[Long-term results with MACOP-B and radiation therapy for aggressive lymphomas]. / Langzeitergebnisse mit MACOP-B und Strahlentherapie bei aggressiven Non-Hodgkin-Lymphomen.

BACKGROUND: Long-term results are needed to evaluate chemotherapy regimens and prognostic factors in non-Hodgkin's lymphomas (NHL). We report the 10-year follow-up data of aggressive NHL classified according to the Kiel classification and treated with MACOP-B. PATIENTS AND METHODS: Between 1985 and 1991, 71 patients with aggressive NHL were treated in a single institution with MACOP-B and adjuvant radiotherapy as first-line therapy. NHL subtypes were classified according to the updated Kiel classification. Follow-up data were available until 1998. RESULTS: The overall survival (OS) at 10 years is 45% (confidence interval 33-57%), the progression-free survival 42% (30-54%), and the relapse-free survival of the 59 patients (82%) in complete remission is 52% (39-65%). The Kiel classification combined with the International Prognostic Index (IPI) identified diffuse large B-cell and anaplastic large T-cell lymphomas with IPI 0-2 as subgroups with very favorable prognosis after MACOP-B (OS 84% and 80% at 10 years). Late relapses (>2 years after therapy) did occur in these patients but had a good prognosis after second remission. Only 3 of 24 relapses were in the radiation field. Three patients died of toxicity, 1 during MACOP-B (1.3%). Risk factors for therapy-related death were age and pulmonary toxicity. Most patients suffered from chemotherapy-associated mucositis. Osteoporosis was a common late toxicity (39%). Three second cancers but no leukemias or myelodysplastic syndromes were observed during follow-up. CONCLUSIONS: MACOP-B in combination with adjuvant radiotherapy is highly effective in diffuse large B-cell or anaplastic large T-cell-lymphomas with IPI 0-2. Patients with IPI >2 or with centrocytic or secondary centroblastic B-cell or non-anaplastic T-cell lymphomas need more intensive therapy or novel approaches. Regarding the toxicity profile, MACOP-B should be replaced by VACOP-B.

Elevated expression of S100P, CAPL and MAGE 3 in doxorubicin-resistant cell lines: comparison of mRNA differential display reverse transcription-polymerase chain reaction and subtractive suppressive hybridization for the analysis of differential gene expression.

Subtractive suppressive hybridization (SSH) and mRNA differential display reverse transcription-polymerase chain reaction (DDRT-PCR) were compared for their ability to detect the expression of drug-resistance associated genes in a doxorubicin-resistant and -sensitive colon carcinoma cell line (LoVo H67P). The expression pattern of more than 9000 bands obtained by DDRT-PCR were identical in both cell lines by more than 95%. Of the remaining differentially expressed DDRT-PCR products, 21 cDNA fragments were further analyzed after cloning. A total of 210 clones were sequenced resulting in 40 different sequences of which only five were differentially expressed as revealed by Northern blot analysis. SSH, on the other hand, resulted in 30 different sequences of 37 clones analyzed. Thirteen of 30 sequences (43%) could be identified by databank analysis (excluding expressed sequence tags) in contrast to nine of 40 clones (23%) obtained by DDRT-PCR. Of the clones identified by SSH, 60% exhibited a differential expression comparing the doxorubicin-resistant and -sensitive cell line, respectively, as compared to only 13% of the DDRT-PCR derived clones. The application of SSH resulted in the identification of differentially expressed genes in three doxorubin-resistant cell lines (LoVo DxR, ARH D60 and KB-V1) as compared to the sensitive parental cell lines. A significant higher expression of S100P, a protein involved in calcium metabolism, as well as MAGE 3 (melanoma antigen gene) was found in the resistant cell lines using this methodology. The expression of CAPL, a second protein involved in calcium metabolism, was only moderately elevated in the doxorubicin-resistant cells. We found that subtractive suppressive hybridization proved to be a more rapid and reliable method for the detection of differentially expressed mRNAs in our system.