Epstein-Barr virus and Hodgkin lymphoma in Jordan

Background and objectives: This study aims to examine the possible association of Epstein-Barr virus [EBV] in Classical Hodgkin lymphoma [cHL] and to shed light on the epidemiology of Hodgkin lymphoma [HL] in Jordan

Patients and Methods: We examined 100 consecutive cases of HL for the presence of EBV in tumor cells by immunohistochemistry for latent membrane protein-1 [LMP-1]. We collected patient data on age, sex and histologic subtype. We reviewed the pathological findings in each case and confirmed diagnosis

Results: Nodular lymphocyte predominant HL was diagnosed in 6% of the cases and these were negative for EBV LMP-1. Of the 94 cases of cHL, 65% were males, the most common subtype was nodular sclerosis [NS], representing 70% of the cases, and 45.7% of cHL [43% of all HL] cases were positive for EBV LMP-1. The positive cases were significantly related to age: 51 years [p: 0.009 and 0.014 respectively], male gender [p: 0.03] and mixed cellularity [MC] subtype [p: <0.0001]. In line with other developing countries, there also appears to be a trend towards a decreasing association of EBV with cHL and a subtype switch from MC to NS in Jordan

Conclusion: The epidemiology of HL in Jordan and some developing countries is approaching that of developed countries

challenges of managing glioblastoma multiforme in developing countries: a between cost and quality of care

The management of glioblastoma multiforme [GBM] in developing countries is hindered by the paucity of clear protocols due in part to growing economic constraints and the lack of availability of expensive chemotherapeutic agents. We evaluated the deliverable treatment protocols and achievable outcomes for patients with GBM in a low-income country prior and subsequent to the worldwide adoption of temozolomide. Retrospective case series. Charts of consecutive patients with a pathologic diagnosis of high-grade glioma diagnosed between January 2003 and December 2008 were retrospectively reviewed. We identified 146 adult patients, including 105 males and 41 females between 19 and 81 years of age [median age, 51 years], with histologically confirmed high-grade glioma. All patients underwent craniotomy. Eighty-two patients were treated with radiotherapy and temozolomide, of whom 42 patients received temozolomide concurrent with radiation followed by adjuvant temozolomide; 40 patients received irradiation followed sequentially by 6 cycles of temozolomide. In 40 patients irradiation was utilized as a single modality treatment adjuvant to surgery. The follow-up ranged from 1 to 56 months [median, 9.4 months]. The median survival for the whole cohort was 10.2 months. The median survival for the radiotherapy-alone group was 5.3 months and for combined radiotherapy/temozolomide was 14.8 months. Survival was similar in both concurrent and sequential groups. Temozolomide conferred a statistically significant survival benefit of 9 months compared with standard therapeutic modalities. The results compare favorably to those reported in developed nations. Current management of GBM in developing countries should include maximal surgical resection followed by radiotherapy/temozolomide whenever medically and/or financially feasible. Outcomes comparable to those obtained within the context of randomized trials can be expected in low-income settings if healthcare delivery is carefully planned. Our results indicate that concurrent and sequential regimens are equally effective in these patients

Eight primary malignancies: case report and review of literature

The incidence of multiple primary malignancies has increased over the past years secondary to the long-term survival of cancer patients due to improvements in the early detection and adequate treatment of cancer. We present a patient with eight primary malignant tumors and review the relevant literature. Our patient was a 59-year-old female with Crohn disease with an otherwise non-contributory medical history. Risk factors for multiple primary tumors were not detected in our patient. At a follow-up of 108 months from the time of diagnosis of the first malignancy, our patient was still alive. Similar long-term survival has been reported in the literature. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients