To apply the German Hodgkin Study Group (GHSG) risk model in patients with recurrent/refractory Hodgkin lymphoma receiving involved-field radiotherapy after autologous stem cell transplantation.
The ...study consisted in the retrospective analysis of 30 consecutive patients with recurrent/refractory Hodgkin lymphoma who received involved-field radiotherapy after autologous stem cell transplantation. Our policy was of adding involved-field radiotherapy for patients with positive PET scan before autologous stem cell transplantation (23 out of 30 patients, 77%), and/or irradiating sites of bulky disease at relapse (11 out of 30 patients, 37%). Patients were stratified into four risk groups according to the presence of the five clinical risk factors identified by the GHSG; (1) stage IV disease; (2) time to relapse≤3 months; (3) ECOG-PS≥1; (4) bulk≥5cm; and (5) inadequate response to salvage chemotherapy.
The median interval from autologous stem cell transplantation to involved-field radiotherapy was 3 months (range, 1–7 months), and the median involved-field radiotherapy dose was 35Gy (range, 12–40Gy). At a median follow-up of 35 months (range, 1–132 months), the 2-year progression-free survival in the entire series was 60%. When examining the four different GHSG risk groups, the progression-free survival rate at 2 years was 86%, 83%, 50%, and 36% for patients with score=0, score=1, score=2, and score=3 to 5, respectively (P=0,01). Among the 12 patients havingat leastthree risk factors who underwent thoracic involved-field radiotherapy, three (25%) developed pneumonitis.
The adoption of the GHSG risk model at the time of recurrence/progression is a useful prognostic tool to select patients with Hodgkin lymphoma for consolidative involved-field radiotherapy after autologous stem cell transplantation.
L'objectif de notre étude était d'appliquer le modèle de risque du German Hodgkin Study Group (GHSG) chez les patients atteints d’un lymphome de Hodgkin récidivant ou réfractaire traité par une irradiation de type « involved field » après une greffe autologue.
Il s'agissait d'une analyse rétrospective des dossiers de 30 patients consécutifs atteints de lymphome de Hodgkin récidivant ou réfractaire traité après une irradiation de type « involved field » après une greffe autologue. Notre politique consistait à ajouter la radiothérapie de type « involved field » en cas de positivité de la TEP avant la greffe autologue (23/30 patients, 77%) et/ou de maladie volumineuse au moment de la rechute (11/30 patients, 37%). Les patients ont été stratifiés en quatre groupes à risque en fonction de la présence des cinq facteurs de risque clinique identifiés par le GHSG: (1) maladie de stade IV, (2) délai de rechute ≤3 mois, (3) indice de performance selon l’Eastern Cooperative Oncology Group≥1, (4) volume≥5cm en diamètre et (5) une réponse insuffisante à la chimiothérapie de sauvetage.
L’intervalle médian entre la greffe autologue et la radiothérapie était de 3 mois (extrêmes: 1–7 mois) et la dose médiane d’irradiation était de 35Gy (12–40Gy). Après un suivi médian de 35 mois (1–132 mois), la probabilité de survie sans progression à 2 ans de l’ensemble de la série était de 60%. Lors de l’examen des quatre groupes de risque, elle était à 2 ans était de 86%, 83%, 50% et 36% pour les patients respectivement avec score de 0, 1, 2 et 3 à 5, (p=0,01). Parmi les 12 patients qui avaientau moins trois facteurs de risque et qui ont reçu une radiothérapie thoracique, trois (25%) ont souffert d’une pneumopathie.
Le modèle de risque du GHSG au moment de la récidive/progression est un outil pronostique utile pour sélectionner les patients atteints de lymphome de Hodgkin pour une radiothérapie de type « involved field » de consolidation après une greffe autologue.
The demographic, clinical, and epidemiological features of subclinical/silent celiac disease in Italy were analyzed in a multicenter study carried out with the participation of 42 centers, in the ...years between 1990 and 1994.
One thousand twenty-six subclinical/silent patients (644 children and 382 adults, 702 women and 324 men) were considered eligible for the study.
The prevalence of the subclinical/silent form increased significantly during the study both in adults (p < 0.001) and in children (p < 0.005), but its prevalence was always lower (p < 0.001) in children than in adults. This increase appears more likely due to a greater diagnostic awareness and to a better use of screening than to a higher number of subclinical/silent cases. Whereas in 1990 a significantly higher proportion (p < 0.001) of subclinical/silent celiac patients was diagnosed in Northern Italy rather than in Southern-Insular Italy, both in adults (46.7% vs 17.2%) and in children (22.0% vs 9.0%), in 1994 such a difference was no longer conspicuous. Both in children and in adults, iron-deficiency anemia appeared to be the most frequent extraintestinal symptom, followed by short stature in children and cutaneous lesions of dermatitis herpetiformis in adults. In 25.9% of the cases another disease was present, with a significantly higher frequency (p < 0.05) in adults (30.1%) than in children (20.7%). Diabetes and atopy appeared to be the most frequently associated conditions both in children and in adults.
This study has provided an analysis of the largest series of subclinical/silent celiac disease reported to date. In Italy, this form is most frequently recognized in adults, and prospective studies will clarify whether the lower frequency observed in children is a real or apparent phenomenon.
AIDS incidence and mortality have decreased since the introduction of highly active antiretroviral therapy (HAART) into clinical practice. HIV-related malignancies, namely Kaposi's sarcoma and ...Non-Hodgkin's lymphoma, have decreased, whereas non-AIDS defining tumors have been increasing. Our aim was to study the impact of HAART on natural history of lung cancer in HIV-positive patients, comparing patients with HIV-lung cancer treated in the pre-HAART era versus the HAART era.
We collected 68 patients with HIV-lung cancer diagnosed from 1986 to 2003. Pre-HAART era included 34 patients who did not receive HAART, whereas the HAART era included 34 patients diagnosed after January 1997 who received HAART.
At diagnosis Performance Status (PS) was significantly different, patients with PS ≥ 2 were 44% in the pre-HAART era, versus 29% in the post-HAART era, p = 0.02. The 79.4% of patients in the post-HAART era received chemotherapy alone or with radiotherapy versus 47% in the pre-HAART era, p = 0.04. Cancer was the leading cause of death for both groups, with 29 (85.3%) and 21 (61.8%) patients in the pre- and post-HAART settings, respectively. The median overall survival (OS) was 3.8 months for the pre-HAART population vs. 7 months for the post-HAART patients, p = 0.01.
HIV-lung cancer patients have a longer overall survival in the post-HAART era versus the pre-HAART era, due to a not detrimental effect of chemotherapy and positive effect of HAART. Lung cancer is the leading cause of death, showing that treatment of the cancer is the most important target now to improve their outcome.
The electroantennogram responses (EAGs) of Macrolophus melanotoma and Macrolophus pygmaeus (Hemiptera: Miridae) exposed to volatile compounds (VOCs) of host and non-host plants were compared. The ...VOCs were identified by gas chromatography. Hosts and non-hosts eliciting similar EAGs were tested in olfactory assays against plants without a significant EAGs for the two Macrolophus species. No characteristic VOC profile was found for hosts and non-hosts. Terpenes predominated in many hosts and carboxylic acids in non-hosts, but no specific VOCs were characteristic of host plants. Significant EAGs (maximum deflection values in mV) were recorded in plants with very different VOC profiles, both hosts and non-hosts. The EAGs were higher for M. melanotoma than for M. pygmaeus, and were higher for males than for females. In M. melanotoma the EAGs were greater with hosts than with non-hosts, but they were similar in M. pygmaeus. The EAGs were correlated with the concentrations of sesquiterpenes and alcohols in both species. In olfactory assays, M. melanotoma and M. pygmaeus preferred their respective hosts, but they did not discriminate between non-host with and without significant EAGs. According to the results, Macrolophus species are expected to rely on ubiquitous VOCs for the identification of their hosts. The variation in the EAGs between M. melanotoma and M. pygmaeus is attributed to the variation in the proportions of olfactory receptor neurones with different sensitivity to VOCs (e.g. sesquiterpenes). Host plant selection is discussed in the light of the perception of VOCs and the processing of information by the central nervous system.
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