[Long-term outcomes of 392 non-Hodgkin's lymphoma patients treated with pirarubicin based regimens]

OBJECTIVE

To analyse the effectiveness and toxicity of combined chemotherapy regimen containing pirarubicin (THP) in the treatment of non-Hodgkin's lymphoma (NHL).

METHODS

Three hundred and ninety two patients with NHL were treated by THP containing regimen with or without involved field radiotherapy. The clinical characteristics, response, toxicity and long-term survival rates were analysed.

RESULTS

The median age of the patients was 47 (5 - 87) years and 26.0% aged more than 60 years. 61.0% of the patients were males and 39.0% females. B-cell and T/NK cell NHL accounted for 68.4% and 23.2% respectively with 56.9% of diffuse large B cell lymphoma and 12.5% of peripheral T cell lymphoma. 92.6% of the patients were ECOG < 1, 63.2% in stage I + II, 84.7% with IPI score 0 - 2 and 25% with B symptoms, 93.9% (368/392) of the patients received CTOP (containing THP) regimen chemotherapy and among them 28.5% (112/392) plus involved field radiotherapy. Altogether 1598 courses were administered on 368 patients. The overall response rate was 88.5% (341/385) with a complete remission (CR) rate of 63.6%, major toxicity was myelosuppression with 12.8%, 1.0% and 1.5% of grade III - IV neutropenia, thrombocytopenia and anemia, respectively. G-CSF support was given for 553 courses (34.6%). Alopecia account for 19.8%. The incidence of mild cardiotoxicity was 5.8%. Treatment-related mortality was 1.6% (6/368). Median follow-up was 24 months. The 1, 3 and 5 year actuarial survival rates were 86.4% , 66.5% and 59.2%, respectively. Median survival time has not been achieved.

CONCLUSION

The efficacy of THP based regimen CTOP for the treatment of aggressive NHL is promising. Further clinical trial is warranted.

[Correlation of GLC-82 lung carcinoma cell aggregation in suspension culture to the activation of protein kinases FAK, AKT, ERK, and SRC]

BACKGROUND & OBJECTIVE

Our previous study revealed that tyrosine kinase FAK can partly mediate the aggregation of tumor cells in suspension culture, therefore, suppress cell apoptosis and promote cell proliferation. However, the downstream pathway of FAK in the formation of cell aggregation is unclear. This study was to investigate the roles of FAK and its potential downstream molecules ERK, AKT, and SRC in mediating aggregation of lung adenocarcinoma GLC-82 cells in suspension culture.

METHODS

Morphology of the aggregations of GLC-82 cells and normal lung HBE cells in polyHEMA suspension culture was observed. Cell apoptosis was studied by DNA electrophoresis on agarose gel. The ability of cell transformation was studied by colony formation assay. The phosphorylation of the protein kinases was investigated by Western blot. FAK was silenced by RNA interference.

RESULTS

GLC-82 cells survived and aggregated in suspension culture; while apoptosis occurred in HBE cells which formed no aggregation in suspension culture. Phosphorylation levels of FAK, ERK, AKT, and SRC were related to GLC-82 cell aggregation. FAK silencing partly blocked the formation of GLC-82 cell aggregation, and decreased the phosphorylation levels of ERK and AKT; the colony formation rate in soft agar was significantly lower in GLC-82 cells with FAK silencing than in GLC-82 cells without FAK silencing [(12.2+/-1.1)% vs. (3.6+/-0.7)%, P=0.001].

CONCLUSION

The formation of GLC-82 cell aggregation is partly mediated by FAK signal pathway, and ERK and AKT are the downstream molecules of FAK.

[Advancement of biotherapy for malignant lymphoma]

In the past 30 years, the incidence of lymphoma was increasing. Although it is very sensitive to chemotherapy, and many new cytotoxic drugs and chemotherapy regimens have emerged, the 5-year survival rate of lymphome patients is only 40%-50%. With the development of immunology, the importance of biotherapy evoked more and more attention, and have became an important composition in the treatment of lymphoma. The most widely used biotherapy methods are listed as follows: monoclonal antibody, radioimmunotherapy, adoptive immunotherapy, active immunotherapy, gene therapy targeting Bcl-2, and targeted chemotherapy. Using these biotherapy methods in combination with other treatment methods reasonably will help to improve the short-term and long-term results of lymphoma.

[Expression of glycoprotein 90K in non-Hodgkin's lymphoma and its clinical significance]

BACKGROUND & OBJECTIVE

90K, a kind of secretory glycoprotein, is related to prognosis of some tumors. So far, little is reported on its relation to prognosis of non-Hodgkin's lymphoma (NHL). This study was to explore the 90K expression in naive NHL tissues and its clinical significance.

METHODS

90K expression in 110 specimens of NHL was detected by immunohistochemistryû its correlations to short-term treatment efficacy of CHOP regimen and long-term survival of the patients were analyzed retrospectively.

RESULTS

Of the 110 NHL specimens, 36 (32.7%) showed negative expression of 90K, 27 (24.5%) showed weak expression, 17 (15.5%) showed fairly strong expression, and 30 (27.3%) showed strong expression; the positive rate of 90K in NHL tissue was 67.3%. 90K expression had no correlation to gender, age, IPI and other clinicopathologic characteristics. All patients received treatment of standard CHOP regimen; the response (complete remission and partial remission) rate was significantly higher in low 90K expression (negative and weak expression) group than in high 90K expression (fairly strong and strong expression) group [82.5% (52/63) vs. 65.2% (30/46), P=0.039], but 90K expression had no correlation to long-term survival (P > 0.05).

CONCLUSIONS

90K expression may be applied to predict short-term efficacy of CHOP regimen on NHL. However, whether 90K could become a prognostic tumor marker of NHL needs further research.

[Detection and clinical significance of circulating tumor cells in peripheral blood of breast cancer patients]

BACKGROUND & OBJECTIVE

Recently, immunocytochemistry and immunomagnetic enrichment have been used in detecting circulating tumor cells (CTCs). This study was designed to investigate the sensitivity and specificity of modified immunomagnetic enrichment of tumor cells in combination with fluorescent immunocytochemistry in detecting CTCs in peripheral blood of patients with breast cancer.

METHODS

The sensitivity of this detection method was evaluated by sparking breast carcinoma cell line MCF-7 into normal peripheral blood. Mononuclear cells were isolated from peripheral blood of 52 naive breast cancer patients and 20 healthy female volunteers. Epithelial cell adhesion molecule (EpiCAM) antibody (Ab), covalently bound to magnetic beads, was used to enrich CTCs expressing EpiCAM antigen. CTCs, indicated by positive staining of cytokeratin (CK) 8/18 (green fluorescence), was detected by modified fluorescent immunocytochemistry, and confirmed by DAPI nuclear staining (deep blue).

RESULTS

The sensitivity of immunomagnetic enrichment with fluorescent immunocytochemistry was so high that 1 tumor cell in 1x10(7) peripheral blood mononuclear cells could be detected. The specificity of this method was 100%. Positive rate of CTCs was significantly higher in peripheral blood of the patients than in peripheral blood of the healthy volunteers (53.8% vs. 0, P<0.001). The presence of CTCs was correlated positively with clinical stage (P<0.001) and axillary lymph node status (P<0.005), and irrelevant with other prognostic factors (P>0.05).

CONCLUSIONS

Modified immunomagnetic enrichment of tumor cells in combination with fluorescent immunocytochemistry is a time-saving, easily-performed, sensitive and specific method for detecting CTCs in peripheral blood of breast cancer patients. The presence of CTCs in peripheral blood correlates positively with clinical stage and axillary lymph node status of breast cancer patients.

[Clinical analysis of 59 cases of primary gastric non-Hodgkin's lymphoma]

BACKGROUND & OBJECTIVE

Gastrointestinal tract is the most common extranodal involvement site of non-Hodgkin's lymphoma (NHL). However, no standard treatment regimen has ever been established for primary gastric NHL (PGNHL). This paper was to summarize the clinical characteristics and treatment results of PGNHL patients.

METHODS

Records of 59 PGNHL patients, treated from Jan. 1980 to Jan. 2002 in Cancer Center of Sun Yat-sen University, were reviewed to summarize their clinical characteristics, and influence of treatment modality on their survival.

RESULTS

Of the 59 PGNHL patients, 46 (78.0%) were in stage I/II. According to Working Formulation, most of them were in intermediate grade (46, 78.0%). The most common immune phenotype was B-cell lineage (46/49, 93.9%). These patients were treated with chemotherapy plus surgery (37,62.7%), chemotherapy alone (17,28.8%), and surgery alone (5,8.5%), respectively. The 2-, 5-, and 10-year survival rates of the 59 patients were 76.4%,63.7%, and 42.5%, respectively. For those patients in intermediate grade (including immunoblastic cell lymphoma), there was no significant difference in the 5-year survival rate between the patients received chemotherapy plus surgery and the patients received chemotherapy alone (52.5% vs. 57.1%).

CONCLUSIONS

Chemotherapy-dominated modality is recommended for patients with PGNHL of intermediate or high grade. The effect of surgery on PGNHL needs to be confirmed by prospective randomized trial.

[Survival outcomes of T-cell non-Hodgkin's lymphoma: a report of 111 cases]

BACKGROUND & OBJECTIVE

T-cell non-Hodgkin's lymphoma (NHL) is a group of heterogeneous malignancies with poor prognosis, and without ideal therapeutic regimen. This study was to summarize clinical and pathologic features of T-cell NHL.

METHODS

Records of 111 patients with T-cell NHL, treated from Jan. 1994 to Dec. 2001 in Cancer Center of Sun Yat-sen University, were retrospectively analyzed. All the patients were classified according to WHO classification criteria.

RESULTS

Median age of the whole group was 37 years (ranged 7-77 years). Of the 111 patients, 82 were men, 29 were women;45 (40.5%) were treated with chemoradiotherapy, 62 (55.8%) were treated with chemotherapy alone, and 4 (3.6%) were treated with radiotherapy alone. The 3-year survival rate of the whole group was 45% with a median follow-up of 28 months. The 3-year survival rates of chemoradiotherapy, chemotherapy, and radiotherapy groups were 56%, 38%, and 25%, respectively. Among all histological type subgroups, the prognosis of NK/T-cell lymphoma was the worst with the 3-year survival rate of only 25%u the 3-year survival rate was 40% in unspecified peripheral T-cell lymphoma group,and 85% in angioimmunoblast T-cell lymphoma group. International prognostic index was a significant factor for predicting overall survival. The 3-year survival rates of low risk,low-intermediate risk,intermediate-high risk, and high risk groups were 60%, 30%, 10%, and 0%, respectively.

CONCLUSIONS

Present treatment modalities for T-cell NHL patients, especially the high risk patients, can't achieve satisfactory outcomes. New treatment modality for these patients needs to be explored.

Anti-SARS-CoV immunoglobulin G in healthcare workers, Guangzhou, China

To determine the prevalence of inapparent infection with severe acute respiratory syndrome (SARS) among healthcare workers, we performed a serosurvey to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1,147 healthcare workers in 3 hospitals that admitted SARS patients in mid-May 2003. Among them were 90 healthcare workers with SARS. As a reference group, 709 healthcare workers who worked in 2 hospitals that never admitted any SARS patients were similarly tested. The seroprevalence rate was 88.9% (80/90) for healthcare workers with SARS and 1.4% (15/1,057) for healthcare workers who were apparently healthy. The seroprevalence in the reference group was 0.4% (3/709). These findings suggest that inapparent infection is uncommon. Low level of immunity among unaffected healthcare workers reinforces the need for adequate personal protection and other infection control measures in hospitals to prevent future epidemics.

[Phase III randomized clinical trial of intratumoral injection of E1B gene-deleted adenovirus (H101) combined with cisplatin-based chemotherapy in treating squamous cell cancer of head and neck or esophagus]

BACKGROUND & OBJECTIVE

H101 is an E1B-55 kDa gene-deleted replication-selective adenovirus, which showed a significant antitumor activity. This study was to compare effects and toxicities of intratumoral H101 injection combined with cisplatin plus 5-fluorouracil (PF) regimen or adriamycin plus 5-fluorouracil (AF) regimen versus PF or AF regimen alone in treating patients with head and neck or esophagus squamous cell cancer.

METHODS

A total of 160 patients were recruited. PF regimen (cisplatin 20 mg/m(2) ivgtt, qd x 5d; 5-fluorouracil 500 mg/m(2) ivgtt, qd x 5d) was administered to patients have no history of PF chemotherapy,or sensitive to PF chemotherapy,while AF regimen (adriamycin 50 mg/m(2) iv,d1; 5-fluorouracil 500 mg/m(2) ivgtt, qd x 5d) was administered to patients didn't response to PF regimen. All patients were randomized to either receive intratumoral H101 injection (5.0 x 10(11)-1.5 x 10(12) VP/day for 5 consecutive days every 3 weeks) or not. Treatment repeated every 3 weeks,all patients have to receive at least 2 cycles of chemotherapy.

RESULTS

Among 123 accordant patients,overall response rate of PF plus H101 group (group A1) was 78.8% (41/52),of PF alone group (group B1) was 39.6% (21/53),of AF plus H101 group (group A2) was 50.0% (7/14),of AF alone group (group B2) was 50.0% (2/4). Differences of response rates between group A1 and group B1,between group A1+A2 and group B1+B2 were significant (P=0.000). Main side effects were fever (45.7%), injection site reaction (28.3%),and influenza-like symptoms (9.8%).

CONCLUSION

Intratumoral H101 injection showed a distinct efficacy in patients with squamous cell cancer of head and neck or esophagus,and was relatively safe.

[Clinical analysis of rituximab combined with chemotherapy in treating aggressive B-cell non-Hodgkin's lymphoma]

BACKGROUND & OBJECTIVE

The efficacy of standard treatment, including cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP regimen), for patients with aggressive B-cell non-Hodgkin's lymphoma (B-NHL) is still unsatisfactory. Rituximab, a chimeric monoclonal antibody against B-cell antigen CD20, has therapeutic activity in B-NHL. This study was to determine efficacy and safety of the combination of rituximab and chemotherapy in treating Chinese patients with aggressive B-NHL, and to analyze influence factors on the response.

METHODS

Records of 75 patients with aggressive B-NHL,received infusions of 375 mg/m(2) of rituximab combined with or without chemotherapy in our center,have been retrospectively analyzed. Influence of age, clinical stage, serum level of lactate dehydrogenase (LDH), international prognostic index (IPI) score, and bulk disease on response were evaluated.

RESULTS

Response rate of rituximab alone group was 83.3% (5/6)with complete response (CR) rate of 66.7% (4/6). In 43 naive patients, the combination of rituximab and chemotherapy achieved an overall response rate (ORR) of 90.7% with CR rate of 67.4%; while in 26 recurrent or relapsed patients, the combination therapy achieved an ORR of 79.2% with CR rate of 29.2% (7/26), and partial response (PR) rate of 50.0% (13/26), 6 patients had a progressive disease (20.8%). Efficacy of immunochemotherapy was poor on patients with advanced disease(P=0.046), increased serum level of LDH (P=0.024), recurrence or relapse (P=0.009), and bulk disease (P=0.013). All patients can tolerate the treatment. No treatment-related death occurred.

CONCLUSION

The addition of rituximab to the chemotherapy regimen increases the response rate and CR rate in Chinese patients with aggressive B-NHL, without a clinically significant increase in toxicity. Patients with advanced disease, higher serum level of LDH, recurrence or relapse, and bulk disease had a poor response.

[Efficacy of modified BFM-90 regimen on children and adolescents with T cell lymphoblastic lymphoma: a report of 20 cases]

BACKGROUND & OBJECTIVE

T-cell lymphoblastic lymphoma in childhood and adolescence is an aggressive malignant disease with higher mortality. BFM-90 regimen for lymphoblastic lymphoma is one of the most effective regimens. This study was designed to evaluate efficacy and toxicities of modified BFM-90 regimen on Chinese children and adolescents with lymphoblastic lymphoma.

METHODS

A total of 20 naive children and adolescents with T cell lymphoblastic lymphoma were enrolled, 7 in stage III, and 13 in stage IV. Eighteen (90%) patients suffered from mediastinal mass with superior vena obstruction syndrome,10(50%) suffered from marrow invasion. All patients received modified BFM-90 regimen consisting of induction, consolidation and central nervous system prophylaxis, reinduced alleviation, and maintenance therapy. Total treatment duration was 2 years. Kaplan-Meier method was used to evaluate long-term survival rate.

RESULTS

After induction remission,18 patients (90%) achieved complete remission (CR), 1 had partial remission (PR), and 1 had progressive disease (PD), overall response rate was 95%. The 2 patients with PR or PD died of tumor progression. Of 2 patients at CR1 received APBSC, 1 relapsed after transplantation, but achieved CR and survived after salvage chemotherapy;1 survived all along. Of other patients achieved CR, 5 relapsed; of these 5 patients, 1 survived after allogeneic stem cell transplantation, 1 survived after autologous stem cell transplantation, 3 died of progressive disease after chemotherapy. The overall 3-year survival rate was 74%. All patients had myelosuppression of grade III-IV during the induction and reinduction phases, but the hemotologic toxicity was manageable.

CONCLUSIONS

Modified BFM-90 regimen is feasible for Chinese children and adolescent patients with lymphoblastic lymphoma, and may improve survival rate of these patients. The major side effect is myelosuppression, but it is manageable.

[Effect of epidermal growth factor receptor-selective tyrosine kinase inhibitor gefitinib on nasopharyngeal carcinoma xenografts]

BACKGROUND & OBJECTIVE

Gefitinib,an anilinoquinazoline,is an orally active,selective epidermal growth factor receptor(EGFR) tyrosine kinase inhibitor,which has been approved for the treatment of advanced non-small cell lung cancer. We have found that the proliferation of nasopharyngeal carcinoma (NPC) cell lines CNE1,CNE2,and SUNE1 was inhibited by Gefitinib. The present study was designed to evaluate the effect of Gefitinib alone or in combination with cisplatin (DDP) on NPC CNE2 xenografts.

METHODS

Exponentially growing CNE2 cells were prepared into cell suspension (1 x 10(7) cells/ml). Suspension of 200 mul of CNE2 cells was injected s.c. into the right flank area of the mice. After 7 days,when well-established tumors of 100-200 mm(3) were detected,mice were randomized into five groups: control group,Gefitinib (100 mg/kg) group,Gefitinib (200 mg/kg) group,DDP group,and Gefitinib (100 mg/kg) plus DDP group. Gefitinib was administered by oral gavage on days 1-5 of each week for 4 weeks. DDP was administered i.p. once a week for 4 weeks. Tumor volume was determined by direct measurement with caliper and calculated by the formula 1/2x(large diameter)x(small diameter)(2). The mice were sacrificed at two days after the treatment ended; tumor masses were removed and weighed. The tumor inhibition rates were calculated. The student's test was used to evaluated the statistical significance of the results.

RESULTS

Growth curves showed that tumor masses of control group grew more rapidly than ones of every treatment group. The average tumor volume was significantly smaller in Gefitinib (200 mg/kg) group than in control group (P=0.02). The average tumor volume had no significant difference between Gefitinib (100 mg/kg) group and control group. The average tumor volume of DDP or Gefitinib (100 mg/kg) plus DDP group was smaller than that of control group(P=0.007 and 0.001,respectively). The average tumor volume had no significant difference between DDP and Gefitinib (100 mg/kg) in combination with DDP group. The tumor inhibition rates of Gefitinib (100 mg/kg) group,Gefitinib (200 mg/kg) group,DDP group,and Gefitinib (100 mg/kg) plus DDP group were 26.3%, 30.6%, 45.7% and 54.8%,respectively. The average tumor weight after treatment had no significant difference between Gefitinib (100 mg/kg) group and control group. The average tumor weights of Gefitinib (200 mg/kg) group,DDP group,Gefitinib (100 mg/kg) plus DDP group were all smaller than that of control group. The average tumor weight had no significant difference between DDP group and Gefitinib (100 mg/kg) plus DDP group.

CONCLUSION

Gefitinib could inhibit the growth of NPC CNE2 xenografts. Gefitinib in combination with DDP did not significantly potentiate the effect of DDP on NPC CNE2 xenografts.

[Distribution of CD8+CD28- T cells and CD3+CD56+ NKT cells in peripheral blood of patients with B-cell non-Hodgkin's lymphoma]

BACKGROUND & OBJECTIVE

Patients with B-cell non-Hodgkin's lymphoma (B-NHL) usually have a poor immune response. CD8(+)CD28(-) T cells (Ts) and CD3(+)CD56(+) NKT cells (NKT) are new types of immune suppressor cells. This study was to analyze proportions and changes of them in peripheral blood of patients with B-NHL, explore their effects on immunosuppression of B-NHL, and the influnce factors, to provide reference for intervening in immune function of B-NHL patients.

METHODS

Peripheral blood samples were got from 79 naive patients with B-NHL before treatment, and 25 healthy people, samples of 18 patients who got complete remission (CR) after 4-6 cycles of chemotherapy were collected either before chemotherapy or after CR. Proportions of Ts and NKT were analyzed by flow cytometry (FCM).

RESULTS

Compared with control group, proportions of Ts, and NKT in peripheral blood of B-NHL patients before chemotherapy were (18.19+/-5.03)%, and (6.08+/-3.29)%, significantly higher than those of healthy people [(11.20+/-3.49)%, P< 0.01; (3.52+/-1.56)%, P< 0.01]. There were no significant differences of proportions of Ts among patients with B-NHL of different clinical stages (P >0.05), and different malignant grade (P >0.05), and between before treatment and after CR (P=0.55). No significant difference of proportions of NKT was found among patients with B-NHL of different clinical stages (P >0.05), and different malignant grade (P >0.05), and between before treatment and after CR (P=0.39).

CONCLUSION

Populations of Ts and NKT commonly increased in peripheral blood of patients with B-NHL, they may play roles in immunosuppression of B-NHL.

[Clinical outcomes of 106 patients with peripheral T-cell lymphoma treated by standard CHOP regimen]

BACKGROUND & OBJECTIVE

T-cell Non-Hodgkin's lymphoma (NHL) are common in Asia, It's biological behavior is different from B-cell NHL. It often shows lower chemo-sensitivity, high incidence of relapse and poor prognosis. This study was designed to analyse the clinical characteristics and to evaluate the effectiveness and toxicity of standard CHOP regimen in the treatment of peripheral T-cell lymphomas-unspecified (PTCL-U) according to the Revised European- American Lymphoma (REAL) classification.

METHODS

106 patients with PTCL-U were treated by standard CHOP regimen with or without involved field radiotherapy from January 1997 to December 2003 in Cancer Center, Sun Yat-sen University, The clinical characteristics, response and long-term survival rates were analysed, retrospectively.

RESULTS

Early stages (I-II) were present in 78.3% (83/106) of the patients. Extranodal involvement account for 84.0% (89/106) with 34.9% (37/106) of more than 1 involved extranodal sites. The percentage of IPI score 0-1 was 78.3% (83/106). All the patients were treated by standard CHOP regimen plus IFRT for bulky disease. 55.7% (59/106) patients were treated by chemotherapy alone and 43.3% (46/106) were treated by chemotherapy plus radiotherapy. The overall response rate was 81.0% (85/105) with 58.2%(65/105) complete remission (CR) rates. The response rate of chemotherapy alone were 69.5% (41/59) and CR rates was 44.1% (26/59). The median duration of response was 16 months (1-88 months). The actual 1, 3 and 5 year overall survival rates were 69.9%, 42.9% and 22.0%, respectively. Median survival times were 24 (12-36) months.

CONCLUSION

Long-term survival of PTCL-U treated by standard CHOP regimen were poor. Further investigation is wanted.

[Clinical outcomes of patients with peripheral T-cell lymphoma (PTCL) treated by EPOCH regimen]

BACKGROUND & OBJECTIVES

The biological behavior of peripheral T-cell lymphoma (PTCL) are different from that of B-cell non-Hodgkin's lymphoma (NHL). It shows low chemosensitivity, high incidence of relapse, poor prognosis, and has no standard chemotherapy regimen. The efficacy of CHOP is poor for PTCL. This study was to evaluate the efficacy and toxicity of EPOCH regimen for PTCL.

METHODS

EPOCH regimen(doxorubicin/epirubicin, vincristine, etoposide over 96 hours' infusion with bolus cyclophosphamide,and oral prednisone) was administered to 21 patients with PTCL. According to WHO classification criteria, 21 cases of PTCL concluded 7 peripheral T-cell lymphoma unspecified (PTCL-U), 7 NK/T-cell lymphoma (NK/TCL), 5 anaplastic large cell lymphoma (ALCL), 1 Mycosis fungoides/Sezary syndrome (MF/SS), and 1 subcutaneous panniculitis-like T-cell lymphoma (SPTCL). Among them there were 14 previously untreated patients, 7 pretreated and recurrent patients. Median cycles of EPOCH regimen administered were 3 (ranged from 1 to 7 cycles).

RESULTS

Of 21 patients, 20 were eligible to evaluate treatment efficacy. The response rate (RR) for the whole group was 85% (17/20) with complete remission (CR) rate of 50% (10/20). The RRs of patients with NK/TCL, PTCL-U, and ALCL were 71.4% (5/7), 100.0% (6/6), and 80.0%(4/5); the CR rates were 57.1% (4/7), 50.0% (3/6), and 40.0% (2/5). The RR of patients which haven't been pretreated was 84.6% (11/13), the CR rate was 61.5% (8/13); While the RR of pretreated patients was 85.5% (6/7), the CR rate was 28.5% (2/7). Seventy cycles of chemotherapy were administered to 21 patients. Major toxicity was myelosuppression, the incidences of grade III-IV neutropenia, thrombocytopenia, and anemia were 34.3%, 14.3%, and 7.1%. Other toxicities were mild, no treatment-related mortality occurred.

CONCLUSION

EPOCH was effective and well tolerant for the patients with PTCL.

[Comparing CHOP, CHOP+HD-MTX,and BFM-90 regimens in the survival rate of children and adolescents with B cell non-Hodgkin's lymphoma]

BACKGROUND & OBJECTIVES

B cell non-Hodgkin's lymphoma (B-NHL) in childhood and adolescence is aggressive. Routine CHOP regimen can improve the survival rate of patients with early-stage disease, but its effect on patients with advanced disease was poor. Therefore, it is worthwhile to further investigate how to treat patients with B-NHL at different stages. This study was designed to retrospectively analyze and compare CHOP, CHOP+HD-MTX, and BFM-90 regimens in the survival rate of children and adolescents with B-NHL,and explore the optimal therapeutic strategy and protocols.

METHODS

Thirty cases of 3- to 17-year-old untreated patients with B-NHL were enrolled in CHOP group, with 13 in Stage I/II, and 17 in stage III/IV (St Jude staging), all patients received standard CHOP for 2 to 8 cycles, the regimen was repeated every 3 weeks. Eighteen cases of 3- to 14-year-old untreated patients with B-NHL were enrolled in CHOP+HD-MTX group, with 6 in Stage I/II, and 12 in stage III/IV (St Jude staging), all patients received CHOP+HD-MTX and intrathecal injection for 2 to 8 cycles, the regimen was repeated every 4 weeks. Twenty-five cases of 1.5- to 15-year-old untreated patients with B-NHL were enrolled in BFM-90 group, with 7 in Stage I/II,and 18 in stage III/IV (St Jude staging). The patients with stage I/II disease received A schema alteration with B schema of BFM-90 regimen for 4 to 6 cycles, while the patients with stage III/IV disease received AA schema alteration with BB schema of BFM-90 regimen for 6 cycles, the interval of cycles was 18-21 days. The survival rates were evaluated by Kaplan-Meier method.

RESULTS

In CHOP group,complete response (CR) rate was 70% (21/30), and partial response (PR) rate was 13% (4/30). In CHOP+HD-MTX group, CR rate was 83%, PR rate was 16%. In BFM-90 group, CR rate was 96% (24/25), and PR rate was 4% (1/25). The hematologic toxicity incidence was higher in BFM-90 group than in the other 2 groups. In CHOP group, the overall 2-year survival rate was 52.79% (72.73% for Stage I/II, and 37.82% for stage III/IV). In CHOP+HD-MTX group, the overall 2-year survival rate was 55.56 % (83.33 % for Stage I/II, and 41.67 % for stage III/IV). There was no significant difference between CHOP group and CHOP+HD-MTX group in survival rate (P=0.78). In BFM-90 group,2-year event-free survival rate (EFS) was 84.01 % (100% for Stage I/II, and 77.04 % for stage III/IV). The differences in survival rate between BFM-90 group and CHOP group, CHOP+HD-MTX group were both significant (P=0.013, and P=0.034).

CONCLUSION

BFM-90 regimen can greatly improve the survival rate of children and adolescents with B-NHL, especially of patients with advanced NHL. CHOP, and CHOP+HD-MTX regimens work better for the early stage patients, but produce low survival rate for patients with advanced NHL. A high intensive chemotherapy like BFM-90 regimen is necessary for children and adolescents with advanced B-NHL.

[Effect of epidermal growth factor receptor-selective tyrosine kinase inhibitor ZD1839 on nasopharyngeal carcinoma cells]

BACKGROUND & OBJECTIVE

ZD1839, an anilinoquinazoline, is an orally active, selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, which has been approved for the treatment of advanced non-small cell lung cancer by FDA. Nasopharyngeal carcinoma is of epithelial origin with overexpression of epidermal growth factor receptor and it remains unclear whether ZD1839 is useful in the treatment of nasopharyngeal carcinoma. The present study was designed to evaluate the effect of ZD1839 on nasopharyngeal carcinoma cell lines.

METHODS

The effect of ZD1839 on nasopharyngeal carcinoma cells (CNE1, CNE2, SUNE1) was determined by MTT assay. The effect of ZD1839 combined with cisplatin (DDP) or 5-fluouracil (5-FU) on nasopharyngeal carcinoma cell CNE2 was also evaluated. Burgi formula was adopted to analyze combination effect. The distribution of cell cycle and cell apoptosis rate were analyzed by flow cytometry.

RESULTS

The proliferation of nasopharyngeal carcinoma cell lines CNE1, CNE2, and SUNE1 was inhibited by ZD1839, and the effect was dose-dependent. The value of IC50 for the effect of ZD1839 on nasopharyngeal carcinoma cell lines CNE1, CNE2, and SUNE1 was 3.9 micromol/L, 5.6 micromol/L, and 5.5 micromol/L, respectively. ZD1839 could enhance the effect of DDP and 5-FU on CNE2 cells. The Q values by Burgi formula were 1.19+/-0.02 and 1.12+/-0.10, respectively. When CNE2 cells were treated with ZD1839 at the concentration of 0, 1.95, 3.9, 7.8, 15.6, 31.25 micromol/L, the percentages of G(0)/G(1) phase were (46.8+/-1.7)%, (48.8+/-1.6)%, (51.3+/-1.3)%, (54.0+/-1.3)%, (61.5+/-2.2)%, and (71.2+/-1.4)%, respectively; the percentages of S phase were (37.5+/-1.3)%, (35.8+/-1.6)%, (31.8+/-2.1)%, (34.3+/-2.7)%, (27.2+/-2.9)%, and (27.6+/-2.4)%, respectively;the percentages of G(2)/M phase were (15.7+/-0.4)%, (15.3+/-0.1)%, (16.9+/-0.9)%, (11.7+/-1.4)%, (11.3+/-0.7)%, and (1.1+/-0.8)%, respectively. When CNE2 cells were treated with ZD1839 at the concentration of 0, 1.95, 3.9, 7.8, 15.6, 31.25, 62.5 micromol/L, the rates of CNE2 cell apoptosis were (1.6+/-0.3)%, (1.7+/-0.3)%, (2.3+/-0.4)%, (3.3+/-0.4)%, (3.9+/-0.8)%,(8.0+/-1.1)%,and(14.3+/-2.3)%, respectively.

CONCLUSION

ZD1839 inhibits the proliferation of nasopharyngeal carcinoma cells and enhances the effect of cytotoxic drugs.ZD1839 induces CNE2 cell cycle arrest in the G1 phase and higher concentration of ZD1839 could induce apoptosis.

[CD4+CD25+T regulatory cells in peripheral blood of B-NHL patients with or without chemotherapy]

BACKGROUND & OBJECTIVE

It is well known that the patients with B-Non-Hodgkin's Lymphoma (B-NHL) usually have a poor immune response. CD4(+)CD25(+)-Tregs is a new type of suppressor cell. It plays an important role in the tumor immune suppression. But its distribution and the mechanism of immune suppression in B-NHL are still unknown. The present study was designed to evaluate the proportion of Tregs in peripheral blood of the patients with B-NHL with or without chemotherapy to investigate the mechanism of immune suppression in B-NHL and the effect of chemotherapy on immune system and provide evidence for effective intervention in immune function.

METHODS

The peripheral blood was collected from 39 patients with B-NHL before chemotherapy, 32 patients with B-NHL who achieved partial remission (PR) or complete remission (CR) after 4-6 cycles of chemotherapy, and 25 healthy people. The population of CD4(+), CD8(+), CD4(+)CD25(+), and CD4(+)CD25(+)CTLA4(+) T cells was evaluated by flow cytometry.

RESULTS

The total number of lymphocyte, the proportion of CD4(+)T cells, and the ratio of CD4/CD8 in the group of B-NHL before chemotherapy was significant less than those of the healthy group (1.3+/-0.39 x 10(9) versus 2.1+/-0.41 x 10(9); 27.5%+/-4.1% versus 32.9%+/-5.8%; 0.9+/-0.21 versus 1.31+/-0.4), but the percentages of CD4(+)CD25(+)-Tregs and CD4(+)CD25(+)CTLA4(+)-T cells were significantly higher than those of the healthy donors (14.7%+/-3.1% versus 8.4%+/-2.5%; 7.4%+/-1.6% versus 5.1%+/-1.4%). In the group of chemotherapy, although the CD4/CD8 ratio (1.19+/-0.3) was almost near to that of the healthy group, the total number of lymphocytes (0.8+/-0.53 x10(9)) was less than those of the other two groups, and the proportions of CD4(+)CD25(+)-Tregs (20.3%+/-4.1%) and CD4(+)CD25(+)CTLA4(+)-T cells (11.5%+/-2.2%) were higher than those of the other two groups.

CONCLUSION

The population of CD4(+)CD25(+)-Tregs in peripheral blood of the patients with B-NHL with or without chemotherapy was significantly higher than those in healthy donors, which may be one of the important reasons of immunosuppression in B-NHL.

[Studies on 5-FU/PEG-PBLG nano-micelles: preparation, characteristics, and drug releasing in vivo]

BACKGROUND & OBJECTIVE

5-Fluorouracil (5-FU) belongs to antimetabolic anticancer drugs and its half-life time in vivo is only about 5 minutes. Continuous infusion (48 hours,72 hours,28 days) was commonly used to maintain long-time steady-state concentration (Css). So it is necessary to exploit new slow-release system for 5-FU. This article was designed to investigate the preparation technique,shape characteristics, and drug releasing characteristics in vivo of 5-FU loaded core-shell type nanoparticles which were made by biodegradable amphiphlic poly (ethylene glycol)-poly (gamma-benzyl-L-glutamate)(PEG-PBLG).

METHODS

The PEG-PBLG nano-micelles were prepared by diafiltration method. Its morphology was observed by transmission electron microscopy and scan electron microscopy. Encapsulating efficiency of 5-FU was determined by ultraviolet spectrophotometry. The 5-FU releasing characteristics from nano-micelles in vivo were investigated by high-performance liquid chromatography (HPLC).

RESULTS

5-FU loaded PEG-PBLG copolymer nano-micelles (5-FU/PEG-PBLG) was of round or ellipsic shape. The diameter of the micelles was 180-250 nm; the size of drug storeroom was about 200 nm and the thickness of hydrophilic zone was about 30 nm. The entrapment efficiency was (29.5+/-0.015)%. In control group, 5-FU is one-compartment in vivo; its half-life was 5.3 minutes; the maximum plasma concentration (C(max)) was 17047.3 microg/L; T(max) was the time of attaining C(max) of the end of infusion; the area under the plasma concentration-time curve (AUC) was 6263.7 microg/L x min. However, the model of nano-micelles in vivo was typical release-drug of nano-micelles namely abrupt release-slow release; its t(1/2) was 63.2 minutes; C(max) was 4563.5 microg/L; T(max) was 1.25 hours; AUC was 5794.5 microg/Lxmin. Compared with 5-FU preparation, T(max) of 5-FU/PEG-PBLG was longer (P< 0.01);C(max) was lower (P< 0.01);t(1/2) was longer (P< 0.01); AUC was similar (P >0.01).

CONCLUSION

The 5-FU/PEG-PBLG nano-micelles can change the pharmacokinetics of 5-FU, prolonging the circulation time in vivo and make a slow release.

[Treatment of lymphoma patients with fludarabine-based regimens: a report of 29 cases]

BACKGROUND & OBJECTIVE

Fludarabine is one of the most effective agents for indolent lymphoma and chronic lymphocyte leukemia (CLL). Response rate of single agent for chemotherapy-naive patients ranged from 40%to 87% with 14-60% complete remission (CR) rate has been reported abroad while the response rate of 30%-70% and the CR rate of 10%-38% for pre- treated patients. Significantly higher response rate can be yielded by combined regimen such as FN, FMD, and FC, etc. The purpose of this study was to investigate the efficacy and toxicity of fludarabine-based regimen for patients with lymphoma in China.

METHODS

Twenty-nine patients with lymphoma were enrolled into this study from April 2001 to December 2003. There were 18 male and 11 female patients with median age of 53 years old (ranged from 27 to 79). Twenty-two patients were low-grade lymphoma and 7 were intermediate-grade lymphoma. Nineteen patients had been treated by FMD(Fludarabine 25 mg/m(2) d1-3,Mitoxantrone 8 mg/m(2) d1 and Dexamethasone 20 mg d1-4) while 3 by R-FMD (Rituximab+FMD) and 7 by other fludarabine- containing regimens. The median therapeutic cycles were 3 (1-6).

RESULTS

Twenty-five patients were available for objective evaluation in 29 enrolled patients. The response rate and the CR rate for indolent group were 86% (18/21) and 38% (8/21). No response was obtained in 4 cases of intermediate grade lymphoma. Myelosuppression and mild GI toxicity were major side effects. The rates of leucopenia, thrombocytopenia, and anemia were 61% (III+IV, 8%), 18% (III+IV, 4%), and 26%, respectively. G-CSF was necessary only in 5% of cycles without red cell or platelet transfusion. Mild nausea and vomiting account for 20%. Five cases of febrile neutropenia during chemotherapy were controlled by intravenous antibiotics and supportive care. Transient liver function abnormality and jaundice encountered in 1 patient and diffusive skin rash in another one.

CONCLUSION

Fludarabine-based regimen is highly effective for indolent lymphoma with mild toxicity. Further investigation is warranted.

Inhibition of DNA primase and induction of apoptosis by 3,3’-diethyl-9-methylthia-carbocyanine iodide in hepatocellular carcinoma BEL-7402 cells

AIM: To evaluate the effects of 3,3’-diethyl-9-methylthia-carbocyanine iodide (DMTCCI) on DNA primase activity and on apoptosis of human hepatocellular carcinoma BEL-7402 cells.

METHODS: DNA primase assay was used to investigate DNA primase activity. MTT assay was applied to determine cell proliferation. Flow cytometric analysis, transmission electron microscopy, DNA fragmentation assay were performed to detect DMTCCI-induced apoptosis. Expression levels of p53, Bcl-2, Bcl-xL, Bad, Bax, survivin, Caspase-3 and poly (ADP-ribose) polymerase (PARP) were evaluated by immunoblot analysis. Caspase-3 activity was assessed with ApoAlert Caspase-3 colorimetric assay kit.

RESULTS: DMTCCI had inhibitory effects on eukaryotic DNA primase activity with IC₅₀ value of 162.2 nmol/L. It also inhibited proliferation of human hepatocellular carcinoma BEL-7402 cells with IC₅₀ value of 2.09 μmol/L. Furthermore, DMTCCI-induced BEL-7402 cell apoptosis was confirmed by DNA fragmentation (DNA ladders and sub-G1 formation) and transmission electron microscopy (apoptotic bodies formation). During the induction of apoptosis, expression of Bcl-2, Bcl-xL and survivin was decreased, and that of p53, Bad and Bax was increased. Caspase-3 was activated and poly (ADP-ribose) polymerase (PARP) was cleaved in BEL-7402 cells treated with DMTCCI.

CONCLUSION: The present data suggest that DMTCCI has inhibitory effects on eukaryotic DNA primase and can induce apoptosis of BEL-7402 cells. The modulation of expression of p53 and Bcl-2 family proteins, and activation of Caspase-3 might be involved in the induction of apoptosis.

[Preliminary study of lyophilized 10-hydroxycamptothecin in advanced or recurrent malignancies]

BACKGROUND & OBJECTIVE

10-Hydroxycamptothecin (HCPT) is the inhibitor of topoisomerase I with anti-cancer effectiveness on several solid tumors. TUOXI (lyophilized HCPT) has higher purity and stability in comparison with solution for injection HCPT. The purpose of this study was to investigate the efficacy, toxicity, and proper dosage of TUOXI as single agent in treatment of advanced and recurrent solid tumors.

METHODS

Sixty patients with the median age of 53 (range from 17 to 73 years) were enrolled into this multicenter phase II clinical trial. Among them, 18 patients were chemonaive and 42 were recurrent from chemotherapy; 22 patients with NSCLC, 12 nasopharyngeal carcinoma, 9 primary liver cancer, 9 colorectal carcinoma, 2 pancreatic carcinoma, and 6 miscellaneous malignancies. HCPT was given at the dosage of 6-8 mg/m(2) x d for 5-10 consecutive days based on the toxicity.

RESULTS

Fifty-one patients were valuable for effectiveness. The objective response rate for the whole group was 15.7%. The partial remission (PR) rates were 16% for 6 mg/m(2) group and 15.4% for 8 mg/m(2) group, respectively. The PR rates were 13.7% (3/22) for NSCLC, 33.3% (3/9) for colorectal carcinoma, and 16.6% (2/12) for advanced nasopharyngeal carcinoma, respectively. The PR rate for 60 intent-to-treat patients was 13.3% (8/60). Myelosuppression was the dose-limiting toxicity and other adverse reactions included nausea/vomiting, diarrhea, and skin rash. The incidence of grade III+IV adverse events were 32%, 8%, 8%, 6%, and 4% for leucopenia, skin rash, thrombocytopenia, nausea/vomiting, and diarrhea, respectively. No renal, pulmonary, and cardiac toxicity were found.

CONCLUSION

TUOXI (HCPT lyophilized powder) had relatively broad- spectrum anti-cancer efficacy and was effective on advanced or recurrent NCSLC, colorectal carcinoma, and NPC. And the recommended dosage is 6-8 mg/m(2) as 4 hours infusion for 5-10 consecutive days every 3 weeks. Further clinical investigation on large number of solid tumors cases are warranted.

[Relationship between tumor necrosis factor genetic polymorphisms and acute lymphocytic leukemia]

BACKGROUND & OBJECTIVE

Acute lymphocytic leukemia(ALL), which is sensitive to tumor necrosis factor (TNF) is one of hematological malignances derived from lymphoid tissue. Genetic polymorphisms in the tumor necrosis factor (TNF) locus can affect transcription and expression of TNF genes. This study was designed to investigate the relationship between -308 bp polymorphism in tumor necrosis factor-alpha(TNFalpha) gene and +252 bp in lymphotoxin-alpha(LTalpha) gene and the pathogenesis, clinical course, and outcome of ALL.

METHODS

The single base mutation polymorphism in TNFalpha gene and LTalpha gene were analyzed among 29 Chinese patients with ALL and 72 normal controls using polymerase chain reaction (PCR)-restrictive fragment length polymorphism (RFLP). The clinical data were collected and survival analysis was performed.

RESULTS

The difference of distribution of genotypes, alleles of TNFalpha(-308), LTalpha(+252), and TNF/LT polymorphic extended haplotypes between the ALL patients and control group were not statistically significant (P >0.05). In patients, no statistically significant association was found between the presence of a given TNF/LT haplotype status and clinical characters such as sex, white blood cell (WBC) counts, central nervous system involvement, and the response to therapy(P >0.05). The estimated 1-year overall survival rates in the groups of patients carrying high-risk and low-risk haplotypes were not statistically significant (P >0.05) using Kaplan-Meier method. In multivariate Cox regression models the TNF/LT haplotype status was not found to be a risk factor for outcome (P >0.05).

CONCLUSION

These data suggest that genetic polymorphisms in the TNFalpha(-308) and LTalpha(+252) are not crucial in the pathogenesis, clinical course, and outcome of ALL patients.

[Predictive significance of serum 90K/Mac-2BP on chemotherapy response in non-Hodgkin's lymphoma]

BACKGROUND & OBJECTIVE

For newly diagnosed non-Hodgkin's lymphoma (NHL), CHOP regimen shows good response, but quite a few patients belong to intrinsic drug resistance, or relapse after complete remission (CR). Clinical study has been focused on screening them out and improving the therapeutic response. The purpose of this study was to explore the predictive value of serum 90K/Mac-2BP on chemotherapy response in newly diagnosed NHLs, and to analyze the potential significance of serum 90K/Mac-2BP as a tumor marker in NHLs.

METHODS

Thirty healthy donors and 100 newly diagnosed patients were included in this study. Serum 90K/Mac-2BP level was measured with the quantitative sandwich enzyme linked immunosorbent assay (ELISA), and the relationship between serum 90K/Mac-2BP level and the therapeutic response as well as clinicopathological features was analyzed.

RESULTS

The level of serum 90K/Mac-2BP was associated with the response of the initial treatment in patients who received CHOP (CTX, ADM, VCR, Pred) chemotherapy. The response rate in patients with higher level (mean serum level >13.62 microg/ml) of 90K/Mac-2BP was 47.6% (20/42). The response rate in patients with lower level (mean serum level <or=13.62 microg/ml) reached 93.6% (44/47) (P< 0.001). The level of serum 90K/Mac-2BP was not relevant to age, gender, pathologic classification, performance status, Ann Arbor stage, international prognostic index(IPI),serum level of lactate dehydrogenase(LDH), bone marrow involvement, and bulky disease (P >0.05).

CONCLUSION

The level of serum 90K/Mac-2BP might predict the response of CHOP chemotherapy in NHLs, and is hopeful to be a new tumor marker.

[Multivariate survival analysis for 423 patients with non-small cell lung cancer]

BACKGROUND & OBJECTIVE

Non-small cell lung cancer(NSCLC) is characterized by high incidence and poor prognosis in our country. New prognostic factors are needed to guide the treatment of patients with NSCLC. This study was designed to evaluate the characteristics and outcome in NSCLC patients who underwent completely surgical resection.

METHODS

A total of 423 cases were analyzed using SPSS10.0 software. The survival differences were compared by univariate and multivariate analysis.

RESULTS

The 5-year survival rate in this group was 46.98%. Multivariate analysis identified two poor prognostic factors: advanced TNM stage (P=0.003) and blood group B (P=0.02). Multivariate analysis also identified two better prognostic factors:adjuvant chemotherapy (P=0.04) and squamous histological type (P=0.005). The number of the risk factors (blood group B and non- squamous) were negatively related to prognosis according to multivariate analysis in stage III a NSCLC (the 5-year survival rates:43.5% vs 23.7% vs 4.0%, P< 0.001).

CONCLUSION

Adjuvant chemotherapy maybe is beneficial to NSCLC patients who underwent completely surgical resection. Cox multivariate analysis demonstrates that evaluation of both histological type and blood-group has a significant prognostic effect in stage IIIa patients.