Edgar M. Moran

Malignant lymphoma arising in angio-immunoblastic lymphadenopathy

This study is based upon 48 patients with angio‐immunoblastic lymphadenopathy and 36 patients whose lymph nodes revealed, in addition to angio‐immunoblastic lymphadenopathy (AILD), histologic features interpreted as malignant lymphoma of the immunoblastic type in the diagnostic biopsy. Progression into immunoblastic lymphoma (IL) was observed in 35%, or eight, of the 23 patients with AILD in whom follow‐up biopsies or autopsy were performed. Multiple clusters or islands of compactly arranged large lymphoid cells constituted the initial histologic evidence of IL. Subsequent tissue examination revealed progression of the disease in the form of diffuse replacement of lymph nodes by the neoplastic cellular proliferation. No significant differences in the past history, clinical or laboratory findings were observed between the patients with AILD and those whose lymph node biopsies were interpreted as AILD + IL. These two groups differed greatly, however, with respect to rate of complete remission following either prednisone or chemotherapy, or both (63% for AILD vs. 26% for AILD + IL; p = 0.01); median survival (35 months for AILD vs. six months for AILD + IL; p = 0.0004); incidence of malignant lymphoma at autopsy (20% for AILD vs. 82% for AILD + IL; p < 0.005); and the finding of extranodal malignant lymphoma at autopsy (10% in AILD vs. 64% in AILD + IL; p < 0.025). In the AILD group, median survival of patients who had complete remission after prednisone was significantly longer than that of patients who had partial or no remissions (p = 0.02) and the same was true for patients who were given chemotherapy (p < 0.003). In the AILD + IL group, a similar difference in the median survival was observed in patients treated with chemotherapy (p < 0.007), but not in those treated with prednisone (p = 0.31).

Angioimmunoblastic lymphadenopathy long‐term follow‐up study

The clinical course of 41 previously reported patients with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) on whom follow‐up information has been obtained for five or more years is described. Of the 41 patients, 27 achieved a complete remission (CR). The durations of the CR ranged from two to 214 months, with a median of 48 months. Nine of these 27 complete responders are still alive and well without evidence of disease, whereas the remaining 18 patients have died of pneumonia, septicemia, immunoblastic lymphoma, or unrelated causes. These 27 patients had a significantly longer median survival (51 mos) than did the 14 patients who had partial or no response (9 mos) (P = 0.0006). Only two of these 14 patients who did not initially achieve a CR are alive (survivals, 66 months and 70 months). There was a trend suggesting that patients who received combination chemotherapy which included prednisone had a slightly longer survival than did the remaining patients (P = 0.087). Lymphocytopenia was evident in a higher proportion of dead patients than in those who remained alive (P = 0.089). Cancer 52:318‐321, 1983.

Bone marrow involvement in non-Hodgkin's lymphoma. Implications for staging and therapy

We evaluated the incidence of bone marrow involvement in 121 patients with non‐Hodgkins lymphoma who were seen prior to the institution of definitive therapy. Involvement of the marrow was found to be dependent on both histologic type and the extent of extramedullary disease. It was observed most frequently in patients with poorly differentiated lymphocytic lymphoma (60%), but was not observed in 36 patients of all histologic types whose clinical evaluation and/or laparotomy revealed disease in stage I or II. Among 56 patients with poorly differentiated lymphocytic lymphoma in stage III or IV exclusive of marrow involvement, disease was observed in the marrow in 40 patients, or 71%. These observations, together with the results of previously reported therapeutic trials, suggest that staging laparotomy and total nodal radiotherapy alone may be of limited value in patients with poorly differentiated lymphocytic lymphoma when clinical evidence of stage III or IV disease is present.

Non-hodgkin's lymphoma, poorly differentiated lymphocytic and mixed cell types. Results of sequential staging procedures, response to therapy, and survival of 100 patients

The results of sequential staging procedures including laparotomy, radiotherapy, and combination chemotherapy are reported for 100 patients with poorly differentiated lymphocytic (PDL) and mixed cell (MC) non‐Hodgkins lymphoma (NHL). Twelve patients were found to have localized disease, pathologic stage (PS) I or II; 88 patients had PS III or IV disease. Bone marrow biopsy showed a high incidence of involvement and advanced 34% of the patients from CS I, II, and III to PS IV. Staging laparotomy has a very limited role in the evaluation of these patients. All of 12 patients with PS I and II NHL were treated with radiotherapy; at 5 years, they had 100% survival, 80% being disease‐free. Fifteen patients with PS III disease were treated with total nodal radiotherapy (TNRT) alone and had a median disease‐free survival of 41 months. The remaining patients with PS III and IV disease were treated with chemotherapy consisting of vincristine and prednisone (V & P); cyclophosphamide, vincristine (Oncovin®), procarbazine, and prednisorte (COPP); cyclophosphamide, vincristine (Oncovin®), adriamycin, and prednisone (COPA); or “palliative therapy”, consisting of chlorambucil and prednisone. Two‐year and 4‐year survivals for patients with diffuse lymphoma were 93% and 60%, respectively; for patients with +2 nodular lymphoma, 80% and 30%; for patients with nodular lymphomas, 76–93% and 50%, respectively. Treatment with COPP showed no advantage over V and P, “palliative therapy,” or TNRT for patients with +2 nodular and nodular disease. The likelihood of cure appears most promising for patients in complete remission (CR) with diffuse lymphoma; patients in CR with nodular lymphoma show a high rate of relapse over 5 years of observation. We conclude that staging laparotomy in PDL and MC NHL is of limited value, and that the role of aggressive chemotherapy for patients with +2 nodular and nodular lymphoma needs to be redefined.

A new method for treating carcinomatous biliary obstruction with intracatheter radium

We describe a new method for relieving biliary obstruction due to malignant solid tumors. The method consists of placement of radium needles in a Ring biliary drainage catheter for three days. After removing the radium needles, the catheter is left in place to allow for repair of irradiated tissues, then it is removed. The object is to leave the patient with a patent biliary tree without a biliary drainage prosthesis. The clinical course of six patients treated by this method is described, and the autopsy findings in three cases are outlined. Three patients died with a serum total bilirubin ranging from 1–4.5 mg/100 ml, two to three months after removing the drainage catheter. Two patients died before the bile drainage catheter could be removed. One patient is alive with a bile drainage catheter in place. Possible modifications in technique and catheters are being considered.

Quality of life after a diagnosis of prostate cancer among men of lower socioeconomic status: results from the Veterans Affairs Cancer of the Prostate Outcomes Study.

OBJECTIVES To evaluate prospectively the health-related and disease-specific quality of life (QOL) at diagnosis and during the first year thereafter for patients with newly diagnosed prostate cancer who received care at Veterans Affairs Medical Centers. METHODS Interviewers administered the European Organization for Research and Treatment of Cancer-QOL Questionnaire, a valid and reliable measure of health status, to 140 patients with prostate cancer at baseline (at diagnosis, before the initiation of treatment) and at 3 and 12 months thereafter at five Veterans Affairs Medical Centers. The mean changes from baseline values were analyzed statistically for patients with localized disease stratified by treatment group and separately for patients with metastatic disease. RESULTS Among the 98 men with localized prostate cancer, significant disease-specific QOL changes noted at 3 and 12 months included worsening of urinary and sexual function among men treated with radical prostatectomy or radiotherapy and worsening of urinary function among those who opted for watchful waiting (each P <0.05). Among the 42 men with metastatic prostate cancer, significant decrements in role and social and sexual function were noted at 3 months, but had resolved on average by 12 months of follow-up. CONCLUSIONS At 12 months, disease-specific QOL decrements persisted for patients with localized disease, but for patients with metastatic disease, disease-specific QOL appeared to return to near baseline (at diagnosis, before treatment initiation) function. Our study, among the first to assess the QOL at baseline before treatment, provides meaningful information on general treatment effects, which are directly relevant to clinicians when discussing treatment options with patients.

Angio-Immunoblastic (Immunoblastic) Lymphadenopathy

The clinical picture of generalized lymphadenopathy with or without hepatosplenomegaly may be seen in a variety of diseases. In such cases, if the clinical laboratory data are not diagnostic of a s...

Quality of life in low-income patients with metastatic prostate cancer: Divergent and convergent validity of three instruments

Few studies have evaluated Quality Of Life (QOL) among low-income patients with cancer. Information is needed about the feasibility and psychometric characteristics of QOL instruments in these populations. The purpose of this study was to examine the convergent and discriminant relationships between scales of three QOL instruments: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC), Functional Assessment of Cancer Therapy – General (FACT), and Quality of Life Index (QLI). Participants included 110 men with metastatic prostate cancer of whom 94% were low income and 62% were African-American. Interviewers administered the questionnaires. Cronbach α internal consistency reliabilities were 0.57 to 0.90 for the EORTC, 0.65 to 0.86 for the FACT, and 0.63 for the QLI. Convergent validity was supported for the EORTC and FACT scales measuring emotional, physical, and role/functional dimensions (r = 0.54 to 0.72), but not on scales measuring social function (r = 0.12). Divergent validity was supported between dissimilar scales (r = 0.14 to 0.38). Analysis with receiver operating characteristics curves provided empirical support for the EORTC and FACT as multidimensional measures. These findings suggest that, even in busy clinical settings with low literacy patients, interviewer-administered EORTC and FACT QOL instruments can provide valid and reliable information.

Malignant histiocytosis: Complete remission with combination chemotherapy

A case of a 16‐year‐old girl with malignant histiocytosis involving the lymph nodes, bone marrow, peripheral blood, liver, and spleen is described. This patient achieved a complete remission with cyclic quadruple chemotherapy consisting of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). She is alive and free of disease more than 4 years after the completion of COPP and after having had maintenance treatment with a small dose of cyclophosphamide for 2 3/4 years. Such good results with the COPP regimen in malignant histiocytosis have not been reported previously, and it is suggested that this modality of treatment warrants further trial.

Scintigraphic evaluation of lymphoma: a comparative study of 67Ga-citrate and 111In-Bleomycin.

Sequential whole-body scans with both 67Ga-citrate and 111In-bleomycin were performed for 14 patients undergoing staging for Hodgkins disease or other lymphomas. A comparison or these scans gave a sensitivity in detecting the pathologically-proved tumor sites of 84% for 67Ga-citrate and only 56% for 111In-bleomycin. In 12 patients, the gallium scan demonstrated the lesions more clearly; in the others, the uptake of the two radionuclides was equal. In no case was a clinically diagnosed or histologically proved lesion identified by 111In-bleomycin that was not also demonstrated by 67Ga-citrate. 111In-bleomycin does not complement the 67Ga-citrate scan in the scintigraphic evaluation of lymphomas.