allopurinol and Lymphoma--B-Cell

Stevens-Johnson syndrome/toxic epidermal necrolysis overlap is an acute hypersensitivity reaction that compromises the integrity of mucous membranes and cutaneous tissue. While the pathophysiology of this syndrome has not been fully elucidated, it is commonly associated with the medication use and carries a significant mortality risk of approximately 30%. No commonalities among causative medications have been identified, and determining the offending agent can be challenging. This case report describes fatal Stevens-Johnson syndrome/toxic epidermal necrolysis overlap in a patient after receiving his first cycle of allopurinol, rituximab, and bendamustine treatment for non-Hodgkin's B-cell lymphoma. An analysis of FDA Medwatch adverse reaction case reports involving allopurinol, rituximab, and bendamustine is also presented.

Topics: Aged; Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Bendamustine Hydrochloride; Fatal Outcome; Humans; Lymphoma, B-Cell; Male; Rituximab; Stevens-Johnson Syndrome

Topics: Aged; Allopurinol; Antimetabolites, Antineoplastic; Brain Neoplasms; Drug Eruptions; Female; Humans; Lymphoma, B-Cell; Methotrexate; Photosensitivity Disorders; Stevens-Johnson Syndrome; Ultraviolet Rays

Acquired ichthyosis is a rare condition that can reveal an unsuspected haematological malignancy, thus allowing early diagnosis and management. If ichthyosis regresses under treatment for the haematological disorder, its recurrence reflects a turning point in the course of the disease and implies worsening of the prognosis.. The patients were examined at a joint dermatology/haematology consultation. The diagnosis of ichthyosis was based on clinical examination alone with no patients undergoing skin biopsy.. Our series included three men and two women aged 38 to 65 years consulting for a variety of reasons including asthenia, anaemia and adenopathy. Ichthyosis occurred 2 to 9 months after the initial symptoms of the blood disease. Lesions consisted of diffuse brown scales. The disease was associated with lymphadenopathy and biological inflammatory syndrome. Two patients were presenting non-Hodgkin lymphoma, one had Hodgkin's disease, one had chronic myeloid leukaemia in progression and one had an undifferentiated lymphomatous process. Treatment was based on chemotherapy and emollients. The ichthyosis progressed in step with the underlying malignancy in all cases, with regression being complete in three cases, partial in one case and absent in one case.. In rare cases, acquired ichthyosis reveals systemic disease, and may be of infectious, endocrine or drug origin; it may also be idiopathic. However, it is most often a paraneoplastic syndrome with cutaneous expression encountered during haematological malignancies. Because of the variety of causative blood dyscrasias, ichthyosis cannot be used to guide their diagnosis, although it remains a reliable monitoring tool.. Acquired ichthyosis should prompt the clinician to search for a neoplastic condition, primarily a haematological disorder, guided by other associated signs, given that in our study, skin lesions generally appear to precede signs of the blood disease.

Topics: Adult; Aged; Allopurinol; Anemia; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Benzamides; Bleomycin; Cyclophosphamide; Doxorubicin; Etoposide; Female; Hematologic Neoplasms; Hodgkin Disease; Humans; Ichthyosis; Imatinib Mesylate; Leukemia, Myeloid, Accelerated Phase; Lung Neoplasms; Lymphoma, B-Cell; Male; Middle Aged; Paraneoplastic Syndromes; Parotid Neoplasms; Piperazines; Platelet Aggregation Inhibitors; Prednisone; Procarbazine; Pyrimidines; Retrospective Studies; Rituximab; Schizophrenia; Stomach Neoplasms; Vincristine

Topics: Aged; Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Dehydration; Doxorubicin; Drug Monitoring; Emergencies; Female; Fluid Therapy; Gout Suppressants; Humans; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Nursing Assessment; Oncology Nursing; Prednisone; Risk Factors; Tumor Lysis Syndrome; Urate Oxidase; Vincristine

The aim of this study was to evaluate and compare the clinical characteristics of the B-cell non-Hodgkin lymphoma (NHL) patients and therapeutic efficacy of modified NHL BFM-90 and NHL BFM-95 protocols in the authors' center. From January 1993 to December 2003, 61 newly diagnosed children with B-NHL were enrolled to the study. The patients were stratified by risk factors and treated either with a modified B-NHL BFM-90 or BFM-95 protocols. The use of 1 or 3 g/m2 of methotrexate instead of 5 g/m2/24 h was the only important modification in BFM-90 protocol. Sixty-one children (12 girls, 49 boys) with a median age of 6.5 years (range: 2.5-16) were treated in the center. There were 14 patients in stage II, 28 in stage III, and 19 in stage IV. The most common initial primary tumor sites were abdomen, head, and neck. Forty-five patients were treated with modified B-cell BFM-90 and 16 patients were treated with B-cell BFM-95 regimens. The 5-year overall survival (OS) for all patients was 85.8%, and event-free survival (EFS) was 82.8%. The 5-year OS rates in modified BFM-90 and in BFM-95 protocols were 85.2 and 87.5%; the 5-year EFS rates in these 2 protocols were 84.6 and 70%, respectively (p >.05). Factors associated with lower EFS by univariate analysis were bulky disease, risk groups, and LDH level > or = 500 IU/L. By multivariate analysis only LDH level was significant. In conclusion, the treatment results in this study were similar to those of BFM group.

Topics: Adolescent; Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Disease-Free Survival; Diuretics; Female; Fluid Therapy; Hematologic Diseases; Humans; Kaplan-Meier Estimate; L-Lactate Dehydrogenase; Leucovorin; Lymphoma, B-Cell; Male; Methotrexate; Mucositis; Neoplasm Proteins; Risk Assessment; Sodium Bicarbonate; Survival Analysis; Survival Rate; Treatment Outcome; Tumor Burden; Tumor Lysis Syndrome; Turkey; Vincristine

Physiologically, vitamin K compounds act as co-factors for g-carboxylation of selected glutamates at the N-terminus of prothrombin and some other coagulation factors. These congeners have some growth inhibitory effects of human neoplastic cells. Furthermore, vitamin K2 (VK2) cause apoptosis of some leukemic cells. In search for a new candidate agent to use in the maintenance treatment of myeloma, we analyzed the growth inhibitory effects and apoptosis-inducing capacity of VK2 in human myeloma cells.. The growth of myeloma, lymphoma and non-lymphoid cells cultured with various concentrations of VK2 with or without dexamethasone or allopurinol was assayed. Flow cytometry was used to detect apoptotic cells, activated caspase-3 and -9, the generation of superoxide by hydroethidine, and mitochondrial membrane potential (E centym). In addition, the activation of apoptosis-inducing MAPK, p38 and JNK, release of cytochrome c from mitochondria, and change in the relative Bcl-XL/Xs expression balance were analyzed by Western blotting.. Myeloma cells and B-cell lymphoma cells were sensitive to VK2. The growth inhibition was caused by apoptosis and activation of caspase-3. The generation of superoxide, and inhibitory effects of the xanthine oxidase inhibitor allopurinol, were demonstrated in myeloma cells. The phosphorylation of MAPK was increased by VK2 in myeloma cells. In addition, the mitochondrial apoptotic pathway was activated.. VK2 may be a good candidate for myeloma patients, particularly patients who are not suitable candidates for intensive cytoreductive chemotherapy due to age and/or complications.

Topics: Allopurinol; Apoptosis; bcl-X Protein; Caspase 3; Caspases; Cell Division; Cell Line, Tumor; Dexamethasone; Drug Screening Assays, Antitumor; Enzyme Activation; Humans; Lymphoma, B-Cell; MAP Kinase Signaling System; Mitochondria; Multiple Myeloma; Neoplasm Proteins; Phosphorylation; Protein Processing, Post-Translational; Reactive Oxygen Species; Superoxides; Vitamin K 2

A 65-year-old female with angiotropic B-cell lymphoma is reported. Despite the absence of systemic involvement on formal staging and the favourable response of the cutaneous lesions to triple systemic chemotherapy with prednisolone, vincristine and cyclophosphamide, postmortem findings showed that death was due to widespread disease dissemination.

Topics: Aged; Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Chlorambucil; Cyclophosphamide; Female; Humans; Lymphoma, B-Cell; Prednisolone; Skin Neoplasms; Vincristine