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Dr. Armitage presents a succinct and thorough review of the role of mitoxantrone (Novantrone) in patients with non-Hodgkin’s lymphoma (NHL). He begins by emphasizing the importance of accurate diagnosis as described in the World Health Organization classification which evolved from the Revised European American Lymphoma classification. Both of these present day classifications are based on the immunologic principles separating lymphomas into B- and T-cell disorders developed in the 1970s by Lennert, Lukes, and Collins.[1,2] His review addresses multiple issues in mitoxantrone therapy, including dose intensity, cardiotoxicity, combination therapy with nucleoside analogs in low-grade lymphomas, the impact of rituximab (Rituxan), therapy for acquired immunodeficiency syndrome (AIDS)-related lymphoma, and the role of high-dose mitoxantrone as part of a preparative regimen for autologous transplants.

In the United States, hospice and palliative care are two distinct expressions of the hospice interdisciplinary team approach to end-of-life care, which originated in Great Britain in the 1960s. The hospice movement developed largely as a home-care program and alternative to conventional care.

The introduction of highly active antiretroviral therapy (HAART) has had a dramatic impact on the morbidity and mortality of individuals living with human immunodeficiency virus (HIV). In addition to contributing to declines in the incidence of several opportunistic infections, HAART is affecting the incidences of several acquired immunodeficiency syndrome (AIDS)-defining malignancies.

The development of doxorubicin was an important advance in the treatment of patients with non-Hodgkin’s lymphoma (NHL). Alternatives to doxorubicin, such as mitoxantrone (Novantrone), have less nonhematologic toxicity and could offer a therapeutic advantage in some situations if similar antilymphoma activity exists. Several combination regimens that include mitoxantrone have been shown to be active.

WASHINGTON-Senator John Breaux and Congresswoman Donna Christianson, speaking at the National Patient Advocate Foundation’s Patient Congress III, called for comprehensive, available health care and health insurance for all, regardless of age, income, or employment status.

Front-line treatment for previously untreated follicular B-cell lymphoma with the iodine-131-labeled anti-CD20 antibody tositumomab (Bexxar) has been reported to result in a 97% response rate and a 74% complete response rate.

WASHINGTON-President Bush’s proposed new budget for the National Institutes of Health (NIH), if enacted by Congress, would complete the 5-year, bipartisan effort to double the agency’s budget over 5 years.

CHICAGO-Computer-aided detection (CAD) has been shown to improve the identification of breast malignancies on film-based mammography in studies involving large databases of films, said Kathryn O’Shaughnessy, PhD, director of clinical and regulatory affairs, R2 Technology, Inc., Los Altos, California. Now, the method has been shown to be equally accurate in the analysis of full-field digital mammography images, she said at the 87th Scientific Assembly and Annual Meeting of the Radiological Society of North America (abstract 995).

ORLANDO-About one third of "bad prognosis" refractory B-cell chronic lymphocytic leukemia (B-CLL) patients are salvageable with alemtuzumab (Campath-1H), according to a compassionate use study presented at the 43rd Annual Meeting of the American Society of Hematology (abstract 1538).

Autoantibodies against factor VIII are rare but may cause life-threatening bleeding. Up to 30% of inhibitors may resolve spontaneously, but immunosuppressive drugs with possible serious adverse effects and costly factor replacement are usually required. Rituximab (Rituxan), a humanized monoclonal antibody against CD20-positive B cells, has been reported to be beneficial in certain antibody-mediated autoimmune diseases. We describe here four consecutively treated patients whose acquired factor VIII inhibitors responded rapidly to immunosuppressive regimens that included rituximab administered at 375 mg/m² weekly for 2 to 4 weeks.

ROCKVILLE, Maryland-The US Food and Drug Administration (FDA) has approved the orphan drug Orfadin (nitisinone capsules, Swedish Orphan International) for treating hereditary tyrosinemia type 1 (HT-1), a rare pediatric disease that causes progressive liver failure and liver cancer. In announcing its approval decision, the agency warned that only physicians experienced in treating the disease should prescribe Orfadin. Rare Diseases Therapeutics, Inc., of Nashville, Tennessee, is the drug’s US distributor.

CHICAGO-Highly active anti-retroviral therapy (HAART) has drastically reduced the incidence of primary central nervous system (CNS) lymphoma in HIV-positive individuals at a French hospital and improved survival in HIV-positive patients who have the brain malignancy.

The optimal therapy for advanced-stage follicular lymphoma is unknown. Combination chemotherapy usually induces remissions in most patients; however, nearly all patients eventually progress and there is no clear plateau on disease-free survival analysis. Single-agent treatment with the monoclonal anti-CD20 antibody rituximab (Rituxan) at 375 mg/m² weekly × 4 doses induces response rates of approximately 50% to 60% in patients with relapsed follicular non-Hodgkin’s lymphoma. In some patients, the molecular detection of disease by polymerase chain reaction assay may be eliminated following antibody therapy.

CHICAGO-Fifteen to 20 years ago, treatment of patients infected with Pseudomonas aeruginosa infection after stem cell transplantation was limited to certain beta-lactam and aminoglycoside antibiotics that were active against the organism.

CHICAGO-Two studies presented at the 87th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) indicate that computer-aided detection (CAD) of lesions on conventional mammography studies is comparable to double-read mammograms, and it produces fewer false-negative results.

BOSTON-Misconceptions about cancer clinical trials are common among trial participants, according to a survey of 205 patients and 61 providers conducted at the Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Massachusetts General Hospital.

At the 2000 American Society of Hematology meeting, we reported the successful treatment of a patient with acquired hemophilia using rituximab (Rituxan). This patient has required no therapy over the past year and has suffered no further hemorrhages. A June 2001 factor VIII level was 35%, and a factor VIII inhibitor level could not be analyzed due to the high level of factor VIII. Since then, three more patients with acquired factor VIII deficiency have received rituximab therapy at the University of Iowa, and are discussed below.

Immune thrombocytopenic purpura (ITP) in adults is a chronic autoimmune disease characterized by antiplatelet antibody (APA)-mediated thrombocytopenia.

Current evidence suggests that rituximab (Rituxan) works in vivo mainly through complement-dependent cytotoxicity (CDC) and/or antibody-dependent cellular cytotoxicity (ADCC). Here we have investigated the sensitivity of freshly isolated cells obtained from 33 B-cell chronic lymphocytic leukemia (B-CLL), 5 prolymphocytic leukemia (PLL), and 6 mantle cell leukemia (MCL) patients to be lysed by rituximab and complement in vitro.

Hairy cell leukemia (HCL) is an indolent B-cell neoplasm that strongly expresses CD20. Despite initial very high response rates with cladribine (Leustatin), many patients ultimately relapse.

BETHESDA, Maryland-Merck & Co. will use a worldwide research network organized and funded by the National Institute of Allergy and Infectious Diseases (NIAID) to test promising HIV vaccines it develops.

ORLANDO-A multicenter, prospective study has shown that anemia is an independent risk factor predicting decreased survival in HIV-infected women and that highly active antiretroviral therapy (HAART) helps resolve anemia in this population group.

WASHINGTON-A National Academy of Sciences (NAS) committee expects to issue a report in June on terrorism that will provide the federal government with a road map for the use of science and technology in all aspects of counterterrorism, Richard D. Klausner, MD, former National Cancer Institute (NCI) director, told ONI.

Tositumomab/iodine-131 tositumomab (Bexxar) is a novel active agent against CD20-positive lymphoma. There is a paucity of data examining the tolerance and outcome of hematopoietic stem cell transplantation (HSCT) for relapse after tositumomab/iodine-131 tositumomab.

ROCKVILLE, Maryland-The number of people who began smoking cigars dropped 22% in 1999, according to a new analysis of data from the 2000 National Household Survey on Drug Abuse (NHSDA). The decline came after a dramatic 208% rise from 1990 to 1998, when nearly 5 million Americans smoked their first cigar.

Both rituximab (Rituxan) and fludarabine (Fludara) have individual antitumor activity against low-grade lymphoma (LGL). The combination of rituximab plus fludarabine has been shown to have synergistic activity against resistant lymphoma cell lines in vitro. We have recently completed a single-institution clinical trial of rituximab plus fludarabine in 40 patients with either treatment-naive or previously treated LGL.

CHICAGO-Brachytherapy devices that deliver radiation therapy directly to the lumpectomy site drastically reduce the time needed for radiotherapy after surgery for early-stage breast cancer, according to two studies presented at the 87th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

BETHESDA, Maryland-A long-term study to determine which of two common strategies is better for treating HIV-infected individuals was initiated in January, as 21 US centers and several Australian sites began enrolling the first 1,000 patients. Participants in the SMART trial (Strategies for Management of Anti-Retroviral Therapies) are randomized to receive immediate, aggressive antiretroviral therapy ("hit-hard-early") or no HIV drugs until CD4+ T-cell counts fall below 250 cells/µL ("go-slow").

The patient is a 58-year-old woman (AA genotype) who was found to have a prolonged activated partial thromboplastin time (aPTT) of 65.7 seconds during a preoperative evaluation for spinal stenosis surgery and mild rectal bleeding. Her aPTT test repeatedly remained abnormally prolonged. The patient had an aPTT mixing study that did not correct immediately or at 2 hours (56.4 seconds vs control 29.7 seconds). Her bleeding time was also abnormally prolonged at 11 minutes.

Wyeth-Ayerst Laboratories announced recently that thousands of patients affected by acute myeloid leukemia (AML) may benefit from the new National Comprehensive Cancer Network (NCCN) guidelines for the appropriate treatment of AML, including the use of gemtuzumab ozogamicin (Mylotarg) in specific clinical situations. The only antibody-targeted chemotherapeutic agent approved by the US Food and Drug Administration, gemtuzumab is indicated for patients with CD33-positive AML in first relapse who are 60 years of age or older and who are not considered candidates for other cytotoxic chemotherapy. The safety and efficacy of this agent in patients with poor performance status and organ dysfunction has not been established.