Good nutrition and nutritional therapy are important for cancer patients before, during and after... more Good nutrition and nutritional therapy are important for cancer patients before, during and after treatment. The goal for the dietary advices and the nutritional therapy is to maintain or improve the nutritional status of the cancer patients. This seems to have beneficial effects on the oncological therapy. To achieve good results by using nutritional therapy in cancer treatment, a close collaboration between nutritionists, doctors and nurses will be important. The National Nutrition Council initiated in 1996 a working group in order to provide recommendations for diet and nutritional therapy in cancer patients. The group performed a literature review and studied the practice of nutritional therapy in Norwegian hospitals using a mailed questionnaire answered by 33 (72%) hospital departments. This paper gives a summary of this work.
In the period 1968 through 1988, The Norwegian Radium Hospital (NRH) treated an unselected popula... more In the period 1968 through 1988, The Norwegian Radium Hospital (NRH) treated an unselected population of 1,152 patients with Hodgkin's disease (HD) that comprised more older patients (mean age, 43 years) than most other institutions. We considered it important to evaluate these patients for development of second cancers (SCs). The Norwegian Cancer Registry identified previously untreated patients with HD treated at NRH who had developed a SC more than 1 year after diagnosis of HD. The relative risk ratio (RR) (observed/expected cases) and the cumulative risk were calculated. Sixty-eight patients had developed a SC, including nine acute nonlymphocytic leukemias (ANLLs), eight non-Hodgkin's lymphomas (NHLs), and 51 solid tumors, including 11 lung cancers. The RR of SC and leukemia was 1.86 (95% confidence interval [CI], 1.4 to 2.4) and 24.3 (95% CI, 11.1 to 46.2), respectively. The RR of SC was highest in younger patients (< 41 years, RR = 3.8). No significant association between splenectomy and development of ANLL was found. The influence of treatment and follow-up time on the development of SC agrees with data from other large cancer institutions. (1) The low RR of developing a SC in this study is probably due to the number of older patients included, who have a lower RR of developing a SC due to less aggressive treatment, shorter follow-up time, and higher incidence of cancer in the expected background population. (2) The low RR and cumulative risk of developing ANLL may be due to the limited use of extensive chemotherapy (CT) in our hospital in the earlier years.
This report describes experiences at the Norwegian Radium Hospital in immunomagnetic purging of l... more This report describes experiences at the Norwegian Radium Hospital in immunomagnetic purging of lymphoma from autologous stem cell grafts by negative and positive selection. Clinical data from 83 patients who received purged marrow grafts and 3 patients who received purged, mobilized leukapheresis products are presented. Early data indicate that immunomagnetic enrichment of CD34+ cells from leukapheresis products does not routinely achieve effective purging, as 1%-2% residual lymphoma cells could still be detected in the selected grafts.
The risk of a second cancer was assessed in 1,152 patients with Hodgkins disease who were treated... more The risk of a second cancer was assessed in 1,152 patients with Hodgkins disease who were treated at the Norwegian Radium Hospital from 1968-85. 68 patients developed a second cancer more than one year after the diagnosis of Hodgkins disease. These included nine acute non-lymphocytic leukemias, eight non-Hodgkins lymphomas and 51 solid tumours, including 11 lung cancers. The overall relative risk (observed/expected ratios) of developing a second cancer was 1.86. After 18 years the cumulative risk of developing a second cancer was 14.4% +/- 2.9%, of which 11.2% +/- 2.6% referred to solid tumours. The cumulative risk of leukemia appeared to reach a plateau level of 1.5% after 12 years while the risk of non-Hodgkins lymphomas and lung cancer continued to rise with time to 2.1% and 3.3% respectively after 18 years. The risk of developing leukemia increased after treatment with alkylating agents and Procarbazine. The risk of non-Hodgkins lymphoma was not related to any specific type of therapy. Excess lung cancer risk was noted in patients treated with radiotherapy, and the cancers appeared within the treated areas.
Evidence of activation of coagulation was sought in serial plasma samples from 25 ABMT candidates... more Evidence of activation of coagulation was sought in serial plasma samples from 25 ABMT candidates with malignant lymphoma admitted for bone marrow harvesting: 10 females and 15 males, median age 41 years (range 27-58 years). Nineteen patients had non-Hodgkin's lymphoma (NHL) and six had Hodgkin's disease. Of those with NHL, 14 had high-grade and five low- grade disease. The plasma levels of markers of activation (prothrombin fragment 1 + 2, thrombin-antithrombin complexes, fibrinopeptide A and fibrinmonomers) increased significantly (P < 0.001) in association with harvesting. Except for fibrinopeptide A, the indicators of activation were still significantly elevated 24 h after marrow aspiration. Beta-thromboglobulin, a marker of the platelet release reaction, also increased significantly (P < 0.01). Four out of nine patients in whom a long-term central venous catheter was inserted just after marrow aspiration, developed catheter-related deep vein thrombosis, verified v...
European journal of haematology. Supplementum, 2001
In this study we explored whether a standard chemotherapy regimen consisting of mitoguazone, ifos... more In this study we explored whether a standard chemotherapy regimen consisting of mitoguazone, ifosfamide, methotrexate and etoposide (MIME) combined with 5 micrograms/kg or 10 micrograms/kg G-CSF was capable of mobilizing peripheral blood progenitor cells (PBPC) in lymphoma patients. Thirty-three patients with Hodgkin's disease (HD) and 108 patients with non-Hodgkin's lymphoma (NHL) were mobilized with MIME/G-CSF. Most patients were heavily treated with different chemotherapy regimens receiving a median of 11 cycles (range 3-40) of chemotherapy prior to mobilization. Eight of 141 patients failed to mobilize PBPC and bone marrow was harvested. In addition, 10 patients obtained a harvest of < 2.0 x 10(6) CD34+ cells/kg. More than 2.0 x 10(6) CD34+ cells/kg were achieved in all HD patients and in 83% of the NHL patients. Fifty-eight per cent of the patients harvested > or = 5 x 10(6) CD34+ cells/kg. Eleven per cent of the patients developed neutropenic fever during the mob...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 20, 1998
Good nutrition and nutritional therapy are important for cancer patients before, during and after... more Good nutrition and nutritional therapy are important for cancer patients before, during and after treatment. The goal for the dietary advices and the nutritional therapy is to maintain or improve the nutritional status of the cancer patients. This seems to have beneficial effects on the oncological therapy. To achieve good results by using nutritional therapy in cancer treatment, a close collaboration between nutritionists, doctors and nurses will be important. The National Nutrition Council initiated in 1996 a working group in order to provide recommendations for diet and nutritional therapy in cancer patients. The group performed a literature review and studied the practice of nutritional therapy in Norwegian hospitals using a mailed questionnaire answered by 33 (72%) hospital departments. This paper gives a summary of this work.
Summary. Two boys, 5 and 18 years old, had had frequent infections from their second month of lif... more Summary. Two boys, 5 and 18 years old, had had frequent infections from their second month of life and had later suffered from generalized lymphadenopathy, intermittent maculopapular exanthema, anaemia, and weight loss. Histopathological features of lymph nodes were consistent with immunoblastic lymphadenopathy. Immunohistochemistry showed hyperimmune state with numerous T cells and macrophages along with selective polyclonal IgM‐producing cell response in one patient, and IgG‐and IgM‐producing cells in the other. Both had severe deficiency of serum IgA. Classification of T‐cell subsets (OKT4+ and OKT8+) in peripheral blood indicated an imbalance with a relative excess of putative suppressor cells (OKT4+/OKT8+<1; normal, 1.7). It is suggested that decreased T‐helper cell activity may explain the observed maturational defects in the B‐cell system which probably underlie a hyper‐reactive state induced by some sort of triggering, e.g. chronic infection. During steroid treatment the ...
Recommended treatment for lymphoblastic lymphomas, a highly aggressive, relatively rare lymphoma ... more Recommended treatment for lymphoblastic lymphomas, a highly aggressive, relatively rare lymphoma entity predominantly seen in teenagers and young adults, includes acute lymphoblastic leukemia (ALL)-like induction chemotherapy. Whether these patients should be consolidated with maintenance chemotherapy or autologous stem cell transplantation (Auto-SCT) and the use of radiotherapy are matters of debate. We reviewed treatment and outcome for 25 consecutive patients above the age of 15 years with lymphoblastic lymphoma (T-lineage; T-LBL, n = 19; B-lineage; B-LBL, n = 6) seen at a single center during a 12-year period (1999-2011). Patients were given an ALL-like chemotherapy induction regimen, and responding patients were consolidated with Auto-SCT and local radiotherapy when applicable. Median age at diagnosis was 33 years (range 15-65). Seventeen of the T-LBL patients had a mediastinal mass, three patients had central nervous system (CNS) involvement. Chemotherapy with intensified CNS prophylaxis induced an overall response rate of 92% (CR 84%, PR 8%). In total 23/25 (92%) patients underwent Auto-SCT in first remission while 13 of 14 eligible patients with mediastinal involvement received local radiotherapy. Twenty percent of the patients had hepatotoxicity grade 3-4 and 32% thromboembolic events (TE). Two patients (8%) died of treatment-related toxicity. One patient had progressive disease and died of lymphoma. Three patients have relapsed, but two of these (both B-LBL) are currently alive in second CR after Allo-SCT. With a median follow-up of 98 months (range 1-163) the 5- and 8-year PFS and OS are 76% and 84%, respectively. Combined intensive ALL-like induction and early consolidation chemotherapy followed by Auto-SCT and local radiation therapy resulted in high sustained cure rates.
Lymphoma survivors after high-dose therapy with autologous stem-cell transplant (HDT-ASCT) are at... more Lymphoma survivors after high-dose therapy with autologous stem-cell transplant (HDT-ASCT) are at risk of several late effects, which might impair their health-related quality of life (HRQoL). We assessed the total late effect burden in this population, and how it affects HRQoL. All lymphoma survivors treated with HDT-ASCT as adults in Norway between 1987 and 2008 were identified, and 271 (68%) attended both a comprehensive clinical assessment and completed a questionnaire. Severity of 45 conditions in 12 organ-system categories were graded as mild, moderate, severe or life-threatening, according to a modified version of CTCAEv4.03. At a median of 8 years after HDT-ASCT, 98% of survivors had at least one moderate or more severe late effect and 56% had severe or life-threatening late effects. Fourteen percent had low, 39% medium and 47% high late effect burden, defined as having moderate or more severe late effects in 0-1, 2-3 and >3 organsystems, respectively. Female sex, increas...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 20, 1992
Between 1986 and 1991, 29 patients with malignant lymphomas were treated with total body irradiat... more Between 1986 and 1991, 29 patients with malignant lymphomas were treated with total body irradiation and high-dose chemotherapy followed by autologous bone marrow transplantation at the Norwegian Radium Hospital. Owing to treatment-induced bone marrow toxicity, the leucocyte count in peripheral blood rapidly fell to zero. The aplastic phase lasted for 25 days (median). All patients experienced fever in the posttransplant period and needed broad-spectrum antibiotics. 12 patients had documented bacteremia, mostly with Gram-positive isolates. There were seven cases of documented focal infections, and antibiotic-associated colitis was seen in two cases. Other complications included bleedings and skin rashes. Four patients died in the post-transplant period from complications related to the cytotoxic treatment. We discuss guidelines for antimicrobial treatment of suspected and confirmed infections in neutropenic patients.
Purpose: To determine, in a randomized clinical trial, whether high-dose therapy (HDT) followed b... more Purpose: To determine, in a randomized clinical trial, whether high-dose therapy (HDT) followed by autologous stem-cell transplantation is more effective than standard treatment with regard to progression-free survival (PFS) and overall survival (OS) in patients with relapsed follicular non-Hodgkin’s lymphoma; and to assess the additional value of B-cell purging of the stem-cell graft with regards to PFS and OS. Patients and Methods: Patients received three cycles of chemotherapy. Responding patients with limited bone marrow infiltration were eligible for random assignment to three further cycles of chemotherapy (C), unpurged HDT (U), or purged HDT (P). Results: Between August 1993 and April 1997, 140 patients were registered from 36 centers internationally, and 89 were randomly assigned. Reasons for not randomizing included patient refusal, early progression, or death on induction therapy. With a 69-month median follow-up, the log-rank P value for PFS and OS were .0037 and .079, re...
Good nutrition and nutritional therapy are important for cancer patients before, during and after... more Good nutrition and nutritional therapy are important for cancer patients before, during and after treatment. The goal for the dietary advices and the nutritional therapy is to maintain or improve the nutritional status of the cancer patients. This seems to have beneficial effects on the oncological therapy. To achieve good results by using nutritional therapy in cancer treatment, a close collaboration between nutritionists, doctors and nurses will be important. The National Nutrition Council initiated in 1996 a working group in order to provide recommendations for diet and nutritional therapy in cancer patients. The group performed a literature review and studied the practice of nutritional therapy in Norwegian hospitals using a mailed questionnaire answered by 33 (72%) hospital departments. This paper gives a summary of this work.
In the period 1968 through 1988, The Norwegian Radium Hospital (NRH) treated an unselected popula... more In the period 1968 through 1988, The Norwegian Radium Hospital (NRH) treated an unselected population of 1,152 patients with Hodgkin&#39;s disease (HD) that comprised more older patients (mean age, 43 years) than most other institutions. We considered it important to evaluate these patients for development of second cancers (SCs). The Norwegian Cancer Registry identified previously untreated patients with HD treated at NRH who had developed a SC more than 1 year after diagnosis of HD. The relative risk ratio (RR) (observed/expected cases) and the cumulative risk were calculated. Sixty-eight patients had developed a SC, including nine acute nonlymphocytic leukemias (ANLLs), eight non-Hodgkin&#39;s lymphomas (NHLs), and 51 solid tumors, including 11 lung cancers. The RR of SC and leukemia was 1.86 (95% confidence interval [CI], 1.4 to 2.4) and 24.3 (95% CI, 11.1 to 46.2), respectively. The RR of SC was highest in younger patients (&lt; 41 years, RR = 3.8). No significant association between splenectomy and development of ANLL was found. The influence of treatment and follow-up time on the development of SC agrees with data from other large cancer institutions. (1) The low RR of developing a SC in this study is probably due to the number of older patients included, who have a lower RR of developing a SC due to less aggressive treatment, shorter follow-up time, and higher incidence of cancer in the expected background population. (2) The low RR and cumulative risk of developing ANLL may be due to the limited use of extensive chemotherapy (CT) in our hospital in the earlier years.
This report describes experiences at the Norwegian Radium Hospital in immunomagnetic purging of l... more This report describes experiences at the Norwegian Radium Hospital in immunomagnetic purging of lymphoma from autologous stem cell grafts by negative and positive selection. Clinical data from 83 patients who received purged marrow grafts and 3 patients who received purged, mobilized leukapheresis products are presented. Early data indicate that immunomagnetic enrichment of CD34+ cells from leukapheresis products does not routinely achieve effective purging, as 1%-2% residual lymphoma cells could still be detected in the selected grafts.
The risk of a second cancer was assessed in 1,152 patients with Hodgkins disease who were treated... more The risk of a second cancer was assessed in 1,152 patients with Hodgkins disease who were treated at the Norwegian Radium Hospital from 1968-85. 68 patients developed a second cancer more than one year after the diagnosis of Hodgkins disease. These included nine acute non-lymphocytic leukemias, eight non-Hodgkins lymphomas and 51 solid tumours, including 11 lung cancers. The overall relative risk (observed/expected ratios) of developing a second cancer was 1.86. After 18 years the cumulative risk of developing a second cancer was 14.4% +/- 2.9%, of which 11.2% +/- 2.6% referred to solid tumours. The cumulative risk of leukemia appeared to reach a plateau level of 1.5% after 12 years while the risk of non-Hodgkins lymphomas and lung cancer continued to rise with time to 2.1% and 3.3% respectively after 18 years. The risk of developing leukemia increased after treatment with alkylating agents and Procarbazine. The risk of non-Hodgkins lymphoma was not related to any specific type of therapy. Excess lung cancer risk was noted in patients treated with radiotherapy, and the cancers appeared within the treated areas.
Evidence of activation of coagulation was sought in serial plasma samples from 25 ABMT candidates... more Evidence of activation of coagulation was sought in serial plasma samples from 25 ABMT candidates with malignant lymphoma admitted for bone marrow harvesting: 10 females and 15 males, median age 41 years (range 27-58 years). Nineteen patients had non-Hodgkin's lymphoma (NHL) and six had Hodgkin's disease. Of those with NHL, 14 had high-grade and five low- grade disease. The plasma levels of markers of activation (prothrombin fragment 1 + 2, thrombin-antithrombin complexes, fibrinopeptide A and fibrinmonomers) increased significantly (P < 0.001) in association with harvesting. Except for fibrinopeptide A, the indicators of activation were still significantly elevated 24 h after marrow aspiration. Beta-thromboglobulin, a marker of the platelet release reaction, also increased significantly (P < 0.01). Four out of nine patients in whom a long-term central venous catheter was inserted just after marrow aspiration, developed catheter-related deep vein thrombosis, verified v...
European journal of haematology. Supplementum, 2001
In this study we explored whether a standard chemotherapy regimen consisting of mitoguazone, ifos... more In this study we explored whether a standard chemotherapy regimen consisting of mitoguazone, ifosfamide, methotrexate and etoposide (MIME) combined with 5 micrograms/kg or 10 micrograms/kg G-CSF was capable of mobilizing peripheral blood progenitor cells (PBPC) in lymphoma patients. Thirty-three patients with Hodgkin's disease (HD) and 108 patients with non-Hodgkin's lymphoma (NHL) were mobilized with MIME/G-CSF. Most patients were heavily treated with different chemotherapy regimens receiving a median of 11 cycles (range 3-40) of chemotherapy prior to mobilization. Eight of 141 patients failed to mobilize PBPC and bone marrow was harvested. In addition, 10 patients obtained a harvest of < 2.0 x 10(6) CD34+ cells/kg. More than 2.0 x 10(6) CD34+ cells/kg were achieved in all HD patients and in 83% of the NHL patients. Fifty-eight per cent of the patients harvested > or = 5 x 10(6) CD34+ cells/kg. Eleven per cent of the patients developed neutropenic fever during the mob...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 20, 1998
Good nutrition and nutritional therapy are important for cancer patients before, during and after... more Good nutrition and nutritional therapy are important for cancer patients before, during and after treatment. The goal for the dietary advices and the nutritional therapy is to maintain or improve the nutritional status of the cancer patients. This seems to have beneficial effects on the oncological therapy. To achieve good results by using nutritional therapy in cancer treatment, a close collaboration between nutritionists, doctors and nurses will be important. The National Nutrition Council initiated in 1996 a working group in order to provide recommendations for diet and nutritional therapy in cancer patients. The group performed a literature review and studied the practice of nutritional therapy in Norwegian hospitals using a mailed questionnaire answered by 33 (72%) hospital departments. This paper gives a summary of this work.
Summary. Two boys, 5 and 18 years old, had had frequent infections from their second month of lif... more Summary. Two boys, 5 and 18 years old, had had frequent infections from their second month of life and had later suffered from generalized lymphadenopathy, intermittent maculopapular exanthema, anaemia, and weight loss. Histopathological features of lymph nodes were consistent with immunoblastic lymphadenopathy. Immunohistochemistry showed hyperimmune state with numerous T cells and macrophages along with selective polyclonal IgM‐producing cell response in one patient, and IgG‐and IgM‐producing cells in the other. Both had severe deficiency of serum IgA. Classification of T‐cell subsets (OKT4+ and OKT8+) in peripheral blood indicated an imbalance with a relative excess of putative suppressor cells (OKT4+/OKT8+<1; normal, 1.7). It is suggested that decreased T‐helper cell activity may explain the observed maturational defects in the B‐cell system which probably underlie a hyper‐reactive state induced by some sort of triggering, e.g. chronic infection. During steroid treatment the ...
Recommended treatment for lymphoblastic lymphomas, a highly aggressive, relatively rare lymphoma ... more Recommended treatment for lymphoblastic lymphomas, a highly aggressive, relatively rare lymphoma entity predominantly seen in teenagers and young adults, includes acute lymphoblastic leukemia (ALL)-like induction chemotherapy. Whether these patients should be consolidated with maintenance chemotherapy or autologous stem cell transplantation (Auto-SCT) and the use of radiotherapy are matters of debate. We reviewed treatment and outcome for 25 consecutive patients above the age of 15 years with lymphoblastic lymphoma (T-lineage; T-LBL, n = 19; B-lineage; B-LBL, n = 6) seen at a single center during a 12-year period (1999-2011). Patients were given an ALL-like chemotherapy induction regimen, and responding patients were consolidated with Auto-SCT and local radiotherapy when applicable. Median age at diagnosis was 33 years (range 15-65). Seventeen of the T-LBL patients had a mediastinal mass, three patients had central nervous system (CNS) involvement. Chemotherapy with intensified CNS prophylaxis induced an overall response rate of 92% (CR 84%, PR 8%). In total 23/25 (92%) patients underwent Auto-SCT in first remission while 13 of 14 eligible patients with mediastinal involvement received local radiotherapy. Twenty percent of the patients had hepatotoxicity grade 3-4 and 32% thromboembolic events (TE). Two patients (8%) died of treatment-related toxicity. One patient had progressive disease and died of lymphoma. Three patients have relapsed, but two of these (both B-LBL) are currently alive in second CR after Allo-SCT. With a median follow-up of 98 months (range 1-163) the 5- and 8-year PFS and OS are 76% and 84%, respectively. Combined intensive ALL-like induction and early consolidation chemotherapy followed by Auto-SCT and local radiation therapy resulted in high sustained cure rates.
Lymphoma survivors after high-dose therapy with autologous stem-cell transplant (HDT-ASCT) are at... more Lymphoma survivors after high-dose therapy with autologous stem-cell transplant (HDT-ASCT) are at risk of several late effects, which might impair their health-related quality of life (HRQoL). We assessed the total late effect burden in this population, and how it affects HRQoL. All lymphoma survivors treated with HDT-ASCT as adults in Norway between 1987 and 2008 were identified, and 271 (68%) attended both a comprehensive clinical assessment and completed a questionnaire. Severity of 45 conditions in 12 organ-system categories were graded as mild, moderate, severe or life-threatening, according to a modified version of CTCAEv4.03. At a median of 8 years after HDT-ASCT, 98% of survivors had at least one moderate or more severe late effect and 56% had severe or life-threatening late effects. Fourteen percent had low, 39% medium and 47% high late effect burden, defined as having moderate or more severe late effects in 0-1, 2-3 and >3 organsystems, respectively. Female sex, increas...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 20, 1992
Between 1986 and 1991, 29 patients with malignant lymphomas were treated with total body irradiat... more Between 1986 and 1991, 29 patients with malignant lymphomas were treated with total body irradiation and high-dose chemotherapy followed by autologous bone marrow transplantation at the Norwegian Radium Hospital. Owing to treatment-induced bone marrow toxicity, the leucocyte count in peripheral blood rapidly fell to zero. The aplastic phase lasted for 25 days (median). All patients experienced fever in the posttransplant period and needed broad-spectrum antibiotics. 12 patients had documented bacteremia, mostly with Gram-positive isolates. There were seven cases of documented focal infections, and antibiotic-associated colitis was seen in two cases. Other complications included bleedings and skin rashes. Four patients died in the post-transplant period from complications related to the cytotoxic treatment. We discuss guidelines for antimicrobial treatment of suspected and confirmed infections in neutropenic patients.
Purpose: To determine, in a randomized clinical trial, whether high-dose therapy (HDT) followed b... more Purpose: To determine, in a randomized clinical trial, whether high-dose therapy (HDT) followed by autologous stem-cell transplantation is more effective than standard treatment with regard to progression-free survival (PFS) and overall survival (OS) in patients with relapsed follicular non-Hodgkin’s lymphoma; and to assess the additional value of B-cell purging of the stem-cell graft with regards to PFS and OS. Patients and Methods: Patients received three cycles of chemotherapy. Responding patients with limited bone marrow infiltration were eligible for random assignment to three further cycles of chemotherapy (C), unpurged HDT (U), or purged HDT (P). Results: Between August 1993 and April 1997, 140 patients were registered from 36 centers internationally, and 89 were randomly assigned. Reasons for not randomizing included patient refusal, early progression, or death on induction therapy. With a 69-month median follow-up, the log-rank P value for PFS and OS were .0037 and .079, re...
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