melphalan and Mediastinal-Neoplasms

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Humans; Male; Mediastinal Neoplasms; Mediastinoscopy; Melphalan; Plasmacytoma; Prednisone; Thalidomide; Tomography; Treatment Outcome

Plasmacytomas could involve any organ, and at times might pose a diagnostic challenge when the site of involvement is unusual, or if the presentation is similar to other diseases. We describe a 48-year-old man presenting with worsening shortness of breath and chest discomfort with radiologic evidence of mediastinal enlargement, mimicking a lymphoma with mediastinal involvement. An excisional biopsy of a mediastinal lymph node showed a plasma-cell infiltrate strongly positive for CD138, with a flow-cytometry analysis showing a population of lambda-restricted neoplastic plasma cells. He failed to respond to 50Gy involved-field radiotherapy, but achieved a partial response to combination chemotherapy. He underwent high-dose chemotherapy with melphalan (200mg/m(2)) followed by lenalidomide maintenance, and is in complete remission 18months postautografting. This case illustrates a unique and rare presentation of primary lymph-node plasmacytomas involving the mediastinum potentially mistaken as lymphoid malignancy. Clinicians should be aware of the plasma-cell origin of the mediastinal neoplastic process.

Topics: Angiogenesis Inhibitors; Antineoplastic Agents, Alkylating; Humans; Lenalidomide; Lymph Nodes; Male; Mediastinal Neoplasms; Mediastinum; Melphalan; Middle Aged; Plasma Cells; Plasmacytoma; Syndecan-1; Thalidomide

To assess the outcomes of overall survival and posttransplantation survival in patients with Hodgkin lymphoma (HL) undergoing autologous stem cell transplantation (ASCT) because of the development of relapse or resistance after chemotherapy (CT) or CT plus radiotherapy (combined modality treatment, CMT).. Forty-five patients undergoing ASCT because of the development of relapse or resistance after CT or CMT for HL were enrolled in the study. Radiotherapy was given as involved-field radiotherapy. Patients were treated with CT alone (n=25) or CMT (n=20). These 2 groups were further divided into 2 subgroups: the patients with early-stage (I to II) and advanced-stage (III to IV) HL.. Median patients age was 29 years (range, 16 to 60 y) and the median follow-up was 60 months (range, 12 to 172 mo). In the patients with advanced-stage HL, there was no statistically significant difference in overall survival between irradiated and nonirradiated patients (n=18, irradiated n=4 and nonirradiated n=14). However, in the patients with early-stage disease, there was a significant difference in 5- and 10-year overall survival between the irradiated and nonirradiated groups (81% vs. 48% and 66% vs. 24%, respectively, P=0.045; n=26, irradiated n=16 and nonirradiated n=10). In the univariate analysis, irradiated group and involvement of 1 to 2 nodal regions were found to be significant for overall survival, whereas irradiated group, early stage, and involvement of 1 to 2 nodal regions were found to be significant for posttransplantation survival. However, only irradiated group was found to be significant for posttransplantation survival in multivariate analysis (P<0.05).. Addition of involved-field radiotherapy to CT in patients undergoing ASCT after relapse or recurrence failed to provide survival benefit in patients with advanced HL, while a survival benefit was observed in patients with early-stage HL. Radiotherapy should be considered as part of CMT in the patients with early-stage HL, which should not be neglected.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Carmustine; Chemoradiotherapy; Cisplatin; Cohort Studies; Cytarabine; Dacarbazine; Dexamethasone; Doxorubicin; Etoposide; Female; Hodgkin Disease; Humans; Ifosfamide; Male; Mediastinal Neoplasms; Melphalan; Methylprednisolone; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Retrospective Studies; Stem Cell Transplantation; Transplantation, Autologous; Treatment Outcome; Vinblastine; Young Adult

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Catheterization, Central Venous; Catheters, Indwelling; Cytarabine; Female; Hematopoietic Stem Cell Transplantation; Humans; Lymphoma, B-Cell; Mediastinal Neoplasms; Melphalan; Podophyllotoxin; Radiography; Thrombosis; Transplantation, Autologous

Residual mediastinal masses are frequently observed in patients with Hodgkin disease (HD) after completed therapy, and the discrimination between active tumor tissue and fibrotic residues remains a clinical challenge. We studied the diagnostic value of metabolic imaging by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in detecting active mediastinal disease and predicting relapse. Twenty-eight HD patients with a residual mediastinal mass of at least 2 cm after initial therapy or after salvage chemotherapy were prospectively assigned to 29 examinations with FDG PET and were evaluated as 29 "subjects." Patients were monitored for at least 1 year after examination and observed for signs of relapse. Median follow-up was 28 months (range, 16 to 68 months). A PET-negative mediastinal tumor was observed in 19 subjects, of whom 16 stayed in remission and 3 relapsed. Progression or relapse occurred in 6 of 10 subjects with a positive PET, whereas 4 subjects remained in remission. The negative predictive value (negative PET result and remission) at 1 year was 95%, and the positive predictive value (positive PET result and relapse) was 60%. The disease-free survival for PET-negative and PET-positive patients at 1 year was 95% and 40%, respectively. The difference was statistically significant. A negative FDG PET indicates that an HD patient with a residual mediastinal mass is unlikely to relapse before 1 year, if ever. On the other hand, a positive PET result indicates a significantly higher risk of relapse and demands further diagnostic procedures and a closer follow-up.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carmustine; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Dacarbazine; Dexamethasone; Diagnosis, Differential; Disease-Free Survival; Doxorubicin; Etoposide; False Negative Reactions; False Positive Reactions; Fibrosis; Fluorodeoxyglucose F18; Follow-Up Studies; Hematopoietic Stem Cell Transplantation; Hodgkin Disease; Humans; Life Tables; Mediastinal Neoplasms; Melphalan; Neoplasm Recurrence, Local; Predictive Value of Tests; Prednisone; Procarbazine; Prospective Studies; Radiopharmaceuticals; Radiotherapy, Adjuvant; Remission Induction; Salvage Therapy; Tomography, Emission-Computed; Transplantation, Autologous; Vinblastine; Vincristine

To achieve a maximal complete remission rate in patients with recurrent and refractory Hodgkin's disease. To find out a group of patients in whom surgical removal of the residual mediastinal mass would be most effective.. 46 patients with Hodgkin's disease received Dexa-BEAM chemotherapy followed by radiotherapy. Surgical removal of the residual mediastinal mass was made in 12 patients.. Second-line Dexa-BEAM therapy produced a 50% complete remission rate. Overall survival was 45.5%, the disease-free survival--43.5%. Removed mediastinal masses were indicative of Hodgkin's disease in 7 cases and fibrosis in 4 cases.. Dexa-BEAM is an effective program in the treatment of recurrent and refractory Hodgkin's disease. Surgical removal of the residual mediastinal mass with radiotherapy and high-dose chemotherapy improves prognosis in very unfavorable, primary progressive form of Hodgkin's disease.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Chemotherapy, Adjuvant; Cytarabine; Dexamethasone; Etoposide; Female; Hodgkin Disease; Humans; Male; Mediastinal Neoplasms; Melphalan; Middle Aged; Neoplasm, Residual; Prognosis; Radiotherapy, Adjuvant; Recurrence; Salvage Therapy

We present two cases of extramedullary plasmacytoma presenting as a mediastinal mass and preceding the onset of full-blown multiple myeloma. The patients are a 62-year-old woman who presented with progressive dyspnea and left-sided chest pain and a 59-year-old asymptomatic man. In both patients, radiographic studies revealed a posterior and anterior mediastinal mass, respectively. Surgical resection of the tumor was performed in the two cases. The tumors were characterized by a well-circumscribed proliferation of plasma cells surrounded by residual lymph nodal tissue. Immunohistochemical studies on paraffin sections demonstrated lambda light chain restriction. Follow-up in our patients revealed that both of them developed multiple myeloma after 6 months and 2 years, respectively. One patient received treatment with melphalan and prednisone and is currently alive and well without evidence of disease, 2 years after diagnosis. The second patient died 4 years after resection of his tumor with evidence of disease in lumbar spine, skull, and lungs. Extramedullary plasmacytoma presenting as a mediastinal mass may precede the onset of full-blown multiple myeloma; therefore, institution of early systemic therapy in these patients may be of value in preventing further progression of the disease.

Topics: Chest Pain; Combined Modality Therapy; Diagnosis, Differential; Dyspnea; Fatal Outcome; Female; Humans; Immunoglobulin lambda-Chains; Male; Mediastinal Neoplasms; Melphalan; Middle Aged; Multiple Myeloma; Plasma Cells; Plasmacytoma; Prednisone

To assess results, complications, treatment techniques, and patterns of failure in patients with bulky mediastinal Hodgkin's disease treated with combined modality therapy.. Between 1980 and 1988, 48 patients with Hodgkin's disease who had large mediastinal masses were treated at Stanford University. All patients were staged with clinical studies which included computed tomographic scans of the chest and bipedal lymphograms. Initially, 10 patients underwent staging laparotomy and splenectomy, subsequently all patients were staged by clinical criteria alone. Mediastinal mass ratios ranged from .35 to .85 (mean .46). The majority of patients had at least one site of extralymphatic extension (E-lesion) within the chest. Combined modality therapy included MOPP (prednisone deleted after mediastinal irradiation) in 15, ABVD in 14, and PAVe in 19 patients. All patients received mantle irradiation (mean dose 44 Gy) but only patients with abdominal disease received subdiaphragmatic irradiation.. The actuarial survival and freedom from relapse were 84% and 88% at 9 years. There was an intrathoracic component of failure in all seven patients who either failed to achieve an initial complete response or who experienced a relapse after a complete response. Both patients who experienced a relapse after a complete response achieved durable second responses with subsequent chemotherapy. Two of five patients who failed to achieve an initial complete response were treated successfully with alternative chemotherapy.. Routine combined modality therapy is the treatment of choice for patients with Hodgkin's disease who have large mediastinal masses.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Dacarbazine; Doxorubicin; Female; Hodgkin Disease; Humans; Male; Mechlorethamine; Mediastinal Neoplasms; Melphalan; Middle Aged; Prednisone; Procarbazine; Radiotherapy; Radiotherapy Dosage; Survival Rate; Vinblastine; Vincristine