ABSTRACT
Objective: To explore the clinical characteristics, the diagnostic framework, and the treatment methods of B cell lymphoblastic lymphoma (B-LBL), and to clarify the progress of diagnosis and treatment of B-LBL to improve the clinician's understanding of the disease and provide the guidance for prognostic evaluation and therapeutic options. Methods: The clinical data including symptoms, physical signs, ancillary testings, diagnosis, treatment and disease prognosis of a child suffered from B-LBL were retrospectively analyzed; in the meantime, the relative literatures were reviewed. Results: The patient was definitly diagnosed as B-LBL according to the clinical characteristics and received combination therapy with vincristine, daunorubicin, L-asparaginase, and prednisone as the first course, along with the intrathecal injection of methotrexate and dexamethasone to prevent central nervous system leukemia (CNS-L). The patient achieved complete remission (CR) 25 d after the first circle chemotherapy but was diagnosed as degree 4 myelosuppression. Therefore, the second cycle combination therapy was adjusted with cyclophosphamide, cytarabine and 6-MP, and the intrathecal injection to prevent CNS concomitantly. Degree IV myelosuppression appeared repeatedly after 2 cycles and the combination chemotherapy was reajdusted. So mercaptopurine and high dose of methotrexate were given as the 4th cycle, and CNS was prevented continously. The patient kept CR until the second cycle finished but get recurrence after the third chemotherapy (prolymphocytes 10%). Then remission and recurrence were found in the disease counrse during which Mary chemotherapy methods were attempted until the patient got stable CR after treatment for 31 months. Then the patient was treated with oral mercaptopurine (50 g · d-1) and methotrexate 25 mg per week) and kept disease-free survival for more than 3 years. Conclusion: B-LBL is a rapidly developed disease with the bone marrow involvement occurring in the short term and easy to relapse during treatment. However, it is extremely easy to transform to recurrent and refractory B-LBL after the first remission. It is of great importance to estimate the risk stratification and to evaluate the prognosis of LBL patients in order to treat as soon as possible for the improvement of one's life quality and the prolongation of survival.
ABSTRACT
Objective:To explore the clinical characteristics,the diagnostic framework,and the treatment methods of B cell lymphoblastic lymphoma(B-LBL),and to clarify the progress of diagnosis and treatment of B-LBL to improve the clinician's understanding of the disease and provide the guidance for prognostic evaluation and therapeutic options.Methods:The clinical data including symptoms,physical signs,ancillary testings,diagnosis, treatment and disease prognosis of a child suffered from B-LBL were retrospectively analyzed;in the meantime,the relative literatures were reviewed.Results:The patient was definitly diagnosed as B-LBL according to the clinical characteristics and received combination therapy with vincristine,daunorubicin,L-asparaginase,and prednisone as the first course,along with the intrathecal injection of methotrexate and dexamethasone to prevent central nervous system leukemia(CNS-L).The patient achieved complete remission(CR)25 d after the first circle chemotherapy but was diagnosed as degree 4 myelosuppression.Therefore,the second cycle combination therapy was adjusted with cyclophosphamide,cytarabine and 6-MP,and the intrathecal injection to prevent CNS concomitantly.DegreeⅣ myelosuppression appeared repeatedly after 2 cycles and the combination chemotherapy was reajdusted. So mercaptopurine and high dose of methotrexate were given as the 4th cycle,and CNS was prevented continously. The patient kept CR until the second cycle finished but get recurrence after the third chemotherapy(prolymphocytes 10%).Then remission and recurrence were found in the disease counrse during which mary chemotherapy methods were attempted until the patient got stable CR after treatment for 31 months.Then the patient was treated with oral mercaptopurine(50 g·d-1)and methotrexate(25 mg per week)and kept disease-free survival for more than 3 years.Conclusion:B-LBL is a rapidly developed disease with the bone marrow involvement occurring in the short term and easy to relapse during treatment.However,it is extremely easy to transform to recurrent and refractory B-LBL after the first remission.It is of great importance to estimate the risk stratification and to evaluate the prognosis of LBL patients in order to treat as soon as possible for the improvement of one's life quality and the prolongation of survival.
ABSTRACT
Background and purpose:The patients with aggressive lymphoma who have a poor prognosis and unlikely to be cured with conventional chemotherapy. This study was aimed to evaluate the effect of high-dose etoposide in mobilization followed auto-SCT in treating refractory lymphoma. Methods:40 patients [median age 33 (13-61) years] with refractory non-Hodgkin’s lymphoma (NHL, n=32) or Hodgkin’s lymphoma (HD, n=8) received high-dose etoposide [VP16 10-15 mg/(kg·d)×2 d] in mobilization in our center. Remission status prior to mobilization was PD (n=40). The use of such granulocyte colony-stimulating factor [G-CSF, 5-10μg/(kg·d)] mobilized peripheral blood stem cells (PBSC) after high-dose etoposide until the end of leukapheresis. Peripheral blood stem cell was collected and frozen in-80℃refrigerator. All these patients received auto peripheral blood stem cell transplantation (auto-PBSCT). Conditioning regimen was BEAM (n=19, 47.5%) or CBV (n=21, 52.5%). Results:Twenty-eight pa-tients (70%) were assessable for response after high-dose etoposide at a median pretreatment time of 39 days (range 17-172 days), 12 patients (30%) had no response. Median follow-up of 28 (4-66) months, 16 patients (40%) reached CR after auto-PBSCT. Fifteen of the 28 patients (53.6%) who had response to high-dose etoposide reached CR, 4 patients (14.3%) reached PR, 9 patients (32.1%) succumb to progression of disease. One of the 12 patients (8.3%) who had no response to high-dose etoposide reached CR, 1 patients (8.3%) reached PR, 10 patients (83.4%) succumb to progression of disease. The estimated 1-year OS and EFS were 69%and 56.7%respectively, 2-years OS and EFS were 63%and 52%respectively. The prognosis of the patients who had no response to etoposide was poor. The estimated 1-year OS and EFS were 25%and 16.7%respectively. Two group of comparison differences have statistics signiifcance (P<0.01). Conclusion: High-dose etoposide could be used in refractory lymphoma as rescue therapy in mobilization. It can increase the EFS and OS of patients who had response. The hematopoietic stem cells collection and hematopoietic reconstitution are not affected by etoposide.
ABSTRACT
BACKGROUND: Patients with non-Hodgkin's lymphoma who do not respond to first-line chemotherapy or those who relapse after obtaining a complete response have a poor prognosis and are rarely cured with usual salvage chemotherapy. We investigated the treatment responses, toxicities, prognostic factors and mobilization efficacy of peripheral blood stem cells (PBSC) used as salvage chemotherapy. METHODS: 55 patients with refractory (36) or relapsed (19) NHL were treated from Novembr 1997 to October 1999 with IVAM (ifosfamide, etoposide, cytarabine, methotrexate) regimen. Each patients was scheduled to receive one to three cycles of chemotherapy. When the leukocyte count reached 5x109/L after chemotherapy, PBSC collection was performed. The treatment was repeated every 4 weeks. RESULTS: The median age was 48 years (range, 19-76). Median 2.1 cycles of chemotherapy were administered. 15 patients (27.3%) achieved complete response and 29 (52.7%) partial response, with an overall response rate of 80.0%. Myelosuppression was the major toxicity, with 98.2% of grade 3, 4 neutropenia and thrombocytopenia, but there was no serious hemorragic event. Neutropenic fever occurred in 25.5% of the patients with one treatment-related death due to sepsis. Non-hematologic toxicity was modest. PBSC was collected in 36 patients for high dose chemotherapy and autologous stem cell transplantation. The median number of mononuclear cells collected was 9.9x108/kg and the median number of CD34(+) cells collected was 11.9x106/kg. After a median follow-up of 13 months (range, 3-26), median progression free survival were 12 months and median overall survival has not been reached yet. 1-year overall survival and progression free survival were 61.9% and 46.1%, respectively. In univariate analyses, unfavorable prognosis was associated with poor performance status (p=0.001), high LDH (p=0.041), stage III,IV (p=0.04), extralymphatic lesion (p=0.027), B sx (p=0.034), bone marrow involvement (p=0.039) and performing high dose chemotherapy (p=0.005). Multivariate analysis showed that performance status(p=0.0042), B sx(p=0.049) was a significant independent risk factors for death. CONCLUSION: These results suggest that IVAM is an effective salvage chemotherapy for refractory or relapsed NHL and allow effective PBSC collection for high dose chemotherapy and autologous PBSCT.