-
Christina Kalpadakis,
Gerassimos A Pangalis,
Maria K Angelopoulou,
Sotirios Sachanas,
Flora N Kontopidou,
Xanthi Yiakoumis,
Stella I Kokoris,
Evagelia M Dimitriadou,
Maria N Dimopoulou,
Maria Moschogiannis,
Penelope Korkolopoulou,
Marie-Christine Kyrtsonis, Marina P Siakantaris,
Theodora Papadaki,
Panayiotis Tsaftaridis,
Eleni Plata,
Helen E Papadaki,
Theodoros P Vassilakopoulos
[show abstract]
[hide abstract]
ABSTRACT: Background. Treatment of splenic marginal zone lymphoma (SMZL) patients is not standardized. Recent data suggest that rituximab is highly effective and could be considered as initial therapy.Aim. To assess the efficacy of rituximab monotherapy in a large series of patients with SMZL and compare these results with splenectomy results.Methods. The studied population included 85 patients. Fifty-eight received rituximab at a dose of 375 mg/m(2) per week for 6 weeks as induction followed by maintenance at the same dose every 2 months for 1-2 years, whereas 27 patients were treated using splenectomy only.Results. The overall response rate to rituximab 2 months after the end of induction was 95% (complete response [CR], 45%; unconfirmed CR, 26%; partial response, 24%). The median times to hematologic and clinical response were 2 weeks and 3 weeks, respectively. Forty-three of 55 patients already completed the maintenance phase: 28 sustained their initial response, 14 improved their response, and one progressed. Eighty-five percent of splenectomized patients responded, and two were treated with rituximab as consolidation after splenectomy and achieved a CR. The 5-year overall and progression-free survival (PFS) rates for rituximab-treated and splenectomized patients were 92% and 77% (p = .09) and 73% and 58% (p = .06), respectively. Furthermore, maintenance therapy with rituximab resulted in a longer duration of response (at 5 years, PFS was 84% for patients receiving maintenance and 36% for patients without maintenance, p <.0001).Conclusions. Rituximab is a very effective and well-tolerated therapy and may be substituted for splenectomy as the first-line treatment of choice for patients with SMZL.
The Oncologist 01/2013; · 3.91 Impact Factor
-
Theodoros P. Vassilakopoulos,
Gerassimos A. Pangalis, Marina P. Siakantaris,
Georgia Levidou,
Xanthi Yiakoumis,
Charalambos Floudas,
Despina Gribabis,
Spyridon Bouros,
Ioannis Metaxas,
Evangelia M. Dimitriadou,
Lambrini Pantazi,
Catherine Tsoukala,
Penelope Korkolopoulou,
Anastasios Andreopoulos,
George Vaiopoulos
[show abstract]
[hide abstract]
ABSTRACT: Kikuchi-Fujimoto disease is a form of reactive lymphadenopathy, which was firstly described in Japan, but is uncommon in the
Western world. We retrospectively reviewed the medical records of nine cases of adult or adolescent Kikuchi’s disease diagnosed
in a single Haematology Unit in Athens, Greece between 1990 and 2006. The median age of the patients was 25years (14–40)
and 8/9 were females. All patients presented with cervical lymphadenopathy sparing the supraclavicular fossa; one had associated
axillary lymphadenopathy, seven had fever and two were asymptomatic. The median duration of lymphadenopathy before presentation
was 30days (10–45). Just palpable splenomegaly was recorded in three patients. The median value of the maximal lymph node
diameter was 2cm (1–5) and only 1/9 had nodes >2cm in their largest diameter. Lymphadenopathy was tender in two patients;
hard nodes were observed in three patients. The median leukocyte count was 4.7×109/l (2.2–4.9) with a normal differential in 7/9 patients. No infectious agent could be demonstrated. One patient had clinical
and laboratory evidence of primary antiphospholipid syndrome (APLS). In conclusion, Kikuchi’s disease represents a rare but
important diagnostic possibility for patients presenting with lymphadenopathy in Greece and other western countries. In this
setting, autoimmune disorders, mainly lupus and APLS, should be considered and excluded by the appropriate laboratory work-up.
KeywordsKikuchi’s disease-Kikuchi-Fujimoto-Lymphadenopathy-Cervical-Antiphospholipid syndrome-Autoimmune disease
Rheumatology International 04/2012; 30(7):925-932. · 1.88 Impact Factor
-
Theodoros P Vassilakopoulos,
Gerassimos A Pangalis,
Andreas Katsigiannis,
Sotirios G Papageorgiou,
Nikos Constantinou,
Evangelos Terpos,
Alexandra Zorbala,
Effimia Vrakidou,
Panagiotis Repoussis,
Christos Poziopoulos, [......],
Evagelia M Dimitriadou, Marina P Siakantaris,
Marie-Christine Kyrtsonis,
John Dervenoulas,
Meletios A Dimopoulos,
John Meletis,
Paraskevi Roussou,
Panayiotis Panayiotidis,
Photis Beris,
Maria K Angelopoulou
[show abstract]
[hide abstract]
ABSTRACT: More aggressive treatment approaches (methotrexate, cytarabine, cyclophosphamide, vincristine, prednisone, and bleomycin [the MACOP-B regimen] or consolidation with high-dose therapy and autologous stem cell transplantation) have been considered to be superior to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in patients with primary mediastinal large B-cell lymphoma (PMLBCL). Rituximab-CHOP (R-CHOP) is the standard of care for diffuse large B-cell lymphoma, whereas efficacy in PMLBCL has not been adequately confirmed.
Seventy-six consecutive PMLBCL patients who received R-CHOP with or without radiotherapy (RT) were compared with 45 consecutive historical controls treated with CHOP with or without RT. Baseline characteristics of the two groups were balanced.
The rate of early treatment failure was much lower with R-CHOP with or without RT (9% versus 30%; p = .004). The 5-year freedom from progression rate after R-CHOP with or without RT was 81%, versus 48% for CHOP with or without RT (p < .0001). The 5-year event-free survival rates were 80% and 47% (p < .0001) and the 5-year overall and lymphoma-specific survival rates were 89% and 69% (p = .003) and 91% and 69% (p = .001), respectively, with only seven of 76 lymphoma-related deaths. Among R-CHOP responders, 52 of 68 received RT.
Based on these results, most patients with PMLBCL appear to be cured by R-CHOP in 21-day cycles with or without RT, which could be the current standard of care. Therefore, the need for more aggressive treatment strategies is questionable unless high-risk patients are adequately defined. Further studies are required to establish the precise role of RT.
The Oncologist 01/2012; 17(2):239-49. · 3.91 Impact Factor
-
Marina P Siakantaris,
Panagiotis Tsirigotis,
Niki Stavroyianni,
Kimon V Argyropoulos,
Konstantinos Girkas,
Vasiliki Pappa,
Spiros Chondropoulos,
Evangelia Papadavid,
Ioanna Sakellari,
Achilles Anagnostopoulos,
Christina Antoniou,
John Dervenoulas
[show abstract]
[hide abstract]
ABSTRACT: Extracorporeal photopheresis (ECP) is an established therapy for cutaneous T-cell lymphoma (CTCL). The objective of this study was to further explore the clinical efficacy of ECP combined with immunomodulatory agents. Eighteen patients with histologically proven CTCL were followed-up after therapy with ECP, mainly combined with interferon-α or bexarotene. A total of 61% of patients responded to therapy (n=11; CR: 5, PR: 6). Median survival was 51 months, progression free survival was 28 months and response duration was 29 ± 23.9 months. ECP combined therapy was highly effective or had a palliative effect in CTCL resistant to previous treatments.
Transfusion and Apheresis Science 12/2011; 46(2):189-93. · 1.25 Impact Factor
-
Sotirios Sachanas,
Gerassimos A Pangalis,
Theodoros P Vassilakopoulos,
Penelope Korkolopoulou,
Flora N Kontopidou,
Maria Athanasoulia,
Xanthi Yiakoumis,
Christina Kalpadakis,
Georgios Georgiou,
Stavroula Masouridis,
Maria Moschogiannis,
Pantelis Tsirkinidis,
Vassiliki Pappis,
Styliani I Kokoris, Marina P Siakantaris,
Panayiotis Panayiotidis,
Maria K Angelopoulou
[show abstract]
[hide abstract]
ABSTRACT: The optimal treatment approach for patients with mantle cell lymphoma (MCL) is not well defined. Intensive therapeutic regimens result in high response rates and prolonged progression-free survival but at the expense of significant toxicity. We report here our results of the administration of rituximab plus chlorambucil (R-Chl) as first line treatment in patients with MCL. Twenty consecutively diagnosed patients were treated with this combination in which an induction and a maintenance arm were included. During induction, rituximab was administered at a dose of 375 mg/m(2) on day 1, while chlorambucil was given afterward at a dose of 10 mg/day for 10 consecutive days for eight cycles and then as a single agent for an additional four cycles. Maintenance consisted of rituximab administration every 2 months for 1 year. Most patients had indolent disease features such as a low mantle-cell international prognostic index (MIPI) score. The overall response rate was 95% (90% CR, 5% PR). Among patients in CR, 78% presented a molecular remission. The 3-year progression-free survival was 89%. There were no serious side effects. These results show that the R-Chl combination could be an effective therapeutic option as first line treatment in MCL, especially for patients with indolent disease characteristics.
Leukemia & lymphoma 03/2011; 52(3):387-93. · 2.40 Impact Factor
-
Christina Kalpadakis,
Gerassimos A Pangalis,
Evangelia Dimitriadou,
Maria K Angelopoulou, Marina P Siakantaris,
Marie-Christine Kyrtsonis,
Maria Ximeris,
Tatiana Tzenou,
Sotirios Sahanas,
Xanthi Yiakoumis,
Eleni A Papadaki,
Panayiotis Panayiotidis,
Theodoros Vassilakopoulos
[show abstract]
[hide abstract]
ABSTRACT: To determine the immunoglobulin variable heavy chain (IgVH) gene usage and somatic mutation patterns in a series of SMZL patients and to correlate these findings with the clinical features and outcome.
IgVH genes were amplified and sequenced from 22 SMZL cases. Clinical and laboratory data of these patients were recorded.
A biased usage of IgVH gene was found with overrepresentation of VH3 in 16/22 cases. A total of 13/22 (59%) of cases were found to have mutated IgVH genes, whereas 9/22 (41%) were unmutated. Positive antigen selection process was identified in two cases. Treatment was different between the cases with mutation and those without. No differences in clinical and laboratory characteristics, or survival were found between the mutated and unmutated cases.
SMZL are characterized by marked molecular heterogeneity. A biased usage of certain sequences suggests antigen selection. Prognostic significance of mutational status was not confirmed in this study. However further studies are needed in order to confirm these results.
Anticancer research 06/2009; 29(5):1811-6. · 1.73 Impact Factor
-
Marina P Siakantaris,
Gerassimos A Pangalis,
Evangelia Dimitriadou,
Flora N Kontopidou,
Theodoros P Vassilakopoulos,
Christina Kalpadakis,
Sotirios Sachanas,
Xanthi Yiakoumis,
Penelope Korkolopoulou,
Marie-Christine Kyrtsonis,
Panayia Bobotsis,
Athina Androulaki,
Eustratios Patsouris,
Panayiotis Panayiotidis,
Maria K Angelopoulou
[show abstract]
[hide abstract]
ABSTRACT: Early-stage gastric mucosa-associated lymphoid tissue lymphoma (GML) is considered a localized disease with an indolent course. Circulating malignant cells have been detected in other early-stage indolent lymphomas by molecular methods. We investigated the incidence of occult blood disease in early-stage GML patients, its impact on clinical outcome, and the similarity between blood and gastric lymphocytic clones. Sixty-two patients with localized GML were included in the study; 51 of them had Helicobacter pylori infection. Monoclonality was investigated by leader polymerase chain reaction. Sequencing was performed for the immunoglobulin variable gene (VH) analysis. Blood involvement was absent in all patients by conventional staging methods. In the whole group of 62 patients, the incidence of blood IgH rearrangement was 45%, and this did not correlate with baseline patient characteristics. The monoclonal blood and gastric products of five patients were sequenced and compared with each other. Clonal identity was evident in four of five patients. The VH3 gene was the most frequently used, both in the blood and in the stomach. Early-stage GML is not a truly localized disease because half the patients had a circulating clone, probably identical to the gastric one. The clinical significance of occult blood disease and the potential appropriate intervention need to be further investigated.
The Oncologist 03/2009; 14(2):148-54. · 3.91 Impact Factor
-
Christina Kalpadakis,
Gerassimos A Pangalis,
Theodoros P Vassilakopoulos,
Maria-Christina Kyrtsonis, Marina P Siakantaris,
Flora N Kontopidou,
Penelope Korkolopoulou,
Panagia Bobotsis,
Sotirios Sahanas,
Tatiana Tzenou,
Dimitra Anagnostou,
Evangelia Dimitriadou,
Xanthi Yiakoumis,
Evangelos Patsouris,
Panagiota Roussou,
Panayiotis Panayiotidis,
Eleni Papadaki,
Maria K Angelopoulou
[show abstract]
[hide abstract]
ABSTRACT: In the present study, we assessed the clinical and pathological data of 76 patients with the diagnosis of non-gastric extranodal marginal zone B-cell lymphoma. The most commonly affected sites were salivary glands, skin, ocular adnexa, lung, intestine and Waldeyer's ring. Ann Arbor stage I disease was present in 39 patients (51%), stage II in 10 (13%) and stage IV in 27 (36%). In 17 cases (21%), the lymphoma presented at multiple mucosal sites. Lymph node and bone marrow involvement were present in 21% and 16%, respectively. Most cases were in the low or low-intermediate risk group. Treatment was heterogeneous and included chlorambucil in 59% either alone or in combination with other agents. Complete and partial remission was achieved in 79% and 7%, respectively, with an overall response rate of 86%. The 5- and 10-year overall survival and cause-specific survival rates were 94%, 82% and 95%, 91%, respectively. The 5- and 10-year progression free survival was 56% and 41%, respectively. The only feature associated with inferior outcome was disease localisation to the lung.
Leukemia & lymphoma 01/2009; 49(12):2308-15. · 2.40 Impact Factor
-
Ipatia A Doussis-Anagnostopoulou,
Theodoros P Vassilakopoulos,
Irini Thymara,
Penelope Korkolopoulou,
Maria K Angelopoulou, Marina P Siakantaris,
Styliani I Kokoris,
Evangelia M Dimitriadou,
Christina Kalpadakis,
Marina Matzouranis,
Loukas Kaklamanis,
Panayiotis Panayiotidis,
Marie-Christine Kyrtsonis,
Athina Androulaki,
Efstratios Patsouris,
Christos Kittas,
Gerassimos A Pangalis
[show abstract]
[hide abstract]
ABSTRACT: To correlate the immunohistochemical expression of topoisomerase IIalpha (topoIIalpha) in Hodgkin's lymphoma (HL) with clinicopathological parameters, the expression of Ki-67 and the outcome of patients, who had been homogenously treated with ABVD or equivalent regimens.
Immunohistochemistry using the monoclonal antibody Ki-S1 (topoIIalpha) was performed in 238 HL patients. MiB1 (Ki-67) expression was evaluated in 211/238.
The mean +/- SD percentage of topoIIalpha- and Ki-67-positive Hodgkin-Reed-Sternberg (HRS) cells was 63 +/- 19% (5%-98%) and 73 +/- 19% (8%-99%), respectively. The median percentage of topoIIalpha-positive HRS cells was 64% (interquartile range, 51-78%). There was no correlation between topoIIalpha expression and patient characteristics. TopoIIalpha and Ki-67 expression were correlated (Spearman's Rho 0.255, P < 0.001). TopoIlalpha expression within the highest quartile of this patient population was predictive of failure free survival (FFS) (10-year rates 82 +/- 3% vs 68 +/- 7%, P = 0.02 for patients falling into the quartiles 1-3 and 4 respectively). In multivariate analysis topoIIalpha expression was independently predictive of FFS.
TopoIIalpha was expressed in all cases of HL showing a correlation with Ki-67 expression. Under current standard therapy including drugs inhibiting its activity, topoIIalpha was an independent adverse predictor of FFS with no statistically significant correlation with other established prognostic factors.
Clinical Cancer Research 03/2008; 14(6):1759-66. · 7.74 Impact Factor
-
Marie-Christine Kyrtsonis,
Theodoros P Vassilakopoulos,
Nicoletta Kafasi,
Sotirios Sachanas,
Tatiana Tzenou,
Argiroula Papadogiannis,
Zacharoula Galanis,
Christina Kalpadakis,
Maria Dimou,
Elias Kyriakou,
Maria K Angelopoulou,
Maria N Dimopoulou, Marina P Siakantaris,
Evangelia M Dimitriadou,
Styliani I Kokoris,
Panayiotis Panayiotidis,
Gerassimos A Pangalis
[show abstract]
[hide abstract]
ABSTRACT: The prognostic value of baseline serum free light chain ratio (sFLCR) was investigated in 94 multiple myeloma (MM) patients. sFLCR was calculated as kappa/lambda or lambda/kappa, depending on the patients' dominating monoclonal light chain. Median baseline sFLCR was 3.57 in kappa-MM patients, 45.09 in lambda-MM. 'High' sFLCR (> or = the observed median value for kappa- and lambda-MM respectively) correlated with elevated serum creatinine and lactate dehydrogenase, extensive marrow infiltration and light chain type MM. The 5-year disease-specific survival was 82% and 30% in patients with sFLCR lower than and equal or greater than the median, respectively (P = 0.0001). sFLCR was an independent prognostic factor.
British Journal of Haematology 05/2007; 137(3):240-3. · 4.94 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Primary cutaneous marginal zone lymphoma (PCMZL) is an indolent disease. Treatment options include excision, local irradiation, interferon-alpha or chemotherapy. We present two patients with PCMZL and multiple skin lesions successfully treated with intralesional administration of the anti-CD20 monoclonal antibody rituximab. The first presented with four red skin lesions and the second with two. Biopsy of the largest lesion revealed marginal zone B-cell lymphoma in both patients. There was no evidence of systemic involvement in either patient. Both patients were treated with intralesional rituximab for 18 consecutive weeks. Skin lesions gradually regressed. Apart from mild local pain during the injection, no other adverse effects were observed. In conclusion, rituximab can be safely administered intralesionally in patients with PCMZL and can produce disease remission.
European Journal Of Haematology 11/2006; 77(4):300-3. · 2.61 Impact Factor
-
Gerassimos A. Pangalis,
Marie-Christine Kyrtsonis,
Theodoros P. Vassilakopoulos,
Maria N. Dimopoulou, Marina P. Siakantaris,
Christos Emmanouilides,
Dimitris Doufexis,
Sotirios Sahanas,
Flora N. Kontopidou,
Christina Kalpadakis,
Maria K. Angelopoulou,
Evangelia M. Dimitriadou,
Styliani I. Kokoris,
Panayiotis Panayiotidis
[show abstract]
[hide abstract]
ABSTRACT: A better understanding of the biology and pathogenesis of hematological malignancies has led to the development of immunotherapeutic and immunoregulatory drugs. Many of these agents have revolutionized the current treatment modalities, while others are under investigation. Rituximab (anti-CD20 antibody) has been established as the gold standard of treatment for aggressive B-cell lymphomas in combination with CHOP and has shown significant activity as monotherapy in the treatment of indolent B-cell lymphomas. In follicular lymphomas the combination of Rituximab with chemotherapy improves the outcome compared to chemotherapy alone. CD 20-based radioimmunotherapy, with the advantage of the bystander effect, represents an additional therapeutic alternative in B-cell lymphomas and may produce tumor regression in Rituximab resistant patients. The anti-CD52 monoclonal antibody, alemtuzumab, further expands the armamentarium against lymphoid malignancies producing high response rates in these entities. Antibody-targeted chemotherapy such as gemtuzumab ozogamicin, consisting of an anti-CD33 antibody combined to calicheamicin, has shown efficacy in the treatment of refractory acute myeloid leukemia; exact indications, timing and dosing schedule for optimized efficacy remain to be determined. Interferons have proven significant activity in cutaneous lymphomas, hairy cell leukemia and chronic myelogenous leukemia by mechanisms that are not fully elucidated. Thalidomide, by acting as an immunomodulatory and antiangiogenic agent can modulate neoplastic cells microenvironment and lead to disease control in multiple myeloma as well as in numerous other hematological malignancies. Bortezomib, a proteasome inhibitor, displays significant anti-tumor activity, especially in multiple myeloma and lymphoproliferative disorders. The addition of these agents in therapeutic regimens has improved considerably the treatment of hematological malignancies.
Current Topics in Medicinal Chemistry 07/2006; 6(16):1657-1686. · 4.17 Impact Factor
-
Gerassimos A Pangalis,
Marie-Christine Kyrtsonis,
Theodoros P Vassilakopoulos,
Maria N Dimopoulou, Marina P Siakantaris,
Christos Emmanouilides,
Dimitris Doufexis,
Sotirios Sahanas,
Flora N Kontopidou,
Christina Kalpadakis,
Maria K Angelopoulou,
Evangelia M Dimitriadou,
Styliani I Kokoris,
Panayiotis Panayiotidis
[show abstract]
[hide abstract]
ABSTRACT: A better understanding of the biology and pathogenesis of hematological malignancies has led to the development of immunotherapeutic and immunoregulatory drugs. Many of these agents have revolutionized the current treatment modalities, while others are under investigation. Rituximab (anti-CD20 antibody) has been established as the gold standard of treatment for aggressive B-cell lymphomas in combination with CHOP and has shown significant activity as monotherapy in the treatment of indolent B-cell lymphomas. In follicular lymphomas the combination of Rituximab with chemotherapy improves the outcome compared to chemotherapy alone. CD 20-based radioimmunotherapy, with the advantage of the bystander effect, represents an additional therapeutic alternative in B-cell lymphomas and may produce tumor regression in Rituximab resistant patients. The anti-CD52 monoclonal antibody, alemtuzumab, further expands the armamentarium against lymphoid malignancies producing high response rates in these entities. Antibody-targeted chemotherapy such as gemtuzumab ozogamicin, consisting of an anti-CD33 antibody combined to calicheamicin, has shown efficacy in the treatment of refractory acute myeloid leukemia; exact indications, timing and dosing schedule for optimized efficacy remain to be determined. Interferons have proven significant activity in cutaneous lymphomas, hairy cell leukemia and chronic myelogenous leukemia by mechanisms that are not fully elucidated. Thalidomide, by acting as an immunomodulatory and antiangiogenic agent can modulate neoplastic cells microenvironment and lead to disease control in multiple myeloma as well as in numerous other hematological malignancies. Bortezomib, a proteasome inhibitor, displays significant anti-tumor activity, especially in multiple myeloma and lymphoproliferative disorders. The addition of these agents in therapeutic regimens has improved considerably the treatment of hematological malignancies.
Current topics in medicinal chemistry 02/2006; 6(16):1657-86. · 4.47 Impact Factor
-
Theodoros P Vassilakopoulos,
Maria K Angelopoulou, Marina P Siakantaris,
Nikos Konstantinou,
Argyrios Symeonidis,
Themistoklis Karmiris,
Panayiotis Repoussis,
Paraskevi Roussou,
Athanassios Meletios Dimopoulos,
Styliani I Kokoris, [......],
Constantinos Tsatalas,
Garyfallia Kokkinis,
Effimia Vrakidou,
Vassiliki Grigoraki,
Christos Poziopoulos,
Marina Stamatellou,
Dimitra Liapis,
George Georgiou,
Panayiotis Panayiotidis,
Gerassimos A Pangalis
[show abstract]
[hide abstract]
ABSTRACT: Pure infradiaphragmatic Hodgkin's lymphoma (HL) is a rare disease. The prognostic impact of a purely infradiaphragmatic localization of this lymphoma is controversial. We aimed to evaluate the baseline clinicopathologic features, prognostic factors and outcome of a large series of consecutive patients with pure infradiaphragmatic HL.
We analyzed 131 patients with clinical stage I/II infradiaphragmatic HL treated with ABVD or equivalent regimens with or without radiotherapy, and compared 54 of them with 444 patients with pure supradiaphragmatic disease, who were treated at the same center.
Older age, clinical stage II (borderline), involvement of > or =3 sites, lymphocyte predominant histology, elevated serum beta2-microglobulin and higher International Prognostic Score were more frequent in patients with infradiaphragmatic disease than in those with supradiaphragmatic disease, while nodular sclerosis was less frequent. The complete remission rate was 100%, 97% and 82% for stages I, IIA and IIB, respectively. Only B-symptoms independently predicted for inferior failure-free survival, while inferior overall survival was independently associated with the involvement of > or =3 sites. At 10 years failure-free survival was 82+/-6% (vs. 85+/-2% for patients with supradiaphragmatic disease, p=0.45), overall survival was 74+/-8% (vs. 91+/-2%, p=0.0006), and disease-specific survival 87+/-5% (vs. 94+/-1%, p=0.04). In multivariate analysis the differences between infradiaphragmatic and supradiaphragmatic disease were obscured by older age and B-symptoms.
Pure infradiaphragmatic HL presents with distinct clinicopathologic characteristics. The previously reported poorer outcome may be explained by the unfavorable profile of the patients rather than the infradiaphragmatic presentation per se. Patients with stage IIB disease should probably be classified as having advanced HL because of the unacceptable rate of primary refractory disease.
Haematologica 01/2006; 91(1):32-9. · 6.42 Impact Factor
-
Gerassimos A Pangalis,
Maria-Christina Kyrtsonis,
Flora N Kontopidou, Marina P Siakantaris,
Maria N Dimopoulou,
Theodoros P Vassilakopoulos,
Tatiana Tzenou,
Styliani Kokoris,
Evangelia Dimitriadou,
Christina Kalpadakis,
Kaliroe Tsalimalma,
Panagiotis Tsaftaridis,
Panagiotis Panayiotidis,
Maria K Angelopoulou
[show abstract]
[hide abstract]
ABSTRACT: Waldenstrom's macroglobulinemia (WM) is characterized by lymphoplasmacytic infiltration of bone marrow and/or other tissues and by the presence of serum monoclonal immunoglobulin M ([IgM], without cutoff limit). Differential diagnosis from other B-cell disorders (BCDs) is usually easy based on clinical, morphologic, histopathologic, immunophenotypic, and genetic features. However, all BCDs potentially produce monoclonal IgM. In this study we reviewed the medical files of 130 patients with IgM-secreting BCDs. Eighty-four patients were diagnosed with WM, 5 with IgM-monoclonal gammopathy of undetermined significance (MGUS), and 41 with other BCDs (9 with B-cell chronic lymphocytic leukemia, 5 with small lymphocytic lymphoma, 14 with marginal zone lymphoma, 5 with mantle-cell lymphoma, 2 with follicular lymphoma, 2 with diffuse large B-cell lymphoma, 2 with cryoglobulinemia, and 2 with low-grade lymphoma not otherwise specified). Median IgM levels were 3215 mg/dL in WM, 840 mg/dL in IgM-MGUS, and 285 mg/dL in other BCDs (5 had IgM levels > 1500 mg/dL). In 10% of non-WM BCDs, monoclonal IgM was found only when more sensitive immunofixation methods were used. Forty-four percent of patients with BCDs (splenic marginal zone lymphoma or small lymphocytic lymphoma) had diagnoses that corresponded to that of WM. Careful diagnosis requires the concomitant evaluation of all parameters of BCDs together. Marginal zone lymphoma is the most frequently overlapping entity. Special attention should be given to mantle cell lymphoma in its atypical forms. Research in this field should continue to further clarify the disease entities that overlap with WM. New technology such as gene-expression profile techniques may contribute to this purpose.
Clinical lymphoma 03/2005; 5(4):235-40. · 3.11 Impact Factor
-
Theodoros P Vassilakopoulos,
Maria K Angelopoulou,
Nikos Constantinou,
Themistoklis Karmiris,
Panayiotis Repoussis,
Paraskevi Roussou, Marina P Siakantaris,
Penelope Korkolopoulou,
Marie-Christine Kyrtsonis,
Styliani I Kokoris, [......],
Nora-Athina Viniou,
Konstantinos Konstantopoulos,
Evangelia M Dimitriadou,
Athina Androulaki,
Efstratios Patsouris,
Ipatia A Doussis-Anagnostopoulou,
Panayiotis Panayiotidis,
Vassiliki A Boussiotis,
Christos Kittas,
Gerassimos A Pangalis
[show abstract]
[hide abstract]
ABSTRACT: We developed a clinical prediction rule for bone marrow involvement (BMI) in Hodgkin lymphoma based on 826 patients and validated it in 654 additional patients. Independent prognostic factors for BMI were x1, B symptoms; x2, stage III/IV prior to bone marrow biopsy; x3, anemia; x4, leukocytes fewer than 6 x 10(9)/L; x5, age 35 years or older; and x6, iliac/inguinal involvement. Each factor was graded as x(i)=1, if present, or x(i)=0, if absent. A simplified score Zs=8x1+6x2+5x3+5x4+3x5+3x6-8 was assigned to each patient. The sensitivity, specificity, and positive and negative predictive value of this prediction rule was 97.8%, 51.5%, 10.6%, and 99.8%, respectively. In the validation group, they were 98.1%, 40.3%, 12.7%, and 99.6%. According to Zs value, 3 risk groups for BMI were defined: low risk (Zs<0, 44% of patients, 0.3% risk), standard risk (Zs, 0-9; 37% of patients; 4.2% risk), and high risk (Zs>or=10, 20% of patients, 25.5% risk). Patients with low risk (stage IA/IIA without anemia and leukopenia; stage IA/IIA, younger than 35 years, with either anemia or leukopenia but no inguinal/iliac involvement; and stage IIIA/IVA without any of these 4 risk factors) do not need bone marrow (BM) biopsy. Patients with standard risk should be staged with unilateral biopsy, but patients with high risk may benefit from bilateral biopsy.
Blood 03/2005; 105(5):1875-80. · 9.90 Impact Factor
-
Theodoros P Vassilakopoulos,
Maria K Angelopoulou, Marina P Siakantaris,
Flora N Kontopidou,
Maria N Dimopoulou,
Styliani I Kokoris,
Marie Christine Kyrtsonis,
Panayiotis Tsaftaridis,
Christos Karkantaris,
Konstantinos Anargyrou,
Dimitrios E Boutsis,
Eleni Variamis,
Thymios Michalopoulos,
Vassiliki A Boussiotis,
Panayiotis Panayiotidis,
Constantinos Papavassiliou,
Gerassimos A Pangalis
[show abstract]
[hide abstract]
ABSTRACT: To present our long-term experience regarding the use of chemotherapy plus low-dose involved-field radiotherapy (IFRT) for clinical Stage I-IIA Hodgkin's lymphoma.
We analyzed the data of 368 patients. Of these, 66 received mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and 302 received doxorubicin (or epirubicin), bleomycin, vinblastine, and dacarbazine [A(E)BVD]. Patients with complete remission or very good partial remission were scheduled for low-dose IFRT (< or =3200 cGy).
The 10-year failure-free survival (FFS) and overall survival (OS) rate was 85% and 86%, respectively. A(E)BVD-treated patients had superior 10-year FFS and OS rates compared with MOPP-treated patients (87% vs. 75%, p = 0.009; and 93% vs. 71%, p = 0.0004, respectively). Only 10 of 41 relapses had any infield (irradiated) component. Of the complete responders/very good partial responders treated with low-dose IFRT, those who received <2800 cGy had inferior FFS but similar OS as those who received 2800-3200 cGy. Adverse prognostic factors for FFS included age > or =45 years, leukocytosis > or =10 x 10(9)/L, and extranodal extension. Secondary acute leukemia developed after MOPP with or without salvage therapy (n = 6) or after ABVD plus salvage therapy (n = 2). None of the nine secondary solid tumors developed within the RT fields.
IFRT at a dose of 2800-3000 cGy is highly effective in clinical Stage I-IIA HL patients who achieved a complete response or very good partial response with A(E)BVD. The long-term toxicity with respect to secondary malignancies appears to be acceptable.
International Journal of Radiation OncologyBiologyPhysics 07/2004; 59(3):765-81. · 4.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Neovascularisation and bone resorption are related to myeloma disease activity.
To investigate the possible prognostic importance of serum syndecan-1, basic fibroblast growth factor (bFGF) and osteoprotegerin (OPG) levels, the relationship between them, with parameters of disease activity and the effect of treatment on their levels.
Twenty-seven patients were studied from diagnosis and an additional five from remission, for a median follow-up of 40 months. Twenty-three patients received chemotherapy plus bisphosphonates and nine only bisphosphonates. Sera from 11 healthy individuals (HI) were used as controls. Cytokines were determined by commercially available enzyme-linked immunosorbent assays (ELISA) kits.
In HI, median syndecan-1 was 40 ng/mL (28-75), bFGF 8 pg/mL (7-30), OPG 35 pg/mL (4-100). Pretreatment median serum syndecan-1 was 177.5 ng/mL (34-3500), bFGF 11.5 pg/mL (8-65) and OPG 100 pg/mL (4-1000). Pretreatment syndecan-1, bFGF and OPG serum levels were increased in patients compared with HI (P = 0.001, 0.03 and 0.01, respectively). Syndecan-1 and bFGF levels were correlated with stage (P = 0.004 and 0.03, respectively). Both syndecan-1 and OPG levels were correlated with beta2M (P = 0.04 and 0.01, respectively). Patients with elevated syndecan-1 and bFGF serum levels had shorter survival than patients with normal levels (P = 0.01 and 0.05, respectively). After chemotherapy syndecan-1 and OPG levels were found to be decreased in responders and syndecan-1 level was reduced in patients receiving bisphosphonates alone.
Pretreatment syndecan-1, bFGF and OPG levels were found to be increased at diagnosis. Syndecan-1 and OPG fluctuated according to MM activity. Elevated serum syndecan-1 and bFGF levels predicted short survival.
European Journal Of Haematology 05/2004; 72(4):252-8. · 2.61 Impact Factor
-
Nephrology Dialysis Transplantation 04/2004; 19(3):733-5. · 3.40 Impact Factor
-
Styliani I Kokoris, Marina P Siakantaris,
Flora N Kontopidou,
Marie-Christine Kyrtsonis,
Athanassios Tsakris,
Nikolaos Spanakis,
Konstantinos Anargyrou,
Theodoros P Vassilakopoulos,
Nora-Athina Viniou,
Penelope Korkolopoulou,
Aglaia D Dimitrakopoulou,
Nikolaos Legakis,
Gerassimos A Pangalis
[show abstract]
[hide abstract]
ABSTRACT: ATLL is etiologically associated with HTLV-I retrovirus. A population of 10 to 20 million worldwide is estimated to be infected by the virus, but only 1-4% develop ATLL during a 70-year lifespan. The latency period is more than 30 years. The aim of this study was to report two cases of ATLL in Greek patients with the concomitant study of their family members. A 55-year-old woman and a 59-year-old man presented with leucocytosis and lymphocytosis. Both were asymptomatic and physical examination was unremarkable except for minimal lymphadenopathy in the second patient. In both patients blood smears showed small-to-medium-sized, multilobulated lymphocytes, with different degrees of nuclear irregularity. Immunophenotypic study was as follows: CD2 + (97%), CD3 + (95%), CD5 + (95%), CD3/CD4 + (93%), CD3/CD25 + (84%), CD7 -/CD4 + (89%) CD2 + /HLA-DR + (53%), TCRabeta + (96%) and CD7-(7%). Bone marrow biopsy revealed a normal cellularity with dyserythropoiesis and scattered small lymphocytes (CD4 + on immunostaining) Serum HTLV I and II antibodies were positive. T-cell receptor gamma-chain rearrangement was positive in blood lymphocytes by PCR. Cytogenetic analysis showed complex karyotypic abnormalities. DNA analysis by PCR demonstrated the integration of the HTLV-I DNA in the DNA of the neoplastic T cells. Both patients rapidly developed acute type ATLL. In the first patient multiple subcutaneous nodules on the palmar surface of both hands were also observed. She received deoxycoformycin, which was stopped because of autoimmune hemolytic anemia. Corticosteroid treatment was initiated, with gradual improvement. She suffered from recurrent opportunistic infections. She is currently under interferon and zidovudine therapy with stable blood parameters. Chemotherapy was administered to the other patient with > 50% initial response. Both patients' families were tested for serum anti HTLV-I antibodies and their mates were found to be positive; they also had detectable viral DNA by PCR analysis while asymptomatic, with no abnormal clinical findings and normal white blood cell count and morphology. In conclusion, the two aforementioned patients are the first fully documented ATLL patients described in Greece. Investigation for HTLV-I antibodies should be mandatory in all patients with T-cell lymphoproliferative disorders.
Leukemia and Lymphoma 04/2004; 45(4):715-21. · 2.58 Impact Factor
