[Biopsy of potentially malignant bone disorders using an electric minidrill; results of 215 diagnostic drillings]. / Biopsie van mogelijk maligne botafwijkingen met behulp van een elektrische miniboormachine; resultaten van 215 diagnostische boringen.

The results were evaluated of cytological and histological examination of 215 bone biopsies taken with an electric minidrill in 211 patients with suspected malignancies in bones. 171 biopsies were taken in 167 patients with a known malignancy. In 78 cases a malignancy was demonstrated including 4 cases of a second primary malignancy. 44 biopsies of patients without a known primary malignancy resulted in 19 cases of malignancy, mainly metastatic disease. There were no primary bone tumours. Follow-up showed a false negative result in 5 patients, all with known primary malignancies. Follow-up of the patients without known malignancies showed no false negatives. The sensitivity of cytology alone was 92% and the sensitivity of histology alone was 76%. The combination of cytology and histology resulted in a sensitivity of 95%. The specificity of the procedure was 100%.

Sequential non-cross-resistant chemotherapy regimens (MOPP and CAVmP) in Hodgkin's disease stage IIIB and IV.

Fifty consecutive patients with advanced Hodgkin's disease were treated in a multicentre study with 6 cycles of an alternating scheme of MOPP and CAVmP followed by irradiation to a dose of 20 Gy. The objective was to increase complete remission (CR) and cure rates by alternating two effective noncross-resistant regimens with subsequent consolidation of the remission by irradiating bulky nodes. A total of 47 patients completed the treatment and are evaluable. In the first 13 patients the irradiation fields amounted to a total or subtotal nodal irradiation with inclusion of the spleen. In case of organ involvement the affected organ was also included in the irradiation field. The irradiation protocol was later changed to an irradiation of the initially involved sites because of severe leucopenia and thrombopenia. After completion of the chemotherapy 32 (68%) patients (for Stage IIIB and IV patients: 63% and 71%, respectively) achieved a CR, after ending the radiotherapy the percentage of CR increased to 87% (for stage IIIB and IV patients: 90% and 86%, respectively). Five of the patients relapsed in an irradiated and nonirradiated area, three patients in a nonirradiated field. The actuarial 3-year survival rate for the entire group was 86% and for patients in CR 94%. The relapse-free survival was 73%. It is concluded that this alternating chemotherapy scheme followed by irradiation is at least equally effective as MOPP treatment in achieving a CR, and is probably superior in terms of survival.

Paraproteinaemia plus osteolytic lesions in typical hairy-cell leukaemia.

Most cases of hairy-cell leukaemia (HCL) involve proliferations of neoplastic B lymphocytes. In rare cases, M-proteins or osteolytic lesions have been documented in patients with HCL. In this study two patients with typical HCL are reported in whom both paraproteinaemia and osteolytic lesions of the femoral neck developed. In one of the patients the production of the M-protein by hairy cells could be established. In the other patient, at autopsy no signs of myeloma were found. The hairy cells from inside the osteolytic lesion had the same immunological phenotype as hairy cells from the peripheral blood, the spleen, and other parts of the bone marrow. These cases once more confirm the B-cell nature of many cases of HCL, and show that hairy cells can have functional capacities usually attributed to much more mature B lymphocytes, i.e. plasma cells.

Delayed alloimmunisation by random single donor platelet transfusions. A randomised study to compare single donor and multiple donor platelet transfusions in cancer patients with severe thrombocytopenia.

The effects of single-donor (SD) and multiple-donor (MD) platelet transfusions in 34 cancer patients with severe thrombocytopenia and haemorrhages were compared in a randomised study. Platelet recovery values in both groups were similar after the first transfusion. After the second transfusion platelet recovery values were significantly better in those receiving SD transfusions. Platelet recovery values gradually declined with subsequent MD transfusions. These results suggest early alloimmunisation in the MD transfused patients only. MD transfusions were estimated to be no longer effective after about nine transfusions. Platelet recovery values were better indicators of early sensitisation than was the lymphocytotoxicity test. Restriction of the number of donors per transfusion may postpone the development of refractoriness to random-donor platelet transfusions in thrombocytopenic patients.

Non-Hodgkin's lymphomata: clinical features in relation to histology.

An analysis is given of the clinico-pathological correlations of non-Hodgkin's lymphomata in 332 patients referred to the Netherlands Cancer Institute in Amsterdam and the Rotterdam Radiotherapy Institute. Clinical staging proved to be an important prognostic index. In Stage I the 5 year survival was 55%, in Stage II 25% and in Stages III and IV less than 10%. The presence of follicular structures in non-Hodgkin's lymphomata has similarly an important prognostic significance especially in Stage I and II. In lymphocytic lymphomata a larger cell size is correlated with less favourable prognosis. The presence of macrophages in non-Hodgkin's lymphomata is found in patients with short survival. The histiocytic lymphomata have a different survival pattern from the lymphocytic lymphomata in Stages I and II.

Spread according to histology in non-Hodgkin's lymphomata.

The spread of non-Hodgkin's lymphomata was investigated in a group of 323 cases. Differences were sought between 4 histological groups: lymphocytic vs histiocytic lymphomata and diffuse vs follicular types. Histiocytic and follicular types were rare in childhood. Histiocytic lymphomata, compared with lymphocytic ones, were more often confined to sites above the diaphragm. They exhibited a higher rate of loco-regional recurrences within the first 3 months and also of late recurrence after 4 years. Lymphocytic lymphomata of the follicular type more commonly presented with nodal involvement below the diaphragm as primary or secondary site than the diffuse form. Follicular types of lymphoma compared with diffuse types, occurred more frequently in women. They were more seldom seen as primary or secondary sites in extranodal localizations. They had a smaller chance of late disease recurrence and were associated with a longer survival time after first recurrence. The mediastinum often remained clinically uninvolved. With regard to this mediastinal "skip" no differences were found between the histological groups.