mesna and Lymphoma--Large-B-Cell--Diffuse

A 56-year-old man was admitted to our hospital for salvage chemotherapy of recurrent diffuse large B cell malignant lymphoma at clinical stage IIIb and which had been treated with 6 cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). Computed tomography showed multiple tumors in the bladder after a cycle of ifosfamide, etoposide and mitoxantrone (MINE), but cystoscopy after the second cycle revealed a single non-papillary tumor about 1cm in diameter. After 3 cycles of MINE therapy, transurethral resection of bladder tumor was performed. At the time of the operation, the protruded lesion disappeared and there remained only a scar. Biopsy of the scar revealed malignant lymphoma infiltrated into the submucosal layer. Although the rate of the bladder involvement of malignant lymphoma reaches 3-20% in autopsy cases, it is very rare for a secondary malignant lymphoma of the urinary bladder to be diagnosed clinically. The prognosis of the secondary bladder lymphoma is much poorer than that of the primary one, because of the widespread dissemination of the disease at the time of diagnosis.

Topics: Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Drug Administration Schedule; Etoposide; Humans; Ifosfamide; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Male; Mesna; Middle Aged; Mitoxantrone; Prednisone; Urinary Bladder Neoplasms; Vincristine

A rare cause of high anion gap acidosis is 5-oxoproline (pyroglutamic acid), an organic acid intermediate of the gamma-glutamyl cycle. Acetaminophen and several other drugs have been implicated in the development of transient 5-oxoprolinemia in adults. We report the case of a patient with lymphoma who was admitted for salvage chemotherapy. The patient subsequently developed fever and neutropenia and was administered 20.8 g of acetaminophen during 10 days. During this time, anion gap increased from 14 to 30 mEq/L (14 to 30 mmol/L) and altered mental status developed. After usual causes of high anion gap acidosis were ruled out, a screen for urine organic acids showed 5-oxoproline levels elevated at 58-fold greater than normal values. Predisposing factors in this case included renal dysfunction and sepsis. Clinicians need to be aware of this unusual cause of anion gap acidosis because it may be more common than expected, early discontinuation of the offending agent is therapeutic, and administration of N -acetylcysteine could be beneficial.

Topics: Acetaminophen; Acid-Base Equilibrium; Acidosis; Adult; Analgesics, Non-Narcotic; Antineoplastic Combined Chemotherapy Protocols; Bicarbonates; Candidiasis; Chlorides; Cytarabine; Etoposide; Fatal Outcome; Fever; Humans; Ifosfamide; Kidney Tubular Necrosis, Acute; Lymphoma, Follicular; Lymphoma, Large B-Cell, Diffuse; Male; Mesna; Neutropenia; Polycystic Kidney, Autosomal Dominant; Pyrrolidonecarboxylic Acid; Salvage Therapy; Systemic Inflammatory Response Syndrome

Gastric (67)gallium uptake in patients with peptic ulcer has been described in many publications literature. We present the case of a jejunal (67)gallium uptake in a patient with a background of total gastrectomy due to a diffuse large B cell gastric lymphoma, associated to benign peptic ulcer which had been identified by endoscopy. We have not found any similar cases in regards to (67)gallium reported in the literature. This study aims to present a review of the causes of gastrointestinal uptake of (67)gallium and of the utility of the radiotracer in patients with gastric lymphoma.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Doxorubicin; Etoposide; Fatal Outcome; Follow-Up Studies; Gallium Radioisotopes; Gastrectomy; Gastroscopy; Humans; Ifosfamide; Lymphoma, Large B-Cell, Diffuse; Male; Mesna; Methylprednisolone; Mitoxantrone; Neoplasm Recurrence, Local; Paclitaxel; Prednisone; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy, Adjuvant; Stomach Neoplasms; Stomach Ulcer; Tomography, X-Ray Computed; Vincristine

Interleukin-10 (IL-10), also known as cytokine synthesis inhibitory factor, has multiple effects on lymphoid development. In addition, it has been previously reported that serum levels of IL-10 correlate with failure-free and overall survival in patients with non-Hodgkin's lymphoma. In this study, we used a sensitive enzyme-linked immunosorbent assay specific for human IL-10 (lower limit of sensitivity, 5 pg/mL) to measure serum levels in 52 newly diagnosed patients with diffuse large cell lymphoma and at least one adverse prognostic feature who were subsequently treated in a uniform way. Lymphoma patients had significantly higher serum levels of IL-10 (median, 7.98 pg/mL; range, < or = 5 to 27,143 pg/mL) than healthy volunteers (N = 50; median, < or = 5 pg/mL; range, < or = 5 to 19.21 pg/mL) (P = .0000012). Individuals with B symptoms had significantly higher serum levels of IL-10 than those without them (P = .03), but there was no correlation between IL-10 levels and any of the other prognostic variables analyzed, including age, lactic dehydrogenase, beta 2-microglobulin levels, performance status, bulky disease, Ann Arbor stage, or International Index score. More importantly, we found no correlation between IL-10 levels and the achievement of complete remission, nor with failure-free survival or overall survival. We conclude that in a uniform population of untreated patients with diffuse large cell lymphoma, serum levels of IL-10 do not appear to have any prognostic value.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Bleomycin; Cisplatin; Cyclophosphamide; Cytarabine; Doxorubicin; Enzyme-Linked Immunosorbent Assay; Etoposide; Female; Follow-Up Studies; Humans; Ifosfamide; Interleukin-10; Life Tables; Lymphoma, Large B-Cell, Diffuse; Male; Mesna; Methotrexate; Methylprednisolone Hemisuccinate; Middle Aged; Mitoxantrone; Neoplasm Proteins; Prognosis; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Survival Analysis; Treatment Outcome; Vincristine

To purpose of this study was to develop a more effective approach to the treatment of patients with poor-prognosis aggressive non-Hodgkin's lymphoma (NHL).. Thirty newly diagnosed patients with bulky (> or = 10 cm) advanced-stage aggressive NHL were enrolled onto a pilot study. The study was designed to determine the maximum-tolerated dosages (MTD) of cyclophosphamide and doxorubicin that could be used in a high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen with granulocyte colony-stimulating factor (G-CSF) support and to assess preliminarily the efficacy of the regimen.. In the initial dose-finding portion of the study, cumulative thrombocytopenia was the dose-limiting toxicity. At the MTD, the regimen included four 21-day cycles of cyclophosphamide 4 gm/m2, doxorubicin 70 mg/m2, vincristine 2 mg, and prednisone 100 mg for 5 days with mesna and G-CSF support. At the MTD, 65% of treatment cycles were complicated by febrile neutropenia, 84% of patients received at least one platelet transfusion for platelet counts less than 20,000/microL, and there was one treatment-related death. Nineteen of 22 (86%; 90% confidence interval [CI], 68 to 96) patients treated at the MTD achieved an initial complete response (CR), and 79% (90% CI, 58 to 92) of the complete responders and 69% of all patients remain progression-free with 20 months median follow-up.. The high-dose CHOP regimen may be an effective alternative for patients with poor-prognosis aggressive NHL.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Dose-Response Relationship, Drug; Doxorubicin; Drug Administration Schedule; Female; Granulocyte Colony-Stimulating Factor; Hematologic Diseases; Hematopoietic Stem Cells; Humans; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Large-Cell, Immunoblastic; Lymphoma, Non-Hodgkin; Male; Mesna; Middle Aged; Pilot Projects; Prednisone; Prognosis; Vincristine