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- Adde, Magdalena, 1960-, et al.
(författare)
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Little usefullness of mid-treatment FDG-PET and biopsy for treatment intensification in patients with aggressive lymphoma
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: To evaluate the experiences of introducing mid-treatment FDG-PET in patients with aggressive lymphoma, in a population based program with decentralized examinations, with emphasis on finding patients who would benefit from dose-escalation. Patients and Methods: Twenty-five patients with aggressive lymphoma were included. Twenty-four (95%) of these having an aggressive B-cell lymphoma (84% diffuse large B-cell lymphoma) were treated with CHOP-like treatment given at two week intervals + rituximab. One patient having an anaplastic T-cell lymphoma was treated with CHOEP-14. Mid-treatment FDG-PET was performed and assessed as positive, uncertain or negative for remaining lymphoma. The intention was to perform a biopsy in those with a positive FDG-PET, and, to change to a platina-containing therapy and consolidate with high-dose therapy if viable lymphoma was found. Retrospective review of the PET investigations was done. Living patients were followed for a median of 22 months. Results: At primary analysis five patients (20%) had positive uptake on FDG-PET. Two of them had biopsy-proven viable tumor but did not complete the planned salvage treatment, one due to chemotherapy toxicity and one due to progressive disease during salvage therapy. Two patients had a negative biopsy and one patient had no biopsy due to technical difficulties at diagnosis. These three patients remain in remission after standard treatment. Out of seven patients (28%) having “uncertain” uptake two relapsed. Thirteen patients (52%) were negative,two of whom relapsed giving a negative predictive value of 85%. Conclusion: Mid-treatment FDG PET-CT in order to find patients with biopsy-proven aggressive lymphoma, who can be salvaged with dose escalation, was not feasible in clinical routine.
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- Adde, Magdalena, et al.
(författare)
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Superior outcome in transformed follicular lymphoma compared to de novo aggressive B-cell lymphoma treated with high-dose therapy and autologous stem-cell support
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: To assess the outcome of high–dose therapy with autologous stem cell support (HDT) in patients with transformed follicular lymphoma compared to patients with de novo aggressive B-cell lymphoma, in a retrospective analysis of patients treated at two Swedish university hospitals. Patients and Methods: 117 patients, mean age 48 years (21-65), 79 with de novo aggressive B-cell lymphoma and 38 with transformed follicular lymphoma, were treated with high-dose-therapy (HDT) as consolidation. Thirteen patients with transformed follicular lymphoma had been treated with a single alkylating agent and 25 were chemonaive at transformation. After transformation, nine patients had HDT as part of first line aggressive therapy, and a further eight failed to obtain CR and had HDT upfront. Twenty-one patients received more than one treatment regimen before HDT. In the de novo aggressive lymphoma group five patients with high risk criteria, and 16 patients who failed to obtain CR, received HDT upfront (CR1), Fifty-eight patients received more than one regimen before HDT because of relapse. Rituximab was given as a single dose to five patients for in vivo purging of the stem cell graft. Results: With a median follow up of 11.5 years (8-20), event free survival (EFS) and overall survival (OS) were 35% and 44% respectively. When comparing the two groups, the ten- year EFS rates were 27% in the de novo group and 55% in the transformed group and the ten-year OS was 33 % and 67% respectively. Treatment related mortality was acceptable with 4% early and 3.5% late mortality. In a multivariate analysis, “transformed vs de novo aggressive” histopathology was the only factor significantly related to outcome. Conclusion: Both EFS and OS were much better in patients with transformed follicular lymphoma compared to patients with de novo aggressive B-cell lymphoma Although the introduction of rituximab certainly has improved the outcome in both groups, HDT should still be considered as a salvage strategy not only in cases of de novo aggressive B-cell lymphoma and especially in transformed follicular lymphoma relapsing after first line treatment..
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- Pettersson, Hans, 1980-, et al.
(författare)
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Risk of hearing loss in relation to vibration-induced white fingers among workers using hand-held vibrating tools
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background Vibration-induced white fingers (VWF) may increase the risk of hearing loss among workers using hand-held vibrating machines who are exposed to noise and hand-arm vibrations (HAV). The present study uses a 21-year follow-up cohort of workers who use hand-held vibrating machines. The aim of this study is to examine the risk of hearing loss for workers with and without VWF who use hand-held vibrating tools.Methods All 184 participants used hand-held vibrating machines and were part of a Swedish cohort. At each follow-up each participant answered a questionnaire on basic individual data, use of hand-held vibrating tools, and VWF symptoms. The VWF symptoms were categorized as with or without VWF. HAV acceleration was measured at each follow-up. Hearing threshold levels from audiometric measurements were categorized as normal hearing and hearing loss. Two exposure estimates were used and divided into two exposure groups: lifetime exposure to HAV (Time) and lifetime exposure to HAV multiplied by acceleration (TimeAcc). To be included in the analysis, each participant had to have hearing status, categorized VWF symptoms, exposure estimates and stated smoking habits measured in the same year for either 1987, 1992, 1997, 2002, or 2008. The relationship between binary outcome of hearing status and the interaction of the explanatory variables, i.e. categorized VWF symptoms, exposure estimates, smoking habits and age, were calculated using binary logistic regression. Because of the repeated measurement of these variables, the Generalized Estimating Equations procedure with a first-order autoregressive correlation structure was used. Three analyses were made for left hand and left ear, right hand and right ear, and hand with worst categorized VWF symptoms and ear with worst categorized hearing status.Results In our study, there was an interaction between exposure estimates (Time and TimeAcc) with the variable categorized VWF symptoms in the left hand on the risk of hearing loss in the left ear. Workers with VWF in the left hand had an increased risk of hearing loss in the left ear if they were in the low exposure group (OR 4.7-7.1) but not in the high exposure groups. There was an increased risk of hearing loss in the left ear for workers in the high exposure group without VWF in the left hand (OR 3.3-3.6) but not for workers with VWF. Workers with VWF in their right hand had an increased risk of hearing loss (OR 2.2-2.3) in the right ear compared to workers without VWF. Workers with VWF on the hand with worst categorization according to the Stockholm Workshop Scale (SWS) for the vascular component did not have any increased risk of hearing loss in the ear with worse hearing status.Conclusions We found that workers with VWF who are using hand-held vibrating machines had an increased risk of hearing loss compared to workers without VWF. This result supports an association between VWF and an increased risk of hearing loss among workers using hand-held vibrating tools in a noisy environment.
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