Outcome of COVID-19 infection in cancer patients during active systemic anticancer treatment. Single-institution experience. A retrospective analysis

INTRODUCTION

Patients with cancer undergoing active systemic anticancer treatment (chemotherapy, immunotherapy, targeted, or combination therapy) are at greater risk of COVID-19 infection than persons without cancer. In this paper, the authors analyse the spread of the coronavirus among cancer patients undergoing systemic therapy, and the impact of COVID-19 infection on the continuation of cancer treatment and its outcome at one community hospital in a mid-sized city in the south of Poland.

MATERIAL AND METHODS

Nasopharyngeal swab was the only collection method used to obtain specimens for testing via real-time reverse-transcriptase polymerase chain reaction (RT-PCR). Only those with positive RT-PCR results were considered as confirmed SARS-CoV-2 cases. We analysed the medical records of patients quarantined in a hospital clinical oncology ward due to confirmed COVID-19 infection in one member of the group. Qualitative measures are presented as the percentage of their occurrence, and these were evaluated with Fisher's test. Differences were considered significant at p < 0.05.

RESULTS

Cancer patients had more frequent confirmed COVID-19 infection than other patients (3.7% vs. 1.2%). Among cancer patients COVID-19 infection was significantly more frequent in women than in men, p = 0.005. The fatality rate was 27.3% in cancer patients undergoing active anticancer therapy, compared to 3% in the general Polish population. Neither heparin nor G-CSF use had any influence on COVID-19 infection.

CONCLUSIONS

In this analysis, the only significant negative factor for COVID-19 infection was female sex, RR (95% CI) = 4.5 (1.3-15.8), (p = 0.005), and this was attributable to individual behaviour.

Abstract P2-07-13: TP53 gene polymorphisms (c.[215G&gt;C]) in breast cancer patients and predisposition to family cancers- Single center experience

Introduction: Somatic mutations in the TP53 gene are one of the most frequent alterations in human cancers, and germline mutations are the underlying cause of Li-Fraumeni syndrome, which predisposes to a wide spectrum of early-onset cancers. The aim of this study was to evaluate the association between TP53 gene polymorphisms (c.[215G&gt;C]) and predisposition to family cancers. Methods: We reviewed the medical records of 89 (21% TP53 gene homozygotes and 79% heterozygotes) breast cancer patients who were diagnosed and treated in COI in Gliwice. The history of family cancers was colected from medical history. Mutation profile was assessed by RFLP-PCR technique. We evaluatedthe presence ofpolymorphism TP53 (c.[215G&gt;C]). Statistical analysis was carried out using STATISTICA 7 software. Results: Cancers in family history were detected in 72% of pts with TP53 polymorphisms and they were observed insignificantly more often in heterozygotes than in homozygotes (76% vs. 58%, p=0.153). The most frequently reported cancers were: breast cancer (33%), lymphoma (17%), colorectal cancer (9%), OUN cancer (8%), gastric cancer (8%), pancreatic cancer (7%), ovarian cancer (6%) and renal cancer (3%). In analyzed group, renal cancers in family were detected more frequently in TP53 homozygotes than in heterozygotes (16% vs. 0, p=0.008). Similarly, there was also observed tendency to the presence of colorectal cancer in TP53 homozygotes (11% vs. 0, p=0.193). Ovarian cancers and cholangiocarcinomas in family were also observed insignificantly more often in homozygotes than in heterozygotes (7% vs. 0, p=0.580) and (5% vs. 1%, p=0.383). There was no association between number of cancers in family and TP53 polymorphisms (47% vs. 43%, p=0.797). Conclusion: TP53 polymorphism (c.[215G&gt;C]) predisposed to development renal and colorectal cancers (TP53 homozygotes) and ovarian cancer or cholangiocarcinoma (TP53 heterozygotes) in family.

Citation Format: Huszno J, Grzybowska E, Nycz Bochenek M, Pamula Pilat J, Tecza K, Nowara E. TP53 gene polymorphisms (c.[215G&gt;C]) in breast cancer patients and predisposition to family cancers- Single center experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-07-13.

Efficacy and safety of vitamin D supplementation in patients with chronic lymphocytic leukemia

BACKGROUND

Vitamin D (VD) deficiency in chronic lymphocytic leukemia (CLL) is associated with inferior prognosis, shorter time to treatment and worse overall survival. VD deficiency is the first potentially modifiable prognostic factor in CLL. Currently, however, there is a lack of studies concerning VD supplementation in CLL patients.

AIM

To evaluate the efficacy and safety of VD supplementation in patients with CLL.

METHODS

A 6-month interventional study was conducted in CLL patients with lower serum 25-OH-D3 concentrations (< 30 ng/ml) than currently recommended. Patients with VD insufficiency (20-30 ng/ml) received 2000 IU of cholecalciferol/day, patients with moderate deficiency (10-19.9 ng/ml) received 4000 IU/day, and patients with severe VD deficiency (<10 ng/ml) received 6000 IU/day.

RESULTS

In the analyzed group of 13 CLL subjects, only 1 patient had a VD level within the optimal range (30-80 ng/ml), 7 had an insufficient concentration, 4 had moderate deficiency, and 1 had severe deficiency. Secondary hyperparathyroidism was diagnosed in 4 subjects. Cholecalciferol supplementation (mean dose of 3384 ± 1211 IU) was followed by a significant increase in 25-OH-D3 concentration (from 17.3 ± 5.8 to 41.4 ± 17.5 ng/ml; p<0.05) and decrease in PTH (p<0.05). Five patients did not achieve the recommended 25-OH-D3 concentration. Calcium level remained unchanged and no patients developed hypercalcemia.

CONCLUSIONS

VD replenishment is safe and can be effectively achieved by means of the employed cholecalciferol dosage in the majority of patients. However, some subjects may require higher doses to obtain the optimal level and immune function.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio before chemotherapy as potential prognostic factors in patients with newly diagnosed epithelial ovarian cancer

Introduction

Recent studies have shown that the presence of systemic inflammation correlates with worse outcomes in many types of cancers. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proposed as indicators of systemic inflammatory response. The aim of the study was to assess the prognostic value of NLR and PLR before starting chemotherapy among patients with newly diagnosed ovarian cancer.

Methods

We conducted a retrospective analysis of medical documentation of 315 patients with newly diagnosed epithelial ovarian cancer, treated in Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, between 2007 and 2013. 31 (12.1%) patients had metastatic disease at the time of diagnosis. Receiver-operating characteristic (ROC) curves for progression free survival (PFS) and overall survival (OS) prediction were plotted to verify cut-off points for NLR and PLR. PFS and OS were analysed for correlation with NLR and PLR, using the Cox regression model. Other potential prognostic variables included in multivariate analysis were: patient's age at diagnosis (<65 vs ≥65 years), Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥2, FIGO stage of the disease and baseline Ca-125 level.

Results

In multivariate analysis, higher pretreatment NLR (p=0.002), poor ECOG-PS (p=0.0002), higher disease stage (p<0.0001) and baseline Ca-125 (p=0.03) level were independent negative prognostic factors for PFS. However, only ECOG-PS ≥2 (p<0.0001), high stage of the disease (p<0.0001) and high baseline Ca-125 level (p=0.0003) were independent negative prognostic factors for OS.

Conclusions

Advanced stage of the disease with high Ca-125 level and poor patient performance status are the most important prognostic factors in ovarian cancer. Higher pretreatment value of NLR was an independent negative prognostic factor for PFS, with no significant impact on OS.

A Comparison between CHEK2*1100delC/I157T Mutation Carrier and Noncarrier Breast Cancer Patients: A Clinicopathological Analysis

OBJECTIVE

The suppressor gene CHEK2 encodes a cell cycle checkpoint kinase, involved in cell cycle regulation, apoptosis and response to DNA damage. The aim of this study was to analyze the differences between CHEK2 mutation carriers (CHEK2*1100delC/I157T) and noncarriers with respect to clinicopathological factors.

METHODS

We reviewed the medical records of 100 early breast cancer patients (46 mutation carriers and 54 noncarriers) who were treated with chemotherapy, hormonotherapy or trastuzumab.

RESULTS

CHEK2 mutation carriers were older (>65 years) than noncarriers (17 vs. 7%; p = 0.215). Twenty-five (54%) of them had a history of cancer in the family. Gastric cancer in the family history was detected in 11% of mutation carriers and in 2% of noncarriers (p = 0.092). There was a trend for more frequent lymph node metastases in patients without the mutation in comparison to mutation carriers (46 vs. 28%; p = 0.098). Luminal B type breast cancer was detected more often in carriers (39 vs. 20%; p = 0.048). Breast-conserving treatment was also conducted more often in mutation carriers (57 vs. 31%; p = 0.015). Histologic grades G1/G2 were detected more frequently in mutation carriers (82 vs. 70%; p = 0.212).

CONCLUSION

Mutation carriers were characterized by older age, a history of gastric cancer in the family, locally advanced disease, lower histologic grade and luminal B type breast cancer.

C–C motif ligand 11 reduction in CLL patients serum after vitamin D supplementation

Background: Vitamin D (VD) deficiency results in a worse prognosis in patients with chronic lymphocytic leukemia (CLL) and may affect the production of cytokines. Nonetheless, there is the lack of studies dealing with VD supplementation and its impact on chemokines in CLL patients.

Aim: The primary endpoint of our interventional study was to evaluate the effect of cholecalciferol supplementation on serum chemokines levels in CLL patients.

Materials and methods: Eighteen subjects with CLL were enrolled for the study. Six-month-long cholecalciferol supplementation was performed in CLL patients with serum 25-OH-D₃ levels below 30 ng/ml. Cytokines levels were assessed at the beginning of the study and after 6 months. Baseline measurements of cytokines were compared to those in apparently healthy controls.

Results: Increased levels of CCL2, CCL3, CCL4, CXCL8, CXCL10, TNFα, bFGF, G-CSF, and VEGF were found in CLL patients in comparison with the healthy controls. In the course of the VD supplementation a decrease in serum levels of chemokines CCL11, CCL3, and cytokine PDGF-BB was observed. The decrease of CCL11 was found in CLL patients on VD supplementation solely, whereas the decrease of CCL3 and PDGF-BB was observed in CLL subjects on both chemotherapy and VD supplementation.

Conclusion: The VD supplementation may exert beneficial effect on chemokines levels in CLL patients with VD deficiency.

A randomized, placebo-controlled phase III trial of masitinib plus gemcitabine in the treatment of advanced pancreatic cancer

BACKGROUND

Masitinib is a selective oral tyrosine-kinase inhibitor. The efficacy and safety of masitinib combined with gemcitabine was compared against single-agent gemcitabine in patients with advanced pancreatic ductal adenocarcinoma (PDAC).

PATIENTS AND METHODS

Patients with inoperable, chemotherapy-naïve, PDAC were randomized (1 : 1) to receive gemcitabine (1000 mg/m(2)) in combination with either masitinib (9 mg/kg/day) or a placebo. The primary endpoint was overall survival (OS) in the modified intent-to-treat population. Secondary OS analyses aimed to characterize subgroups with poor survival while receiving single-agent gemcitabine with subsequent evaluation of masitinib therapeutic benefit. These prospectively declared subgroups were based on pharmacogenomic data or a baseline characteristic.

RESULTS

Three hundred and fifty-three patients were randomly assigned to receive either masitinib plus gemcitabine (N = 175) or placebo plus gemcitabine (N = 178). Median OS was similar between treatment-arms for the overall population, at respectively, 7.7 and 7.1 months, with a hazard ratio (HR) of 0.89 (95% CI [0.70; 1.13]. Secondary analyses identified two subgroups having a significantly poor survival rate when receiving single-agent gemcitabine; one defined by an overexpression of acyl-CoA oxidase-1 (ACOX1) in blood, and another via a baseline pain intensity threshold (VAS > 20 mm). These subgroups represent a critical unmet medical need as evidenced from median OS of 5.5 months in patients receiving single-agent gemcitabine, and comprise an estimated 63% of patients. A significant treatment effect was observed in these subgroups for masitinib with median OS of 11.7 months in the 'ACOX1' subgroup [HR = 0.23 (0.10; 0.51), P = 0.001], and 8.0 months in the 'pain' subgroup [HR = 0.62 (0.43; 0.89), P = 0.012]. Despite an increased toxicity of the combination as compared with single-agent gemcitabine, side-effects remained manageable.

CONCLUSIONS

The present data warrant initiation of a confirmatory study that may support the use of masitinib plus gemcitabine for treatment of PDAC patients with overexpression of ACOX1 or baseline pain (VAS > 20mm). Masitinib's effect in these subgroups is also supported by biological plausibility and evidence of internal clinical validation.

TRIAL REGISTRATION

ClinicalTrials.gov:NCT00789633.

The influence of steroid receptor status on the cardiotoxicity risk in HER2-positive breast cancer patients receiving trastuzumab

INTRODUCTION

Expression of steroid receptors and HER2 overexpression in breast cancer cells are predictive and prognostic factors. Overexpression of HER2 allows the use of immunotherapy, in which the most serious side effect is cardiotoxicity. The aim of this study was to evaluate the influence of steroid receptor status on cardiotoxicity risk in HER2 breast cancer patients receiving trastuzumab both in adjuvant treatment and in the case of disease dissemination. This study also assessed well-known cardiac risk factors.

MATERIAL AND METHODS

The study was conducted on 166 patients who received immunotherapy in the Clinical and Experimental Oncology Department, between the years 2006 and 2012.

RESULTS

A predisposition to cardiac side effects (13% vs. 5%) in patients with negative steroid receptor status was observed (p = 0.08). The decrease of left ventricular ejection fraction (LVEF) (12% vs. 0) and cardiac adverse side effects (2% vs. 0) were detected only in ER-/PR- patients but without statistical significance. Discontinuation of therapy because of cardiotoxicity was associated with negative receptor status (33% vs. 7%) (p = 0.019). Irrespective of steroid receptor status, older age of patients (p = 0.009) and previous radiotherapy to the left side of the chest (p = 0.02) were associated with the occurrence of cardiotoxicity and decrease of LVEF. In patients who received previous anthracycline-based chemotherapy, acute cardiac side effects were observed significantly more often (p = 0.01).

CONCLUSIONS

There was no influence of steroid receptor status on the cardiac side effects. Breast cancer type containing Erb-B2 overexpression was associated with predisposition to cardiotoxicity. The results require confirmation in a larger group of patients.

A randomized controlled phase II trial of a novel composition of paclitaxel embedded into neutral and cationic lipids targeting tumor endothelial cells in advanced triple-negative breast cancer (TNBC)

BACKGROUND

EndoTAG-1, composed of paclitaxel embedded in liposomal membranes targeting tumor endothelial cells, was evaluated for safety and efficacy in advanced triple-negative breast cancer (TNBC).

PATIENTS AND METHODS

One hundred and forty patients were treated with weekly EndoTAG-1 (22 mg/m(2)) plus paclitaxel (70 mg/m(2)), twice weekly EndoTAG-1 (2× 44 mg/m(2)), or weekly paclitaxel (90 mg/m(2)) for greater than or equal to four cycles (3-week treatment + 1-week rest) or until progression/toxicity. Primary end point was progression-free survival (PFS) rate evaluated centrally after four cycles of therapy (week 16). The study was not powered for intergroup comparisons.

RESULTS

The PFS rate at week 16 was 59.1% [one-sided 95% CI: 45.6, ∞] on combination treatment, 34.2% [21.6, ∞] on EndoTAG-1, and 48.0% [30.5, ∞] on paclitaxel. Median PFS reached 4.2, 3.4, and 3.7 months, respectively. After complete treatment (week 41 analysis), median overall survival (OS) was 13.0, 11.9, and 13.1 months for the modified Intention-to-Treat (ITT) population and 15.1, 12.5, and 8.9 months for the per-protocol population, respectively. The clinical benefit rate was 53%, 31%, and 36% for the treatment groups. Safety analysis revealed known toxicities of the drugs with slight increases of grade 3/4 neutropenia on combination therapy.

CONCLUSION

Treatment of advanced TNBC with a combination of EndoTAG-1 and standard paclitaxel [Taxol® (Bristol-Myers Squibb GmbH), or equivalent generic formulation] was well tolerated and showed antitumor efficacy. The positive trend needs to be confirmed in a randomized phase III trial.

STUDY REGISTRATION

European Clinical Trials Database: EudraCT number 2006-002221-23. ClinicalTrials.gov identifier: NCT00448305.

Unfavorable prognosis of nephroblastoma in adults

Wilms' tumor is the most common type of malignant kidney tumor in children. Due to the fact that this type of cancer is so rare in adults, however, there is a significant lack of treatment strategies in this age group. Moreover, the treatment of adults is often based on protocols used in children. The present report describes a case of a 25-year-old male with nephroblastoma stage IV, who had a primary surgery and underwent chemotherapy with CDVC (cyclophosphamide, doxorubicin, vepesid, carboplatin). During the systemic treatment, the authors observed progression of disease and serious side effects.

The influence of BRCA1/BRCA2 mutations on toxicity related to chemotherapy and radiotherapy in early breast cancer patients

OBJECTIVE

The presence of BRCA gene mutation and low expressions of BRCA proteins are associated with a greater sensitivity of tumor cells to ionizing radiation and to cytostatics damaging the DNA of the cells. The purpose of this study was to estimate the rate of adverse events in BRCA1/2-associated breast cancer patients receiving anthracycline-based chemotherapy compared to patients without mutation. The authors also compared radiotherapy toxicity in these 2 groups.

METHODS

The analysis included 270 early-stage breast cancer patients treated between 2006 and 2012. All patients were examined for the presence of BRCA1/2 mutations.

RESULTS

BRCA mutation was detected in 41 (15%) patients. Toxicity grade 3, especially nausea and vomiting, was observed more often in noncarriers (7 vs. 13%, p = 0.0008). Neutropenia was detected more frequently in patients with BRCA1/2 mutation (32 vs. 10%), but only after 1 cycle of chemotherapy (p = 0.0007). There was increased radiation toxicity in BRCA1/2 patients who underwent mastectomy and neoadjuvant chemotherapy (p = 0.016).

CONCLUSIONS

BRCA1/2 mutation carriers seemed to be more at risk of neutropenia after the first cycle of the treatment. In terms of other side effects, there was a lack of increased toxicity in this group. Mastectomy and neoadjuvant chemotherapy were risk factors for radiation toxicity in mutation carriers.

A randomized, placebo-controlled phase 2 study of ganitumab or conatumumab in combination with FOLFIRI for second-line treatment of mutant KRAS metastatic colorectal cancer

BACKGROUND

Targeted agents presently available for mutant KRAS metastatic colorectal cancer (mCRC) are bevacizumab and aflibercept. We evaluated the efficacy and safety of conatumumab (an agonistic monoclonal antibody against human death receptor 5) and ganitumab (a monoclonal antibody against the type 1 insulin-like growth factor receptor) combined with standard FOLFIRI chemotherapy as a second-line treatment in patients with mutant KRAS mCRC.

PATIENTS AND METHODS

Patients with mutant KRAS metastatic adenocarcinoma of the colon or rectum refractory to fluoropyrimidine- and oxaliplatin-based chemotherapy were randomized 1 : 1 : 1 to receive intravenous FOLFIRI plus conatumumab 10 mg/kg (Arm A), ganitumab 12 mg/kg (Arm B), or placebo (Arm C) Q2W. The primary end point was progression-free survival (PFS).

RESULTS

In total, 155 patients were randomized. Median PFS in Arms A, B, and C was 6.5 months (HR, 0.69; P = 0.147), 4.5 months (HR, 1.01; P = 0.998), and 4.6 months, respectively; median overall survival was 12.3 months (HR, 0.89; P = 0.650), 12.4 months (HR, 1.27; P = 0.357), and 12.0 months; and objective response rate was 14%, 8%, and 2%. The most common grade ≥3 adverse events in Arms A/B/C included neutropenia (30%/25%/18%) and diarrhea (18%/2%/10%).

CONCLUSIONS

Conatumumab, but not ganitumab, plus FOLFIRI was associated with a trend toward improved PFS. Both combinations had acceptable toxicity.

Adult Wilms' tumor - diagnosis and current therapy

INTRODUCTION

Wilms' tumour is one of the commonest malignant tumours of childhood. It appears mainly in the first 5 years of life. Incidental examples of nephroblastoma in adults have been described in literature (about 3% of all described cases). There are diagnostic and therapeutic difficulties in that older age group. The preoperative diagnosis of nephroblastoma in adults is difficult because there are no specific radiographic findings that allow to distinguished it from the more common adult renal tumors. Histopathologically, there is no difference between adult and childhood Wilms' tumor.

MATERIALS AND METHODS

The PubMed database and current literature search was conducted for reports on clinical and histopathological features of nephroblastoma in adults. We also reviewed the literature in terms of treatment strategy, toxicity and prognostic factors.

RESULTS

Up till now, several biological factors have been identified that may be in future new prognostic factors. Modern treatment regiments improved OS in this group of patients (OS rates of 90%). The prognosis remain still worse for about 25% of patients with anaplastic, bilateral and recurrent disease.

CONCLUSIONS

Due to the fact that nephroblastoma is a very rare type of cancer, adult patients should be treated in an individual way based on the available schemes used in children. Toxicity in adults is higher than in children.

Chemotherapy in the Management of Disseminated Thymoma: A Case Report and the Authors’ Own Experience

Thymomas are tumours originating from the epithelial tissue of the thymus. While surgery is the mainstay of therapy in thymoma, chemotherapy may significantly improve the prognosis. Effective chemotherapy may be administered in the neoadjuvant setting (prior to surgery), in the adjuvant setting (following surgery), may be combined with radiotherapy or be used for palliation in disseminated disease. We report a case of a 66-year-old male with advanced thymoma who received second-line treatment with a good outcome.

A randomized, phase I/II trial of AMG 102 or AMG 479 in combination with panitumumab (pmab) compared with pmab alone in patients (pts) with wild-type (WT) KRAS metastatic colorectal cancer (mCRC): Safety and efficacy results

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Background: Pmab is a fully human anti-epidermal growth factor receptor monoclonal antibody (mAb) approved as monotherapy for pts with mCRC. AMG 102 and AMG 479 are investigational, fully human mAbs against hepatocyte growth factor (HGF) and insulin-like growth factor receptor 1 (IGF1R), respectively. This 3-part study evaluated the safety and efficacy of AMG 102 or AMG 479 in combination with pmab.

Methods: Part 1 was a phase 1b, open-label, dose-finding study to determine a tolerable dose of AMG 102 in combination with pmab. Part 2 was a phase II, randomized, blinded, placebo-controlled trial that explored pmab + the dose of AMG 102 selected in Part 1 vs pmab + AMG 479 vs pmab + placebo. Part 3 is a 2-arm randomized extension study for pts who developed disease progression (PD) or intolerability to pmab + placebo in part 2. Eligible pts were ≥ 18 years old with WT KRAS mCRC and ECOG PS 0/1. In part 1, all pts received 6 mg/kg pmab + 10 mg/kg AMG 102 Q2W IV until PD or intolerability. The primary endpoint of part 1 was the incidence of dose-limiting toxicities (DLTs). The primary endpoint for part 2 is objective response rate (ORR).

Results: In part 1, no DLTs were reported for the first 6 DLT-evaluable pts. A total of 11 pts were enrolled in part 1 prior to the decision to use the 10 mg/kg Q2W AMG 102 dose in part 2; 5 pts were men; mean (range) age was 56 (37-75) yrs; ECOG 0/1 was 55%/45%. Grade 3 treatment-related adverse events (AEs) were acneiform dermatitis or rash (55%), paronychia (18%), infection (9%), capillary leak syndrome (9%), erythema (9%), nail disorder (9%), and pruritus (9%). There were no grade 4 or 5 treatment-related AEs. Serious AEs included acneiform dermatitis (n = 1), intestinal obstruction (n = 1), cerebrovascular accident (n = 1), capillary leak syndrome (n = 1), and anemia/general health deterioration (n = 1). One pt died on study from PD. In part 2, 142 pts received at least one dose of study drug; enrollment is complete, and data analyses are ongoing.

Conclusions: In part 1, 6 mg/kg pmab + 10 mg/kg AMG 102 Q2W was well tolerated. Primary efficacy results from part 2, including ORR and progression-free survival, will be presented.

[Table: see text]

[Chemotherapy in disseminated thymoma--case report, own experience]

Thymomas are thymic epithelial neoplasms. Surgery plays a major role in thymoma treatment but chemotherapy can significantly improve prognoses for this group of patients. Neoadjuvant chemotherapy (before surgery), adjuvant chemotherapy (after surgery), chemotherapy combined with radiotherapy and palliative chemotherapy in dissemination stage could be required in effective therapy. The aim of this paper is description of the effective systemic second line treatment in the case of 66 years old patient with advanced thymoma.

[Primary non-Hodgkin's lymphoma of the maxillary sinus]

The head and neck region is one of the most common sites of extranodal non-Hodgkin's lymphoma, but it is an infrequent tumor at the paranasal sinuses site, representing no more than 5.8-8 percent of the entire malignant tumours in this localization and 0.3-2 percent of all extranodal lymphomas. These rare tumors are characterized by bulky local disease, and a propensity for central nervous system spread. Most of patients with paranasal sinus lymphoma have stage I or IIE disease, but according to the TNM system, more than half have T3-4 disease. Most of these tumors are asymptomatic in the early stages and are diagnosed only after invasion of adjacent structures with local bone destruction. Treatment is basically radiotherapy in combination with aggressive multidrug chemotherapy, also in elderly patients, even at the beginning of the illness. A case of primary extranodal non-Hodgkin's lymphoma arising in maxillary sinus, in 64 year-old man is reported. He was staged IAE by the Ann-Arbor system, and according to the TNM staging T4N0M0. He was treated with irradiation and polychemotherapy and responded complete local regression, but during chemotherapy has been developed extranodal dissemination to central nervous system.

[The palatal tonsils as a part of the lymphatic system. Inflow and outflow of newly-formed lymphocytes]

Many lymphocytes continuously migrate from one lymphoid organ to another. The tonsils are also included in the migratory stream of long-lived lymphocytes. We investigated the question whether newly formed lymphocytes, for example, those produced in the spleen or mesenteric lymph nodes, also migrate to the tonsils and to which compartment. The spleen and mesenteric lymph nodes of normal young pigs were selectively labelled with the DNA precursor 3H-thymidine and one day later smears and sections of the tonsils were autoradiographed. About 1% of all spleen-derived young lymphocytes and about 0.5% of all emigrated mesenteric lymph node lymphocytes were found in palatine tonsils. These were almost exclusively small to medium sized lymphocytes. These cells were mainly found in the interfollicular area around high endothelial venules. Surprisingly high numbers were also located in the reticular epithelium of the crypts, in the corona and even in follicles. In a second series of experiment palatine tonsils were selectively labelled by multiple minute injections of 3H-thymidine. The follicles showed a very high labelling index but labelled lymphocytes were also identified in other compartments. One day later tonsil-derived lymphocytes were found in the spleen and lymph nodes. There is thus a continuous exchange of newly formed lymphocytes between the tonsils and other lymphoid organs.

The emigration of lymphocytes from palatine tonsils after local labelling

Lymphocytes in the palatine tonsils of normal young pigs were selectively labelled by minute multiple injections of fluorescein isothiocyanate into the tonsils. One day later the numbers of tonsil-derived lymphocytes were determined in cervical, bronchial and mesenteric lymph nodes, spleen, Peyer's patches, thymus, bone marrow and blood. Although not all tonsillar lymphocytes could be labelled by this technique, a total of approximately 0.6 X 10(9) lymphocytes emigrated from the tonsils. Relatively more lymphocytes were found in lymph nodes than in the spleen and very few in the thymus, Peyer's patches and bone marrow. This organ distribution was different from the results from selectively labelling lymphocytes in lymph nodes, spleen and bone marrow.

Organ distribution and fate of newly formed splenic lymphocytes in the pig

The production of lymphoid cells in the pig spleen was studied autoradiographically after selective labeling of the spleen using an extracorporeal perfusion circuit. Tritiated thymidine was added as a DNA precursor. One to 4 days after local labeling of the spleen the relative and absolute number of spleen-derived lymphocytes were determined in the following organs: mesenteric, cervical and inguinal lymph nodes, thymus, bone marrow, Peyer's patches, tonsils, three different parts of the gut, lung, liver, and blood. The labeled lymphocytes which migrated to these organs were all small lymphocytes, except for some large cells in the lamina propria. In the bone marrow, however, a considerable number of the spleen-derived immigrants were transformed into plasma cells. The total number of labeled lymphocytes decreased dramatically from Day 1 to Day 4 after labeling, indicating a high percentage of short-lived cells. Within the spleen, plasma cells had the highest labeling index of about 30% at Day 1 but this dropped to only 1.5% on Day 3. The organ distribution of the splenic emigrants changed from Day 1 to Day 4 with a relative increase in lymphocytes found in lymph nodes and a decrease in the lung and intestinal wall. The newly formed splenic lymphocytes migrated to T-and B-cell areas in lymph nodes, Peyer's patches and tonsils. In the intestinal wall labeled lymphocytes were found in the lamina propria and also as intraepithelial lymphocytes. There was no obvious redistribution between organ compartments with time after labeling of the spleen. The spleen produces large numbers of lymphocytes, which show typical organ distribution and homing to areas in lymphoid and nonlymphoid organs.