Outcomes of first line chemotherapy in patients with chronic lymphocytic leukemia

Objective: Chronic lymphocytic leukemia [CLL] is a heterogeneous disease in terms of survival with and without treatment. Many chemo and immunotherapeutic agents are available to treat this indolent disease. Aim of this study was to determine the outcomes of patients with chronic lymphocytic leukemia treated with different available chemotherapeutic regimens

Methods:All patients with diagnosis of CLL from 2008 to 2013 were included. Data were collected from hospital information system. Objective response rate [ORR] in terms of complete or partial response [CR, PR], stable or progressive disease [SD, PD], overall survival [OS], and progression free survival [PFS] were calculated

Results:Fifty seven patients were included; 42 [74%] male and 15 [26%] were female. Patients with Binet stage A 10 [18%]; B 20 [35%] and C were 27[47%]. Median age was 50.9 years. Forty six [80%] were treated and 11[20%] remained on watch and wait. Treatment indications were B symptoms 14 [30%], symptomatic nodal disease 18[39%], thrombocytopenia 4[9%], anemia 7[15%] and doubling of lymphocyte count 3 [7%]. Chemotherapy regimens used were FC in 38 [83%], FCR 5[11%], chlorambucil 2[4%] and CVP in 1[2%] patient. Twenty two [56%] patients had CR, 13[33%] PR, 3[7.6 %] SD, and 1[2.5%] had PD. ORR was 89%. Median PFS was 23.1 months and median 3 years OS was 55%

Conclusion:Majority of patients was in a relatively younger age group and presented with advanced stage disease requiring treatment. Small number of patients received rituximab due to cost. PFS and OS are comparable with published literature

Chemotherapy alone or combined chemotherapy and involved field radiotherapy in favorable risk early-stage classical Hodgkin lymphoma - a 10 years experience

Objective: To determine the outcome of patients with early-stage [stage I-II] favorable risk classical Hodgkin lymphoma treated with chemotherapy alone or combined modality treatment [CMT] utilizing chemotherapy and involved field radiotherapy

Methods: This retrospective study was done at Department of Medical oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan from January 2004 to December 2013

Results: There were 101 patients, with male predominance [71.3%]. Mean age was 34 years. Sixty three [62.4%] patients received CMT and 38 [37.6%] patients had chemotherapy alone. Ninety eight percent patients had ABVD chemotherapy. Dose of radiotherapy ranged from 20 to 36 gray. Difference between baseline characteristics and major toxicities among the two groups was insignificant. Patients treated with CMT had better overall survival compared to chemotherapy alone: 100% versus 91% at five years and 96% versus 81% at 10 years, respectively [p=0.03]. Progression free survival was also better with CMT against chemotherapy alone at five years [98% versus 81%] and 10 years [82% versus 71%] [p=0.01]

Conclusion: Favorable risk classical Hodgkin lymphoma patients had better overall survival and progression free survival when treated with CMT against chemotherapy alone

Clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital

Objective: To determine the clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital

Methods: This was a cross-sectional study conducted on 200 patients undergoing first line chemotherapy with minimum of two cycles at inpatient department and chemotherapy bay of Shaukat Khanum Memorial Cancer Hospital and Research Centre Pakistan. Anticipatory nausea and vomiting develops before administration of chemotherapy. Clinical signs and symptoms in patients with or without anticipatory emesis were compared using chi square test statistics

Results: The mean age of the study participants was 36.68 years [SD +/- 12.23]. The mean numbers of chemotherapy cycles administered were 3.23 [SD +/- 1.2]. Chemotherapy related nausea and vomiting was experienced by 188 [94%] patients and anticipatory nausea vomiting was reported in 90 [45%] of patients. Greater proportions of patients with anticipatory emesis were females. Fourteen [15.5%] p-value=0.031 patients with anticipatory emesis had history of anxiety and depression. Fifty nine [65.5%] p-value =< 0.0001 patients with anticipatory emesis had severe nausea after last chemotherapy cycle. Forty six [51.11%] p=<0.0001 patients had motion sickness

Conclusion: Female gender, history of motion sickness, anxiety and depression, severe nausea and vomiting experienced in pervious cycle of chemotherapy were clinical predictors of anticipatory nausea and vomiting