Rituximab (anti-CD20 monoclonal antibody) as single first-line therapy for patients with follicular lymphoma with a low tumor burden: clinical and molecular evaluation.

The clinical activity of rituximab, a chimeric monoclonal antibody which binds to the CD20 antigen, was evaluated as a single first-line therapy for patients with follicular non-Hodgkin lymphoma (NHL). Fifty patients with follicular CD20(+) NHL and a low tumor burden were analyzed for clinical and molecular responses. They received 4 weekly infusions of rituximab at a dose of 375 mg/m(2). The response rate a month after treatment (day 50) was 36 of 49 (73%), with 10 patients in complete remission, 3 patients in complete remission/unconfirmed, and 23 patients in partial remission. Ten patients had stable disease, and the disease progressed in 3 patients. One of 13 (8%) patients in complete remission, 9 of 23 (39%) patients in partial remission, and 5 of 10 (50%) patients with stable disease exhibited disease progression during the first year. Within the study population, 32 patients were initially informative for polymerase chain reaction (PCR) data on bcl-2-J(H) rearrangement. On day 50, 17 of 30 patients (57%) were negative for bcl-2-J(H) rearrangement in peripheral blood, and 9 of 29 (31%) were negative in bone marrow; a significant association was observed between molecular and clinical responses (P <.0001). At month 12, 16 of 26 patients (62%) were PCR negative in peripheral blood. These results indicate that early molecular responses can be sustained for up to 12 months and that this response is highly correlated with progression-free survival. Rituximab has a high clinical activity and a low toxicity and induces a high complete molecular response rate in patients with follicular lymphoma and a low tumor burden.

[Bronchopulmonary cancer, antiphospholipid syndrome and coagulation disorders]. / Cancer bronchique, syndrome des antiphospholipides et pathologie de la coagulation.

INTRODUCTION: The antiphospholipid syndrome includes recurrent thrombotic manifestations related to antiphospholipid antibodies. Adrenal insufficiency is a rare complication of the antiphospholipid syndrome. EXEGESIS: We report a case of acute adrenal insufficiency secondary to bilateral adrenal hemorrhage in a 45-year-old man. The finding of antiphospholipid antibodies and 6 months later of a polymetastatic bronchopulmonary cancer led us to diagnose a paraneoplasic antiphospholipid syndrome. CONCLUSION: We discuss the role of coagulation disorders in the pathogenesis of tumor growth and rapid metastatic spread. Assessment of the high risk for thrombosis may be of prognostic and therapeutic value in patients with evolutive bronchopulmonary cancer. Early anticoagulation treatment in association with classical treatment of cancer may contribute to prevent malignant process from extending and avoid metastatic spread.

[Cancer in patients infected with the human immunodeficiency virus. The unusual aspects]. / Cancer chez des patients infectés par le virus de l'immunodéficience humaine. Aspects inhabituels.

CANCER AND HIV INFECTION: As the HIV epidemic advances, the spectrum of non-AIDS defining malignancy is expanding. Recent reports suggest an increased incidence of skin cancers, squamous cell carcinomas of the anus, and Hodgkin's disease in HIV-infected patients. Other neoplasms encountered in this setting include oral mucosa, head and neck carcinoma without evidence of increased incidence. PARTICULAR FEATURES: The natural history of lung, testicle and skin cancer (excepting Kaposi sarcoma) as well as ENT cancer appears to be modified in HIV-infected patients. The main problem raised by these tumors is confounding infection which may lead to late diagnosis or an error in tumor staging.

[Tyrosine kinase: implications in tumor pathology and therapeutic perspectives]. / Tyrosine kinase: implications en pathologie tumorale et perspectives thérapeutiques.

The tyrosine kinase family includes growth factor receptor and cytoplasmic enzymes. It plays a key role in normal cell division and abnormal cell proliferation and differentiation. The most common tyrosine kinases are the epidermal-growth factor (EGFR) and platelet-derived growth factor (PDGF) receptors, and a chromosome Philadelphia product, the Bcr-abl oncogene. Many studies have attempted to correlate clinical evolution of tumors with tyrosine kinase expression. However, clinical application of these new prognostic factors has not yet been demonstrated. More recently, tyrosine-phosphorylation inhibitors (tryphostin) have been developed in phase I studies. Results that were obtained show some objective responses in patients with glioblastoma and polymetastatic cancer. Another approach to block tyrosine kinase expression is the use of monoclonal antibodies. Trials using such antibodies have shown interesting preliminary results.

[Hypercalcemia associated with hyperleukocytosis, a new paraneoplastic syndrome]. / Association hypercalcémie-hyperleucocytose, un syndrome paranéoplasique original.

BACKGROUND: The association of hypercalcemia and leukocytosis constitutes a novel paraneoplastic syndrome rarely reported in the course of head and neck and lung squamous cell carcinoma. We report 7 new cases. CASE REPORTS: In 5 cases the diagnosis was well-differentiated squamous cell carcinoma, in 1 differentiated non-small-cell carcinoma and in 1 adenocarcinoma of unknown origin. There was no argument favoring hyperparathyroidism in any of the cases. Microbiology tests were negative and large spectrum antibiotics were unsuccessful, eliminating an associated infection as cause of the leukocytosis. DISCUSSION: This association probably involves the secretion of hematopoietic growth factors such as G-CSF or GM-CSF by the tumor, acting simultaneously on osteoclasts and granulomonocytic cells which have common precursers.

[Lung cancer in patients infected with human immunodeficiency virus. Clinical course and therapeutic implications]. / Cancer du poumon chez les malades infectés par le virus de l'immunodéficience humaine. Particularités évolutives et implications thérapeutiques.

OBJECTIVES: HIV infection is associated with increased frequency of non-Hodgkin's lymphoma and Kaposi sarcoma. Like other malignancies, lung cancer has been described in HIV-infected patients although no evidence of a statistical correlation has been reported. PATIENTS AND METHODS: We performed a retrospective analysis of 15 HIV-infected patients with lung cancer. The patients were relatively younger (mean age 45 years) than is commonly found in lung cancer cohorts. RESULTS: The 15 patients had mild immunodepression (240 CD4+/mm3) and were in advanced clinical stage at diagnosis. Mean overall survival was 6 months and no clinical or biological prognostic factors were found. Death was usually due to infection, suggesting a synergetic effect between HIV and chemotherapy-induced immunodepression. CONCLUSION: We propose early antiretroviral therapy in cases of chemotherapy-treated HIV patients, even when commonly accepted immunological and/or clinical criteria are absent.

Investigation of the thoracic aorta in cholesterol embolism by transoesophageal echocardiography.

OBJECTIVES: To examine the thoracic aorta of patients with severe cholesterol embolism (CE) by transoesophageal echocardiography (TOE). METHODS: The thoracic aorta of 20 consecutive patients with CE was compared with that in a control population matched for age and risk factors by TOE. Patients were prescribed steroids after CE was diagnosed. Follow up is reported and compared with results in the literature. RESULTS: Aortic plaques and debris were more common in patients with CE than in the control population (p < 0.001 and p < 0.0001, respectively). The mean (SD) number of aortic plaques in the CE patients was 2.6 (0.7). This aortic atheroma was found predominantly in the descending aorta. One patient died during a mean (SD) follow up of 24 (10) months. CONCLUSIONS: Aortic atheroma, as detected by TOE, should be considered as the main source of CE. In addition, the prognosis in our series, in which steroids were systemically prescribed, is much better than in others reported in the literature.

[Spinal cord compression of sarcoidosis origin: a case]. / Compression médullaire d'origine sarcoïdosique: une observation.

This observation reports the case of a rapid paraparesia occurring in a young man. Imaging disclosed a spina tumor. Diagnosis of sarcoidosis leads us to suspect a specific spinal granuloma involvement and to start corticosteroid pulses. Clinical and radiological symptoms improved dramatically.

Two cases of localized B-cell lymphoma in the acquired immunodeficiency syndrome.

We report 2 cases of localized B-cell non-Hodgkin lymphoma occurring on the face in AIDS patients. The tumors were limited to the skin and bone, without other involvement. They were characterized by an aggressive local behavior that caused infectious and compressive complications and resulted in fatal outcome. Knowledge of the possibility that lymphoma may remain localized in AIDS patients should prompt clinicians to perform a biopsy as soon as possible, regardless of the CD4 count. Indeed, early diagnosis might increase the efficacity of treatment and might avoid disastrous local complications.

[Edwardsellia tarda septicemia in chronic lymphoid leukemia]. / Septicémie à Edwardsellia tarda au cours d'une leucemie lymphoïde chronique.

Edwardsiella tarda is a Gram negative bacilli. At least 300 cases have been reported in the literature. Here we report a new case of Edwardsiella tarda septicemia in an immunocompromised patient with chronic lymphocytic leukemia. Chief infections associated with this bacterium include bacterial gastroenteritis and septicemia with fatal evolution in 50% of cases. Risk factors associated with Edwardsiella tarda infections include exposure to aquatic environments and exotic animals. Although studies indicate that this bacterium is susceptible to most commonly prescribed antibiotics, it is interesting to note that in our case, Edwardsiella tarda was resistant to numerous beta-lactamins.

[A nidulans bronchial aspergillosis after treatment of low-grade lymphoma with fludarabine]. / Aspergillose bronchique à A nidulans après traitement par fludarabine d'un lymphome de bas grade.

Pulmonary aspergillosis is a common complication in neutropenic patients. The most important fungus is Aspergillus fumigatus. We report a case of invasive pulmonary aspergillosis due to Aspergillus nidulans secondary to fludarabine therapy. There are few cases of pulmonary aspergillosis due to Aspergillus nidulans (one chronic necrotizing pulmonary aspergillosis, one aspergilloma). Fludarabine induces a marked decreased of CD4 lymphocyte count responsible for opportunistic infections. It is the first case of aspergillosis after fludarabine therapy and the occurrence of such infection must be considered after purine analog therapy.