[Lymphoid depletion type 4 Hodgkin disease. Anatomoclinical review of 35 cases]. / Maladie de Hodgkin type 4 à déplétion lymphoïde. Révision anatomoclinique de 35 cas.

The pathological material of 35 patients with Hodgkin's disease lymphocyte-depletion type (type 4) is reviewed with an immunohistochemistry study on paraffin-embedded sections. The new pathologic data are compared with clinical features. These 35 patients are 4.7% of 742 previously untreated patients managed in this institution from 1960 to 1991. The diagnosis of 31 of the 35 patients was rectified, 17 to non-Hodgkin's lymphoma (12 unclassifiable and five anaplastic Ki-1 positive) and 14 to another type of Hodgkin's disease (six nodular sclerosis and eight mixed cellularity). In four cases, the pathologic material was neither sufficient nor satisfactory to allow a clear-cut distinction between Hodgkin's disease and non-Hodgkin's lymphoma. The analysis of clinical data before and after pathological revision did not show any difference in clinical features, either between Hodgkin's disease "type 4" and other types (1, 2 or 3) or between cases with Hodgkin's disease and those with non-Hodgkin's lymphoma. There is, however, a significant male predominance for Hodgkin's disease versus non-Hodgkin's lymphoma (P = 0.029, exact Fisher test), and B symptoms in non-Hodgkin's lymphomas (P = 0.056), whereas B symptoms are commonly seen in advanced stages of Hodgkin's disease. It is emphasized that all Hodgkin's disease of lymphocyte-depletion type should be reviewed and discussed before any treatment, and this diagnosis actually means non-Hodgkin's lymphoma or other types of Hodgkin's disease.

Adjuvant bacillus Calmette-Guérin therapy in non-Hodgkin's malignant lymphomas: long-term results of a randomized trial in a single institution.

Between 1973 and 1977, 48 patients less than 65 years old with non-Hodgkin's malignant lymphoma (NHML) of poor prognosis (+/- high grade malignancy, +/- clinical stages III or IV, +/- first or repeated relapse) were included in a prospective clinical trial. After complete remission (CR), obtained with chemotherapy and radiotherapy, patients were randomized to receive bacillus Calmette-Guérin (BCG) or no further therapy. BCG was administered in weekly scarifications up to 3 years. Forty-three patients are assessable. Twenty-four patients have relapsed: nine out of 21 in the BCG group, and 15 out of 22 in the control group. There is a significant difference in favor of the BCG group in disease-free survival (P = .03). Twenty-one patients have died, 18 from NHML: seven in the BCG group, and 11 in the control group. There is a significant difference in favor of the BCG group for overall survival at 10 years (P = .05). A multivariate analysis points out BCG as a significant prognostic factor. Adjuvant BCG may improve particularly disease-free survival and overall survival for patients with clinical stages I and II or intermediate- and high-grade malignancy. These results suggest that in patients less than 65 years old with NHML of poor prognosis, BCG may significantly increase disease-free survival and overall survival.

Non-Hodgkin's malignant lymphomas in patients older than 80. 70 cases.

In two centers (a comprehensive cancer center and a university hospital) 1300 patients with non-Hodgkin's lymphomas (NHL) were observed during the past 15 years. Seventy patients (5.4%) were diagnosed after they were 80 years old. Thirty-four patients had low-grade NHL, eight had intermediate grade, and 28 had high-grade NHL. The majority of them were classified as Stage I (n = 24) or II (n = 18), and the rest as Stage III (n = 16) or IV (n = 12). Treatment varied with grade of NHL, tumoral extension, and performance status. Forty-seven patients were given chemotherapy, 37 radiotherapy, and six patients had surgery. Overall, treatment was considered to be optimal in 12 patients, good in 34 patients, and limited in 24 patients. Toxicity was minimal in 62 patients, treatment-limiting in two patients, and lethal in six patients. Thirty-seven patients achieved a complete remission (CR), 21 a partial remission, five experienced stabilization, and seven failed to respond. For all patients, the median survival (MS) was 18 months. In contrast to younger patients, malignancy grade had no significant influence. The only significant parameter is CR (P = 0.02). In conclusion, very old patients must be treated correctly but carefully. Better tolerated treatments are needed to improve results that are neither very poor nor as good as in younger patients.

Interleukin-2 receptor is functionally linked with in vitro activation of B cells isolated from non-Hodgkin's lymphomas.

Proliferation and differentiation of B cells can be promoted by a number of inducing factors, including interleukin-2 (IL-2). In vitro-stimulated normal B cells usually express IL-2 receptors (TAC). Furthermore, it has been reported that some minor sub-populations of B cells in normal lymphoid tissue also express TAC antigen, as do some leukemic B cells. In the present study, the reactivity of 20 specimens of non-Hodgkin's lymphoma or B-cell origin was examined for a wide panel of monoclonal antibodies (MAb), including an anti-TAC MAb. The ability of the isolated and purified B cells to proliferate in the presence of B-cell mitogens and culture supernatants (containing various growth factors, including IL-2) was also investigated. These experiments provided some evidence that the TAC-negative cells remained unreactive, whereas the TAC-positive cells entered the cell cycle and proliferated. IL-2 responsiveness of neoplastic B cells is therefore discussed.

Distinct entities among low-grade non-Hodgkin's malignant lymphomas. Analysis of a series of 377 cases.

A series of 377 low-grade non-Hodgkin's lymphomas, observed in the same Institute, was analysed. Pathological types following the Kiel classification were crossed with the usual parameters of patients (sex, age) and disease (tumoural extension, main anatomical involvement, biological data, course of the disease). Small differences appeared for the survivals for the overall series. By contrast many significant differences were observed for sex, age, dissemination of the disease, special tissue involvement, monoclonal gammopathy, complete remission rate and further involvement in case of relapse. These parameters allow one to distinguish different clinicopathological entities after the morphological cellular features. Such correspondences appear meaningful and might be offered by any other classification which should not be based only on the prognosis.

Secondary involvement of the central nervous system in malignant non-Hodgkin's lymphoma. A study of 30 cases in a series of 498 patients.

Of 498 patients with non-Hodgkin's lymphoma (NHL), 30 showed secondary central nervous system (CNS) involvement. Of these 30 patients, 26 had high-grade malignancy and 21 lymphoblastic lymphoma, mainly convoluted (n = 8) or Burkitt (n = 6) type according to the Kiel classification. In half of the 30 patients, CNS involvement was associated with progressive lymphoma. Bone marrow involvement was found in half of the patients before or at the time of the diagnosis of CNS involvement, which was 12 months (mean) after the diagnosis of NHL. Eight patients received CNS prophylaxis. Results of treatment for CNS involvement are poor (mean survival time from CNS involvement: 3.5 months). The Kiel classification allows good identification of patients at high risk of CNS lymphoma: systematic CNS prophylaxis is indicated only in the convoluted and Burkitt types. An efficient prophylaxis must be found and results must be confirmed by other studies.

[Prognosis of follicular lymphoma in a series of 180 cases]. / Pronostic des lymphomes folliculaires dans une série de 180 cas.

In this series, the prognosis and the course of 180 cases of follicular lymphomas, classified according to Kiel's classification, seen before any treatment, treated and followed in the same institution were analyzed. In the first part, 6 primary prognostic factors were identified: compression, age of patient, stage, general symptoms, pathological subtype, lymphography. The most significant parameter (p less than 10(-10], obtained secondarily, was complete remission obtained in 63.9% of patients. In the second part, a multivariate analysis permitted to identify a few groups of patients for whom the probability of complete remission varied between 25 and 100%. Knowledge of these prognostic parameters may help to tailor treatment to each case and to obtain the best survival possible.

Hodgkin's disease in the elderly. A series of 30 patients aged older than 70 years.

Thirty patients aged older than 70 years formed 6.9% of all cases of previously untreated Hodgkin's disease seen in Bordeaux Cancer Center over a 20-year period. The subtype of mixed cellularity was predominant in this age group (P = 0.00035). One patient received no treatment; 20 patients received primary chemotherapy (14 polychemotherapy); all but 2 of the 18 patients in clinical Stages I or II received radical radiotherapy. Median survival for all patients is 15 months. In five cases the treatment could be held responsible for death. Eleven patients died of Hodgkin's disease within a 36-month period. Five patients are alive and the nine other patients died from other causes. The disease-free survival figures showed that one third of the patients could be considered as cured.

Lymphoblastic lymphoma with convoluted nuclei. A report of 19 cases.

A clinically homogeneous population of patients who presented with lymphoblastic lymphoma of convoluted nuclear type was isolated using a histopathological criterion that can easily be applied by trained pathologists. This disease type preferentially affects young male patients, in over half of whom there is initial mediastinal involvement. There is a tendency for the disease to become leukemic and to invade the central nervous system. In spite of heavy chemotherapy and early neuromeningeal prophylaxis, the prognosis is poor.

Distinctive clinical features between lymphoblastic and immunoblastic non-Hodgkin's malignant lymphomas (Kiel's classification) in a series of 141 patients.

Out of a series of 427 NHML based on the Kiel classification and without previous treatment, 186 were of high grade malignancy and among them were 83 lymphoblastic (LB) and 58 immunoblastic (IB) lymphomas which were included in this study. The LB and IB, which represent the majority of high grade NHML, were compared regarding their clinical features and courses. Eight main criteria were significantly different between these two groups: age of patient, immunological history, mediastinal and pleural involvement, primary or secondary involvement of the bone marrow, secondary leukaemia, secondary meningeal involvement, and involvement of the facial region. Some of these differences (mediastinum and meningeal involvement) are related to subtypes within LB. The differences between these two groups suggest that different treatment programs may be warranted.

[Quality of life during and following radiochemotherapy for Hodgkin's disease. Evaluation of 60 patients]. / Qualité de vie pendant et après association radio-chimiothérapique pour maladie de Hodgkin. Appréciation de 60 malades.

Sixty patients treated for Hodgkin's disease by radio + chemotherapy and remaining in complete remission with a median follow-up of 26 months answered a questionnaire dealing with their quality of life during and after treatment. Their main request was to be better informed about their disease, treatment and its side effects. Therapeutic toxicity is mainly due to chemotherapy and is digestive in nature (nausea and vomiting) symptoms. The majority of patients complained of disturbances in their personal and professional lives. It is concluded that more complete knowledge of all patients' disorders may help doctors to improve treatment planning in order that the patient's quality of life be less disturbed.

Maintenance immunotherapy with BCG in non-Hodgkin's malignant lymphomas: a progress report of randomized trial.

Ninety-eight patients with non-Hodgkin's malignant lymphoma were first put into complete remission by a combination of chemotherapy and radiotherapy, and then received one course of chemotherapy as reinforcement. They were then randomized to receive either maintenance BCG therapy or no other treatment. Ninety-three patients were available for this analysis. There was a significant difference (P = 0.021) in relapse-free survival times between the two groups of patients. This difference is particularly significant in male patients, in patients ages 50-65 years, in all histologic classes, in patients treated after an initial relapse, and in clinical stages I and II. There was also a difference in crude survival, but the difference was not significant.

Non-Hodgkin's malignant lymphomas: treatment of localized relapses with chemo + radio + BCG-therapy.

16 patients with relapsing non-Hodgkin's malignant lymphomas considered as clinical stage I or II were treated by an association of chemo + radiotherapy and thereafter by maintenance BCG therapy. 5 of them were included in a randomized trial and have a significantly different disease-free survival from patients receiving the same treatment but without BCG. 11 were systematically treated by BCG and they also have a fairly good disease-free survival. Such a treatment appears to be of value in treating these patients and even probably of curing some of them.

Hodgkin's disease, clinical stages I and II. Results of radical irradiation with or without chemotherapy.

From 1965 to 1976, 170 patients with Hodgkin's disease, clinical stages I or II, were treated with radical irradiation. A first group of 42 patients was treated with irradiation alone, a second group of 24 patients received one course of chemotherapy followed by irradiation, and a third group of 104 patients was treated with a sandwich regimen including chemotherapy + irradiation + chemotherapy. Although the treatment were not randomized, the comparison of the results shows a striking improvement in the group submitted to the C + R + C regimen: in this group the plateau of disease-free survival was 90 per cent. This result was obtained after treatment for about 3 months without surgical staging or maintenance chemotherapy. However, this treatment may favor some complications,. mainly the development of a second malignancy; these risks may be decreased by reducing the treatment in patients with good prognosis.

[Non-Hodgkin's malignant lymphomas. Clinico-pathological data and course in 370 patients (author's transl)]. / Lymphomes malins non hodgkiniens. Caractères anatomocliniques et évolutifs dans une série de 370 malades.

Three hundred and seventy non-Hodgkin's malignant lymphomas were seen at the Fondation Bergoniéé between 1965 and 1978 and classified according to the Kiel classification. Pretherapeutic data and evolution allow to recognize three distinct pathologic groups: 1) a first type of lymphosarcoma, so-called "low grade malignancy", is observed only in adults and old patients; the disease is often disseminated, the evolution is slow and the prognosis favorable; 2) a second type, so-called "lymphoblastosarcoma", is only one observed in young patients, the evolution is fast with frequent leukemic transformation and this group is thus very close to acute lymphoid leukemia; 3) a third type, so-called "immunoblastosarcoma", is observed only in old patients; the evolution is fast but without major spread; for these two latter groups, the prognosis is unfavorable. This highly significant and clearcut distinction may be a help for scheduling treatment according to each group of patients.

Total body irradiation (T.B.I.). Preliminary results of a new technique in 30 patients with hematologic malignancy.

The authors present the preliminary results of a new technique of total body irradiation (T.B.I.) used in 30 patients with hematological malignancy. The schedule proposed is easy to use and reproducible. The clinical and hematologic tolerance is good even for patients having had previous cyclic polychemotherapy and/or large-field irradiation. Low-grade non-Hodgkin lymphomas previously nontreated appear to be the best indication. Further investigations have to be performed particularly to specify the interest of combining T.B.I. and chemotherapy or T.B.I. and radiotherapy in the treatment of non-Hodgkin lymphomas.