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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2010.05.021 Byline: Xiao Zhou (a), Shyam Teegala (a), Auris Huen (a), Yuan Ji (b), Luis Fayad (c), Fredrick B. Hagemeister (c), Gregory Gladish (c), Saroj Vadhan-Raj (a)(c) Keywords: Cancer; Lymphoma; Risk factor; Thrombosis Abstract: Cancer patients are at increased risk of venous thromboembolism; however, the incidence and risk factors for venous thromboembolism in lymphoma patients are not well defined. Author Affiliation: (a) Department of Sarcoma Medical Oncology, Section of Cytokines & Supportive Oncology, The University of Texas MD Anderson Cancer Center, Houston (b) Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston (c) Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston Article Note: (footnote) Funding: Clinical research funding., Conflict of Interest: The authors indicated no potential conflicts of interest., Authorship: Saroj Vadhan-Raj, the principal investigator, was responsible for conception and design, execution of the study, analysis and interpretation of the data, and drafting of the article. Xiao Zhou, Shyam Teegala, and Auris Huen assisted with the writing of the protocol and manuscript, coordinated the collection and the statistical analysis of the data and critical review of the article. Yuan Ji was responsible for the statistical analysis and the interpretation of the results. Luis Fayad and Fredrick B. Hagemeister provided the study participants and critically reviewed the article, and Gregory Gladish provided radiologic expertise and critically reviewed the article.

Background. Numerous treatment strategies have been tried with the aim of improving results for patients with intermediate-grade lymphomas (IGL) over those achieved with cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-BLEO), and numerous prognostic models have been developed to identify and separate risk groups. This study reports on a new protocol for Ann Arbor Stages II-IV IGL that consists of CHOP-Bleo alternated with a new regimen of cyclophosphamide, methotrexate, etoposide, and dexamethasone (CMED) and radiation therapy and demonstrates the usefulness of prognostic models for identifying risk groups and comparing treatment programs. Methods. One hundred seventy patients with Ann Arbor Stages II-IV IGL were treated with alternating cycles of CHOP-Bleo and CMED for a total of 12 cycles. Involved field radiation therapy was interspersed with courses of chemotherapy for patients with Stage 11 and Stage III disease. Results were analyzed and compared with those of the authors' previous study of CHOP-Bleo and radiation therapy using the Ann Arbor staging system, their earlier prognostic model, and the recently published International Index. Results. A complete remission occurred in 78% of the patients. The overall 5-year survival rate was 67%. Survival was better for patients with Ann Arbor Stage II disease (80%) than for those with Stage III or Stage IV (67% and 58%, respectively). High tumor burden, above-normal levels of serum lactic dehydrogenase, serum [beta]2-microglobulin, and Ann Arbor Stage IV disease were adverse factors. The International Index and the authors' earlier prognostic model separated four prognostic groups. CHOP-Bleo/CMED was generally well tolerated. Neutropenic fever was the major complication that occurred in 25 patients during treatment. Six of these patients died of sepsis. Conclusions. This study demonstrated that CHOP-Bleo/CMED is a well-tolerated regimen that produced better results than those reported for a former study that used CHOP-Bleo alone. Further, results for CHOP-Bleo/ CMED compared favorably with those of other second- and third-generation regimens. The study also validated the usefulness of prognostic models and, in particular, the new International Index for identifying risk groups. Cancer 1994; 73:2408-16.

Beta-2 microglobulin (B-2M) is a protein that is found on the surface of most cells in the body. Levels of B-2M can be measured in the blood, and have been found to be increased in patients with many cancers. High levels of B-2M have been associated with poor survival rates in multiple myeloma, a cancer of the bone marrow, and in very aggressive lymphomas. A group of 80 patients with low-grade lymphoma were studied to determine if levels of B-2M were also related to their prognosis. High levels of B-2M were found in patients who experienced the greatest number of treatment failures and who had the shortest time to relapse. Blood levels of the enzyme lactic dehydrogenase (LDH) have previously been shown to correlate to severity of disease in lymphoma; this study found that LDH levels corresponded to B-2M levels. Determining levels of B-2M and LDH in low-grade lymphoma patients should prove to be predictive of response to treatment and time to treatment failure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diffuse large cell lymphoma (DLCL) is a cancer of the lymphatic system. The burden or size of the tumor in DLCL influences survival from this disease. Among 147 patients with early DLCL, treated between 1974 and 1984, 10-year survival was 54 percent for 85 patients with 'bulky' disease or a large tumor burden, and 76 percent for 62 patients without bulky disease. Fourteen of the patients without bulky disease had greater than 80 percent of their tumor removed by surgery in a procedure referred to as surgical debulking. The surgically treated patients without a large tumor burden were compared with 14 patients with bulky disease, who had similar physical and disease characteristics. Patients in both groups received the anticancer agents cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin, as well as radiation treatment. At 7-year follow-up, the survival rate was 93 percent in the patients who underwent surgical debulking, and 35 percent among the patients with bulky disease who did not have surgery. Surgical debulking was also associated with a decrease in levels of the enzyme lactate dehydrogenase, which indicated a better prognosis. These findings suggest that surgical debulking is effective in improving DLCL survival in patients without bulky disease. The role of surgical debulking in treatment of bulky DLCL requires further investigation; the frequency and safety of this procedure must be explored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hodgkin's disease is much more commonly found in the upper torso than in the lower torso. Due to the relative paucity of information, it is difficult to reliably estimate survival rates for patients with lower torso disease; it is also difficult to evaluate the effectiveness of treatment without sufficient data for comparison. To review the treatment of Hodgkin's disease in the lower torso, the case histories of 60 patients, diagnosed between 1956 and 1987, were examined. All patients received radiotherapy; some received adjuvant chemotherapy consisting of mechlorethamine (also called Mustargen), vincristine, procarbazine, and prednisone (abbreviated the MOPP protocol). The overall 10-year survival rate for these patients was 90 percent. Among patients receiving only radiation, those with inguinal/femoral or pelvic disease fared better than those with abdominal lymphomas; the overall 10-year survival was 90 and 66 percent for patients with pelvic and abdominal disease, respectively. However, the addition of the MOPP to the radiotherapy of the patients with abdominal disease produced a striking improvement in the outcome. Of 14 patients with abdominal lymphomas treated with radiation and MOPP, 100 percent are alive and 92 percent are free from progression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fredrick B. Hagemeister, MD Professor of Medicine The University of Texas M.D. Anderson Cancer Center Houston, Texas Abstract Despite significant improvements in the treatment of Hodgkin's lymphoma over the past [...]