Rituximab (Mabthera, Rituxan) in patients with recurrent indolent lymphoma: evaluation of safety and efficacy in a multicenter study.

The objective of this multiinstitutional study was to evaluate the safety and efficacy of rituximab at standard four weekly doses in patients with recurrent indolent lymphoma. Thirty-eight patients entered into this study, 63% had follicular lymphoma and 61% had an IPI score of 2 or more. Median disease duration was 3 yr, median number of prior treatments was three, and 66% of patients responded to the immediate past treatment with a median remission duration of 3 mo. A total of 158 antibody doses were given, including two patients who received two courses of four infusions each. One patient developed acute respiratory failure after the second dose and required assisted ventilation. There was no immediate relationship to the antibody infusion and no evidence of infection. This complication resolved and the patient successfully completed the full course of the antibody treatment. Another patient discontinued therapy after the second dose owing to intolerable fever and painful erythema. Sixty percent of the first, and 20% of subsequent rituximab infusions were associated with infusion-related reactions including mild fever, chills, and occasional skin eruptions. Complete and partial responses were achieved in 24% and 35% of 34 evaluable patients, respectively, for an overall response rate of 59%. The median time to progression/relapse in responding patients was 16 mo (95% CI, 6.4, 25.6) compared with a median of 3 mo duration of response to the immediate previous therapy in these patients. Longer response duration post rituximab monotherapy than with previous treatment in this series of heavily pretreated patients suggests a major role for the antibody in the therapy of patients with indolent lymphoma.

Chronic lymphocytic leukaemia presenting with central nervous system involvement.

A 68-year-old man presented with hemiparesis, lymphocytosis, and cerebral lesions on MRI. Flow cytometry of blood, bone marrow and cerebrospinal fluid showed B-CLL lymphocytes with bright CD20 expression, sIg, and absence of CD23 antigen. Fluorescence in situ hybridisation showed trisomy 12 in 50% of analysed peripheral mononuclear cells. The patient died 6 months after the diagnosis. Rapidly progressive and fatal course of the disease was consistent with known bad prognostic significance of CD20 bright expression and trisomy 12.

Environmental factors may regulate BCL2 associated lymphomagenesis: a very low incidence of BCL2-MBR translocation in Poland.

A characteristic feature of follicular non-Hodgkin's lymphomas (FL) is a chromosome translocation t(14;18)(q32;q21). In American patients the t(14;18) can be found in the large majority (approximately 70%) of FL and in a significant (10-40%) percentage of diffuse large cell lymphomas (DLCL). However there are reports suggesting that geographic or racial factors may regulate genesis of lymphomas with BCL2 abnormalities. Herein we present results of molecular analysis for t(14;18) in lymphomas in Poland. Analyses were performed on 37 cases of FL, 55 cases of diffuse lymphomas (DL) and 39 cases of Hodgkin's disease (HD). By Southern and polymerase chain reaction BCL2 translocation within major breakpoint region was found only in 3 of 37 FL, 1 of 55 DL and 2 of 39 HD. These results are the lowest reported ratio. We hypothesize that environmental factors may regulate BCL2 associated lymphomagenesis.

[Identification of a limited form of small cell lung cancer among 103 patients pre-selected for chemotherapy combined with surgery]. / Wyodrebnienie postaci ograniczonej drobnokomórkowego raka pluca w grupie 103 chorych wstepnie wyselekcjonowanych do chemioterapii w skojarzeniu z chirurgia.

Between Nov. 1981 and Nov. 1987 103 patients preselected for chemotherapy combined with surgery, therefore with local extension within homolateral mediastinal lymph nodes, with no signs of remote metastases, PS greater than or equal to 70, with no contraindication for resectional surgery including pneumonectomy, no diabetes, no prior treatment underwent first staging. Staging included: case history, physical examination, full blood count, biochemical tests (alkaline phosphatase, SGOT, GGTP, LDH), CEA, X-ray assessment including CT scan of the chest, bronchoscopy, peritoneoscopy, liver scan (US was not routinely used at the beginning), bilateral bone marrow trephine biopsy, and bone scan. Staging was discontinued when secondaries were detected in one, the more so as in two organs or systems (25 pts), and/or bronchoscopic contraindication for thoracotomy (11 pts), and this group of patients was out of the study. To 67 patients chemotherapy was given and after 3 courses these patients were reevaluated. In 21 patients PD, NC or CR was found. Forty six patients with PR underwent supplementary staging procedures: CT of the brain, CT of the upper retroperitoneal space and liver. Metastatic sites were found in 7 patients. Limited disease was identified in 39 patients. Limited-stage disease can be determined only after exclusion of extensive disease on the ground of: case history, physical assessment, X-ray of the chest (PA + lateral) + CT chest scan, bronchoscopy with biopsy or cytology, and outside the chest: 1. bone marrow trephbine biopsy and bone scan--bone marrow and skeleton, 2. CT head scan--brain, 3. CT abdominal scan--upper retroperitoneal space and liver.

Ampicillin effect on lymphatic tissue of mice and its reaction to sheep erythrocytes.

Ampicillin given to B6A F1 mice in multiple doses of 250 mg/kg of body weight caused changes of the thymus with reduction in size, weight and cellularity of the organ, and with a decrease of the migratory activity in vitro of thymocytes derived from mice treated with ampicillin. Ampicillin produced also a stimulatory influence on the reaction of B-lymphocyte zone in the subpopliteal lymph nodes of mice stimulated with sheep erythrocytes, and delayed the development of this reaction in the thymus-dependent zone of these nodes in response to syngeneic erythrocytes.

Clinical significance of histologic (Kiel) classification combined with immunologic definition of malignant lymphoma.

An actuarial survival (Kaplan and Meier) and complete remission (CR) rate were studied in 106 patients with malignant lymphoma (ML) in whom the histologic diagnosis (Kiel) was combined with the results of immunologic and cytochemical definition of tumor cells. There were 62 low grade (LG) and 44 high grade (HG) ML. Non-B cell malignancies constituted 42% of LG and 29.5% of HG tumors. Prognosis appeared to be related to the histological grade of malignancy and--only within the HG ML group--to the immunologic characteristics of tumor cells. The probability of 3-year survival of patients with HG B cell malignancies was 42%, with U cell tumors 25% and with T cell ML 11%. CR rate was 42% in B cell and 23% in non B cell HG ML. Immunological typing appears to be especially important in HG ML.

Immunosuppressive effect of concanavalin A. IV. The effect of Con A on the local graft versus host (GvH) reaction in the mouse popliteal lymph node.

In the applied parental F1 hybrid system, the GvH character of the regional lymph node reaction was checked against syngeneic and the absolute control systems. It was found that a cortical B-cell zone of the recipients did not participate in the acute phase of the GvH reaction. Cytologically, the GvH response consisted in a significant increase in large pyroninophilic cells, histologically - in a cellular proliferation and pyroninophilia, as well as in a marked angiogenesis beyond the cortical zone of the lymph node. The injection of Con A into the F1 hybrid mice, 24 hours before the administration of the parental cells, inhibited the earlier (presumably donor origin) cellular reaction and intensified the later (presumably host origin) response.

Malignant lymphoma reference centres: GDR, Hungary and Poland, 1979.

In the present paper, the more important data on malignant lymphoma cases seen by the Malignant Lymphoma Reference Centres of the GDR, Hungary and Poland in 1979 are summarized. Altogether 655 new malignant lymphomas were diagnosed pathohistologically, 141 of them (21.5%) representing Hodgkin's disease and 514 (78.5%) non-Hodgkin's malignant lymphomas. Besides, 16 cases of malignant histiocytosis were recorded in the three Centres. The ratio of Hodgkin's disease to non-Hodgkin's malignant lymphoma (see above) and that of low-grade to high-grade tumours (68.5% vs 31.5%) were similar in the three Centres. Ways of further development of the collaboration of the Centres and the measures necessary to increase the comparability of the accumulated material are discussed.

Cytoplasmic immunoglobulins in giant lymph node hyperplasia (Castleman's tumour).

The immunohistologic features were studied in 6 cases of giant lymph node hyperplasia (GLNH) and the cytoplasmic immunoglobulin (CIg) characteristics were compared with those of follicular lymphoma and non-specific follicular lymph node hyperplasia. By use of the peroxidase - antiperoxidase (PAP) technique it was shown that GLNH comprised a mosaic, polyclonal population of CIG-producing cells, the CIg pattern being comparable with that observed in follicular lymphadenitis. In contrast, follicular lymphomas disclosed a definite monoclonal pattern, the cytoplasmic Ig containing only one light chain of kappa type. This led to the conclusion that GLNH is not a neoplastic change, but has the characteristics of a reactive process within the B-cell compartment.