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B Hoerni

Publications and source records attributed to B Hoerni.

At least 37 records · Page 2Linked to original sources
PubMed1999

Evolution of BCL-2/IgH hybrid gene RNA expression during treatment of T(14;18)-bearing follicular lymphomas.

Bcl-2, the gene over-expressed in follicular lymphomas (FL), is able to block chemotherapy-induced apoptosis. Consequently, we wondered whether bcl-2/IgH expression variations during treatment of FL could predict the outcome of patients with t(14;18)-bearing FL. For this purpose, we used a reverse transcription polymerase chain reaction (RT-PCR) assay to analyse 180 serial peripheral blood samples (PBS) during 34 treatment phases in 25 patients with t(14;18)-bearing FL. In all patients but two, bcl-2/IgH gene expression was demonstrated in pre-treatment samples. During 16 out of the 34 treatment phases (47%), bcl-2/IgH expression became negative: all but one were responders to chemotherapy. This conversion was transient in six cases. In 18 treatment phases, bcl2/IgH expression remained detectable: eight were clinically considered as treatment failures, while eight others achieved PR and two achieved CR. We observed a significant correlation between treatment response and RNA PCR results (P = 0.002). Three-year overall survival of patients with stable bcl2/IgH-negative conversion was 100% compared to 54% for the remaining patients (P = 0.069); 3-year freedom from progression was respectively 87.5% and 13% (P = 0.005). These results indicate a correlation between bcl-2/IgH expression variations and both clinical response and outcome. Whether this might predict disease outcome early remains to be confirmed.

Adult↗
PubMed1999

[Adult's anaplastic CD30+ large cell lymphomas].

Anaplastic large-cell lymphomas were recognized by Stein in 1985. Less than fifteen years were necessary to confirm this entity, as well as her phenotype and to characterize the t(2;5) (p23;q35) chromosomal abnormality. This rare subgroup of non-Hodgkin's lymphomas (15% of peripheral T cell lymphomas and 8% of all diffuse aggressive lymphomas) is individualized in the Real classification. This disease, which had a bimodal age distribution, is clinically characterized by a diffuse nodal involvement and the frequency of extranodal involvement, especially skin and lungs. Primitive cutaneous anaplastic large cell lymphomas belong to the cutaneous CD30+ lymphoproliferative diseases spectrum. Among peripheral T cell and diffuse aggressive lymphomas, they have the better prognosis. We present in this paper a review of the recent advances in the knowledge, treatment and prognosis of this peculiar entity.

Adult↗
PubMed1998

Place of low-dose total body irradiation in the treatment of localized follicular non-Hodgkin's lymphoma: results of a pilot study.

PURPOSE: In a first prospective nonrandomized trial, 107 patients with Stage III and IV "low-grade" lymphomas have been treated with a combination of chemotherapy and low-dose total body irradiation (LD-TBI). This study shows that this scheme of LD-TBI was very well tolerated, gave a high response rate (83%), and extended RFS. It incited us to start a pilot study on localized follicular lymphomas. METHODS AND MATERIALS: From January 1986 through October 1994, 34 patients with previously untreated localized low-grade non-Hodgkin's lymphomas have been included in a prospective trial with LD-TBI followed by radical involved field radiotherapy (IF-RT). Patients received two courses of whole body irradiation of 0.75 Gy in 5 fractions and 1 week separated by a rest period of 2 weeks. After 1 month, patients were reevaluated, and received 40 Gy in 20 fractions, and 4 weeks on initially pathological lymph node areas. Eight patients have been excluded from the study: 4 after histologic review (2 centrocytic, 1 lymphocytic, 1 centroblastic) and 4 patients with Stage IV because of bone-marrow involvement. The remaining 26 patients were 11 men and 15 women, 50 years old median age (mean: 50.2; range: 35-73.5) with clinical Stage I (10 pts), II1 (8 pts), and II2 (8 pts). All patients received the planned treatment. RESULTS: Clinical tolerance was excellent, and the hematological follow-up shows a mean nadir value of 3.9.10(9)/l (2.1-8.1) for leucocytes, 13.4 g/l (10.8-15.4) for hemoglobin, and 124.10(9)/l (46-216) for platelets, with a median delay of 3.2 months. Of 26 patients, 24 achieved complete remission (CR) after the LD-TBI that was before the IF-RT. All patients, except one, were in complete remission after IF-RT. Nineteen patients remain alive without any evidence of disease, with a median follow-up of 56.2 months. Five patients relapsed; 3 of them died. CONCLUSION: As delivered, this schedule of LD-TBI give a very high rate of CR in localized follicular non-Hodgkin's lymphoma, with a very good tolerance. It remains to prove that this immediate efficacy has an impact on long-term disease-free survival in such patients, and to understand how the LD-TBI works (direct and/or indirect induction of apoptosis; relationship with t(14;18) translocation and overexpression of bcl-2). These will be the two aims of a new EORTC prospective randomized trial comparing LD-TBI followed by IF-RT vs. IF-RT alone.

Adult↗
PubMed1998

[The law of 30 November 1892].

The law of 30th November 1892 abolished the situation of "officiers de santé", gave medical doctors the monopoly of the practice of medicine and sought to punish illegal practice more efficiently than in the past. The law updated the regulations concerning dentists and midwives. It gave those three professions the right set up professional associations and the responsibility of making known epidemics.

France↗
PubMed1998

[Information and consent].

Informed consent is applied more and more in routine medical practice. It is the consequence of a long history during which patients' rights have been progressively better recognised. This process begins by the right to be informed about one's health or disease and about consecutive treatment. After this information is given the patient is free to give opinion, consent or refusal with regard to what the physician proposes to improve his/her health or to treat the disease, according to present medical knowledge. Medical science has a power which must not constrain excessively patients, who may refuse some medical intervention, particularly if they have received adequate information and if they have their faculties. The physician is responsible for affording consistent information and for respecting patient's right to self-determination.

Ethics, Medical↗
PubMed1998

[Interferon alpha in the treatment of non-Hodgkin's lymphomas of low malignancy].

Incidence of non Hodgkin's lymphomas (NHL) has been increased regularly during the last two decades. Overall survival did not progress at all during this period. According to the results of preliminary studies, alpha interferon is an attractive approach for NHL treatment. The review analyze published randomized controlled trials which tested interferon alpha either in addition with polychemotherapy or as maintenance of chemotherapy-induced response in disseminated low grade NHL. After literature search, nine studies have been included. Interpretation of results was complicated by various patient's selection criteria (age, tumoral burden, histology) and heterogeneous treatment schemes (interferon schedule and dose, chemotherapy combination). Significant overall improvement was observed in two studies while only relapse free survival and time to treatment failure were improved in seven trials, always in interferon group. Significant observed toxicities were hematologic ones and asthenia since they led either to dose adjustment or to interferon interruption. Finally, we cannot recommend interferon use out of prospective trials. Further studies are warranted to confirm overall survival benefit and to define optimal strategy to use this molecule.

Antineoplastic Agents↗
PubMed1997

[Clinical research and Huriet's law in medical oncology. Results of a French investigation among medical oncologists].

In early 1996 a postal investigation was done among french medical oncologists to have their opinion about practical application of the law about clinical research. 58.3% answered, the majority of them having practice in public hospitals or cancer centers and teaching activities. All but 2 had been involved in such a research, half of them as main investigator of at least 1 trial. Two types of difficulties are declared: (1) methodological ones, to select patients, follow them up, fill in the different forms for administrative purpose; (2) relational ones, to inform patients, particularly on randomization of their treatment, due to potentially lethal course of their cancer. The majority of answering oncologists acknowledge the importance of such a research and the necessary rigorous methodology. Following their opinions, improvements should come from a better training of physicians and from an increase of human and material means to perform such a research.

Adult↗
PubMed1997

[Mediastinal large B-cell lymphoma. A retrospective anatomic-clinical study of 26 cases].

Mediastinal B-cell lymphomas (with or without sclerosis) have been recently recognized as an entity with particular clinical features. We report 26 patients with a mediastinal large B-cell lymphoma. They represent 5% of the patients with aggressive non-Hodgkin's lymphoma and 2% of all non-Hodgkin's lymphoma seen in our centre between 1962 and 1990. They include 19 females (73%) and 7 males (27%). The sex ratio was 2.7 and the median age was 44 years (range: 17-84 years). Compressive symptoms in relation with a bulky mediastinum were present in 21 cases (80%) and with B symptoms in 5 cases. All these patients received 2 to 4 cycles of chemotherapy with a CHOP-like protocol (epirubicin or doxorubicin, cyclophosphamide, vincristine and prednisone) followed in 24 cases by mediastinum irradiation (40 Gy). Two patients progressed during chemotherapy and did not receive radiotherapy. Nineteen patients had a consolidation chemotherapy according to the same protocol. Twenty-one patients achieved a complete remission after chemotherapy or radiotherapy and 5 failed. Two patients relapsed at 10 months and 9 years. Seventeen patients are alive and in first complete remission with a median follow-up of 102 months (range: 60-260 months). Using the Kaplan-Meier method, the overall survival at 5 and 10 years was respectively 77 and 61% and the relapse-free survival was respectively 68 and 57%. These results confirm the previous findings concerning this distinct entity which is characterized by a predilection for young women, compressive symptoms, a slow response to treatment and a rather good prognosis.

Adolescent↗
PubMed1996

Is there any place for a wait-and-see policy in stage I0 follicular lymphoma? A study of 43 consecutive patients in a single center.

BACKGROUND: A wait-and-see policy (WS) does not appear to modify the long-term prognosis of advanced-stage follicular lymphomas (FL), while irradiation of limited stages sometimes causes complications and does not avert distant relapses. Consequently, we decided to test WS in a selected subset of the localized FL, i.e., patients in complete remission (CR) after the initial lymph node biopsy (stage I0). PATIENTS AND METHODS: Forty-three previously untreated patients were diagnosed with stage I0 FL and 26 of them were included in the WS. Their median age was 60.3 years; 19 were male and 24 female. All histological slides were reviewed and confirmed the diagnosis of FL. Median follow-up was 6.3 years (y). RESULTS: Thirteen of the 26 untreated patients are still relapse-free, while six relapsed locally only (median: 4.2 years after diagnosis), and reattained CR with radiotherapy. Seven patients relapsed at distant sites (median: 1 year after diagnosis). No localized relapses were observed in the treated group, but there were 7 distant relapses. CONCLUSIONS: The use of WS in stage I0 FL did not appear to modify the prognosis of these patients. Furthermore, we observed two distinct patterns of relapse (local and distant) that are difficult to differentiate at onset.

Adult↗
PubMed1996

[The uneven history of clinical examination].

Clinical examination was developed by Hippocrates to understand diseases and patients. This approach was later almost abandoned in the Middle Age before a revival and a period of flowering at the beginning of the XIXth century. The multiplication of other new means of examination again provoked its decline, which has presently stopped, allowing a better balance of clinical practice.

Clinical Medicine↗
PubMed1996

[Evaluation of a clinical course in an oncology department during the second cycle of medical education. A 12-year study by questionnaire among 321 students].

The comprehensive cancer center in the Southwest of France, Bergonié Institute hosts medical students in 4th-6th year of their studies, for 4-month courses. This course was evaluated at its end by a questionnaire, during two periods of 6 years: 1983-88. 161 students; 1990-95, 160 students. Due to the policy of the Bordeaux University, these students were significantly younger during the second period: 48.4% in 4th year vs 25.8% in the first period (P = 0.00024). The main reasons for choosing this hospital were to meet cancer patients (54.8%), to improve knowledge in oncology (49.7%) or to see a variety of diseases, unlike in other specialty services (20.8%). At the end of the course, the main investigation in oncology appeared to be pathology (40.8%), radiology (38.2%) or blood cell counts (14.5%). Their training was highly (2+) or very highly (3+) rated by 67.9% of the students in theoretical matters, by 66% in clinical practice and by 92.5% in behavior. The best-learned fields were relations with patients (67.4%), treatments (24.5%) and clinical examination (23.5%). Students declare to have been negatively impressed by failures and deaths (34.7%), patients in poor condition (24.7%) or treatments poorly tolerated or not efficient enough (12.2%). They declare to have been well impressed by cooperation of caregivers (26.5%), comprehensive care (22.7%), teachers' efforts (22.1%), patient-caregiver relations (21.%) and courageous patients (18.1%). Finally students' presence during consultation is useful to see outpatients in good condition or cured patients. Between the first and the second period, there is a significant decrease of clinical training and a trend in favor of improved treatment and better prognosis. Thus this hospital appears mainly useful for training in patient-doctor relations and in clinical practice in a variety of diseases. Efforts have to be made to further improve clinical training. Such an investigation should be pursued to check the students' training periodically. This will allow the adaptation and improvement of the teaching, in accordance with changes in patients' conditions and treatments.

Adult↗
PubMed1995

[Education of cancer patients].

Increasing patients' information is currently evolving toward real education, mainly concerning chronic diseases. Cancer patients could also benefit from this evolution of medical care. Rationale for such education certainly includes theoretical endpoints (patient's autonomy) but also practical considerations that will improve treatment quality (compliance), tolerance and further rehabilitation. Many patients may benefit from this education during complex and long-term treatments. Furthermore, sequelae and handicaps will be either reduced or better tolerated. This education is provided by practitioners and other care-providers. That implies improved specific training and further need for written and video-taped documents. Such an evolution should further lead to proper evaluation and cost-benefit analyses in order to ensure real improvement of both treatment quality and patient's experience.

Humans↗
PubMed1994

Childhood anaplastic large cell lymphoma Ki-1/CD30: clinicopathologic features of 19 cases.

The authors report their cumulative experience of 19 children with what was previously called malignant histiocytosis (MH) but is now considered a true lymphoma and termed anaplastic large cell lymphoma (ALCL). The median age at diagnosis was 10 years and 6 months (range 2 y, 11 m, to 15 y). There were 13 males and 6 females. Most cases presented with fever, wasting and enlarged, often tender, lymph nodes. Other features were: fleeting cutaneous rashes in 7 cases; spontaneous regression of lymph nodes and skin lesions were seen in 5 patients. Bone marrow involvement was present in 3 cases, pulmonary infiltrate in 5, kidneys in 2, and central nervous system in none. The morphology of lymph node involvement was consistent with so-called MH, a description originally applied to sinusoïdal infiltration by large "histiocytic" cells. The coexpression of lymphoid activation antigens Ki-1/CD 30 (18/19), epithelial membrane antigen EMA (18/19) and interleukin-2 receptor/CD 25 (10/10) was the unifying immunopathologic feature of the neoplasm. Lineage antigens were not identifiable in 8/19 instances (null phenotype), while 10/19 expressed a T-cell phenotype. None of the tumors expressed histiocytic markers. After variable, but intensive, combination chemotherapy, 15 children out of 18 evaluable achieved complete remission (CR). Among all patients, thirteen are still alive in CR (ten in first CR) with a median follow-up of 5 years. This evaluation in the pediatric age group reinforces that so-called MH is a lymphoid neoplasm, a conceptual change that could lead to improved understanding and therapy.

Adolescent↗