Objective To study the clinical features, effects of therapeutic regimen and prognosis of patents with mantle cell lymphoma (MCL). Methods Clinical data of 27 MCL patients admitted in Tianjin Medical University Cancer Institute&Hospital from January 2008 to December 2014 were retrospectively analyzed. Cox regression analysis was used to analyze influencing factors of prognosis of MCL. Results The median age was 68 years old for 27 patients, and the male-to-female ratio was 4.4∶1. Ann Arbor staging showed that 25 cases were stageⅢ-Ⅳ(92.6%), 8 cases were heptosplenomegaly (29.6%), 7 cases showed extranodal involvement (25.9%). ECOG scoring showed that 4 cases with scores of 2-4 (14.8%), 8 cases were 0-3 (29.6%), 14 cases were 4-5 (51.9%) and 5 cases were 6-11 (18.5%). The Ki-67 index≤30%was found in 9 cases (33.3%), and>30%was found in 18 cases (67.7%). Patients with B symptom was found in 10 (37.0%). The elevated lactate dehydrogenase (LDH) was found in 17 cases (63.0%). The increased Beta 2- microglobulin was found in 8 cases (29.6%). Seven patients were found with bone marrow involvement. The total effective rate (ORR) was 81.8%in group with R-CHOP method, and the ORR was 68.8%in group with CHOP method. Multivariate analysis showed that age, LDH and Ki-67 were independent factors influencing the prognosis of MCL (P<0.05). Conclusion Most patients with MCL are found in advanced stage. Patients with age>60 years, elevated LDH and Ki-67 index>30%are with poor prognosis.

Objective:To compare the therapeutic efficacy and safety of Hyper-CVAD/MA regimen and CHOP/CHOP-like regimen in the treatment of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Methods:The 78 primary PTCL-NOS patients who were initially diagnosed and treated in Tianjin Medical University Cancer Institute and Hospital and Tianjin Union Medical Center from June 2004 to June 2012 were retrospectively analyzed. The patients were then divided into two groups:Hyper-CVAD/MA group (n=21) and CHOP/CHOP-like group (n=57). Curative efficacies and toxicities were analyzed by Chi-square test, and survival was estimated by Ka-plan-Meier method. Results: In the Hyper-CVAD/MA group, complete response (CR) was 42.9%, overall response rate (ORR) was 85.7%, median progression-free survival (PFS) was 20 months, and the three-year overall survival (OS) was 56.9%. In the CHOP/CHOP-like group, the CR, ORR, and three-year OS were 28.1%, 59.6%, and 49.6%, respectively, and the median PFS was 13 months. Compara-tive analysis showed that the ORR and three-year OS were statistically significant (P<0.05), but the relapse rates (57.1%versus 77.2%) and three-year OS were similar (P>0.05). The incidence rates ofⅢ/Ⅳneutrocytopenia and thrombocytopenia in Hyper-CVAD/MA group (66.7%and 61.9%, respectively) were significantly higher than those of the CHOP/CHOP-like group (22.8%and 14.0%, respec-tively) (P<0.05). Conclusion:Hyper-CVAD/MA regimen can achieve satisfactory efficacy in parents with PTCL-NOS, and toxicity can be controlled with granulocyte colony stimulating factor (G-CSF).

Objective To explore the clinical significance of plasma D-dimer level before and after chemotherapy in patients with malignant lymphoma.Methods 402 patients admitted to Tianjin Medical University Cancer Institute and Hospital and pathologically diagnosed with malignant lymphoma were retrospectively analyzed to investigate the relationship between patients' plasma D-dimer level and their clinic pathology.Meanwhile,the association between patients' plasma D-dimer level change after chemotherapy and therapeutic effect was also evaluated.Results The median plasma D-dimer levels in malignant lymphoma patients (734.51ng/ml) was distinctly higher than that in normal population (＜500 ng/ml).The plasma D-dimer level had obvious correlation with age,pathological type,level of LDH,clinical stage,B symptom and IPI score.The level of plasma D-dimer in positive response group significantly decreased from 949.40 ng/ml to 499.88 ng/ml after chemotherapy (P ＜ 0.05),whereas that in the negtive response group significantly increased from 611.09 ng/ml to 899.76 ng/ml (P ＜ 0.05).Conclusion The level of plasma D-dimer may provide the basis for evaluating the chemotherapeutic effect in patients with malignant lymphoma.

Objective:This study was conducted to evaluate and discuss the curative effect and toxicity of gemcitabine, navel-bine, and therarubicin (GNT) regimen for patients with refractory or relapsed T-cell lymphoma (TCL). Methods:A total of 69 patients with refractory or relapsed TCL treated with GNT were enrolled. The treatment protocol was set as follows:800 mg/m2 gemcitabine ad-ministered at 1 and 8 d;25 mg/m2 navelbine administered at 1 d;and 20 mg/m2 therarubicin administered at 1 d. This protocol was re-peated every three weeks. The median cycle was 4 (range:2 to 6). Results:The overall response rate was 65.2%and the achieved com-plete remission was 29.0%. Hematology toxicities were the main adverse reactions observed in all of the patients. The incidence rates of grades 1 and 2 toxicity in leukopenia or neutropenia, anemia, and thrombocytopenia were 50.7%, 33.3%, and 26.1%, respectively. Grades 3 and 4 treatment-associated toxicities were detected in 23.1%of the responding patients. One-, three-, and five-year estimated overall survival (OS) of the whole cohort were 71.7%, 47.3%, and 32.4%, respectively. The median OS was 36 months. Conclusion:GNT was effective and suitable for patients with refractory or relapsed TCL.

Objective:This study aimed to investigate the inhibitory effect of zoledronic acid (ZOL) alone or the combined treat-ment of ZOL and paclitaxel (PTX) on the cell growth of lung cancer cell line in vitro. Methods:The effects of different concentrations of ZOL alone, 2 nM PTX, and combined treatment of ZOL and PTX on the growth of A-549 cell line were determined using methyl thi-azolyl tetrazolium (MTT) method. The mechanism of the curative effect was analyzed by flow cytometry on the basis of apoptotic rate. AKT, phospho-AKT, ERK, phospho-ERK, and Bcl-2 expressions were determined by western blot analysis. AKT and ERK gene ex-pressions were determined by RT-PCR. Results:MTT results showed that ZOL alone could inhibit the growth of lung cancer cell line A-549 in a dose-dependent manner. The combined therapy of ZOL and PTX could inhibit cell growth. This combined treatment is more effective than the single treatment with either ZOL or PTX alone. The synergistic inhibition rate is dependent on drug sequencing. Fur-thermore, maximum inhibition was induced by sequence order, i.e., initial treatment with PTX and then with ZOL. RT-PCR results dem-onstrated that the mRNA of ERK and AKT of the group treated with PTX and then ZOL were lower than that in other treatment groups. Western blot analysis results demonstrated that the ERK and AKT levels of the treated groups were parallel in the cell line. However, the lowest phospho-ERK, phospho-AKT, and Bcl-2 levels were observed in the PTX then ZOL group. The cell lines treated with PTX alone and ZOL alone ranked second and third among the lowest results, respectively. The highest level was observed in the control group. Conclusion: The combined ZOL and PTX treatment induced the downregulation of phospho-ERK, phospho-AKT, and Bcl-2 protein expressions in RAF/MEK/ERK and PI3K/AKT signaling pathway. This pathway could be one of the synergistic antitumor mechanisms of the two drugs.

Objective:To observe the clinical efficacy and toxicities of bendamustine hydrochloride in patients with rituximab-re-fractory indolent B-cell non-Hodgkin's lymphoma (NHL). Methods:A total of 25 patients with rituximab-refractory NHL received bendamustine hydrochloride 120 mg/m2 intravenously on days 1 and 2 of the 21-day cycle. The short-term response, progression free survival, and toxicities were evaluated. Results:The total number of chemotherapy of the 25 patients was 122 cycles, and the median number was 5 cycles. All patients could be evaluated for efficacy. Among the patients, 6 had complete remission, 13 had partial remis-sion, 3 had stable disease, and 3 had progression disease. The overall response rate and clinical benefit rate were 76%and 88%, respec-tively. Until the deadline, 13 patients had progression disease. The median duration of response was 8 months, and the median progres-sion-free survival (PFS) was 9.3 months. Subgroup analysis showed that PFS is significantly related to bone marrow involvement and serum LDH level (P<0.05). The main adverse effects were myelosuppression, gastrointestinal reactions, and infection. Rash was found in 2 patients, and 1 case of gastric cancer was discovered after 5 cycles of treatment. Conclusion:Bendamustine hydrochloride was ef-fective and tolerable in patients with rituximab-refractory indolent B-cell NHL.

Objective:To evaluate the efficacy and safety of pegaspargase plus GEMOX (pegaspargase, gemcitabine, oxaliplatin) regimen in the initial treatment of nasal NK/T-cell lymphoma. Methods: Twelve preliminarily diagnosed nasal NK/T-cell lymphoma patients in Tianjin Medical University Cancer Institute and Hospital from June 2011 to March 2012 were analyzed. All patients took the pegaspargase plus GEMOX regimen (gemcitabine 800-1 000 mg/m2 on days 1 and 8, oxaliplatin 130 mg/m2 on day 1, and pegaspargase 2 500 IU/m2 on day 2), every three weeks for one cycle. The efficacy and toxicity of the regimen were evaluated in the follow-up treat-ment. Results:After two cycle treatments, 1 patient dropped out of treatment because of acute pancreatitis;the remaining 11 patients had response, in which 1 achieved complete response , 7 had partial response, 2 had stable disease, and 1 had progressive disease. The objective response rate was 72.7%, and the disease control rate was 90.9%. The 2-year overall survival rate was 90.9%. With median 6-cycle P-GEMOX regimen treatment, 81.8% of 11 patients presented side effects, primarily myelosuppression and hepatic dysfunc-tion. Conclusion:Pegaspargase plus GEMOX regimen showed high efficacy on the initial treatment of nasal NK/T-cell lymphoma pa-tients, but the incidence of adverse effect was still high.

Objectives To investigate the clinical features,diagnosis,treatment and prognosis of primary hepatic lymphoma (PHL).Methods A retrospective study was carried out on the clinical records of 6 patients with primary hepatic lymphoma (PHL) treated at the Tianjin Medical University Cancer Hospital from April 2005 to September 2010.The domestic and foreign medical literatures were reviewed.Results For the 6 patients with PHL,the median age was 57 years (range 31-78 years).The male-to-female ratio was 2: 1.The most common initial symptoms were abdominal pain and fever.Serum transaminase,lactate dehydrogenase and β2-microglobulin levels were elevated in 4 of 6 patients.For the 3 patients who were tested for alpha-fetoprotein and carcinoembryonic antigen levels,the results were normal.None of the patients had a history of hepatitis or cirrhosis.The diagnosis was non-Hodgkin's lymphoma.A R0 resection was carried out in 1 patient who was lost to follow-up soon after surgery.A R2 resection was carried out in another patient.The remaining 4 patients received liver biopsy.Five patients were treated by CHOP or CHOP-like chemotherapy.A patient died of brain metastases after 8 cycles of chemotherapy,and another patient was lost to follow-up after 1 cycle of chemotherapy.Chemotherapy combined with rituximab were given to the other 3 patients.There was a complete remission in 2 patients after chemotherapy and biotherapy,and these patients were still alive at the last follow-up.Partial remission was achieved in the remaining patient after chemotherapy.The patient was given radiotherapy,but he died finally of tumor progression.Conclusions PHL is an extremely rare lymphoma.Its clinical presentations and imaging manifestations are non-specific.PHL should be considered when the patient has abdominal pain or fever,with a mass in the liver.The ultimate diagnosis depends on histopathologic examination.The pathological type is mainly non Hodgkin's lymphoma,with diffuse large B cell lymphoma.There is still no standard treatment.Surgery,chemotherapy,radiotherapy,targeted therapy and biotherapy can be used.

Primary testicular lymphoma comprises 1% to 9% of testicular neoplasms and represents 1% to 2% of all non-Hodg-kin lymphomas. Histologically, the majority of the tumor consists of diffuse large B-cell non-Hodgkin lymphomas that are of intermedi-ate- or high-grade neoplasm. Clinically, the disease typically presents as a painless testicular swelling that develops over a span of weeks to months. B symptoms such as fever, weight loss, and anorexia are present in 25% to 41% of the patients. This tumor is an ag-gressive type, with frequent invasion of the epididymis, spermatic cord, and scrotum, as well as a marked tendency to relapse, especial-ly in the CNS. The treatment is mainly based on orchiectomy (mostly in stages ⅠE and ⅡE) regardless of its association with prophy-lactic irradiation of the scrotum and administration of intrathecal chemotherapy, cyclophosphamide, doxorubicin, vincristine, and pred-nisone regimen chemotherapy plus rituximab (R-CHOP) (stages ⅢE and ⅣE) and radiotherapy. The multi-modality treatment marked-ly improved progression-free and overall survival. We introduce as reference one case that received a multidisciplinary comprehensive discussion in the Department Lymphoma, Tianjin Medical University Cancer Hospital.

[Objective] To assess the predilection age,clinical features,treatment and pognostic factors of primary cutaneous B-cell lymphoma (PCBCL).[Methods] A total of 31 patients with PCBCL were registered in Tianjin Cancer Central Registry from January 1970 to September 2010,and 26 patients had complete medical recortds.A retrospective analysis was conducted on the 26 patients.The following indices were analyzed,including gender,age,body sites of initial involvement,extent of cutaneous involvement,pathological subtypes,metastatic sites,treatment,survival and prognosis.Data were processed with SPSS16.0 software,survival analysis was carried out by using Kaplan-Meier method,univariate analysis of prognostic factors by Log-rank test,multivariate analysis of prognostic faetors by COX proportional hazards model,and variables were selected by Forward LR method.[Results] Clinical manifestafions were atypical in these patients.The ratio of man and women was 1:1.6.Of the 26 cases,12 were primary cutaneous follicle-center lymphoma (PCFCL),8 were primary cutaneous marginal zone lymaphoma (PCMZL),and 4 were PCLBCL,leg type.Follow-up revealed lymph node involvement in 8 patients (4 in cervical nodes and 4 in inguinal nodes),distant metastasis of organs in 3 patients ( 1 in lung and pleura,1 in bone marrow and 1 in central nervous system).Most patients received surgical treatment combined with chemotherapy or chemoradiation.The 5-year overall survival rate was 80.8％(21/26).Statistical analysis showed that the prognosis of PCBCL was associated with histological subtype,lactate dehydrogenase (LDH) level and globulin level,but unrelated to gender,age,site of initial involvement,extent of cutaneous involvement,involvement of lymph nodes and organs,presence of B symptoms,treatment strategies,number of relapses,level of β2-globulin and hemoglobin,or lymphocyte absolute value.[Conclusion]s PCBCL,as a kind of rare extra-nodal lymphoma,usually occurs with atypical clinical mainfestations in persons aged from 39 to 66 years.The 5-year overall survival rate was 80.8％ in these patients.The prognosis of PCBCL seems to be related to histological subtypes,LDH and globulin levels.