The integration of radiotherapy into the primary treatment of non-Hodgkin's lymphoma.
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Abdominal Neoplasms↗
Biomedical subjects
H Brincker
Publications and source records attributed to H Brincker.
Non-Hodgkin's lymphoma in the elderly. A study of 602 patients aged 70 or older from a Danish population-based registry. The Danish LYEO-Study Group.
Within a 7-year period 1,597 newly diagnosed cases of non-Hodgkin's lymphoma (NHL) were included in a Danish population-based NHL registry. Of these, 602 (38%) were aged 70 years or older (age range 70-94, median: 76.8). They represent the population defined as 'elderly' patients in the present study. The average annual incidence rate for this elderly patient population was 35.7/10(5), as compared with 6.6/10(5) for patients aged less than 70 (overall annual incidence: 9.5/10(5)). Localised cases (stage I and II) and extranodal manifestations were found more frequently among elderly patients. The most common sites of extranodal involvement were the stomach (21% of all extranodal cases) and the bone marrow (16%). Histologically, follicular centroblastic/centrocytic cases were found to be less frequent (p less than 0.01) in elderly patients as compared to their younger counterparts (less than 70 years), who in contrast had a lower occurrence of diffuse centroblastic cases (p less than 0.01). Overall 7-year survival for the elderly patient population was 35% (median 1.7 years), and for patients aged less than 70 it was 57%. This difference persisted after correction for apparently NHL-unrelated deaths (52% vs. 66%, respectively, p less than 0.0001). Elderly patients with poor prognosis were characterised by the following features identified in a Cox-regression model: hepatic involvement, presence of B-symptoms, high-grade histology and elevated s-LDH. The corresponding relative risk values were in the order 2.4, 2.2, 1.9 and 1.6.
Aged↗
Interpretation of granulomatous lesions in malignancy.
In patients with malignancy the most frequent granuloma-associated conditions are tumor-related sarcoid reactions, sarcoidosis, tuberculosis and other infections. Quite often, the finding of granulomatous lesions in patients with cancer may lead to difficulties of interpretation resulting in inappropriate treatment of both granulomatous disease and malignancy. This problem is reviewed and exemplified by a number of typical case histories. A systematic diagnostic approach must integrate anamnestic, clinical, histomorphological, immunohistological and laboratory information. In addition, prolonged follow-up may be necessary in order to establish the true nature of a granuloma-associated condition.
Adult↗
Clinicopathological features and prognostic factors in extranodal non-Hodgkin lymphomas. Danish LYFO Study Group.
In a Danish population-based non-Hodgkin lymphoma (NHL) registry, 1257 newly diagnosed NHL cases were registered over a 5-year period. Of these, 463 (37%) were extranodal. The gastrointestinal tract was the most common site of extranodal involvement (30% of the cases). Histologically, 44% of all extranodal NHL cases had high-grade, 17% intermediate and 27% low-grade features, while 12% were unclassified. The most common histological subtype (Kiel) was the centroblastic diffuse (23% of cases). 50% of all extranodal NHL were localised (stage IE or IIE) and 27% had B symptoms. Site-specific features included a strong age-correlation for thyroid and testes lymphoma (greater than 50 years) and a high prevalence of female cases in thyroid and salivary glands lymphomas (M/F 0.14 and 0.30, respectively). Overall 7-year survival for extranodal NHL was 46% (median 4.9 years). Poor prognosis patients could be identified by the presence of one or more of the following presentation characteristics: age greater than 65 years, B symptoms, high-grade histology, disseminated disease, elevated s-IgA and hyperuricaemia. Relative risk values ranged from 2.1 for age and B symptoms to 1.7 for hyperuricaemia.
Adolescent↗
Immunohistologic separation of B-cell-positive granulomas from B-cell-negative granulomas in paraffin-embedded tissues with special reference to tumor-related sarcoid reactions.
Frozen and formalin-fixed paraffin-embedded tissue sections were studied concurrently in 17 cases of granulomatous lesions of different etiologies using antibodies recognizing either fixation-sensitive or fixation-resistant antigens. In fixed tissues, the antibodies 4KB5 and L26 for B cells and UCHL1 and MT1 for T cells gave results similar to those obtained in frozen tissues with anti-leu-12/leu-14 for B cells and T-3 for T cells. Paraffin-embedded sections from 35 additional cases of granulomatous lesions were studied retrospectively using the same markers. The combined results from all 52 cases show that granulomas can be divided into two main "families" according to the presence or absence of B cells within the granulomas: one is a B-cell-negative family of lesions to which sarcoidosis and mycobacterial infection belong; the other is a B-cell-positive family of lesions to which toxoplasmosis, granulomatous lesions of unknown significance and tumor-related sarcoid reactions belong.
Antibodies, Monoclonal↗
The malignancy-sarcoidosis syndrome.
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Humans↗
MIME combination chemotherapy in recurrent or refractory lymphoproliferative malignancies. A phase II study.
Seventy-two patients with recurrent or refractory malignant lymphoproliferative diseases were treated with MIME combination chemotherapy (methyl-GAG, ifosfamide, methotrexate, etoposide) and concurrent mesna to prevent urothelial toxicity; 41 patients had high/intermediate-grade non-Hodgkin's lymphoma (NHL), 18 low-grade NHL/chronic lymphocytic leukemia (CLL), and 13 Hodgkin's disease (HD). The overall response rates were 56% in high/intermediate-grade NHL, 11% in low-grade NHL/CLL, and 69% in HD respectively. Median survival in the same 3 groups was 7, 2 and 10 months respectively. Neither previous type of response to chemotherapy nor previous amount of treatment predicted the outcome of MIME chemotherapy. Toxicity was modest, hemorrhagic cystitis did not occur, and only one therapy-related death occurred. Although MIME appears to be a safe treatment with considerable activity in recurrent or refractory lymphoproliferative disease very few patients become long-term survivors. However, MIME is well suited for remission induction in patients intended for subsequent autologous bone-marrow transplantation.
Adult↗
Aclarubicin plus cytosine arabinoside versus daunorubicin plus cytosine arabinoside in previously untreated patients with acute myeloid leukemia: a Danish national phase III trial. The Danish Society of Hematology Study Group on AML, Denmark.
A regimen of aclarubicin (ACR) of 75 mg/m2 daily for 3 days plus a continuous intravenous infusion of cytosine arabinoside (ara-C) of 100 mg/m2 per day for 7 days was compared with daunorubicin (DNR) 45 mg/m2/day for 3 days plus ara-C for 7 days as first-line chemotherapy of de novo acute myeloid leukemia (AML) in a randomized, nationwide Danish study. A total of 180 patients aged between 17 and 65 years were entered onto the protocol. Patients who achieved complete remission (CR) were given five courses of intensive consolidation therapy consisting of two courses of high dose ara-C, two courses of amsacrine plus etoposide, and one course of DNR plus ara-C. Of 174 evaluable patients, 99 achieved CR. The rate of CR was significantly higher on ACR plus ara-C than on DNR plus ara-C [66% versus 50% (p = 0.043)] and decreased significantly with increasing age. The hematological toxicity was identical for the two regimens. A total of 83 patients entered consolidation therapy. At 4 years, 37% of patients with CR following ACR were still in remission compared with 33% following DNR (p = 0.48), and the total survival at 4 years was 29% versus 20% (p = 0.26). The duration of remission and total survival both decreased with increasing age. ACR plus ara-C seem at least as good or better than DNR plus ara-C as first-line chemotherapy of AML.
Aclarubicin↗
Long-term survival and late relapses in acute leukaemia in adults.
34 out of 403 apparently unselected adult patients with acute leukaemia referred to a single department from 1970 through 1989 survived more than 3 years. The cumulative rate of relapse after 3 years was 39% in patients with acute myeloblastic leukaemia (AML) and 74% in patients with acute lymphoblastic leukaemia (ALL). The latest relapse was observed 75 months after diagnosis in AML and 98 months after diagnosis in ALL. 65% of the long-term survivors were able to undertake normal physical activity, 26% had decreased activity, and 9% were unable to work. 5-year survival for all patients, whether treated or not, during two successive decades was 16% versus 18% and 5% versus 6%, respectively, for ALL and AML. The departmental results were identical with population-based national results. Only in patients 15-49 years of age with AML was there evidence that more intensive treatment had led to better survival.
Adolescent↗
Phase III trial of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) versus cisplatin, etoposide, bleomycin and prednisone (CisEBP) for the treatment of advanced non-Hodgkin's lymphoma of high grade malignancy. The Danish Lymphoma Study Group.
The trial included 85 previously untreated patients (median age 61 years) with stage III or IV non-Hodgkin's lymphoma (NHL) of the subtypes centrocytic lymphoma, diffuse centroblastic lymphoma, immunocytoma, immunoblastic lymphoma, or unclassified lymphoma of high grade malignancy. The patients were randomized to 9 monthly treatment cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CisEBP (cisplatin, bleomycin, etoposide, prednisone). Patients who had failed to achieve even a partial response (PR) after the completion of 2 cycles were switched to the alternative regimen. Complete response (CR) on primary treatment was obtained in 70% (55-83%) of CHOP-treated patients and in 25% (13-41%) of CisEBP-treated patients (p = 0.0004). Secondary CHOP treatment produced CR in 7 (30%) of 24 patients and secondary CisEBP treatment led to CR in 2 (15%) of 14 patients. The median survival was 3.4 years in the CHOP arm and 2.6 years in the CisEBP arm (p = 0.78). Hematologic toxicity was mainly leukocytopenia and anemia in both treatment arms. Non-hematological toxicity was slight, and late toxicity was insignificant. Three treatment-related deaths were noted. We conclude that CHOP induces more remissions than CisEBP in advanced lymphomas of high grade malignancy.
Adult↗
Granulomatous lesions of unknown significance in biopsies from lymph-nodes and other tissues: the GLUS-syndrome.
Granulomatous lesions of unknown significance (GLUS) have been described primarily in liver and lymph-node biopsies, and the overall frequency of GLUS among all types of granulomatous lesions is approximately 20-25%. Regardless of localization GLUS is characterized by a benign self-healing course. The combination of this clinical picture with a characteristic histomorphologic and immunohistologic pattern appears to justify the proposal of the existence of a special GLUS-syndrome, possibly with a single or a few related etiologies.
Biopsy↗
Late relapses after treatment for acute lymphoblastic leukemia in childhood: a population-based study from the Nordic countries.
Seven late relapses of acute lymphoblastic leukemia occurring 5.5 to 12.3 years after cessation of therapy are reported in 986 patients who had discontinued treatment for leukemia acquired before the age of 15. The study covers patients from the five Nordic countries. Of the 434 patients with ALL who had passed 5 years of follow-up without recurrence, seven have subsequently relapsed so far; an estimated cumulative proportion of 6.9% within the 10 years. In addition, we report a girl 15.9 years old at diagnosis who relapsed 7.3 years after cessation of therapy. These findings confirm that "cure" of acute lymphoblastic leukemia treated in the 1970s cannot be considered definite, even 5 years after discontinuation of therapy.
Adolescent↗
Immunological marker patterns in granulomatous lymph node lesions.
The distribution of various types of lymphocytes and macrophages was studied in 19 cases with granulomatous lymph node lesions using 14 monoclonal antibodies. Cases of sarcoidosis, tuberculosis and atypical mycobacteriosis all showed well demarcated granulomas devoid of B-lymphocytes and natural killer cells. In these cases, T-helper: T-suppressor cell ratios were greater than 2 and poor preservation of the normal lymphoid tissue outside the granulomas was seen. In contrast, cases of non-specific lymphadenitis showed less well-demarcated granulomas always containing B-lymphocytes and natural killer cells, with a T-helper:T-suppressor cell ratio less than 1 and good preservation of the normal lymphoid tissue outside the granulomas. Immunological marker studies may be helpful in the differential diagnosis of granulomatous lymph node lesions, as well as in the study of the pathogenesis of such lesions.
Adolescent↗
Coexistence of sarcoidosis and myeloproliferative disease: a case of sarcoidosis preceding polycythaemia vera with a literature review.
A patient with the chronic active type of sarcoidosis developed polycythaemia vera 20 years later. A review of the literature shows that sarcoidosis preceding myeloproliferative disease tends to be of the chronic active variety. The same pattern is observed in associations of sarcoidosis with malignant lymphoproliferative disease and solid tumours, in which sarcoidosis appears to be the underlying cause of the subsequent malignancy.
Aged↗
Castration induced by cytotoxic chemotherapy.
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Adult↗
Coexistence of sarcoidosis and malignant disease: causality or coincidence?
A review of 131 cases of coexistent sarcoidosis and malignancy indicates that this association is not fortuitous: 1) A nonrandom sample of tumor types is observed. 2) The chronic active type of sarcoidosis is involved much more often than the subacute self-healing type. 3) The temporal relationship between sarcoidosis and subsequent malignancy is not a random one, at least not in malignant lymphoproliferative disease, in which sarcoidosis almost invariably precedes malignancy. 4) The observed incidences of malignant lymphoproliferative disease and of lung cancer are significantly higher than expected. The association of sarcoidosis and malignant lymphoproliferative disease is so constant that the existence of a sarcoidosis-lymphoma syndrome is suggested, in which the chronic active type of sarcoidosis appears to be responsible for an increased risk of malignant transformation of lymphoid cells.
Adolescent↗
Undergraduate oncology education in Scandinavia.
An overview of undergraduate education in general oncology in 18 medical schools in Scandinavia demonstrated that insufficient resources were allocated to this activity, and that there was a lack of integrated multidisciplinary educational activities. Further, there was a lack of clear consensus about the contents of a curriculum in oncology. To remedy this situation a minimal list of recommendations is suggested for the undergraduate education in oncology in Scandinavia. The main points are: (1) a better coordination of the curriculum in general oncology with the curricula of other specialty disciplines, (2) a two-week period of clinical clerkship in the department of general oncology early in the study, (3) a two-week concentrated course in general oncology late in the study, (4) a final knowledge test, and (5) adequate funding of cancer educators.
Curriculum↗
A Danish randomized trial comparing breast-preserving therapy with mastectomy in mammary carcinoma. Preliminary results.
The present study comprises 847 women operated upon for invasive breast carcinoma at 19 surgical departments and enrolled in protocol DBCG-82TM from January 1983 to November 1987. Among them 662 (78%) were allocated for breast-preserving therapy or mastectomy by randomization, while 185 patients (22%) did not accept randomization. Within the randomized group 6% could not be entered into adjuvant protocols, i.e. subsequent programmes of postoperative therapy and follow-up. This left 619 evaluable patients. In the non-randomized series 26% did not fulfil the demands for entrance into the adjuvant protocols, leaving 136 evaluable patients, 60 of whom had chosen a breast-preserving operation and 76 mastectomy. In the randomized series the patients in the two treatment arms were comparable in age, menopausal status, site of tumour, pathoanatomical diameter of the tumour, number of removed axillary lymph nodes, number of metastatic axillary lymph nodes, and distribution on adjuvant regimens. Ninety per cent of the patients in the randomized group accepted the method offered, whereas 10% declined and wanted the alternate form of operation. The median follow-up period was approximately 1.75 years. The cumulative recurrence rate in the randomized group was 13% and in the non-randomized group 7%. These results are preliminary. Life-table analyses have not so far demonstrated differences in recurrence-free survival either in the randomized or the non-randomized series.
Adult↗