Search

Background: Infections are major complications in chronic lymphoproliferative disorders, among them indolent non-Hodgkin's lymphoma (iNHL) including chronic lymphocytic leukemia, follicular lymphoma and multiple myeloma.We report on a retrospective cohort analysis of outpatients with indolent non-Hodgkin's lymphoma who were treated in an oncology / hematology group practice and received intravenous polyvalent immunoglobulin G (IVIG) as supportive care. The aim was to describe the treated iNHL population, the course of therapy and the effects of IVIG administrations on the levels of immunoglobulin G (IgG), the incidence of infections and the survival time., Patients and Method: 57 patients with secondary iNHL antibody deficiencies (n = 46) or IgG subclass deficiencies (n = 11) who received IVIG substitution were included. Patients received median 11 IVIG doses with a mean dose of 28 g over a period of median 9.5 months., Results: Mean IgG levels increased with IVIG substitution at about twice and then remained within the normal range. The incidence of infections decreased in 46 % of treated patients. Effects on survival could not be observed. Median overall survival was in the group of substituted patients 124 months (range 7-124), the control group had a median survival time of 96 months (range 3-129) (p = 0.537)., Conclusion: IgG levels should be reviewed during IVIG substitution on a regular basis and dosage and intervals should be adjusted individually., (© Georg Thieme Verlag KG Stuttgart · New York.)

Malignant lymphomas are differentiated clinically, morphologically and molecular-biologically, into aggressive (formerly high-grade malignant) and indolent (formerly low-grade malignant) lymphomas. In the meantime, virtually all patients can be diagnosed and treated on an ambulatory basis. The introduction of the monoclonal antibody rituximab (R) in combination with chemotherapeutic agents, has led to the development of highly potent forms of chemoimmunotherapy. In the case of aggressive lymphomas, R-CHOP has been shown to be significantly superior to CHOP alone, both in elderly and younger patients. In stage III and IV indolent (follicular) lymphomas, rituximab/chemotherapy combinations achieve response rates in excess of 90%, and prolonged progression-free survival rates which, for the first time hold out hope of a cure. Monoclonal antibodies that can be coupled to radioisotopes open up new possibilities for potent radioimmunotherapy which look promising for effecting a cure or long-lasting palliation in additional proportion of the patients.

History and Clinical Findings: A 39-year-old woman with a history of slowly progressive muscular dystrophia was transferred to us for further evaluations of a hypochromic, microcytic anaemia. The patient complained about progressive muscle weakness, loss of appetite and constipation, sleep disorders as well as muscle and back pain. Clinical examination revealed a tetraparesis without any detectable muscle reflexes and atrophic muscles of the extremities. A bilateral radial paresis was found with a loss of power., Investigations: She presented with a hypochromic, microcytic anaemia with a haemoglobin of 7.9 g/dl. Re-evaluation of her peripheral blood smear showed basophilic stippling of the erythrocytes. Bone marrow biopsy revealed a marked dyserythropoiesis with 50% ring sideroblasts. After the examination of the bone marrow, the blood lead level was found to be grossly elevated up to 880 microg/l., Diagnosis: Re-evaluation of the patient's history revealed that she had been to India for an Ayurvedic treatment approach to improve her muscle dystrophia. She had taken regularly 4 different natural plant pills which she had bought in an Ayurvedic health centre. Toxicologic analysis of these pills revealed one to have a lead concentration of 50.4 mg/g., Treatment and Course: The patient was treated with 16 infusions of sodium-EDTA followed by a 4-week treatment with dimercaptopropionic acid orally. Her neurological condition improved and the radial paresis resolved gradually so that she could return to work. Her haematological parameters normalized., Conclusion: This case report underscores the importance, while asking patients for their drug history, to ask additionally if natural plant medicine is taken or applied regularly. The report reveals that Ayurvedic pills from India may have a high concentration of lead and may cause severe poisoning.

Background: Premedication with dexamethasone, ranitidine and clemastine is mandatory for patients receiving paclitaxel to avoid hypersensitivity reactions. The proposed dexamethasone dose is 20 mg orally 12 and 6 h prior to paclitaxel infusion. With this premedication severe hypersensitivity reactions are reduced to 1-2% of the treated patients. Besides this oral schedule a single dose of dexamethasone, 40 mg given i.v., just prior to paclitaxel has been shown to be equally effective. In an attempt to reduce steroid-induced side effects, especially for patients receiving weekly paclitaxel protocols, we reduced the dexamethasone dose., Patients and Methods: A total of 132 patients were treated on an outpatient basis with paclitaxel-containing protocols. Paclitaxel was given in doses of 135-175 mg/m(2) once every 3 weeks in 76 patients and/or with 100 mg/m(2) weekly in 70 patients. Dexamethasone premedication was given in a single dose (40, 20, 10 mg) as an infusion directly before paclitaxel., Results: 0/46 patients receiving 40 mg dexamethasone premedication in 235 cycles and 0/48 patients receiving 20 mg dexamethasone premedication in 186 cycles experienced a severe hypersensitivity reaction. 1/52 patients receiving 10 mg dexamethasone in 480 applications developed a severe hypersensitivity reaction with bronchospasm, hypotension and supraventricular tachycardia shortly after her first paclitaxel infusion started., Conclusion: No increase of severe hypersensitivity reactions is seen when dexamethasone premedication is reduced to doses of 20 or even 10 mg prior to paclitaxel infusion., (Copyright 2001 S. Karger GmbH, Freiburg)

Abdominal sonography is now the most frequently used screening method for the detection of abdominal lymph node enlargement. For proper classification, size, localisation and infiltration pattern must be known. The definitive determination whether lymph nodes are benign or malignant cannot be made by the size of the lesion alone. The localisation (parietal/visceral) of enlarged lymph nodes has been shown to be of significance in the staging of abdominal carcinomas. Different infiltration patterns (diffuse small nodular, focal small nodular, focal large nodular, bulky formations) show the broad spectrum of abdominal lymphomas detected by ultrasound. Knowledge of these different infiltration patterns together with clinical information often helps to discriminate between lymph node enlargement caused by inflammation, metastasis, or malignant lymphoma. The definitive diagnosis is made via laparotomy, ultrasound guided biopsy or sonographic follow-up studies.

Unlabelled: Between 1980 and 1993, 680 patients with malignant lymphoma were referred for abdominal sonography as a part of staging. In 67 (9.8%) individuals with non-Hodgkin's lymphoma (NHL) sonography showed different degrees of lesions of the spleen. Splenic involvement was confirmed by histological examination (n = 5) and by clinical (n = 67) and sonographic follow-up examination (n = 56). 38 patients had low-grade (lg NHL), and 29 had high-grade non-Hodgkin's lymphoma (hg NHL). Four different sonographic patterns were found: diffuse infiltration (n = 20; 29.9%), small nodular lesions (n = 25; 37.3%), large nodular lesions (n = 20; 29.9%), and "bulky" disease (n = 2; 2.9%). All hg NHL exhibited focal lesions, which were large nodular in 15 out of 29 patients. In lg NHL small nodular and diffuse destruction of the splenic tissue texture were seen in 35 out of 38., Conclusion: Different texture patterns of the spleen can be found in patients with non-Hodgkin's lymphoma and splenic involvement with different lymphomas tending to exhibit different echomorphological infiltration patterns.

The abdominal sonograms of 680 patients with malignant non-Hodgkin's lymphomas (NHL) and Hodgkin's lymphomas (HD) were reviewed. An involvement in the spleen (n = 101), liver (n = 47), gastrointestinal tract (n = 70), kidney (n = 17), and various other organs (n = 19) could be demonstrated on ultrasound. Lesions were confirmed by histology (n = 117), sonographic (n = 141) and clinical follow-up. The different sonographic features of lymphomatous infiltrates in different extranodal sites are described, and possible correlations between lymphoma subtypes and sonographic texture characteristics are discussed. In cases with splenic and liver involvement, lymphoma subtypes had different patterns. A predominantly diffuse or small nodular infiltration was found in NHL of low-grade malignancy, and large nodular lesions were found to be more typical in high-grade NHL. The ultrasound findings basically do not allow a specific diagnosis and even may resemble a variety of malignant and non-malignant diseases other than lymphomas.

Between 1980 and 1993, 680 patients with malignant lymphoma were referred for abdominal sonography as a part of initial staging. In 53 patients intrahepatic abnormalities suspected for lymphoma involvement were detected. 6 of these had metastases of lung cancer (n = 4) or microabscesses (n = 2). Sonographic findings of 47 patients with hepatic lymphoma were reviewed. Hepatic lymphoma was confirmed by histologic examination (n = 23) and sonographic/clinical follow-up (n = 24). 12 patients had Hodgkin's disease, 18 high-grade NHL, and 17 low-grade NHL. Lesions were hypoechoic in all cases. Five different sonographic patterns were found: small nodular lesions (n = 28; 60%), large nodular lesions (n = 14; 30%), bulky disease (n = 2; 4%) and diffuse involvement (n = 2; 4%). One patient (2%) had lymphomatous involvement which surrounded the portal vessels. High-grade NHL preferred patterns of large nodular or bulky diseases (9 of 17 patients). Small lesions were found to be more typical in low-grade NHL (13 of 18 patients), and Hodgkin's disease (9 of 12 patients).