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Lymphoma in a patient with rheumatoid arthritis receiving methotrexate treatment: successful treatment with rituximab

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ANNALS OF THE RHEUMATIC DISEASES 2001年第9期60卷 892-893页

作者： Stewart, M Malkovska, V Krishnan, J Lessin, L Barth, W Washington Hosp Ctr Dept Rheumatol Washington DC 20010 USA Washington Hosp Ctr Dept Haematol Oncol Washington DC 20010 USA Washington Hosp Ctr Dept Pathol Washington DC 20010 USA

A 55 year old man with chronic lymphocytic leukaemia (CLL) and rheumatoid arthritis (RA), treated for four years with methotrexate (MTX), who developed a B cell non-Hodgkin's lymphoma (B-NHL), is described. The tumour was localised to the shoulder and axillary lymph nodes, and positive for Epstein-Barr viral antigens. After failure of radiation and chemotherapy, a complete remission was achieved with a combination of antibody treatment (rituximab) and EPOCH. The development of a second malignancy in a patient with RA receiving MTX has not been described before. The summation of T cell deficiencies induced by MTX, CLL, and RA may all have contributed to the development of the B-NHL.

关键词：抗体单克隆/治疗应用抗肿瘤药/治疗应用抗肿瘤联合化疗方案/治疗应用抗风湿药/治疗应用关节炎类风湿/并发症关节炎类风湿/药物疗法免疫减弱宿主淋巴瘤 B细胞/药物疗法淋巴瘤 B细胞/病因学甲氨蝶呤/治疗应用肿瘤继发原发性/药物疗法肿瘤继发原发性/病因学治疗结果人类男(雄)性中年人

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BLOOD 2000年第11期95卷 3273-3279页

作者： Pedersen-Bjergaard, J Andersen, MK Christiansen, DH Rigshosp Dept Clin Genet Julaine Marie Ctr Sect 4052 DK-2100 Copenhagen O Denmark Rigshosp Cytogenet Lab Hematol Oncol Sect Copenhagen Denmark

Therapy-related myelodysplasia (t-MDS) and acute myeloid leukemia (t-AML) after high-dose chemotherapy (HD-CT) and autologous stem cell transplantation (ASCI) for malignant diseases have become an important problem, The actuarial risk has varied, but has often been high if compared to the risk after conventional therapy. Prior chemotherapy with large cumulative doses of alkylating agents is the most important risk factor. In addition, patient age end previous radiotherapy, particularly the use of total body irradiation (TBI) in the preparative regimen for ASCT, have been identified as risk factors, In 3 studies, patients transplanted with CD34(+) cells from peripheral blood after chemotherapy priming showed a higher risk of t-MDS or t-AML than patients transplanted with cells isolated from the bone marrow without priming. To what extent this higher risk relates to the prior therapy with a different contamination with preleukemic, hematopoietic precursors of the CD34(+) cells obtained by the 2 methods, or is a direct result of chemotherapy priming, or of an increasing awareness of these complications, remains to be determined. The latent period from ASCT to t-MDS and t-AML has often been short, 12 months or less in 27% of the patients. Bone marrow pathology of early cases of t-MDS after ASCT has often been neither diagnostic nor prognostic, but most patients presented chromosome aberrations, primarily deletions or loss of the long arms of chromosomes 5 and 7, The prognosis was in general poor, although 17% with indolent t-MDS survived more than 18 months from diagnosis, and most of these presented a normal karyotype or a single chromosome aberration. (Blood, 2000;95:3273-3279) (C) 2000 by The American Society of Hematology.

关键词：急性病染色体畸变白血病髓样/化学诱导白血病髓样/病因学白血病髓样/遗传学骨髓增生异常综合征/化学诱导骨髓增生异常综合征/病因学骨髓增生异常综合征/遗传学肿瘤/药物疗法肿瘤/治疗肿瘤继发原发性/化学诱导肿瘤继发原发性/病因学肿瘤继发原发性/遗传学危险因素移植自体人类

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Predictors of therapy-related leukemia and myelodysplasia following autologous transplantation for lymphoma: an assessment of risk factors

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BLOOD 2000年第5期95卷 1588-1593页

作者： Krishnan, A Bhatia, S Slovak, ML Arber, DA Niland, JC Nademanee, A Fung, H Bhatia, R Kashyap, A Molina, A O'Donnell, MR Parker, PA Sniecinski, I Snyder, DS Spielberger, R Stein, A Forman, SJ City Hope Natl Med Ctr Div Pediat Oncol Duarte CA 91010 USA City Hope Natl Med Ctr Div Hematol & Bone Marrow Transplantat Duarte CA 91010 USA City Hope Natl Med Ctr Div Biostat & Pathol Duarte CA 91010 USA

We analyzed data on 612 patients who had undergone high-dose chemoradiotherapy (HDT) with autologous stem cell rescue for Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) at the City of Hope National Medical Center, to evaluate the incidence of therapy-related myelodysplasia (t-MDS) or therapy-related acute myeloid leukemia (t-AML) and associated risk factors. A retrospective cohort and a nested case-control study design were used to evaluate the role of pretransplant therapeutic exposures and transplant conditioning regimens. Twenty-two patients developed morphologic evidence of tMDS/t-AML. The estimated cumulative probability of developing morphologic t-MDS/t-AML was 8.6% +/- 2.1% at 6 years. Multivariate analysis of the entire cohort revealed stem cell priming with VP-16 (RR = 7.7, P = 0.002) to be independently associated with an increased risk of t-MDS/t-AML. The influence of pretransplant therapy on subsequent t-MDS/t-AML risk was determined by a case-control study. Multivariate analysis revealed an association between pretransplant radiation and the risk of t-MDS/t-AML, but failed to reveal any association with pretransplant chemotherapy or conditioning regimens. However, patients who had been primed with VP-16 for stem cell mobilization were at a 12.3-fold increased risk of developing t-AML with 11q23/21q22 abnormalities (P = 0.006). Patients undergoing HDT with stem cell rescue are at an increased risk of t-MDS/t-AML, especially those receiving priming with VP-16 for peripheral stem cell collection. (C) 2000 by The American Society of Hematology.

关键词：加利福尼亚/流行病学病例对照研究队列研究综合疗法依托泊甙/投药和剂量造血干细胞动员/方法白血病/化学诱导白血病/流行病学白血病/病因学白血病辐射性/流行病学白血病辐射性/病因学淋巴瘤/药物疗法淋巴瘤/放射疗法淋巴瘤/治疗多元分析骨髓增生异常综合征/化学诱导骨髓增生异常综合征/流行病学骨髓增生异常综合征/病因学肿瘤继发原发性/化学诱导肿瘤继发原发性/流行病学肿瘤继发原发性/病因学比值比回顾性研究危险因素治疗结果女(雌)性人类男(雄)性中年人

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Emergence of genetic instability in children treated for leukemia

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SCIENCE 2000年第5465期288卷 514-517页

作者： Finette, BA Homans, AC Albertini, RJ Univ Vermont Dept Pediat Burlington VT 05405 USA Univ Vermont Dept Microbiol & Mol Genet Burlington VT 05405 USA Univ Vermont Vermont Canc Ctr Burlington VT 05405 USA Univ Vermont Dept Med Burlington VT 05405 USA

T cells from patients who had received chemotherapy for B-lineage acute lymphocytic Leukemia were studied to determine whether genetic instability, a principal characteristic of cancer cells, can also occur in nonmalignant cells. Consistent with expectations for a genetic instability phenotype, multiple mutations were detected in the hypoxanthine-guanine phosphoribosyltransferase (HPRT) reporter gene in independently isolated mutant T cells expressing identical rearranged T cell receptor beta (TCR beta) gene hypervariable regions. These results indicate that cancer treatment can lead to genetic instability in nonmalignant cells in some individuals. They also suggest a mechanistic paradigm for the induction of second malignancies and drug resistance.

关键词：等位基因抗肿瘤药/治疗应用伯基特淋巴瘤/血液伯基特淋巴瘤/药物疗法伯基特淋巴瘤/遗传学细胞谱系细胞转化肿瘤克隆细胞抗药性肿瘤基因重排 β链T细胞抗原受体基因报告基因 T细胞受体次黄嘌呤磷酸核糖转移酶/遗传学突变肿瘤继发原发性/病因学前体细胞淋巴母细胞白血病淋巴瘤/血液前体细胞淋巴母细胞白血病淋巴瘤/药物疗法前体细胞淋巴母细胞白血病淋巴瘤/遗传学复发 T淋巴细胞青少年成年人儿童儿童学龄前人类婴儿

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Limits to the "benefits" from our oncologic interventions: A case report

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GYNECOLOGIC ONCOLOGY 2000年第2期78卷 261-262页

作者： Markman, M Cleveland Clin Fdn Cleveland Clin Taussig Canc Ctr Cleveland OH 44195 USA Cleveland Clin Fdn Dept Med Hematol Oncol Cleveland OH 44195 USA Cleveland Clin Fdn Dept Obstet Gynecol Cleveland OH 44195 USA

Purpose. The aim of this study was to discuss the potential implications of prolonged and aggressive treatment of long-term survivors of ovarian cancer. Methods. A case report of a patient with ovarian cancer extensively treated with platinum-based chemotherapy and aggressive surgery is presented. Results. A woman with a >15-year history of ovarian cancer experienced severe neurotoxicity (peripheral neuropathy, hearing loss), underwent aggressive resection of asymptomatic and longstanding metastatic disease in the liver (with tumor recurrence <1 year after surgery), and subsequently died of secondary acute leukemia. Conclusion. It is critical that oncologists remember that the theoretical benefits of available anti-neoplastic interventions must be carefully and constantly weighted against the potential harm they may cause. (C) 2000 Academic Press.

关键词：顺铂/投药和剂量综合疗法环磷酰胺/投药和剂量聋/化学诱导肝肿瘤/药物疗法肝肿瘤/继发性肝肿瘤/外科学肿瘤继发原发性/病因学卵巢肿瘤/药物疗法卵巢肿瘤/外科学卵巢肿瘤/治疗周围神经系统疾病/化学诱导治疗结果女(雌)性人类中年人

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Comparative risk assessment of secondary cancer incidence after treatment of Hodgkin's disease with photon and proton radiation

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RADIATION RESEARCH 2000年第4期154卷 382-388页

作者： Schneider, U Lomax, A Lombriser, N City Hosp Triemli Dept Radiat Oncol & Nucl Med CH-8063 Zurich Switzerland Paul Scherrer Inst Dept Radiat Med CH-5232 Villigen Switzerland

Probabilities for secondary cancer incidence have been estimated for a patient with Hodgkin's disease for whom treatment has been planned with different radiation modalities using photons and protons. The ICRP calculation scheme has been used to calculate cancer incidence from dose distributions. For this purpose, target volumes as well as critical structures have been outlined in the CT set of a patient with Hodgkin's disease. Dose distributions have been calculated using conventional as well as intensity-modulated treatment techniques using photon and proton radiation. The cancer incidence has been derived from the mean doses for each organ. The results of this work are: (a) Intensity-modulated treatment of Hodgkin's disease using nine photon fields (15 MV) results in nearly the same cancer incidence as treating with two opposed photon fields (6 MV). (b) Intensity-modulated treatment using nine proton fields (maximum energy 177.25 MeV) results in nearly the same cancer incidence as treating with one proton field (160 MeV), (c) Irradiation with protons using the spot scanning technique decreases the avoidable cancer incidence compared to photon treatment by a factor of about two. This result is independent of the number of beams used. Our work suggests that there are radiotherapy indications in which intensity-modulated treatments will result in little or no reduction of cancer incidence compared to conventional treatments. However, proton treatment can result in a lower cancer incidence than photon treatment. (C) 2000 by Radiation Research Society.

关键词：剂量效应关系辐射霍奇金病/放射疗法发病率肿瘤辐射性/流行病学肿瘤辐射性/病因学肿瘤继发原发性/流行病学肿瘤继发原发性/病因学器官特异性光子/副作用光子/治疗应用质子/副作用放射疗法高能/副作用放射疗法高能/方法危险性评估成年人女(雌)性人类

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Multiple basal cell carcinomas and malignant melanoma following radiotherapy for ankylosing spondylitis

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CLINICAL AND EXPERIMENTAL DERMATOLOGY 2000年第5期25卷 381-383页

作者： Beswick, SJ Garrido, MC Fryer, AA Strange, RC Smith, AG N Staffordshire Hosp Postgrad Med Sch Dept Dermatol Stoke On Trent ST4 7PA Staffs England N Staffordshire Hosp Postgrad Med Sch Dept Histopathol Stoke On Trent ST4 7PA Staffs England N Staffordshire Hosp Postgrad Med Sch Ctr Cell & Mol Med Stoke On Trent ST4 7PA Staffs England

We present the case of a 53-year-old Caucasian woman with seven basal cell carcinomas and one malignant melanoma in situ along her back overlying her spine, which was irradiated in 1968 for ankylosing spondylitis. These lesions developed between 1997 and 1999. She has no other known risk factors for cutaneous malignancy, in particular no history of excessive sun exposure. She has skin type 2. Molecular studies of glutathione S-transferase and cytochrome P450 status showed her genotype not to constitute an overall increased inherited susceptibility. We therefore postulate that all her skin cancers have arisen as a consequence of her radiotherapy. To our knowledge this is the first case of multiple basal cell carcinoma in addition to a malignant melanoma following radiotherapy for benign disease.

关键词：癌基底细胞/病因学癌基底细胞/病理学黑色素瘤/病因学黑色素瘤/病理学肿瘤辐射性/病因学肿瘤继发原发性/病因学肿瘤继发原发性/病理学皮肤肿瘤/病因学皮肤肿瘤/病理学脊柱炎强直性/放射疗法胸椎女(雌)性人类男(雄)性

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22-year-old woman with severe microcytic anemia

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MAYO CLINIC PROCEEDINGS 2000年第8期75卷 861-864页

作者： Shoho, AR Go, RS Tefferi, A Mayo Clin & Mayo Grad Sch Med Rochester MN 55901 USA Mayo Clin Div Hematol Rochester MN 55905 USA

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Problems in histological diagnosis of cancer associated with chemo- and/or radiotherapy

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JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY 1999年第3-4期125卷 239-244页

作者： Ishikawa, Y Kato, Y Kitagawa, T Japanese Fdn Canc Res Inst Canc Dept Pathol Toshima Ku Tokyo 1708455 Japan

This special report discusses problems relevant to histological diagnosis of cancer after chemo- and/or radiotherapy. One of the issues relates to pitfalls, i.e. over-, under- or misdiagnosis or oversight, stemming from a lack of concern or awareness of therapeutic effects on tumors or normal tissues. Another set of questions concerns inadequacy or insufficiency in the evaluation of therapeutic effects stemming from practical difficulties. In view of the importance of this area, we should set out a comprehensive research programme with close cooperation among clinicians, pathologists and molecular biologists to overcome these problems.

关键词：诊断鉴别误诊肿瘤继发原发性/诊断肿瘤继发原发性/病因学肿瘤继发原发性/病理学老年人女(雌)性人类中年人

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MALIGNANT MYOEPITHELIOMA AFTER RADIATION FOR RETINOBLASTOMA

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1992年第4期114卷 512-513页

作者： SAXE, SJ GROSSNIKLAUS, HE SOMEREN, AO EMORY UNIV SCH MEDDEPT OPHTHALMOLATLANTAGA 30322 EMORY UNIV SCH MEDDEPT PATHOLATLANTAGA 30322

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