irregularly outlined erythema on her right back. Physical examination and CT scan of the chest and abdomen revealed no evidence of peripheral lymphadenopathy or hepatosplenomegaly. All laboratory values were normal, including serum lactate dehydrogenase (LDH) and soluble IL-2 receptor. Serologic studies were negative for human T lymphocytotropic virus-I (HTLV-I) and human immunodeficiency virus (HIV). Bone marrow aspiration and biopsy revealed no involvement by atypical lymphocytes.Skin biopsy of a nodule on her left back revealed an atypical large lymphocyte infiltration of the entire dermis, with epidermotropis...
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