Biomedical subjects
Publications and source records attributed to F R Dick.
The case of a patient with myelofibrosis and painful osteolytic lesions is described. Biopsy of the involved bone demonstrated myeloid proliferation. Foci of myeloid metaplasia may occasionally result in clinical disability, with bone pain and rarefaction. Myeloid metaplasia should be considered when these symptoms and signs occur in the setting of myelofibrosis. The role of radiation therapy as a palliative maneuver remains uncertain.
Two cases of nodular lymphocytic lymphoma that transformed into leukemic processes with IgM-kappa-type monoclonal proteins are reported. The transformations occurred 21 and 34 months after the diagnosis of lymphoma and were associated with rapid deterioration of the patients' conditions. The leukemic phase was characterized by plasmacytic and immunoblastic appearing lymphoid cells in the peripheral blood and marrow. Such transformation, though rare, is not unexpected in view of the currently postulated origin of nodular lymphomas in germinal center cells and of immunoglobulin-producing tumors in cells derived from germinal center cells.
Twenty-four patients with non-Hodgkin's lymphoma and CNS involvement are presented. There were 7 cases with diffuse histiocytic lymphoma (HL), 9 with diffuse poorly differentiated lymphocytic lymphoma (PDLL-D), of whom 6 patients were in leukemic conversion, 5 patients with nodular poorly differentiated lymphocytic lymphoma (PDLL-N), and 3 cases with undifferentiated lymphoma (UL). CNS complications were noted only in Stage IV lymphoma; the prognosis was generally poor. Histiocytic lymphoma was associated with widespread parenchymatous infiltration, whereas PDLL was usually associated with leptomeningeal seeding. The clinical course and the neuropathologic findings are discussed.
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Recombinant DNA techniques to detect the rearrangement of genes encoding immunoglobulins and T-cell-antigen receptors have been used to identify clonality in lymphoid lesions. To determine the utility of such techniques in cytologic specimens, DNA was analyzed in 24 effusions and 6 fine needle aspirates. Immunophenotypic studies were also performed on the 19 specimens with suspected hematopoietic malignancies. Sufficient material for DNA analysis was present in 28 of the 30 specimens. Immunoglobulin or T-cell-receptor gene rearrangement was present in 13 specimens with atypical cytologic findings; DNA studies provided more information than did the immunologic studies in 3 cases. One T-cell malignancy showed T-cell receptor and heavy-chain gene rearrangement, and one B-cell malignancy showed immunoglobulin and T-cell receptor gene rearrangement. In all patients except one with no evidence of gene rearrangement, the morphologic and immunologic studies also favored a reactive process. Control specimens showed a germline configuration. This study demonstrated that DNA gene rearrangement studies are feasible on many cytologic specimens and may be useful in diagnostically difficult cases.
Twenty patients are described who received chemotherapy for the diagnosis of acute myeloid leukemia but who were subsequently reclassified as having dysmyelopoietic syndrome using the French-American-British criteria. Thirteen patients had refractory anemia with excess blast cells (RAEB) (age range, 23-82 years; median, 68) and seven had chronic myelomonocytic leukemia (CMML) (age range, 44-79 years; median, 70). Three patients (two with RAEB and one with chronic myelomonocytic leukemia) had previously been treated with cytotoxic therapy for another malignancy. In 15 patients the antileukemic therapy was a chemotherapy regimen that was highly active in acute nonlymphoblastic leukemia (ie, containing daunorubicin and/or cytarabine). These patients achieved complete remission lasting 14, 34+, and 36+ months and survival times of 31, 35+, and 37+ months. All three patients were from a subgroup of four patients characterized by RAEB, younger age, no previous cytotoxic therapy, and treatment with an aggressive chemotherapy regimen. The median survival time of the patients not achieving remission was 1 month (range, less than 1-22). Our results suggest that while most patients with the dysmyelopoietic syndrome appear to have their life shortened by chemotherapy, there is a subgroup characterized by younger age, absence of previous cytotoxic therapy, and the morphologic picture of RAEB who can have a favorable response to aggressive treatment.
Thirty-one patients with stage III or IV diffuse histiocytic lymphoma were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) at 3- or 4-week intervals for at least six cycles or until two cycles after complete remission (CR) was achieved. At the completion of therapy, CR was documented by examination of sites known to previously contain disease. After documentation of CR, patients were followed without maintenance therapy. Fifteen patients (48%) achieved CR, four (13%) had equivocal lymphangiograms on restaging but were otherwise free of disease, two (6%) died of unrelated causes during therapy, two (6%) developed central nervous system lymphoma during therapy and despite peripheral remission eventually died of the CNS disease, and eight (26%) had either partial or no response. Twelve of the 15 patients achieving CR remain disease-free with no therapy for 9+ to 43+ months. Three patients relapsed at 3, 4, and 23 months after discontinuation of therapy. Three of the four patients with equivocal restaging lymphangiograms remain without progressive disease with no therapy for 10+ months. The projected median survival time for all patients is 41 months. The risks of long-term (maintenance) chemotherapy are considerable and include the induction of acute nonlymphoblastic leukemia. CHOP without maintenance therapy is able to induce long-term disease-free survival (and probable cure) in a significant number of patients with advanced diffuse histiocytic lymphoma.
Diffuse histiocytic lymphoma (DHL) developed in 14 patients with a different non-Hodgkin's lymphoma and one with chronic lymphocytic leukemia. The median time from the diagnosis of the first malignancy to the appearance of DHL was 47 months (range, 8--112). The most common presentation of histologic conversion was new or recurrent lymphadenopathy. Hypercalcemia was associated with the onset of the DHL in four of 15 patients. Eight patients with DHL after histologic conversion were treated with doxorubicin, vincristine, and prednisone with or without cyclophosphamide, but none achieved complete remission. Two other patients did achieve a complete response with therapy (one with radiotherapy and one with cyclophosphamide, vincristine, procarbazine, and prednisone), but they had brief remissions, and no patient in this study achieved long-term, disease-free survival. This was reflected in the short (12-month) median survival after histologic transformation to DHL. It appears that patients with DHL after histologic conversion have a worse prognosis than those with de novo DHL.