Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides ...Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.展开更多
目的:研究非霍奇金淋巴瘤(non-hodgkin's lymphoma,NHL)中微小染色体维持蛋白2(Minichromosome maintenance protein 2,MCM2)与细胞间隙连接蛋白43(Connexin 43,Cx43)以及S期激酶相关蛋白2(S phase kinase-associated protein 2,Sk...目的:研究非霍奇金淋巴瘤(non-hodgkin's lymphoma,NHL)中微小染色体维持蛋白2(Minichromosome maintenance protein 2,MCM2)与细胞间隙连接蛋白43(Connexin 43,Cx43)以及S期激酶相关蛋白2(S phase kinase-associated protein 2,Skp2)在非霍奇金淋巴瘤中的表达及临床意义,以期为临床诊治非霍奇金淋巴瘤提供一定的参考。方法:选取2013年1月至2015年1月间入院诊治的非霍奇金淋巴瘤36例作为实验组,并选取同期入院诊治的淋巴结反应性增生18例作为对照组,应用免疫组化法检测MCM2、Cx43、Skp2的表达情况,同时分析MCM2、Cx43、Skp2的表达与非霍奇金淋巴瘤恶性程度、临床分期等的相关性。结果:实验组NHL患者MCM2阳性表达率为83.33%、Skp2阳性表达率为86.11%,显著高于对照组22.22%与27.78%的阳性表达率(P<0.01);NHL患者Cx43阳性表达率为22.22%,显著低于对照组61.11%阳性表达率(P<0.01)。NHL患者MCM2阳性表达与肿瘤恶性程度、临床分期及Ki67水平密切相关(P<0.05);NHL患者Cx43阳性表达与肿瘤恶性程度呈负相关(P<0.01);NHL患者Skp2阳性表达与肿瘤恶性程度及临床分期密切相关(P<0.05)。结论:MCM2、Cx43、Skp2的异常表达与非霍奇金淋巴瘤的恶性程度密切相关,联合检测MCM2、Cx43、Skp2可为非霍奇金淋巴瘤的诊治提供一定的参考。展开更多
文摘Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.
文摘目的:研究非霍奇金淋巴瘤(non-hodgkin's lymphoma,NHL)中微小染色体维持蛋白2(Minichromosome maintenance protein 2,MCM2)与细胞间隙连接蛋白43(Connexin 43,Cx43)以及S期激酶相关蛋白2(S phase kinase-associated protein 2,Skp2)在非霍奇金淋巴瘤中的表达及临床意义,以期为临床诊治非霍奇金淋巴瘤提供一定的参考。方法:选取2013年1月至2015年1月间入院诊治的非霍奇金淋巴瘤36例作为实验组,并选取同期入院诊治的淋巴结反应性增生18例作为对照组,应用免疫组化法检测MCM2、Cx43、Skp2的表达情况,同时分析MCM2、Cx43、Skp2的表达与非霍奇金淋巴瘤恶性程度、临床分期等的相关性。结果:实验组NHL患者MCM2阳性表达率为83.33%、Skp2阳性表达率为86.11%,显著高于对照组22.22%与27.78%的阳性表达率(P<0.01);NHL患者Cx43阳性表达率为22.22%,显著低于对照组61.11%阳性表达率(P<0.01)。NHL患者MCM2阳性表达与肿瘤恶性程度、临床分期及Ki67水平密切相关(P<0.05);NHL患者Cx43阳性表达与肿瘤恶性程度呈负相关(P<0.01);NHL患者Skp2阳性表达与肿瘤恶性程度及临床分期密切相关(P<0.05)。结论:MCM2、Cx43、Skp2的异常表达与非霍奇金淋巴瘤的恶性程度密切相关,联合检测MCM2、Cx43、Skp2可为非霍奇金淋巴瘤的诊治提供一定的参考。
