value of determination of paraproteins in malignant lymphoma

Forty three patients in stage III and IV malignant lymphoma [17 H.D. and 26 N.H.L] were investigated in this study for presence of paraproteins in their sera and subsequently of clinical manifestations of paraproteinaemia. Twenty nine of them were males and 14 were females. Their ages ranged between 15 and 65 years. Twenty one [48.8%] presented with one or more of the clinical manifestations related to paraproteins in their sera: cold urticaria was detected in 12 occasions, purpura in 8, chilblains in 6. tingling and numbness in 4, Chronic leg ulcers in 4, acrocyanosis in 2, vasculitis and Raynaud's phenomenon each in one occasion. Qualitative and quantitative determination of the different types of paraproteins was performed. Cryoglobulin was found in the sera of 30 patients [69.7%]. paraglobulin was detected in 14 patients [32.5%]. Simple type of cryoglobulin [mostly of IgG] was present in 19 patients and mixed type [IgG and IgM] in 11 patients and both types were more frequent in females. Cold urticaria, purpura, chilbains and chronic leg ulcers were associated with simple cryoglobulins in most occasions, while patients complaining of tingling sensation and numbness, acrocyanosis and vasculitis had mostly mixed cryoglobulins. Pyroglobulin have no clinical significance, yet it was associated with high level of cryoglobulin. Hypoalbuminaemia was detected in 56% of cases. The main disturbance in globulin was elevation in total globulin, alpha-1 and gamma fractions. Hypergammaglobulinaemia was marked in H.D. [88.1%] than N.H.L. patients [34.6%]. Chemotherapy treatment showed decrease in cryoglobulin level in some cases, while there was an obvious increase in the albumin, normalisation of globulin and improvement in the general condition of patients

Effect of combination chemotherapy on the clinical response of malignant lymphoma

This study included 56 patients with advanced stages of malignant lymphoma: 36 NHL, and 20 HD. The most common pathological subtypes were diffuse poorly differentiated lymphocytic in NHL and mixed cellularity in HD, both of which are known to be of unfavorable prognosis. Conventional combination chemotherapy produced nearly the same CR rate in both HD [57%] and NHL [50%], whereas the <> chemotherapy was more effective in HD [CR rate with MOPP-6 = 71.4%] and less effective in NHL [CR rate with CHOP= 40%, and CHOP-L 33.3%]. Although <> combinations were known to be better for clearing the disease, additional toxicities of these combinations apparently resulted in disturbing the patient-tumor relationship. This might explain the poorer response of NHL patients who received the aggressive combinations