Synergistic cytotoxicity of Bcl-xL inhibitor, gossypol and chemotherapeutic agents in non-Hodgkin's lymphoma cells

Anti-apoptotic proteins Bcl-2 and Bcl-xL are overexpressed in 80% of non Hodgkin's lymphoma cells and are thought to play an important role in the resistance of lymphoma cells to current chemotherapeutic agents. Gossypol, an orally-active polyphenolic aldehyde derived from the cotton plant, has been known to have potential anti-neoplastic activity. Recently, gossypol was found to bind to the BH3 binding groove of Bcl-xL and with lesser affinity to Bcl-2. The present study was conducted to determine whether gossypol increases the sensitivity of non-Hodgkin's lymphoma cells to the actions of chemotherapeutic agents by potentiating treatment-induced apoptosis. The interactions observed between gossypol and chemotherapeutic drugs were analyzed using the median effect principle (CalcuSyn analysis). Our data showed that treatment of Ramos cells with gossypol not only induced cell arrest on the G(0)/G(1) phase, but also augmented apoptosis and growth inhibition induced by etoposide (VP-16), doxorubicin hydrochloride (ADM), vincristine (VCR), and paclitaxel (taxol). However, when gossypol was combined with cisplatin (DDP) an antagonistic effect was observed. Gossypol-induced cell cycle arrest was accompanied by decreased expression of cyclin D1 in Ramos cells. In addition, the peroxisome proliferator-activated receptor (PARP) pathway is, at least in part, involved in the gossypol-induced apoptosis when combined with VP-16. These data indicate that single-agent gossypol is effective in inhibiting growth of non-Hodgkin's lymphoma cells in vitro and combination studies with certain secondary chemotherapeutic agents further demonstrate it's synergistic cytotoxicity. These findings support future preclinical and clinical studies of gossypol in the treatment of non-Hodgkin's lymphoma.

[Expression of CD16zeta in NK cells of B-cell non-Hodgkin's lymphoma patients and in vitro killing effect of rituximab combined lymphokine-activated killer cells on B-NHL cells]

BACKGROUND & OBJECTIVE

Natural killer (NK) cells are the main effector of antibody-dependent cellular cytotoxicity (ADCC). The activation disorder of NK cells in cancer patients may affect the treatment effect of monoclonal antibody. Reversing the dysfunction of signal transduction of CD16zeta chain in NK cells and combining lymphokine-activated killer (LAK) cells with rituximab may give rise to synergistic effect. This study was to find out whether the activation disorder of NK cells exist in B-cell non-Hodgkin's lymphoma (B-NHL) patients, whether interleukin-2 (IL-2) can reverse the activation disorder in vitro, and whether the combination of rituximab and LAK cells can produce synergistic antitumor effect.

METHODS

Peripheral blood mononuclear cells (PBMCs) were isolated from 69 B-NHL patients and 30 healthy donors by density gradient centrifugation method, and cultured with IL-2 (1 000 U/ml) to prepare LAK cells. The positive rate and median fluorescence intensity (MFI) of CD16zeta chain in PBMCs and LAK cells were detected by flow cytometry (FCM). The expression of CD20 on Raji cells was also detected by FCM. The apoptosis of Raji cells after treatment of rituximab was detected by FCM with Annexin V/PI staining. The cytotoxicity was assessed by lactate dehydrogenase (LDH) release experiment.

RESULTS

The positive rate and MFI value of CD16zeta chain on CD56+ cells were significantly lower in B-NHL group than in control group [(63.3+/-16.4)% vs. (97.8+/-3.1)%, P<0.001; 1.3+/-1.3 vs. 3.6+/-1.7, P<0.001]. There was no significant difference in the positive rate and MFI value of CD16zeta on LAK cells between the 2 groups [(99.3+/-4.1)% vs. (99.7+/-3.9)%, P=0.145; 29.2+/-12.5 vs. 31.4+/-13.8, P=0.44]. At the concentration of 40 mug/ml, rituximab completely combined CD20 antigens on cell membrane. The obvious enhancive effect of rituximab on cell apoptosis appeared at 24 h after treatment. The killing rate of Raji cells was significantly higher in rituximab combined LAK group than in LAK group (P<0.05). While the combination of LAK cells and Herceptin (40 mug/ml) didn't make a significant increase as compared with Herceptin alone (P>0.05). There was no significant difference in killing rate of Jurket cells between rituximab combined LAK group and LAK group (P>0.05).

CONCLUSIONS

The down-regulation of CD16zeta chain expression widely exists in B-NHL patients, while high dose of IL-2 could enhance the expression of CD16zeta chain greatly in vitro. The combination of rituximab and LAK cells shows strong killing effect on Raji cells.

[Primary non-Hodgkin's lymphoma of the paranasal sinuses: a report of 14 cases]

BACKGROUND & OBJECTIVE

Primary paranasal sinus lymphoma (PPSL) is a rare presentation of extranodal non-Hodgkin's lymphoma with a natural history distinct from other lymphomas. This study was to evaluate the clinical and pathologic characteristics, treatment outcomes and prognosis of PPSL.

METHODS

The records of 14 PPSL patients, treated at Cancer Center of Sun Yat-sen University from 1994 to 2006, were analyzed.

RESULTS

The primary involvement sites included the maxillary sinus (11 cases), ethmoid sinus (2 cases), and sphenoid sinus (1 case). All patients were at stage I-II (Ann Arbor system). According to the AJCC TNM staging system, most patients had advanced T3-T4 disease. Of the 14 patients, 12 had B-cell PPSL, 1 had T-cell PPSL, and 1 had unclassified PPSL. The most common type was diffuse large B-cell PPSL (6 cases, 42.9%). Two patients underwent total maxillectomy and 12 underwent local excision or biopsy. All patients received chemotherapy and 6 received radiotherapy after chemotherapy. Both 5-year overall and event-free survival rates were 78.6%, with a median survival of 59.5 months(range, 2-192 months).

CONCLUSIONS

PPSL is an uncommon presentation of lymphoma characterized by bulky local disease. Diffuse large B-cell lymphoma is the most common histologic type and the maxillary sinus is the most common original site of PPSL. A combined-modality approach with systemic chemotherapy and local-regional radiation is recommended for PPSL patients. The prognosis of PPSL is relatively good.

[Clinical tolerance trial on recombinant human endostatin adenovirus]

BACKGROUND & OBJECTIVE

Recently, some phase I trials on endostatin has shown broad antitumor activity with low toxicity. This study was to determine the maximal tolerant dose (MTD) of recombinant human endostatin adenovirus Ad-Es for human.

METHODS

For the sake of safety, 1 patient was treated with 1x10(10) VP Ad-Es single intratumoral injection in advance. A total of 14 patients with malignant tumors received weekly intratumoral injection of Ad-Es in a dose-escalation manner (1x10(11) VP, 5x10(11) VP, 1x10(12) VP) for 2 weeks.

RESULTS

Toxicity profiles in all 15 cases were available. All patients tolerated well. No dose-limited toxicity (DLT) and serious adverse event were observed during treatment. Main adverse events were injection reaction (40.0%) and fever (53.3%). One patient with nasopharyngeal carcinoma had a minor response, 12 patients showed stable disease and 2 patients had progressive disease.

CONCLUSION

Ad-Es is well tolerated up to 1x10(12) VP. The recommended dose for phase II trial is 1x10(12) VP intratumor injection for 4 consecutive weeks.

[Efficacy of CPT-11 combined 5-FU/CF (FOLFIRI) regimen on advanced colorectal cancer]

BACKGROUND & OBJECTIVE

Combination therapy of irinotecan, leucovorin (LV), and 5-fluorouracil (5-FU)(FOLFIRI regimen) has certain effect on advanced colorectal cancer. However, data of this regimen as first-line chemotherapy for Chinese patients with advanced colorectal cancer is still lacking, and its efficacy and safety still needs to be defined. This study was to explore the efficacy of FOLFIRI regimen as first-line chemotherapy on advanced colorectal cancer in Chinese patients, and observe its safety.

METHODS

Clinical data of 54 chemotherapy-naive patients with advanced colorectal cancer, treated with FOLFIRI regimen from Jan. 2002 to Sep. 2005 in Cancer Center of Sun Yat-sen University, were analyzed.

RESULTS

Of the 54 patients, 52 were evaluable for response. The overall response rate was 42.6%, the time to progression (TTP) was 6 months, and the overall survival time was 15.2 months. The most common drug-related adverse events were neutropenia (38.9%), diarrhea (37.1%) and nausea and vomiting (50.0%). The occurrence rates of these grade 3-4 events were 5.6%, 9.3%, and 9.3%, respectively. All adverse events were tolerable.

CONCLUSION

FOLFIRI regimen is effective and well-tolerated as first-line treatment for Chinese patients with advanced colorectal cancer.

High incidence of hepatitis B virus infection in B-cell subtype non-Hodgkin lymphoma compared with other cancers

BACKGROUND

The authors investigated the prevalence of hepatitis B virus (HBV) infection by using serologic markers in non-Hodgkin lymphoma (NHL) compared with other types of cancers in Chinese patients.

METHODS

In this case-control study, HBV and other hepatitis markers were compared between a study group and a control group. The study group included 587 patients with NHL (age range, 16-86 years), and the control group included 1237 patients (age range, 16-89 years) who were diagnosed with other cancers except liver cancer. An enzyme-linked immunosorbent assay was used to test serum samples from both groups for HBV markers and other hepatitis markers.

RESULTS

Logistic regression analysis showed that there was a higher prevalence of HBV infection in patients with the B-cell subtype of NHL (30.2%) than in patients with other cancers (14.8%; odds ratio [OR], 2.6; 95% confidence interval [95% CI], 2.0-3.4); however, in patients with the T-cell subtype of NHL, the HBV infection rate (19.8%) was similar to that among patients with other cancers (OR, 1.2; 95% CI, 0.8-1.8). A significant difference in HBV prevalence was found between B-cell and T-cell NHL (OR, 2.3; 95% CI, 1.4-3.6). In the patients with B-cell NHL, those who were infected with HBV had a significantly earlier disease onset (9.5 years) than those who were not infected with HBV. CONCLUSIONS.: The current results demonstrated that patients with B-cell NHL, but not patients with T-cell NHL, had a higher prevalence of HBV infection. HBV infection was associated with a significantly earlier disease onset (P < .001), a finding that suggested the possibility that HBV may play an etiologic role in the induction of B-cell NHL.

[Expression and clinical significance of Mcl-1 in T-cell non-Hodgkin's lymphoma]

BACKGROUND & OBJECTIVE

The prognosis of T-cell non-Hodgkin's lymphoma (T-NHL) is poor. Overexpression of myeloid cell leukemia-1 (Mcl-1) gene could inhibit irradiation-and drug-induced apoptosis in several lymphoma cell lines. This study was to detect the expression of Mcl-1 in T-NHL of various subtypes, and explore its correlation to clinicopathologic features and prognosis of T-NHL.

METHODS

The expression of Mcl-1 protein in 72 specimens of T-NHL was detected by immunohistochemistry. The clinical features, treatments, and outcomes of the T-NHL patients were analyzed retrospectively.

RESULTS

The weak positive rates of Mcl-1 were 44.4% in precursor T lymphoblastic lymphoma (T-LBL), 0% in anaplastic large T-cell lymphoma (ALCL), and 18.9% in other peripheral T-cell lymphoma (PTL); the positive rates were 0%, 100%, and 49.1%, respectively (P<0.001). Weak diffuse cytoplasmic staining of Mcl-1 was detected in T-LBL, and strong cytoplasmic staining with perinuclear accentuation was detected in ALCL. The overall survival time was significantly longer in the PTL patients with high Mcl-1 expression than in the PTL patients with weak/negative Mcl-1 expression (>32 months vs. 15 months, P=0.007), and longer in the T-LBL patients without Mcl-1 expression than in the T-LBL patients with weak Mcl-1 expression (21 months vs. 7 months, P=0.58).

CONCLUSIONS

The intensities of Mcl-1 expression in T-NHL of various histological subtypes are different. It is specifically highly expressed in ALCL. High expression of Mcl-1 is correlated to better prognosis of PTL.

[Retrospective analysis of 98 cases of breast cancer with liver metastasis]

BACKGROUND & OBJECTIVE

The prognosis of breast cancer patients with liver metastasis is poor. How to improve treatment efficacy and prolong survival of these patients is a challenge in clinic. This study was to explore the efficacy of chemotherapy and transcatheter arterial chemoembolization (TACE) on breast cancer patients with liver metastasis, and analyze prognostic factors.

METHODS

Clinical data of 98 breast cancer patients with liver metastasis, treated from 1996 to 2005 in Cancer Center of Sun Yat-sen University, were analyzed retrospectively. The prognostic factors correlated to clinical features and treatment approaches were determined using Cox multivariate model.

RESULTS

The total response rate was 45.9% for all patients, 48.6% for the 74 patients received systemic chemotherapy, 23.1% for the 13 patients received TACE, and 54.6% for the 11 patients received chemotherapy plus TACE. At a median follow-up of 17 months (3-56 months), the 1-, 2-, 3-, and 4-year survival rates were 36%, 19%, 13%, and 3%, respectively; the median survival was 17 months (3-56 months), and the progression-free survival was 6 months (0-50 months).

CONCLUSION

The combination of systemic chemotherapy and TACE may prolong the survival of breast cancer patients with liver metastasis.

[Efficacy of docetaxel combined capecitabine on metastatic breast cancer]

BACKGROUND & OBJECTIVE

Few treatment options are available for metastatic breast cancer with resistance to both anthracycline-and taxane-based chemotherapy regimens. Docetaxel combined capecitabine (DC regimen) is approved as a new active regimen for metastatic breast cancer. This study was to explore the efficacy of DC regimen on metastatic breast cancer, and evaluate its safety.

METHODS

A total of 31 metastatic breast cancer patients received DC regimen during each 3-week chemotherapy cycle. All patients received oral administration of capecitabine (1250 mg/m(2)) twice daily, within 30 min after meal on day 1 to Day 14, and infusion of docetaxel (75 mg/m(2)) on the first day of each 3-week cycle. All patients received prophylactic therapy with oral dexamethasone (8 mg) twice daily on 3 successive days.

RESULTS

A total of 116 cycles of DC regimen were administered, with a median of 3.7 cycles. The objective response rate was 41.9%, with a complete remission (CR) rate of 9.6%. The most frequent treatment-related adverse events were fatigue, leukopenia, nausea, vomiting, hand-foot syndrome, and stomatitis. The median follow-up was 10.8 months (range 2-23 months). Two patients were died of tumor progression.

CONCLUSION

The combination of docetaxel and capecitabine provides a well-tolerated and active chemotherapy regimen for metastatic breast cancer.

[Clinical pharmacokinetic trial of intravenous injection of recombinant human lymphotoxin-alpha derivative]

BACKGROUND & OBJECTIVE

Animal experiment showed that recombinant human lymphotoxin-alpha derivate (rhLTalpha-Da) could inhibit tumor growth,activate immunity, sensitize tumors to chemotherapy, and has low toxicity in vivo. rhLTalpha-Da won't accumulate after multiple administrations. This study was to investigate pharmacokinetic profile of rhLTalpha-Da in tumor patients to provide reference for phase II clinical trail.

METHODS

The dosage of rhLTalpha-Da was 10, 20, and 33 microg x m(-2) x d(-1) according to phase I clinical endurance trial. rhLTalpha-Da was mixed with 100 ml 5% glucose solution, and then infused over 30 min on each of 5 consecutive days. Blood samples and urine samples were collected before and after infusion at different time points. Enzyme-linked immunosorbent assay (ELISA) and fluorescent bead immunoassay (FBI) were used to detect the concentration of rhLTalpha-Da in blood and urine. The main pharmacokinetic parameters were calculated by 3p97 pharmacokinetic program.

RESULTS

From Feb. 2003 to Dec. 2003, 19 patients were enrolled. The linear range, specificity, precision, accuracy, and stability of ELISA method were satisfied. The lower limit of quantification (LLOQ) was 39 pg/ml. The linear range, sensitivity, specificity, intra-assay precision, and accuracy of FBI method were satisfied, but coefficient of variation of inter-assay precision was over 20%. rhLTalpha-Da in pharmacokinetics conformed to be a one-compartment open model:it had been eliminated quickly from serum and could not be detected 2 h after the cessation of infusion. The half lives (t1/2) of 33 microg x m(-2) x d(-1) and 20 microg x m(-2) x d(-1) of rhLTalpha-Da were (0.24+/-0.09) h and (0.25+/-0.10) h; the abundant volumes of distribution (Vd) were (35.8+/-1.6) L/m(2) and (43.3+/-26.0) L/m(2); the clearance (CL) were (343.36+/-63.23) ng x m(-2) x h(-1) and (269.60+/-24.52)ng x m(-2) x h(-1); the areas under concentration-time curve (AUC) were (74.6+/-18.4) ng x h x L(-1) and (99.0+/-17.8) ng x h x L(-1), respectively.

CONCLUSIONS

The pharmacokinetics of rhLTalpha-Da after infusion is fitted to one compartment model and its elimination is linear. There is no rhLTalpha-Da accumulation after multiple administrations.

[Phase II clinical trial of home-produced Nedaplatin in treating advanced esophageal carcinoma]

BACKGROUND & OBJECTIVE

Nedaplatin is a second-generation anticancer drug containing organic platinum. Clinical researches in overseas showed that Nedaplatin is an anticancer drug with broad spectrum and high efficiency, especially in treating esophageal carcinoma. But the therapeutic efficacy and toxicity of home-produced Nedaplatin in China are unclear. This study was to evaluate the efficacy of home-produced Nedaplatin in China on esophageal carcinoma, and observe its toxicity.

METHODS

A multi-center, phase II, prospective clinical trial was conducted. Naive patients with esophageal carcinoma were enrolled and randomized into trial group and control group. The patients in trial group were treated with home-produced Nedaplatin plus 5-fluorouracil (5-FU); the patients in control group were treated with cisplatin (DDP) plus 5-FU.

RESULTS

A total of 52 patients were enrolled: 30 in trial group, and 22 in control group. For trial group, therapeutic efficacy was evaluable in 27 cases, and toxicity was evaluable in all cases; for control group, therapeutic efficacy and toxicity were evaluable in all cases. The response rate was significantly higher in trial group than in control group (29.62% vs. 22.72%, P<0.05). The complete remission (CR) rates were 18.51% in trial group and 4.55% in control group. When considering myelosuppression, the occurrence rate of anemia was similar in the 2 groups; but the occurrence rates of neutropenia and thrombocytopenia were higher in trial group than in control group, especially for grade III-IV thrombocytopenia (20.68% vs. 0%, P<0.01). The occurrence rate of gastrointestinal reaction was lower in trial group than in control group. There were no significant differences in hepatotoxicity, renal toxicity, heart toxicity, peripheral nerve toxicity, and alopecia between the 2 groups.

CONCLUSIONS

Nedaplatin is an effective platinum drug for esophageal carcinoma. The treatment efficacy of Nedaplatin plus 5-FU regimen is better than that of DDP plus 5-FU regimen. It has a good clinical tolerance. The main toxicity is myelosuppression, and thrombocytopenia is predominant.

[Primary non-Hodgkin's lymphoma of the nasal cavity at early stage: long-term treatment outcomes and prognostic analyses of 108 cases]

BACKGROUND & OBJECTIVE

Primary non-Hodgkin's lymphoma (NHL) of the nasal cavity has unique clinicopathologic features, and optimal treatment regimen remains unclear. This study was to summarize the clinical features, treatment outcomes, and prognostic factors of primary NHL of the nasal cavity at early stage.

METHODS

Records of 108 patients with primary NHL of the nasal cavity, consecutively treated at Cancer Center, Sun Yat-sen University from Jun. 1990 to Sep. 2004, were reviewed. All diagnoses were confirmed with pathology and immunochemistry. Seven cases were of B-cell phenotype. Survival prognostic factors were analyzed by Kaplan-Meier method and Cox regression model with SPSS12.0 software.

RESULTS

Median follow-up time for survived patients was 41 months. The overall complete remission (CR) rate after primary treatment was 67.6%, and CR rates were 80.2% for the patients received radiochemotherapy and 29.6% for the patients received chemotherapy alone. There were evidences indicating systemic relapse in 33 (30.6%) patients. With regard to the control of local, regional, and systemic failure, radiochemotherapy was better than chemotherapy alone. The 5-year overall survival rate was 50.0% for all patients. Both univariate analysis and multivariate analysis showed that pre-treatment history of more than 3 months, primary lesion limited in the nasal cavity, CR after primary treatment, and radiochemotherapy were favorable prognostic factors.

CONCLUSIONS

Nasal cavity is frequently involved by peripheral T- and NK-cell lymphomas. Pre-treatment history of disease, extent of primary lesion involvement, and response to the primary treatment may be independent prognostic factors.

[Expression and clinical significance of hypoxia-inducible factor-1alpha in gastric cancer]

BACKGROUND & OBJECTIVE

Hypoxia-inducible factor-1alpha (HIF-1alpha) is correlated to the genesis, progression, invasion, metastasis, and prognosis of some malignancies. This study was to evaluate the expression of HIF-1alpha in gastric cancer, and explore its correlation to clinical features of gastric cancer.

METHODS

The expression of HIF-1alpha in 96 specimens of gastric cancer was detected by SP immunohistochemistry. The correlations of HIF-1alpha to clinicopathologic features and prognosis of gastric cancer were analyzed with SPSS10.0 software.

RESULTS

Of the 96 specimens, 77 (80.2%) were HIF-1alpha-positive: 7 were grade (+), 29 were grade (++), 27 were grade (+++), and 14 were grade (++++). The positive rate of HIF-1alpha was significantly lower in stage I-II patients than in stage III-IV patients (66.7% vs. 87.3%, P=0.016), significantly lower in stage T1-T2 patients than in stage T3-T4 patients (57.9% vs. 88.0%, P=0.007), and slightly lower in the patients without distant metastasis than in the patients with distant metastasis (75.9% vs. 100%, P=0.055). The 5-year overall survival rate was significantly lower in HIF-1alpha-positive patients than in HIF-1alpha-negative patients (31.2% vs. 57.9%, P=0.027). However, HIF-1alpha was not an independent prognostic factor of gastric cancer in multivariate analysis.

CONCLUSIONS

The expression of HIF-1alpha is correlated to patients' survival, tumor stage, invasion depth, and distant metastasis of gastric cancer, and may be considered as a reference criterion in evaluating the progression, metastasis, and prognosis of gastric cancer.

Apoptosis induced by DNA primase inhibitor 3,3'-diethyl-9-methylthia-carbocyanine iodide in human leukemia HL-60 cells

AIM

To investigate apoptosis induced by 3,3'-diethyl-9-methylthia-carbocyanine iodide (DMTCCI), an inhibitor of DNA primase found in our previous study, and the mechanism of DMTCCI in human myelogenous leukemia HL-60 cells.

METHODS

HL-60 cells were cultured in RPMI-1640 medium and treated with different concentrations of DMTCCI. MTT assay was used to detect growth inhibition. Flow cytometry and DNA ladders were used to detect apoptosis. Western blotting was used to observe the expression of survivin, Bcl-xL, Bad, Bax, Bcl-2, caspase-9, caspase-3, caspase-6, PARP, DFF45 and lamin B protein. Caspase-3 activity was measured by ApoAlert Caspase-3 Assay Kit.

RESULTS

DMTCCI inhibited proliferation of human leukemia HL-60 cells with IC50 value of 0.24 micromol x L(-1). The results of flow cytometry and DNA ladders showed that DMTCCI could induce apoptosis of HL-60 cells. The expression levels of protein survivin and Bcl-xL were down-regulated, Bad and Bax were up-regulated, while Bcl-2 protein had no change in response to DMTCCI treatment in HL-60 cells. Treatment of HL-60 cells with DMTCCI induced the proteolytic cleavage of caspase-9, caspase-3, caspase-6, PARP, DFF45 and lamin B protein. Caspase-3 activity apparently increased at 3 h and reached a peak at 12 h after exposure to 1 micromol x L(-1) of DMTCCI in HL-60 cells.

CONCLUSION

DMTCCI inhibited proliferation and induced apoptosis of human leukemia HL-60 cells. Bcl-2 family proteins, survivin and caspases family proteins might play a role in the apoptosis process induced by DMTCCI.

[Prognostic analysis of 220 colorectal cancer patients with synchronous liver metastases]

BACKGROUND & OBJECTIVE

Colorectal cancer is one of the most common malignant tumors in China. Synchronous liver metastases occur in 10%-25% colorectal cancer patients. This study was to elucidate the prognostic factors and treatment choices for colorectal cancer patients with synchronous liver metastases.

METHODS

Records of 220 colorectal cancer patients with synchronous liver metastases initially treated at Cancer Center of Sun Yat-sen University from Dec. 1995 to Dec. 2002 were reviewed. Prognostic factors were analyzed by Kaplan-Meier method and Cox regression model with SPSS12.0 software.

RESULTS

The 5-year overall survival rate was 5.52%, the median survival time of the patients was 12.93 months. Univariate analysis of clinical characteristics revealed that the number, size and distribution of liver metastases, extrahepatic disease, serum CEA level at diagnosis, N status, and histology were prognostic factors. Univariate analysis of clinical treatment factors showed that treatment modality, primary site resection, and chemotherapy regimen were prognostic factors. Multivariate analysis showed that the number and size of liver metastases, extrahepatic disease, serum CEA value at diagnosis, treatment modality, primary tumor resection, and chemotherapy regimen were independent prognostic factors of colorectal cancer patients with synchronous liver metastases.

CONCLUSIONS

Liver metastases larger than 5 cm in diameter, bilobar liver metastases, extrahepatic invasion or metastases, and CEA level more than 200 microg/L at diagnosis are adverse prognostic factors. Primary tumor resection and liver resection should be considered for all suitable patients with colorectal metastases to the liver alone. Liver-target intervention and/or systemic chemotherapy might be a good choice for inoperable patients. If possible, systemic chemotherapy containing oxaliplatin is preferred.

[Correlative analysis between serum dihydropyrimidine dehydrogenase, activity, concentration of 5-fluorouracil and adverse events in the treatment of advanced gastric cancer patients]

BACKGROUND & OBJECTIVE

Toxicities and their severities vary among advanced gastric cancer patients when they receive the same regimen containing continuous infusion of 5-fluorouracil (5-FU). Dihydropyrimidine dehydrogenase (DPD) is the key rate-limiting enzymes which is closely related to toxicities of 5-FU in chemotherapy. This study was to explore the relationship between activity of DPD and concentration of 5-FU, and their correlation to adverse events among advanced gastric cancer patients treated with the same regimen containing 5-FU continuous infusion.

METHODS

Patients received the same regimen (intravenous injection of paclitaxel 75 mg/m(2), leucovorin 200 mg/m(2) and 5-FU 375 mg/m(2), continuous infusion of 5-FU 2.5 g/m2 for 46 hours every two weeks). The peripheral blood was collected from 36 patients with advanced gastric cancer before and after chemotherapy to detect the activity of DPD and concentration of 5-FU by high-performance liquid chromatography (HPLC). Adverse events were assessed every cycle.

RESULTS

Serum activity of DPD revealed a unimodel distribution, which globally fits to a guassian distribution (range 1.56-6.01). Mean and median DPD activity values were 2.38 and 2.13, respectively. No total DPD deficiency was found in the patients. The concentration of 5-FU varied from 179.2 microg/L to 1 589.2 microg/L, which demonstrated normality distribution after a logarithmic transformation was applied. The DPD activity was inversely correlated with 5-FU concentration (r=-0.376, P=0.024). The patients with low activity of DPD were more frequently suffering from severe diarrhea, mucositis, and myelosuppression. And high level of 5-FU concentration led to the increase of adverse events.

CONCLUSION

Pre-chemotherapy DPD activity and 5-FU concentration during chemotherapy vary among gastric cancer patients, which may help to prevent severe toxicities during the treatment.

Lamivudine prophylaxis reduces the incidence and severity of hepatitis in hepatitis B virus carriers who receive chemotherapy for lymphoma

BACKGROUND

Hepatitis B virus (HBV) infection is a common disease in China. Severe hepatitis is a well recognized complication in HBV carriers with malignant disease who receive cytotoxic chemotherapy. The objective of the current study was to assess the value of antiviral lamivudine for reducing the incidence and severity of hepatitis in HBV carriers with lymphoma who receive chemotherapy.

METHODS

Two groups were compared in this nonrandomized study. The prophylactic lamivudine group was comprised of 40 patients who received oral lamivudine at a dose of 100 mg daily before and until at least 8 weeks after they discontinued chemotherapy. The historic control group was comprised of 116 patients who received chemotherapy without lamivudine. The incidence and severity of hepatitis and other adverse clinical outcomes were compared between the two groups. Significant prognostic factors for the development of hepatitis were determined based on data derived from the control group.

RESULTS

The two groups were comparable in most clinical baseline characteristics, including gender distribution, age, tumor types, primary treatment, hepatitis Be antigen status, and the use of anthracyclines or/and prednisone. In the prophylactic lamivudine group, there was significantly less incidence of hepatitis (17.5% vs. 51.7% in the control group; P = 0.000); less severe hepatitis (according to World Health Organization [WHO] criteria) (10% with Grade 1, 5% with Grade 2, and 2.5% with Grade 3 hepatitis vs. 3.4% with Grade 1, 12.1% with Grade 2, 12.9% with Grade 3, and 23.3% with Grade 4 hepatitis in the control group; P = 0.000); and less disruption of chemotherapy (10.0% vs. 37.1% in the control group; P = 0.001). The overall mortality as a result of hepatitis in the prophylactic lamivudine group was lower compared with that in the control group, but the difference was not statistically significant (0.0% vs. 5.2%; P = 0.163). In the control group, the factor associated with a greater risk of developing hepatitis was the use of prednisone. In the prophylactic lamivudine group, 1 of 40 patients (2.5%) developed hepatitis that was attributable to HBV reactivation. Further examination demonstrated that this single patient had a variation of HBV with YMDD mutations after the use of lamivudine for 9.2 months.

CONCLUSIONS

The results of the current study confirmed previous reports that lamivudine prophylaxis significantly reduced the incidence and severity of hepatitis in HBV carriers who were receiving chemotherapy for lymphoma. The chemotherapy disruption rate as a result of severe hepatitis also was decreased significantly.

[Efficacy of rituximab-containing regimens on indolent B-cell lymphoma--a report of 34 cases]

BACKGROUND & OBJECTIVE

The efficacy of rituximab given alone or in combination with chemotherapy on naive or relapsed indolent lymphoma is good. This study was to investigate the efficacy and safety of rituximab-containing regimens for patients with indolent B-cell lymphoma in China.

METHODS

From Mar. 1999 to Jan. 2005, 34 patients with indolent B-cell lymphoma received rituximab-containing regimens with a median of 5 cycles (ranged from 3 to 8 cycles). Of the 34 patients, 2 received rituximab alone, and 32 received rituximab-based regimens, which including CHOP (16 cases), FMD (5 cases), CHOPE (4 cases), EPOCH (2 cases), DICE (2 cases), DAHP (2 cases), and FN (1 case).

RESULTS

Of the 34 patients, 30 were evaluable for objective response. The overall response (OR) rate was 93.3%, and the complete response (CR) rate was 60.0%; the OR rate and CR rate of 22 evaluable naive patients were 95.4% and 66.7%, those of 18 evaluable follicular lymphoma patients were 88.9% and 66.7%. With a median follow-up of 17 months (4-68 months), the 1-year progression-freely survival rate was 85.3%. Myelosuppression was the major adverse event: 19 patients suffered from leukopenia with 4 cases of grade III-IV event, 5 suffered from thrombocytopenia with 4 cases of grade III-IV event, and 2 suffered from febrile neutropenia. Other adverse events included grade I-II nausea/vomiting, mild alopecia, and transient liver function abnormality. The infusional reaction of rituximab consisted of grade I-II rigor/febrile, skin rash, mild hypotension, and asymptomatic ventricular premature beat.

CONCLUSION

Rituximab-containing chemotherapeutic regimens are effective for indolent B-cell lymphoma with mild toxicity.

[Efficacy of rituximab-containing salvage regimens on relapsed or refractory B-cell non-Hodgkin's lymphoma]

BACKGROUND & OBJECTIVE

The prognosis of relapsed or refractory B-cell lymphoma is poor, with a short-term survival after conventional second-line chemotherapy. Rituximab, a chimeric anti-CD20 antigen, in combination with CHOP or CHOP-like chemotherapy may improve both disease-freely survival and overall survival of naive patients, but it's role in the second-line treatment for relapsed non-Hodgkin's lymphoma (NHL) is uncertain. This study was to evaluate the efficacy of rituximab-containing salvage regimens on relapsed or refractory NHL, and observe the toxicities.

METHODS

Clinical data of 35 patients with relapsed or refractory NHL, treated in Cancer Center of Sun Yat-sen University, were analyzed retrospectively. Of the 35 patients, 19 were man, and 16 were women, with a median age of 53.5 years (ranged from 21 to 77); for ECOG performance status, 33 (94.3%) scored 0-1; for international prognostic index (IPI), 20 (57.1%) scored 0-1, 7 (20%) scored 2, 4 (11.4%) scored 3, and 4 (11.4%) scored 4-5; 23 cases of diffuse large B-cell lymphoma (DLBL) accounted for 65.7% among all subtypes. Rituximab (375 mg/m2) was administered intravenously at the day before each chemotherapy cycle. The second-or third-line salvage regimens included EPOCH, CHOP, DHAP, DICE, IVAC, IMVP-16, and FND.

RESULTS

Of the 35 patients, 30 received rituximab-combined regimens, and 5 received rituximab alone. A total of 102 cycles of rituximab-containing salvage regimens were administered. The objective response rate of the 32 evaluable cases was 68.8%, with a complete remission (CR) rate of 40.6%; 3 patients achieved CR after radiotherapy following rituximab-based regimens, and 3 achieved CR after autologous hematopoietic stem cell transplantation. The most frequent adverse events were nausea, leukopenia, and alopecia. The addition of rituximab to chemotherapy only elevated the occurrence of mild infusion-related reactions, such as chills, fever, and pruritus. The median follow-up time was 12.5 months (ranged from 3 to 69 months); 2 patients were lost, 10 were died (9 died of lymphoma, and 1 died of severe hepatitis), the other patients remained alive. The median progression-freely survival was 11.8 months (ranged from 3 to 33 months). The overall 1-, 2-, and 3-year survival rates were 72.9%, 62.8%, and 62.8%, respectively.

CONCLUSION

Rituximab-containing salvage regimens are effective and well tolerated, even in extensively pretreated patients with relapsed or refractory B-cell NHL.

[Phase I clinical trial of intravenous recombinant human lymphotoxin-alpha derivative]

BACKGROUND & OBJECTIVE

Intravenous recombinant human lymphotoxin-alpha derivative (rhLTalpha-Da) is a novel biological antitumor reagent developed in China. This study was to evaluate the tolerance of tumor patients to rhLTalpha-Da, confirm its maximum tolerable dose (MTD) in vivo, and to provide recommending dose for phase II trial.

METHODS

The dose escalation of rhLTalpha-Da was as follows: 10 microg.(m2.day)-1, 20 microg.(m2.day)-1, and 33 microg.(m2.day)-. Each group contained at least 3 patients. rhLTalpha-Da was solved in 5% GS (100 ml), and intravenously infused over 30 minutes daily for 5 consecutive days.

RESULTS

A total of 24 patients were enrolled. Grade I-III chill and fever were the most common adverse events, with the occurrence rate of 79.2% (19/24). Other adverse events observed were dyspnea (3/24), nausea/vomiting (3/24), headache (4/24), fatigue (2/24), hypotension (2/24), and skin discomfort at irradiation region (2/24). No obvious abnormity of liver and renal functions was observed. The dose-limiting toxicities (DLT), which occurred at dose level of 33 microg.(m2.day)-1, were grade III chill, grade III fever, and grade III dyspnea. Although there was no definite efficacy showed in this primary study, initial response to rhLTalpha-Da was seen on a minority of patients with cancers, including malignant melanoma, mycosis fungoides, and renal carcinoma.

CONCLUSIONS

The MTD of rhLTalpha-Da is 33 microg.(m2.day)-1. The recommended dose for phase II clinical trial is 20 microg.(m2.day)-1.

[Impact of CPP-Id on expression of co-stimulating molecules on dendritic cells in mice]

BACKGROUND & OBJECTIVE

Idiotypic immunoglobin (Id) derived from B-cell lymphoma, as a tumor-specific antigen, can suppress tumor development by inducing immune response. This study was to confirm the presence of Id epitope on cytotoxic T lymphocytes (Id-CTL) in mouse lymphoma cell line A20, detect the quantity and distribution of cell-penetrating peptide-loaded Id (CPP-Id) in dendritic cells (DCs) at different time points, and explore its impact on the expression of surface molecules on DCs.

METHODS

Id-CTL epitope in A20 cells was amplified by reverse transcription-polymerase chain reaction (RT-PCR) and sequenced. The quantity of CPP-Id and Id alone in DCs and the expression of DC surface molecules were detected by flow cytometry. The process of CPP-Id entering DCs was observed under confocal microscope, and its distribution was observed under fluorescent microscope.

RESULTS

A 660 bp-length fragment was amplified from A20 cells by RT-PCR, and identified as Id-CTL epitope by sequencing. CPP-Id entered DCs quickly during the initial 200 s, but few Id entered DCs. The mean fluorescent intensity (MFI) in DCs was significantly higher in CPP-Id group than in Id group (4.35+/-0.48 vs. 1.14+/-0.33, P<0.005). The expression of surface molecules CD80, CD86, CD54 and MHC-I, MHC-II were higher on the DCs loaded by either CPP-Id or Id alone than on immature DCs.

CONCLUSIONS

CPP can enhance the quantity of Id entering DCs. CPP-Id can up-regulate the expression of MHC I, MHC-II and CD80, CD86, and CD54 on DCs, and may help to activate CTLs.

[Clinical analysis of liver damage of 116 malignant lymphoma patients with chronic HBV infection after cytotoxic chemotherapy]

BACKGROUND & OBJECTIVE

Chronic hepatitis B virus (HBV) infection increases the prevalence of liver damage and related death of malignant tumor patients. This study was to investigate the prevalence of liver damage and clinical results in lymphoma patients with chronic HBV infection after standard chemotherapy, and assess high risk factors associated with liver damage for better guidance in clinic.

METHODS

Records of 116 lymphoma patients with chronic HBV infection, treated with standard chemotherapy from Jan. 1985 to Jan. 2002 in Cancer Center of Sun Yat-sen University, were reviewed to analyze the prevalence of liver damage, clinical results, and related high risk factors.

RESULTS

Of the 116 patients, 60 (51.7%) suffered liver damage. According to WHO criteria of liver toxicity, 4 (3.4%) were in grade I, 14 (12.1%) in grade II, 15 (12.9%) in grade III, and 27 (23.3%) in grade IV. After treatment for liver damage, 11 (9.5%) patients completed chemotherapy without delay, 27(23.3%) completed chemotherapy with delay of more than 8 days, 16 (13.8%) terminated chemotherapy, 6 (5.2%) died. Logistic multivariate analysis showed that steroid was a high risk factor of liver damage after chemotherapy.

CONCLUSIONS

The prevalence of liver damage is high in lymphoma patients with chronic HBV infection after standard chemotherapy, which led to treatment delay or discontinue, even death. Steroid is a high risk of liver damage.

[Prognostic analysis of patients with nasal-type NK/T-cell non-Hodgkin's lymphoma--a report of 93 cases]

BACKGROUND & OBJECTIVE

Nasal-type NK/T-cell non-Hodgkin's lymphoma (NHL) is a unique subtype with the manifestation of local necrosis, infection and fever. The efficacy of chemotherapy alone is unsatisfactory; while radiochemotherapy plays some roles in the management of NK/T-cell lymphoma (NK/TCL). This study was to summarize the clinical characteristics, treatment outcome and prognosis of NK/TCL patients.

METHODS

Records of 93 patients with NK/TCL from Jan. 1997 to Jun. 2004 were analyzed retrospectively. All the patients were classified according to WHO classification system.

RESULTS

Of the 93 patients, 75 (80.6%) were in stage I-II, and 18 (19.4%) were in stage III-IV. The most common symptoms were nasal obstruction, rhinorrhea, and epistaxis. The disease course was 1-24 months with a median of 6.5 months. Of the 93 patients, 15 (16.1%) presented perforation of hard palate and/or nasal septum, 35 (37.6%) presented B symptoms; 35 (37.6%) were treated with chemotherapy alone, 2 (2.2%) were treated with radiotherapy alone, 54 (58.0%) were treated with radiochemotherapy, and 2 (2.2%) received no treatment. The first-line chemotherapy regimens were mainly CHOP and EPOCH. The overall response rate (RR) was 84.4% (76/90) with complete remission (CR) rate of 64.4% (58/90). The response rate of chemotherapy alone group was 67.6% (23/34) with CR rate of 41.2% (14/34). The response rate of combined modality group was 94.4% (51/54) with CR rate of 83.3% (45/54). The 2 patients who received no treatment died within 6 months. The major toxicity of chemotherapy was myelosuppression. The prevalence of grade III-IV neutropenia, thrombocytopenia, and anemia were 37.7%, 13.7%, and 10.7%. The major toxicities of radiotherapy were grade I-II mucosa lesion and myelosuppression. Other toxicities were mild. The mortality was 66.7% (62/93). The 1-, 3-, and 5-year overall survival (OS) rates were 63.4%, 43.1%, and 17.6%, respectively. Multivariate analysis showed that perforation of hard palate and/or nasal septum, B symptoms and therapeutic modality were independent prognostic factors of NK/TCL (P=0.035, P<0.001, and P=0.004).

CONCLUSIONS

NK/TCL has low chemotherapy sensitivity. Although combined chemoradiotherapy yield better outcome, the long-term survival was still poor. Investigation of optional treatment is needed.

[Inducement effect of Meisoindigo on apoptosis of leukemia cell line HL-60 and its mechanism]

BACKGROUND & OBJECTIVE

Meisoindigo is a powerful drug used in treating chronic myeloid leukemia (CML), but little is known about the mechanisms. This study was to investigate the inducement effect of meisoindigo on apoptosis of myelocytic leukemia cell line HL-60, and explore the possible mechanisms.

METHODS

After treatment of meisoindigo, the proliferation of HL-60 cells was detected by trypan blue exclusion assay, and DNA fragmentation by agarose electrophoresis; cell morphology was observed under fluorescent microscope. Cell apoptosis and the expression of Fas were detected by flow cytometry. The expression of Caspase-3, Caspase-8, Caspase-9, PARP, Bcl-2, Bax and the concentration of cytochrome c in cytosol were analyzed by Western blot.

RESULTS

Meisoindigo inhibited proliferation and induced apoptosis in HL-60 cells. When treated with 20 micromol/L meisoindigo for 12-48 h, the proliferation of HL-60 cells was significantly inhibited. When treated for 1 h, the apoptosis rate of HL-60 cells was (3.70+/-0.56)%; the apoptosis rate was significantly higher in HL-60 cells treated for 3, 6, and 12 h than in control cells [(19.80+/-1.13)%, (29.20+/-2.69)%, and (47.05+/-7.70)% vs. (2.65+/-0.78)%, P<0.05]. When treated with meisoindigo for 3 h, typical changes of apoptosis, such as chromatin condensation and DNA ladder, were detected in HL-60 cells. The positive rate of Fas was significantly higher in cells treated with 20 micromol/L meisoindigo for 1 h than in control cells [(21.30+/-1.27)% vs. (9.35+/-0.21)%, P<0.05]. Meisoindigo activated Caspase-3, Caspase-8, Caspase-9 and PARP, down-regulated the expression of Bcl-2, up-regulated the expression of Bax and the concentration of cytochrome c. Furthermore, pretreatment of caspase-3 inhibitor z-DEVD-fmk partially reversed the inhibitory effect of meisoindigo on cell proliferation, and decreased cell apoptosis; when treated with meisoindigo for 5 h, the apoptosis rate was significantly higher in pretreated cells than in cells without pretreatment [(29.8+/-5.4)% vs. (16.5+/-5.5)%, P<0.05]; when treated with meisoindigo for 12 h, the alive cell number was significantly lower in pretreated cells than in cells without pretreatment [(1.80+/-0.14) x 10(5)/ml vs. (3.57+/-0.18) x 10(5)/ml, P<0.05].

CONCLUSION

Meisoindigo induces apoptosis of HL-60 cells which may relate to regulation of caspases pathway and bcl-2 family proteins.

[Feasibility of chitosan as gene therapy vehicle]

BACKGROUND & OBJECTIVE

Recently, chitosan, as a nonviral vehicle for transferring DNA molecules into the cells, has attracted much attention because of its cationic properties. This study was to investigate characteristics and transfection activity of chitosan-pDNA microparticles, and confirm the feasibility of chitosan as gene therapy vehicle, which may be employed in further in vivo study.

METHODS

Plasmid DNAs were amplified in Eschericha Coli JM109 with transfection of enhanced green fluorescence protein (EGFP) gene, and isolated according to the protocol of Qiagen plasmid midi kit. Chitosan-pDNA microparticles were prepared by the coacervation method, and observed under transmission electronic microscope. In vitro releasing experiment and ultraviolet spectrophotometry were used to measure DNA loading capacity and loading efficiency. The location of pDNA in the microparticles was analyzed by gel retardation assay. Transfection efficiency of chitosan-pDNA microparticles was evaluated by detecting gene expression of EGFP in HEK293 cells after transfection.

RESULTS

Chitosan-pDNA microparticles were global, and the size ranged 100-200 nm, with the average of (138 +/- 43) nm. DNA loading capacity and loading efficiency of the microparticles were (46.8 +/- 9.0)% and 100%, respectively. Gel retardation assay confirmed that DNA was wholly encapsulated in the microparticles. In vitro study revealed that the release of DNA from chitosan-pDNA microparticles included two-step process, namely burst effect with a slow second phase. Most of DNA could be released at the time of 48 h. In vitro transfection results indicated that chitosan could efficiently deliver pEGFP into HEK293 cells and stably express green florescence protein.

CONCLUSIONS

Chitosan can efficiently transfer target DNA molecules into mammalian cells, continuously release DNA, and stably express DNA. It can be potentially employed as a gene therapy vehicle.