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C Gisselbrecht

Publications and source records attributed to C Gisselbrecht.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Gallium-67 scintigraphy in malignant lymphoma].

The presence of a residual mass is a frequent and difficult problem in the treatment of Hodgkin's or non-Hodgkin's lymphoma: since it is of major importance to determine whether the lesion is a fibrous mass or a still progressing tumour requiring additional therapy. Gallium-67 scanning, performed in a series of 52 patients, provides an answer to this question since there is an excellent correlation between gallium uptake by the tumoral masses and their progressiveness. Magnetic resonance imaging was carried out in half of our patients: the finding of a low-intensity signal on T2-weighted sequences proved that the residual mass was fibrous, whereas a high-intensity signal on T2-weighted sequences did not distinguish between fibrous and tumour masses. The priceless information provided by the simple and non invasive method that is gallium scanning is extremely useful to evaluate the extension of lymphomas and to determine whether residual masses are tumoral or fibrous.

Adult↗
PubMed1993

Human immunodeficiency virus-related lymphoma treatment with intensive combination chemotherapy. French-Italian Cooperative Group.

PURPOSE: An increased risk of high-grade non-Hodgkin's lymphoma is observed in patients who are seropositive for human immunodeficiency virus (HIV). Treatment of such patients is complicated by their underlying acquired immunodeficiency syndrome (AIDS). Intensive strategies such as those used in non-HIV-related lymphoma may be poorly tolerated. However, patients without severe AIDS may derive significant benefits from such an approach. In a prospective multicenter study, treatment outcomes were assessed in 141 cases of HIV-seropositive lymphomas submitted to aggressive chemotherapy. PATIENTS AND METHODS: Adult patients with lymphoma with a performance status less than 3 and no active opportunistic infection were consecutively treated with three cycles of doxorubicin 75 mg/m2, cyclophosphamide 1,200 mg/m2, vindesine 2 mg/m2 for 2 days, bleomycin 10 mg for 2 days, and prednisolone 60 mg/m2 for 5 days (ACVB). This treatment was followed by a consolidation phase of high-dose methotrexate plus leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH84). Central nervous system prophylaxis with intrathecal methotrexate was routinely used. Zidovudine maintenance therapy was started after chemotherapy. Ninety-three patients had high-grade lymphomas (59 Burkitt's type) and 48 had intermediate-grade lymphomas. Disseminated stage III-IV was present in 86 patients, meningeal involvement in 29, and bone marrow infiltration in 30; 62 patients had more than 2 extranodal localizations. Lactate dehydrogenase levels were above the normal value in 95 cases. The median CD4-positive lymphocyte count was 227 x 10(6)/L. RESULTS: Eighty-nine patients (63%) achieved complete remission (CR) and 19 (13%) partial remission, whereas 13 did not respond and 20 (14%) died during the course of ACVB, 8 of them from progressive disease. With a median follow-up of 28 months, median survival and disease-free survival were 9 and 16 months, respectively. Median survival for nonresponders was 5 months; 23 patients died of opportunistic infections while in persistent CR. In multivariate analysis, four factors were strongly associated with shorter survival: (1) CD4 count less than 100 x 10(6)/L, (2) performance status greater than 1, (3) immunoblastic lymphoma, and (4) prior AIDS. In the absence of all risk factors, the probability of survival at 2 years was 50%. CONCLUSION: In a selected group of HIV-related lymphomas, intensive chemotherapy with LNH84 is feasible and yields a high CR rate. Survival is short due to death from HIV-related infections; however, in a subgroup of patients without adverse prognostic factors, long-term remission was observed.

Adult↗
PubMed1993

Multivariate analysis of prognostic factors in patients with non HIV-related primary cerebral lymphoma. A proposal for a prognostic scoring.

Between 1982 and 1991, 41 patients were treated for non HIV related primary cerebral lymphoma (PCL) in our institute. The purpose of this study was to perform a multivariate analysis of prognostic factors for survival in these patients. The presence of a CSF protein level over 0.6 g l-1 at diagnosis was found to be the most significant unfavourable prognostic factor in univariate analysis and had not previously been reported. Among the five significant prognostic factors at diagnosis, (age over 60 years, performance status--ECOG scale--over 2, memory dysfunction, non hemispheric tumour site, CSF protein level over 0.6 g l-1 at the diagnosis), three independent factors were identified in multivariate analysis: (1) CSF protein level (P = 0.007; RR = 4.7); (2) PS > 2 (P = 0.04, RR = 2.65); (3) age over 60 (P = 0.08; RR = 2.43). Using the regression coefficient of these three parameters, we determined a prognostic index which allowed us to distinguish three risk groups whose theoretical median survival is 4, 20 and 54, months respectively in patients with non HIV related PCL. These results indicate that PCL is an heterogeneous disease in terms of the prognostic in which three subgroups with discriminant survival can be identified.

Adolescent↗
PubMed1993

Autologous hematopoietic stem cell transplantation in intermediate and high grade non-Hodgkin's lymphoma: a review.

High dose therapy with or without hematopoietic stem cell rescue has been widely used in the past decade for treating aggressive Non-Hodgkin's lymphoma. Recent data in high and intermediate grade lymphoma were reviewed. Evidence that dose intensity is a critical factor for remission in poor prognosis lymphoma has been accumulated, although the impact on survival has not been clearly established through randomized studies. Intensive treatment with autologous bone marrow transplantation (ABMT) have been reported in more than 1,000 relapsing patients in non randomized trials. For those who are still sensitive to salvage chemotherapy, at 5 years a 40% probability of disease free survival has been uniformly noted. ABMT is accepted by most centers as the treatment of choice for relapsing lymphoma. Consequently, very few randomized studies testing ABMT vs. conventional chemotherapy such as the PARMA protocol are in progress. In patients achieving complete remission, ABMT has been proposed for consolidation in a group of lymphoma sharing adverse prognostic factors with a high risk of relapse. Results from pilot studies were encouraging. However, interim analysis of the large randomized trial LNH87, did not show at the present time an advantage for ABMT performed after CR when compared to conventional chemotherapy. Such a strategy should be only proposed in prospective studies. For patients who did not achieve CR after conventional treatment, but who are still sensitive to chemotherapy, ABMT may improve the results. Pilot studies as well as recent randomized study are in support of this approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Agents↗
PubMed1993

Prognostic significance of received relative dose intensity in non-Hodgkin's lymphoma patients: application to LNH-87 protocol. The GELA. (Groupe d'Etude des Lymphomes de l'Adulte).

BACKGROUND: To evaluate the effects of chemotherapy dose intensity (DI) on outcome in patients with aggressive lymphoma, the received relative DI (received RDI) is usually calculated using Hryniuk's model. We applied this model to a selected patient subgroup included in the LNH87 protocol (LNH87-2 protocol), who had been treated with the ACVB induction regimen. PATIENTS AND METHODS: Patients aged < 55 who had at least one of the following prognostic factors: performance status (PS) > or = 2, number of extranodal sites > or = 2, tumor burden > or = 10 cm, bone marrow or central nervous system involvement, and Burkitt's or lymphoblastic histologic subtype, were included in this study. Actual DI was calculated using the definition of DI as mg/m2/week previously described by Hryniuk. RESULTS: Eighty-seven of the 311 patients included in the study (28%) presented a RDI below 70% of the theoretical DI. We demonstrated a decreased response rate (65% vs. 79%, p = 0.01) and shorter overall 2-year survival (61% vs. 72%, p = 0.02) in patients receiving a DI < 70%. This difference was still significant when the multiparametric analysis was used (p = 0.004). CONCLUSION: Results obtained when this model was applied to aggressive lymphoma patients included in the LNH-87 protocol led to the demonstration of a strong relationship between received RDI and survival.

Adult↗
PubMed1993

Adult acute lymphoblastic leukemia: a multicentric randomized trial testing bone marrow transplantation as postremission therapy. The French Group on Therapy for Adult Acute Lymphoblastic Leukemia.

PURPOSE: In a prospective multicenter study, we analyzed the benefits of allogeneic bone marrow transplantation (BMT) in a nonselected group of adult patients with acute lymphoblastic leukemia (ALL) and, by a randomized trial, evaluated the effectiveness of autologous BMT over chemotherapy as postremission therapy in patients younger than 50 years who were not candidates for allogeneic BMT. PATIENTS AND METHODS: After induction therapy that randomized patients to receive one of two anthracycline-containing regimens, either daunorubicin (DNR) or zorubicin (ZRB), patients were assigned to postremission treatment according to age and results of HLA typing. Patients younger than 40 years with an HLA-identical sibling (group 1) were scheduled to receive cyclophosphamide 60 mg/kg on days 1 and 2, total-body irradiation (TBI), and allogeneic BMT. Patients older than 50 years (group 2) received the chemotherapy arm composed of three monthly consolidation courses (DNR or ZRB, cytarabine, and asparaginase) followed by maintenance chemotherapy (modified L10 regimen). The remaining population (group 3) was randomly assigned to receive, after the three 1-month consolidation courses, either the chemotherapy arm or autologous BMT following a conditioning regimen similar to that of group 1. RESULTS: Of the 572 assessable patients, 436 achieved complete remission (78% +/- 2% for DNR v 74% +/- 3% for ZRB; P = .3). The estimated 3-year disease-free survival (DFS) rate for the 116 patients included in group 1 was 43% +/- 5%. Both autologous BMT (95 patients) and chemotherapy (96 patients) produced comparable 3-year DFS rates (39% +/- 5% v 32% +/- 5%) and survival durations (49% +/- 5% v 42% +/- 5%). However, late relapses after 36 months were mainly observed in the chemotherapy arm. CONCLUSION: This first interim analysis did not demonstrate a benefit of this autologous BMT procedure over classical maintenance chemotherapy in patients with ALL who received consolidation chemotherapy.

Adolescent↗
PubMed1993

Intensive chemotherapy plus hematopoietic stem cells transplantation for relapsing non-Hodgkin's lymphoma: the GELA experience.

Prognosis of non-Hodgkin's aggressive lymphoma in relapse is very poor. Because of lymphoma high sensitivity to chemotherapy, intensive treatment followed by hematopoietic stem cells transplantation (SCT) could be an appropriate choice. Although randomized studies results are not yet available, evidence of favourable impact of intensive chemotherapy plus SCT was produced by retrospective studies. Our study on relapsing patients after LNH84 regimen showed a longer survival for transplanted patients in comparison with conventional chemotherapy treated patients. In follicular lymphomas after progression, a prolonged event free survival could be achieved at least when an effective marrow purging procedure was obtained. Despite mortality related to complications, allogenic bone marrow transplantation was followed by a low relapse rate suggesting a graft versus lymphoma effect. However, the majority of patients were treated by intensive chemotherapy with autologous stem cells rescue and a great challenge remains to decrease documented high relapse rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Epstein-Barr virus-latent gene expression and tumor cell phenotype in acquired immunodeficiency syndrome-related non-Hodgkin's lymphoma. Correlation of lymphoma phenotype with three distinct patterns of viral latency.

We investigated 49 acquired immunodeficiency syndrome-related lymphomas (ARLs) for Epstein-Barr virus (EBV) by Southern blotting and in situ hybridization and, in positive cases, used cryostat immunohistology to compare EBV-latent gene expression (EBV encoded small RNA-1 [EBER-1], EBV nuclear antigen-2 [EBNA-2], latent membrane protein-1 [LMP-1] and host cell immunophenotype (CD11a, CD18, CD54, CD58, CD21, CD23, CD30, CD39, CDw70, immunoglobulin) patterns with those reported in other EBV infections. EBV+ immunoblast-rich/large cell ARLs (n = 22) showed three patterns of latency: broad (EBER+EBNA-2+/LMP-1+; n = 9), reminiscent of a lymphoblastoid cell line phenotype; restricted (EBER+/EBNA-2-/LMP-1-; n = 6), similar to endemic Burkitt's lymphoma; and intermediate (EBER+/EBNA-2-/LMP-1+; n = 7), a pattern rarely described in vitro but seen in certain EBV-related malignancies. EBNA-2 expression was associated with extranodal lymphomas. EBV+ Burkitt-type ARLs (n = 11) usually showed the restricted latency pattern (n = 8), but some expressed the intermediate form (n = 3). Adhesion (CD54, CD58) and activation (CD30, CD39, CDw70) molecule expression varied with morphology (immunoblast-rich/large cell versus Burkitt-type), but was not independently correlated with EBV-positivity. CD30 and LMP-1 expression were associated. ARLs show heterogeneity regarding both the presence of EBV and latency pattern. Comparison of these phenotypically distinct lymphoma groups with known forms of EBV infection provides clues to their possible pathogenesis.

Adult↗
PubMed1993

Pancreatic and hepatic plasmocytomas: an exceptional case.

Extra medullary plasmocytoma (EMP) is a plasma cell proliferation of low frequency as compared to multiple myeloma which develops in the upper digestive and respiratory tracts and sometimes in the digestive tract. Other sites are possible but pancreatic or hepatic localizations are unusual with few cases being reported in the literature. This study describes an exceptional observation of pancreatic followed by hepatic plasmocytomas occurring after a long evolution of recurrent EMP. A review of the literature shows that the usual forms of treatment are surgery and radiotherapy. In our patient, this was possible for the pancreatic plasmocytoma, whereas the hepatic lesion was first treated with general polychemotherapy because of the tumour size and adverse prognostic factors. Surgery was then followed by recombinant interferon alpha therapy to obtain complete and hopefully prolonged remission.

Combined Modality Therapy↗
PubMed1993

Changes in protein C, factor VII and endothelial markers after autologous bone marrow transplantation: possible implications in the pathogenesis of veno-occlusive disease.

In a recent prospective study of allogenic bone marrow transplantation we reported that decreases in factor VII and protein C were predictive markers for high risk of veno-occlusive disease (VOD). In order to determine the relative involvement of endothelial and hepatocyte injury in the genesis of VOD, 34 consecutive patients undergoing autologous bone marrow transplantation (BMT) were studied. Conditioning was performed by chemotherapy alone or associated with total body irradiation (TBI). Protein C and factor VII, the endothelial markers Von Willebrand factor (vWF and t-PA, fibrinogen and fibronectin were measured weekly before and after BMT. Protein C and factor VII were within the normal range before BMT, decreased significantly on day 7 to 73 and 64% respectively (p < .01) and then returned to normal values. Fibrinogen increased to 7 g/l (p < .001) on day 7 but then returned to normal levels. Fibronectin was abnormally high (p < .001) before BMT and decreased thereafter, while vWF increased (p < 0.001) for three consecutive weeks. t-PA was low (p < 0.001) before conditioning but increased thereafter. These results demonstrate the presence of endothelial lesions before BMT and acute hepatic and endothelial lesions after conditioning. Although VOD was never observed in our patients, this complication could well arise from preexisting vascular lesions due to previous chemotherapy and/or from acute hepatocytic injury, which could also be of endothelial origin, after conditioning.

Biomarkers↗
PubMed1993

Residual mediastinal mass in malignant lymphoma: value of magnetic resonance imaging and gallium scan.

Following treatment for mediastinal lymphoma, residual masses are defined as a mass greater than 2 cm observed on the CT scan in the absence of other evolutive signs of lymphoma. In this study, we examined 55 patients with residual mediastinal mass after optimal therapy, using gallium scan (37 cases) or magnetic resonance imaging (MRI, 44 cases). The group comprised 41 subjects with Hodgkin's disease and 14 with non Hodgkin's lymphoma, stages I and II (32 cases) and stages III and IV (23 cases); 35 subjects (64%) having bulky mediastinal involvement at diagnosis. A negative gallium scan or fibrotic signal on MRI was correlated with complete remission in 48 cases (87%). In seven of these 48 patients, MRI was not conclusive with a high signal of indeterminate tissue following radiotherapy, but four of the seven had fibrotic tissue on biopsy and none relapsed. Positive gallium scan was observed in six cases. In conclusion, we suggest performing a gallium scan at the end of induction chemotherapy and when it is negative, treatment may be continued without surgical biopsy or salvage therapy. MRI is of value when it shows fibrotic tissue but can be inconclusive.

Adolescent↗