Increasing incidence of primary gastric lymphoma

Article Abstract:

The National Cancer Institute organized the SEER program to collect data on cancer incidence and mortality in the United States. The SEER program, which stands for Surveillance, Epidemiology, and End Results, has established 9 regional cancer registries, which include 13 percent of the US population. Data from the SEER program was used to determine changes in the incidence of gastric lymphoma over the period from 1973 to 1986. A two-fold change in the age-adjusted incidence was observed, but it is important to rule out possible statistical artifacts that may artificially inflate this number. For example, the rise of AIDS during this period accounts for many new cases of lymphoma. However, gastric lymphoma is generally seen in older patients; in the present study, most of the increase was observed in patients over 60 years of age. In addition, the increase was similar in men and women. Taken together, these facts indicate that AIDS is not responsible for the increased incidence of gastric lymphoma. Alterations in the collection of data may throw more marginal cases into the ''bin'' of gastric lymphoma, and thus produce an artifactual increase. An increased incidence could also be observed in the metastatic spread of lymphoma to lymph nodes near the stomach; this would not be observed if the increase were due only to changes in the definition of gastric lymphoma. It is difficult to rule out an increased incidence that is due to improvements in the diagnosis of gastric lymphoma. It is now recognized that some pseudolymphomas may be malignant. Since pseudolymphomas are not reported, it is difficult to ascertain a shift in diagnosis. Improvements in fiber optic gastroscopy may result in a greater number of gastric lymphomas being diagnosed. Any potential contribution of these factors to the changes in the SEER data cannot be determined. Further studies of gastric lymphoma should be conducted to determine if the incidence of this cancer is actually on the rise in the United States. (Consumer Summary produced by Reliance Medical Information, Inc.)

Stomach cancer

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Treatment of low-grade and intermediate-grade lymphoma with intensive combination chemotherapy results in long-term, disease-free survival

Article Abstract:

Although the use of combination chemotherapy in the treatment of some high-grade lymphomas has achieved some success, the application of combination regimens to patients with low- and intermediate-grade lymphomas has been less rewarding. Among patients with diffuse histiocytic lymphoma, or diffuse undifferentiated lymphoma, both high-grade lymphomas, a complete remission rate of 60 to 80 percent may be achieved and half of these patients may be cured. Among patients with low- and intermediate-grade lymphomas, a group with a more favorable prognosis, similar treatments may result in an eight-year disease-free survival of 30 percent. To further examine the role of intensive combination chemotherapy in the treatment of low- and intermediate-grade lymphomas, 49 patients were treated with methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone. A complete response was achieved by 59 percent of the patients, and the overall median survival was 81 months. Among the complete responders, the median survival was 113 months. At the time of publication, 27 percent of the 49 patients continued to be free of disease at a median of 76 months. The results indicate that long-term survival can be achieved through intensive combination chemotherapy. Unfortunately, the findings also reveal that relapses may occur after a very long remission. Patients under the age of 60 had a far greater disease-free survival than patients over 60, 128 versus 14 months, respectively. This same difference was observed for overall survival, at 95 versus 15 months. However, the demonstration of any actual advantage of intensive combination chemotherapy over single-agent chemotherapy for patients with low-and intermediate-grade lymphomas will require a randomized controlled trial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Non-Hodgkin's lymphomas, Chemotherapy, Combination, Combination chemotherapy

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Drug-related pulmonary toxicity in non-Hodgkin's lymphoma: comparative results with three different treatment regimens

Article Abstract:

Most chemotherapeutic regimens in current use employ not one but several chemotherapeutic agents. Often, this poses problems, since the toxic side effects of the individual agents often combine in ways which are not fully appreciated. Pulmonary toxicity is a common complication in the chemotherapeutic treatment of non-Hodgkin's lymphomas. The evaluation of this toxicity is a major diagnostic challenge in practice, however. Because chemotherapeutic treatment suppresses the immune system, it also increases the likelihood of infection, and it is thus often difficult to distinguish between respiratory symptoms caused by infection and those which might be due to treatment toxicity. A retrospective study of 207 patients treated for non-Hodgkin's lymphomas was carried out to identify the details of treatment most relevant to pulmonary toxicity. The pulmonary toxicity was clearly related to the chemotherapeutic treatment. Eighteen percent of the 134 patients treated with methotrexate, calcium, leucovorin, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone developed pulmonary toxicity. Pulmonary toxicity was also observed in 14 percent of the 43 patients who received a similar treatment regimen lacking only bleomycin. However none of the 30 patients treated with cyclophosphamide, doxorubicin, vincristine, and prednisone developed pulmonary toxicity. These observations suggest that bleomycin is not a major contributing factor to the development of pulmonary toxicity. The results also suggest that methotrexate may be the component of the combination treatment which may play an important role in the development of pulmonary toxicity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Complications and side effects, Lungs, Lung, Methotrexate, Pulmonary toxicology, Bleomycin

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