188 results on '"Berard CW"'
Search Results
2. Clinicopathologic features and treatment outcome of children with large- cell lymphoma and the t(2;5)(p23;q35)
- Author
-
Sandlund, JT, primary, Pui, CH, additional, Roberts, WM, additional, Santana, VM, additional, Morris, SW, additional, Berard, CW, additional, Hutchison, RE, additional, Ribeiro, RC, additional, Mahmoud, H, additional, and Crist, WM, additional
- Published
- 1994
- Full Text
- View/download PDF
3. SOME STUDIES OF WOUND HEALING: EXPERIMENTAL METHODS, EFFECT OF ASCORBIC ACID AND EFFECT OF DEUTERIUM OXIDE
- Author
-
Hyman Rosen, Stanley M. Levenson, Erving F. Geever, Leo V. Crowley, and Berard Cw
- Subjects
Histology ,Biochemical Phenomena ,Guinea Pigs ,Biomedical Technology ,Biophysics ,Oxide ,Ascorbic Acid ,Critical Care and Intensive Care Medicine ,Biochemistry ,Biophysical Phenomena ,Tendons ,Hydroxyproline ,chemistry.chemical_compound ,Medical Laboratory Science ,Pathology ,Animals ,Medicine ,Deuterium Oxide ,Polyvinyls ,Skin ,Pharmacology ,Chromatography ,Wound Healing ,Vitamin C ,business.industry ,Research ,Proteins ,Deuterium ,Ascorbic acid ,Rats ,Equipment and Supplies ,chemistry ,Surgery ,Collagen ,Scurvy ,Experimental methods ,business ,Wound healing ,Nuclear chemistry - Published
- 1964
4. Clinical features and outcome in childhood T-cell leukemia-lymphoma according to stage of thymocyte differentiation: a Pediatric Oncology Group Study
- Author
-
Crist, WM, Shuster, JJ, Falletta, J, Pullen, DJ, Berard, CW, Vietti, TJ, Alvarado, CS, Roper, MA, Prasthofer, E, and Grossi, CE
- Abstract
The immunophenotypes of lymphoblasts from children with newly diagnosed T-cell acute lymphoid leukemia (T-ALL, n = 101) or T-cell non-Hodgkin lymphoma (T-NHL, n = 31) were analyzed to correlate stage of thymocyte differentiation with clinical features and outcome. The 67 boys and 34 girls with T-ALL were 1 month to 18 years old (median, 8 years) with leukocyte counts ranging from 2 to 810 x 10(9)/L (median, 55 x 10(9)/L). Eighteen of these patients were black, and 70 had a mediastinal mass. Twenty-six boys and five girls with a median age of 9 years (range, 1 to 20 years) had T-NHL. Seven of these patients were black, and 24 had a mediastinal mass. The distributions of thymocyte developmental stages (early [CD7+], intermediate [CD1+ and/or CD4+ and/or CD8+], and mature [CD3+]) in cases of T-ALL and T-NHL were significantly different: 34%, 43%, and 23% v 6%, 62%, and 32% (P = .02). A comparison of the patients' clinical features according to the maturational stage of thymocytes failed to disclose significant differences in the majority of characteristics studied. However, patients with mature-stage T-NHL, with or without the addition of subjects with mature-stage T-ALL, were less likely to have a mediastinal mass (P = .02 for both comparisons). Those with intermediate-stage T-cell malignancy (T-ALL and T-NHL combined) were the subgroup most likely to have a mediastinal mass (P = .01). Response to remission induction therapy was significantly worse in the T-ALL subgroup with an early-stage phenotype: a failure rate of 21% v 0% and 6% for the two more differentiated phenotypic subgroups (P = .007). Event-free survival was not affected by thymocyte maturational stage in cases of either T-ALL or T-NHL. Despite evidence of clinical heterogeneity among the maturational stages of T-cell malignancies in children, these developmental subdivisions do not appear to be critical determinants of outcome once remission is achieved. We conclude that such phenotypes need not be included in the stratification plans for clinical trials using common induction treatment.
- Published
- 1988
- Full Text
- View/download PDF
5. Increased serum CD8 antigen level in childhood Hodgkin's disease relates to advanced stage and poor treatment outcome
- Author
-
Pui, CH, Ip, SH, Thompson, E, Dodge, RK, Brown, M, Wilimas, J, Carrabis, S, Kung, P, Berard, CW, and Crist, WM
- Abstract
Measurement of the soluble form of CD8 antigen, a surface membrane component of suppressor/cytotoxic T cells, has yielded useful information relevant to prognosis in the lymphoid malignancies of childhood. We therefore determined pretreatment levels of serum CD8 antigen in 90 children with newly diagnosed Hodgkin's disease. The findings ranged widely, from 220 to 2,585 U/mL (median, 556 U/mL). In patients with advanced disease (stage III or IV), the median serum CD8 level was significantly higher than in those with less disease extension (stage I or II): 675 v 477 U/mL, P = .003. It was also higher in children with B symptoms compared with all others: 622 v 494 U/mL, P = .005. Cases with a histologic classification of mixed cellularity had a significantly higher median level of the antigen than did those classified as nodular sclerosis: 847 v 509 U/mL, P = .005. Finally, higher serum CD8 levels (greater than 430 U/mL) were significantly associated with an increased probability of treatment failure (P = .02). In a multivariate analysis, serum CD8 level retained its impact on treatment outcome after adjustment for other potentially useful prognostic factors, including disease stage, presence of B symptoms, histology, erythrocyte sedimentation rate, sex, age, and race. The prognostic strength shown by soluble CD8 in this analysis suggests that the antigen has clinical value. We postulate that increased CD8 levels in serum indicate enhanced suppressor T-cell activity, which may compromise the host's antitumor immunity, leading to unusually aggressive disease.
- Published
- 1989
- Full Text
- View/download PDF
6. Nodular mixed lymphoma: results of a randomized trial failing to confirm prolonged disease-free survival with COPP chemotherapy
- Author
-
Glick, JH, Barnes, JM, Ezdinli, EZ, Berard, CW, Orlow, EL, and Bennett, JM
- Abstract
Fifty-two patients with stage III or IV nodular mixed lymphocytic- histiocytic lymphoma (NM) were entered on a prospective randomized trial comparing cyclophosphamide-prednisone (CP) to either COPP (cyclophosphamide, vincristine, procarbazine, prednisone) or BCVP (BCNU, cyclophosphamide, vincristine, prednisone). The COPP regimen utilized in this Eastern Cooperative Oncology Group (ECOG) trial was similar to the four-drug regimen C-MOPP reported by the National Cancer Institute to achieve prolonged relapse-free survival in this histology. No significant differences in complete response rates, response duration, or overall survival were noted among the three regimens. A pattern of continuous late relapse was observed for all three chemotherapy programs. Although 11 of the 18 (61%) COPP patients achieved a complete response, only 3/11 (27%) remain disease-free with a median follow-up of over 3 yr. However, two of these three long-term complete responders have died with no clinical evidence of recurrent disease. The COPP patients received 84% of the calculated ideal doses of cyclophosphamide and 78% of the ideal dosage of procarbazine. Grade 3–4 hematologic toxicity was noted in 22% of the COPP group, 36% with BCVP, and 0% for the CP patients. We were unable to confirm the ability of COPP to achieve durable complete remissions in NM lymphoma. The cyclophosphamide-prednisone combination was equally effective when compared with COPP and BCVP, but produced minimal toxicity.
- Published
- 1981
- Full Text
- View/download PDF
7. Factors predicting long-term survival in diffuse mixed, histiocytic, or undifferentiated lymphoma
- Author
-
Fisher, RI, Hubbard, SM, DeVita, VT, Berard, CW, Wesley, R, Cossman, J, and Young, RC
- Abstract
Clinical and histopathologic material from 151 cases of diffuse mixed, diffuse histiocytic, and diffuse undifferentiated non-Burkitt's lymphomas have been reviewed to determine the factors that predict long- term survival. Median survival of all patients was 34 mo with 43% alive at 70 mo. Factors associated with a poor prognosis include: male sex, constitutional symptoms, advanced stage, bone marrow involvement, huge (greater than 10 cm) abdominal masses with gastrointestinal involvement, hepatic involvement, hemoglobin greater than 12 g/dl, or serum LDH greater than 250 U. The best prediction of a given patient's survival was defined by a set of four variables, which includes sex, symptoms, bone marrow status, and the presence or absence of a huge abdominal mass with gastrointestinal involvement. In contrast, classification of these patients according to the histopathologic categories of Rappaport of Strauchen did not define patient groups with significant differences in survival, nor did these categories correlate with the previously described clinical factors. Knowledge of the distribution of these prognostic factors in any clinical trial is needed before therapeutic results can be compared. In addition, such data may define subsets of patients for whom current therapy is inadequate and conversely those patients for whom current therapy yields excellent long-term survival.
- Published
- 1981
- Full Text
- View/download PDF
8. Nodular histiocytic lymphoma: an aggressive nodular lymphoma with potential for prolonged disease-free survival
- Author
-
Osborne, CK, Norton, L, Young, RC, Garvin, AJ, Simon, RM, Berard, CW, Hubbard, S, and DeVita, VT Jr
- Abstract
Nodular histiocytic lymphoma (NH) is uncommon, and its natural history is not well defined. Of 473 patients with non-Hodgkin's lymphoma, we found 16 (3.4%) with NH. Most patients (13/16) presented with pathologic stage (PS) III or IV disease, including 7 with liver involvement. One patient (PS III) was initially treated with cyclophosphamide alone, and 4 patients received only radiotherapy, and none were long-term survivors. Eleven patients received combination chemotherapy, and 8 achieved complete remission. Only one of these patients relapsed and died at 19 mo; the other 7 continue in complete remission without maintenance therapy with a minimum followup of 4.5 yr. The survival of the entire group of patients with NH is intermediate between that of the other nodular lymphomas and diffuse histiocytic lymphoma. Nine of 16 patients had either a repeat lymph node biopsy during the course of their disease or lymph node examination at autopsy. Lymph node histology in the majority converted to a diffuse, less differentiated subtype of lymphoma. NH has a natural history similar to that of diffuse histiocytic lymphoma and should be approached with the same therapeutic strategy.
- Published
- 1980
- Full Text
- View/download PDF
9. An effective therapy for both undifferentiated (including Burkitt's) lymphomas and lymphoblastic lymphomas in children and young adults
- Author
-
Magrath, IT, Janus, C, Edwards, BK, Spiegel, R, Jaffe, ES, Berard, CW, Miliauskas, J, Morris, K, and Barnwell, R
- Abstract
We have used a single intensive chemotherapy regimen in the treatment of young patients with diffuse, aggressive, malignant lymphomas. There were two major histologic types of lymphoma in our series: lymphoblastic lymphomas, which presented most often with mediastinal tumor (64%), and undifferentiated lymphomas (mostly Burkitt’s lymphomas), which occurred predominantly in the abdomen (86%). Our objective was to examine the determinants of prognosis in a uniformly treated patient group that included 31 children (2–16 yr) and 34 young adults 17–35 yr). Patients with extensive bone marrow involvement (greater than 50% replacement by tumor cells) were included in the study. Treatment consisted essentially of a 4-drug combination (cytoxan, adriamycin, vincristine, and prednisone) alternating with a 42-hr methotrexate infusion, followed by leukovorin rescue, and included intrathecal prophylactic therapy against central nervous system (CNS) disease. Patients with localized or resected undifferentiated lymphoma received 6 therapy cycles; all other patients received 15 cycles. Radiation therapy was used only in exceptional circumstances. Fifty-eight of 65 patients (89%) achieved complete remission: 97% of children and 82% of adults. The estimated 3-yr survival was 60% (SE 6.4%) with a median follow-up of 3 yr. Analysis of factors associated with remission duration and survival indicated that bone marrow involvement at referral and extensive disease were poor prognostic variables. Patients with lymphoblastic lymphomas and patients with completely resected undifferentiated lymphomas had the best prognosis (81% +/- 12% and 94% +/- 6% estimated 3-yr survival, respectively). Patients with extensive intraabdominal undifferentiated lymphoma (stage D) had the worst prognosis (33% +/- 11% estimated 3 yr survival), but even in this subgroup, bone marrow involvement was an adverse factor (estimated survival in stage D patients with and without bone marrow involvement was 14% +/- 13% and 43% +/- 15%, respectively). Elevated uric acid and/or lactic dehydrogenase (LDH) were also of prognostic significance, but predominantly reflected state, i.e., extent of disease. Age did not significantly influence prognosis. In the undifferentiated lymphoma subgroup, histology (i.e., Burkitt's lymphoma versus non-Burkitt’s lymphoma) was not of prognostic significance. Total white count was below 1,000/cu mm in 39% of cycles, and fever associated with granulocytopenia occurred in 17% of cycles. Stomatitis of moderate to severe extent occurred in 50% of cycles.(ABSTRACT TRUNCATED AT 400 WORDS)
- Published
- 1984
- Full Text
- View/download PDF
10. High serum interleukin-2 receptor levels are related to advanced disease and a poor outcome in childhood non-Hodgkin's lymphoma
- Author
-
Pui, CH, Ip, SH, Kung, P, Dodge, RK, Berard, CW, Crist, WM, and Murphy, SB
- Abstract
The clinical usefulness of serum interleukin-2 receptor (IL2R) measurements was determined in 59 children with non-Hodgkin's lymphoma (NHL) and six with B cell acute lymphoblastic leukemia (B-ALL). Levels of the receptor showed a clear relationship to disease stage, as follows: B-ALL greater than stage III or IV diffuse small noncleaved- cell NHL greater than stage III or IV lymphoblastic NHL greater than stage I or II NHL. Soluble IL2R levels were also closely correlated with serum lactic dehydrogenase levels (r = 0.7, P = .0001), a recognized indicator of tumor cell burden. Children with higher soluble IL2R levels (greater than 1,000 U/mL) were significantly more likely to fail treatment (P = .001), even when the analysis was limited to those with more advanced disease: stages III and IV NHL and B-ALL (P = .02). In a multivariate analysis, soluble IL2R level was found to have greater predictive strength than either serum lactic dehydrogenase level or disease stage. Thus, the measurement of soluble IL2R in children with NHL could be expected to improve existing methods of risk assignment in this disease.
- Published
- 1987
- Full Text
- View/download PDF
11. Histologic progression in non-Hodgkin's lymphoma
- Author
-
Hubbard, SM, Chabner, BA, DeVita, VT Jr, Simon, R, Berard, CW, Jones, RB, Garvin, AJ, Canellos, GP, Osborne, CK, and Young, RC
- Published
- 1982
- Full Text
- View/download PDF
12. Heterogeneity of immunologic markers and surface morphology in childhood lymphoblastic lymphoma
- Author
-
Jaffe, ES, Braylan, RC, Frank, MM, Green, I, and Berard, CW
- Abstract
The neoplastic cells from seven patients with childhood lymphoblastic lymphoma were studied for cell surface markers and surface morphology in the scanning electron microscope (SEM). The cells were studied for surface immunoglobulin (Slg), complement receptors (EAC), receptors for cytophilic antibody (IgGEA), and nonimmune rosette formation with sheep red blood cells (E). In one patient the cells exclusively bound E, suggesting a T-lymphocytic origin. In two patients the cells bound EAC, but demonstrated no other B-lymphocytic markers. In two patients no markers were detected, and in two patients receptors for both E and EAC were demonstrated. Additional studies in one of these patients permitted simultaneous demonstration of both markers on the same neoplastic cells. The neoplastic cells were also examined by SEM after fixation and critical point dehydration. No consistent surface morphology was observed. In four patients the cells were predominately smooth, whereas in two patients variable numbers of surface microvilli were present. A correlation of the surface features with membrane markers could not be established. A comparison of the surface markers with clinical and cytologic features revealed clinical homogeneity in spite of the heterogeneous immunologic markers. This heterogeneity was most likely a reflection of neoplastic alteration and disordered differentiation of the cells. The observation of complement receptors on the cells of four cases is a feature not previously reported in this disease and should be investigated in other presumed T-cell malignancies.
- Published
- 1976
- Full Text
- View/download PDF
13. Serum levels of CD8 antigen in childhood lymphoid malignancies: a possible indicator of increased suppressor cell activity in poor-risk patients
- Author
-
Pui, CH, Ip, SH, Dodge, RK, Carrabis, S, Brown, M, Crist, WM, Berard, CW, Kung, P, Dahl, GV, and Murphy, SB
- Abstract
Serum concentrations of CD8 antigen were measured at diagnosis with an enzyme-linked immunoassay in children with acute lymphoblastic leukemia (n = 344) or non-Hodgkin's lymphoma (n = 65). All patients had detectable levels of the serum antigen, which in its soluble nonreduced form appeared to be a 52-Kd homodimer as compared with the 66-Kd surface membrane component on most thymocytes and on a subset of functionally distinct T cells (suppressor/cytotoxic). Increased serum levels of CD8 in leukemia patients were significantly related to recognized high-risk prognostic features: high leukocyte count, large liver and spleen size, high serum lactic dehydrogenase level, T-cell immunophenotype, presence of a mediastinal mass, pseudodiploid karyotype, DNA index less than 1.16, and chromosomal translocation. Children with serum CD8 levels greater than or equal to 450 U/mL were more likely to fail treatment than were those with lower levels (P = .002), even in the group with non-T-cell leukemia (P = .003). In a multivariate analysis, serum CD8 antigen contributed independent prognostic information beyond that conveyed by age, leukocyte count, and race (P = .02). High serum CD8 antigen levels also correlated with advanced stages of disease in children with non-Hodgkin's lymphoma or B- cell leukemia. Children with higher serum CD8 antigen levels (greater than or equal to 700 U/mL) had a poorer treatment outcome (P = .003), even after results were adjusted for disease stage and serum lactic dehydrogenase level (P = .05). Measurement of serum levels of CD8 antigen not only has important prognostic value in childhood lymphoid malignancies but also could be useful in assessing the immunoregulatory role of T cells in patients with cancer.
- Published
- 1988
- Full Text
- View/download PDF
14. Evolution of Angio-Immunoblastic Lymphadenopathy
- Author
-
Long Jc, Frizzera G, and Berard Cw
- Subjects
Diagnosis, Differential ,Immunoblastic lymphadenopathy ,Pathology ,medicine.medical_specialty ,business.industry ,Immunoglobulin gamma-Chains ,Humans ,Medicine ,Lymph Nodes ,General Medicine ,Immunoglobulin Heavy Chains ,business ,Heavy Chain Disease - Published
- 1977
15. Presence of Clonal Chromosome Abnormalities in Virtually All Cases of Acute Lymphoblastic Leukemia
- Author
-
Sharon B. Murphy, Stephen L. George, Dorothy L. Williams, Gaston K. Rivera, Susana C. Raimondi, and Berard Cw
- Subjects
Chromosome Aberrations ,business.industry ,Lymphoblastic Leukemia ,Cancer research ,Humans ,Chromosome ,Medicine ,General Medicine ,business ,Clone Cells ,Leukemia, Lymphoid - Published
- 1985
16. Simone's OncOpinion -- Concierge medicine Revisited (12/10/06 issue)
- Author
-
Berard CW and Simone JV
- Published
- 2007
- Full Text
- View/download PDF
17. Treatment of children and young adults with early-stage non-Hodgkin's lymphoma.
- Author
-
Link MP, Shuster JJ, Donaldson SS, Berard CW, and Murphy SB
- Published
- 1997
18. CNS involvement in children with newly diagnosed non-Hodgkin's lymphoma.
- Author
-
Sandlund JT, Murphy SB, Santana VM, Behm F, Jones D, Berard CW, Furman WL, Ribeiro R, Crist WM, Greenwald C, Chen G, Walter A, and Pui CH
- Subjects
- Adolescent, Antineoplastic Agents administration & dosage, Central Nervous System Diseases cerebrospinal fluid, Cerebrospinal Fluid cytology, Chi-Square Distribution, Child, Child, Preschool, Cranial Irradiation, Disease-Free Survival, Female, Humans, Infant, Injections, Intralesional, L-Lactate Dehydrogenase blood, Lymphoma, Large B-Cell, Diffuse cerebrospinal fluid, Lymphoma, Large B-Cell, Diffuse complications, Lymphoma, Large B-Cell, Diffuse therapy, Lymphoma, Non-Hodgkin therapy, Male, Multivariate Analysis, Odds Ratio, Precursor Cell Lymphoblastic Leukemia-Lymphoma cerebrospinal fluid, Precursor Cell Lymphoblastic Leukemia-Lymphoma complications, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy, Prognosis, Recurrence, Retrospective Studies, Treatment Outcome, Central Nervous System Diseases etiology, Cranial Nerve Diseases etiology, Lymphoma, Non-Hodgkin cerebrospinal fluid, Lymphoma, Non-Hodgkin complications
- Abstract
Purpose: To determine the frequency of CNS involvement at diagnosis of non-Hodgkin's lymphoma (NHL), to characterize its pattern of presentation, and to determine its prognostic significance., Patients and Methods: We reviewed the records of 445 children (1975 through 1995) diagnosed with NHL (small noncleaved cell NHL/B-cell acute lymphoblastic leukemia [SNCC NHL/B-ALL], 201 patients; lymphoblastic, 113; large cell, 119; other, 12). Tumor burden was estimated by serum lactate dehydrogenase (LDH) measurement and reclassification of disease stage irrespective of CNS involvement (modified stage)., Results: Thirty-six of 445 children with newly diagnosed NHL had CNS involvement (lymphoma cells in the CSF [n = 23], cranial nerve palsy [n = 9], both features [n = 4]), representing 13%, 7%, and 1% of small noncleaved cell lymphoma, lymphoblastic lymphoma, and large-cell cases, respectively. By univariate analysis, CNS disease at diagnosis did not significantly impact event-free survival (P =. 095), whereas stage and LDH did; however, children with CNS disease at diagnosis were at 2.0 times greater risk of death than those without CNS disease at diagnosis. In a multivariate analysis, CNS disease was not significantly associated with either overall or event-free survival, whereas both serum LDH and stage influenced both overall and event-free survival. Among cases of SNCC NHL/B-ALL, CNS disease was significantly associated with event-free and overall survival (univariate analysis); however, in multivariate analysis, only LDH had independent prognostic significance. Elevated serum LDH or higher modified stage were associated with a trend toward poorer overall survival among children with CNS disease., Conclusion: A greater tumor burden at diagnosis adversely influences the treatment outcome of children with NHL and CNS disease at diagnosis, suggesting a need for ongoing improvement in both systemic and CNS-directed therapy.
- Published
- 2000
- Full Text
- View/download PDF
19. Large proportion of Epstein-Barr virus-associated small noncleaved cell lymphomas among children with non-Hodgkin's lymphoma at a single institution in Moscow, Russia.
- Author
-
Sandlund JT, Gorban ZI, Berard CW, Sixbey J, Razzouk B, Talalayev AG, Toopytsyn NN, Rumjantsev AG, Lebedev VV, Karachunsky AI, Belikova LH, Kryzhanovsky OI, Chen G, Crist WM, Pui CH, and Samochatova EV
- Subjects
- Adolescent, Burkitt Lymphoma virology, Child, Child, Preschool, Female, Humans, Incidence, Infant, Male, Russia epidemiology, Burkitt Lymphoma epidemiology, Herpesvirus 4, Human
- Abstract
To evaluate clinical and biologic features of children with non-Hodgkin's lymphoma (NHL) treated in Moscow, Russia, we studied 53 cases treated in the Republican Children's Hospital from 1990 to 1994. Histologic examination disclosed a predominance of the small noncleaved cell subtype (32 cases, 60%); a smaller percentage of the lymphoblastic and large-cell subtypes (14 cases, 26% and 7 cases, 13%, respectively) were identified. The frequencies of primary sites of involvement in descending order included 60% in abdomen, 19% in mediastinum, 15% in head/neck, and 4% in peripheral nodes. The majority of children presented with advanced stage disease (St. Jude stage III/IV/B-ALL, 92.5%). Of interest, 8 of 15 (53%) small noncleaved cell NHL cases examined contained Epstein-Barr virus (EBV). The high frequency of EBV association in this study suggests that this virus may play a more global role in NHL pathogenesis than previously recognized.
- Published
- 1999
- Full Text
- View/download PDF
20. Fractionated cylophosphamide and back to back high dose methotrexate and cytosine arabinoside improves outcome in patients with stage III high grade small non-cleaved cell lymphomas (SNCCL): a randomized trial of the Pediatric Oncology Group.
- Author
-
Brecher ML, Schwenn MR, Coppes MJ, Bowman WP, Link MP, Berard CW, Shuster JJ, and Murphy SB
- Subjects
- Adolescent, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Child, Child, Preschool, Cyclophosphamide administration & dosage, Cytarabine administration & dosage, Drug Administration Schedule, Female, Humans, Infant, Lymphoma, Non-Hodgkin pathology, Male, Methotrexate administration & dosage, Neoplasm Staging, Prognosis, Prospective Studies, Survival Analysis, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymphoma, Non-Hodgkin drug therapy
- Abstract
Background: The Pediatric Oncology Group (POG) conducted a two-arm, randomized study for the treatment of children and adolescents with stage III small, non-cleaved cell lymphoma (SNCCL). Regimen A, based on the group's previous best treatment for this group of patients, included cyclophosphamide (CTX) and high-dose methotrexate (MTX), as well as vincristine (VCR), prednisone (PRED), and intrathecal (IT) chemoprophylaxis. Regimen B, based on a single institution pilot study (Total B therapy), consisted of two rapidly alternating chemotherapy combinations (CTX, VCR, doxorubicin; MTX, and cytarabine (Ara-C) plus coordinated IT chemotherapy., Procedure: One hundred thirty-four consecutive patients were entered on this study. Seventy patients were randomized to Regimen A, and 64 patients to Regimen B. One hundred and twenty-two patients are eligible for response., Results: Complete remission (CR) was achieved by 81% (52/64) of patients on Regimen A, and 95% (55/58) of patients on Regimen B (p=0.014 one-sided). The two-year event-free survival (EFS) is 64% (SE=6%) on Regimen A, and 79% (SE=6%) on Regimen B (p=0.027 by one-sided logrank test). No patient has relapsed on either regimen after a year from diagnosis, although one patient had a second malignancy at day 371. Severe, but manageable, hematologic toxicity was seen in the majority of patients on both regimens, but was more frequent on Regimen B., Conclusions: We conclude that the cure rate in stage III SNCCL is significantly improved with the use of a short, six-month chemotherapy regimen of fractionated CTX alternated with coordinated MTX and Ara-C. Results suggest that drug schedule, not simple drug selection, influences outcome.
- Published
- 1997
- Full Text
- View/download PDF
21. The spectrum of mucosa-associated lymphoid tissue lesions in pediatric patients infected with HIV: A clinicopathologic study of six cases.
- Author
-
Joshi VV, Gagnon GA, Chadwick EG, Berard CW, McClain KL, Leach CT, Jenson HB, and Murphy SB
- Subjects
- Adolescent, Adult, Chemotherapy, Adjuvant, Child, Child, Preschool, Female, Genome, Viral, HIV immunology, Herpesviridae Infections diagnosis, Herpesvirus 4, Human genetics, Humans, Lung pathology, Lymphoid Tissue pathology, Lymphoma, AIDS-Related complications, Lymphoma, AIDS-Related therapy, Lymphoma, B-Cell, Marginal Zone complications, Lymphoma, B-Cell, Marginal Zone therapy, Male, Palatine Tonsil pathology, Radiotherapy, Adjuvant, Salivary Glands pathology, Sialadenitis complications, Sialadenitis diagnosis, Tumor Virus Infections diagnosis, HIV isolation & purification, Lymphoma, AIDS-Related pathology, Lymphoma, B-Cell, Marginal Zone pathology
- Abstract
Mucosa-associated lymphoid tissue (MALT) lesions in nonimmunocompromised individuals include reactive lymphoid proliferations and both low- and high-grade lymphoid neoplasms. These lesions occur at extranodal mucosal sites, such as the gastrointestinal tract, bronchus, salivary gland, and other locations. The spectrum of MALT lesions in children with HIV infection had not been previously described. In this study, six cases that demonstrated the spectrum of MALT lesions in pediatric patients, aged 28 months to 23 years, who had HIV infection were described. Half the patients acquired the infection perinatally, and half acquired it by transfusion. Mucosal sites of involvement included the salivary gland (4 patients), bronchiolar mucosa (2 patients), and oropharyngeal mucosa (1 patient). One patient had lesions in lung and oropharynx sequentially; all others had involvement of solitary sites. The histologic diagnoses included myoepithelial sialadenitis (MESA), MESA with low-grade MALT lymphoma, typical low-grade MALT lymphoma, diffuse large cell lymphoma (DLCL), and atypical pulmonary lymphoid hyperplasia and lymphoid interstitial pneumonitis complex. The two cases of high-grade DLCL were confined to mucosal sites (tonsil and parotid); in one of these patients, a previous biopsy specimen showed a MALT lesion with low-grade features. In two cases, quantitation of the Epstein-Barr virus (EBV) genome by the polymerase chain reaction showed a very high copy number in peripheral blood mononuclear cells but a low copy number in the MALT lesion, which suggested that MALT lesions may not be directly associated with EBV infection. Two patients who had high-grade tumors (DLCL) were successfully treated with chemotherapy and radiation therapy. The remaining patients, all of whom had low-grade MALT lesions, received either corticosteroids or alpha-interferon or no specific therapy; in all patients, the lesions followed an indolent clinical course. Clinicians and pathologists should be alert to the possibility that MALT lesions, including MALT lymphomas, may be present in children who have AIDS.
- Published
- 1997
- Full Text
- View/download PDF
22. The problem of classifying lymphomas: an orderly prescription for progress.
- Author
-
Berard CW and Hutchison RE
- Subjects
- Hodgkin Disease classification, Humans, Lymphoma, B-Cell classification, Lymphoma, Non-Hodgkin classification, Lymphoma, T-Cell classification, Lymphoma classification
- Abstract
In the late 1960s and early 1970s, the most widely recognized 'new' classifications of the non-Hodgkin's lymphomas were those proposed by Rappaport (the 'Rappaport' classification) and by Lennert (the 'Kiel' classification). With the advent of immunologic and histochemical markers in the early 1970s, however, new concepts arose to supplement the traditional purely morphologic approach to diagnosis and classification of these tumors. Lymphomas were increasingly recognized to be neoplasms of the immune system, composed of malignant proliferations which retained many of the morphologic and functional characteristics of their normal counterparts. These advances led to a flurry of new classifications proposed in 1974-1976, leading to confusion for both clinicians and pathologists, perhaps most evident at the International Cancer Congress in Florence in 1974. To address this problem, the National Cancer Institute (USA) sponsored an international workshop of expert pathologists and clinicians on 4-5 September 1975. It became apparent at that meeting that only a well-planned retrospective study would provide data for meaningful progress and resolution of differences. From 1976 to 1980, such a massive collaborative project was accomplished and served as the basis for the Working Formulation for Clinical Usage, proposed as a vehicle for translation among the six tested schema. Since the Working Formulation was published in 1982 there have been momentous strides in scientific and clinical understanding of these cancers, fueled by contributions from immunology, cytogenetics, and molecular biology. To recognize and disseminate understanding of these newer observations, the International Lymphoma Study Group promulgated in 1994 a new proposal entitled 'A Revised European-American Classification of Lymphoid Neoplasms'. As a sequel to another international assembly of pathologists and clinicians, held at the National Cancer Institute (USA) on 21-23 March 1994, a second large-scale retrospective study has been accomplished, the results of which were presented at the Sixth International Conference on Malignant Lymphoma, 5-8 June 1996, along with data from other institutions and cooperative groups. Concurrent with these events, the World Health Organization has enlisted a committee of expert pathologists to prepare a new edition of 'Neoplastic Diseases of Hematopoietic and Lymphoid Tissues'. Composed of 10 pathology subcommittees and a clinical advisory committee, with broad international representation, this body should generate in the near future a consensus proposal with broad scientific and geographic support. These historical and ongoing efforts in lymphoma pathology are a paradigm for progress in clinicopathologic understanding of all cancers.
- Published
- 1997
23. Use of an anti-ALK antibody in the characterization of anaplastic large-cell lymphoma of childhood.
- Author
-
Hutchison RE, Banki K, Shuster JJ, Barrett D, Dieck C, Berard CW, Murphy SB, Link MP, Pick TE, Laver J, Schwenn M, Mathew P, and Morris SW
- Subjects
- Adult, Anaplastic Lymphoma Kinase, Child, Humans, Ki-1 Antigen analysis, Lymphoma, Large B-Cell, Diffuse pathology, Neoplasm Proteins immunology, Paraffin Embedding, Protein-Tyrosine Kinases immunology, Receptor Protein-Tyrosine Kinases, Antibodies, Lymphoma, Large B-Cell, Diffuse enzymology, Neoplasm Proteins analysis, Protein-Tyrosine Kinases analysis
- Abstract
Background: Anaplastic lymphoma kinase (ALK) is a tyrosine kinase inappropriately expressed in lymphoid tissue involved by CD30+ anaplastic large-cell lymphoma (ALCL) with the translocation t(2;5)(p23;q35)(, which juxtaposes the nucleophosmin gene (NPM) with that encoding ALK, resulting in a hybrid (NPM-ALK) message., Patients and Methods: A polyclonal antibody against residues of the kinase portion of NPM-ALK (designated anti-ALK 11) was tested for clinical utility in paraffin sections of 44 cases of pediatric large-cell lymphoma (LCL) and 17 additional lymphoma cases, by streptavidin-biotin-alkaline phosphatase method., Results: Nineteen of 20 CD30+ cases (the majority exhibiting anaplastic morphology) labeled with anti-ALK 11, and 5/28 CD30- cases were also ALK+ (3 T cells, 1 null cell, and 1 B cell). Sixteen of 17 B-cell pediatric LCLs were negative, as were 6/6 cases of Hodgkin's disease and 7/7 cases of adult B-cell lymphoma. In pediatric LCLs with adequate follow-up (24/44 ALK+), there was no significant association between ALK expression and two-year event-free survival, similar to the finding reported previously for CD30 expression in these cases., Conclusion: We conclude that the majority of pediatric CD30+ ALCLs show ALK overexpression, consistent with the presence of the t(2;5)-encoded NPM-ALK fusion, but that the clinical significance of this entity remains unproven.
- Published
- 1997
24. Methods to detect P-glycoprotein-associated multidrug resistance in patients' tumors: consensus recommendations.
- Author
-
Beck WT, Grogan TM, Willman CL, Cordon-Cardo C, Parham DM, Kuttesch JF, Andreeff M, Bates SE, Berard CW, Boyett JM, Brophy NA, Broxterman HJ, Chan HS, Dalton WS, Dietel M, Fojo AT, Gascoyne RD, Head D, Houghton PJ, Srivastava DK, Lehnert M, Leith CP, Paietta E, Pavelic ZP, and Weinstein R
- Subjects
- ATP Binding Cassette Transporter, Subfamily B, Member 1 pharmacology, Evaluation Studies as Topic, Humans, Immunohistochemistry, KB Cells, Tumor Cells, Cultured, ATP Binding Cassette Transporter, Subfamily B, Member 1 analysis, Drug Resistance, Multiple, Neoplasms chemistry, Neoplasms drug therapy
- Abstract
Multidrug resistance (MDR), especially that associated with overexpression of MDR1 and its product, P-glycoprotein (Pgp), is thought to play a role in the outcome of therapy for some human tumors; however, a consensus conclusion has been difficult to reach, owing to the variable results published by different laboratories. Many factors appear to influence the detection of Pgp in clinical specimens, including its low and heterogeneous expression; conflicting definitions of detection end points; differences in methods of sample preparation, fixation, and analysis; use of immunological reagents with variable Pgp specificity and avidity and with different recognition epitopes; use of secondary reagents and chromogens; and differences in clinical end points. Also, mechanisms other than Pgp overexpression may contribute to clinical MDR. The combined effect of these factors is clearly important, especially among tumors with low expression of Pgp. Thus, a workshop was organized in Memphis, Tennessee, to promote the standardization of approaches to MDR1 and Pgp detection in clinical specimens. The 15 North American and European institutions that agreed to participate conducted three preworkshop trials with well-characterized MDR myeloma and carcinoma cell lines that expressed increasing amounts of Pgp. The intent was to establish standard materials and methods for a fourth trial, assays of Pgp and MDR1 in clinical specimens. The general conclusions emerging from these efforts led to a number of recommendations for future studies: (a) although detection of Pgp and MDR1 is at present likely to be more reliable in leukemias and lymphomas than in solid tumors, accurate measurement of low levels of Pgp expression under most conditions remains an elusive goal; (b) tissue-specific controls, antibody controls, and standardized MDR cell lines are essential for calibrating any detection method and for subsequent analyses of clinical samples; (c) use of two or more vendor-standardized anti-Pgp antibody reagents that recognize different epitopes improves the reliability of immunological detection of Pgp; (d) sample fixation and antigen preservation must be carefully controlled; (e) multiparameter analysis is useful in clinical assays of MDR1/Pgp expression; (f) immunostaining data are best reported as staining intensity and the percentage of positive cells; and (g) arbitrary minimal cutoff points for analysis compromise the reliability of conclusions. The recommendations made by workshop participants should enhance the quality of research on the role of Pgp in clinical MDR development and provide a paradigm for investigations of other drug resistance-associated proteins.
- Published
- 1996
25. B-cell lineage confers a favorable outcome among children and adolescents with large-cell lymphoma: a Pediatric Oncology Group study.
- Author
-
Hutchison RE, Berard CW, Shuster JJ, Link MP, Pick TE, and Murphy SB
- Subjects
- Adolescent, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Canada, Chi-Square Distribution, Child, Disease-Free Survival, Female, Humans, Immunophenotyping, Ki-1 Antigen metabolism, Lymphoma, B-Cell immunology, Lymphoma, B-Cell mortality, Lymphoma, Large B-Cell, Diffuse immunology, Lymphoma, Large B-Cell, Diffuse mortality, Lymphoma, T-Cell immunology, Lymphoma, T-Cell mortality, Lymphoma, T-Cell therapy, Male, Prognosis, Risk Factors, United States, Lymphoma, B-Cell drug therapy, Lymphoma, Large B-Cell, Diffuse drug therapy
- Abstract
Purpose: The goal of this study was to assess the immunophenotype of uniformly treated cases of pediatric large-cell non-Hodgkin's lymphoma (NHL) to determine the prognostic importance of B-cell and T-cell lineages and of CD30 positivity., Patients and Methods: Sixty-nine patients were analyzed by immunochemistry. All patients were classified histologically, staged in a uniform manner, and treated according to one of two protocols for localized (stage I and II) NHL or advanced (stage III and IV) large-cell NHL. Antibodies included anti-CD45, CD20, CD45Ra, MB-2 (not clustered), CD3, CD45Ro, CD43, CD15, CD30, and CD68. Statistical analysis used the exact conditional chi 2 and Kruskall-Wallace tests for clinical features and the log-rank test to evaluate event-free survival (EFS)., Results: Immunophenotypic results demonstrated 25 B-cell, 23 T-cell, and 21 indeterminate lineage. Twenty-seven patients expressed CD30 (17 T-cell and 10 indeterminate lineage), and of these, 22 showed histology of anaplastic large-cell lymphoma (ALCL). B-cell patients were older (P = .018) and showed more favorable survival than patients with T-cell or indeterminate lineage (96% EFS at 3 years, 96% v 67% and 74%, B v T and indeterminate lineage [P = .027]). B-cell lineage was seen more frequently in limited-stage patients, but was also associated with favorable survival when stratified for stage (P = .036). CD30 expression (P = .96) and ALCL histology (P = .90) did not show significant associations with survival., Conclusion: We conclude that among pediatric large-cell lymphomas, B-cell lineage is proportionately less frequent than in adults and CD30 antigen-expressing lymphomas are frequent among patients with T-cell and indeterminate lineage. B-cell phenotype tends to occur in older children and is associated with superior survival.
- Published
- 1995
- Full Text
- View/download PDF
26. Large cell non-Hodgkin lymphoma of childhood: clinical characteristics and outcome.
- Author
-
Sandlund JT, Santana V, Abromowitch M, Ribeiro R, Mahmoud H, Ayers GD, Lin JS, Hutchison RE, Berard CW, and Greenwald CA
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Infant, Lymphoma, Large B-Cell, Diffuse radiotherapy, Male, Neoplasm Staging, Outcome Assessment, Health Care, Prognosis, Risk Factors, Treatment Failure, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymphoma, Large B-Cell, Diffuse drug therapy, Lymphoma, Large B-Cell, Diffuse pathology
- Abstract
Less is known about the clinical features and treatment outcome in pediatric large cell non-Hodgkin lymphoma (NHL) than the lymphoblastic and small noncleaved cell subtypes of NHL. To characterize presenting features and assess possible risk factors associated with this diagnosis, we analyzed data for 91 patients treated on a succession of multiagent regimens from 1975 to 1990. Five-year event-free survival (EFS) (+/- SE) was related to disease extent (St Jude system): stage I (n = 24), 95% +/- 5%; stage II (n = 20), 84% +/- 9%; stage III (n = 38), 50% +/- 10%; and stage IV (n = 9), 22% +/- 11%. Advanced stage disease, age < or = 5 years and serum LDH > 500 U/l were associated with poorer EFS in the univariate model (p < 0.001, 0.005, and 0.002, respectively). In the multivariate model, advanced stage and age retained prognostic significance (p = 0.001 and 0.02, respectively), but LDH did not. Among limited stage cases, age < or = 5 years was the only adverse risk feature (p = 0.016); treatment era (pre- vs. post-1979) was the only significant feature in patients with advanced disease (p = 0.004). Intrathoracic primaries were associated with a better outcome than other sites among the 38 stage III patients (p = 0.005). Only one of eight patients with bone marrow disease remains failure-free. The excellent results for limited stage pediatric large cell NHL permit consideration of treatment modifications to decrease toxicity; for cases with advanced disease, especially those with bone marrow involvement, novel therapeutic approaches are clearly needed.
- Published
- 1994
27. Factors contributing to the prognostic significance of bone marrow involvement in childhood non-Hodgkin lymphoma.
- Author
-
Sandlund JT, Ribeiro R, Lin JS, Ayers D, Santana VM, Furman WL, Mahmoud H, Berard CW, Hutchison RE, and Crist WM
- Subjects
- Adolescent, Child, Child, Preschool, Female, Humans, Infant, L-Lactate Dehydrogenase blood, Lymphoma, Non-Hodgkin enzymology, Lymphoma, Non-Hodgkin mortality, Male, Prognosis, Survival Rate, Bone Marrow pathology, Lymphoma, Non-Hodgkin pathology
- Abstract
To evaluate the clinical characteristics and treatment outcome of childhood non-Hodgkin lymphoma (NHL) cases with bone marrow involvement, we studied 13 lymphoblastic, 15 small noncleaved cell, and 8 large cell cases with tumor cells in their marrow. They represented 16%, 11%, and 9% of consecutive NHL cases with these respective histologic subtypes. The treatment outcome differed significantly according to histologic subtype--the 5-year event-free survivals (EFS +/- SE) for large cell NHL, small non-cleaved cell NHL, and lymphoblastic NHL cases were 11 +/- 8%, 40 +/- 20%, and 62 +/- 15%, respectively. Increased serum lactate dehydrogenase (LDH) levels (> 500 U/L) were associated with a poorer EFS (5-year EFS, 0% vs. 50 +/- 10%; P < 0.001). Children < or = 5 years of age had a poorer EFS survival than older children (5-year EFS, 14 +/- 9% vs. 44 +/- 10%; P = 0.03). The degree of bone marrow involvement (< 5% vs. > or = 5%) and race were not significantly associated with treatment outcome. Although intensive chemotherapy has substantially improved survival for patients with advanced stage lymphoblastic or small noncleaved cell lymphoma, patients with large cell NHL and associated marrow involvement continue to have a dismal outcome and require novel or more intensive therapy.
- Published
- 1994
- Full Text
- View/download PDF
28. Extranodal primary tumor site indicates poor prognosis in childhood head and neck non-Hodgkin's lymphomas.
- Author
-
Ribeiro RC, Fairclough DL, Sandlund JT, Crist WM, Berard CW, and Pui CH
- Subjects
- Adolescent, Child, Child, Preschool, Female, Head and Neck Neoplasms mortality, Humans, Infant, Lymphoma, Non-Hodgkin mortality, Male, Neoplasm Staging, Prognosis, Remission Induction, Survival Analysis, Head and Neck Neoplasms pathology, Lymphoma, Non-Hodgkin pathology
- Abstract
As a result of the diversity of lymphoid structures in the head and neck, we analyzed clinical characteristics and outcomes of 87 consecutive children with non-Hodgkin's lymphoma (NHL) arising in this region to determine if the nodal versus extranodal primary site influences prognosis. Thirty-one children had primary nodal NHL whereas 56 had extranodal NHL. The two groups were similar in the distribution of age, gender, race, serum lactic dehydrogenase levels, and disease stage. However, extranodal tumors were slightly more likely to have small non-cleaved cell histology (32/56 versus 11/31, p = 0.07) than nodal tumors. In a multivariate analysis, extranodal involvement (p = 0.017), advanced stage disease (p = 0.054) and treatment era (p = 0.056) were each significantly associated with a shorter time of event-free survival. Children with extranodal and extralymphatic NHL had an even worse treatment outcome than did others (p = 0.006). The poor prognosis of extranodal involvement was also evident among children with stage I or II NHL. We conclude that extranodal involvement has an adverse influence on treatment outcome in children with NHL arising in the head and neck region.
- Published
- 1991
29. Clinical significance of histology and immunophenotype in childhood diffuse large cell lymphoma.
- Author
-
Hutchison RE, Fairclough DL, Holt H, Pui CH, Sandlund JT, and Berard CW
- Subjects
- Adolescent, Adult, B-Lymphocytes, Child, Child, Preschool, Female, Humans, Immunophenotyping, Infant, Lymphoma, Large B-Cell, Diffuse mortality, Male, Survival Analysis, T-Lymphocytes, Lymphoma, Large B-Cell, Diffuse pathology
- Abstract
To correlate the histologic subtype of diffuse large cell (DLC) lymphoma with immunophenotype, clinical features, and treatment outcome, 88 consecutively diagnosed children with this disease were studied. Of these cases, 42 (48%) were immunoblastic (IB), polymorphous subtype; 17 (19%) IB, plasmacytoid; 8 (9%) IB, clear cell; 6 (7%) IB, not otherwise specified; and 15 (17%) DLC-follicular center cell (DLC-FCC) type. Of 34 cases successfully phenotyped from paraffin sections, 13 were T cell and 9 were B cell; of the remaining cases, 8 were suggestive of T-cell lineage, 3 of B-cell lineage, and 1 of histiocytic differentiation. Although histologic subtype did not correlate with clinical features or outcome, it did correlate with immunophenotype among those cases for which lineage could be unequivocally assigned (5 of 18 IB vs. 4 of 4 DLC cases were B cell; P = 0.02) Immunophenotype was also correlated with stage of disease (11 of 13 T-cell vs. 3 of 9 B-cell cases had stage III-IV disease; P = 0.03). (Stage III includes all primary thoracic tumors; stage IV includes all with central nervous system and/or bone marrow involvement.) Significant prognostic features were clinical stage and era (thus type) of therapy (P less than 0.001). The authors conclude that most cases of large cell non-Hodgkin's lymphoma in children are of IB morphologic type, most frequently of T-cell lineage, and those with T-cell phenotype appeared to have more advanced disease.
- Published
- 1991
- Full Text
- View/download PDF
30. Pleural effusion is associated with a poor treatment outcome in stage III small non-cleaved cell lymphoma.
- Author
-
Sandlund JT, Crist WM, Abromowitch M, Fairclough D, Berard CW, Rafferty M, and Pui CH
- Subjects
- Adolescent, Child, Child, Preschool, Female, Humans, L-Lactate Dehydrogenase blood, Lymphoma, Non-Hodgkin pathology, Male, Neoplasm Staging, Receptors, Interleukin-2 blood, Abdominal Neoplasms drug therapy, Lymphoma, Non-Hodgkin drug therapy, Pleural Effusion drug therapy
- Abstract
The clinical significance of pleural effusion was assessed in 24 children with unresectable abdominal small non-cleaved cell lymphoma (St. Jude Stage III). Patients were consecutively enrolled and treated on a regimen including high dose fractionated cyclophosphamide and co-ordinated high dose methotrexate and cytarabine. The overall results were excellent, with 20 of 24 patients alive and event-free at a median follow-up of 4 years. Only one of the patients who lacked pleural effusion has relapsed (testicular), even though many had massive disease. In contrast, three of seven patients with pleural effusion have failed treatment (p = 0.02) and subsequently died. Two measures of tumor burden, serum lactic dehydrogenase and, in a subset of patients, interleukin-2-receptor levels, were significantly higher in patients with pleural effusion (p = 0.002 and p = 0.05, respectively). These findings suggest that unresectable abdominal small non-cleaved cell lymphoma associated with pleural effusion should be up-staged and that these patients should receive more intensive chemotherapy.
- Published
- 1991
31. Follicular lymphomas in pediatric patients.
- Author
-
Pinto A, Hutchison RE, Grant LH, Trevenen CL, and Berard CW
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Lymphoma, Follicular genetics, Male, Remission Induction methods, Remission, Spontaneous, Translocation, Genetic genetics, Lymphoma, Follicular pathology
- Abstract
The clinicopathologic features of twenty cases of follicular lymphoma (FL) in pediatric patients are described. Fifteen boys and five girls were 2 to 20 yr (mean 10 yr) of age at diagnosis. In ten cases (50%) the lymphoma was localized in lymph nodes and in ten cases (50%) in extranodal sites. Fifteen patients had stage I, two stage II and three stage III disease at the time of presentation. The faucial tonsils were the primary site in seven cases, other head and neck sites in five, inguinal lymph nodes in four and possibly another, and the abdomen in two. Six cases (30%) were classified as follicular small cleaved cell type (FSCC), five (25%) as follicular mixed small cleaved and large cell (FMC), and nine (45%) as follicular large cell (FLC). The architectural pattern was purely follicular (F) in five cases (20%), predominantly follicular (F greater than D) in six (30%), follicular and diffuse (F = D) in six (30%) and predominantly diffuse (F less than D) in three (15%). In one case a progression from F greater than D LC to F less than D LC was documented. All patients attained complete remission (CR). One died of acute lymphoblastic leukemia 7 yr after the original diagnosis of FSCC non-Hodgkin's lymphoma (NHL), but the others are all alive and free of disease with a follow-up ranging from 6 mo to 16 yr (median 4 yr). In three patients therapy was initially deferred with no known adverse influence on outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1990
32. Results of treatment of childhood localized non-Hodgkin's lymphoma with combination chemotherapy with or without radiotherapy.
- Author
-
Link MP, Donaldson SS, Berard CW, Shuster JJ, and Murphy SB
- Subjects
- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Humans, Lymphoma, Non-Hodgkin mortality, Neoplasm Staging, Radiotherapy adverse effects, Randomized Controlled Trials as Topic, Survival Rate, Lymphoma, Non-Hodgkin therapy
- Abstract
Combined radiotherapy and intensive chemotherapy have led to improved prognosis in children with non-Hodgkin's lymphoma, but the toxic effects of these forms of treatment are additive and seriously limit the benefits of their use. In an effort to limit the adverse acute and late effects of treatment, we conducted a randomized, controlled trial to determine whether irradiation of primary sites of involvement could safely be omitted from the treatment of children with localized non-Hodgkin's lymphoma (Stages I and II) who have a favorable prognosis. In addition, the chemotherapy regimen was less intense and shorter (eight months) than usual. A total of 129 patients were randomly assigned to receive either chemotherapy (vincristine, cyclophosphamide, doxorubicin, prednisone, mercaptopurine, and methotrexate) with irradiation (27 Gy) of the involved field (combined chemotherapy and radiotherapy) or chemotherapy alone. Half the patients have been followed for more than 38 months (range, 13 to 68), and the projected disease-free survival (+/- SE) at four years among patients assigned to chemotherapy alone is 87.9 +/- 8.8 percent, as compared with 87.3 +/- 9.4 percent among patients assigned to combined therapy (P = 0.44). The majority of patients tolerated therapy very well, although the toxic effects of treatment (myelosuppression, mucositis, and infection) were significantly worse among patients who received the combination of chemotherapy and radiotherapy. We conclude that most children with localized non-Hodgkin's lymphoma can be cured by a chemotherapy regimen of reduced intensity and duration. Radiotherapy can be safely omitted from the therapy of such children without substantially jeopardizing their excellent chance of cure.
- Published
- 1990
- Full Text
- View/download PDF
33. Prognostic factors for patients with diffuse large cell or immunoblastic non-Hodgkin's lymphomas: experience of the non-Hodgkin's Lymphoma Pathologic Classification Project.
- Author
-
Simon R, Durrleman S, Hoppe RT, Bonadonna G, Bloomfield CD, Rudders RA, Cheson BD, and Berard CW
- Subjects
- Adult, Age Factors, Aged, Female, Follow-Up Studies, Humans, Lymphoma, Non-Hodgkin classification, Lymphoma, Non-Hodgkin pathology, Male, Middle Aged, Multicenter Studies as Topic, Multivariate Analysis, Neoplasm Staging, Prognosis, Proportional Hazards Models, Remission Induction, Risk Factors, Survival Rate, Lymphoma, Non-Hodgkin mortality
- Abstract
Prognostic factors for long-term survival of 312 patients with diffuse large cell or immunoblastic non-Hodgkin's lymphoma are presented based on analysis of the multiinstitution clinicopathologic study sponsored by the National Cancer Institute. At the time of analysis, 75% of the patients had died and the median follow-up for patients still alive was 11 years. The distribution of Ann Arbor stages was 21% stage I, 32% stage II, 17% stage III, and 30% stage IV. Factors of prognostic significance for survival included age, stage, histologic subtype, presence of B symptoms, size of the largest lesion, number of extra-lymphoid organs involved, and extent of lymphatic involvement. Recursive partitioning analysis suggested a prognostic classification system based on stage, age, size of the largest lesion, and presence of mediastinal involvement. Stage I patient less than 50 years of age had a 10 year survival rate of 65% compared to 36% for older stage I patients. Stage II patients less than 65 years old without bulky lesions or mediastinal involvement had a 10 year survival rate of 45% compared to 10% for the poorer risk stage II patients. Although statistically significant prognostic factors were identified for the stage III/IV patients, they were not strong discriminants of 5-10 year survival rate. Because of the correlation among potential prognostic factors, there is no uniquely best classification system. Reasons for discrepancies among reported prognostic factor analyses are discussed, and a prognostic grouping that synthesizes our results with those of others is proposed.
- Published
- 1990
- Full Text
- View/download PDF
34. The classification of non-Hodgkin's lymphomas.
- Author
-
Braylan R and Berard CW
- Subjects
- Humans, Terminology as Topic, Lymphoma classification
- Published
- 1976
35. Pathological staging of 100 consecutive untreated patients with non-Hodgkin's lymphomas: extramedullary sites of disease.
- Author
-
Lotz MJ, Chabner B, DeVita VT Jr, Johnson RE, and Berard CW
- Subjects
- Age Factors, Biopsy methods, Female, Humans, Liver Neoplasms pathology, Lymph Nodes pathology, Lymphatic Metastasis pathology, Male, Sex Factors, Spleen pathology, Splenic Neoplasms pathology, Lymphoma pathology
- Abstract
One hundred consecutive untreated cases of non-Hodgkin's lymphomas were reviewed according to Rappaport's classification. There were 49 males and 51 females, almost evenly distributed between nodular (49) and diffuse (51) patterns. Only diffuse lymphomas were seen in patients under age 20 and they were twice as common as nodular lymphomas in patients over 60. Nodular lymphomas were predominantly lymphocytic (61%) or mixed (35%) while diffuse lymphomas were commonly histiocytic (43%). Standardized pathological staging was based upon the serial performance of bone marrow needle biopsy, percutaneous hepatic biopsy, peritoneoscopic hepatic biopsies and exploratory laparotomy. For all patients this sequence terminated with the first positive biopsy. Hepatic involvement was documented in 40 patients by either percutaneous biopsies,18 peritoneoscopic biopsies,9 or wedge biopsy at laparotomy.13 Thirty-seven of 49 patients who underwent laparotomy had biopsy-proven abdominal involvement. Overall incidence of biopsy-proven abdominal disease was 64%. Positive spleens varied widely in weight but all negative spleens weighed less than 270 g. Constancy of histologic type in multiple sites was observed in 90% of cases.
- Published
- 1976
- Full Text
- View/download PDF
36. Effect of the degree of nodularity on the survival of patients with nodular lymphomas.
- Author
-
Ezdinli EZ, Costello WG, Kucuk O, and Berard CW
- Subjects
- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Drug Administration Schedule, Female, Humans, Lymphatic Metastasis, Lymphoma, Non-Hodgkin drug therapy, Male, Middle Aged, Neoplasm Staging, Prognosis, Retrospective Studies, Lymph Nodes pathology, Lymphoma, Non-Hodgkin pathology
- Abstract
The survival of patients with favorable lymphoma entered on various Eastern Cooperative Oncology Group (ECOG) studies was analyzed according to the degree of nodularity. A pure nodular pattern (NN), defined as nodularity involving 75% or more of the cross-sectional area, was found to be an important favorable prognostic indicator as compared with a nodular-diffuse pattern (ND). The median survival in 336 patients with NN of 68.2 months was significantly better than the 39.6 months in 87 patients with ND (P less than .003). The median survival in NN-lymphocytic poorly differentiated (LPD) was 77.2 months v 44.3 months for ND-LPD. NN-M median survival of 56.4 months contrasted with only 25.5 months for ND-mixed lymphocytic and histiocytic (M). The degree of nodularity as defined in this study appears to have significant prognostic implication and should be more widely used by pathologists.
- Published
- 1987
- Full Text
- View/download PDF
37. Annulate in four cases of diffuse lymphocytic lymphoma.
- Author
-
Watanabe S, Berard CW, and Triche T
- Subjects
- Adult, Cell Membrane immunology, Cell Nucleus ultrastructure, Endoplasmic Reticulum ultrastructure, Female, Golgi Apparatus ultrastructure, Humans, Lymphocytes ultrastructure, Lymphoma, Non-Hodgkin immunology, Male, Membranes ultrastructure, Middle Aged, Receptors, Antigen, B-Cell, Lymphoma, Non-Hodgkin ultrastructure, Organoids ultrastructure
- Abstract
Annulate lamellae were observed in 4 cases of diffuse lymphocytic lymphoma. Two lymphomas were well differentiated and 2 were of intermediate differentiation. These lymphomas had additional abnormalities of membranes: specifically, excessive blebbing of nuclear membranes and lattice-like formations of tubular endoplasmic reticulum.
- Published
- 1977
- Full Text
- View/download PDF
38. Non-Hodgkin's lymphomas of childhood: an analysis of the histology, staging, and response to treatment of 338 cases at a single institution.
- Author
-
Murphy SB, Fairclough DL, Hutchison RE, and Berard CW
- Subjects
- Adolescent, Child, Child, Preschool, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Infant, L-Lactate Dehydrogenase blood, Lymphoma, Non-Hodgkin enzymology, Lymphoma, Non-Hodgkin therapy, Male, Neoplasm Staging, Prognosis, Remission Induction, Lymphoma, Non-Hodgkin pathology
- Abstract
Between 1962 and 1986, a total of 338 consecutive newly diagnosed children and adolescents with non-Hodgkin's lymphomas (NHLs) were evaluated and treated at St Jude Children's Research Hospital (SJCRH). Median follow-up is 6.6 years (range, 1.8 to 23 years). The patients ranged in age from 7 months to 21 years (median, 10 years), and 71% were males. All cases were staged (I to IV) by a clinical staging system. Eighteen percent were stage I, 21% stage II, 43% stage III, and 18% stage IV. Cases frankly leukemic at diagnosis (ie, greater than 25% marrow blasts) were excluded from the analysis. Pathologic material from all cases was reviewed and classified according to the Working Formulation. The histologic distribution of cases was as follows: 38.8% diffuse small non-cleaved cell (undifferentiated, Burkitt's and non-Burkitt's); 26.3% diffuse large-cell, mainly immunoblastic; 28.1% lymphoblastic; and 6.8% other. Treatment policy evolved over time to a stage- and histology-specific strategy for treatment assignment, and overall results significantly improved by era from 37% (+/- 5%) 2-year event-free survival (EFS) for patients treated before 1975 to 77% (+/- 4%) since 1978. By univariate and multivariate Cox regression analyses, the era of treatment (hence, the protocol-specific treatment itself), the stage, and the log of the initial serum lactic dehydrogenase (LDH) emerged as the most powerful prognostic indicators, while histology per se was not significantly related to outcome. For the 154 patients treated since 1978, the 2-year EFS by stage was 97% (+/- 3%) for stage I, 86% (+/- 6%) for stage II, 73% (+/- 6%) for stage III, and 47% (+/- 11%) for stage IV (P less than .0001). Compared with our previous experience, we conclude that the cure rate of childhood NHL has doubled in the last decade with modern management.
- Published
- 1989
- Full Text
- View/download PDF
39. The American Burkitt Lymphoma Registry: a progress report.
- Author
-
Levine PH, Connelly RR, Berard CW, O'Connor GT, Dorfman RF, EASTON JM, and DeVita VT
- Subjects
- Adolescent, Adult, Africa, Aged, Burkitt Lymphoma drug therapy, Burkitt Lymphoma mortality, Child, Child, Preschool, Demography, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Registries, Sex Factors, Time Factors, United States, Burkitt Lymphoma epidemiology
- Abstract
The American Burkitt Lymphoma Registry (ABLR) investigates the cause of Burkitt's lymphoma through comparative studies involving endemic and nonendemic regions. In 3 years 114 cases have been confirmed. Diagnosis was based on evaluation of pathologic materialy submitted to ABLR pathologists. Similarities between American and African patients included abrupt clinical presentation with involvement of the gastrointestinal tract, jaw, gonads, and central nervous system. Response to high-dose cyclophosphamide and an apparent high cure rate distinguish American Burkitt's lymphoma from poorly differentiated lymphocytic lymphoma (lymphosarcoma) of childhood. Time-space clustering and absence of cases in high-altitude regions are seen in American and African patients; young American patients resemble Africans in a predominance of men and high Epstein-Barr virus titers. American patients have bone-marrow and peripheral lymph-node involvement more frequently and are less likely to have Epstein-Barr virus genome in their tumors; most are white. Identification of specific causal factors requires the study of more cases and better pretreatment material for pathologic review.
- Published
- 1975
- Full Text
- View/download PDF
40. The Rappaport classification of non-Hodgkin's lymphomas: a closer look using other proposed classifications.
- Author
-
Garvin AJ, Simon R, Young RC, DeVita VT, and Berard CW
- Subjects
- Adolescent, Adult, Age Factors, Female, Humans, Lymphoma mortality, Lymphoma, Follicular pathology, Lymphoma, Large B-Cell, Diffuse pathology, Lymphoma, Non-Hodgkin pathology, Male, Middle Aged, Lymphoma classification
- Abstract
An essential purpose of a pathologic classification of non-Hodgkin's lymphomas is to supply guidance in the clinical management of patients. Ideally, an optimal subclassification should also be scientifically accurate, highly reproducible, and readily teachable. Such a system, when used in conjunction with uniform staging, should enable relatively homogeneous groups of patients to be defined. In the present study, we have evaluated four new systems for possible additions to the traditional Rappaport classifcation. In response to specific questions the following tentative conclusions could be drawn: (1) Within the Rappaport nodular lymphomas, there are no differences in survival between lymphomas that are totally nodular verusus those that are nodular and diffuse. (2) In lymphomas composed of small cleaved follicular center cells of the Lukes-Collins system, survival appears to be independent of pattern (follicular, follicular and diffuse, or diffuse). In contrast, in tumors classified as centroblastic-centrocytic in the Kiel classification or those classified as large cleaved or large noncleaved in the Lukes-Collins system, a totally or partially follicular pattern confers a better prognosis than its diffuse counterpart. (3) The numbers are small but there is no apparent difference in survival between cases of Rappaport's difuse well differentiated lymphocytic lymphomas with or without plasmacytoid differentiation. (4) Within the original Rappaport DPDL there were at least two distinct types of lymphomas: (1) a convoluted lymphoblastic that occurs in younger patients has a high frequency of B symptoms and carries a poor prognosis; and (2) a diffuse lymphoma that is cytologically identical to nodular PDL, occurs in older patients, and has a relatively good prognosis. In August of 1976 Rappaport modified his classification to recognize these lymphoblastic lymphomas as a distinct clinicopathologic entity. (5) In this 22-yr retrospective review, neither the Kiel nor the Lukes-Collins system could identify any relatively favorable subsets within Rappaport's category of diffuse histiocytic lymphoma. Prospective studies applying the same approach to large numbers of patients subjected to modern uniform staging and aggressive combination chemotherapy may provide data upon which to base an optimal subclassification of DHL.
- Published
- 1980
41. Comparative trial of two teniposide-based combination chemotherapy regimens for the treatment of advanced malignant lymphomas.
- Author
-
O'Connell MJ, Anderson J, Merrill JM, Bennett JM, Glick JH, Berard CW, Neiman RS, and Brodovsky HS
- Subjects
- Adult, Altretamine administration & dosage, Altretamine adverse effects, Cisplatin administration & dosage, Cisplatin adverse effects, Clinical Trials as Topic, Drug Therapy, Combination, Female, Hematopoietic System drug effects, Humans, Lymphoma mortality, Male, Middle Aged, Prednisone administration & dosage, Prospective Studies, Random Allocation, Teniposide adverse effects, Lymphoma drug therapy, Podophyllotoxin analogs & derivatives, Teniposide administration & dosage
- Abstract
One hundred and twenty-three patients with advanced measureable malignant lymphomas resistant to conventional chemotherapy were entered in a prospectively randomized trial of two teniposide (VM-26)-based combination chemotherapy regimens: V-PLAT (VM-26, cisplatin, and prednisone) and V-HEX (VM-26, hexamethylmelamine, and prednisone). Ninety-seven eligible and evaluable patients received protocol therapy. Sixteen percent of the patients had Hodgkin's disease, and 84% had non-Hodgkin's lymphoma. All patients were ambulatory (Eastern Cooperative Oncology Group Performance status 0, 1, or 2), 70% had stage IV disease, 59% had "B" symptoms, and all had failed either two or three previous chemotherapy regimens. Toxicity was mainly hematologic and significantly greater with V-PLAT. Objective tumor responses were seen in nine of 45 patients (20%) treated with V-PLAT (duration, 4-35 + weeks) and in four of 51 patients (8%) treated with V-HEX (duration, 10-65 + weeks). Among the 12 patients with histologically confirmed histiocytic lymphoma treated with V-PLAT, five (42%) experienced objective tumor responses, including two complete responses. Overall median survival was approximately 6 months, with no difference between treatment regimens. Limited antitumor activity of these combination regimens in patients with advanced malignant lymphomas has been demonstrated. However, the objective response rates were not higher than we have previously seen with either VM-26 (22%) or hexamethylmelamine (27%) given in maximum tolerable doses as single agents.
- Published
- 1982
42. End results of treating children with localized non-Hodgkin's lymphomas with a combined modality approach of lessened intensity.
- Author
-
Murphy SB, Hustu HO, Rivera G, and Berard CW
- Subjects
- Adolescent, Antineoplastic Combined Chemotherapy Protocols adverse effects, Child, Child, Preschool, Combined Modality Therapy, Cyclophosphamide administration & dosage, Enteritis chemically induced, Evaluation Studies as Topic, Female, Hematuria chemically induced, Humans, Lymphoma radiotherapy, Male, Methotrexate administration & dosage, Nausea chemically induced, Neoplasm Staging, Prednisone administration & dosage, Prognosis, Vincristine administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymphoma drug therapy
- Abstract
From 1978 to 1982, 28 children with localized non-Hodgkin's lymphomas, stages I and II, were treated with a combined modality protocol, reduced in intensity in comparison to our previous institutional protocol (1975-1978, reported in Cancer 45: 630-637, 1980), and modest by comparison to many current intensive regimens in widespread use. Induction consisted of vincristine (6 weekly doses, 1.5 mg/m2), cyclophosphamide (3 doses, on days 0, 21, and 42, 600 mg/m2 IV), and oral prednisone (40 mg/m2, daily for 1 mo) combined with low-dose, involved-field, supervoltage radiotherapy (2000 rads). Prophylactic treatment of the central nervous system was not given to all children, but only to those with primary tumors in the head and neck region, and consisted of intermittent intrathecal methotrexate only (12 mg/dose, three times in induction, and subsequently every 6 wk). Maintenance therapy, consisting of oral daily 6-mercaptopurine (75 mg/m2) and oral weekly methotrexate (30 mg/m2), was continued for a total duration of 15 mo from diagnosis. Overall, there were 15 children with stage I and 13 with stage II disease, and the majority of the cases (17 of 28) were localized to the head and neck. In addition, 7 children, all stage II, had completely resected gastrointestinal tumors; the other 4 cases presented in inguinal nodes. Histologically, 27 of the 28 tumors were high-grade diffuse (13 undifferentiated, i.e., small noncleaved cell type; 11 histiocytic, i.e., 5 large noncleaved cell type, and 6 immunoblastic type; and 3 lymphoblastic type); 1 case was mixed cell type, nodular and diffuse. All children were judged to be in complete remission at the end of induction, and 24 of 28 (85.7%) remain free of disease 4+ mo to nearly 4 yr from diagnosis (median 24+ mo); 19 have completed all planned therapy and are in unmaintained remission. The 4 cases failing therapy all were characterized by diffuse undifferentiated (small noncleaved cell) histology and exhibited regrowth of local tumor, resulting in a failure rate for this group (4 of 13, 30%) significantly different than for all remaining cases of other histologies (0 of 15), p less than 0.02 by log rank analysis. Patient tolerance to therapy was excellent, with negligible acute toxicity, and ambulatory outpatient management was the norm. Long-term follow-up will be necessary to judge whether adverse late consequences of treatment have been reduced by this approach. We conclude that a reduction in the intensity of therapy for children with stage I and II non-Hodgkin's lymphomas is feasible, apparently without significantly jeopardizing their excellent chance for cure.
- Published
- 1983
- Full Text
- View/download PDF
43. Letter: Surface characteristics of Hodgkin's lymphoma cells.
- Author
-
Braylan RC, Jaffe ES, and Berard CW
- Subjects
- Animals, Cells, Cultured, Centrifugation, Erythrocytes immunology, Hodgkin Disease immunology, Humans, Immune Adherence Reaction, Immunoglobulins isolation & purification, Lymph Nodes pathology, Microscopy, Electron, Sheep immunology, Spleen pathology, Staining and Labeling, T-Lymphocytes immunology, Hodgkin Disease pathology, Surface Properties
- Published
- 1974
- Full Text
- View/download PDF
44. The Non-Hodgkin Lymphoma Pathologic Classification Project. Long-term follow-up of 1153 patients with non-Hodgkin lymphomas.
- Author
-
Simon R, Durrleman S, Hoppe RT, Bonadonna G, Bloomfield CD, Rudders RA, Cheson BD, and Berard CW
- Subjects
- Bone Marrow pathology, Female, Follow-Up Studies, Humans, Lymphoma, Non-Hodgkin mortality, Lymphoma, Non-Hodgkin pathology, Lymphoma, Non-Hodgkin therapy, Male, Middle Aged, Multicenter Studies as Topic, Neoplasm Staging, Prognosis, Lymphoma, Non-Hodgkin classification
- Abstract
Study Objective: To document the long-term prognosis of patients with non-Hodgkin lymphoma treated between 1971 and 1975 and to determine how the prognosis varies by histologic subtype and stage., Setting: Three cancer referral centers in the United States and one center in Italy., Patients: A consecutive sample of 1153 previously untreated patients with non-Hodgkin lymphoma. At the time of analysis, 71% of the patients had died and the median follow-up for patients still alive was 11.2 years., Measurements and Main Results: The 10-year survival proportions were 45% (CI, 40% to 50%); 26% (CI, 22% to 30%); and 23% (CI, 18% to 30%) for patients with low-, intermediate-, and high-grade lymphomas, respectively. Patients with intermediate- and high-grade lymphomas were curable, but this was not apparent for patients with advanced stage low-grade lymphomas. For the low-grade follicular small cleaved and follicular mixed lymphomas, the Ann Arbor staging system distinguished the prognosis of patients with stage I disease from those with more extensive involvement. For the diffuse large cell and immunoblastic lymphomas, the Ann Arbor staging system distinguished long-term prognosis for patients with stage I disease from patients with stage II disease and those with more disseminated involvement., Conclusions: The probability of long-term survival for unselected patients with non-Hodgkin lymphoma can be substantial. Long-term prognosis depends on the histologic subtype of the tumor and the extent of dissemination. The Working Formulation for non-Hodgkin lymphomas is a simple and useful nomenclature for selecting treatment and reporting results. The Ann Arbor staging system is a useful but imperfect prognostic indicator.
- Published
- 1988
- Full Text
- View/download PDF
45. The classification and pathology of the lymphomas and leukemias.
- Author
-
Callihan TR and Berard CW
- Subjects
- Burkitt Lymphoma pathology, Hodgkin Disease pathology, Humans, Leukemia pathology, Leukemia, Lymphoid pathology, Leukemia, Myeloid, Acute pathology, Lymphoma pathology, Lymphoma, Follicular pathology, Lymphoma, Large B-Cell, Diffuse classification, Lymphoma, Large B-Cell, Diffuse pathology, Lymphoma, Non-Hodgkin classification, Lymphoma, Non-Hodgkin pathology, Leukemia classification, Lymphoma classification
- Published
- 1980
- Full Text
- View/download PDF
46. Predictability of immunologic phenotype by morphologic criteria in diffuse aggressive non-Hodgkin's lymphomas.
- Author
-
Jaffe ES, Strauchen JA, and Berard CW
- Subjects
- Adult, Humans, Lymphoma classification, Lymphoma pathology, Phenotype, Receptors, Antigen, B-Cell analysis, Rosette Formation, Lymphoma immunology
- Abstract
Diffuse aggressive non-Hodgkin's lymphomas are immunologically and morphologically heterogeneous. Morphologic subclassifications have been proposed with a presumptive relationship to immunologic phenotype. Six histologic types were studied, four of presumed follicular origin (large cleaved, large non-cleaved, mixed follicular center cell, and blastic) and two of presumed nonfollicular origin (pleomorphic pyroninophilic and pleomorphic convoluted). Two of these follicular subtypes were found to be associated with the frequent presence of B-cell markers; large non-cleaved, six of seven; and blastic, four of six. However, four of nine T-cell lymphomas were misclassified as lesions of follicular center cell type, indicating the difficulty of distinguishing some convoluted cells of T-cell lymphoma from irregularly cleaved cells of follicular lymphoma. Pleomorphic pyroninophilic or B-immunoblastic morphology was associated with B-cell markers in only two of six cases; two additional cases had T-cell markers, one had histiocytic markers and in one case, no markers were demonstrable. Thus, this morphology may reflect a common pathway of transformed lymphoid cells. Some cases of T-cell origin could be recognized by the striking pleomorphic convoluted histology (three of five cases) but morphologic overlap with pleomorphic B-cell tumors, particularly transformed nodular lymphomas, posed a problem. This histopathologic subclassification correctly predicted immunologic phenotype in only 61% of cases, suggesting that in diffuse non-Hodgkin's lymphomas, histologic appearance alone may not be a reliable indicator of immunologic surface markers.
- Published
- 1982
- Full Text
- View/download PDF
47. Sequential cyclophosphamide-prednisone and vincristine-bleomycin (CPOB). An effective, schedule-dependent treatment for advanced diffuse histiocytic lymphoma.
- Author
-
Johnson GJ, Costello WG, Oken MM, Sponzo RW, Barnes JM, Ezdinli EZ, Bennett JM, Silverstein MN, Glick JH, and Berard CW
- Subjects
- Antineoplastic Agents adverse effects, Bleomycin administration & dosage, Clinical Trials as Topic, Cyclophosphamide administration & dosage, Drug Administration Schedule, Drug Therapy, Combination, Follow-Up Studies, Humans, Prednisolone, Prednisone administration & dosage, Vincristine administration & dosage, Antineoplastic Agents therapeutic use, Antineoplastic Combined Chemotherapy Protocols, Lymphoma, Large B-Cell, Diffuse drug therapy
- Abstract
In an Eastern Cooperative Oncology Group non-Hodgkin's lymphoma clinical trial, 90 patients with Stage III or IV diffuse histiocytic lymphoma (DHL) were treated with one of four chemotherapy regimens. All patients were previously untreated with chemotherapy, and careful restaging was required to document responses. Each treatment included cyclophosphamide, vincristine and prednisone (COP) plus Adriamycin (COPA), BCNU (BCVP) or bleomycin (COPB and CPOB). The two bleomycin-containing regimens differed only in the schedule of drug administration. CPOB-treated patients received cyclophosphamide on day 1, prednisone on days 1 to 5 and vincristine and bleomycin on day 15 of each 21-day cycle. COPB-treated patients received the same four drugs in the same dosage; however, the schedule was changed so that vincristine and bleomycin were given on day 1. Treatment of responders was continued for 8 cycles. Those with a complete response (CR) were randomized to maintenance therapy with BCVP or no treatment. Treatment with CPOB yielded a CR rate of 55% compared to 25% for COPB (P = 0.07). In contrast to COPB, treatment with CPOB was associated with a significantly longer median duration of CR (26.5 versus 5.7 months; P less than 0.05) and median survival (27.7 versus 11.2 months; P less than 0.02). The CR rate was 31% for BCVP and 45% for COPA, and the median survivals were 10.7 months and 14.4 months, respectively. One half of the CPOB-treated patients who achieved CR remained alive in continuous CR after 30 to 72 months. No advantage for maintenance therapy was observed. Myelotoxicity was greater with CPOB than COPB, but comparable to COPA. This trial demonstrated that the results of treatment of DHL with COP plus bleomycin were strikingly dependent upon the schedule of administration of bleomycin and vincristine. Bleomycin effectively combined with COP, as in CPOB, yielded results comparable to those obtained when Adriamycin was added to COP. CPOB appears to be an effective treatment for DHL that should be considered as an alternative to other regimens, particularly for patients who cannot receive Adriamycin.
- Published
- 1983
- Full Text
- View/download PDF
48. Morphological definition of Burkitt's tumour: historical review and present status.
- Author
-
Berard CW
- Subjects
- Africa, Burkitt Lymphoma history, History, 20th Century, Humans, Burkitt Lymphoma pathology
- Published
- 1985
49. Cell volumes and DNA distributions of normal and neoplastic human lymphoid cells.
- Author
-
Braylan RC, Fowlkes BJ, Jaffe ES, Sanders SK, Berard CW, and Herman CJ
- Subjects
- Burkitt Lymphoma pathology, Cell Count, Humans, Leukemia metabolism, Leukemia, Hairy Cell pathology, Leukemia, Lymphoid pathology, Lymphocytes metabolism, Lymphoma metabolism, Lymphoma, Large B-Cell, Diffuse pathology, Lymphoma, Non-Hodgkin pathology, DNA metabolism, DNA, Neoplasm metabolism, Leukemia pathology, Lymphocytes cytology, Lymphoma pathology
- Published
- 1978
- Full Text
- View/download PDF
50. Undifferentiated non-Hodgkin's lymphomas (Burkitt's and non-Burkitt's types). The relevance of making this histologic distinction.
- Author
-
Miliauskas JR, Berard CW, Young RC, Garvin AJ, Edwards BK, and DeVita VT Jr
- Subjects
- Abdomen, Adolescent, Adult, Age Factors, Bone Marrow pathology, Burkitt Lymphoma therapy, Child, Child, Preschool, Female, Humans, Lymph Nodes pathology, Lymphoma therapy, Male, Neck, Neoplasm Staging, Prognosis, Retrospective Studies, Sex Factors, Burkitt Lymphoma pathology, Lymphoma pathology
- Abstract
A retrospective study of 66 cases of undifferentiated non-Hodgkin's lymphomas at the National Cancer Institute over a 22-year period suggests that the histologic distinction between Burkitt's and non-Burkitt's types is clinicopathologically meaningful. Thirty-nine patients with Burkitt's lymphoma had a median age at presentation of ten years. The primary site of disease in these patients was more commonly extranodal; at the time of diagnosis 26 (66%) of these cases revealed intra-abdominal involvement; 25 (64%) of the cases were Stage IV. The 27 patients with non-Burkitt's lymphomas had a median age at presentation of 34 years; the primary site of disease was more commonly nodal (peripheral adenopathy was often present at the time of diagnosis); only nine (33%) of the cases were Stage IV. Median survival was essentially equivalent in the two groups, 9.5 months for Burkitt's lymphoma and 10.0 months for the non-Burkitt's lymphoma. Overall, survival was not significantly different among the two patient populations; however, patients with Burkitt's lymphoma had a longer survival than those with non-Burkitt's lymphoma. Estimates of five-year survival (with 95% confidence) are 42% for Burkitt's lymphoma and 11% for non-Burkitt's lymphoma, respectively, which are significantly different (P = 0.01).
- Published
- 1982
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.