A case of Hodgkin's disease which was complicated by disseminated cryptococcemia terminally is reported. The patient was a 19 year old girl and complained of high fever with shaking chins and dyspnea. In the past history, antituberculous treatment was given using PAS, INH and streptomycin for 2 months under the diagnosis of tuberculous pleurisy and several antibiotics and steroids were also given. On admission, antituberculous treatment was continued and prednisolone was also prescribed. She was discharged 15 days later but was readmitted because of abdominal pain and uncontrolable fever. On the third hospital day, a leftcervical lymphnode biopsy revealed. Hodgkin's disease, paragranuloma type. Endoxan and cobalt 60 irradiation were given to the abdomen. On the sixtieth hospital day, she became irritable and comatose and expired. At autopsy, disseminated Hodgkin's sarcoma was noted involving multiple lymphnodes, esophagus, small and large intestines, pancreas, liver, spleen, diaphragm, lungs, peritoneum, uterus, left ovary and bone marrow. In addition, evidence of cryptococcemia involving kidneys, lungs, heart, brain, pituitary gland and lymphnodes, was noted. A brief review of the literature was also made.
Adult ; Autopsy ; Cryptococcosis/complications* ; Cryptococcosis/pathology ; Female ; Hodgkin Disease/complications* ; Hodgkin Disease/pathology ; Human ; Lymph Nodes/pathology ; Septicemia/etiology*

Epstein-Barr Virus Infections/complications* ; Herpesvirus 4, Human ; Hodgkin Disease/etiology* ; Humans ; Lymphoma, T-Cell, Peripheral

Adult ; Hodgkin Disease ; complications ; pathology ; therapy ; Humans ; Lymphoma, Large B-Cell, Diffuse ; etiology ; pathology ; therapy ; Male ; Sclerosis

Female ; Hodgkin Disease ; radiotherapy ; Humans ; Middle Aged ; Nose Neoplasms ; radiotherapy ; Radiotherapy ; adverse effects ; Vocal Cord Paralysis ; etiology

Post-transplant lymphoproliferative disorders (PTLD) have been recognized as a complication of immunosuppression and occur with a reported incidence of 1 to 8% of recipients receiving solid organ transplantation. PTLD are classified into two major categories, polymorphic and monomorphic PTLD. The majority of the monomorphic PTLD cases are non-Hodgkin's lymphoma of B-cell origin. Hodgkin's disease is not part of the typical spectrum of PTLD; however, it has been rarely reported. We describe a case of Hodgkin's disease following renal transplantation. A 41-year-old man developed right cervical lymphadenopathy following renal transplantation 116 months previously for chronic renal failure of unknown origin. He had been taking cyclosporine, mycophenolate mofetil and prednisone. A lymph node biopsy revealed mixed cellularity Hodgkin's disease. Immunohistochemical staining was positive for CD30 and EBV-latent membrane protein-1. No other site of disease was identified. The immunosuppressive agents were reduced (mycophenolate mofetil was discontinued, cyclosporine dose reduced from 200 mg to 150 mg and prednisone continued at 5 mg). After 2 cycles of ABVD followed by radiation therapy (3600 cGy), he achieved complete remission.
Male ; Lymphoproliferative Disorders/*chemically induced/immunology/virology ; Kidney Transplantation/*adverse effects ; Immunosuppressive Agents/*adverse effects ; Humans ; Hodgkin Disease/*etiology ; *Herpesvirus 4, Human ; Epstein-Barr Virus Infections/*complications ; Adult

Nonmyeloablative stem cell transplantation (NST) is increasingly used with beneficial effects because it can be applied to older patients with hematological malignancies and those with various complications who are not suitable for conventional myeloablative stem cell transplantation (CST). Various conditioning regimens differ in their myeloablative and immunosuppressive intensity. Regardless of the type of conditioning regimen, graft-versus- host disease (GVHD) in NST occurs almost equally in CST, although a slightly delayed development of acute GVHD is observed in NST. Although graft-versus-hematological malignancy effects (i.e., graft-versus-leukemia effect, graft-versus-lymphoma effect, and graft-versus-myeloma effect) also occur in NST, completely eradicating residual malignant cells through allogeneic immune responses is insufficient in cases with rapidly growing disease or uncontrolled progressive disease. Donor lymphocyte infusion (DLI) is sometimes combined to support engraftment and to augment the graft-versus-hematological malignancy effect, such as the graft-versus-leukemia effect. DLI is especially effective for controlling relapse in the chronic phase of chronic myelogenous leukemia, but not so effective against other diseases. Indeed, NST is a beneficial procedure for expanding the opportunity of allogeneic hematopoietic stem cell transplantation to many patients with hematological malignancies. However, a more sophisticated improvement in separating graft-versus-hematological malignancy effects from GVHD is required in the future.
Antigen-Presenting Cells/physiology ; Graft vs Host Disease/etiology ; *Graft vs Leukemia Effect ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Leukemia/therapy ; Lymphocyte Transfusion ; Lymphoma, Non-Hodgkin/therapy ; Multiple Myeloma/therapy ; *Transplantation Conditioning

CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.
Adult ; Antiviral Agents/therapeutic use ; Cytomegalovirus Infections/drug therapy ; Cytomegalovirus Infections/diagnosis ; Cytomegalovirus Infections/complications* ; Disease-Free Survival ; Enteritis/virology ; Enteritis/surgery ; Enteritis/complications ; Ganciclovir/therapeutic use ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Hemorrhage/etiology* ; Gastrointestinal Hemorrhage/diagnosis ; Human ; Jejunal Diseases/virology ; Jejunal Diseases/surgery ; Jejunal Diseases/complications* ; Lymphoma, Non-Hodgkin/drug therapy ; Lymphoma, Non-Hodgkin/diagnosis ; Lymphoma, Non-Hodgkin/complications* ; Male ; Opportunistic Infections/drug therapy ; Opportunistic Infections/diagnosis ; Opportunistic Infections/complications* ; Substances: Ganciclovir ; Substances: Antiviral Agents

Adolescent ; Adult ; Disease-Free Survival ; Female ; Graft vs Host Disease ; etiology ; prevention & control ; Hematologic Neoplasms ; therapy ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; therapy ; Leukemia, Myeloid, Acute ; therapy ; Lymphocyte Transfusion ; Lymphoma, Non-Hodgkin ; therapy ; Male ; Middle Aged ; Recurrence ; Survival Rate ; Transplantation, Homologous ; Young Adult

OBJECTIVEThe aim of this study was to investigate the clinicopathological characteristics, effective treatment and prognosis in childhood and adolescent Hodgkin's lymphoma.

METHODSA total of 88 patients with childhood and adolescent Hodgkin's lymphoma were treated in the Cancer Hospital of CAMS from 1998 to 2005. The clinicopathological and follow-up data of the patients were retrospectively reviewed. The survival rate was calculated by Kaplan-Meier method and compared by log-rank test. COX multivariate prognosis analysis was performed.

RESULTSThe 2-year event-free survival rate of the 88 patients was 86.4%, the 5-year event-free survival rate was 61.4%, and the 5-year overall survival rate was 95.5%. Univariate analysis showed that the stage of disease (P = 0.033), "B" symptoms (P = 0.028), bulky disease (P = 0.007), splenomegaly (P = 0.050), LDH elevation (P = 0.020), chemotherapy regimen (P = 0.003) were prognostic factors in the 5-year event-free survival rate. Splenomegaly (P = 0.039), LDH elevation (P = 0.033), chemotherapy regimen (P = 0.008) were prognostic factors of 5-year overall survival rate. Multivariate analysis showed that chemotherapy regimen (P = 0.033), stage of disease (P = 0.023), LDH elevation (P = 0.008), "B" symptoms (P = 0.044), bulky disease (P = 0.009) were independent prognostic factors of 5-year event-free survival rate. The chemotherapy regimen (P = 0.012) and LDH elevation (P = 0.046) were independent prognostic factors of 5-year overall survival rate.

CONCLUSIONSThe non-ABVD chemotherapy regimen, stage IV disease, LDH elevation, associated with "B" symptoms and bulky disease are independent prognostic factors of 5-year event-free survival rate. LDH elevation and non-ABVD chemotherapy regimen are independent prognostic factors of 5-year overall survival rate.

Adolescent ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; therapeutic use ; Child ; Child, Preschool ; Combined Modality Therapy ; Cyclophosphamide ; therapeutic use ; Dacarbazine ; therapeutic use ; Disease-Free Survival ; Doxorubicin ; therapeutic use ; Female ; Follow-Up Studies ; Hodgkin Disease ; complications ; drug therapy ; pathology ; radiotherapy ; Humans ; L-Lactate Dehydrogenase ; blood ; Male ; Mechlorethamine ; therapeutic use ; Neoplasm Staging ; Prednisone ; therapeutic use ; Procarbazine ; therapeutic use ; Retrospective Studies ; Splenomegaly ; etiology ; Survival Rate ; Vinblastine ; therapeutic use ; Vincristine ; therapeutic use

OBJECTIVETo evaluate whether involved-field (IF) radiotherapy is equally effective and less toxic in comparison with extended-field (EF) radiotherapy for patients with early-stage Hodgkin's disease (HD) who received combined modality therapy.

METHODSThe data of 88 early-stage HD patients treated with combined modality therapy were retrospectively reviewed. According to Ann Arbor classification, 12 patients (13.7%) had stage IA disease, 56 stage IIA (63.6%), and 20 IIB (22.7%). Forty-two (47.7%) patients underwent involved field radiotherapy (IF group), whereas the other 46 (52.3%) received extended field radiotherapy (EF group).

RESULTSOf 6 patients who developed recurrence, 3 (7.1%) were in IF group and the other 3 (6.5%) in EF group. Only one patient's recurrence developed inside the radiation field in EF group. Three patients (7.2%) in IF group and 9 (19.5%) in EF group had WHO grade 1 and 2 leukopenia (P = 0.089). Overall survival rate at 1-, 2- and 3-year was 100.0%, 97.1%, and 97.1% in IF group versus 100.0%, 100%, and 95.8% in EF group (P = 0.86), respectively. Freedom from progression survival rate at 1-, 2- and 3-year was 97.6%, 94.8%, and 91.7% in IF group versus 97.8%, 93.2%, and 93.2% in EF group (P = 0.65), respectively.

CONCLUSIONCompared with extended-field radiotherapy, involved-field radiotherapy is equally effective and less toxic for patient with early-stage Hodgkin's disease treated with combined modality therapy.

Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Bleomycin ; administration & dosage ; Combined Modality Therapy ; Dacarbazine ; administration & dosage ; Doxorubicin ; administration & dosage ; Female ; Follow-Up Studies ; Hodgkin Disease ; drug therapy ; pathology ; radiotherapy ; Humans ; Leukopenia ; etiology ; Lymphatic Irradiation ; adverse effects ; methods ; Lymphatic Metastasis ; Male ; Mechlorethamine ; administration & dosage ; Middle Aged ; Neoplasm Staging ; Prednisone ; administration & dosage ; Procarbazine ; administration & dosage ; Recurrence ; Retrospective Studies ; Survival Rate ; Vinblastine ; administration & dosage ; Vincristine ; administration & dosage