Modified outpatient dexamethazone, cytarabine and cisplatin regimen may lead to high response rates and low toxicity in Lymphoma

Objective: Our purpose was to investigate the efficacy of and establish a toxicity profile for a modified regimen of dexamethasone, cytarabine and cisplatin (DHAP) for lymphoma outpatients. Subjects and Methods: Fifty-one lymphoma patients, 26 with Hodgkin's disease and 25 with non-Hodgkin's lymphoma, were included. The patients' median age was 32 years (range: 17-61). Twenty had progressive/refractory disease and 31 relapsed disease. Twenty-five were in clinical stage I/II and 26 in clinical stage III/IV before the initiation of salvage chemotherapy. DHAP consisted of dexamethasone (40 mg i.v. on days 1-4), cytarabine (2 g/m(2) i.v. as 3-hour infusion on days 2 in the evening and 3 in the morning) and cisplatin (35 mg/m(2) as 2-hour infusion on days 1-3) were administered every 21 days. A total of 154 cycles of modified DHAP were administered, with a median of 3 cycles per patient (range: 2-4). Results: The main toxicity was myelosuppression. WHO grade III-IV neutropenia and grade III-IV thrombocytopenia were observed in 27 (52.9%) and 21 (41%) patients, respectively. The overall response rate (85% for Hodgkin's disease and 95% for non-Hodgkin's lymphoma) was 88.3% (39.2% complete response and 49.1% partial response). Conclusion: The results showed that this outpatient schedule of DHAP was well tolerated and an effective salvage regimen

A case of advanced scalp angiosarcoma successfully treated with combination chemotherapy of adriamycin, cisplatin and ifosfamide

Scalp angiosarcoma is a rare and highly malignant tumour originating from endothelial cells of vessels and occurring predominantly in elderly men. Its prognosis is poor and the 5-year survival rate of patients is reported to be 12–33% [1]. Complete surgical excision with wide margins remains the cornerstone of therapy for localised tumours. Additional radiotherapy may provide improved local control. Given the rarity of this tumour, an optimum chemotherapy regimen has not yet been defined for metastatic cases. Here we report a case of scalp angiosarcoma with local recurrence and distant metastases which was successfully treated with a combination chemotherapy consisting of adriamycin, cisplatin, ifosfamide and mesna (APIM). A 24-year-old man presented to a plastic surgeon in January 2005 with a painless nodule on the scalp measuring 3 cm in diameter. Surgical total excision of the nodule was carried out, providing a negative surgical margin (2 cm). The diagnosis of angiosarcoma was confirmed pathologically. An X-ray of the scull, magnetic resonance imaging of the brain and computed tomography of the neck, thorax and abdomen revealed no evidence of local or distant metastases at the time of diagnosis. The patient was not given any adjuvant therapy. Five months after the surgery, the patient developed two new angiosarcoma lesions (1.5 and 2 cm in diameter) on different sites of the scalp. In addition, computed tomography of the neck and chest revealed conglomerate lymph nodes on the left side of the neck and five small metastatic nodules, up to 1.5 cm greatest dimension in bilateral lung fields

A Case with POEMS Syndrome Presenting with Loss of Vision and Skeletal Muscle Strength

POEMS syndrome (osteosclerotic myeloma) is a plasma-cell proliferative disorder and a combination of several organ system manifestations. The term POEMS is an acronym for polyneuropathy, organomegaly, endocrinopathy, monoclonal proteinemia and skin changes. Although the diagnostic criteria have been modified in time to cover those findings that are seen more frequently but are less specific to make a certain decision, the rare nature of the disease may also be associated with the fact that many patients present with symptoms or signs which are thought to be related to certain organ systems. Here we present a case of POEMS syndrome with almost complete visual loss, dyspnea and loss of sceletal muscle strength and their significant recovery after treatmen