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Arpád Illés

Publications and source records attributed to Arpád Illés.

At least 19 recordsLinked to original sources

Uncommon lymphadenopathies of immunopathogenesis can be misinterpreted as malignant diseases.

Lymphadenomegaly is a common sign of benign and malignant disorders. In our practice, only every fifth patient is found to have primary or secondary nodal malignancy. Benign disorders, including banal infections and other non-neoplastic conditions, however, cause most of the cases. Among these, there are some rare entities, resulting in persistent lymphadenopathy that may cause differential diagnostic problems in the daily practice. We report here three patients, having Rosai-Dorfman disease, multicentric Castleman's disease and Kikuchi's lymphadenitis, who exemplify such cases. Our purpose with this presentation is to emphasise importance of vigorous co-operation between clinicians and pathologists. In general, it is imperative to prefer specialised haematopathological laboratories that may facilitate proper diagnosis.

Adult↗

Malignant lymphomas in the elderly: a single institute experience highlights future directions.

In this study, our experience with the diagnostics and treatment of malignant lymphoma patients were analyzed, with a special consideration of the elderly. Between 1980 and 2005, there were 181 cases found (35%) among 517 non-Hodgkin's lymphoma (NHL) patients and 46 cases (8.1%) among 565 Hodgkin's lymphoma (HL) patients, who were at least 65 years old at the time of diagnosis. Comparing elderly patients to young ones, the time from first symptoms to diagnosis was significantly longer (NHL: 7.6 months versus 4.1 months, HL: 11.4 months versus 5.6 months). B-cell and indolent NHL-s were more common (92.8% versus 79.2% and 56.4% versus 35.1%) such as classical lymphocyte predominant (cLP) HL-s (30.4% versus 15.0%); however nodular sclerosis (NS) HL-s occurred less frequently (10.9% versus 32.2%). Stages were more advanced and comorbidity was more common. Primary therapies were more often inappropriate (NHL: 20.4% versus 5.1%, HL: 26.0% versus 6.0%); there were more complications, but less cases with complete remission (NHL: 17.1% versus 61.1%, HL: 63.0% versus 79.2%) and dose reductions were more commonly applied (NHL: 46.7% versus 17.2%, HL: 52.9% versus 11.3%). Remission rates were significantly worsened by dose reductions (NHL: 68.5% versus 34.5%, HL: 61.8% versus 44.4%). Appropriate therapies resulted in significantly better overall survival (OS) rates (log-rank<0.05). It can be concluded that more favourable results can be achieved in the remission and survival rates of elderly malignant lymphoma patients if the appropriate curative or palliative therapies, considering new and less toxic protocols such as supportive care, are chosen.

Adolescent↗

[Expression of ZEBRA protein of Epstein-Barr virus in Hungarian patients with Hodgkin lymphoma: latent or lytic cycle?].

INTRODUCTION: Epstein-Barr virus is a ubiquitous human herpes virus in the Hungarian population. The virus is associated with an increasing number of lymphoid malignancies, such as Hodgkin and non-Hodgkin lymphomas. The ability of the virus to establish life-long persistent infection and induce growth transformation is related to the viral proteins that are variously expressed in both normal and malignant cells. Although the presence of ZEBRA protein induces lytic cycle, some lymphoma cases show this protein expression. AIM: In our present study we investigated the frequency of expression of ZEBRA protein in Hungarian patients with Hodgkin lymphoma associated with Epstein-Barr virus infection. The authors wanted to clarify whether this expression is specific to latency type II or occurs in some non-Hodgkin lymphoma cases with latency type III as well. Does the expression of ZEBRA protein have any effect on therapeutic response and survival rate of the patients? METHOD: 109 HL and 59 NHL were studied for the presence of the virus in the tumor and for expression of the latency proteins and ZEBRA by immunohistochemistry. RESULTS: 25 samples were evaluated successfully for ZEBRA of the 47 LMP1 positive HL samples. We detected the weak expression of ZEBRA protein in 13 of the 25 LMP1 positive Hodgkin lymphoma cases and in 6 of the 18 LMP1 positive non-Hodgkin lymphoma samples. The authors could not find correlation between the expression of ZEBRA protein and the type of latency. During the followed 120 months the total survival of patients with ZEBRA positivity proved to be significantly shorter as compared to that of ZEBRA negative cases. The authors could not find significant difference in the uneventful survival of these two groups. CONCLUSION: In the examined group of patients the ZEBRA positivity associated with a poor prognosis of the disease. Besides this relatively small number of cases, additional extensive studies are needed to conclude our observation. Elucidation of the switching mechanisms by which Epstein-Barr virus induces lytic cycle may provide an efficacious therapeutic approach to the EBV-related malignancies.

Adult↗

[Differences of arteria carotis in patients with Hodgkin's lymphoma].

Radiotherapy increases the risk of cardiovascular morbidity. We examined arteria carotis atherosclerosis and stenosis in Hodgkin's lymphoma patients. We examined arteria carotis of 120 Hodgkin's lymphoma patients who have been in complete remission for at least 5 years. 70 patients received neck irradiation (mean age at the time of the examination was 44.6 years). Twenty-four (34.3%) of them had carotis sclerosis or stenosis, and it was significantly more than in the control group [8 out of 60 patients 13.3%)]. Twelve patients of the 50 who did not receive radiotherapy had carotis lesions, and there was no significant difference compared to the control group. Significant stenosis (>50%) was detected in only 3 patients (in the irradiated group). TIA, stroke or amaurosis fugax did not occur. Carotis stenosis does not seem to play a role in late mortality in Hodgkin's lymphoma, but if the patient has an increased risk for atherosclerotic changes, then regular examinations are necessary, and other risk factors (smoking, hypertension, diabetes mellitus, hypothyroidism, early menopause) need to be treated.

Adult↗

Immunoregulatory T cells in the peripheral blood of patients with Hodgkin's lymphoma.

We aimed at investigating the distribution of various types of immunoregulatory T cells in the peripheral blood of patients with Hodgkin's lymphoma (HL) (n = 94) being in the state of long-lasting complete remission using flow cytometry. Healthy patients (n = 41) as 'negative' and patients in complete remission with breast cancer (n = 47) as 'positive' controls were investigated in the study. We found significant elevations in the number of CD4+ CD25high naturally occurring regulatory T cells, CD4+/intracellular IL-10+ (Tr1) and CD8+/intracellular IL-10+ T cells in HL compared to the healthy controls. In carcinoma patients, however, the number of Tr1 and CD8+/IL-10+ T cells was higher than that in the other two groups. The increase in the number of CD4+ CD25high T cells seems to be characteristic of HL compared to the two other types of regulatory T cells. This change exists for a long time and it seems to be a characteristic of HL and independent of the types of therapy and the duration of time since therapy.

Adult↗

Paraneoplastic rheumatic syndromes.

Paraneoplastic symptoms caused by a malignancy but not directly related to tumour invasion are the result of a wide variety of tumour-derived biologic mediators, such as hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Recognition of paraneoplastic syndromes is important, as it may lead to an early diagnosis of cancer. On the other hand, the clinical severity of the symptoms can be used as a guide to the extent of response to underlying tumour therapy. The quality of life of the patient is affected, therefore the palliative treatment of paraneoplasia is very important.

Humans↗

[Association of Hodgkin lymphoma with Epstein-Barr virus in Hungary].

INTRODUCTION: The occurrence of Epstein-Barr virus associated Hodgkin's lymphoma shows considerable variation from continent to continent and from country to country but in Hungary no such investigations have been performed so far. AIM: The authors analyse the presence of Epstein-Barr virus and the type of latency in histologic samples taken from Hodgkin's disease patients. METHOD: They have analyzed the presence of virus using PCR, in situ hybridisation and immunohistochemistry. RESULTS: Out of 109 cases, 61 patients (56%) showed virus positivity by PCR while latent membrane protein 1 positivity was found in 47 cases (43%). As regards to gender ratio, 53% female and 58% male patients were virus positive by PCR. Epstein-Barr virus association did not show any alteration in children (1-14 years) when compared to that of adults (out of the 10 children 6 were positive by PCR). As regards to the lifestyle of Epstein-Barr virus positive patients, the incidence of smoking and the ratio of poor social conditions were significantly higher. Mixed cell type was the most frequent (65%) in these patients and Epstein-Barr PCR virus positivity was highest in this type (60%), primarily in age groups 11-20 and over 51 years. Epstein-Barr virus PCR positivity was 52% in nodular sclerosis (negative cases cumulated in the age group 15-30 years), other histologic subtypes could not be evaluated due to the small number of cases. On examining Hodgkin's lymphoma and Epstein-Barr virus association disease models, they could not categorize their patients into any of them though characteristic patient groups could be more or less observed also in their material. This may be explained by the socioeconomic differences of the population living under different economic conditions. CONCLUSION: These results indicate that Epstein-Barr infection may play an important role in the development of Hodgkin's lymphoma in Hungary, too.

Adolescent↗

[Nephrotic syndrome in Hodgkin's disease].

The authors are presenting a rare paraneoplastic syndrome in Hodgkin's disease. Young female patient presented with symptoms of nephrotic syndrome. Renal biopsy showed mesangiocapillary glomerulonephritis. Remission was achieved with combined therapy. Four months later, when the nephrosis syndrome relapsed, Hodgkin's disease was diagnosed (nodular sclerosing subtype). Hodgkin's disease was staged as III/BS. Polychemotherapy resulted complete remission of both Hodgkin's disease and nephrotic syndrome. Causes of nephrotic syndrome in Hodgkin's disease can include renal vein thrombosis, amyloidosis or paraneoplastic syndrome. Nephrotic syndrome in Hodgkin's disease may relate to dysfunction of T-cells or altered cytokine balance, but the exact pathogenesis is not known. This case attracts attention that a rare cause of nephrotic syndrome can be Hodgkin's disease.

Adult↗

Can CD3+/HLA-DR+ activated T cells predict the prognosis of non-Hodgkin's lymphoma patients?

The immune system has several mechanisms to fight against developing malignant cell clones in the host, one of them is the activated T-cell response. Both CD4+ helper and CD8+ cytotoxic T-cells bear HLA-DR molecules as important surface activation markers. Our aim was to determine, how the ratio of activated T cells change in the peripheral blood of non-Hodgkin's lymphoma (NHL) patients during the periods of polychemotherapy. Using the methods of immunofluorescence staining and flow cytometry, we found the ratio of CD3+/HLA-DR+ cells significantly higher in NHL patients before treatment compared to healthy controls (10.63% versus 2.97%, P<0.001). During the period of polychemotherapy, this ratio began to increase significantly (10.63% versus 16.94%, P=0.006). After treatment, the ratio of activated T cells decreased, however, we detected significantly higher rate of CD3+/HLA-DR+ lymphocytes in patients who relapsed within 1 year than in those who stayed in remission (9.55% versus 20.62%, P<0.001). We suppose that investigation of CD3+/HLA-DR+ activated T cells might be a promising method to determine the prognostics of lymphoma patients.

Adult↗

[Primary treatment of advanced Hodgkin's disease].

Primary treatment of advanced Hodgkin's disease. Hodgkin's disease is one of the few malignant diseases that can be cured even in an advanced stage in the majority of cases. By employing a polychemotherapy containing anthracyclines, a long remission and recovery can be achieved in 60-70% of the patients. At present the standard treatment is ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) scheme for the following reasons: besides good treatment results early side effects are more favourable; sterility and secondary acute leukemia present themselves less often than by employing regimens containing alkylating agents. Unfortunately, some of the patients do not react properly to the treatment and about one third of the patients who are in remission following primary treatment will relapse at a later stage. The main goal is now to further improve treatment (recovery) results without an increase, or even a decrease of early or late side effects. Awareness of prognostic factors should lead to the employment of a less intensive but not toxic therapy in patients with good prognosis to prevent overtreatment, while in cases with bad prognosis a more effective regimen is needed (even for the price of expected complications). The latest meta-analysis on the subject has shown that--similarly to sequential high dose therapy--the addition of radiotherapy to an effective chemotherapy does not seem to prolong the survival of patients. Despite the excellent therapeutic results achieved by the many new "intensive" chemotherapies, there is unfortunately no optimal therapy or protocol available today. The multicentre analysis to confirm these results and to compare them with standard scheme is still under way. It is to be hoped that risk adapted management for advanced stage Hodgkin's disease will also be available soon.

Age Factors↗

[Primary treatment of early stage Hodgkin's disease].

Until the beginning of the 1990s, early stage Hodgkin's disease had been treated by (involved field) radiotherapy in most cases. Since the mid-1990s, by revealing a range of prognostic factors and late complications of radiotherapy, the treatment protocol has been modified. The use of combined modality therapy (programmed combined use of chemo- and radiotherapy) has gained ground. At present, in early stage Hodgkin's disease, 2-6 cycles ABVD followed by decreased dose involved field irradiation is considered to be the standard treatment. The number of chemotherapy cycles depends on the prognostic factors and reaction time. In cases of early stage nodular lymphocyte predominance with good prognosis, only involved field irradiation therapy is used.

Antineoplastic Combined Chemotherapy Protocols↗

[Treating Hodgkin's disease: for whom the more means better?].

During the last half century, our knowledge and expertise increased, and Hodgkin's disease became one of the most curable malignant diseases. However, our results are still not satisfactory in the case of advanced stage. Apart from standard chemotherapy regimens, several other, so-called intensive first line therapy schedules have been tried, whose common characteristic is that more antineoplastic drugs within a reasonably shorter period and sometimes with increased dose had been administered. Out of these regimens, escalated dose BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisolone), the therapy yielding the best results and inciting hot debates in the literature is discussed here in detail. Though many questions related to BEACOPP scheme are still unanswered and at present it is not recommended for use in first line therapy except for trials, it seems that patients under 60 years of age, with advanced stage disease having poor prognosis, may benefit from this treatment.

Antineoplastic Combined Chemotherapy Protocols↗

Intracellular IL-4/IFN-gamma producing peripheral T lymphocyte subsets in B cell non-Hodgkin's lymphoma patients.

AIM: The availability of several biological therapy options is rapidly growing in the field of malignant lymphomas. This emphasizes the need to understand the precise interaction of the host immune system with the malignant disease. We measured the intracellular cytokine responses in lymphoma patients' lymphocytes, to characterize the polarization changes in their immune system. METHODS: Patients with B cell non-Hodgkin's lymphoma were involved in the study. Peripheral lymphocytes were labeled with anti-CD4 or anti-CD8 antibodies and intracellular accumulation of IL-4 or IFN-gamma was detected after in vitro incubation the cells with activating cocktail. The frequency of different T-cell subsets were measured within the lymphocyte population. RESULTS: Significantly increased CD4+, IFN-gamma producing (Th1) cell percentage were found in untreated lymphoma cases (28.8% vs. 21.8%). CD8+ IL-4 and IFN-gamma producing (Tc0) T cell frequency is significantly higher in untreated lymphoma patients compared with normal controls (1.3% vs. 0.47%). The frequency of CD4+ IL-4 producing (Th2) cells is significantly lower in untreated patients (0.96% vs. 1.19%). Patients in long-term remission have lower frequency of CD4+, IL4 producing (Th2) cell ratio (0.31% vs. 1.19%) and increased CD4+ IFN-gamma producing (Th1) cell frequency (30.1% vs. 21.8%), compared with healthy normal controls. CONCLUSION: Our results demonstrate that there is a sustained increase in the CD4+ IFN-gamma producing cell frequency in lymphoma patients. The frequency of CD4+ IL-4 producing cells is decreasing by treatment. These may contribute to strong polarization toward Th1 type response, needed for lymphoma clearance and remission.

Adult↗

Is the treatment of Hodgkin's disease detrimental to the parathyroid gland?

The thyroid gland is often injured by supradiaphragmatic irradiation for Hodgkin's lymphoma. The aim of the present study was to examine whether the parathyroid gland gets injured by the treatment for Hodgkin's disease. Calcium, phosphorus and parathormone levels of 143 patients with primary treatment for Hodgkin's disease and in complete remission for 2 years were measured as well as the presence of antiparathyroid antibody in patients having antithyroid antibody. Out of the 143 patients studied, 104 received neck irradiation (with or without chemotherapy); among them laboratory alterations were observed in 7 cases. 39 patients received only chemotherapy; 3 of them had alterations. In contrast to the injury of the thyroid gland, no damage to the parathyroid glands associated with the treatment for Hodgkin's disease was noted. It has been concluded that the use of high-dose external radiotherapy does not mean a higher risk as regards the parathyroid gland but further follow-up studies of the patients may result in the revelation of the development of parathyroid lesions.

Adolescent↗

HCV and HGV infection in Hodgkin's disease.

Numerous observations imply that the pathogenesis of malignant lymphomas is multifactorial and that viruses probably play an important etiologic role. Besides Epstein-Barr virus, there might be other viruses among the causes of Hodgkin's disease. A total of 111 randomly selected patients with Hodgkin's disease were included in this study, and hepatitis C and G viruses were tested with polymerase chain reaction. The results were compared to hepatitis C and G virus infection ratios assessed by polymerase chain reaction in the Hungarian blood bank. Hepatitis C virus was diagnosed in 10 (9%) patients, and hepatitis G virus in 9 (8,1%), which is a 12-fold and a 1,5-fold infection rate as compared to that of the Hungarian blood bank, respectively. There was no significant difference between hepatitis positive and negative patients concerning mean age at the time of diagnosis, sex, disease stage, histology type, treatment applied, risk factors in the history of the infection and liver enzymes. Hepatitis C virus positivity in patients with Hodgkin's disease differs significantly from that in blood donors. Based on these results and data in the literature, no definite statement can be made on the etiological role of viruses, but further studies are needed.

Adolescent↗

[Follicular lymphoma].

Follicular lymphoma is one of the most common indolent nodal non-Hodgkin's lymphomas. The follicular lymphoma should be differentiated from other nodal non-germinal centre derived lymphomas. Since bcl-2 gene translocation can be detected in 80-90% of the cases, it could be used for the confirmation of the diagnosis, measure of the treatment efficacy as well as for the evaluation of the prognosis and follow-up of the disease. There is no uniform therapy employed for follicular lymphoma patients. The treatment depends on the histological grade, stage, age and condition of the patients. Since disease cannot be cured by conventional dosage therapy in the vast majority of the cases, a treatment--adjusted to the condition of the patients as well as the stage and grade of the disease--ensuring the longest period and best quality of life should be selected. The authors review the questions of diagnosis and treatment, including the results of radiotherapy and chemotherapy and discuss the role of the interferon-alpha, purine analogues, monoclonal antibodies and high-dose therapy.

Antibodies, Monoclonal↗

[Renal and ureter complications from the treatment of Hodgkin's disease].

PURPOSE: The authors analysed renal and ureter complications in Hodgkin's disease patients after treatment. PATIENTS AND METHODS: We examined retrospectively 512 primary treated and followed up patients with Hodgkin's disease. RESULTS: We observed renal, ureter or bladder complications after irradiation in 16 cases (3.125%). Five patients had injured left kidney, out of them only two had pyuria or proteinuria and 4 received radiotherapy and chemotherapy as well. We observed complications of both kidneys in 7 patients. Four patients had pyelonephritis or cystitis. We did not find severe cystitis in patients treated wsith cyclophosphamide. CONCLUSIONS: Acute and chronic irradiation nephropathy are rather anatomic than functional lesions. Planning, dose and period of the radiotherapy, irradiation volume play parts in the development of complications. Prior chemotherapy increases incidence of irradiation nephropathy. These rare complications of Hodgkin's disease are usually avoided with the use of modern radiotherapy apparatus and the up to date treatment methods.

Adult↗