Showing papers by "Hande Turna published in 2004"

Reactivation of hepatitis B virus infection with cytotoxic therapy in non-Hodgkin's lymphoma.

Abstract: In patients with non-Hodgkin’s lymphoma (NHL), there are some well-known tumor-related adverse prognostic factors that may increase the mortality rate. However, secondary factors such as viral hepatitis carriers that may decrease the cure rates are usually ignored. Reactivation of hepatitis B virus (HBV) infection in patients undergoing cytotoxic treatment for NHL is a well-known complication. Charts of 112 patients with NHL were retrospectively analyzed regarding their hepatitis serology, the indirect effects of seropositivity on disease outcome, and the precautions undertaken in these seropositive patients with NHL. Twelve patients (11%) with HBsAg positivity and two patients (1.7%) with antibody to hepatitis C virus positivity were detected. Eight out of 12 patients (67%) with HBsAg positivity and two patients (50%) with anti-HCV positivity showed reactivation of hepatitis during treatment of NHL. No reactivation was detected in four patients seropositive for HBV, who were given lamivudine prophylaxis before the initiation of chemotherapy schedules. Among patients with hepatitis reactivation, two were treated with lamivudine resulting in dramatic improvement and clinical remission of the disease. The remaining six patients with reactivation were left untreated, resulting in four deaths (67%) due to liver failure secondary to HBV and two deaths secondary to delayed treatment of NHL. One patient seropositive for anti-HCV also developed chronic hepatitis C. Determination of hepatitis serology in all patients with NHL before any chemotherapy administration is crucial, but insufficient, if not taken into consideration. In seropositive patients, HBV DNA should be determined and antiviral prophylaxis with lamivudine should be initiated before any treatment.

Rituximab-induced tumor progression: does it really happen?

Abstract: Monoclonal antibodies have been gaining a wide role in the treatment of malignant diseases. A human chimeric anti-CD20 monoclonal antibody (Mab) rituximab (Rituxan in USA; Mabthera in Europe) was approved for the treatment of refractory or relapsed low-grade or follicular non-Hodgkin's lymphoma (NHL) in 1997 (1-3). Rituximab has efficacy in other refractory CD20+ NHLs, hairy cell leukemia, plasma cell dyscrasias, posttransplant lymphoproliferative syndrome, autoimmune phenomena such as refractory hemo lytic anemias, and immune thrombocytopenias (4-8). Its combination with standard chemotherapy protocols for NHL has been investigated thoroughly owing to its synergistic effect when combined with chemotherapeutic agents (3). Coiffier et al. recently published a randomized trial showing a statistically significant survival benefit of rituximab-CHOP combination over CHOP alone in elderly patients with diffuse large-B-cell lymphoma (9,10). In addition to these widening beneficial therapeutic effects, rituximab has well-known side effects, encountered especially during its first infusion, such as chills, fever, allergic reactions, cardiopulmonary syndrome, and tumor lysis syndrome. We would like to share our clinical observation in a patient with NHL, whose disease seemed to go into an accelerated progression phase after rituximab administration.

Do we really benefit from checking tumor markers in detecting recurrence in gastrointestinal cancer

Abstract: PURPOSE To evaluate the role of tumor markers carcinoembryonic antigen (CEA) and CA 19.9 in the early detection of local or systemic recurrence in gastrointestinal malignancies. PATIENTS AND METHODS Twenty-six patients with operable gastrointestinal cancer, who had elevated levels of either CEA or CA 19.9 or both during the postoperative follow-up period were evaluated. Serum estimation of tumor markers were carried out at 3-month intervals and the imaging and endoscopic procedures were performed at 6-month intervals or when a patient had an elevated tumor marker during follow-up. RESULTS The difference of mean serum levels of CA 19.9 but not of CEA was found to be statistically significant between the two groups of patients with or without radiographically / endoscopically evident recurrent disease (p < 0.05). CONCLUSION CA 19.9 was found to be a better, though not specific, indicator of recurrence. The relative small number of patients precludes reaching a firm conclusion. Further studies are needed to establish the role of these markers in determining early recurrence and their impact in overall survival.

Should mammographic screening be done in primary ovarian cancer?: A case control study in Turkish women.

Abstract: Breast cancer is a significant global health problem. It is the most common malignancy in women. Mammographic screening is recommended for women older than 40 yr for early detection of breast cancer. The aim of this study is to evaluate the role of screening mammography in ovarian cancer independent of age. Eighty-four patients with ovarian cancer were evaluated with bilateral mammography. Two hundred asymptomatic healthy controls with a similar age distribution were also imaged with screening mammography. Mammography results were classified according to the American College of Radiology criteria in five groups. The median age of the study group was 51.4 (range, 27-77) and 49.3 (range, 30-75) in the control group. Screening mammography detected four cases of malignancy (4.8%) in patients with ovarian cancer; two were the primary breast carcinomas(2.5%) and two were metastatic cancers from the ovary. Five subjects (2.5%) among healthy controls were also found to have breast cancer. Although the incidence of primary breast carcinoma was found to be similar in the two groups (2.5%), mammographic imaging detected metastatic disease to the breast from the ovaries. Mammography should therefore be considered in patients with ovarian cancer independent of age.