Clinical Analysis of B-Cell Non-Hodgkin Lymphoma Treated with Modified Conditioning Regimen / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy, safety and prognosis of auto-HSCT between classical and modified conditioning regimen in patients with B-cell non-Hodgkin lymphoma.@*METHODS@#36 patients diagnosed as B-cell non-Hodgkin lymphoma treated with autologous hematopoietic stem cell transplantation from January 2015 to June 2018 in Tianjin Cancer Hospital were retrospectively analyzed. The patients were divided into two groups: Idarubicin group and non-Idarubicin group. The overall survival (OS), progression-free survival (PFS), adverse reactions and hematopoietic reconstitution time between the two groups were compared. Survival analysis was performed by using the Kaplan-Meier method. Log-rank test was used for comparison between groups, and Cox regression was used for multivariate analysis.@*RESULTS@#The median follow-up time was 29 months. Among these 36 patients with B-cell non-Hodgkin lymphoma before transplantation, 21 patients achieved CR and 15 patients achieved PR. The reconstitution time of neutrophil (P>0.05) and platelet (P>0.05) was not significantly different between Idarubicin and non-Idarubicin group. Also, the adverse reactions were not significantly different between two groups. The addition of idarubicin showed not aggravate the adverse reactions of patients. The OS and PFS of patients with idarubicin was longer than that of patients without idarubicin. The multivariate analysis showed that, the modified conditioning regimen and the remission state before transplantation were closely associated with prognosis.@*CONCLUSION@#The above-mentioned results indicated that the combination of modified conditioning regimen with idarubicin can lengthen the OS and PFS of the patients significantly, and show not aggravate of bone marrow inhibition, moreover, the hematopoietic reconsititution time show not lengthen, which means that it can be a safe and effective choice for autologous HSCT in the patients with B cell non-Hodgkin lymphoma.

Different sites of extranodal involvement may affect the survival of patients with relapsed or refractory non-Hodgkin lymphoma after chimeric antigen receptor T cell therapy / 医学前沿

Factors associated with complete and durable remissions after anti-CD19 chimeric antigen receptor T (CAR-T) cell immunotherapy for relapsed or refractory non-Hodgkin lymphoma (r/r NHL) have not been well characterized. In this study, we found that the different sites of extranodal involvement may affect response, overall survival (OS), and progression-free survival (PFS) in patients with r/r NHL treated with anti-CD19 CAR-T cells. In a cohort of 32 treated patients, 12 (37.5%) and 8 (25%) patients exhibited soft tissue lymphoma and bone marrow (BM) infiltrations, respectively, and 13 (41%) patients exhibited infiltration at other sites. The factors that may affect prognosis were identified through multivariable analysis. As an independent risk factor, soft tissue infiltration was the only factor significantly correlated with adverse prognosis (P < 0.05), whereas other factors did not reach statistical significance. Furthermore, the site of extranodal tumor infiltration significantly and negatively affected OS and PFS in patients with r/r NHL treated with anti-CD19 CAR-T cell therapy. PFS and OS in patients with BM involvement were not significantly different from those of patients with lymph node involvement alone. Thus, anti-CD19 CAR-T cell therapy may improve the prognosis of patients with BM infiltration.

TAC y PET/TC con 18-FDG para evaluar la respuesta al tratamiento en linfoma de Hodgkin y no Hodgkin / CT and PET/CT with 18-FDG to evaluate the response to treatment in Hodgkin's and non-Hodgkin's lymphoma

Resumen Introducción: La evaluación de la respuesta al tratamiento de linfoma se basa en estudios de imagen. Objetivo: Correlacionar la evaluación de la respuesta al tratamiento de linfoma mediante tomografía axial computarizada (TAC) y tomografía por emisión de positrones/tomografía computarizada (PET/TC). Método: Estudio observacional transversal en el que se revisaron expedientes de pacientes con linfoma en vigilancia mediante TAC y PET/TC. Resultados: La población de estudio estuvo constituida por 43 pacientes con edad media de 32.7 ± 22.4 años; 26 (60.5 %) tenían diagnóstico de linfoma de Hodgkin y 17 (9.5 %), de linfoma no Hodgkin. Por TAC se diagnosticaron 34 (79.1 %) con enfermedad y nueve (20.9 %) sin enfermedad. El criterio para evaluar la respuesta fue la experiencia del médico imagenólogo en 39 (90.7 %) y RECIST 1.1 en cuatro (9.3 %). Por PET/TC con 18-FDG se diagnosticó falta de respuesta al tratamiento o respuesta parcial-recurrencia en 32 pacientes (74.4 %) y con respuesta al tratamiento en 11 (25.6 %); con los criterios PERCIST en 13 (30.2 %) y con los de Deuaville en 30 (69.8 %). Al comparar el diagnóstico por TAC contra PET/TC, de 11 pacientes con respuesta total, tres tuvieron diagnóstico tomográfico similar. De los 34 pacientes con datos de enfermedad diagnosticados por tomografía, 26 tuvieron resultados similares por PET/TC con 18-FDG (p = 0.54). Conclusión: El valor de la respuesta al tratamiento por TAC en linfoma no concuerda con el obtenido mediante PET/TC con 18-FDG.

Abstract Introduction: The assessment of lymphoma response to treatment is based on imaging studies. Objective: To correlate the assessment of lymphoma treatment response by computed tomography (CT) and by positron emission tomography/computed tomography (PET/CT). Method: Cross-sectional, observational study, where records of patients with lymphoma under surveillance by CT and PET/CT were reviewed. Results: The study population consisted of 43 patients with a mean age of 32.7 ± 22.4 years; 26 (60.5 %) had a diagnosis of Hodgkin’s lymphoma and 17 (9.5 %) had non-Hodgkin lymphoma. By CT, 34 (79.1 %) were diagnosed with disease and nine (20.9 %) without disease. The criteria used to assess the response was radiologist experience in 39 (90.7 %) and RECIST 1.1 criteria in four (9.3 %). The diagnosis by 18-FDG PET/CT was no response to treatment or partial response-recurrence in 32 (74.4 %) and response to treatment in 11 (25.6 %); with PERCIST criteria in 13 (30.2 %) and Deuaville criteria in 30 (69.8 %). When the diagnosis by CT versus 18-FDG PET/CT was compared, out of 11 patients with complete response on PET/CT, three had a similar CT diagnosis. Of the 34 patients with data consistent disease diagnosed by CT, 26 had similar results by 18-FDG PET/CT (p = 0.54). Conclusion: The value of lymphoma treatment response on CT does not agree with that obtained by 18-FDG PET/CT.

Wernicke's encephalopathy in a patient with non-Hodgkin's lymphoma post-Autologous HSCT

SUMMARY Wernick's Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin's lymphoma post-Autologous HSCT. We conclude that WE should be considered in patients submitted to autologous HSCT associated with prolonged use of TPN and malnutrition.

Seguridad y efecto del uso compasivo del anticuerpo monoclonal anti-CD20 CIMABior® / Safety and response to treatment of compassionate use of an anti-CD20 monoclonal antibody CIMABior®

Introducción: el uso de anticuerpos monoclonales transformó el tratamiento de los linfomas no hodgkinianos. El Centro de Inmunología Molecular generó un anticuerpo anti-CD20 (CIMABior®) biosimilar del rituximab, que se ha caracterizado desde el punto de vista biológico, pero la seguridad y eficacia aún están en estudio. Objetivo: evaluar la seguridad y la respuesta al tratamiento con CIMABior ®, en pacientes con síndromes linfoproliferativos de células B tratados con intención compasiva. Métodos: estudio multicéntrico, exploratorio, con dos grupos de tratamiento (monoterapia o combinado con quimioterapia) no controlado, ni aleatorizado. Se incluyeron adultos con linfomas no hodgkinianos y leucemia linfocítica crónica, no elegibles para el ensayo clínico en ejecución con este producto. Se determinó la frecuencia de eventos adversos y se caracterizaron. La respuesta al tratamiento se definió como: remisión completa, remisión parcial, enfermedad estable o en progresión. Se calculó la tasa de respuesta objetiva (remisión completa más remisión parcial) con el intervalo de confianza al 95 por ciento, se evaluó la relación de algunas variables con la respuesta y se estimó la razón de Odss. Como medida de balance beneficio-riesgo se estimó el factor de Bayes. Resultados: los eventos adversos más frecuentes fueron: temblor (12,8 por ciento) y fiebre (10,3 por ciento). Los relacionados con el producto (43,4 por ciento) fueron leves o moderados y evolucionaron hacia la recuperación. No se informó muerte asociada directamente al tratamiento. Se constató respuesta objetiva global de 71,2 por ciento (59,6 por ciento de remisiones completas y 11,5 por ciento, parciales). La respuesta objetiva en el grupo de monoterapia fue de 66,7 por ciento y de 73,0 por ciento en el grupo de CIMABior® más quimioterapia, con remisiones completas de 46,7 por ciento y 64,9 por ciento, respectivamente. Conclusiones: el AcM CIMABior® es seguro, bien tolerado y se demostraron evidencias de efecto. El tratamiento aportó un beneficio clínico superior al riesgo de desarrollar algún evento adverso grave(AU)

Introduction : The use of monoclonal antibodies transformed the treatment of non-Hodgkin lymphomas. The Center of Molecular Immunology created an anti-CD20 monoclonal antibody (CIMABior®), biosimilar of rituximab, which has been characterized from a biological point of view, but the safety and effectiveness are still being studied. Objective: Evaluate the safety and response to treatment, in patients with B-cell malignancies with compassionate use of CIMABior®. Methods : A multicenter, exploratory, non-controlled, non-randomized study was conducted with two variants of treatments (monotherapy or combined with chemotherapy). Adults with non-Hodgkin lymphomas and chronic lymphocytic leukemia not eligible for clinical trial with this product were included. Frequency of adverse events was calculated and those were characterized. The response to treatment was defined as: complete response, partial response, stable disease or progressive disease. Overall response rate (complete plus partial remission) was calculated with 95 percent confidence interval. The relation of some variables with response was estimated per Odss ratio. As a measure of the benefit-risk balance, the Bayes factor was estimated. Results : The more frequent adverse events were: tremors (12.8 percent) and fever (10.3 percent). Those related to the product (43.4 percent) were minor and evolved to recovery. There were no deaths in reference to the treatment. An overall response of 71.2 percent was confirmed (59.6 percent complete remissions and 11.5 percent partial remission). The monotherapy group objective response was 66.7 percent and 73.0 percent in the CIMABior® plus chemotherapy group, with complete remissions of 46.7 percent and 64.9 percent respectively. Conclusions: The monoclonal antibodies CIMABor® is safe, well tolerated and evidences of its effectiveness was demonstrated. The treatment provided a superior clinical benefit to the risk of developing a severe adverse event(AU)

Guía de Práctica Clínica para la detección, tratamiento y seguimiento de Linfomas Hodgkin y No Hodgkin en población mayor de 18 años / Clinical practice guideline for the detection, treatment and follow-up of Hodgkin and Non-Hodgkin lymphomas in a population over 18 years of age

Esta guía esta dirigida al personal de la salud involucrado directamente en la atención de pacientes adultos mayores de 18 años con sospecha o diagnóstico de linfoma no Hodgkin B difuso de célula grande (Linfoma B difuso de células grandes), linfoma folicular (LF), linfoma de células del manto (LCM) y linfoma Hodgkin (LH), y a las instancias administrativas, empresas aseguradoras y entes gubernamentales involucrados en la generación de políticas en salud. Esta GPC basada en la evidencia incluye los temas de diagnóstico y tratamiento del Linfoma B difuso de células grandes, LF, LM y LH, bajo la perspectiva del Sistema General de Seguridad Social en Salud colombiano. Objetivos: Determinar los métodos diagnósticos más apropiados en pacientes con LBDCG para garantizar un diagnóstico preciso que permita una adecuada selección del tratamiento; Establecer las líneas de tratamiento en pacientes con LF para disminuir la heterogeneidad en la atención y mejorar los resultados del tratamiento; Determinar los esquemas de tratamiento de primera línea para pacientes con LCM en diferentes grupos de edad para disminuir la heterogeneidad y mejorar los resultados del mismo; y Mejorar la supervivencia libre de enfermedad y la supervivencia global de los pacientes adultos con LH.

Comportamiento del linfoma no Hodgkin en la edad pediátrica / Behavior of non-Hodgkin lymphoma at pediatric ages

INTRODUCCIÓN: los linfomas no Hodgkin son neoplasias hematológicas frecuentes en la infancia. OBJETIVO: describir las diferentes formas de presentación de esta enfermedad en la edad pediátrica, y determinar el promedio de años vividos después de concluido el tratamiento. MÉTODOS: se realizó un estudio descriptivo retrospectivo en 79 pacientes con diagnóstico de linfomas no Hodgkin atendidos en el servicio de Oncocirugía del Hospital Pediátrico Docente "William Soler", de marzo de 1995 a marzo de 2014. RESULTADOS: 48 pacientes fueron del sexo masculino y 31 del femenino. El grupo de edad de mayor afectación fue el de 10 a 14 años. El 54,4 % de los pacientes tuvieron linfomas de localización abdominal y el 29,1 % fueron de localización mediastinal. Otros sitios afectados fueron la región cervical, la amígdala palatina y renal primaria en el 10,1, 3,8 y 2,6 % de los pacientes respectivamente. La variante histológica más frecuente fue el linfoma no Hodgkin inmunofenotipo B (75,9 %), seguido del linfoma no Hodgkin inmunofenotipo tipo T en el 21,5 % de los casos. El dolor abdominal y la masa tumoral palpable fue la manifestación clínica principal en el 64,5 %. El promedio de años vividos en el linfoma no Hodgkin de localización renal, cervical y amígdala palatina fue ligeramente superior (5,7 ± 0,3, 5,5 ± 1,8 y 5,2 ± 0,7 respectivamente). CONCLUSIONES: el linfoma no Hodgkin inmunofenotipo B de localización abdominal es el más frecuente. El dolor y el tumor abdominal son las manifestaciones clínicas principales, y los pacientes con linfomas no Hodgkin de la región cervical y amígdala palatina tienen mayor promedio de vida después de concluido el tratamiento.

INTRODUCTION: non-Hodgkin lymphomas are frequent hematological neoplasias in infancy. OBJECTIVE: to describe the different forms of presentation of this disease at the pediatric age and to determine the average years lived after the treatment. METHODS: a retrospective and descriptive study of 79 patients was conducted; they had been diagnosed as non-Hodgkin lymphoma cases and attended to at the oncologic surgery service of "William Soler" pediatric teaching hospital from March 1995 to March 2014. RESULTS: forty eight patients were males and 31 were females. The most affected age group was the 10-14 years-old one. In the group, 54.4 % of patients had lymphomas located in the abdominal region and 29.1 % in the mediastinal location. Other affected areas were cervical region, palatal tonsil and primary renal region in 10.1 %, 3.8 % and 2.6 % of patients, respectively. The most common histological variant was immunophenotype B non-Hodgkin lymphoma (75.9 %) followed by immunophenotype T non-Hodgkin lymphoma (21.5 %). Abdominal pain and palpable tumor mass was the main clinical manifestation in 64.5 % of cases. The average life years in non-Hodgkin lymphoma located in the renal region, cervical region and palatal tonsil was slightly higher (5.7±0.3, 5.5±1.8 and 5.2±0.7, respectively). CONCLUSIONS: the immunophenotype B non-Hodgkin lymphoma of abdominal location is the most common. Abdominal pain and tumors are the main clinical manifestations and the patients with non-Hodgkin lymphomas in the cervical region and the palatal tonsil show higher average life years after treatment.

Citosina Arabinósido 100 mg y 500 mg en solución / Cytosine Arabinoside 100 mg and 500 mg in solution

FORMA FARMACÉUTICA: bulbo DENOMINACIÓN COMÚN INTERNACIONAL: arabinósido de citosina. COMPOSICIÓN: cada bulbo contiene 100 mg y 500 mg de arabinósido de citosina en solución. CATEGORÍA FARMACOLÓGICA: antineoplásico, agente citotóxico, antimetabolito, analógo de las pirimidinas. FARMACOCINÉTICA: la biodisponibilidad por VO es escasa (menor que 20 %). La distribución es amplia y rápida por los tejidos. Atraviesa las barreras placentarias y hematoencefálica, alcanza el LCR hasta 40‒50 por ciento de la concentración plasmática. Es metabolizado por citidina desaminasa, dando lugar fundamentalmente a arabinósido de uracilo, que es un metabolito inactivo y a trifosfato de aracitidina (activo). La desaminación se produce en el hígado, plasma y tejidos periféricos. Se elimina por la orina (± 80 por ciento) en las primeras 24 h. La vida media de eliminación terminal es 1-3 h. INDICACIONES: leucemia linfocítica y mielocítica aguda y leucemia meníngea. También se emplea en esquemas de segunda o tercera línea de linfomas no Hodgkin y leucemia mieloide crónica. Eritroleucemia. CONTRAINDICACIONES: hipersensibilidad conocida a la citosina. Pacientes con depresión de la médula ósea, enfermedades debilitantes e infecciones virales recientes como varicela o herpes zoster. USO EN POBLACIONES ESPECIALES: LM: datos no disponibles. E: categoría de riesgo D PRECAUCIONES: LM: no se conoce su excreción por la leche humana; no obstante, se recomienda suspender la lactancia materna durante la administración del fármaco. CARCINOGENICIDAD: grupo de riesgo 3. Los efectos depresores de la médula ósea de la citarabina pueden dar lugar a un aumento de la incidencia de infecciones, retardo en la cicatrización y hemorragia gingival. Deben ser cuidadosamente monitoreados los recuentos hemáticos. Si el recuento de leucocitos arroja CAN menor que 1 000 células/mm3 y las plaquetas están por debajo de 50 000 celulas/mm3, el tratamiento debe ser interrumpido. Los valores pueden continuar bajando aún después de que la administración de citarabina sea suspendida. El tratamiento puede reiniciarse cuando existen signos evidentes de recuperación de la médula ósea. Cuando se administran de forma rápida altas dosis por vía IV, los pacientes pueden presentar náusea y vómito durante algunas horas después de la inyección; este problema se presenta en forma menos severa cuando se administra por infusión. En pacientes con enfermedad hepática previa se deberán suministrar dosis menores de citosina, ya que en el hígado ocurre el proceso de detoxificación de este medicamento. Cuando tiene lugar una lisis celular rápida, se deben tomar las debidas precauciones para evitar hiperuricemia y hiperuricosuria y el riesgo de nefropatía por ácido úrico. La neurotoxicidad está asociada con los tratamientos de altas dosis y pueden presentarse como: toxicidad cerebelar aguda o puede ser severa con convulsiones y/o coma, incluso suele ser retardada, hasta 3‒8 días después que el tratamiento haya comenzado. El riesgo de toxicidad cerebelar se incrementa cuando el aclaramiento de creatinina sea inferior a 60 mL/min, edad mayor de 50 años, lesión preexistente del SNC y niveles de fosfatasa alcalina mayor que tres veces el límite superior normal. La conjuntivitis es prevenida y tratada con gotas de solución salina y/o corticosteroides. Como profilaxis, las gotas oculares deben comenzarse de 6 a 12 h antes de iniciar el tratamiento con la citarabina, y continuar hasta 24 h después de haber finalizado esta. El término de altas dosis se define como dosis IV de 2 a 3 g/m2/dosis, cada 12‒24 h, por 4‒12 dosis o de 36 g/m2 en monoterapia, generalmente combinado con otros agentes utilizados en tratamientos con altas dosis de quimioterapia. Puede presentarse el llamado síndrome de la citarabina que se caracteriza por fiebre, mialgia, dolor óseo, dolor torácico, rash maculopapular, astenia y conjuntivitis, puede ocurrir de 6 a 12 h después de la administración de la citarabina. Puede ser tratado de manera eficaz con...(AU)

Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02)×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65)×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days) and had platelet counts of >20×109/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.

Acantosis nigricans y linfoma no Hodgkin: presentación de un caso / Acanthosis nigricans and non-Hodgkin’s lymphoma: a case presentation

La acantosis nigricans fue la primera dermatosis en la que se reconoció un carácter paraneoplásico. La característica sobresaliente es la hiperpigmentación simétrica y el engrosamiento aterciopelado de la piel. Se sugiere que algún factor producido por el tumor estimula el crecimiento epidérmico.Objetivo: presentar un caso poco frecuente de un paciente con el diagnóstico de linfoma no Hodgkin y acantosis nigricans.Caso clínico: se presenta el caso de un paciente masculino de 62 años de edad con antecedentes de hipertensión arterial que un año previo a su ingreso manifestó cambios en la coloración de la piel, dermatosis generalizada, hiperpigmentación e hiperqueratosis en las palmas de las manos y el cuello.Conclusiones: el tumor más frecuente asociado con acantosis es el adenocarcinoma abdominal en 90 por ciento de los casos, entre los cuales 64 a 69 por ciento son de origen gástrico; el resto (10 por ciento ) se asocian con cáncer no digestivo; linfoma de Hodgkin, micosis fungoide, cáncer de esófago, próstata y tiroides. En el linfoma no Hodgkin su asociación es considerada muy rara y son pocos los casos reportados en la bibliografía...

Acanthosis nigricans was the first dermatosis in which a paraneoplastic nature was identified. The most significant feature is symmetrical hyperpigmentation and velvety thickening of the skin. It is suggested that any factor produced by the tumor stimulates the epidermal growth.Objective: to present the infrequent case of a patient diagnosed with non-Hodgkin’s lymphoma and acanthosis nigricans.Clinical case: the case of a sixty-two-year-old male patient with a personal history of high blood pressure is presented. A year before his admission the patient presented changes in the coloration of the skin, widespread dermatosis, hyperpigmentation and hyperkeratosis in the hands and neck.Conclusions: the most frequent tumor associated to acanthosis was abdominal adenocarcinoma, found in the 90 percent of the cases; among them a 64 to 69 percent were of gastric origin; the rest of the cases (10 percent) were associated to non-digestive cancer, Hodgkin’s lymphoma, mycosis fungoides, esophagus cancer, prostate cancer, and thyroid cancer. In relation to Hodgkin’s lymphoma, the association is considered as rare, and there are just a few cases reported in the bibliography...

Intervenciones de enfermería en la atención del adulto con linfoma no hodgkin folicular (LNHF) / Nursing interventions in adult attention with Follicular Non-Hodgkin lymphoma (LNHF)

Introducción: Esta guía pone a disposición del personal de enfermería que labora en unidades médicas de tercer nivel de atención, las recomendaciones basadas en la mejor evidencia disponible para la toma de decisiones clínicas, las intervenciones de enfermería en la atención del adulto con Linfoma no Hodgkin Folicular. Método: Se realizó una búsqueda y revisión sistemática en la base de datos de PubMed, sitios específicos de Guías de Práctica Clínica y la biblioteca Cochrane; publicados entre 2002 y 2012, de los cuales se seleccionaron las fuentes con mayor puntaje obtenido en la evaluación de su metodología y las de mayor nivel en cuanto a gradación de evidencias y recomendaciones. Resultados: En la revisión sistemática fueron seleccionados 19 documentos para la elaboración de la guía. Se recomienda al profesional de enfermería fomentar la valoración del paciente identificando las necesidades físicas y emocionales del paciente y de la familia. Las intervenciones deben ser dirigidas antes, durante y después del tratamiento con enfasis en los cuidados de los efectos secundarios de la quimioterapia.Conclusiones: La incorporación de las recomendaciones en la práctica asistencial de enfermería podrá favorecer en la limitación del daño, disminución de comorbilidad y mejora en la calidad de vida en los pacientes mayores de 18 años con linfoma no Hodgkin folicular.

Introduction: This guide provides nursing staff working in medical units tertiary care recommendations based on the best evidence available for clinical decision making, nursing interventions in the care of adults with follicular Non-Hodgkin lymphoma.Method: A search and systematic review was performed in the PubMed database, specific sites Clinical Practice Guidelines and the Cochrane Library; were published between 2002 and 2012, of which the sources were selected with the highest score obtained in the evaluation of its methodology and higher level as to grading evidence and recommendations.Results: In the systematic review they were selected 19 documents for the development of the guide. It is recommended to encourage nurse patient assessment identifying the physical and emotional patient and family needs. Interventions should be directed before, during and after treatment with emphasis on the care of the side effects of chemotherapy.Conclusions: The incorporation of the recommendations in the nursing care practice may favor in limiting the damage, decreased morbidity and improved quality of life in patients over 18 years with follicular non-Hodgkin Lymphoma.

Introdução: Este guia fornece a equipe de enfermagem que trabalham em unidades médicas terciárias cuidar recomendações baseadas na melhor evidência disponível para a tomada de decisão clínica, intervenções de enfermagem no cuidado de adultos com Linfoma folicular não-Hodgkin.Método: Uma pesquisa e revisão sistemática foi realizada no banco de dados PubMed, sites específicos diretrizes de prática clínica e da Biblioteca Cochrane; foram publicados entre 2002 e 2012, dos quais as fontes foram selecionados com a maior pontuação obtida na avaliação de sua metodologia e nível superior quanto à classificação de evidências e recomendações.Resultados: Na revisão sistemática foram selecionados 19 documentos para o desenvolvimento do guia. Recomenda-se a incentivar a enfermeira avaliação do paciente identificar as necessidades físicas e emocionais do paciente e da família. As intervenções devem ser dirigidos antes, durante e após o tratamento com ênfase no cuidado dos efeitos colaterais da quimioterapia.Conclusões: A incorporação das recomendações na prática de cuidados de enfermagem pode favorecer em limitar os danos, diminuição da morbidade e melhor qualidade de vida em pacientes com mais de 18 anos com linfoma não-Hodgkin folicular.

Linfoma no hodgkin asociado a infección por virus de inmunodeficiencia humana estudio de cohorte / Non hodgkin lymphoma associated to human immunodeficiency virus cohort study

Los pacientes con linfoma no Hodgkin asociado a la infección por el virus de inmunodeficiencia humana tienen una mejor sobrevida después de la terapia antirretroviral de alta eficacia. Evaluar el comportamiento de los pacientes con linfoma no Hodgkin asociado a la infección por el virus de inmunodeficiencia humana antes y después de la terapia antirretroviral de alta eficacia. Estudio de cohorte entre 1986 y 2011 de los pacientes con linfoma no Hodgkin asociado a la infección por el virus de inmunodeficiencia humana tratado con ciclofosfamida doxorrubicina vincristina-prednisona. Hubo un 34% de respuestas globales (completa + parcial) en el grupo tratado antes de la terapia antirretroviral de alta eficacia y un 66% después de ella 65% de los pacientes antes de esta terapia murieron de infección por oportunista y 70% después de ella murieron de progresión o recaída del linfoma; hubo mayor toxicidad hematológica y hepática antes de la terapia antirretroviral; la sobrevida fue mayor en los pacientes tratados después de esta. En pacientes con un estado general satisfactorio, buena adherencia a la terapia antirretroviral de alta eficacia, en quienes se mejora la inmunidad celular y se obtiene una carga viral indetectable; podemos lograr que un grupo de ellos tenga una sobrevida larga, con respuestas clínicas completas posterior al tratamiento con el esquema de quimioterapia antes mencionado.

The human immunodeficiency virus infections related to non-Hodgkin´s lymphoma patients have improved their survival since the introduction of highly active antiretroviral therapy of high efficacy. These study behavior of the human immunodeficiency infection related to non Hodgkin lymphoma patients before and after the introduction of highly active and efficacy antiretroviral therapy. Study of cohort between the years 1986 and 2011 of the human immunodeficiency virus infection related to non Hodgkin lymphoma patients treated with these chemotherapy schedule: Cyclophosphamide, doxorubicin, vincristine, and the prednisone. There was 34% of a global (complete + partial) response in the group of patients treated before highly active and efficacy antiretroviral therapy and 66% after these antiretroviral therapy; 65% of patients died due to opportunistic infections before the highly active antiretroviral and efficacy therapy and 70% died due to progression or relapse of lymphoma after the antiretroviral therapy; hematologic and hepatic toxicity were higher before the highly active antiretroviral and efficacy therapy; and the survival was better after the antiretroviral therapy. The patients with good performance status and good adherence to highly active antiretroviral efficacy therapy, and in who improved of the cellular immunity and undetected the viral load were obtained, we can achieve a group of patients with long survival, in complete clinical response after treatment with chemotherapy regimen previous mentioned.

Primary testicular non-Hodgkin lymphoma. A 10-year Tunisian single-institute experience

Primary testicular non-Hodgkin lymphoma [NHL] is an uncommon extra nodal presentation, accounting for 1% of all NHL and 1 to 9% of testicular neoplasms. Median age at time of presentation is 60 years old. Anthracycline based chemotherapies are most frequently used. To analyze baseline characteristics, treatment modalities and survival of six cases of primary testicular non-Hodgkin lymphoma. We screened 46 testicular neoplasm cases registered from January 1999 to January 2009 and found six primary testicular lymphoma patients. These six cases were analyzed for baseline clinical features, investigations, treatment and outcome variables. Median age was 50 years old and median duration of symptoms was 4 months. All patients had testicular swelling. Four patients had abdominal lymphadenopathy. Most patients had diffuse large B-cell histology. All patients underwent high inguinal orchidectomy and five were treated with anthracycline based chemotherapy. Four patients completed therapy and one of them relapsed two years later. Primary testicular NHL is an uncommon entity and with current combined modality treatment, the outcome may be as good as nodal NHL

Linfoma no Hodgkin primario de vagina / Primary non Hodgkin's lymphoma of the vagina

La afectación primaria del tracto genital femenino de los linfomas no Hodgkin es poco frecuente (2 por ciento de los linfomas primarios extraganglionares). Los órganos más afectados son los ovarios seguidos del cérvix, siendo la localización endometrial y vaginal extremadamente rara. Presentamos el caso de una paciente de 44 años diagnosticada de linfoma primario de vagina, estadio IE A, con remisión completa tras tratamiento combinado quimioterápico y quirúrgico. Es importante tener presente estas raras aunque posibles localizaciones de linfomas para evitar que se puedan confundir con lesiones inflamatorias u otros tipos de tumores que nos lleven a un fracaso terapéutico.

Primary non-Hodgkin lymphomas rarely involve the female genital tract (2 percent of primary extranodal lym-phomas). The ovaries followed by the cervix are the most common affected sites while the involvement of the endometrium and vagina is extremely rare. We report the case of a 44 year old woman with a primary lymphoma of the vagina, stage IE A, with complete remission after combined chemotherapy and surgical treatment. These rare but possible locations must be kept in mind to avoid misdiagnosis with inflammatory lesions or other types of tumors which may lead us to a therapeutic failure.

Low grade follicular lymphoma with high proliferation index; diagnostic and management issues.

Follicular Lymphoma (FL) is the second most common B-Non Hodgkin Lymphoma after diffuse large B cell lymphoma (DLBCL). Low grade FL is known for its indolent behavior; however, one subset of FL behave aggressively and may require intensive therapy. One of the diagnostic issues in FL is to identify this subgroup of cases. Proliferation index can have prognostic importance in this subset of cases. We discuss one case of low grade FL with a paradoxically high proliferative index. A 63 year male presented with generalized lymphadenopathy of one year duration, which was gradually increasing in size. On examination, patient had bilateral cervical, axillary and inguinal nodes. Biopsy of the left cervical lymph node was reported as FL - Grade 2, with high proliferative Index (60%). The patient was put on CHOP regimen targeted for high grade lymphomas, and had complete remission. High proliferative index in FL is a poor prognostic factor irrespective of the histologic grade. So, proliferative index should be assessed in all cases of FL as an adjunct to histologic grading.

Presentación mandibular primaria de linfoma no Hodgkin / Primary non-Hodgkin´s lymphoma of the jaw

Se informa sobre el caso de una paciente de 80 años que presentó un linfoma no Hodgkin con compromiso de la mandíbula, con una tumoración de rápido crecimiento en el lado derecho de la cara, de 20 días de evolución. Se llegó al diagnóstico final de linfoma difuso de células grandes de fenotipo B (LDCGB), y la paciente fue derivada a un centro oncológico regional, donde pudo alcanzar una resolución casi completa del tumor

Linfoma Não Hodgkin - Resenha / Non Hodgkin's Lymphoma - Review

Background: CHOP-21 has remained the standard chemotherapy for aggressive non-Hodgkin’s lymphoma (NHL), and dose intensification is a potential strategy for improving therapeutic results. We conducted a phase III trial to determine whether dose-dense strategy involving interval shortening of CHOP (CHOP-14) is superior to CHOP-21. Patients and methods: A total of 323 previously untreated patients (aged 15-69 years) with stages II-IV aggressive NHL were randomized. The primary end point was progression-free survival (PFS). Results: Treatment compliance was comparable in both study arms. At 7-year follow-up, no substantial differences were observed in PFS and overall survival (OS) between CHOP-21 (n = 161) and CHOP-14 (n = 162) arms. Median PFS was 2.8 and 2.6 years with CHOP-21 and CHOP-14, respectively (one-sided log-rank P = 0.79). Eight-year OS and PFS rates were 56% and 42% [95% confidence interval (CI) 47% to 64% and 34% to 49%], respectively, with CHOP-21 and 55% and 38% (95% CI 47% to 63% and 31% to 46%), respectively, with CHOP-14. Subgroup analyses showed no remarkable differences in PFS or OS for patients stratified as per the International Prognostic Index or by age. Conclusion: Dose-intensification strategy involving interval shortening of CHOP did not prolong PFS in advanced, aggressive NHL.

CHOP-21 tem sido o esquema padrão para pacientes com linfoma não Hodgkin (LNH) agressivo ao longo dos últimos 30 anos. No entanto, apenas 30% a 50% dos casos são curados com este protocolo. Na tentativa de aumentar as taxas de sobrevida, vários esquemas com poliquimioterapia e intensificação de dose têm sido testados, mas sem impacto na sobrevida. Neste estudo os autores comparam CHOP-21 e CHOP-14 tendo como objetivo primário a sobrevida livre de progressão, levando-se em conta que a redução do intervalo dos ciclos poderia trazer benefícios para pacientes com LNH agressivo. Após sete anos de observação não se notou aumento na sobrevida livre de progressão e na sobrevida global com doses densas (CHOP-14). Mas apesar dos grupos estarem pareados e de não haver vantagens para nenhum dos lados, e ainda da análise de subgrupos, levando-se em conta estratificação de risco e idade, é importante ressaltar que neste estudo os pacientes foram incluídos de acordo com a classificação Working Formulation, em grau intermediário e alto, o que coloca lado a lado doenças com comportamento biológico muito diferente, inclusive misturando linfomas de linhagens distintas (B e T). Futuramente, deve-se considerar estudo comparativo entre CHOP-14 e CHOP-21 em linfomas com status biológico equivalente e padrão de agressividade semelhante.

Primary Non-Hodgkins lymphoma of the parotid gland / Linfomas malignos primários nas glandulas salivares

Primary malignant lymphomas in the salivary glands are relatively rare. Clinical presentation is not characteristic and the disease is often overlooked resulting in diagnosis and treatment delays. AIM: To stress the importance of the diagnostic process and combined management, we present a series of eight patients with malignant lymphoma of the parotid who were diagnosed only after surgery and managed with radiation and chemotherapy. METHODS: Retrospective series of patients with primary malignant lymphoma of the parotid gland managed with radiotherapy and diagnostic surgical partial resection. RESULTS: After treatment completion we achieved a loco-regional control rate of 87.5 percent. Toxicity was charted according to the Common Toxicity Criteria and it was seen in six patients (75 percent). Six patients are still alive without evidence of recurrent disease in their last follow-up. CONCLUSION: Our study confirms that primary early stage Non-Hodgkin Lymphoma of the parotid gland is a disease with an excellent prognosis and a good local control rate, with minimal morbidity.

Linfomas primários das glândulas salivares são relativamente raros. Sua apresentação clínica não écaracterística e, frequentemente, a doença passa despercebida, resultando em atrasos no diagnóstico e tratamento. OBJETIVO: Enfatizar a importância do diagnóstico e tratamento combinado. Apresentamos uma casuística de oito pacientes com linfoma maligno da parótida, que foram diagnosticados somente após a cirurgia e tratados com radio e quimioterapia. MÉTODOS: Estudo retrospectivo de pacientes com linfoma maligno primário da glândula parótida, tratados com radioterapia e ressecção cirúrgica parcial diagnóstica. RESULTADOS: Após a conclusão do tratamento, atingimos uma taxa de controle loco-regional de 87,5 por cento. A toxicidade foi classificada de acordo com os Critérios Comuns de Toxicidade e afetou seis pacientes (75 por cento). Seis pacientes ainda estão vivos, sem evidência de doença na mais recente consulta de acompanhamento. CONCLUSÃO: Nosso estudo confirma que o Linfoma primário Não-Hodgkin em estágios iniciais da glândula parótida é uma doença com excelente prognóstico e boa taxa de controle local, com mínima morbidade.

Epidemiología del linfoma con compromiso de cabeza y cuello en el Centro Asistencial Sótero del Río / Epidemiology of lymphoma of the head and neck in the Centro Asistencial Sótero del Río

Introducción: Los linfomas son la neoplasia hematológica más frecuente del adulto, ocupando el tercer lugar de las neoplasias de cabeza y cuello (CyC). Se distinguen dos tipos, el linfoma de Hodgkin (LH) y el linfoma no Hodgkin (LNH), constituyendo dos entidades clínicas separadas. Objetivo: Evaluar las manifestaciones de los linfomas en la región de CyC, analizando las diferencias de presentación y comportamiento entre en LH y el LNH. Material y método: Estudio retrospectivo de todos los casos de linfomas de CyC en el Centro Asistencial Dr. Sótero del Roo (CASR) entre los años 2005 y 2009, documentando específicamente presentación clínica, factores de riesgo, el tipo de linfoma, diagnóstico histológico, localización anatómica, etapificación al momento del diagnóstico, tratamiento administrado, sobrevida. Resultados: Se incluyeron 80 casos de pacientes con linfoma de CyC en el estudio, 16 (20 por ciento) con LH y 64 (80 por ciento) con LNH. Se encontraron diferencias estadísticamente significativas entre ambos para la edad de diagnóstico, el compromiso extranodal, compromiso de mediastino, presencia de síntomas B y sobrevida. Conclusión: En el CASR la presentación de los linfomas es similar a la reportada mundialmente con diferencias similares entre LH y LNH.

Introduction: Lymphomas are the most common hematologic neoplasia in the adult and the third most common neoplasias of the head and neck (CyC). There are two types of lymphoma: Hodgkin and non-Hodgkin lymphomas, which constitute two unique clinical entities. Aim: To evaluate the clinical manifestations of lymphomas in the CyC region, analizing the diferences between the clinical presentation and behavior of LH and LNH. Material and method: This is an retrospective study of all the cases of lymphoma of CyC in the Centro Asistencial Dr. Sótero del Río (CASR) between the years 2005 and 2009, describing specifically the clinical presentation, risk factors, type of lymphoma, histologic diagnosis, anatomical localization, etapification at diagnosis, treatment received and survival. Results: Eighty cases of lymphoma of the CyC were included, 16 patients (20 percent) with LH and 64 patients (80 percent) with LNH. We found statistically significant differences between both groups for their age at diagnosis, extranodal disease, mediastinal compromise, presence of "B" symptoms and survival. Conclusion: in the CASR the clinical presentation of lymphomas is similar to that reported in the international literature, maintaining the unique characteristics for LH and LNH.

Autologous blood stem cell transplantation for Hodgkin and non-Hodgkin lymphoma: Complications and outcome.

Background. We analysed data on patients of Hodgkin and non-Hodgkin lymphoma treated with high dose chemotherapy followed by autologous stem cell transplantation to determine the toxicity, pattern of infections and long term outcome. Methods. There were 34 male and 10 female patients (median age 35 years, range 15–67 years). Before transplantation, 31 patients (70.5%) had chemosensitive disease and 13 (29.5%) had chemoresistant disease. Granulocyte-colony stimulating factor mobilized peripheral blood stem cells were used as the source of stem cells. The patients received high dose chemotherapy using CBV (cyclophosphamide, BCNU and VP- 16 [etoposide] n=38), BEAM (BCNU, etoposide, cytosine arabinoside and melphalan, n=3), cytosine arabinoside, etoposide and melphalan (n=2) and melphalan alone (n=1). Prophylaxis with antifungal drugs (fluconazole/itraconazole) and acyclovir was used. Results. Following transplant, 32 patients (72.7%) responded; complete response was achieved in 25 patients (56.8%) and partial response in 7 (15.9%). The rate of complete response was higher for patients with pre-transplant chemosensitive disease (23/31 [74.2%] v. 2/13 [15.4%], p<0.001). Gastrointestinal toxicity, and renal and liver dysfunctions were major non-haematological toxicities; 3 patients (7%) died of regimen-related toxicity. Infections (predominantly Gram-negative) accounted for 2 deaths (4.5%) seen before day 30. At a median follow up of 79 months (range 14–168 months), median overall and event-free survival were 78 months and 28 months, respectively. Estimated mean (SE) overall and event-free survival at 60 months were 54.34% (0.07) and 34.3% (9.88), respectively. Conclusion. Patients with pre-transplant chemosensitive disease and those who achieved complete response following transplant had a significantly better chance of survival.