[Treatment of hairy cell leukemia with cladribine]. / Lijecenje leukemije vlasastih stanica kladribinom.

Hairy cell leukemia is a chronic B-cell lymphoproliferative disorder characterized by clonal proliferation of hairy cells. Treatments of choice are purine analogues, particularly cladribine. We treated thirty patients with cladribine either by continuous 7-day infusion at a daily dose of 0.1 mg/kg or by 2-h infusion for 5 consecutive days at a daily dose of 0.14 mg/kg. Remission was achieved in 90% of the patients. After a median follow-up of 44 months overall survival is 93% and time to treatment failure more than 6 years. Two patients did not respond, one patient died of infection shortly after the treatment. Side-effects resulted mainly from hematological toxicity, 23% of the patients had neutropenic fever while 20% required platelets or packed red cell transfusions. Our results show that cladribine is safe and effective in the treatment of hairy cell leukemia. There were no significant differences in toxicity and response between 7-day continuous infusion and 5-day intermittent infusions of the drug.

Successful reversal of anticoagulant effect of superwarfarin poisoning with recombinant activated factor VII.

The use of second-generation anticoagulants termed "superwarfarins" as rodenticides, although widespread, is poorly controlled. Products containing superwarfarin have been marketed in over-the-counter rodenticides and can be easily purchased. Poor control potentiates the risk of accidental or intentional poisoning, but clinicians may underestimate the incidence of superwarfarin toxicity. Therefore, when cases of unexplained acquired coagulopathy and selective deficiency of vitamin K-dependent clotting factors occur in patients in the absence of liver disease or inhibitors, physicians should consider the possibility of superwarfarin poisoning as a cause. According to our own experience, recombinant activated factor VII (NovoSeven; Novo Nordisk, Bagsvaerd, Denmark) appears to be a safe and effective therapy for acute bleeding caused by superwarfarin poisoning. Due to the extended half-life of the second-generation rodenticides, follow-up therapy with oral vitamin K1 should be of long-term duration.

[Rituximab in the treatment of indolent non-Hodgkin's lymphoma]. / Rituksimab u lijecenju indolentnih nehodgkinovih limfoma.

Indolent Non-Hodgkin's lymphomas (NHL) are a group of slowly progressive immune system malignancies that cannot be cured with conventional treatment. Rituximab is an anti-CD20 monoclonal antibody that has recently become a part of the standard treatment of B-cell lymphoid malignancies. Here we present our experience in 25 patients with indolent NHL treated with rituximab with or without chemotherapy. Rituximab was administered at 3-4 week intervals in the standard dose of 375 mg/m2. 88% of the patients responded, 16 achieved a complete and 6 partial remission. Estimated 2-year actuarial survival is 63%. Response and survival rates were significantly better in patients with favorable prognosis (lower IPI score). Adverse effects related to rituximab occurred in 2 patients and were mild. Our results are completely comparable to previously reported studies and show that rituximab is effective and safe for the treatment of indolent B-cell NHL.

Combination of ifosfamide, methotrexate, and etoposide (IMVP) as a salvage therapy for relapsed and refractory aggressive non-Hodgkin lymphoma: retrospective study.

AIM: There are contradictory reports on the outcomes of IMVP (ifosfamide, methotrexate, and etoposide) treatment in patients with aggressive non-Hodgkin s lymphomas. Our aim was to evaluate retrospectively the results of this treatment in our institution. METHODS: Twenty eight patients with refractory or relapsed aggressive non-Hodgkin s lymphomas received IMVP between April 1997 and June 2001. Median follow-up of the survivors was 24 months. There were 15 women and 13 men, aged 15-68 years. Twelve patients were refractory to primary treatment. The number of previous treatment lines varied between one and five. The overall response rate to IMVP treatment was 39%, with 6 patients achieving complete and 5 partial response/remission. Eleven patients received a subsequent hematopoietic stem cell transplant after IMVP therapy. RESULTS: Median duration of the survival for all patients was 6 months, and the response duration for responders 6 months. Nine patients had grade 3 hematologic toxicity or higher, 5 developed significant infectious complications, and one developed the tumor lysis syndrome. There was one treatment-related death due to infection. The patients with a low or low-intermediate international prognostic index at the start of IMVP had a significantly better survival and progression-free survival rates than those with high or high-intermediate score. Seven patients with hematopoietic stem cell transplant were alive in December 2001. CONCLUSION: IMVP is an active regimen with acceptable level of toxicity in patients with relapsed or refractory aggressive non-Hodgkin s lymphoma. However, outcomes of this treatment are unsatisfactory and better treatment is still needed.

Surgical resection in the treatment of primary gastrointestinal non-Hodgkin's lymphoma: retrospective study.

AIM: To evaluate the role of surgical resection in the treatment of patients with primary gastrointestinal non-Hodgkin s lymphoma in our institution. METHOD: The retrospective study included 79 patients with a histologically confirmed primary gastrointestinal lymphoma, who were diagnosed and treated for the disease in the 1978-1997 period. According to the treatment modality, the patients were divided into surgically treated and surgically non-treated group. Data were analyzed with Fisher s exact test, long-rank test, and Kaplan-Meier method. RESULTS: The stomach was the primary site of non-Hodgkin s lymphoma in 45 (57%) patients, small intestine in 19 (24%), and colon in 9 (11%) patients. Six patients (8%) had multifocal disease. There were 56 (71%) patients with stages IE and IIE, and 23 (29%) with stages III and IV. Aggressive histology was found in 51 cases (65%), and low grade mucosa-associated lymphoid tissue (MALT) lymphoma in 28 (35%). Helicobacter pylori infection was registered in 20 out of 45 patients with gastric lymphoma. Twenty-six (33%) patients underwent surgical resection followed by chemotherapy, 47 (59%) were treated with chemotherapy alone, and 6 (8%) received antibiotics plus chemotherapy. Fifteen patients needed urgent surgical intervention. The overall response rate was 77%. Complete remission was achieved in 54 (68%) patients and partial remission in 7 (9%). Eighteen patients (23%) experienced progressive disease. A 10-year overall survival (OS) was 63% and event-free survival (EFS) was 52% for all patients. Patients with gastric lymphoma had better OS and EFS than patients with primary lymphoma at other sites (65% vs 42%, and 62 vs 28%, respectively) (p=0.005). A 10-year EFS rates were 58% and 52% for surgically treated and non-treated group, respectively. There was no significant difference between patients with resected and non-resected tumors (p=0.855). Patients with early-stage disease had significantly better OS and PFS than patients with advanced-stage disease (p=0.048). CONCLUSION: Primary gastrointestinal lymphoma can be successfully treated with chemotherapy alone but surgery remains an important therapeutic option for emergency problems. The main prognostic factors were primary tumor site and extent of the disease.