David S. Rosenthal

Improved prognosis of diffuse histiocytic and undifferentiated lymphoma by use of high dose methotrexate alternating with standard agents (M- BACOD)

A new combination chemotherapy program (M-BACOD) was administered to 101 patients with advanced diffuse histiocytic and diffuse undifferentiated lymphoma (DHL and DUL). High dose methotrexate (M) 3 g/m2 with leucovorin factor rescue was given on day 14 between cycles of bleomycin (B), adriamycin (A), cyclophosphamide (C), oncovin (O), and dexamethasone (D) administered every 3 weeks for 10 cycles. The complete remission rate (CR) was 72% in all 101 patients or 77% in 95 evaluable patients. The median follow-up is 3 yr 2 mo with one-third of CR patients followed beyond 4 yr. Twenty-six percent of CR patients have relapsed with a projected 5-yr survival rate of 80% (5-yr disease-free rate 65%). The overall survival of all 101 study patients reaches a plateau at 59% projected out to 5 yr. Patients with prior therapy had a significantly lower CR rate than those without prior treatment (p = 0.001); however, no other unfavorable prognostic characteristics could be identified. Relapse in the central nervous system CNS occurred in only 5.4% of CR patients. M-BACOD results in prolonged survival and possible cure in a high proportion of all patients with DHL and DUL.

CNS involvement in the non‐hodgkin's lymphomas

Instances of central nervous system (CNS) lymphomatous involvement occurring amongst 592 cases of non‐Hodgkins lymphoma (NHL) seen between 1967 and 1977 were reviewed. Lymphomatous complications of the CNS were found in 52 patients (9%): 24 with meningeal lymphoma, 20 with epidural compression and 8 with intracerebral lymphoma. Intracerebral lymphoma presented clinically as large parenchymal deposits of tumor unrelated to leptomeningeal disease. Ninety‐eight percent (50/52) of all patients had a diffuse histologic subtype and 82% (42/52) had either histiocytic or diffuse, poorly differentiated lymphocytic lymphoma. Bone marrow involvement was an additional determinant of risk and aided in the selection of patients for possible CNS prophylaxis. Either meningeal or intracerebral lymphoma developed in 35% (6/17) of patients with diffuse histiocytic lymphoma and positive bone marrow biopsies. This subgroup was particularly felt to warrant CNS prophylaxis. Further diagnostic and therapeutic management regarding CNS involvement in NHL is discussed.

Identification of Major Prognostic Subgroups of Patients with Large-Cell Lymphoma Treated with m-BACOD or M-BACOD

One hundred twenty-one patients with diffuse large-cell lymphoma treated with m- or M-BACOD (methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone) were evaluated for pretreatment characteristics predictive for response and survival. Two characteristics, poor performance status and massive bulky disease, were negatively associated with response rate in a multivariate analysis. These two characteristics were also negatively associated with survival in multivariate analysis, as was another factor, an increased number of extranodal sites of disease. These three pretreatment characteristics were used to construct a model containing 12 categories of patients at increasing risk for relapse and shortened survival. These categories divided naturally into three broad groups of patients with respective 5-year survival rates of 68%, 55%, and 24%.

Treatment of acute myelogenous leukemia in children and adults

We designed a protocol to address the problem of relapse from complete remission in acute myelogenous leukemia. Patients in remission were treated for 14 months; early and later intensification of chemotherapy, sequential drug combinations, and high-dose continuous infusions of cytarabine were included. Eighty-three consecutive patients under 50 years of age were entered into this study from February 1976 to October 1979. The rate of complete remission is 70 per cent. A Kaplan-Meier analysis predicts that 49 +/- 17 per cent of patients (mean +/- 2 S.D.) who entered complete remission will remain free of disease at two years. Durations of complete remission for patients in the 0 to 17-year and 18 to 50-year age groups are comparable.

The National Cancer Data Base report on prostate carcinoma after the peak in incidence rates in the U. S.

Prostate carcinoma incidence has been declining since 1992 after a period of marked increase. Recent data from the National Cancer Data Base (NCDB) were examined to assess changes in prostate carcinoma patient characteristics and disease and treatment patterns coincidental to this decline. The NCDB is a program of the American College of Surgeons Commission on Cancer and the American Cancer Society that collects timely data from institutions representing every level of cancer care.

Cyclophosphamide, carmustine, and etoposide with autologous bone marrow transplantation in refractory Hodgkin's disease and non-Hodgkin's lymphoma: a dose-finding study.

Cyclophosphamide, carmustine (BCNU), and etoposide (VP-16) (CBV) is a widely used conditioning regimen in autologous bone marrow transplantation (ABMT) of patients with refractory and relapsed lymphoma. However, the maximum-tolerated dose (MTD) of these agents when used in combination has not been systematically explored. We treated 58 patients (28 with non-Hodgkins lymphoma [NHL], 30 with Hodgkins disease [HD]) at seven dose levels of CBV. Doses were cyclophosphamide 4,500 to 7,200 mg/m2, BCNU 450 to 600 g/m2, and VP-16 1,200 to 2,000 mg/m2. The MTD was cyclophosphamide 7,200 mg/m2, BCNU 450 mg/m2, and VP-16 2,000 mg/m2. Six hundred milligrams per square meter of BCNU was associated with five of 18 cases of interstitial pneumonitis versus two of 40 at 450 mg/m2 (P = .02). Treatment-related mortality was 5% at dose levels less than or equal to the MTD and 22% at the highest dose. In this heavily pretreated patient population, most of whom had high volume residual disease, complete responses (CRs) to CBV and ABMT occurred in 25% of assessable patients with NHL and 43% of patients with HD. Thirteen of 28 patients with NHL and 14 of 30 with HD remain free from disease progression with median follow-up of 212 and 215 days, respectively. CBV can be administered with acceptable toxicity over a wide range of doses to patients with refractory and relapsed lymphoma.

Mucosal melanoma of the nose and paranasal sinuses, a contemporary experience from the M. D. Anderson cancer center

Sinonasal mucosal melanoma is a rare disease associated with a very poor prognosis. Because most of the series extend retrospectively several decades, we sought to determine prognostic factors and outcomes with recent treatment modalities.

Impact of Medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial

Background: Substantial numbers of cancer patients use complementary medicine therapies, even without a supportive evidence base. This study aimed to evaluate in a randomized controlled trial, the use of Medical Qigong (MQ) compared with usual care to improve the quality of life (QOL) of cancer patients. Patients and methods: One hundred and sixty-two patients with a range of cancers were recruited. QOL and fatigue were measured by Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Fatigue, respectively, and mood status by Profile of Mood State. The inflammatory marker serum C-reactive protein (CRP) was monitored serially. Results: Regression analysis indicated that the MQ group significantly improved overall QOL (t144 = −5.761, P < 0.001), fatigue (t153 = −5.621, P < 0.001), mood disturbance (t122 =2.346, P = 0.021) and inflammation (CRP) (t99 = 2.042, P < 0.044) compared with usual care after controlling for baseline variables. Conclusions: This study indicates that MQ can improve cancer patients’ overall QOL and mood status and reduce specific side-effects of treatment. It may also produce physical benefits in the long term through reduced inflammation.

Effect of medical Qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: A randomized controlled trial

PurposeCancer patients often experience diminished cognitive function (CF) and quality of life (QOL) due to the side effects of treatment and the disease symptoms. This study evaluates the effects of medical Qigong (MQ; combination of gentle exercise and meditation) on CF, QOL, and inflammation in cancer patients.MethodsEighty-one cancer patients recruited between October 2007 and May 2008 were randomly assigned to two groups: a control group (n = 44) who received the usual health care and an intervention group (n = 37) who participated in a 10-week MQ program. Self-reported CF was measured by the European Organization for Research and Treatment of Cancer (EORTC-CF) and the Functional Assessment of Cancer Therapy—Cognitive (FACT-Cog). The Functional Assessment of Cancer Therapy—General (FACT-G) was used to measure QOL. C-reactive protein (CRP) was assessed as a biomarker of inflammation.ResultsThe MQ group self-reported significantly improved CF (mean difference (MD) = 7.78, t51 = −2.532, p = 0.014) in the EORTC-CF and all the FACT-Cog subscales [perceived cognitive impairment (MD = 4.70, t43 = −2.254, p = 0.029), impact of perceived cognitive impairment on QOL (MD = 1.64, t45 = −2.377, p = 0.024), and perceived cognitive abilities (MD = 3.61, t45 = −2.229, p = 0.031)] compared to controls. The MQ group also reported significantly improved QOL (MD = 12.66, t45 = −5.715, p < 0.001) and had reduced CRP levels (MD = −0.72, t45 = 2.092, p = 0.042) compared to controls.ConclusionsResults suggest that MQ benefits cancer patients’ self-reported CF, QOL, and inflammation. A larger randomized controlled trial including an objective assessment of CF is planned.

Pulmonary complications associated with combination chemotherapy programs containing bleomycin

Abstract The risk of drug-induced lung complications may be greater in patients receiving bleomycin as a component of combination chemotherapy regimens compared with those receiving bleomycin alone. To determine the incidence and types of complications, a review of patients receiving bleomycin as a part of two treatment protocols was undertaken. In 18 percent of patients (15 of 83) undergoing the M-BACOD (methotrexate, bleomycin, Adriamycin, cyclophosphamide, Oncovin, and dexamethasone) program for non-Hodgkins lymphomas receiving minimal doses of bleomycin (median total dose 36 units), significant symptoms developed from an acute pulmonary reaction that was completely reversible both clinically and radiographically in all but two patients. The rate of pulmonary complications associated with this program was substantially higher than expected among patients receiving singleagent bleomycin in comparable total doses. This suggests that interactions with other antineoplastic agents may potentiate its toxicity. A younger patient population undergoing the VBP (vinblastine, bleomycin, cisplatinum) regimen (total bleomycin dose 360 units) for male germ cell neoplasms had a 6.3 percent incidence (five of 79) of symptomatic pulmonary complications. An additional 7.6 percent of these patients (six of 79) were asymptomatic in the presence of radiographic changes consistent with bleomycin toxicity. In contrast to patients receiving the M-BACOD program, residual fibrosis on chest x-ray was common among patients surviving at least six months after VBP therapy (seven of eight). An acute respiratory distress syndrome occurred in two patients who received VBP and then underwent tumor-reductive surgery. Careful monitoring of inspired oxygen concentration and fluid replacement during surgery is required to minimize such complications in this patient population.