ABSTRACT
Background and Objective: Central nervous system [CNS] relapse of diffuse large B cell lymphoma [DLBCL] is relatively uncommon and nearly fatal. Two years CNS relapse risk is 0.8% in low, 3.9% in intermediate and 12 % in high risk patients. Our aim was to study, the baseline characteristics and outcome in term of median survival of DLBCL patients with CNS relapse
Methods: This is a retrospective analysis. All patients of DLBCL with CNS relapse from 2006 to 2014 were included. Data were collected from computerized Hospital Information System and analyzed for characteristics and median survival
Results: Out of twenty one patients included in the study, 14[66.3%] males and 7[33.7%] were females. On initial diagnosis of DLBCL, median age was 37.4 years [27-47]. Ann Arbor stage of I-IV was in 3 [14.3%], 2[9.5%], 4[19%] and 12[57.1%] patients, respectively. Extra-nodal involvement was noted in 16[76.2%], high LDH in 18[85.7%], bone marrow involvement in 8[38.1%] and bulky disease in 5[23.8%] patients. International Prognostic Index [IPI] score was 1 in 4[19%], 2 in 9[42.9%], 3 in 8[38.1%] patients. Extra-nodal sites were gut in 2[9.1%] while 1[4.5%] patient of each of following organs involvement was seen: cervix, gluteal muscle, iliac bone, liver, ovaries, pancreas, parotid gland and testes. Chemotherapy CHOP was given to 16[76.2%] and RCHOP in 5[23.8%] patients. Prophylactic intrathecal methotrexate was given to 10[47.6%] patients. Complete response was in 10 [47.6%], partial response was in 3 [14.3%] and disease progression was in 8 [38.1%] patients. CNS relapse occurred in 17 [81%] patients within six months after completion of therapy. CNS relapse along with systemic disease was in 14[66.6%] patients. Isolated CNS relapse was noted in 7[33.3%] patients. Second line chemotherapy regimens were HDMTX 5[23.8%], HDMTX/ TRIO IT 3[14.2%], HDMTX/HDAC 2[9.5%], HCVAD 3[14.2%], ICE 4[19.4%], DHAP 1[4.7%], ICE/HDMTX 1[4.7%], none 2[9.5%]. Overall median survival of CNS relapsed patients was 54 days
Conclusion: Patients with DLBCL who had advanced stage, high LDH and extra-nodal involvement at initial presentation are at high risk for CNS relapse. About half of the patients had CNS relapse despite primary CNS prophylaxis. Once relapsed in CNS, these patients have very poor prognosis
ABSTRACT
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