natriuretic-peptide--brain and Lymphoma--B-Cell

This phase I infusion rate escalation trial was undertaken to evaluate the maximum applicable infusion rate for rituximab without steroid premedication in patients having received one previous rituximab infusion.. Cohorts of at least three patients were assigned to rituximab with or without concomitant chemotherapy. The initial infusion rate was 200 mg/h in the first cohort, and was increased by 100 mg/h in each subsequent cohort to a maximum of 700 mg/h. In each patient the infusion rate was increased by 100 mg/h every 30 minutes to the total dose (375 mg/m2). In the first six cohorts (21 patients), two well-tolerated rituximab administrations were required; in the 7th cohort (11 patients) one previously well-tolerated rituximab infusion was required. Patients did not receive steroid premedication and were monitored with electrocardiograms (ECG), echocardiograms, Holter ECGs, troponin, and brain natriuretic peptide (BNP).. Thirty-two patients were included and 128 cycles were done, 85 at a rate of 700 mg/h. Patients tolerated infusion rates without major side effects. There were no new clinically relevant ECG alterations. Troponin (< 0.1 ng/L) and mean cardiac ejection fraction (65%) remained in the reference range; BNP baseline level increased significantly 24 hours after rituximab administration (from 30.4 to 64.1 ng/L; P < 0.0001).. Rituximab can be administered safely at 700 mg/h without steroid premedication in patients having received at least one rituximab dose in the previous 3 months.

Topics: Adult; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Blood Pressure; Electrocardiography; Female; Heart; Humans; Lymphoma, B-Cell; Male; Maximum Tolerated Dose; Middle Aged; Natriuretic Peptide, Brain; Rituximab; Troponin

Standard treatment for elderly patients with relapsed or refractory DLBCL has not been established. CPT-11 has a broad spectrum of anticancer activities including a cytotoxic effect in a variety of malignant tumors. The results of combined treatment with CPT-11 and rituximab have not been reported. The R-CMD regimen was given to elderly patients with relapsed or refractory DLBCL. The safety and efficacy of this regimen were studied. In addition, the serum nm23-H1 level was determined to study whether or not it can serve as a prognostic factor. Thirty elderly patients with DLBCL were studied. The main non-hematological toxicities were infusion-related adverse events. Grade 3/4 hematological toxicity was seen in 19 patients. Following R-CMD treatment, the BNP and troponin T levels did not increase. The CR rate was 57%, PR rate was 17%, 2-year survival rate was 45.2%, and PFS rate was 37.2%. Patients with serum nm23-H1 levels of higher than 80 ng/mL before the treatment showed significantly poorer prognosis. The serum nm23-H1 level of the 30 subjects before the treatment was elevated at 39.4 +/- 41.3 ng/mL, but it significantly decreased only in the subset of patients who achieved CR. The R-CMD regimen was safe in elderly patients with DLBCL. No new signs of cardiotoxicity were observed with this regimen. It was also effective in patients with relapsed or refractory DLBCL who had previously used DXR.

Topics: Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Camptothecin; Dexamethasone; Disease-Free Survival; Drug Resistance, Neoplasm; Female; Humans; Irinotecan; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Male; Mitoxantrone; Natriuretic Peptide, Brain; NM23 Nucleoside Diphosphate Kinases; Nucleoside-Diphosphate Kinase; Prognosis; Recurrence; Rituximab; Survival Analysis; Survival Rate; Treatment Outcome; Troponin T

A 50-year-old woman received a diagnosis of diffuse large B-cell non-Hodgkin's lymphoma in 2000 and achieved complete remission. In April 2004, echocardiography and computed tomography examinations identified a tumor attached to the tricuspid valve and protruding within the right atrium. Bone marrow and lymph node biopsies showed a relapse of large cell lymphoma. The patient had a markedly elevated level of B-type natriuretic peptide (BNP) but a normal level of cardiac troponin I. The follow-up evaluation of the BNP level after chemotherapy showed that it had returned to within normal limits, and an echocardiogram showed regression of the tumor. Use of the BNP level as a monitor in the treatment of cardiac lymphoma has never been reported. This article is the first to report the use of BNP monitoring before and after chemotherapy to evaluate a patient with an unusual relapsed lymphoma with cardiac involvement.

Topics: Female; Heart Neoplasms; Heart Valve Diseases; Humans; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Monitoring, Physiologic; Natriuretic Peptide, Brain; Radiography; Recurrence; Tricuspid Valve