BACKGROUND: This study was conducted to evaluate the long-term outcomes in patients with stage IE and IIE mucosa-associated lymphoid tissue (MALT) lymphomas treated with involved field radiotherapy (RT). METHODS: Between 1989 and 2004, 192 patients with stage I and II MALT lymphomas were treated. The report focuses on 167 patients who received RT. The median age of patients was 58 years with a female predominance (2:1). Presenting sites were as follows: orbital adnexa in 71 patients, salivary glands in 28 patients, stomach in 25 patients, thyroid in 21 patients, and other sites in 22 patients. The median dose to nonorbital sites was 30 grays (Gy) (range, 17.5-35 Gy) and was 25 Gy for the orbit (range, 25-35 Gy). The median follow-up was 7.4 years (range, 0.67-16.20 years). RESULTS: Complete response and complete response, unconfirmed (CR/CRu) was noted in 166 (99%) patients. The 10-year recurrence-free rate (RFR) was 76%, the disease-free survival (DFS) rate was 68%, the overall survival (OS) rate was 87%, and the cause-specific survival rate was 98%. According to presenting site, the 10-year RFR was 95% for thyroid, 92% for stomach, 68% for salivary glands, and 67% for orbit. Patients with thyroid and gastric MALTs had better outcome compared with patients with MALTs diagnosed at other sites (P ¼.004). Among those patients who achieved CR, 19% developed disease recurrence (n ¼ 31), chiefly in distant sites or untreated contralateral-paired organs. At the time of disease recurrence, 7 patients (23%) had transformed to diffuse large B-cell lymphoma, 2 of whom died of lymphoma. The 5-year OS rate after treatment failure was 83%. CONCLUSIONS: Patients with localized MALT lymphomas are reported to have excellent clinical outcome after moderate-dose RT, and some are likely cured. In the current study, thyroid and gastric MALTs were found to have significantly less risk of distant recurrence. Despite disease recurrence, the overall survival remains excellent in these patients. Cancer 2010;116:3815-24.
Ketoconazole results in biochemical and hormonal improvement for most patients with ECS. It has few adverse effects, but may impair the cortisol response to stress. For that reason, replacement corticosteroids should be considered for patients with hormonal response, and moderate- to high-dose corticosteroids should be given for any potential stress situations. The ultimate control of the syndrome is dependent on successful treatment of the underlying tumor.
Summary:The use of lineage-specific hematopoietic growth factors such as GM-CSF and G-CSF shortens the duration of neuWe studied the effects of escalating doses of recombitropenia following high-dose chemotherapy and ABMT. 1-3 nant human IL-1 in patients receiving high-doseRecently with molecular cloning much interest has emerged chemotherapy and ABMT for metastatic breast cancer in the use of growth factors, which have multilineage proor malignant melanoma. Sixteen patients received ILliferative effects, to shorten the duration of neutropenia and 1, 4 to 32 ng/kg/day administered subcutaneously for platelet transfusion-dependence and to decrease the number 7 days beginning 3 h after bone marrow infusion. Three of red blood cell transfusions. 4 patients at the highest dose level also received G-CSF IL-1 is a polypeptide which exerts effects on hematofollowing completion of IL-1. All patients completed poiesis through several mechanisms, and produces a broad the 7 days of therapy. The majority of patients experispectrum of metabolic, immunologic and inflammatory enced chills and fever following one or more injections, effects. 5,6 In addition to having a direct stimulatory effect and seven had severe pain at the injection site. There on early myeloid precursors, 7 IL-1 stimulates the prowas one episode of hypotension and one episode of tranduction of other cytokines by accessory cells, including Gsient confusion at the highest dose level; other signifi-CSF, GM-CSF, M-CSF, IL-6, IL-1 receptor antagonist cant toxicity was not identified. Recovery of neutrophils molecule (IL-1ra) and soluble receptors for tumor necrosis to Ͼ0.5 ؋ 10 9 /l and platelet transfusion independence factor (sTNF-r) 8-11 all of which appear important in the occurred at a median of 23 and 22 days, respectively, growth of both early and late hematopoietic progenitor which was comparable to historical controls. The mean cells. IL-1 increases the proliferation and differentiation of number of bone marrow colony-forming unit granulobone marrow progenitor cells in the presence of G-CSF. 12 cyte-macrophage (CFU-GM) per 10 5 mononuclear cells IL-1 also enhances the resistance of normal and neutroon day ؉21 post-ABMT was more than twice that of penic mice to gram-negative infections and enhances hemacontrol patients or patients receiving G-CSF or GMtopoietic recovery after lethal irradiation or treatment with CSF. A linear correlation was found between the dose 5-fluorouracil. 13 Enhancement of natural killer (NK) cell of IL-1 and endogenous concentrations of several cytoactivity by IL-1 and direct cytotoxic activity against tumor kines. These patients also displayed significantly higher cells has also been reported. 5 Preclinical studies in nonconcentrations of endogenous G-CSF compared to hishuman primates have demonstrated enhanced neutrophil torical controls receiving GM-CSF. While IL-1 was recovery following chemotherapy in animals receiving ILmoderately toxic and had no effect on recovery of 1. 14 Phase I studies in humans with normal...
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