Study of nonrandom chromosome aberrations in bone marrow and blood cells of patients with non-Hodgkin's lymphomas.

Complete karyotyping of G-stained chromosomes of bone marrow and blood cells was carried out in patients with non-Hodgkin's lymphomas before and after antitumor therapy, in remissions and relapses. Clones with 1q41-43, 2q35, and 6q24-27 deletions were most incident. Their incidence in patients increased after antitumor therapy.

Cytogenetic study of bone marrow and blood cells in patients with non-Hodgkin lymphoma before and after antitumor therapy.

Non-clonal and clonal abnormal cells (hypodiploid, polyploid, and with chromosome aberrations) were detected by the G-method in the bone marrow and blood of the majority of patients with non-Hodgkin lymphomas before therapy. The manifestation of these abnormalities changed individually after treatment. The most incident were clones -22, del(1)(q42-43), del(2)(q-33-35), del(3)(q27), 4q-, and del(6q).

Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials.

BACKGROUND: Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial. PATIENTS AND METHODS: We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method. RESULTS: Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25). CONCLUSIONS: Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies.

Management of Hodgkin's disease patients with mediastinal adenopathy and pulmonary involvement (stage IIE).

Two hundred and fifty-five patients with Hodgkin's disease and with localized pulmonary involvement (Stage IIE) were retrospectively assessed for their response to different treatment programmes while considering the size of mediastinal lymph nodes and the extent of pulmonary disease (involvement of lung subsegment, segment or lobe). Five-year overall and disease-free survival rates in 255 patients were 89.6% and 72.3%, respectively. In patients with mediastinal index < 1/3 and lung segment and/or subsegment involvement, 5-year overall and disease-free survival rates were 96.6%. For patients with mediastinal index > 1/3 and similar lung involvement the corresponding values were, respectively, 88.6% and 73.5%; and for those with a lung lobe involvement the values were 76.4% and 56.7%, respectively. Patients were treated according to the following programmes: 1 combination chemotherapy cycle + radiotherapy (RT) + 4-5 combination chemotherapy cycles; 3 combination chemotherapy cycles + RT; 6 combination chemotherapy cycles + RT. The best results were obtained with the programme consisting of 1 combination chemotherapy cycle + lymphoid irradiation above the diaphragm and irradiation of the spleen to a total tumour dose of 40 Gy and irradiation of involved lung sites to a total tumour dose of 20 Gy + 4-5 combination chemotherapy cycles.

[The clinical significance of bone involvement in patients with primary lymphogranulomatosis]. / Klinicheskoe znachenie porazheniia kostei u pervichnykh bol'nykh limfogranulematozom.

A retrospective analysis of 2450 case histories of primary Hodgkin's disease established bone lesions incidence at 3.8%. They occurred in cases of general symptoms (6%) rather than otherwise (1.6%). Bone involvement came about chiefly via the blood flow pathway (59%), with several bones being involved in most cases. Dissemination through contact was less frequent 39%), the breast bone or vertebrae being involved relatively more often. Both radiation and polychemotherapy caused local healing effect which would lead to full recovery of bone structure in some cases. Therefore, combined (polychemotherapy + radiation) treatment should be recommended in cases of single lesions whereas treatment for multiple lesions may be limited to medication.

[Pleural lesions in patients with Hodgkin's disease with pulmonary involvement]. / Porazhenie plevry u bol'nykh limfogranulematozom s vovlecheniem v protsess legkikh.

A retrospective study of 334 primary patients with Hodgkin's disease with the affected mediastinal lymph nodes and pulmonary tissue (stages IIE, IV) was carried out. Pleural affection was detected in 280 (88.8%) patients. Limited pleural affection resulting from contact dissemination from the enlarged lymph nodes was shown to make no effect on prognosis. Generalized involvement of the pleura was shown to deteriorate considerably a course of disease in patients with contact (localized) pulmonary involvement and to have no prognostic importance in disseminated involvement.

[The combined (polychemical and radiation) and drug treatment of lymphogranulomatosis patients with generalized lung involvement (stage IV)]. / Kombinirovannoe (polikhimio- i luchevoe) i lekarstvennoe lechenie bol'nykh limfogranulematozom s generalizovannym porazheniem legkikh (IV stadii).

The paper is concerned with analysis of the peculiarities of a course of disease and effectiveness of different therapeutic programs in 121 primary patients suffering from Hodgkin's disease with generalized lung lesion (true stage IV). The 5-year total and recurrence-free survival of patients after polychemoradiotherapy was 59.5 and 45.6%, respectively. Prognosis of disease in patient with generalized lung lesion is determined mainly by the development of a specific process in pulmonary tissue and, to a lesser degree, by spreading of disease via the lymphatic collectors. The authors have shown the appropriateness of combined therapy of this group of patients. Therapy includes cycles of polychemotherapy for achieving remission and radiotherapy including total irradiation of the affected lung for its consolidation.

[Status of the heart during a combined method of treating patients with stage I to II lymphogranulomatosis]. / Sostoianie serdtsa pri kombinirovannom metode lecheniia bol'nykh limfogranulematozom I-II stadii.

The effects of combined therapy (polychemotherapy and radiotherapy) of 162 patients with stage I-II Hodgkin's disease were studied. A retrospective analysis of x-ray findings led to the detection of exudate in the pericardial cavity unrecognized in hospital in 7.7% of the patients. Combined therapy caused its reverse development into adhesive pericarditis. X-ray assessment of the cardiac state during a follow-up (3-5 yrs.) revealed various postradiation complications: limited pleuropericardial adhesions (17%), extensive pleuropericardial adhesions revealing the right spinal contour (12.7%), exudative pericarditis (0.7%), and adhesive pericarditis (12.7%). A low rate and degree of postradiation injuries of the pericardium could be accounted for by preliminary polychemotherapy making it possible to reduce radiation fields in subsequent irradiation.

[Course of lymphogranulomatosis with primary location below the diaphragm]. / Osobennosti techeniia limfogranulematoza pri pervichnoi lokalizatsii porazheniia nizhe diafragmy.

Some peculiarities in a course of stage I-II Hodgkin's disease with a primary site below the diaphragm are analyzed. This site is more common in men and in a mixed cell histological variant of lymphogranuloma. The frequency of recurrence is higher in this group than in patients with a primary site above the diaphragm. Recurrences affect more frequently the lymphatic areas above the diaphragm. The data obtained suggest the necessity of irradiation of the lymphatic collectors on both sides of the diaphragm in a primary site below the diaphragm, particularly in patients with "mixed cell" and "lymphoid depletion" histological variants of lymphogranuloma.

The efficiency of different combined treatment programs (combination chemotherapy-radiotherapy) used for stage I-II Hodgkin's disease.

This study presents the analysis of results obtained in 237 Hodgkin's disease patients, stages I and II, treated with combined modality therapy. The overall and disease-free survival rates at 5 years were 96.6 and 85.2%, respectively. The study has demonstrated the superiority of the following treatment program: one cycle of combination chemotherapy + radiation therapy + 5 cycles of combination chemotherapy. It has been found possible to reduce the number of radiation fields in combined modality therapy: for patients with stage IA-IIA lymphocyte predominant or nodular sclerosing Hodgkin's disease it was sufficient only to treat clinically involved sites. Short- and long-term consequences of combined modality therapy have been analysed.

[Changes in the lungs in patients with lymphogranulomatosis, Stages I-II, following combination therapy]. / Izmeneniia v legkikh u bol'nykh limfogranulematozom I-II stadii posle kombinirovannogo lecheniia.

Early and late pulmonary changes in 140 patients with Hodgkin's disease, Stages I-II, following combined treatment (polychemo- and radiotherapy) are analysed. Radiation pulmonitis and local paramediastinal fibrosis occur less frequently and they are less noticeable in combined therapy as compared to similar changes developing after radiation therapy only. It can be due to the fact that a course of polychemotherapy at its first stage results in a considerable decrease of the mediastinal lymph nodes (up to their complete regression) thus making it possible to shape irradiation fields of smaller sizes and to decrease the volume of pulmonary tissue to be irradiated.

[3-year results of the combined treatment of stage I and II lymphogranulomatosis patients]. / Trekhletnie rezul'taty kombinirovannogo lecheniia bol'nykh limfogranulematozom I--II stadii.

The authors present the results of the combined treatment (radiotherapy combined with 6 cycles of polychemotherapy using either the COPP or CVPP scheme) of 120 patients according to 4 programs differing in the volume of irradiation and intervals, between the cycles of polychemotherapy. The results of the study were compared to those of radiotherapy (irradiation of unilateral diaphragmatic and splenic lymph nodes) of 277 patients with Hodgkin's disease, Stages I--II. The combined treatment was shown to yield in better rates of a recurrence-free course of the disease and in slightly increased 3-year survival rates. It was shown that with identical drug therapy (6 cycles of polychemotherapy) the results of treatment in the groups of patients with different volumes of irradiation (irradiation of the clinically detectable foci of lesion only or of all the lymph nodes over the diaphragm and spleen) are rather similar. The results obtained indicate the advantages of the combined method of treatment of patients with Hodgkin's disease, Stages I--II. A reduced volume of irradiation seems possible in some cases.