Purpose: The combination of chemotherapy with the chimeric anti-CD20 antibody Rituximab has been reported to be highly active in the treatment of follicular lymphoma. The frequency and dosage of rituximab required to induce the maximum effect in follicular NHL is not defined. To evaluate how often rituximab should be added to standard chemotherapy to achieve maximum remission rates, we have initiated a prospective randomized multicenter phase II study.

In a prospective multicenter trial the efficiency of the response-adapted COP-BLAM/IMVP-16 protocol to induce complete remissions (CR) in high-grade malignant non-Hodgkin's lymphomas as well as the prognostic relevance of adjuvant radiotherapy were investigated. From 1986-1989, 548 patients (median age 56 years) with stage II-IV (Ann Arbor) disease were treated with five cycles of COP-BLAM followed by two cycles of IMVP-16. If only a partial remission was obtained at the time of first restaging (RS) after three cycles (delayed response), treatment was switched to IMVP-16 (two to five courses) immediately. Patients achieving CR by the second RS after chemotherapy were randomized to adjuvant radiotherapy or observation. Responses to chemotherapy were 63% CR in patients completing the second RS (N = 350) or 72% if patients achieving late CR by consolidating radiotherapy are added; responses were 58% or 65% if all deaths prior to the second RS are included (N = 50). Overall and relapse-free survival were 71% and 68% at one year and 63% and 61% at two years. Multivariate risk factor analysis proved the early (by first RS) CR response to possess predominant prognostic relevance for survival. A significant advantage of adjuvant radiotherapy over no further treatment for duration of CR is not yet discernible. These results emphasize the importance of a rapidly achieved CR, thus contributing to the design of future trials.

Fallgeschichte einer Patientin, die in der 28. Schwangerschaftswoche ihrer ersten Graviditat die Klinik einer Praeklampsie entwickelte. Innerhalb eines Tages trat eine schwere Hamolyse und eine diffuse Gerinnungsstorung auf, so das eine Notfall-Sectio durchgefuhrt wurde. Im weiteren Verlauf wurde eine kontrollierte Beatmung wegen einer diffusen streifigen Verdichtung der Lunge notwendig. Die Laborwerte waren beweisend fur eine thrombotisch-thrombozytopenische Purpura (Moschcowitz-Syndrom), so das eine Plasmaaustauschtherapie 7 Tage lang durchgefuhrt wurde: Diese Therapie fuhrte zu einer schnellen und vollstandigen Heilung und zur Normalisierung der Laborwerte. Die Fallgeschichte wird anhand der betreffenden Literatur und der speziellen Perspektive einer pathophysiologischen Identitat zwischen den zwei Syndromen HELLP (hemolysis, elevated liver enzymes, low platelets) und Moschcowitz-Syndrom (Thrombotische thrombozytopenische Purpura) diskutiert; dieser Aspekt erscheint von speziellem Interesse wegen der adaquaten Plasmaaustauschtherapie. Case history of a patient is reported who developed signs of preeclampsia in 28th week of her first gravidity. Within one day severe haemolysis and diffuse haemorrhage occurred and an emergency section was performed. Subsequently, supported respiration became necessary because of diffuse infiltrations of the lung. Laboratory data then were conclusive for a thrombotic thrombocytopenic purpura (Mosehcowitz's disease) and therefore the patient was subjected to plasma exchange during seven days: this measure induced rapid and full clinical and laboratory remission. The case history is discussed on the background of the pertinent literature and the special perspective of a pathophysiological identity between the two syndromes: HELLP (haemolysis, elevated liver enzymes, low platelets) and Moschcowitz's disease (thrombotic thrombocytopenic purpura); this seems to be of special interest for an adequate therapy by plasma exchange.

Case history of a patient is reported who developed signs of preeclampsia in 28th week of her first gravidity. Within one day severe haemolysis and diffuse haemorrhage occurred and an emergency section was performed. Subsequently, supported respiration became necessary because of diffuse infiltrations of the lung. Laboratory data then were conclusive for a thrombotic thrombocytopenic purpura (Moschcowitz's disease) and therefore the patient was subjected to plasma exchange during seven days: this measure induced rapid and full clinical and laboratory remission. The case history is discussed on the background of the pertinent literature and the special perspective of a pathophysiological identity between the two syndromes: HELLP (haemolysis, elevated liver enzymes, low platelets) and Moschcowitz's disease (thrombotic thrombocytopenic purpura); this seems to be of special interest for an adequate therapy by plasma exchange.

Within a multicentre observation study on non-Hodgkin lymphomas (NHL) diagnosed according to the Kiel classification advanced stages III and IV of centrocytic (CC) lymphoma exhibited the worst prognosis among lymphomas of low-grade malignancy with a 5-year survival probability of less than 10 per cent. Treatment had been solely expectative and palliative with treatment results showing a prognostic superiority of patients achieving partial and complete remissions over non-responders. Therefore, a randomized multicentre study was initiated to compare the remission-inducing potential of the COP regimen (Bagley et al., 1972) with that of the more intensive adriamycin-containing CHOP regimen (McKelvey et al., 1976). From 91 newly diagnosed CC lymphomas 63 fulfilled randomization criteria with 37 patients assigned to the COP regimen and 26 patients to the CHOP regimen. Between the COP- and CHOP-treated patients no significant differences could be demonstrated with respect to initial clinical parameters, rate of complete (41 per cent versus 58 per cent) or partial remissions (43 per cent versus 31 per cent), median overall survival probability (32 versus 37 months), relapse-free survival (10 versus 7 months) and rates of relapse (73 per cent versus 67 per cent) and death (57 per cent versus 50 per cent). It can be concluded that CC lymphoma is a typical lymphoma of low-grade malignancy with its inability to reach stable remissions while the demonstration of identical survival probabilities for patients with complete and partial remissions constitutes a unique feature of this lymphoma entity. These observations prove advanced CC lymphoma to represent an incurable neoplastic disease under conventional therapeutic approaches.

Im Rahmen einer multizentrischen prospektiven randomisierten Studie zur Behandlung von Non-Hodgkin-Lymphomen (NHL) hoher Malignität (Kiel-Klassifikation) der Stadien II-IV (Ann-Arbor-Klassifikation) wurde eine sequentielle Kombination der COP-BLAM(5 Zyklen)- und IMVP-16(2 Zyklen)-Schemata eingesetzt. Der Therapieerfolg wurde durch erstes Restaging bereits nach 2–3 Zyklen über-prüft, um in einer risikoadaptierten Strategic bei inadäquatem Ansprechen die Therapie sofort auf das IMVP-16-Schema umsetzen zu können. Ziel der Studie ist die Evalierung dieses Konzeptes bezüglich der Vollremissionsrate und -dauer. Zusätzlich wird im randomisierten Vergleich nach Erreichen einer Vollremission (2. Restaging) die prognostische Relevanz einer adjuvanten Radiotherapie überprüft. Von 191 für die Studie qualifizierten Patienten sind bislang rund 80% auswertbar. Danach erreichten nach 3 Therapiezyklen 76/148 (51%), bis zum 2. Restaging 52/85 (61%) der Patienten eine Vollremission. Die Toxizität dieser Polychemotherapie erreichte nur jeweils in wenigen Fallen die WHO-Schweregrade 3–4, wobei es sich um Affektionen des Gastrointestinaltraktes, Infektionen, Sepsis, Myelotoxizität und Stomatitiden handelte. Bislang verstarben 29 Patienten, 4 Patienten in Vollremission an Therapiekomplikationen, 22/29 (76%) in Progression, 3 Patienten an anderen Ursachen.