PubMed Health⌕ Search

Biomedical subjects

M Bendandi

Publications and source records attributed to M Bendandi.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Bulky mediastinal lymphomas: role of magnetic resonance and SPECT-Ga-67 in the evaluation of residual masses].

A residual mediastinal mass is a common finding during and/or after treatment for bulky mediastinal lymphoma and represents a difficult diagnostic problem. For correct therapy modulation, fibrosis must be distinguished from active disease. To assess diagnostic imaging potentials in the characterization of residual masses, 41 patients with bulky mediastinal lymphoma were examined with CT, MRI and Ga67-SPET; 92 examinations were performed for each technique: 14 before treatment, 42 during and after chemotherapy, 13 after radiotherapy and 23 six months after the end of treatment. CT provides useful pieces of information on tumor size but fails to depict tissue changes: therefore, only MR and SPET results were considered and compared with clinico-biological and follow-up findings. MRI and SPET were often in agreement with each other (78/92 cases) and with clinical data (98.7%); each examination yielded only one false positive. In case of disagreement (14/92 patients), MRI yielded more false-positive findings because it failed to differentiate neoplastic tissue from treatment-related conditions, i.e., granulation tissue, inflammation, necrosis, early fibrosis. In contrast, negative MR results were more reliable, MR negative predictive value being 100%. Ga67-SPET exhibited high sensitivity (97.1%) and specificity (91.2%), with fewer false positives than MRI (5 vs. 10). In conclusion, both examinations were accurate in the characterization of residual mediastinal masses during and after therapy, but MRI had higher sensitivity and Ga67-SPET higher specificity. Therefore, the authors acknowledge the complementary role of these two techniques and the necessity of an integrated approach, i.e., combined MRI and Ga67-SPET or CT and Ga67-SPET.

Adolescent↗
PubMed1994

CEP regimen (CCNU, etoposide, prednimustine) for relapsed/refractory Hodgkin's disease.

AIMS AND BACKGROUND: Although initial treatment of Hodgkin's disease induces a complete remission in most patients, approximately 50% of patients with advanced disease will not achieve a complete remission or will relapse following the first complete remission. PATIENTS AND METHODS: Twenty-three patients with relapsed/resistant Hodgkin's disease, observed between January 1991 and October 1993, underwent CEP combination chemotherapy (CCNU, etoposide, prednimustine). All patients had previously received MOPP and ABVD regimens, in combination at diagnosis or sequentially (at diagnosis and at the first relapse). RESULTS: Thirteen (56%) patients achieved complete responses and 4 (18%) had partial responses. Two partial responders obtained a complete remission after a successive autologous bone marrow transplantation. The complete remission was not influenced by the timing of MOPP and ABVD treatments, presence of extranodal involvement or presence of bulky disease, but was affected by the presence of a primary disease refractory to the first standard programs. All the complete responders but 2 were alive and relapse-free at a median follow-up of 15 months; no major toxic effects were recorded. CONCLUSIONS: These data suggest, as did those of other studies, that CEP is an effective regimen in patients with Hodgkin's disease in first or second relapse, also to reduce the tumor burden and to determine chemosensitivity before contingent bone marrow or peripheral blood stem cell support.

Adult↗
PubMed1994

Apoptosis induction with three nucleoside analogs on freshly isolated B-chronic lymphocytic leukemia cells.

The cytotoxic effects and the induction of programmed cell death (apoptosis) by Fludarabine (FLU), 2-chlorodeoxyadenosine (2-CdA), and deoxycoformycin (DCF) with/without alpha-interferon (alpha-IFN) were evaluated in vitro against freshly isolated B-chronic lymphocytic leukemia (B-CLL) cells. Cytotoxicity was evaluated according to the soluble tetrazolium/formazan assay. Regarding the cytotoxicity, FLU, 2-CdA, and DCF showed a mean antitumor activity of 45% +/- 3.39 (mean +/- S.D.), 55% +/- 4.72, and 20% +/- 3.16, respectively. alpha-IFN alone showed a mean cytotoxic activity of 10% +/- 2.72. The cytotoxicity of these purine analogues in combination with alpha-IFN was 52% +/- 2.97, 75% +/- 3.41, and 26% +/- 7.09, respectively. We observed a statistically significant increase of cytotoxicity compared to controls in FLU alone (P < 0.05), 2-CdA (P < 0.05), and their combination with alpha-IFN (P < 0.05). Apoptosis was evaluated by electrophoresis gel of DNA oligonucleosomal fragments and by a cytofluorimetric method. Only FLU and 2-CdA activated the apoptosis and DCF showed a minor apoptotic pathway amount. These apoptosis data were confirmed by both gel electrophoresis of DNA and by propidium iodide cytofluorimetric method. FLU and 2-CdA show activity in B-CLL cells by direct cytotoxic action and the induction of cell death by apoptosis; in the future, it would be interesting to utilize these in vitro assays in monitoring chemosensitivity and predicting response for the clinical use.

Aged↗
PubMed1994

Adult Burkitt's lymphoma: clinical and prognostic evaluation of 20 patients.

Burkitt's lymphoma (BL), a rapidly growing lymphoma, is recognized by its aggressive course, brief median survival, and low rates of long-term survival for patients. Several polychemotherapeutic approaches are utilized. Twenty adult patients with BL identified according to the Kiel classification were analysed retrospectively. Therapeutic modifications depended upon the different times of the diagnosis. Eight patients received the LSA2-L2 regimen, 11 patients were treated with third generation polychemotherapeutic regimens for high-grade non-Hodgkin's lymphomas: F-MACHOP and MACOP-B, and 1 elderly patient was given the COP regimen. Of the 11 patients treated with cyclic conventional therapy (7 with F-MACHOP and 4 with MACOP-B), 8 achieved a complete response (CR). Of the 8 patients who were given the LSA2-L2 protocol, 4 obtained a CR. One elderly patient treated with the COP regimen obtained a partial response. Early stage of disease, low levels of LDH, and the absence of bone marrow involvement were characteristics of patients with good prognoses. Effective conventional third-generation polychemotherapy regimens (F-MACHOP and MACOP-B), normally used for high-grade non-Hodgkin's lymphomas, were equally effective for a large fraction of adults with BL. Furthermore, our study confirms the important role of LDH level, stage, and bone marrow involvement as prognostic factors in BL as well as the roles of tumor burden in the CR rate and relapse-free survival.

Adolescent↗
PubMed1994

Radiotherapy in early stage Hodgkin's disease.

Ninety-nine patients with "standard risk" Stage IA-IIA Hodgkin's disease observed between January 1983 and December 1990, received radiotherapy only. The complete response rate was 98% (97/99). Twenty-one patients (21%) relapsed, 17 of whom (81%) obtained a second complete remission. The projected 9-year overall survival and disease-free survival were 95% and 78%, respectively. In this study our goals were to reduce the irradiation volumes, to decrease the number of splenectomies performed at diagnosis, and to utilize radiotherapy alone in these patients. We were able to reduce the irradiation volumes in over 50% and 80% of the patients with disease in the upper torso and subdiaphragm, respectively. Furthermore, this therapeutic approach permitted us to reduce the acute and long-term toxic effects related to splenectomy and combined modality treatment.

Adolescent↗
PubMed1993

Fludarabine: an active agent in the treatment of previously-treated and untreated low-grade non-Hodgkin's lymphoma.

BACKGROUND: Fludarabine (FLU) is a new antimetabolite chemotherapeutic agent with a promising therapeutic activity in the lymphoproliferative disorders. PATIENTS AND METHODS: We performed a phase II study with this drug in previously untreated and treated patients with resistant and/or relapsed low-grade non-Hodgkin's lymphoma (LG-NHL) to determine its response rate. Twenty-one patients were treated at a dosage of 25 mg/m2 per day for 5 consecutive days. RESULTS: Of the 21 patients, 3 achieved complete responses (CR) and 11 partial responses (PR). In addition, three patients obtained minor responses, and the remaining 4 showed no benefit from the treatment. An increased response rate was achieved in 8 untreated patients in which 3 CR and 3 PR were documented. Furthermore, 4 of the 5 patients showing a leukemic blood picture experienced significant reductions of lymphocyte count and 2 patients with macroglobulinemic lymphomas experienced significant reductions of the IgM monoclonal component from 7.8 and 5.9 g/100 mL to 1.0 and 1.1 g/100 mL, respectively. The toxicity on platelets was negligible. The major toxic effects observed were neutropenia (62%) and infections and/or febrile episodes (19%) that were fatal to only one patient. CONCLUSIONS: In consideration of its significant activity, the role of FLU needs to be further evaluated in the management of pretreated and untreated patients with LG-NHL.

Adult↗
PubMed1992

Massive mediastinal involvement in stage I-II Hodgkin's disease: response to combined modality treatment.

Thirty-seven patients with stage I-II Hodgkin's disease and massive mediastinal involvement, observed between June 1981 and November 1989, underwent combined modality treatment. This treatment included: 3 cycles of mechlorethamine, vincristine, procarbazine, and prednisone followed by mantle-field irradiation, and subsequently by 3 additional cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine. Thirty-five (95%) patients achieved complete responses and only 2 (5%) had partial responses. All the complete responders are living and relapse-free at a median follow-up of 62 months; no major toxic reactions were recorded. These data suggest, as did those of other studies, that combined modality therapy is superior to either radiotherapy or chemotherapy alone for patients in stage I-II with bulky disease, especially in the mediastinum. In fact, in these particular patients, if adequately treated with a combination of chemotherapy and radiotherapy, the role of massive mediastinal involvement as a poor prognostic factor appears to be less significant.

Adolescent↗
PubMedDate not supplied

[Active immunotherapy in the treatment of haematological neoplasias].

The continuous search for therapeutic approaches that improve the conventional treatments of neoplasms, together with an improved understanding of the immune system, has led in recent years to the development of Immunotherapy. Basically, a distinction can be made between two forms of immunotherapy: passive immunotherapy, which consists in the transfer of antibodies or cells previously generated in vitro that are directed against the tumour, and active immunotherapy, which attempts to activate in vivo the immune system and induce it to elaborate a specific response against the tumor antibodies. Hematological neoplasms, specifically some B lymphomas, express in their membrane an immunoglobulin that is considered a specific antigen of the tumour, which is why these diseases have become the ideal target for immunotherapy treatments. There are many alternatives, ranging from protein vaccines, which have already shown clinical benefits, to those of the second generation, which make use of the new techniques of molecular biology to increase the efficacy of the vaccines and obtain their production in a quicker and less costly way, but with which there are not yet definitive clinical results.

Cancer Vaccines↗
PubMedDate not supplied

[The immunotherapy potential of agonistic anti-CD137 (4-1BB) monoclonal antibodies for malignancies and chronic viral diseases].

Pharmacological intervention on the immune system to achieve more intense lymphocyte responses has potential application in tumour immunology and in the treatment of chronic viral diseases. Immunostimulating monoclonal antibodies are defined as a new family of drugs that augment cellular immune responses. They interact as artificial ligands with functional proteins of the immune system, either activating or inhibiting their functions. There are humanized monoclonal antibodies directed to the inhibitory receptor CD152 (CTLA-4) that are being tested in clinical trials with evidence of antitumoural activity. As a drawback, anti-CTLA-4 monoclonal antibodies induce severe autoimmunity reactions in a fraction of the patients. Anti-CD137 monoclonal antibodies have the ability to induce potent immune responses mainly mediated by cytotoxic lymphocytes with the result of frequent complete tumour eradications in mice. Comparative studies in experimental models indicate that the antitumour activity of anti-CD137 monoclonal antibodies is superior to that of anti-CD152. CD137 (4-1BB) is a leukocyte differentiation antigen selectively expressed on the surface of activated T and NK lymphocytes, as well as on dendritic cells. Monoclonal antibodies acting as artificial stimulatory ligands of this receptor (anti-CD137 agonist antibodies) enhance cellular antitumoural and antiviral immunity in a variety of mouse models. Paradoxically, anti-CD137 monoclonal antibodies are therapeutic or preventive in the course of model autoimmune diseases in mice. In light of these experimental results, a number of research groups have humanized antibodies against human CD137 and early clinical trials are about to start.

Animals↗
PubMedDate not supplied

Hodgkin's disease: summary of twenty years' experience.

BACKGROUND: A retrospective analysis on HODGKIN'S DISEASE (HD) was finalized to see if changing the management and therapy during the years we improved the cure rate of lymphomas and reduced the incidence of side effects due to therapy. Up to twenty years' experience was based in two major therapeutic periods: the first included patients observed between 1970 and June 1980 and the second between July 1980 and December 1987. Significant differences between the two periods were the reduction of splenectomies as staging procedure, the reduction of radiation dose and extension and the sequential use of MOPP/ABVD instead of MOPP alone. METHODS: The analysis included all patients observed over the twenty years under study by looking to the differences concerning response to therapy, survival, relapse-free survival and major consequences due to therapy, namely death not directly related to lymphoma. 377 pts entered the first period and 193 the second one with a minimum follow-up of 4 years. RESULTS: Significant differences were recorded on CR rate, 80.9% vs 90.5%, respectively (p = 0.0024) and deaths in CR, 15.1% vs 2.6%, respectively (p = 0.000). The overall survival shows a probability of 60% and 83% at 11 years for the first and the second group, respectively (p = 0.000) being the probability of survival of 50% at 20 years for the first group of pts. The probability of being in remission is similarly of 79% and 78%, for the first and second group, respectively. The risk of death in remission accounting all causes not related to lymphoma shows a 17% probability vs 6% at 11 years (p = 0.006) for the first and second group, respectively, being 38% for the former group at 20 years. The most frequent single cause of death in remission was secondary leukemia which was recorded in 14 pts on the group of pts observed between 1970 and 1980, all splenectomized and treated by MOPP and extensive radiotherapy. CONCLUSIONS: The modifications of therapy of HD have produced improvements concerning the prognosis of pts; these improvements are due mainly to the reduction of late side effects such as acute leukemia and second solid tumor, and to the increase of remission rate and cure rate of the lymphoma.

Adolescent↗
PubMedDate not supplied

"Very late" relapses in Hodgkin's disease patients: a rare but real phenomenon.

In the past several decades, scientific and therapeutic advances have transformed Hodgkin's disease from a uniformly fatal illness to one that can be treated with the expectation of long-term remission or cure in the majority of cases. Because patients now survive for long periods after treatment, various late complications are being identified. Among patients with such late complications, some have been reported to experience "very late" relapses (> 10 years). Here we document recurrences in three patients with Hodgkin's disease more than 10 years after remission.

Adult↗
PubMedDate not supplied

Alpha-interferon as maintenance drug after initial fludarabine therapy for patients with chronic lymphocytic leukemia and low-grade non-Hodgkin's lymphoma.

BACKGROUND: Fludarabine monophosphate (FLU) is an adenine nucleoside analogue with promising therapeutic activity in lymphoproliferative disorders. In addition, the effectiveness of alpha-interferon (alpha-IFN) in low-grade non-Hodgkin's lymphoma (LG-NHL) and B-cell chronic lymphocytic leukemia (B-CLL) has been demonstrated in several clinical trials. METHODS: In a phase II study of 45 patients with B-CLL and 28 with LG-NHL, we used FLU as second and third-line chemotherapy. Dosages of 25 mg/m2 were given in 30-minute infusions for 5 consecutive days. Treatment was repeated every 28 days depending on patients' clinical status for a maximum of 6 cycles. Entrance in the human lymphoblastoid alpha-IFN maintenance portion of the study depended on response to initial FLU. Following randomization we administered alpha-IFN, or no therapy at all, to patients who obtained a complete or a partial response after FLU therapy. The alpha-IFN dose was 3 x 10(6) U three times per week until disease progression. RESULTS: Twenty-one B-CLL patients achieved major responses, as did 17 of those with LG-NHL. Twenty-four of the former group and 11 of the latter failed to respond or obtained only a minor response. The 38 patients who responded well and entered the second part of the trial showed significant prolongation of remission duration with maintenance alpha-IFN. CONCLUSIONS: In consideration of its significant activity, the role of FLU in the management of lymphoproliferative disorders needs to be evaluated further; at the same time, this preliminary analysis seems to indicate that maintenance alpha-IFN may extend remission duration in B-CLL and LG-NHL.

Adult↗
PubMedDate not supplied

[Past, present and future of anti-idiotype vaccination].

Cancer vaccines are conceived as therapeutic tools, in contrast to the prophylactic vaccines used to fight against infectious diseases. Among the most potent therapeutic vaccines, anti-idiotype vaccination is directed against the tumor idiotype, the only well-characterized tumor antigen displayed in neoplastic B-cells. Anti-idiotype vaccines have demonstrated clinical benefit against follicular lymphoma and are currently being evaluated in two different phase III clinical trials. Additional emerging strategies, which include the use of dendritic cells and the production of vaccines via molecular means will surely allow us to draw important conclusions concerning the treatment of cancer patients.

Cancer Vaccines↗
PubMedDate not supplied

VNCOP-B regimen in the treatment of high-grade non-Hodgkin's lymphoma in the elderly.

BACKGROUND: Age is an important factor, especially in patients with advanced lymphoma who require more intensive and extensive therapy for any possible chance of cure. In fact, attenuation of treatment to diminish treatment-related toxicity decreases the capacity of the therapy to effect a cure. METHODS: Between December, 1991 and February 1993, 29 previously untreated patients 60 years and older with high-grade non-Hodgkin's lymphoma (HG-NHL), according to the Kiel classification, were treated with a combination therapy including cyclophosphamide, mitoxantrone, vincristine, etoposide, bleomycin, and prednisone (VNCOP-B). RESULTS: Twenty-two patients achieved a complete pathologic remission and 5 had a partial response, with a reduction of more than 50% of tumor-related manifestations. Only two cases were resistant to VNCOP-B. Overall survival was 75%, with a median follow-up of 13 months from diagnosis; four of the patients who achieved complete response relapsed after a median follow-up of 11 months from the completion of treatment. Clinical and hematologic toxicity was irrelevant: in 12 patients, neutropenia was responsible for a temporary interruption of therapy for 1-2 weeks. CONCLUSIONS: This regimen was effective in inducing a good remission rate with moderate toxic effects in elderly patients with HG-NHL, but a longer follow-up is warranted before definitive conclusions can be drawn.

Aged↗
PubMedDate not supplied

Ifosfamide, epirubicin and etoposide (IEV) therapy in relapsed and refractory high-grade non-Hodgkin's lymphoma and Hodgkin's disease.

BACKGROUND: A fundamental principle in the therapeutic strategy for recurrent lymphomas is the employment of agents that are not part of the usual front line combination regimens. Ideally, the cytotoxic agents should lack complete cross resistance with those utilized up front. PATIENTS AND METHODS: A three-drug combination of ifosfamide, epirubicin and etoposide (IEV) was used to treat 20 patients with relapsing or refractory high-grade non-Hodgkin's lymphoma (HG-NHL) or Hodgkin's disease (HD). RESULTS: Of 14 patients with HG-NHL, 5 (36%) achieved a complete response (CR) and 4 partial remission (PR), giving an overall response rate of 64%. To date, all the complete responders are still in CR at +5, +5, +6, +7, and +9 months, respectively. Of 6 patients with HD, 4 (66%) obtained CR and 2 PR, giving an overall response rate of 100%. The 4 CRs are still in remission after +4, +5, +9, and +13 months, respectively. Clinical and hematologic toxic effects were moderate: neutropenia was responsible for delaying treatment for a week in 6 patients. CONCLUSIONS: These results confirm the efficacy of the IEV regimen in inducing a good remission rate with moderate side effects in relapsing/refractory HG-NHL and HD patients and they show that further investigations with this combination are warranted.

Adult↗