Data on the long-term treatment of myeloma bone disease with bisphosphonates are scanty. In a prospective pilot trial we evaluated the effect of long-term parenteral administration of dichloromethylene bisphosphonate (Clodronate), in addition to standard chemotherapy, in 30 patients with active myeloma bone disease. Patients were treated with a mean of 4 courses (range 2-8) of Clodronate: 300 mg/day i.v. for seven days followed by 100 mg/day i.m. for 10 days, administered at a mean interval of 4 months (range 3-6). The median follow-up was 24 months (range 8-36). Clodronate reduced bone pain rapidly and significantly, and reduced the mean values of the biochemical indices of bone resorption to within normal limits; these effects were maintained throughout the follow-up. In three hypercalcemic episodes serum calcium became normal after 2-5 days of treatment with Clodronate. No toxic or side effects were noticed. The occurrence of skeletal morbidity in patients treated with Clodronate was compared with that observed in the control group of myeloma patients (p less than 0.001) in severe bone pain as well as in the incidence of new osteolytic lesions and pathological fractures (p less than 0.001). Supportive Clodronate therapy contributes significantly in controlling the progression of myeloma bone disease.

Bone Diseases↗

PubMedDate not supplied

Primary gastrointestinal lymphoma: a clinicopathological study of 58 cases.

BACKGROUND: Primary non Hodgkin's lymphoma (NHL) of the gastrointestinal tract (GI) is the most frequent extranodal lymphoma accounting for approximately 40% of all extranodal primary NHL. The role of surgery and other treatment modalities in the management of these patients is still controversial. PATIENTS AND METHODS: We reviewed the records of 68 patients with primary GI-NHL. Ten patients had incomplete records and were excluded from further evaluation. The records of 58 patients were considered, and all were available for analysis and follow-up. RESULTS: The most frequent site of involvement was the stomach (47 patients), followed by ileum (7 patients), large bowel (3 patients) and duodenum (1 patient). Malignant lymphomas of follicular center cell origin represented the most prevalent histologic types, accounting for 58% (34 of 58) of all cases. Stage, evaluated according to the criteria of Musshoff, was Ie in 15 cases, IIe in 16, IIIe in 7, and IV in the remaining 20 cases. The median survival for the entire group of 58 patients was 54 months, with 46% of patients surviving at 5 years. The median survival was 71 months for patients in stage I-II, 60 for patients in stage III, and 25 for patients in stage IV (p = 0.016). Moreover, we found significantly improved survival in patients undergoing surgical tumor resection (p = 0.003). CONCLUSIONS: Even if at the present time the optimal management of primary GI-NHL is difficult to assess, our data suggest that it is prudent to advise resection followed by adjuvant CT in most patients, whereas CT alone should be considered only when surgery cannot be performed.

Adolescent↗

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Stiff-man syndrome in a patient with Hodgkin's disease. An unusual paraneoplastic syndrome.

A case of stiff-man syndrome (SMS), a rare and dramatic CNS disease characterized by continuous muscle activity and painful spasms resembling a chronic form of tetanus, occurring in a patient with Hodgkin's disease (HD) is reported. The patient developed the clinical features of SMS at the same time as the HD relapse. A satisfactory improvement was obtained with diazepam, but the complete recovery from stiffness was achieved only after chemotherapy was started. Cerebellar autoantibodies were found in the serum of the patient. With chemotherapy the patient achieved a second complete remission (CR). Eighteen months later the patient developed a second HD relapse, and at that time no signs of SMS were detected.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Relationship between prognostic factors and therapy in high-grade non-Hodgkin's lymphomas over two decades.

We considered the prognostic factors in high-grade non-Hodgkin's lymphomas (HG-NHL) over the past two decades. In an effort to clarify the relationship between prognostic factors and therapy, we pooled the literature reports concerning 3,480 patients into four different periods according to the mean years of the clinical trials. The most important prognostic factors discovered in period A (mean year prior to 1970) were histology, symptoms and stage. In period B (1970 through 1975), in addition to the former indicators, two new factors were pointed out: bone marrow involvement and serum lactic dehydrogenase. In period C (1976 through 1980) the significance of stage was reduced, while bulk and measures of lymph nodal and extranodal involvement (LSI, ESI) were found to be better prognostic factors. In studies related to this period the prognostic role of albumin, hemoglobin and erythrocyte sedimentation rate were also emphasized. Period D (1980 through 1985) was characterized by a decrease in the importance of the Kiel and Working Formulation (WF) classifications by virtue of the better outcome, in different reports, of HG-NHL with respect to low-grade NHL. The conclusion of our analysis is that symptoms, ESI, bulk, LDH, albumin and hemoglobin should be the most important factors used today in planning the therapy and management of patients with HG-NHL. In addition, an update of the WF is necessary.

Humans↗

PubMedDate not supplied

[Current role of chemotherapy in musculo-invasive transitional carcinoma of the bladder].

The results obtained with chemotherapy (CT) in the management of muscle-infiltrating transitional cell bladder carcinoma (TCBC) are compared with those of radiotherapy (RT) and surgery (S). Cisplatin and methotrexate are the most effective agents, with an overall response rate ranging from 20 to 45% when administered singly. Other chemotherapeutic drugs which proved of some antitumor activity in TCBC are doxorubicin and vinblastine, with an overall response rate of approximately 15% (range 4.28%). With each drug used singly, however, complete response (CR) is uncommon. Combination CT regimens (cisplatin + methotrexate, cisplatin + methotrexate + vinblastine, methotrexate + vinblastine + doxorubicin + cisplatin) are inducing a higher number of CR with an overall response rate between 40 and 70%. CT, previously used as adjuvant or salvage therapy in advanced TCBC, is now given in neo-adjuvant fashion in order to achieve tumor size reduction and control of micrometastases. With these multiagent regimens a significant down-staging can be obtained without major toxicity in over 50% of patients with muscle-infiltrating TCBC, thus increasing the number of patients which can be cured by surgery. These neo-adjuvant programs suggests potential benefit, yet randomized studies and prolonged observations are required to provide definitive results.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied