mercaptopurine and Lymphoma--B-Cell

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child; Child, Preschool; Cyclophosphamide; Cytarabine; Daunorubicin; Female; Humans; Infant; Infant, Newborn; Lymphoma, B-Cell; Male; Mercaptopurine; Methotrexate; Neoplasm, Residual; Prednisone; Retrospective Studies; Vincristine

Topics: Asymptomatic Diseases; Colonoscopy; Drug Therapy, Combination; Humans; Inflammatory Bowel Diseases; Infliximab; Lymphoma, B-Cell; Male; Mercaptopurine; Middle Aged; Mutation; Proto-Oncogene Proteins c-bcl-2; Proto-Oncogene Proteins c-bcl-6; Proto-Oncogene Proteins c-myc; Rare Diseases; Sigmoid Neoplasms

Topics: Aged, 80 and over; Antibodies, Bispecific; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Breast Neoplasms; Carcinoma, Transitional Cell; Cytarabine; Female; Humans; Lymphoma, B-Cell; Mercaptopurine; Methotrexate; Neoplasms, Second Primary; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Remission Induction; Salvage Therapy; Urinary Bladder Neoplasms; Vincristine

Topics: Aged; Antibodies, Monoclonal; Brain; Brain Neoplasms; Crohn Disease; Diagnosis, Differential; Epstein-Barr Virus Infections; Fatal Outcome; Female; Groin; Herpesvirus 4, Human; Humans; Immunosuppressive Agents; Infliximab; Lymph Nodes; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Magnetic Resonance Imaging; Mercaptopurine; Tomography, X-Ray Computed; Unconsciousness

The risk of lymphoma in inflammatory bowel disease (IBD) has raised concerns regarding the lymphogenic potential of immunomodulatory therapy. The link between immunosuppressive therapy and lymphoma risk is well established in patients with solid organ transplantations. In this population, it is postulated that lymphocytes infected with the Epstein-Barr virus (EBV) proliferate unchecked due to impaired cell-mediated immunity. A similar phenomenon may occur in IBD patients treated with multiple immunomodulators and biological agents. In this report, we describe a case of EBV-positive non-Hodgkin's lymphoma arising in the ileal pouch of a patient with ulcerative colitis. This patient was maintained on prednisone (>20 mg/day) for 8 months, cyclosporine for 7 months, and 6-mercaptopurine for nearly 2 years prior to a single infusion of infliximab (5 mg/kg). The cumulative effects of more than three agents, simultaneously and/or sequentially, may simulate posttransplantation immunosuppression and pose a significant threat of malignancy. Such patients may warrant more aggressive diagnostic surveillance and evaluation.

Topics: Adult; Anastomosis, Surgical; Antineoplastic Combined Chemotherapy Protocols; Colitis, Ulcerative; Colonic Pouches; Cyclosporine; Glucocorticoids; Humans; Ileum; Immunosuppressive Agents; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Male; Mercaptopurine; Prednisone

To analyse the clinical features of patients with B cell lymphoblastic lymphoma(BCLL) and the outcomes after modified BFM-90 protocol therapy.. The clinical features of 14 patients with BCLL were analysed, and compared with that of T cell lymphoblastic lymphoma in the same period. The efficacy and toxicity of modified BFM-90 protocol were analysed.. The 14 patients were aged 3 to 18 and diagnosed as BCLL by morphology and immunohistology. One case was in stage I , 2 stage III and 11 stage IV. Most common involved sites were lymph nodes (70% ), skin (50% ) and bone marrow (64% ). One patient received CHOP + HD-MTX, and 13 received modified BFM-90 protocol chemotherapy. Twelve patients (92.3%) achieved complete remission( CR) , 1 patient(7. 7% ) partial remission( PR). The median follow-up duration was 19. 5 months (2 to 44 months). At present 13 patients are alive except one PR patient who gave up treatment and died of disease. The major toxicity of the protocol was myelosuppression, but could be tolerated.. The most common involvement sites of BCLL were lymph nodes, skin and bone marrow. The effectiveness is improved as treated with modified BFM-90 protocol.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Lymphoma, B-Cell; Male; Mercaptopurine; Methotrexate; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome

During treatment for inflammatory bowel disease (IBD) 2 men with ulcerative colitis, aged 52 and 38 years, and a 37-year-old man with Crohn's disease developed Epstein-Barr virus (EBV)-related non-Hodgkin's B-cell lymphoma. The first 2 patients underwent proctocolectomy and the use of immunosuppressive agents was discontinued, after which the lymphoma disappeared. The third patient had icterus, hepatosplenomegaly and pancytopenia; he died from multiple organ failure. Azathioprine and 6-mercaptopurine are first choice therapy in the treatment of steroid-refractory IBD. These immunomodulating agents are associated with the development of EBV-positive lymphomas in the setting of solid organ transplantation. This type of lymphoma is a rare complication in IBD, although the incidence in referral centres appears to be increasing. Since azathioprine is an important drug in IBD, there is a need for identification of IBD patients at risk of developing a lymphoma. EBV-DNA in plasma or in faeces may be a candidate tumour marker.

Topics: Adult; Azathioprine; Colitis, Ulcerative; Crohn Disease; Epstein-Barr Virus Infections; Fatal Outcome; Humans; Immunosuppressive Agents; Incidence; Lymphoma, B-Cell; Male; Mercaptopurine; Middle Aged; Risk Factors

Non-Hodgkin lymphomas (NHL) in children are the second most common malignant tumors in Kuwait. Until 1995 the patients (pts) received institutional protocols. From October 1995 to September 2000 21 children with NHL were treated. Five children were treated by NHL BFM 90 protocol, 7 pts received NHL BFM 95 scheme, and 9 children underwent therapy abroad or according to different types of protocols. The results of a retrospective analysis of NHL BFM 95 protocol in Kuwait are reported. Seven patients diagnosed with NHL--group B: 3 children with Burkitt lymphoma (B-cell NHL) and group A: 4 children with lymphoblastic lymphoma (T-cell NHL)--were treated from October 1995 to September 2000 in the Kuwait Cancer Control Centre according to NHL BFM 95 protocol. Group B consisted of 2 girls and 1 boy; median age at diagnosis was 4 years 8 months, 2 pts classified as stage II and 1 pt as stage III. All patients were assigned to risk group R2. Median follow-up is 2 years 8 months. Group A included 1 girl and 3 boys; median age at diagnosis was 5 years 8 months, 1 pt classified as stage III and 3 pts as stage IV. All patients were assigned to IR group. Median follow-up is 3 years 6 months. In group B all 3 pts are in 1st CR; in group A 3 pts are in 1st CR and 1 pt having Li-Fraumani syndrome died after the 3rd relapse of disease during therapy. In both groups there was no toxic death, myelotoxicity WHO grade III-IV, hepatotoxicity WHO grade II-III. Treatment results of NHL BFM 95 study in our small group of patients are very optimistic. Six patients are in 1st CR and one died due to progression of disease. Despite the small group of patients, the results suggest that NHL BFM 95 protocol is highly effective and safe with regular supportive care.

Topics: Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Burkitt Lymphoma; Child; Child, Preschool; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Daunorubicin; Dexamethasone; Doxorubicin; Drug Administration Schedule; Etoposide; Female; Follow-Up Studies; Humans; Ifosfamide; Infant; Kuwait; Leucovorin; Lymphoma, B-Cell; Lymphoma, Non-Hodgkin; Lymphoma, T-Cell; Male; Mercaptopurine; Mesna; Methotrexate; Neoplasm Staging; Prednisolone; Prednisone; Survival Rate; Thioguanine; Treatment Outcome; Vincristine

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Child; Herpesvirus 4, Human; Humans; Immunosuppressive Agents; Lung Neoplasms; Lymphoma, B-Cell; Male; Mercaptopurine; Methotrexate; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome

A 61-year-old man with multiple subcutaneous, ileocecal and neurologic manifestations was reported. Histological examination of subcutaneous and ileocecal mass showed non-Hodgkin's lymphoma (diffuse medium cell type [LSG classification]), B-cell type. Headache, somnolence and incontinence of urine were considered owing to the CNS involvement by lymphoma cells. The cranial CT findings showed diffuse spread involving the lateral and third ventricle and hypothalamus with adjacent edema. Then he was treated by VEMP regimen and repeated intrathecal MTX injections. The neurologic remission with improvement of cranial CT findings was obtained and he has been free of the disease for 15 years.

Topics: Antineoplastic Combined Chemotherapy Protocols; Central Nervous System Neoplasms; Cyclophosphamide; Humans; Lymphoma, B-Cell; Male; Mercaptopurine; Methotrexate; Middle Aged; Neoplasm Invasiveness; Prednisolone; Survivors; Vincristine