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Biomedical subjects

E Zucca

Publications and source records attributed to E Zucca.

At least 73 records · Page 4Linked to original sources
PubMed1997

Clinical features, treatment and outcome in a series of 93 patients with low-grade gastric MALT lymphoma.

The purpose of this paper is to report the clinical characteristics and treatment outcome following different therapeutic approaches in a large series of patients with primary low-grade MALT lymphoma of the stomach. A total of ninety-three patients (median age 63 years) were reviewed. The patients were treated by different modalities (local treatment alone, combined treatment, chemotherapy, antibiotics alone); seven patients refused any treatment. The antibiotic-treated group of patients was prospectively followed with regular endoscopic biopsies, and their responses were histologically evaluated. The 5-years projected overall survival is 82% (95% C.I.; 67%-91%) in the series as a whole. Second tumors were observed in 21.5% of the patients in this series (95% CI 14%v to 31%). There was no apparent difference in overall survival and event-free survival between patients who received different treatments. In the antibiotic-treated group histologic regression of MALT lymphoma was documented in 67% of patients (95% CI 51% to 80%). In conclusion the indolent nature of the disease justifies a conservative approach. The use of antibiotics as first-line therapy may avert or at least postpone the indication for surgical resection in the majority of patients.

Adult↗
PubMed1996

Gut lymphomas.

Gut lymphoma still remains the subject of much debate and controversy with respect to pathological classification, clinical staging and treatment. This is mainly due to the fact that most studies reported retrospective non-randomized evaluations of small series and lacked uniformity in histological classification, patients' characteristics and type of treatment. Moreover, most of the historical series were published before the recognition of MALT as the origin of most GI lymphomas. Hence, there is a compelling need for the use of modern histological criteria for primary GI lymphomas because of their unique histology, special features and origin in mucosal tissue. General adoption of the histological classification proposed in 1988 by Isaacson et al (Table 1) can be recommended which follows the general principles of the Kiel Classification and includes the MALT lymphomas as a particular disease entity. Combination chemotherapy is the treatment of choice for gut lymphomas with aggressive histology and multiple node involvement or disseminated disease. The effectiveness of combination chemotherapy in advanced disease has excited a reconsideration of the role of primary surgery in less advanced cases where surgery has, historically, been the initial procedure of choice. This is particularly true for gastric lymphomas where it is possible that, in future, surgery will be resorted to as a potential approach for salvage when complete remission is not achieved with conservative therapy. For primary intestinal lymphoma, however, there are as yet no studies which clearly demonstrate that surgery is not necessary. With respect to the group of localized low-grade MALT lymphomas of the stomach and the indolent nature of the disease make plausible a conservative approach, with antibiotic eradication of H. pylori as the sole initial treatment. This may avert or at least postpone the indication for surgical resection in the majority of patients.

Gastrointestinal Neoplasms↗
PubMed1996

Clinical significance of bcl-2 (MBR)/JH rearrangement in the peripheral blood of patients with diffuse large B-cell lymphomas.

BACKGROUND: Approximately one-fourth of diffuse large B-cell lymphomas (DLCL) carry the bcl-2(MBR)/JH rearrangement caused by the t(14;18) translocation. The clinical significance of this rearrangement in patients with DLCL remains controversial. By polymerase chain reaction (PCR) we prospectively evaluated the prognostic relevance of the bcl-2 (MBR)/JH rearrangement present in circulating B-cells at the time of diagnosis. MATERIALS AND METHODS: The bcl-2 (MBR)/JH rearrangement was analysed by a nested-PCR method in peripheral blood samples of 51 HIV-negative patients with previously untreated DLCL. RESULTS: The bcl-2 (MBR)/JH rearrangement was detected in 16 cases (31%). Peripheral blood bcl-2 (MBR)/JH rearrangement detection by PCR at diagnosis was correlated with poor overall survival, lymphoma-specific survival and time to progression (log-rank P < 0.05). There was no statistically significant difference between the clinical characteristics at presentation of bcl-2/JH-positive and negative patients. CONCLUSIONS: The peripheral blood is a readily accessible tissue for this type of analysis, and this study indicates that detection of the t(14;18) translocation at presentation in the blood of patients with DLCL may presage a poor prognosis.

Chromosomes, Human, Pair 14↗
PubMed1996

2-chlorodeoxyadenosine (2-CDA) therapy in previously untreated patients with follicular stage III-IV non-Hodgkin's lymphoma.

PURPOSE: This phase II multi-institutional trial was designed to assess response and toxicity of 2-chlorodeoxyadenosine (2-CDA) in patients with previously untreated follicular lymphoma. The clinical significance of detecting cells carrying the t(14;18) translocation (bcl-2/JH rearrangement) in peripheral blood and bone marrow by polymerase chain reaction (PCR) before, during and after treatment was also examined. PATIENTS AND METHODS: Between May 1993 and October 1995, 37 patients were accrued: male/female: 15/22, median age 51 years (range: 20-78), stage III/IV: 9/28. Patients received a total 2-CDA dose of 0.7 mg/kg as continuous s.c. or i.v. infusions over 7 days, every 28 days for a maximum of 5 cycles. A total of 165 cycles were administered. In 25 patients, blood and bone marrow before, during and after treatment were available for PCR analysis of the bcl-2/JH rearrangements. RESULTS: All 37 patients were evaluable for response and toxicity. The overall response rate was 84% (95% confidence interval, 68%-94%) with 14% CR (n = 5) and 70% PR (n = 26) and a median time to treatment failure of 15.7 months. bcl-2/JH rearrangement in peripheral blood and/or bone marrow was found in 10/25 of patients (40%) before treatment and 5 of these became repeatedly negative after 2-CDA therapy. There was no apparent association between bcl-2/ JH result and response. In 11 patients, 2-CDA was stopped because of progressive disease (n = 4), myelotoxicity (grade 2-3, n = 4), and other causes (n = 3, pulmonary embolism, metabolic disorder, and patient's decision). Four patients (11%) suffered from infections (grade 2-3). In 6 patients, persistent thrombocytopenia of 7.5 months (range: 3-21) occurred after completion of the 5 cycles. CONCLUSION: 2-CDA is active in untreated follicular lymphomas, but time to treatment failure suggests no advantage compared with standard treatment and toxicity on haematopoietic stem cells appears to be more pronounced. Molecular remission is induced in a considerable proportion of patients with disappearance of the bcl-2/JH rearrangement, and its possible significance as a predictive factor for quality of response and relapse warrants further study.

2-Chloroadenosine↗
PubMed1995

Eradication of Helicobacter pylori infection in primary low-grade gastric lymphoma of mucosa-associated lymphoid tissue.

OBJECTIVE: To determine the effect of eradicating Helicobacter pylori infection on the course of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. DESIGN: Prospective cohort study. SETTING: University internal medicine clinics, a referral oncology center in southern Switzerland, and a gastroenterology referral center in northern Italy. PATIENTS: 26 patients with localized primary low-grade gastric MALT lymphoma. INTERVENTION: Treatment for H. pylori infection (bismuth or omeprazole or both, amoxicillin, and metronidazole for 14 days). MAIN OUTCOME MEASURES: Endoscopic biopsy specimens of the gastric mucosa were obtained every 3 to 6 months after treatment for H. pylori infection. RESULTS: Helicobacter pylori was completely eradicated in 25 of 26 patients, but 4 patients needed second-line antibiotic treatment to eradicate the microorganism. Disappearance or almost total regression of the lymphomatous tissue was observed in 15 of the 25 evaluable patients (60%; CI, 39% to 79%); however, disappearance or almost total regression was evident in the first biopsy specimen after treatment for H. pylori infection in only 8 of the 15 patients. CONCLUSIONS: Our study confirms recent anecdotal reports of regression of gastric MALT lymphoma after eradication of H. pylori and indicates that the growth of these extranodal lymphomas may depend on H. pylori.

Adult↗
PubMed1995

Patterns of survival in mantle cell lymphoma.

BACKGROUND: The term mantle cell lymphoma (MCL) describes a subtype of non-Hodgkin's lymphoma that includes those lymphomas previously defined as centrocytic lymphoma, intermediate lymphocytic lymphoma, and mantle zone lymphoma. Since MCL has only recently been recognised as a distinct entity, the clinical literature is sparse and very little information is available about its treatment. PATIENTS AND METHODS: We retrospectively attempted to analyse the clinical features and outcome of 65 patients with mantle cell lymphoma (MCL) treated from 1979 to 1993 at two institutions in the same geographic area. Univariate (Log-rank test) and multivariate (Cox regression) analyses of the major prognostic factors were performed. RESULTS: At the time of analysis the median follow-up was 49 months. Median age was 64 years with a range of 27-85 years. The male to female ratio was 2:1. Forty-seven patients (72%) had stage IV at presentation and 20 (31%) had B-symptoms at presentation. The patients usually presented with generalised adenopathy (78% of cases) and bone marrow involvement (58%). Serum LDH were analysed at diagnosis in 61 patients and found to be elevated in 30%. beta 2-Microglobulin was determined at presentation in 42 patients and was higher than normal in 54% of them. In comparison with the other subtypes of NHLs in our series, MCL appears to have a very poor survival pattern. The median overall survival was 42 months. The CR rate was 51% with a median DFS of 44 months. Good performance status, normal LDH, normal beta 2-microglobulin, younger age (< 65 years), and a low prognostic risk according to the International Index were significantly associated (p < 0.05) with a better outcome. CONCLUSIONS: The characteristics of the patients in this study appear to be in general agreement with those in most of the previously reported series except for the somewhat lower rate of bone marrow infiltration observed in this series. Despite the limitations of a retrospective analysis and the lack of randomization between the treatment options, this study seems to suggest a survival advantage with anthracycline-containing regimens in some patients with MCL. However, this benefit was evident only for the patients with favourable International Index prognostic scores (i.e., low- and to low-intermediate-risk disease) who may already have a better prognosis. Patients with intermediate-high and high-risk disease according to the International Index have a poor prognosis regardless of the type of therapy given.

Adult↗
PubMed1995

High incidence of other neoplasms in patients with low-grade gastric MALT lymphoma.

BACKGROUND: Low-grade gastric MALT lymphoma is an uncommon tumour for which a close association with chronic Helicobacter pylori infection has been suggested. However, given the rarity of MALT lymphoma of the stomach despite the high prevalence of H. pylori infection, it seems plausible that genetic host factors might play a fundamental role in gastric lymphomagenesis. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 83 patients with low-grade gastric MALT, all of whom resided in a geographic area (southern Switzerland and northern Italy) where the incidence of gastric tumours appears to be uncommonly high. RESULTS: One or more additional cancers were observed in 17 of 83 patients (20%, 95% CI 12% to 31%) for a total of 23 tumours. Of these, 5 were diagnosed prior to, 12 concomitantly with, and 7 after the gastric MALT lymphoma. Eleven patients had a single additional solid tumour (13%, 95% CI 7% to 22%); 3 patients had non-Hodgkin's lymphoma and one had Hodgkin's disease. Multiple additional cancers were present in 3 cases. Nine of 83 patients have died and 8 of them of a second cancer. CONCLUSIONS: Unexpectedly an extraordinarily large number of patients with other malignancies was observed in this series. The reasons for this finding are still unknown, but genetic alterations are speculated to play an important role.

Female↗
PubMed1995

Detection of chromosome 11 alterations in blood and bone marrow by interphase cytogenetics in mantle cell lymphoma.

The t(11;14)(q13;q32) translocation is a consistent chromosome change in mantle cell lymphomas. This study investigates the application of fluorescent in situ hybridization (FISH) with chromosome painting probes for interphase cytogenetic analysis in patients with mantle cell lymphomas. Chromosome 11 paints have been able to show splitting of the chromosome signal consistent with the t(11;14) translocation in interphase cells from bone marrow and blood of patients with mantle cell lymphomas. These include some in clinical remission. The chromosome probes conjugated with fluorescent molecules are hybridized with patient's DNA allowing the easy detection of chromosome 11 abnormalities with fluorescent-light microscopes. Interphase FISH has a higher sensitivity and is quicker than standard metaphase cytogenetics. This may be beneficial in rapid detection of chromosome 11 abnormalities, assisting in the diagnosis of mantle cell lymphomas. In addition, detection of a clonal population of cells is possible.

Bone Marrow↗
PubMed1994

Treatment and prognosis of centrocytic (mantle cell) lymphoma: a retrospective analysis of twenty-six patients treated in one institution.

We retrospectively attempted to analyse prognostic factors in a group of 26 patients with centrocytic lymphomas (CCL) treated from 1979 to 1991 (representing 7% of all cases of NHL diagnosed in our institution during that period). Ten of the patients were females and 16 males, and their median age at diagnosis was 69 years (range 38-85). The majority of patients (77%) had advanced disease (Ann Arbor stage III-IV) at presentation. Twenty-two patients (85%) had good performance status (0-1 ECOG). B-symptoms were present in 10 cases. Most patients (87%) presented with generalized adenopathies. Bone marrow involvement was observed in 12 patients (46%) and Waldeyer's ring involvement in 5 (4 of them with stage I-II). In 5 cases the liver was involved and 3 pts had gastrointestinal localizations; 15 patients had more than 2 sites of disease: LDH elevation was observed in 8/24 pts. Fourteen patients (54%) received single-agent chlorambucil (3 pts) or CVP (11 pts). Eleven patients were treated with ADM-containing regimens (7 with CHOP or M-ACOD and 4 with 3rd generation regimens). One patient had radiotherapy alone. The complete response (CR) rate was 50% (13/26); 8 patients relapsed with a median time to progression of 19 months, and only 3 responded to salvage treatment. The median overall survival was 33 months, with fewer than 40% of patients surviving longer than 3 years. At univariate analysis the use of ADM-containing regimens seems significantly correlated with the CR rate (p = 0.047), the failure-free survival (p = 0.023), and the overall survival (p = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Detection of bcl-2/JH rearrangement in follicular and diffuse lymphoma: concordant results of peripheral blood and bone marrow analysis at diagnosis.

The capacity to detect t(14;18) breakpoints in non-Hodgkin's lymphoma (NHL) peripheral blood and bone marrow was studied by DNA PCR. We studied 33 patients with follicular lymphoma (FL) (Working Formulation subtypes B, C, D) and 38 patients with intermediate-grade NHL (subtypes F, G). In the FL subgroup, 86% of the morphologically-positive bone marrow patients had amplifiable t(14;18) breakpoints by PCR. Remarkably, of 19 FL patients with 'negative' bone marrows, 11 (58%) were PCR-positive. In addition, half of the early clinical stage patients (I and II) had detectable breakpoints in their bone marrow DNA. Samples from NHL patients with intermediate-grade disease exhibit the same phenomena but at a considerably lower frequency. Paired peripheral blood and bone marrow samples were available at diagnosis in a subset of 56 patients. The concordance between bone marrow and peripheral blood PCR findings was high, with peripheral blood of 55/56 showing the same PCR results as the corresponding bone marrow.

Base Sequence↗
PubMed1991

Direct sequence analysis of 14q+ and 18q- chromosome junctions at the MBR and MCR revealing clustering within the MBR in follicular lymphoma.

The t(14;18) translocation is a highly consistent feature of follicular lymphoma although the underlying mechanism generating this fusion remains uncertain. The breakpoints on chromosome 18 are at one of two sites, designated mbr and mcr, in the bcl-2 gene. A polymerase chain reaction strategy has been developed for amplification and direct sequencing of the resultant 14q+ and 18q- reciprocal junctions. Sequence analysis of the amplified 14q+ junction established that 21 tumours contained a bcl-2 (mbr) sequence to an immunoglobulin JH region, the majority being J5 or J6. A nonrandom pattern of breakpoints within the mbr region was found. Clustering of the breakpoint occurred with over 60% of the translocations clustering within 10 bases. There was a second cluster within the mbr 50 bases 3' of the first cluster. One of these junctions had an unusual configuration with the bcl-2 and JH sequences separated by a recognisable DH region. This suggests that at least some of the junctional sequences, previously thought of as N insertions, may be fragments of unrecognised DH regions. In one of these tumours it was possible to sequence the reciprocal 18q- junction, showing it to consist of a DH/bcl-2 (mbr) fusion. Analysis of both reciprocal junctions for a translocation in the mcr region of bcl-2, showed that this 18q- junction also consisted of DH fused to a bcl-2 sequence. In contrast to previous analyses, which demonstrated either loss or duplication of bcl-2 sequences at the breakpoints, the bcl-2 sequence was conserved during the mbr and mcr translocations in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Base Sequence↗
PubMed1991

Altered gene expression and oncogenesis of B-cell neoplasia.

B-cell malignancies reveal a number of consistent translocations involving the C-MYC, BCL and IG genes. In common, these rearrangements usually lead to an inability of the involved B-cells to respond to normal regulatory controls for expression of the genes. This usually lead to over-production of the protein products of the genes at inappropriate times of the cell growth cycle and appears to allow a survival advantage to the B-cell. The result of these changes almost certainly plays a prominent role in the development of B-cell neoplasia. Classification of these lymphoma's at a molecular level may be of benefit to determine the prognosis and treatment in addition to providing a useful marker of disease. Determining the molecular basis of these B-cell lymphomas may help our understanding of their pathogenesis. This in turn could lead to more rational treatment aimed at altering the abnormal molecular changes and returning the neoplastic cells to normal cell development.

Chromosomes, Human, Pair 11↗
PubMed1990

Direct sequence analysis of the 14q+ and 18q- chromosome junctions in follicular lymphoma.

Although the t(14;18) chromosome translocation has been demonstrated to be a highly consistent feature of follicular lymphomas, the underlying mechanism generating this fusion has remained uncertain. To examine this question further, a polymerase chain reaction strategy has been devised to permit the amplification and direct sequencing of the resultant 14q+ and 18q- reciprocal junctions. Direct sequence analysis of amplified 14q+ junctions established that 7 of 11 tumors contained a bcl-2 (mbr) sequence fused to an immunoglobulin JH region (five were J6 and two were J5). One of these junctions had an unusual configuration with the bcl-2 and JH sequences separated by a recognizable DH region. This finding suggests that at least some of the junctional sequences, previously thought of as N insertions, may be fragments of unrecognized DH regions. It was also possible to amplify and sequence 18q- junctions using a primer based on the DH recombination signal sequences. Several 18q- junctions were shown to consist of DH/bcl-2 (either mbr or mcr) fusions. In two tumors the 14q+ and 18q- junctions were fully sequenced, and it was demonstrated that the bcl-2 sequence was conserved during mbr and mcr translocations. This contrasts with previous analyses that demonstrated either loss or duplication of several bases at the breakpoints in the bcl-2 gene.

Base Sequence↗
PubMed1987

Enzymuria in carboplatin nephrotoxicity.

Urinary excretion of N-acetyl-beta-glucosaminidase (NAG) is an early marker of nephrotoxicity. NAG activity was assayed by the fluorimetric method of Leaback and Walker in 17 patients treated (22 courses) with carboplatin (CBDCA, 220-550 mg/m2) before infusion and 24, 48, 72 and 96 h after. Increased excretion of NAG, a sensitive index of renal tubular damage, was observed following 10 of the 22 courses. A transient increase in plasma creatinine and/or abnormal proteinuria was observed in 6 cases. Impaired renal function prior to therapy seems to be a predisposing factor to the nephrotoxicity.

Acetylglucosaminidase↗