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1.
Int J Cancer ; 123(5): 1089-93, 2008 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-18528860

RESUMEN

Ocular adnexal MALT lymphoma (OAML) is linked to Chlamydophila psittaci (Cp) infection. Viability and infectivity of Cp, demonstrated by growth in culture, has not been yet investigated in these patients. We conducted a single-center prospective case-control study to assess the prevalence, viability and infectivity of Cp in 20 OAML patients and 42 blood donors registered in a 6-month period. The presence of Cp in conjunctival swabs and peripheral blood mononuclear cells (PBMC) of patients and donors was assessed by TETR-PCR and in vitro cultures. From an epidemiological point of view, OAML patients often resided in rural areas, and reported a history of chronic conjunctivitis and prolonged contact with household animals (85% vs. 38% of donors; p = 0.00001). Cp was detected in lymphoma tissue in 15 (75%) patients. Cp DNA was detected in conjunctival swabs and/or PBMC from 10 (50%) patients and in PBMC from 1 (2%) donor (p = 0.01). Viability and infectivity of Cp, demonstrated by growth in culture, were confirmed in conjunctival swabs and/or PBMC from 5 (25%) patients, but not in donors (p = 0.002). This prospective study demonstrates, for the first time, that Cp present in the conjunctiva and PBMC of OAML patients is capable to grow and be isolated in cell cultures. Cp infection is common in OAML patients and exceptional in blood donors. Epidemiological data of OAML patients (prolonged contact with household animals and chronic conjunctivitis) are consistent with Cp exposure risk.


Asunto(s)
Infecciones por Chlamydia/complicaciones , Chlamydophila psittaci/aislamiento & purificación , Chlamydophila psittaci/patogenicidad , Neoplasias de la Conjuntiva/microbiología , Conjuntivitis/complicaciones , Linfoma de Células B de la Zona Marginal/microbiología , Neoplasias Orbitales/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Crianza de Animales Domésticos , Estudios de Casos y Controles , Infecciones por Chlamydia/microbiología , Chlamydophila psittaci/genética , Enfermedad Crónica , Conjuntivitis/microbiología , ADN Bacteriano/aislamiento & purificación , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Leucocitos Mononucleares/microbiología , Masculino , Persona de Mediana Edad , Exposición Profesional/efectos adversos , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Factores de Riesgo
2.
Br J Haematol ; 143(2): 253-7, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18699850

RESUMEN

Some case reports and a Japanese series suggest benefit from the use of rituximab in patients with intravascular large B-cell lymphoma (IVL). Rituximab efficacy was evaluated in Western patients with IVL, comparing outcome of 10 patients treated with rituximab + chemotherapy (R-CT) and of 20 patients treated with chemotherapy alone (CT). There were no significant differences in patients' characteristics between the two subgroups. The addition of rituximab was associated with improved complete remission rate (90% vs. 50%; P = 0.04), event-free survival (3-year: 89% vs. 35%; P = 0.003) and overall survival (3-year: 89% vs. 38%; P = 0.01). In conclusion, rituximab may substantially change the dismal prognosis of IVL.


Asunto(s)
Antraciclinas/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Factores Inmunológicos/uso terapéutico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Neoplasias Vasculares/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales de Origen Murino , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Ciclofosfamida/administración & dosificación , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Rituximab , Tasa de Supervivencia , Vincristina/administración & dosificación
3.
Haematologica ; 92(4): 486-92, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17488659

RESUMEN

BACKGROUND AND OBJECTIVES: This study explored variations in the clinical manifestations of intravascular lymphoma (IVL) on the bases of the association with hemophagocytosis and the country where the diagnosis was made. DESIGN AND METHODS: The clinical features of 50 Western patients with IVL were compared with those of 123 patients with IVL diagnosed in Eastern countries (87 diagnosed in Japan and 36 in other Asian countries), previously reported in English literature, and collected by an electronic bibliographic search. RESULTS: Hemophagocytosis was absent in Western patients, but reported in 38 (44%) Japanese patients (p=0.00001) and in seven (19%) patients from other Asian countries (p=0.002). No clinical differences were evident between patients with hemophagocytosis-negative IVL diagnosed in Western countries, Japan and other Asian Countries. Conversely, Japanese and non-Japanese patients with hemophagocytosis-related IVL more frequently had stage IV disease, fever, hepato-splenic involvement, marrow infiltration, dyspnea, anemia, and thrombocytopenia, and rarely exhibited cutaneous or central nervous system involvement. Lymph node and peripheral blood involvement was uncommon in all subgroups. In Western patients, anthracycline-based chemotherapy was associated with a 52% remission rate, and a 2-year overall survival of 46%. INTERPRETATION AND CONCLUSIONS: The clinical features of IVL vary according to the association with hemophagocytosis, regardless of the country in which the diagnosis is made. Western, Japanese and other Asian patients with hemophagocytosis-negative IVL display similar clinical characteristics and should be considered as having classical IVL. Patients with hemophagocytosis-related IVL show significantly different clinical features. Both forms have a poor prognosis. Extensive molecular studies are needed to explore whether these clinical differences might reflect discordant biological entities within IVL.


Asunto(s)
Linfohistiocitosis Hemofagocítica/epidemiología , Linfoma de Células B Grandes Difuso/epidemiología , Neoplasias Vasculares/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antraciclinas/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Asia/epidemiología , Pueblo Asiatico/estadística & datos numéricos , Neoplasias Encefálicas/epidemiología , Neoplasias Encefálicas/etnología , Neoplasias Encefálicas/patología , Progresión de la Enfermedad , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Predicción , Humanos , Japón/etnología , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/etnología , Linfohistiocitosis Hemofagocítica/etiología , Linfoma de Células B Grandes Difuso/clasificación , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/etnología , Linfoma de Células B Grandes Difuso/patología , Masculino , Persona de Mediana Edad , Especificidad de Órganos , Fenotipo , Pronóstico , Estudios Retrospectivos , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etnología , Neoplasias Cutáneas/patología , Encuestas y Cuestionarios , Resultado del Tratamiento , Neoplasias Vasculares/clasificación , Neoplasias Vasculares/complicaciones , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/tratamiento farmacológico , Neoplasias Vasculares/etnología , Neoplasias Vasculares/patología , Población Blanca/estadística & datos numéricos
5.
Expert Opin Pharmacother ; 8(8): 1073-83, 2007 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17922636

RESUMEN

Non-Hodgkin lymphomas constitute 50% of all orbital malignancies. Mucosa-associated lymphoid tissue (MALT)-type lymphoma is the most common histology category in this anatomic region. Ocular adnexal lymphoma of MALT-type is an indolent and rarely lethal malignancy that can often be managed with observation alone. Occasionally, lymphomatous lesions determine the symptoms that condition a patient's quality of life, and so require an immediate antineoplastic treatment. Several strategies are available, but reliable indications supported by prospective trials do not exist. Some therapeutic strategies are associated with substantial side effects and require a well-balanced therapeutic decision, which should take into account several variables related to the patient, the lymphoma, and the treatment itself. In this review, the authors analyze related literature and propose therapeutic guidelines for the management of ocular adnexal lymphoma of MALT-type.


Asunto(s)
Neoplasias del Ojo/terapia , Linfoma de Células B de la Zona Marginal/terapia , Antineoplásicos/uso terapéutico , Neoplasias del Ojo/etiología , Neoplasias del Ojo/patología , Humanos , Linfoma de Células B de la Zona Marginal/etiología , Linfoma de Células B de la Zona Marginal/patología
6.
J Natl Cancer Inst ; 98(19): 1375-82, 2006 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-17018784

RESUMEN

BACKGROUND: An association between ocular adnexal MALT lymphoma (OAL) and Chlamydia psittaci (Cp) infection has been proposed, and recent reports suggest that doxycycline treatment causes tumor regression in patients with Cp-related OAL. The effectiveness of doxycycline treatment in Cp-negative OAL has not been tested. METHODS: In a prospective trial, 27 OAL patients (15 newly diagnosed and 12 having experienced relapse) were given a 3-week course of doxycycline therapy. Objective lymphoma response was assessed by computerized tomography scans or magnetic resonance imaging at 1, 3, and 6 months after the conclusion of therapy and every 6 months during follow-up. Cp infection in patients was determined by touchdown enzyme time-release polymerase chain reaction (TETR-PCR). Statistical tests were two-sided. RESULTS: Eleven patients were Cp DNA-positive and 16 were Cp DNA negative. Doxycycline was well tolerated. At a median follow-up of 14 months, lymphoma regression was complete in six patients, and a partial response (> or = 50% reduction of all measurable lesions) was observed in seven patients (overall response rate [complete and partial responses] = 48%). Lymphoma regression was observed in both Cp DNA-positive patients (seven of 11 experienced regression) and Cp DNA-negative patients (six of 16 experienced regression) (64% versus 38%; P = .25, Fisher's exact test). The three patients with regional lymphadenopathies and three of the five patients with bilateral disease achieved objective response. In relapsed patients, response was observed both in previously irradiated and nonirradiated patients. The 2-year failure-free survival rate among the doxycycline-treated patients was 66% (95% confidence interval = 54 to 78), and 20 of the 27 patients were progression free. CONCLUSIONS: Doxycycline is a fast, safe, and active therapy for Cp DNA-positive OAL that was effective even in patients with multiple failures involving previously irradiated areas or regional lymphadenopathies. The responses observed in PCR-negative OAL may suggest a need for development of more sensitive methods for Cp detection and investigation of the potential role of other doxycycline-sensitive bacteria.


Asunto(s)
Antibacterianos/uso terapéutico , Antineoplásicos/uso terapéutico , Chlamydophila psittaci/efectos de los fármacos , Doxiciclina/uso terapéutico , Linfoma de Células B de la Zona Marginal/tratamiento farmacológico , Neoplasias Orbitales/tratamiento farmacológico , Psitacosis/tratamiento farmacológico , Adulto , Anciano , Chlamydophila psittaci/aislamiento & purificación , ADN Bacteriano/aislamiento & purificación , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Linfoma de Células B de la Zona Marginal/microbiología , Linfoma de Células B de la Zona Marginal/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias Orbitales/microbiología , Neoplasias Orbitales/patología , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Psitacosis/complicaciones , Resultado del Tratamiento
8.
J Natl Cancer Inst ; 99(18): 1418-9, 2007 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-17848672
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