[Cardiac toxicity of anthracyclines. Clinical forms, incidence, surveillance]

Anthracyclines have greatly contributed to improvement in the prognosis of certain cancers, but their beneficial effect is impaired by an unquestionable toxicity affecting notably the heart. Changes in blood pressure or electrocardiograms, benign pericardial reactions and rare but severe myocarditis may occur at an early stage of treatment. The cumulative toxicity of anthracyclines limits their use. With a cumulative dose of 550 mg/m2 the mean incidence of toxicity varies from 5 to 10 percent. The occurrence of toxicity largely depends on the total dose, but other factors such as patient's age and general condition, and previous treatments with chemo- or radiotherapy must be taken into account. The best methods to monitor the cardiotoxicity of anthracyclines are echocardiography, radionuclide study of ejection fraction and myocardial biopsy for histological study. The rational use of these three types of examination must be adjusted to each individual patient. It should reduce the incidence of severe myocarditis which sometimes cancels all the beneficial effects of the anticancer treatment.

Paraneoplastic Raynaud's phenomenon

A testicular tumour could be diagnosed by the occurrence of a Raynaud's phenomenon complicated by severe digital arteritis. The arteritis rapidly regressed under prostacyclin therapy. Such vascular manifestations are frequent in testicular carcinoma, but they usually develop after chemotherapy. To our knowledge, this is the first case where they preceded the diagnosis and specific treatment of a tumour of the testis.

[Malignant lymphoma in rheumatoid arthritis treated by low doses of methotrexate]

The authors report a case of non-Hodgkin's malignant lymphoma which developed in a patient under low-dose methotrexate for rheumatoid arthritis. Although rheumatoid arthritis without immunosuppressive therapy may be associated with an increased incidence of malignant lymphoma, the immunosuppressive effects of methotrexate may further promote the development of malignant lymphoma.

Lymphoma developing in a patient with rheumatoid arthritis taking methotrexate

We report one case of non-Hodgkin lymphoma in a patient, with a 30-year history of rheumatoid arthritis, taking low dose methotrexate weekly over a 10-month period. The mild immunosuppression that occurs with methotrexate therapy probably places patients with rheumatoid arthritis at added risk of developing lymphoproliferative diseases, but coincidence cannot be excluded.

MACOP-B chemotherapy for the treatment of high-grade lymphomas in patients with HIV-1 infection

Recent studies showed that patients with non-Hodgkin's lymphoma (NHL) with human immunodeficiency virus type 1 (HIV-1) infection may benefit from an intensive chemotherapeutic regimen. We report on our experience in the treatment of NHL-associated HIV-1 infection, with excellent prognostic factors, with MACOP-B regimen.