Trends in the profile of non hodgkins lymphoma in North and South India: a study from two tertiary care hospitals in India

Background: A number of environmental and chemical factors have been thought to been implicated in the occurrence of Non-Hodgkin’s Lymphomas (NHLs).To fill the knowledge gap in various aspect of the disease, this study was undertaken at this tertiary care centre in Delhi and Bangalore.Methods: This was a prospective observational study conducted in two defenses medical centre in India among patients of Non Hodgkins Lymphoma, registered at Command hospital Airforce Bangalore and Army Hospital (Research and Referral), New Delhi, between March 2016 and March 2019.Results: The disease showed a bimodal onset in both centres with 26 (26%) and 24 (24%) cases occurring in the age group of 31-40 years and 24 (24%) and 25 (25%) cases occurring in the age group of >60 years at CHAF (B) and AH (RR) respectively. B cell Lymphoma was the most common type of NHL seen in 85% and 89% patients, whereas T-cell lymphomas constituted 13% and 11% at CHAF (B) and AH (RR).  32(32%) patients presented with an Ann Arbor Stage 1 or 2 disease whereas 68(68%) patients were with Stage 3 or 4 disease at both the centers. IPI score was ≥3 in 45 % and 43% patients.Conclusions: NHL in India is a homogeneous and uniform disease. But there was increased detection of hepatosplenomegaly and associated hepatitis B/C in the southern part of India. Also, the occurrence of Cutaneous T cell lymphoma was only seen in the south India centre. The early stage NHLs has better survival and increase chance of complete response.

A 54-year-old male with diabetic nephropathy and suspected disseminated tuberculosis: Clinicopathologic correlation in a rare diagnosis

Tuberculosis (TB) and Non-Hodgkins lymphoma (NHL) share similar clinical and radiological features, which make diagnosis a challenge. It is often difficult to rule out a diagnosis of extrapulmonary and/or disseminated TB because of its paucibacillary nature and difficulty in accessing the involved organs. In countries with high prevalence of TB like ours, empirical antitubercular treatment (ATT) is started, and the patient is followed up closely for response. We present a rare case of a 54-year old diabetic male who was suspected to be a case of disseminated TB but had a rapid downhill course despite ATT. A postmortem revealed features of a rare, aggressive T-cell NHL masquerading as disseminated TB.

Distribution of nodal lymphomas in a referral hospital of Mangalore city.

CONTEXT: The distribution of different types of lymphoma varies across geographic regions. AIMS: The present study was done to understand the occurrence of nodal lymphomas in a referral hospital of Mangalore city. SETTINGS AND DESIGN: Descriptive study. SETTING: The present study was conducted on 95 lymph node biopsy specimens, received in a referral hospital of Mangalore city. MATERIALS AND METHODS: All cases of nodal lymphoma diagnosed between January 2007 and June 2010 in a referral hospital of Mangalore were selected for the study. The patients age and clinical details were obtained. Immunophenotyping was done for all cases of NHL and selected cases of HL. IPI score for NHL was noted and correlated with the outcome. STATISTICAL ANALYSIS USED: Chi square test was used. RESULTS: Out of the total 95 cases of nodal lymphoma 37 (39%) were HL while 58 (61%) were NHL. Classical HL was diagnosed in 35 cases (37%) while 2 cases (2%) were diagnosed NLPHL. B cell lymphoma formed 72% of NHL. Follicular lymphoma accounted for 28% of all NHL. T cell lymphoma formed 28% of NHL. CONCLUSIONS: In conclusion the following points are significant about the distribution of lymphomas in a referral hospital of Mangalore city. The incidence of NSHL is higher while national data suggests MCHL as the most common subtype. The incidence of FL as well as T cell NHL is much higher when compared to national incidence. The epidemiological factors for this high frequency (either genetic or environmental) needs to be studied further.

A Rare Case of Angioimmunoblastic Lymphoma: A Report.

Angioimmunoblastic lymphoma is a rare type of T-cell lymphoma. A 60-year-old male presented with complaints of cough with expectoration and chest pain associated with exertional dyspnea since two months. There was history of significant loss of weight. Chest X-ray showed large opacity suggestive of mass with ill-defined margins seen in left posterosuperior aspect overlapping the posterior aspect of aortic arch and proximal descending aorta. CT guided biopsy showed angioimmunoblastic T-cell lymphoma. This case is presented for its rarity.

The Clinical and Pathological Analysis of 1,012 Cases of Non-Hodgkins Lymphoma / 中国肿瘤临床

Objective: To explore the clinicopathologic features of non-Hodgkin' s lymphoma (NHL) patients seen in our hospital in the recent ten years and to discuss the relationship between clinical data and the prognostic factors. Methods: The clinical and pathological features of 1,012 NHL cases were retrospectively analyzed. Results: The main pathological subtypes included 346 (34.1%) cases of diffuse large B-cell lymphoma (DLBCL), 185 (18.3%) cases of peripheral T-cell lymphoma (PTCL), 97 (9.6%) cases of follicular lymphoma (FL), 94 (9.3%) cases of extranodal mucosa-associated lymphoid tissue (MALT), 62 (6.1%) cases of nasal NK/T-cell lymphoma and 47 (4.6%) cases of T-lymphoblastic lymphoma. There were 619 (61.2%) cases classified as nodal lymphoma and 393 (38.8%) cases classified as extranodal lymphoma. For the whole group, the 5-year overall survival (OS) rate was 45.8%. The univariate analysis showed that the clinical stage, performance status (PS), B-symptom, age, tumor size, the serum lactate dehydrogenase (LDH) level, the number of extranodal involvement and IPI were correlated with prognosis of NHL(P＜0.05). The multivariate analysis showed that the source of T cells, Ⅲ/Ⅳ clinical stage, IPI (3～5) and increased LDH were correlated with poor prognosis (P＜0.05). Conclusion: The incidence of NHL in middle-aged people is relatively higher. Extranodal lymphoma and B-cell lymphoma are more frequent in Xinjiang. Immunophenotypes, clinical stages, IPI and the level of LDH expression are closely correlated with prognosis of NHL.

The Clinical Significance of LDH and ?_2-MG Measuring in Patients with non-Hodgkins Lymphoma / 医学研究杂志

Objective To evaluate the clinical significance of the serum lactic dehydrogenate(LDH) and ?2-Microglobulin(?2-MG) measuring in N0n-Hodgkins Lymphoma(NHL) Patients.Methods The LDH and ?2-MG are collected from 126 NHL patients and measured by rate method and radioimmunoassay respectively.Results The 2-year survial,4-year survial and alleviation rate of Patientsinnormat LDH and ?2-MG level group were obviously higher than those intevel increasing group.Difference is of significance(p

A Phase 2 Trial of Verapamil for Reversal of Drug Resistance in Refractory Non - Hodgkin's Lymphoma / 대한암학회지

PURPOSE: Drug resistance is one of the major obstacles to treatment of cancer. Multidrug resistance (MDR) caused by overexpression of p-glycoprotein (Pgp) in cancer cell membrane is a well-known mechanism of drug resistance in in vitro system and was reported to be a significant mechanism of resistance in non-Hodgkins lymphoma (NHL). Verapamil, a calcium channel blocker, is proven in vitro to overcome the MDR caused by Pgp. We performed a phase II trial of verapamil in patients with NHL refractory to EPOCH regimen (etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin) to overcome the MDR caused by Pgp. MATERIALS AND METHODS: Verapamil was administered via intravenous route from 1 hour before to 12 hour after the 96-hour infusion of etoposide, doxorubicin, and vincristine which were known to be substrates of Pgp in EPOCH regimen. The dose of verapamil was 0.15 mg/Kg in bolus and 0.2 mg/Kg/hr in infusion at the beginning and escalated by 0.05 mg/Kg/hr every 24 hours if there was no dose-limiting toxicities such as 2nd or 3rd degree AV block, hypotension, or congestive heart failure. Plasma verapamil concentrations were measured every 24 hour by gas chromatography. Mdrl expression level in tumor tissues was measured by RT-PCR. RESULTS: From Feb. to Nov. 1994, 14 patients were treated with this protocoL However, poor tolerability and no response in these patients led to early closure of the study at this 1st stage of patient accrual according to Gehans method. Among 14 patients, 12 experienced 2nd or 3rd degree AV block and/or hypotension and required temporary cessation of infusion and reduction of verapamil dose. However, there was no congestive heart failure or treatment-related death. The peak concentrations of verapamil were 0.29-1.94 pM (mean 0.93 pM) and mean concentrations during the 4-day infusion were 0.22-1.21 pM (mean 0.6 pM). Mdrl expression levels measured in 6 patients were 0.99-14.43 U (median 4.39). CONCLUSION: These results suggest that verapamil in this dose and schedule was neither tolerable nor effective for the reversal of drug resistance in NHL patients.

Therapeutic Outcome and Prognosis in Dlderly Patients with Non - Hodgkin's Lymphoma / 대한암학회지

PURPOSE: The prognosis of non-Hodgkins lymphoma (NHL) in elderly patients seems to be poorer than that in patients aged less than 60 years. This may be due to the lower tolerance for combination chemotherapy in the elderly. Aggressive combination chemo-therapy, which is the treatment of choice in intermediate and high grade NHL of adulthood, may be associated with unpredictab1y severe and lethal toxicity and worsened quality of life in the elderly. We investigated the treatment responses, toxicities and prognostic factors of NHL in elderly patients treated with combination chemotherapy. MATERIALS AND METHODS: We treated 116 elderly (>60 yrs) patients with NHL between January 1986 and June 1996 with adriamycin-containing regimens, such as CHOP (cyclo- phosphamide, adriamycin, vincristine, prednisolone), BACOP (bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone), and mBACOP (methotrexate, bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone). Patients in this study ranged from 60 to 81 (median 67) years of age. Fifty-five percent of patients were in stage I or II and the rest (45%) were in stage III or IV. The histologic grade was predominantly (91%) of intermediate and high grade type. RESULTS: The treatment responses were complete (CR) in 55% and partial (PR) in 25%. The median durstion of CR was 32 (3-132) months. The CR rate was significantly higher in patients treated with RDI (relative dose intensity) > 75% than that in the patients treated with RDI 75% vs 75%). CONCLUSION: Our data suggests that achievement of the CR after combination chemotherpy is the most important prognostic factor in the elderly patients with NHL. Suboptimal chemotherapy (RDI<75%) reduced the complete remission rate without reducing the likelihood of developing severe toxicities. Optimal chemotherapy with supportive cares involving the use of hematopoietic growth factors may be needed to improve the treatment response and the survival in the elderly patients with aggressive NHL.

Clinicopathologic Charcteristics of Korean Non - Hodgkin's Lymphomas Based on REAL Classification / 대한암학회지

PURPOSE: Non-Hodgkins lymphoma (NHL) is recognized as not a single disease but a group of diseases heterogeneous in biology and clinical characteristics. Recently, a new pathologic classification system, the REAL classification, has been introduced into the clinic. Although REAL classification has tried to define the subtypes biologically more correctly, its clinical usefulness has not been established yet. A retrospective study was performed to define the clinical characteristics of Korean NHLs according to the REAL classification and to determine its clinical usefulness. MATERIALS AND METHODS: Pathologies of NHLs managed at 3 major hospitals in Korea between 1989 and 1995 were reviewed with immunophenotyping to determine the pathologic subtypes according to REAL classification. Clinical characteristics at the presentation and treatment outcomes of the eligible patients were analyzed. To determine the differences from the NHLs in the western countries, data of Non-Hodgkins Lymphoma Classification Project (NHLCP) were also compared. RESULTS: Total 802 cases were eligible for this study. Although it was similar to NHLCP study that B-cell subtypes were the majority and diffuse large B-cell lymphoma was the most common subtype, the proportion of T-cell subtypes were much higher in our patient population than in the western population. It was because peripheral T-cell lymphomas, angiocentric lymphoma in particular, were more common and follicular lymphomas were less common in our patients. Eleven common pathologic subtypes could be classified into 3 prognostic groups. Marginal zone B-cell lymphoma and lymphoplasmacytoid lymphoma of which 5-year overall survival rate (5-yOSR) were > 80% were classified in the good prognostic group. Precursor T-lymphoblastic lymphoma was classified in the poor prognostic group because its 5-yOSR was less than 30%. The other 9 subtypes were classified in the intermediate prognostic group with S-yOSR of 30-79%. CONCLUSION: The clinical. character' tics and prognoses of Korean NHLs could be defined according to REAL classification. These information would be helpful for the clinicians in formulating treatment strategies of Korean NHLs according to REAL classification.

Primary CHOP Chemotherapy Followed by Involved Field Radiation Therapy in Clinical Stage I or II Aggressive Non-Hodgkin's Lymphomas / 대한암학회지

PURPOSE: Although radiation therapy had been the treatment of choice for localized non-Hodgkin's lymphoma(NHL), recent studies have revealed that treatment result after radiation therapy alone is not successful for localized aggressive NHL, if it is not pathologically but clinically staged. A prospective phase II trial was conducted to evaluate the therapeutic results of 4 cycles of CHOP chemotherapy followed by involved field radiation therapy in clinically staged localized aggressive NHL. MATERIALS AND METHODS: Patients with a diagnosis of aggressive NHL(all intermediate grade and immunoblastic histology in NCI working formulation), Ann Arbor stage I or II without poor prognostic factors(presence of B symptoms, bulky diseases, or 2 or more extranodal involvement) were treated with 4 cycles of CHOP(cyclophosphamide, doxorubicin, vincristine, prednisolone) followed by involved field radiation therapy of 3,000~6,000(median: 4,500) cGy. RESULTS: Between April 1990 and March 1995, 62 consecutive patients entered this trial. Forty six patients with measurable diseases were evaluable for response. Complete response was achieved in 41(89.1%) patients after CHOP chemotherapy and 4 more patients after subsequent radiation therapy, making total CR rate of 98%. Progression free survival(PFS) of all 62 patients were 2.2+~73+ months and 5 year PFS rate was 64.6%. Overall survival(OS) were 2.4+~75+ months and 5 year OS rate was 75.2%. Old age (> 60) was the only significant prognostic factor, which-affected overall survival negatively. Treatment was relatively well tolerated, but 3 patients died associated with treatment. CONCLUSIONS: Four cycles of CHOP chemotherapy followed by involved field radiation therapy is highly curative and safe treatment for clinically staged, localized aggressive NHLs.

High-Dose Chemotherapy with Vandervilt Regimen and CSF Support for High-Risk Aggressive Non-Hodgkin's Lymphoma / 대한암학회지

PURPOSE: To detennine the therapeutic effect and toxicities of high-dose chemotherapy with Vanderbilt regimen and colany-stimulating factors(CSF) support for high-risk aggressive non-Hodgkin's lymphoma(NHL). MATERIALS AND METHODS: Between Aug. 1995 and Mar. 1997, 40 patients with high-risk aggressive NHLs were treated with high-dose chemotherapy with Vandebilt regimen and CSF support. If the complete response(CR) was induced, four cycles of CHOP were administered for the maintenance of response. In cases of lymphoblastic lymphomas, CNS prophyiaxis with cranial irradiation and intrathecal methotrexate was done after CR. RESULTS: CR was achieved after Vanderbilt regimen in 62.5%(25/40) of the total patients. CR rste in refractory group(12.5%: 1/8) was significantly lower than in other groups (75%: 24/32)(p=0.001). With a median follow-up of 14 months, the failure free survival (FFS) was 0~18+ months(median 6.1 months). The overall FFS rate at one year was 31.7%. The 1-year FFS rate in refractory group(0%) was significantly lower than in other patients groups(41%)(p=0.001). The range of survival time was 0.5~18+ months, and median survival time was 6.2 months. Grade 4 leukopenia was observed in 100% of chemotherapy cycles and its median duration was 7 days. However, only one patient died due to treatment-relate sepsis. Non-hematological toxicities were tolerable and all reversible. CONCLUSION: High-dose chemotherapy with Vanderbilt regimen was effcctive for induction of CR in high-risk aggressive NHL patients and safe with the CSF support. However, poor CR rate in reftactory group and poor FFS in other groups indicate that a new, more intensive approach is needed for the induction of CR in refractory group and for the maintenance of CR in other high-risk patient groups.

Clinical Characteristics and Prognostic Factors of Non-Hodgkins Lymphoma / 대한내과학회지

OBJECTIVES: The advent of intense combination chemotherapy has transformed aggressive non-Hod-gkins lymphoma from a disease that was once uniformly fatal to one that is now often curable. Remission rates and survival may be improved by using intensive chemotherapy regimens. However, this more aggressive approach is inevitably associated with increased toxicity, and an accurate pretreament prognostic assessment of patients is required to guide the physician in selecting the most appropriate therapeutic regimen. Many studies have reported prognostic factors of non-Hodgkins lymphoma in western countries, but there are few reports on prognostic factors in Koreans and it is suggested that clinical characteristcs of non-Hodgkins lymphoma in Korea differ from those in western countries. The purpose of this study was to illustrate clinical characteristics, prognostic factors and treatment outcome in non-Hodgkins lymphoma in Korea. METHODS: Clinical features of 151patients (age over 15years) with non-Hodgkins lymphoma registered at Asan Medical Center from March 1989 to December 1993 were retrospectively reviewed. Prognostic factors and treatment outcome were evaluated among 121previously untreated patients. Multi variate analysis of potential pretreatment prognostic factors was performed using Coxs proportional hazards model. RESULTS: Of the 151patients evaluated, 55% had diffuse large cell type, while low-grades were encountered in less than 1% of the patients. Extranodal involvement was noted in 76% of the patients. Cental nervous system was the commonest primary extranodal site, followed by stomach. Complete remission was achieved in 73 of 121patients (60%). The median follow-up for 121patients was 24months and the actuarial overall survival was 48% at 3years and 44N at 5years with a median overall survival of 33months. At the median followup of 32months, the actuarial 5year disease-free survival rate among 73patient with complete remission was 65% and median remission duration was not reached. Presence of systemic B symptoms and advanced clinical stages were associated with a low complete remission rate. None turned out to be associated with the remission duration. The Coxs proportional hazards model identified age above 60years, presence of systemic B symptoms and elevated LDH level as significant independent poor prognostic factors influencing overall survival. CONCLUSION: This study reveals a low prevalence rate of the low-grades lymphoma and a higher propensity of diffuse large cell type. These results suggest that clinical characteristics of non-Hodgkins lymphoma in Korea are different from those in the western countries. Our data also show that certain pretreatment clinical factors can help in predicting survival and in planning treatment.