High dose epirubicin versus mitoxantrone in a seven-drug combination regimen for intermediate and high grade NHL: results of a randomized pilot study

The aim of the present pilot study was an attempt to improve the therapeutic outcome of this group of patients by increasing the dose of the most active drug i.e. anthracycline, through the use of high dose Epirubicin and compare it with the standard regimen in common use in the institution. Also, this work aimed at studying the safety of increasing the Epirubicin dose especially in terms of hematological [BM] and cardiotoxicity

Treatment of chronic myelogenous leukaemia with interferons [IFN]

The aim of this work was to evaluate the safety and efficacy of recombinant alpha-2 IFN alone or with Hydroxyura [H.U.] in the treatment of patients wit chronic phase Philadelphia positive [PH + Ve] CML. Between November 1990 and December 1991 inclusive 8 previously untreated patients with PH + Ve chronic phase of CML were allocated to receive either IFN alone [group A] or IFN + H.U. [group B]. The two groups were comparable as regards number of patients [4], age, sex, presenting symptoms, peroformance status, peripheral blood A patients was 215x10 /L versus 239x10 /L for group B. The mean follow- up period for group A and B were 32 and 20.5 months respectively. All patients [8/8] went into complete hematologic remission [CHR]. However, time to attain CHR was much shorter in group B [mean 2.6 months] than in group A [mean 6.6 months]. Complete cytogenetic remission [CCR] was documented in 3/4 patients of group A and in 2/4 patients of group B. However, 3 of these 5 patients in CCR has residual palpable spleen the nature of which was not histopathologically confirmed, but ultrasonographic findings of bilharziasis were evident. All patients [8/8] showed hematologic relapse after a mean period of 2 months [range 1-3] of cessation of maintenance IFN. Only one of these relapsed patients [1/8] was retreated with IFN alone for 3 months during which he attained a second CHR and CCR but he relapsed within 6 months of cessation of IFN. No life threatening complication was recoreded although a variable degrees of musculoskeletal pains were recorded. In conclusion, alpha 2-IFN is an effective safe treatment of chronic phase PH + Ve CML patients and is capable of inducing CCR. Achieving a second CCR by alpha 2-IFN is possible i.e lack of drug resistance and the addition of H.U. to alpha 2-IFN during induction can reduce time to CHR by about 4 months. Reappearance of PH [+] ve cells shortly after cessation of maintenance alpha 2-IFN may indicate the need of its prolongation and the importance of confirming complete remission at molecular level

Pattern of failure after treatment of Hodgkin's disease [HD]

This study included 156 consecutive cases of Hodgkin's disease registered and treated at Kasr El-Aini Center of Radiation Oncology and Nuclear Medicine [NEMROCK] between 1978 and 1982 inclusive. Mean age of the whole group was 27.8 years. There were 114 males and 42 females. Sixty-seven [49%] were in stage one and two. Mixed cellular HD was the commonest histologic subtype in the present study [35%]. Fifty-three patients in stage one and two were evaluable. 85% were disease free after a mean follow up of 27 months. Nine patients in stage one, two relapsed after a mean time of 19 months with a range of 3-36 months; 6/9 relapses were in para-aortic region. Four were in previously treated sites. Second complete remission could be achieved in 6 of the relapsed cases. Only 39% of stages three and four could complete the prescribed treatment. 75% of those who completed this treatment achieved complete remission and 25% had partial response. Age and constitutional symptoms were the only positive risk factors that correlated with relapse in stage one and two

Wilms' tumour: the value of post-operative treatment in decreasing relapse rate

A retrospective clinico-epidemiologicalstudyand evaluation of therapeutic modalities in patients suffering from Wilm's tumour has been carried out at Kasr El-Aini center of radiation oncology and nuclear medicine[NEMROCK] during the period 1971-1985 inclusive. Eighty-four cases had a histological confirmation of their disease. Wilms'tumour represented 6.6% of all cancer in children below 15 years old. The mean age was 47.8 +/- 41.2 months. It was 40. 2 +/- 20.3 years for males and 56.7 +/- 55.5 years for females. The male to female ratio was1.2:1. Clinical stages I and II constituted 32.1% of the case while stage III represented 30.9% and "Unstaged" group [inadequate date for staging] represented 29.8%. Eight cases[9.5] were reported histologically unfavourable, one had a clear cell and seven had diffuse anaplasia. Cases associated withbonemetastasis [Unfavourable behaviour] were only considered of unfavourable histology if histologically confirmed. In 43 evaluable patients a better prognosis was seen in early clinical sages [14 cases with stage I and II] than the remaining cases [29 cases]. A statistically significant low relapse rate of42.8% [12/28 cases] was observed in cases who received post- operative therapy [both radiotherapy and chemotherapy] than cases who did not receive such treatment [100%, 7/7 cases]. In cases who started therapy within 10 days after the operation no relapse occurred, while those who started therapy after 10 days the relapse rate was 64.1% [25/39 cases]. A statistically significant lower abdominal relapse rate [6.1%,2/33 cases] was observed following abdominal irradiation than in cases who did not receive such irradiation [60.0%, 6/10 cases]. Four out of eight cases with pulmonary metastasis [50.0%] achieved complete response after combination chemotherapy [2 relapsed with a median duration of 4.5 months and 2 still free of disease with a disease free survival of 17 and 21 months]

Clinico-epidemiological and treatment of gastrointestinal non-Hodgkin's lymphoma

Gastrointestinal NHL represented 38% of all extranodal cases. The gastrointestinal tract was the most common extranodal site if the Waldeyer's ring NHL are excluded. 52% of pediatric extranodal cases occurred in the GIT. Opposed to 24% of adult ones. The small intestine was the commonest primary GIT. Site [50%] with a more proximal loops affection. Forty-one cases were classified according to the International Working Formulation, only three cases were of low grade histology and none of them occurred in the pediatric group. Thirty-nine patients were avaluable for immediate assessment with complete remission of 46.2% and 33.3% had no response. Twenty-four cases were avaluable for more than 12 months follow-up or died from the disease during this period. Eleven of them achieved complete remission with a median survival of 32 months versus 11.5 and 5 months for partial and non responders, respectively. While, the age and the clinical stages were the statistically significant prognostic factors, the primary site and the treatment policy may also influence the prognosis. The addition of methotrexate in pediatric patients improved the prognosis significantly

Primary mediastinal non Hodgkin's lymphoma: clinicopathologic study and response to treatment

Out of 982 histologically confirmed cases of malignant lymphoma presenting to NEMROCK between 1970-1981 inclusive, non-Hodgkin's lymphoma constituted 59.5% [585 cases]. Among this later group, 66 patients had intrathoracic disease. Primary mediastinal NHL represented 6.2% of NHL [36 cases]. The male to female ratio was 2.6:1 with the peak age incidence in the third decade of life. Lymphoblastic lymphoma was the main histological subtype of primary mediastinal NHL, 42.9% of the histologically revised group [21 cases]. The main presenting symptoms were those of mediastinal syndrome. Bone marrow infiltration was recorded either initially or subsequently in 50%. Advanced stages predominated early ones [69.7% versus 30.3%]. Leukemic transformation was recorded in 38.9% of cases of primary mediastinal NHL [14 cases]. The overall infiltration of CNS was 14% of cases. However, the overall complete and partial remission [CR and PR] at end of treatment was 20% and 32% respectively. Response rate [CR and PR] was only 25% among the lymphoblastic group. Early stages [I and II] responded favorably to treatment than later stages [III and IV] with an overall response of 72% versus 45% respectively. Comparison between clinical features and response to treatment of the lymphoblastic and other histological subtype of primary mediastinal NHL was carried out