The clinical presentation of non-hodgkin lymphomas of the major salivary glands.

The aim of this study was to examine the clinical presentation of patients with malignant lymphoma of the major salivary glands. In a retrospective study, 26 patients with a non-Hodgkin lymphoma (NHL) of the major salivary glands were examined. The results showed a distinct preference for the female gender. Two groups with clinical differences were observed depending on lymphoma manifestation as either extranodal-parenchymal (extranodal) or with intra- or periglandular (nodal) lymph node disease. Differences between these two groups existed with regard to the length of clinical history, recurrent vs continuously progressing symptoms and presentation on ultrasound examination (multiple masses compared to solitary masses). Patients with an extranodal lymphoma always showed disease limited to the affected gland, whereas those patients with a nodal lymphoma presented with stage II or higher (Ann Arbor Classification). In these patients, local recurrence was also five times higher (5/13; 38.4%) than in patients with an extranodal lymphoma (1/13; 7.7%). In 1 patient (7.7%) with extranodal lymphoma, dissemination was observed, compared to 6/13 patients (46.2%) in the group with nodal disease. Seven out of 13 patients (53.8%) with nodal disease died due to lymphoma spread and 1/13 (7.7%) of the patients with extranodal disease. There seem to be distinct clinical differences in the course of patients with NHL of the major salivary glands, depending on extranodal or nodal disease presentation. The histopathological diagnosis, with special recognition of the particular lymphoma pathogenesis, constitutes an important prognostic factor in these patients.

[Clinical presentation, therapy and prognosis of non-Hodgkin lymphomas of the major salivary glands]. / Zur Klinik, Therapie und Prognose der Non-Hodgkin-Lymphome der grossen Kopfspeicheldrüsen1.

INTRODUCTION: About 5 - 10 % of all Non-Hodgkin-Lymphomas (NHL) present within the major salivary glands. Two etio-pathologically different groups, the (extranodal)-parenchymal NHL and NHL of intra- or periglandular lymphnodes (nodal lymphomas) have to be distinguished. It was the aim of this study to evaluate the clinical presentation, therapy and biological behaviour of these etiopathologically different lymphoma-groups. MATERIAL AND METHOD: In a retrospective study, therapy and course of disease of 26 patients with a NHL of the major salivary glands were examined (diagnosis and treatment between 1988 and 1996). RESULTS: Staging results in the group of parenchymal lymphoma always showed the disease limited to the effected gland, whereas nodal NHL presented with a stadium II to IV (Ann-Arbor) at time of diagnosis. Local recurrencies were five times higher in nodal NHL compared to parenchymal NHL. In only one case (7.7 %) of the patients with parenchymal NHL, dissemination was observed. In the group of nodal NHL, a dissemination was observed in 6 patients (46.2 %). 7 of 13 patients (53.8 %) with a nodal NHL died due to lymphoma dissemination, compared to one patient (7.7 %) with a parenchymal NHL. CONCLUSION: Based on the presented data, the histopathological diagnosis, under special recognition of the particular lymphoma-pathogenesis, constitutes an important prognostic factor in patients with NHL of the major salivary glands.

Allogeneic bone marrow transplantation for refractory mantle cell lymphoma.

We report about a 28-year-old woman with relapsed mantle cell lymphoma (MCL, centrocytic lymphoma according to the Kiel classification) refractory to salvage chemotherapy. The patient underwent allogeneic bone marrow transplantation from a HLA-identical brother after myeloablative chemotherapy consisting of busulfan, etoposide, and cyclophosphamide. The patient experienced hepatic toxicity (grade I), mucositis (grade II) according the Bearman scale, and graft versus host disease of the skin (grade II) and showed stable engraftment with complete chimerism on day 15 after bone marrow transplantation. Eight years after transplantation, the patient is still disease free and in good condition without any late side effects. This report suggests a curative potential of allogeneic stem cell transplantation in MCL.

Isolated angiitis of the central nervous system: lack of inflammation after long-term treatment.

A case of isolated angiitis of the CNS was observed for 5 years. Initial response to cyclophosphamide was followed by relapse on therapy interruption. After renewed treatment, clinical stabilization was achieved despite progressive stenoses shown by angiography. The patient died of cyclophosphamide-induced myelodysplastic syndrome. Autopsy revealed lack of inflammation, vascular scarring, and amyloid angiopathy. We conclude that cure from isolated angiitis of the CNS is possible and that the risk of overtreatment should be minimized.

[Laparoscopic splenectomy]. / Laparoskopische Splenektomie.

From August until October 1992 laparoscopic splenectomy has been performed upon three patients with idiopathic thrombocytopenia. The splenic vessels were divided by an Endo-GIA. The spleen could be removed through a slightly extended trocar-incision. The Idiopathic thrombocytopenia without an enlarged spleen provides a possible indication for laparoscopic surgery.

[Dose-finding study for hyperfractionated, accelerated radiotherapy plus simultaneous carboplatin administration in patients with locoregionally advanced head and neck cancer]. / Dosisfindungsstudie zur hyperfraktionierten, akzelerierten Strahlentherapie plus simultaner Carboplatin-Gabe bei Patienten mit lokoregionär fortgeschrittenen Kopf-Hals-Karzinomen.

Therapy of large inoperable squamous cell-carcinomas of the head and neck is considerably problemful. Combined simultaneous radio-chemotherapy with carboplatin and radiotherapy with hyperfractionated accelerated radiation is small effective than conventional monofractionated radiotherapy alone and may reduce side effects. Aim of the following study was dosage optimisation of the applicated carboplatin.

[Cisplatin-Vepeside versus Endoxan-Vepeside in the treatment of small cell bronchial cancer. A randomized study]. / Cisplatin-Vepesid versus Endoxan-Vepesid in der Behandlung kleinzelliger Bronchialkarzinome. Eine randomisierte Studie.

Within the framework of a multi-centre prospective randomised therapeutic trial, 150 patients with small-cell lung cancer (SCLC) were treated with cisplatin/vepesid and endoxan/vepesid. The aim of the study was to establish whether cisplatin--which although effective is commonly associated with adverse effects--can be replaced by endoxan. The sequence of treatment was oriented to the stage and course of the tumour disease. In the event of a treatment failure, cross-over to the alternative combination was effected. In terms of remission rates, the combination cisplatin/vepesid proved to be more effective than endoxan/vepesid, in particular in the case of patients with extensive disease. With respect to duration of remission and survival duration, however, no significant differences were to be seen.

[Chemotherapy of small cell bronchial cancer with a combination of carboplatin, vincristine and etoposide]. / Die Chemotherapie des kleinzelligen Bronchialkarzinoms mit einer Kombination aus Carboplatin, Vincristin und Etoposid.

In a phase II study, the combination of the new platinum derivative carboplatin with vincristine and etoposide is associated with a remission rate of 81.8 per cent (LD 84.4%, ED 79.1%). The median survival rates for patients with limited disease have not yet been reached, and, at 11.5 months in the case of patients with extensive disease, are unexpectedly high. In comparison with combinations containing cisplatin, the present combination would appear to be superior, and its toxicity is also lower. For a definitive assessment of its usefulness, it must be compared with other standard treatment regimens in prospective, randomized studies.

Phase II study of carboplatin in untreated, inoperable non-small-cell lung cancer.

A total of 51 previously untreated patients with non-small-cell lung cancer (NSCLC) were treated with 130 mg/m2 carboplatin given every 4 weeks as an i.v. infusion on days 1, 3, and 5. Ten patients achieved a partial response and five, a minor response. The overall response rate was 20% (95% confidence limits, 8%-32%). The median duration of response was 3 months and the median overall survival was 4.5 months. Leucopenia, thrombocytopenia and anemia of WHO grade 3 occurred in 4%-6% of patients and grade 3 nausea and vomiting was observed in 8% of our subjects. Grade 4 thrombocytopenia occurred in 3 (6%) patients. Apart from nausea and vomiting, nonhematologic toxicities above grade 2 were not observed. Further trials using carboplatin in NSCLC as a single agent or in combination with other chemotherapeutic agents or radiation are warranted.

[Therapeutic possibilities and demands on radiology from the internist-oncologist viewpoint in liver and pancreatic tumors]. / Therapeutische Möglichkeiten und Forderungen an die Radiologie aus internistisch-onkologischer Sicht bei Leber und Pankreastumoren.

For most cases of malignant tumours of the liver and pancreas there is no cure. That is why the diagnosis should be made using a minimum of technical examinations, whereas the use of the entire armamentarium of modern radiological diagnostics is justified in those cases where there is a chance for curative resection.

[Possibilities of chemotherapy in patients with bronchial cancer]. / Möglichkeiten der Chemotherapie bei Patienten mit Bronchialkarzinom.

The introduction of chemotherapy in the treatment of small cell lung cancer made this a potentially curable disease. Despite intensive efforts, non-small cell lung cancer, however, remains refractory to chemotherapy. In patients with small cell lung cancer efforts are concentrating on increasing the cure rates. In patients with non-small lung cancer efforts are directed at achieving an optimal combination of palliative action and quality of life.

[Phase III therapy study in patients with small cell bronchial cancer]. / Phase-III-Therapiestudie bei Patienten mit kleinzelligem Bronchialkarzinom.

In a prospective randomized study 150 patients with small cell lung carcinoma (80 cases with extended, 70 cases with limited disease) received either cisplatin + etoposide (DDP/VP) or cyclophosphamide + etoposide (cyclo/VP) as induction chemotherapy. Patients were crossed over when less than complete remission was achieved. Treatment failures received a salvage regimen with adriamycin + vindesine (ADM/VDS). Remission rates (complete + partial remissions) achieved with DDP/VP were 87.4% (40.6% + 46.8%) in limited disease and 72.2% (10.1% + 62.1%) in extended disease; response rates seen following cyclo/VP were 78.8% (31.5% + 47.3%) in limited and 51.0% (6.9% + 44.1%) in extended disease. Median survival time for patients in complete remission was 12.0 months following DDP/VP and 14 months following cyclo/VP; for patients in partial remission 10.0 and 9.0 months, respectively. The analysis of the treatment results shows an equal effectivity of both induction regimes which, however, seem to be largely cross resistant. DDP/VP probably causes more stable longtime remissions. The salvage regimen ADM/VDS was ineffective. The results achieved with this rather complex therapeutic strategy are not superior to those seen with simpler regimes.

[Chemotherapy with mitomycin C, vindesine and ifosfamide in the treatment of inoperable non-small cell bronchial carcinoma]. / Chemotherapie mit Mitomycin C, Vindesin und Ifosfamid in der Behandlung des inoperablen nicht-kleinzelligen Bronchialkarzinoms.

27 patients (24 male und 3 female) with inoperable non-small-cell lung cancer were treated with combined mitomycin C, vindesine, and ifosfamide. The performance status of all patients was over 70%. 20 patients had extensive disease, 7 limited disease. The most frequent histology was squamous cell carcinoma found in 20 patients. Only 3 patients had large cell carcinoma and 4 patients adenocarcinoma. 2 complete (7.7%) and 9 partial remissions (34.6%) were achieved. 3/26 (11.5%) patients showed a minor response. In 7/26 patients (26.9%) there was no change, 5/26 (19.2%) showed progressive disease. Because of the short observation time, no deductions regarding the duration of remission and survival time of the patients can be made. The toxicity of the regimen was relatively mild. In particular, the subjective gastro-intestinal symptoms occurred only in 50% of our patients. The hematological toxicity was acceptable. Also the renal toxicity did not pose problems. Considering an exact lung function analysis with diffusing capacity and spirometric data, we found an unexpectedly high proportion of pulmonary toxicity in about 30%, but clinically obvious in only 10% of patients. According to the remission rates, this regimen is comparable to combinations with cisplatin and appears to have much less toxicity.

[Cisplatin, vindesine and VP 16-213 in the treatment of inoperable non-small cell bronchial carcinoma. A clinical phase II study]. / Cisplatin, Vindesin und VP 16-213 in der Behandlung des inoperablen nicht-kleinzelligen Bronchialkarzinoms. Eine klinische Phase-II-Studie.

In the treatment of non-small-cell lung cancer a drug-combination of cis-platinum, vindesine and VP-16 seemed logical because the drugs were non cross-resistant and there would be an additive effectiveness with acceptable toxicity. That was the basis for a phase-II trial started in July 1981 in which 60 patients with untreated non-small-cell lung cancer were entered until November 1982. There were 51 male and 9 female evaluable. The performance status of all patients was over 70%. Over 65% had extensive disease. The most frequent histology was squamous cell carcinoma that we found in 45% of our patients with bronchial carcinomas. Only 14 patients had large cell carcinomas and only 8 patients adenocarcinomas. 40% was the objective remission rate (5% complete remissions and 35% partial remissions). 9 patients (=15%) had a minor response; in 18 patients (=30%) there was no change, 9 patients showed progressive disease. The median survival time of responders is presently 14.9 months, which is significantly higher than the 9.1 months of non-responders. The toxicity of the triple-drug-combination was tolerable. The greatest problem was gastrointestinal toxicity with nausea and vomiting. The hematological toxicity was not as severe as expected. The renal toxicity was not a problem. We did not see drug related deaths.

Low-dose cytosine-arabinoside in the treatment of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS).

Ten AML- and two MDS-patients in whom conventional chemotherapy was contraindicated or ineffective were treated with low dose ARA-C, 10 mg/m2 per 12hS.C. for 2-4 weeks. Seven patients obtained a complete and two a partial remission. Our findings suggest that low dose ARA-C may act both by induction of differentiation and/or inhibition of proliferation.

Predominant cutaneous infiltration by OKT6- and OKT8-positive cells in a case of Sézary syndrome.

Using an immunoperoxidase (skin biopsy) and an immunofluorescence (peripheral blood, bone marrow punctate) technique, and monoclonal antibodies raised against peripheral mature lymphocytes, T helper subsets, T suppressor subsets, and Langerhans cells, we found a predominant dermal infiltration with lymphocytes of the suppressor phenotype and a predominant epidermal infiltration with Langerhans cells in a patient with Sézary syndrome (cutaneous T-cell lymphoma, CTCL). Repeated peripheral blood examinations showed an increased percentage of lymphocytes of the helper phenotype. A bone marrow examination revealed a ratio of suppressor/helper subsets of 1:4. The findings in the skin seem to be inconsistent with most of the results of previous studies in patients with CTCL; the significance of these findings is discussed.