254 results on '"Hochberg, Fred H."'
Search Results
252. BCL-6 expression predicts improved survival in patients with primary central nervous system lymphoma.
- Author
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Braaten KM, Betensky RA, de Leval L, Okada Y, Hochberg FH, Louis DN, Harris NL, and Batchelor TT
- Subjects
- Adult, Aged, Aged, 80 and over, Algorithms, Cell Differentiation, Central Nervous System Neoplasms drug therapy, Central Nervous System Neoplasms genetics, Central Nervous System Neoplasms mortality, Cohort Studies, Cyclin-Dependent Kinase Inhibitor p16 biosynthesis, DNA-Binding Proteins genetics, Female, Humans, Hyaluronan Receptors biosynthesis, Immunohistochemistry, In Situ Hybridization, Fluorescence, Interferon Regulatory Factors, Lymphoma drug therapy, Lymphoma genetics, Lymphoma mortality, Male, Membrane Glycoproteins biosynthesis, Methotrexate therapeutic use, Middle Aged, Neprilysin biosynthesis, Polymerase Chain Reaction, Prognosis, Proteoglycans biosynthesis, Proto-Oncogene Proteins genetics, Proto-Oncogene Proteins c-bcl-2 biosynthesis, Proto-Oncogene Proteins c-bcl-6, Syndecan-1, Syndecans, Transcription Factors genetics, Treatment Outcome, Tumor Suppressor Protein p53 biosynthesis, Central Nervous System Neoplasms metabolism, DNA-Binding Proteins biosynthesis, Lymphoma metabolism, Proto-Oncogene Proteins biosynthesis, Transcription Factors biosynthesis
- Abstract
Purpose: The purpose of this study was to investigate the histogenetic origin of primary central nervous system lymphoma (PCNSL) with respect to stage of B-cell differentiation and to identify prognostic markers in a cohort of patients with PCNSL treated with i.v. high-dose methotrexate therapy., Experimental Design: This study included 33 patients with PCNSL treated with high-dose i.v. methotrexate at the Massachusetts General Hospital for whom archival tumor tissue was available. All 33 patients tested negative for HIV. The lymphomas were morphologically subclassified according to the Kiel system, as modified in the WHO classification. Immunohistochemistry for the following antigens was performed: BCL-6; BCL-2; MUM1; CD10; vs38c; CD138; CD44; p16; and p53. Fluorescence in situ hybridization and multiplex PCR for CDKN2A/p16 were also performed., Results: There were 17 women and 16 men enrolled, with a median age of 60 years. All tumors were diffuse large B-cell lymphomas. Of the 23 cases that could be subclassified, 22 were centroblastic, and 1 was immunoblastic. Twenty-six of 33 tumors were BCL-6+, 6 of 32 tumors were CD10+, 27 of 29 tumors were BCL-2+, 31 of 32 tumors were MUM1+, 11 of 31 tumors were CD44+, 4 of 33 tumors were vs38c+, and 0 of 32 tumors were CD138+. There were 18 of 32 (56%) complete responses and 8 of 32 (25%) partial responses to methotrexate, whereas 6 of 33 (18%) progressed during treatment. Ten patients died of disease. Expression of BCL-6 was significantly associated with longer overall survival (P = 0.002; median survival, 101 versus 14.7 months, with approximately 95% lower confidence limits of 41.7 and 8.8 months, respectively)., Conclusions: In this group of 33 patients with PCNSL, expression of BCL-6 was significantly associated with longer overall survival. BCL-6 warrants further investigation as a potentially important prognostic marker in this disease.
- Published
- 2003
253. A new approach to the diagnosis and treatment of intravascular lymphoma.
- Author
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Baehring JM, Longtine J, and Hochberg FH
- Subjects
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Brain Neoplasms diagnosis, Combined Modality Therapy, Cyclophosphamide therapeutic use, Diagnosis, Differential, Diffusion Magnetic Resonance Imaging, Doxorubicin therapeutic use, Female, Gene Rearrangement, Genes, Immunoglobulin, Humans, Lymphoma, Non-Hodgkin genetics, Male, Methotrexate administration & dosage, Middle Aged, Prednisone therapeutic use, Spinal Cord Neoplasms diagnosis, Vascular Neoplasms genetics, Vincristine therapeutic use, Lymphoma, Non-Hodgkin diagnosis, Lymphoma, Non-Hodgkin therapy, Vascular Neoplasms diagnosis, Vascular Neoplasms therapy
- Abstract
In intravascular lymphoma (IVL) tumor cells are initially restricted to vascular lumina. Neurological syndromes predominate and are caused by ischemia as well as tumor infiltration into the nervous system. Ante mortem diagnosis is challenging and frequently impossible. Chemotherapy is effective if started prior to ischemic damage. Over a three year period, we have diagnosed IVL in seven patients. Tissue diagnosis could be accomplished in only three cases. Forthose in whom tissue diagnosis failed we based our diagnosis on clinical presentation, typical magnetic resonance imaging findings, spinal fluid cytopathology, and molecular analyses. Six patients were treated with methotrexate chemotherapy alone or in combination with CHOP. Three patients are in complete remission 9-20 months after initial diagnosis. Another patient achieved a partial response. Two patients died due to progressive disease shortly after initiation of treatment. Grade III toxicity was observed in only 4 of 61 cycles. Based on a small retrospective series of patients, we conclude that methotrexate is a well tolerated and effective agent for the treatment of IVL.
- Published
- 2003
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254. The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy, and carmustine.
- Author
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Selker RG, Shapiro WR, Burger P, Blackwood MS, Arena VC, Gilder JC, Malkin MG, Mealey JJ Jr, Neal JH, Olson J, Robertson JT, Barnett GH, Bloomfield S, Albright R, Hochberg FH, Hiesiger E, and Green S
- Subjects
- Brachytherapy, Combined Modality Therapy, Dose-Response Relationship, Radiation, Female, Humans, Male, Middle Aged, Pilot Projects, Quality Assurance, Health Care, Survival Analysis, Antineoplastic Agents, Alkylating therapeutic use, Brain Neoplasms therapy, Carmustine therapeutic use, Glioma therapy, Neurosurgical Procedures, Radiotherapy methods
- Abstract
Objective: The objective of the Brain Tumor Cooperative Group NIH Trial 87-01 trial was to investigate the effect of additional implanted radiation therapy in newly diagnosed patients with pathologically confirmed malignant gliomas., Methods: The study involved a randomized comparison of surgery, external beam radiotherapy, and carmustine (BCNU) versus surgery, external beam therapy, interstitial radiotherapy boost, and BCNU in newly diagnosed malignant gliomas. (125)I was chosen as best suited for this effort because it allowed preimplantation planning and postimplantation quality assurance review. Two hundred ninety-nine patients met the eligibility criteria and were randomized into the two arms of the study between December 1987 and April 1994. Follow-up continued for an additional 3 years. Twenty-nine patients were identified as having committed protocol violations and were excluded, resulting in 270 subjects in the Valid Study Group. One hundred thirty-seven patients received external beam radiation and BCNU, and 133 underwent the (125)I implantation plus external beam radiation and BCNU therapy., Results: The overall median survival for the Valid Study Group was 64.3 weeks. The median survival for patients receiving additional therapy of (125)I was 68.1 weeks, and median survival for those receiving only external beam radiation and BCNU was 58.8 weeks. The cumulative proportion surviving between the two treatment groups was not statistically significantly different (log-rank test, P = 0.101). As in other studies in the literature, age, Karnofsky score, and pathology were predictors of mortality. Additional analyses incorporating an adjustment for these prognostic variables, either in a stratified analysis or Cox proportional hazards model, did not result in statistically significant differences in the cumulative proportion of patients surviving between the two treatment groups., Conclusion: We conclude that there is no long-term survival advantage of increased radiation dose with (125)I seeds in newly diagnosed glioma patients.
- Published
- 2002
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