OBJECTIVETo explore the clinical efficacy and safety of lenalidomide plus low dose dexamethasone for treating patients with multiple myeloma (MM).

METHODSA total of 19 MM patients were enrolled to receive the therapeutic schedule of lenalidomide plus dexamethasone in our hospital from May 2013 to June 2015. Lenalidomide 25 mg was taken orally daily for 21 days and resting for 7 days, and dexamethasone 10 mg was taken orally daily on the day 1-4, 7-10 and 13-16. The regimens were Rd (lenalidomide and dexamethasone, n = 12), and RCd (lenalidomide, ifosfamide and dexamethasone, n = 7).

RESULTSAmong 19 patients received 1 cycle of treatment 3 patients achieved complete remission (CR), 3 patients achieved very good partial remission (VGPR), 10 patients achieved partial remission (PR) and 3 patients in stable disease (SD) with an overall response rate (ORR = CR + VGPR + PR) of 84%; their ORR rate was 89% after 2 cycles of treatment. In the early stage of treatment, the renal function was improved in 4 out of 5 patients with renal dysfunction. And the common adverse reactions were hematologic toxicity in 4 patients, 1 degree rash in 5 patients, and gastrointestinal side effects in 4 patients.

CONCLUSIONThe lenalidomide plus dexamethasone regimen has a good anti-multiple myeloma effect, which can control the disease rapidly and overcome the multidrug resistance in MM, improving the poor prognosis with renal dysfunction, and showing high remission rate in the patients exposed to bortezomib with low toxicity.

Antineoplastic Combined Chemotherapy Protocols ; Dexamethasone ; administration & dosage ; therapeutic use ; Humans ; Ifosfamide ; therapeutic use ; Multiple Myeloma ; drug therapy ; Remission Induction ; Thalidomide ; administration & dosage ; analogs & derivatives ; therapeutic use

Undifferentiated embryonal sarcoma is a rare primary malignant neoplasm of the liver. Undifferentiated sarcoma of the liver in adult is an uncommon hepatic tumor of mesenchymal origin, generally considered an aggressive neoplasm with an unfavorable prognosis. We present a case of undifferentiated sarcoma in a 61-year-old woman. CT scan demonstrated a large heterogenous, exophytic growing hepatic mass in the right lobe with pulmonary metastatic nodules. US guided liver biopsy was done and pathological findings of the liver specimen revealed that isolated or grouped round pleomorphic cells and spindle to stellate cells were present. Immunohistochemical stain showed that tumor cells expressed positivity for vimentin and partially positivity or negativity for cytokeratin. She was diagnosed as having undifferentiated sarcoma of the liver. She received seven courses of VAIA chemotherapy by CWS protocols. Chemotherapy was efficacious and the size of the tumor decreased considerably after the treatment. No tumor recurrence for 12 months is noted.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Dactinomycin/therapeutic use ; Doxorubicin/therapeutic use ; Female ; Humans ; Ifosfamide/therapeutic use ; Liver Neoplasms/*diagnosis/*drug therapy/pathology ; Middle Aged ; Sarcoma/*diagnosis/*drug therapy/pathology ; Tomography, X-Ray Computed ; Vincristine/therapeutic use

The prognosis for patients with primary central nervous system (CNS) lymphoma (PCNSL) who relapse after the initial response is usually poor. A standard treatment for relapsed PCNSL has not yet been identified because of the heterogeneity of the therapies employed and the lack of large, prospective clinical trials. We describe a 46-year-old relapsed PCNSL patient who was successfully treated with intraventricular applications of rituximab to minimize neurotoxicity, 2 cycles of salvage chemotherapy with etoposide, ifosfamide, and cytarabine (VIA) regimen and high-dose chemotherapy with autologous stem cell rescue. The high-dose chemotherapy consisted of bischloroethylnitrosourea, etoposide, cytarabine, and melphalan (BEAM) regimen. Partial remission was detected after intraventricular rituximab therapy and the patient has been in complete remission without evidence of neurotoxicity for 28 months after high-dose chemotherapy with autologous stem cell rescue. This case indicates a new appropriate treatment guideline in relapsed PCNSL patient after initial intensive chemo-radiotherapy.
Antibodies, Monoclonal/*therapeutic use ; Central Nervous System Neoplasms/*drug therapy/*therapy ; Cytarabine/therapeutic use ; Etoposide/therapeutic use ; Female ; Humans ; Ifosfamide/therapeutic use ; Lymphoma, Non-Hodgkin/*drug therapy/*therapy ; Middle Aged ; Stem Cell Transplantation/*methods

The aim of this trial was to investigate the efficacy and toxicity of combination chemotherapy with etoposide and ifosfamide (ETI) in the management of heavily pretreated recurrent or persistent epithelial ovarian cancer (EOC). Patients with recurrent or persistent EOC who had measurable disease and at least two prior chemotherapy participating in this phase II trial were to receive etoposide at a dose of 100 mg/m2/day intravenously (IV) on days 1 to 3 in combination with ifosfamide 1 g/m2/day IV on days 1 to 5, every 21 days. Thirty-seven patients were treated; about 78% had previously received more than two separate regimens. The response rate (RR) was 18.9% and median duration of response was 7 months (range, 1-15). Treatment free interval prior to ETI (TFI) has significant correlation with RR rate (P=0.034). Patients (n=6) with TFI > or =6 months had 50% of RR, while patients (n=31) with TFI <6 months had 12.9%. Median survival was 9 months at a median follow-up of 9.2 months. Grade 3 or 4 toxicities included neutropenia in 20.1% of the 139 cycles of ETI, anemia in 7.2% and thrombocytopenia in 8.6%. The ETI produces relatively low toxicity and modest activity in heavily pretreated recurrent or persistent EOC. This is significant in patients with TFI > or =6 months.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Etoposide/administration & dosage/*therapeutic use ; Female ; Humans ; Ifosfamide/administration & dosage/*therapeutic use ; Middle Aged ; Neoplasm Recurrence, Local/*drug therapy ; Ovarian Neoplasms/*drug therapy/mortality ; Survival Rate ; Treatment Outcome

OBJECTIVETo investigate and compare the clinical effects and safety of DICE regimen combined with rituximab and GDP regimen combined with rituximab for the treatment of elderly patients with relapsed and refractory diffuse large B cell lymphoma.

METHODSNinety elderly patients with relapsed and refractory diffuse large B cell lymphoma were admitted in our hospital from January 2008 to June 2013 and randomly divided into 2 groups, including A group (45 patients) and B group (45 patients), the patients in A group were treated by DICL regimen combined with rituximab, while the patients in B group were treated by GDP regimen combined with rituximab; the clinical efficacy, disease-free survival time, the survival rate with follow-up and the incidence of toxic side-effects in 2 groups were compared.

RESULTSThe clinical efficacy of B group was significant better than that of A group (P < 0.05). The disease-free survival time of B group was significantly longer than that of A group (P < 0.05). The survival rate with follow-up of B group was significantly higher than that of A group (P < 0.05). The difference was not significant in incidence of the toxic side effects between 2 groups (P > 0.05).

CONCLUSIONCompared with DICE regimen combined with rituximab, GDP regimen combined with rituximab in treatment of elderly patients with relapsed and refractory diffuse large B cell lymphoma can efficiently reduce tumor loading, prolong the disease-free survival time, improve the long-term clinical prognosis, and not aggravate the side effects of drugs.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cisplatin ; therapeutic use ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Dexamethasone ; therapeutic use ; Disease-Free Survival ; Etoposide ; therapeutic use ; Humans ; Ifosfamide ; therapeutic use ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; Prognosis ; Remission Induction ; Rituximab ; therapeutic use ; Salvage Therapy ; Survival Rate ; Treatment Outcome

OBJECTIVETo investigate the clinical and pathological features, optimal treatment and prognostic factor in primary mediastinal germ cell tumors (PMGCT).

METHODSThe clinical presentation, pathological features and therapeutic results of 29 patients with PMGCT were retrospectively analyzed.

RESULTSAll the 29 patients were male with a mean age of 26.1 +/- 9.6 years at diagnosis. All tumors were originated from the anterior mediastinum with a mean diameter of 16.0 +/- 5.2 cm. There were 5 (17.2%) primary mediastinal seminomas (PMSGCT) and 24 (82.8%) primary mediastinal nonseminomas (PMNSGCT) in this series. Dyspnea, cough and chest pain were the most common symptoms. Multimodality treatment consisting of cisplatin-based chemotherapy, surgery and radiotherapy was the principal therapy for PMGCT patients. The median survival of the 24 PMNSGCT patients was 19.0 months with 1-, 2-year survival rate of 65.3% and 28.1%, respectively; whereas the median survival of the 5 PMSGCT patients has not reached but longer with significant differences (P = 0.008). Cox multivariate analysis indicated that limited mediastinal disease at diagnosis (P = 0.004) and the use of cisplatin-based combined chemotherapy (P = 0.005) were independent good prognostic factors of PMNSGCT.

CONCLUSIONPrimary mediastinal nonseminoma constitutes the most of primary mediastinal germ cell tumors. Cisplatin-based combined chemotherapy may be the most effective for the treatment of primary mediastinal germ cell tumors. The prognosis of primary mediastinal nonseminomas is significantly worse than that of primary mediastinal seminomas, and correlated with the extent of disease and chemotherapy.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; therapeutic use ; Child ; Cisplatin ; therapeutic use ; Combined Modality Therapy ; Etoposide ; therapeutic use ; Follow-Up Studies ; Humans ; Ifosfamide ; therapeutic use ; Male ; Mediastinal Neoplasms ; radiotherapy ; therapy ; Mediastinum ; surgery ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; radiotherapy ; therapy ; Remission Induction ; Retrospective Studies ; Seminoma ; radiotherapy ; therapy ; Survival Rate ; Taxoids ; therapeutic use ; Young Adult

BACKGROUNDHigh-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a promising approach for lymphomas. This study aimed to evaluate the effect of ifosfamide, cisplatin or carboplatin, and etoposide (ICE)-based regimen as a mobilization regimen on relapsed, refractory, or high-risk aggressive lymphoma.

METHODSFrom June 2001 to May 2013, patients with lymphomas who mobilized by ICE-based regimen for ASCT were analyzed in this retrospective study. The results of the autologous peripheral blood stem cells collection, toxicity, engraftment after ICE-based mobilization regimen were analyzed in this study. Furthermore, risk factors for overall survival (OS) and progression free survival (PFS) were evaluated by univariate analysis.

RESULTSThe stem cells were mobilized using ICE-based regimen plus rituximab or ICE-based regimen alone in 12 patients and 54 patients, respectively. The results of stem cell mobilization were excellent. Ninety-seven percentages of the patients had the stem cell collection of at least 2.0 × 10 6 CD34 + cells/kg and 68% had at least 5 × 10 6 CD34 + cells/kg. Fifty-eight percentage of the patients experienced Grade 4 neutropenia, 20% developed febrile neutropenia, and only 12% had Grade 4 thrombocytopenia. At a median follow-up of 63.8 months, the 5-year PFS and OS were 64.4% and 75.3%, respectively.

CONCLUSIONICE is a powerful regimen for stem cell mobilization in patients with lymphomas.

Adolescent ; Adult ; Antineoplastic Agents ; therapeutic use ; Carboplatin ; therapeutic use ; Child ; Cisplatin ; therapeutic use ; Etoposide ; therapeutic use ; Female ; Hematopoietic Stem Cell Mobilization ; methods ; Humans ; Ifosfamide ; therapeutic use ; Lymphoma ; drug therapy ; Male ; Middle Aged ; Retrospective Studies ; Stem Cell Transplantation ; methods ; Transplantation, Autologous ; Young Adult

OBJECTIVETo investigate the feasibility and efficacy of rituximab combined with high-dose chemotherapy supported by autologous peripheral blood stem cell transplantation (ASCT) in patients with aggressive B-cell non-Hodgkin lymphoma (NHL).

METHODSTwenty-eight patients with aggressive B-cell NHL (22 newly diagnosed, 6 relapsed) were enrolled in this study. The high-dose chemotherapy included CHOP regimen (CTX + ADM + VCR + PDN) for the newly diagnosed patients and DICE (DEX + IFO + DDP + VP-16) or EPOCH (VP-16 + PDN + VCR + CTX + ADM) for the relapsed patients. Each patient received infusion of rituximab at a dose of 375 mg/m(2) for four times, on D1 before and on D7 of peripheral blood stem cell mobilization, and on D1 before and D8 after stem cell reinfusion.

RESULTSComplete remission was achieved in all patients after high dose chemotherapy and ASCT. At a median follow-up of 37 months, the estimated overall 4-year survival and progression-free survival rate for all patients were 75.0% and 70.3%, respectively, while both were 72.7% for the previously untreated patients. The therapy was generally well tolerated with few side-effects attributable to rituximab.

CONCLUSIONThese results suggest that adding rituximab to high-dose chemotherapy with peripheral blood stem cell transplantation is feasible and may be beneficial for patients with aggressive B-cell non-Hodgkin lymphoma.

Adolescent ; Adult ; Antibodies, Monoclonal, Murine-Derived ; adverse effects ; therapeutic use ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cisplatin ; adverse effects ; therapeutic use ; Combined Modality Therapy ; Cyclophosphamide ; adverse effects ; therapeutic use ; Dexamethasone ; adverse effects ; therapeutic use ; Disease-Free Survival ; Doxorubicin ; adverse effects ; therapeutic use ; Etoposide ; adverse effects ; therapeutic use ; Female ; Fever ; chemically induced ; etiology ; Humans ; Ifosfamide ; adverse effects ; therapeutic use ; Lymphoma, Large B-Cell, Diffuse ; therapy ; Male ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Prednisolone ; adverse effects ; therapeutic use ; Prednisone ; adverse effects ; therapeutic use ; Prospective Studies ; Remission Induction ; Rituximab ; Survival Rate ; Vincristine ; adverse effects ; therapeutic use ; Vomiting ; chemically induced ; Young Adult

Neoadjuvant chemotherapy (NACT), which can reduce the size and therefore increase the resectability of tumors, has recently evolved as a treatment for locally advanced cervical cancer. NACT has been reported to decrease the risk of pathologic factors related to prognosis of cervical cancer. To further assess the effects of NACT on surgery and the pathologic characteristics of cervical cancer, we reviewed 110 cases of locally advanced cervical cancer treated with radical hysterectomy with or without NACT at the People's Hospital of Peking University between January 2006 and December 2010. Of 110 patients, 68 underwent platinum-based NACT prior to surgery (NACT group) and 42 underwent primary surgery treatment (PST group). Our results showed 48 of 68 (70.6%) patients achieved a complete response or partial response to NACT. Estimated blood loss, operation time, and number of removed lymph nodes during surgery, as well as complication rates during and after surgery were not significantly different between the NACT group and the PST group. The rates of deep stromal invasion, positive parametria, positive surgical vaginal margins, and lymph node metastasis were not significantly different between the two groups. However, the rate of lymph-vascular space involvement (LVSI) was significantly lower in the NACT group than in the PST group (P = 0.021). In addition, the response rate of NACT was significantly higher in the patients with chemotherapeutic drugs administrated via artery than via vein. Our results suggest that NACT is a safe and effective treatment for locally advanced cervical cancer and significantly decreases the rate of LVSI.
Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; surgery ; Cisplatin ; therapeutic use ; Female ; Humans ; Hysterectomy ; methods ; Ifosfamide ; therapeutic use ; Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Invasiveness ; Neoplasm Staging ; Remission Induction ; Retrospective Studies ; Uterine Cervical Neoplasms ; drug therapy ; pathology ; surgery

OBJECTIVETo investigate the clinicopathologic features, diagnosis, treatment and prognosis of uterine mullerian adenosarcoma.

METHODSThe clinicopathological data of 9 cases of uterine mullerian adenosarcoma in PUMC hospital from January 2003 to February 2009 were retrospectively analyzed.

RESULTSThere were 6 uterine endometrial adenosarcomas and 3 cervical adenosarcomas. The main clinical manifestations were abnormal vaginal bleeding and pelvic pain. Physical examination showed cervical/vaginal mass, enlarged uterus or pelvic mass. The adenosarcoma was characterized by benign or atypical-appearing neoplastic glands within a sarcomatous stroma. This stroma could appear as periglandular cuffs or intraglandular polypoid projections of increased cellular structure. The primary diagnostic rate was 66.7% and the most common clinical stage was stage I (7/9). All patients received surgical treatment and seven had postoperative chemotherapy, radiotherapy or hormone therapy. Conservation of unilateral ovary or bilateral ovaries was performed in 5 cases. Three patients underwent local excision, which resulted in the preservation of reproductive function. During the follow-up, 2 cases of uterine endometrial adenosarcoma recurred. One patient of clinical stage III containing sarcomatous overgrowth died from recurrence 13 months after surgery. The other one recurred 2 years after local excision of the tumor in the uterine cavity and she remained healthy since hysterectomy.

CONCLUSIONUterine mullerian adenosarcoma is a rare tumor without specific clinical symptoms and signs. The diagnosis depends on pathomorphologic examination. The tumors show low malignant potential and the vast majority are at early stage. Surgical excision is the main treatment strategy with a good prognosis in the early stage disease with complete removal of tumors. The prognosis is poor in advanced adenosarcoma with sarcomatous overgrowth. Due to the relatively high rate of recurrence, long-term follow-up is recommended.

Adenosarcoma ; drug therapy ; pathology ; surgery ; Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemotherapy, Adjuvant ; Cisplatin ; therapeutic use ; Endometrial Neoplasms ; drug therapy ; pathology ; surgery ; Etoposide ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Ifosfamide ; therapeutic use ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Retrospective Studies ; Uterine Cervical Neoplasms ; drug therapy ; pathology ; surgery ; Uterine Neoplasms ; drug therapy ; pathology ; surgery ; Young Adult