R-CHOP and consolidation radiotherapy for limited-stage and low-IPI high-grade b-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements: A single-center case series and review of literature

@#High-Grade B-Cell Lymphoma (HGBCL) with gene rearrangements in MYC and BCL2 and/or BCL6 is an aggressive malignancy usually presenting in advanced stages. Current recommendations suggest the use of regimens more intensive than R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone), which are based on retrospective studies and single-arm prospective trials that included patients who are mostly in the advanced stage, and did not receive consolidation radiotherapy. The optimal approach and treatment of HGBCL, whether limited-stage (LS) or advanced-stage, remains to be determined. Here we describe the promising outcomes of three patients with LS and low IPI HGBCL with the use of R-CHOP as induction chemotherapy regimen, which was followed by consolidation radiotherapy. Three women, 54-, 60-, and 64-years of age diagnosed to have HGBCL with MYC, and BCL2 and/or BCL6 rearrangements, with Ann Arbor stages I-IIE were included in this case series. All three patients had complete metabolic response to 6 cycles of R-CHOP and was subsequently treated with consolidation involved site radiotherapy (ISRT; total dose 30-36 Gy). Chemotherapy and radiotherapy were tolerated very well. All patients remain to be in remission, with the longest being at 23 months. Outcomes of patients with HGBCL generally remain to be poor, but this may not be the case for patients with limited-stage disease and favorable clinicopathologic risk profile. Nevertheless, the treatment of HGBCL is currently evolving and more studies are needed to determine the ideal approach and preferred chemotherapy regimen. Also, more studies are needed to elucidate the potential role of consolidation radiotherapy in patients with limited-stage HGBCL to improve survival outcomes. Findings of this case series suggest that patients with LS HGBCL may still derive benefit from R-CHOP followed by consolidation ISRT, but prospective trials are needed to confirm this.

Effects of interpregnancy interval and outcome of preceding pregnancy on present pregnancy outcome

Background: The objective of the present study was to estimate the effects of interpregnancy interval and outcome of preceding pregnancy on present pregnancy outcome.Methods: This study was undertaken as observational study. 1000 women were included in this study then interpregnancy interval categorized in 4 groups. Outcome of preceding pregnancy were included in term of induce abortion, miscarriage, still birth and live birth.Results: For each group the highest rate of IA occur for woman whose previous pregnancy ended with an IA. For pregnancy after an IA the rate of subsequent IA is 16.6%, 11.6%, 5% for IPI of <6 month, 6-14 months and 27-50 months respectively. Overall lowest rate of IA found for IPI of 27-50 months following live birth i.e. 1.25% and for group III 2% only. Rate of miscarriage was higher for IPI of <26 months began with a miscarriage 15.6% and 13.6% for following live birth.Conclusions: Outcome of present pregnancy not only depend upon interpregnancy interval but also depend upon outcome of preceding pregnancy. So, outcome of previous pregnancy will also determine outcome of present pregnancy.

Expression of CD30 and its correlation with prognosis of patients with peripheral T cell lymphoma, unspecified / 中国肿瘤临床

Objective: The expression of CD30 in peripheral lymphoma T cell lymphoma,unspecified (PTCL-U) was analyzed, and the correlations between CD30 and clinical survival and prognosis were studied. Methods: The clinical and pathological indicators of 56 patients with PTCL-U, who were newly treated in The First Affiliated Hospital of Zhengzhou University from January 2013 to December 2017, were obtained. Among the 56 patients, the male to female ratio was 1.7∶1. The median age was 60 (16?76) years. The categorical variables were analyzed by the Chi-square test. Kaplan-Meier method was used for the survival analysis along with an assessment of the differences by Log-rank test. Logistic univariate analysis and Cox multivariate regression model analysis were used to analyze the indicators affecting survival. Results: The 3-year and 5-year overall survival (OS) rates of 56 patients were 42.2% and 20.4%, respectively, and the progression-free survival (PFS) rates were 32.1% and 17.8%, respectively. The median overall survival (median-OS, mOS) was 31 months, and the median progression-free survival (median-PFS, mPFS) was 11 months. The positive expression rate of CD30 in PTCL-U patients was 35.7%. The positive expression of CD30 was more common in advanced patients. The LDH level was increased, and the number of extra-nodal lesions was≥2 in the middle-high risk patients. Further, the initial treatment effects in the positive patients were not good (P<0.05). Among the 56 patients, CHOP regimen and GDPT regimen were adopted for chemotherapy, and the two regimens showed no statistically significant effects on OS and PFS (P>0.05). The survivals in the CD30 positive and negative groups were as follows: the 3 years-OS were 16.5% and 54.9%, respectively (P=0.001); and the 3-years PFS were 11.2% and 44.5%, respectively (P=0.016). The univariate analysis showed that advanced disease, CD30-positivity, IPI/aaIPI-high risk, and PIT-high risk (P>0.05) were adverse prognostic factors. The multivariate analysis showed that staging and PIT were correlated with survival. Conclusions: The expression of CD30 in PTCL-U was low, and the prognosis of the positive-expression group was poor. The positive expression was more associated with advanced disease, high level of LDH, and medium-high risk group. The positive group was more prone to extranodal involvement and the objective remission rate was lower. Staging, CD30, IPI/aaIPI, and PIT could affect the prognosis in these patients.

Role of Immune Microenvironmental Factors for Improving the IPI-related Risk Stratification of Aggressive B Cell Lymphoma / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the risk stratification of aggressive B cell lymphoma using the immune microenvironment and clinical factors.</p><p><b>METHODS</b>A total of 127 patients with aggressive B cell lymphoma between 2014 and 2015 were enrolled in this study. CD4, Foxp3, CD8, CD68, CD163, PD-1, and PD-L1 expression levels were evaluated in paraffin-embedded lymphoma tissues to identify their roles in the risk stratification. Eleven factors were identified for further evaluation using analysis of variance, chi-square, and multinomial logistic regression analysis.</p><p><b>RESULTS</b>Significant differences in 11 factors (age, Ann Arbor stage, B symptom, ECOG performance status, infiltrating CD8+ T cells, PD-L1 expression, absolute blood monocyte count, serum lactate dehydrogenase, serum iron, serum albumin, and serum β2-microglobulin) were observed among patient groups stratified by at least two risk stratification methods [International Prognostic Index (IPI), revised IPI, and NCCN-IPI models] (P < 0.05). Concordance rates were high (81.4%-100.0%) when these factors were used for the risk stratification. No difference in the risk stratification results was observed with or without the Ann Arbor stage data.</p><p><b>CONCLUSION</b>We developed a convenient and inexpensive tool for use in risk stratification of aggressive B cell lymphomas, although further studies on the role of immune microenvironmental factors are needed.</p>

Relevance of prognostic index with β2-microglobulin for patients with diffuse large B-cell lymphoma in the rituximab era

BACKGROUND: The International Prognostic Index (IPI) has been a useful tool for predicting the prognosis of aggressive non-Hodgkin lymphoma in the last 20 years. Herein, we aimed to develop a new prognostic model for diffuse large B-cell lymphoma (DLBCL) in the rituximab era. METHODS: Between March 2004 and June 2012, patients with DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy regimen were identified in the database of the Asan Medical Center (AMC) Lymphoma Registry. The primary and secondary endpoints were a new prognostic index for DLBCL and validation of the National Comprehensive Cancer Network-International Prognostic Index in our cohort, respectively. RESULTS: The AMC cohort comprised 621 patients. The median follow-up duration was 43.3 months (range, 6.2–122.5 mo). Univariate analysis revealed that age (≤60 vs. >60 yr), lactate dehydrogenase (LDH; within normal vs. increased), Eastern Cooperative Oncology Group performance status (ECOG PS; 0 or 1 vs. ≥2), advanced stage (Ann Arbor stage I/II vs. III/IV), extra-nodal involvement (≤1 vs. >1), B symptoms (no vs. yes), and beta-2 microglobulin (β2MG, ≤2.5 vs. >2.5) can be used to predict overall survival (OS). In multivariate analysis, only age, LDH, ECOG performance status, and β2MG were significantly associated with OS, and we developed a new prognostic model with these 4 factors. The new prognostic model showed better discriminative power compared with the classic IPI. CONCLUSION: Our new prognostic index model for DLBCL in the rituximab era has good discriminative power and is convenient to use.

Maximum standardized uptake value on positron emission tomography/computed tomography predicts clinical outcome in patients with relapsed or refractory diffuse large B-cell lymphoma

BACKGROUND: Few clinical studies have clarified the prognostic factors that affect clinical outcomes for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) after immunochemotherapy. METHODS: A total of 158 patients with relapsed or refractory DLBCL were enrolled. All patients underwent positron emission tomography/computed tomography (PET/CT) before and after salvage therapy. All enrolled patients previously received the ifosfamide, carboplatin, and etoposide regimen. Clinical outcomes were compared according to several factors (age > or = 65 years, low age-adjusted International Prognostic Index [aa-IPI], maximum standardized uptake value [SUVmax] or =12 months, complete response after salvage therapy). A low aa-IPI, SUVmax or = 12 months were independent prognostic factors for survival. RESULTS: In univariate analysis and multivariate analysis, SUVmax below 6.0 (P<0.001 for progression-free survival (PFS), P<0.001 for overall survival (OS)) and low aa-IPI (P<0.001 for PFS, P<0.001 for OS) were independent prognostic factors associated with favorable outcome. CONCLUSION: The aa-IPI and initial SUVmax were powerful prognostic factors in patients with relapsed or refractory DLBCL.

Linfomas asociados a infección por VIH en pacientes del Hospital Clínico San Borja Arriarán / Fundación Arriarán2001-2008 / Lymphomas associated with HIV infection in patients at the Hospital San Borja Arriarán /Fundación Arriarán 2001-2008, Santiago, Chile

Introduction: Hodgkin lymphomas (HL) and non Hodgkin lymphomas (NHL) are frequently associated to acquired immunodeficiency syndrome in adults. Objective: To systematize the clinical features and histological characteristics of lymphomas in AIDS patients, its treatment and outcomes in our institution. Patients and Methods: Retrospective analysis of patients with HIV-associated lymphoma between January 2001 and December 2008 at the San Borja Arriarán Hospital complex. Results: Information was obtained from 30 patients with NHL and 7 with HL, with a median of 40 years. The majority of tumors were Burkitt lymphoma (47%), diffuse large cell lymphoma B-cell (37%) and NHL of T lineage (10%). There was no CNS or cavities lymphoma. Almost all patients (86.7%) with NHL were treated with CHOP chemotherapy, 57% of those receiving treatment had progression or relapse from complete remission. A rescue chemotherapy was indicated in 4 patients. 73% of patients receiving CHOP, complete 5 to 6 cycles of chemotherapy. The use of CHOP chemotherapy for the subgroup of patients with Burkitt lymphoma achieved low rates of complete remission and frequent relapse and disease progression, showing that CHOP was ineffective in improving survival, especially in high risk patients. We found statistically significant differences in survival according to IPIae (International prognostic Index age-adjusted). Conclusion: Non-Hodgkin lymphoma in HIV patients treated with chemotherapy protocols PAlNDA persists in our environment as a disease with a poor prognosis compared with findings in the international literature. The incorporation of new drugs of proven utility as rituximab and specific schemes chemotherapy could improve these results. The establishment of prognostic groups established by IPIae can guide clinical work for the use of chemotherapy tailored to their specific risk and optimized according to histological type.

Introducción: Los linfomas de Hodgkin (LH) y no Hodgkin (LNH) se asocian con alta frecuencia al síndrome de inmunodeficiencia humana en adultos. Objetivo: Sistematizar los aspectos clínicos e histológicos de los linfoma que afectan a pacientes con SIDA, su tratamiento y resultados globales en nuestra institución. Pacientes y Métodos: Análisis retrospectivo de pacientes con linfoma asociado a VIH entre enero de 2001 y diciembre de 2008 en el complejo hospitalario San Borja Arriarán. Resultados: Se obtuvo información de 30 pacientes con LNH y 7 LH, con una mediana de 40 años. Los tipos histológicos predominantes fueron linfoma de Burkitt (47 %), linfoma difuso de células grandes de estirpe B (37 %) y LNH de estirpe T (10%). No se diagnosticaron LNH del SNC ni linfoma de cavidades. Casi la totalidad de los pacientes (86,7%) con LNH se trataron con esquema CHOP, 57% de quienes recibieron tratamiento presentaron progresión o recaída desde remisión completa, ofreciéndoles una quimioterapia de rescate a cuatro pacientes. El 73% de los pacientes que recibieron CHOP lograron completar entre cinco y seis ciclos de quimioterapia. El uso de quimioterapia CHOP para el subgrupo de pacientes con linfoma de Burkitt alcanzó bajos porcentajes de remisión completa y mayoritariamente progresó la enfermedad, siendo esta quimioterapia, inefectiva para mejorar la sobrevida, especialmente en los pacientes de riesgo alto. Se encontraron diferencias estadísticamente significativas en sobrevida según el IPIae (índice internacional pronóstico ajustado por edad) al ingreso. Conclusión: El LNH en los pacientes con VIH tratados con los protocolos de quimioterapia PANDA persiste en nuestro medio como una enfermedad de muy mal pronóstico comparado con los resultados en la literatura internacional. La incorporación de nuevos fármacos de demostrada utilidad como rituximab y esquemas específicos de quimioterapia podrían mejorar estos resultados. El establecimiento de grupos pronósticos establecidos por IPIae puede orientar el trabajo clínico para el uso de quimioterapia ajustada a su riesgo específico y optimizado según tipo histológico.

Epidemiology and control of Schistosomiasis and other intestinal parasitic infections among school children in three rural villages of south Saint Lucia.

Objective: The purpose of this study was to determine the epidemiology of parasitic infections and the efficacy of treatment among school children in rural villages of south Saint Lucia. Method: A total of 554 school children participated in this study. Parasitic infections were confirmed by using Kato-Katz method. Results & conclusion: Overall, 61.6% of the school children were infected by any parasitic infection. The helminths identified were Ascaris lumbricoides (15.7%), Hookworm (11.9%), Strongyloides (9.7%), Trichuris trichiura (4.7%), Schistosoma mansoni (0.6%), Taenia solium (0.8%) and Enterobius vermicularis (2.1%), Entamoeba coli (9.7%), Iodameba butschlii (5%), Entamoeba histolytica (1.1%), Giardia lamblia (1.8%) and Endolimax nana (2.1%). The control intervention included treatment with albendazole 400 mg and praziquantel 40 mg/kg as well as awareness campaigns. Post-interventional assessment showed the total prevalence of intestinal parasitic infection reduced from 61.6 to 3.6% with a cure rate of 94.2%, following the control methods.