[Central nervous system relapse in adults with acute lymphoblastic leukemia]

Relapse of acute lymphoblastic leukemia [ALL] in the central nervous system [CNS] in adults is considered a poor prognostic feature. Few reports have analyzed this issue. The objective of this study was to estimate the experience with CNS recurrence in adult patients with ALL, then to choose the best therapy. Between January 2004 and January 2008, the records of 50 consecutive, newly diagnosed patients with ALL, of age above 13 years, who were treated at Almouassat Hospital Center. Patients were treated with published regimen [LALA-94]: [Vincristine, Doxorubicin, Prednisone and Cyclophosphamide] who achieved complete remission [CR], All patients had received CNS prophylaxis tailored to the risk of CNS. Recurrence with systemic chemotherapy with intrathecal [IT] chemotherapy depended on: abnormal lymphocytes or blast lymphocytes in intrathecal fluid. All patients received systemic chemotherapy due to non existence of bone marrow transplantation. ALL-3 was excluded. The median age at the time of diagnosis was 25 years. The median CR duration prior to CNS recurrence was 44 weeks. Three groups were identified: 1] patients with an isolated CNS recurrence [n = 3 patients], 2] patients with CNS recurrences after bone marrow [BM] recurrence [n = 1 patients], and 3] patients with simultaneous CNS and BM recurrences [n = 1 patients]. IT chemotherapy was effective in achieving a CNS CR in 3 patients [60%], but 1 patients [20%] had a second CNS recurrence. The median survival from CNS recurrence was 7 months; 40% of patients were alive at 1 year. Adults with ALL and CNS recurrences have a poor prognosis despite effective IT chemotherapy. Future studies should investigate better approaches in the treatment of these patients to improve their long-term survival. Effective CNS prophylaxis remains the single best approach for treating patients with CNS leukemia

[Combination chemotherapy of [vip] [ifosfamide, carboplatin, and etoposide] for advanced hodgkin's lymphoma [relapse and resistant]]

Hodgkin's lymphoma [HL] is a disease of good response on initial radio-chemotherapy, but there is a ratio of 5-35% does not respond, and some relapses after initial chemotherapy [CT] appear to have a poor prognosis, especially if the duration of the first complete remission [CR] was short. So the aim was to improve the survival by use the combination of VIP. Prospective Study of patients with Hodgkin's lymphoma, of age more than 13 years, who had relapses after combination of ABVD, and the resistant cases. Diagnosed in Almouassat hospital, within 1/2004- 1/2oo9. Then the patients were treated with the combination of VIP. Evaluation of relapse and resistant depended on CT-scan, biopsy, and Gallium scanning. 32 patients were in first relapse or resistance. they were divided into 3 groups, group-1: included 15 patients [47%] without bad prognosis, the interval of end treatment- relapse is about 4,5 years, Treated with ABVD. result was complete remission in 12 patients [80%]. Group- 2; included nine relapsed patients with bad prognosis; the interval of end treatment- relapse is about 1 year, treated with combination of VIP and Radiation Therapy if It is necessary. Result was complete remission in 3 patients, partial remission in 3 patients, and resistance in 2 patients. The whole response is 78%. Group- 3; included 6 resistant patients, treated with combination of VIP combination CT followed by radiotherapy [RT], result was complete remission in 4 patients [78%], partial remission in 2 patients. There was a significant difference, especially in group-3. The protocol ABVD is still the treatment of choice in patients with far relapse and without bad prognosis. while The combination of VIP, followed by radiotherapy or no, is useful and efficacy in resistant and relapse Hodgkin's lymphoma.

Association between hodgkin's lymphoma and tuberculosis

Background: tuberculosis [TB] is endemic in Syria, especially in the north region[Aleppe and Agjazira], the incidence 38/100000 of population nearly. chemotherapy and Hodgkin's lymphoma [HL] reduce cell mediated immunity. Thus increased risk of TB is expected in HL, but there is limited literature on this association, with some case reports and rare studies as Turkish study 2003. Aim: to study the association of HL and TB in patients diagnosed with HL. Methods and patients Ninety patients with HL undergone to this retrospective study, from 1/2005 to 1/2009 for HL cases associated with TB. Tuberculosis was concidered to be associated with HL if It was diagnosed - [a] 6 months before diagnosis of HL, -[b] concomitantly or during treatment or - [c] within 6 months after completion of treatment of HL. Radiological data, Ziehl neelsen [ZN] staininig for acid fast bacilli, culture, study of biopsy. TB was treated by anti tuberculosis drugs and HL treated by the protocol ABVD. Results: Of 90 patients with Hodgkin's lymphoma, 6 patients had TB, 2 cases diagnosed before 6 months of diagnosis of HL, response partially to anti tuberculosis treatment. Reevaluation revealed HL, the third case developed HL after 3 months, while 3 cases diagnosed TB after 6 months of completion of treatment of HL. Case 6 developed bilateral axillary adenopathies and fever then fistulization resulting pus during 3 months of chemotherapy; he received chemotherapy in addition to anti tuberculosis treatment, but he died. All cases received subsequent chemotherapy and TB lesions cured except the case 6. None had a past history of TB. The incidence of TB associating to HL is 6, 6% which is elevated; 2 cases diagnosed as TB without any response. Reevaluation assessed HL and they had response on chemotherapy, this refers to difficulty of differentiation between TB and HL. Conclusion: Increased risk of TB in HL patients. and difficulty of differentiation between TB and HL make the response to treatment important to affirm the diagnosis. The association between TB and HL is considered especially in case of unexpected response to treatment. We recommend to make in mind the risk of association between TB and HL, and to do all tests to confirm or to exclude TB. Key words: tuberculosis, Hodgkin's lymphom

Bone marrow involvement and the value of bone marrow trephine biopsy in the prognosis of hodgkin's lymphoma in Almouassah University Hospital

Bone marrow involvement [BMI] in Hodgkin's lymphomas is rare, and there is no clear correlation with prognosis, so this study is to describe the incidence of BMI and to evaluate the prognosis revalence of BMI. prospective study for 4 years on 75 patients diagnosed by biopsy, undergone to bone marrow biopsy and Aspiration, treated with ABVD Protocol. The incidence of BMI was 3.5% low Ratio formed 48% of states with stage IV. all accompanied with constitutional symptoms, elevation of ESR, but normal LDH. there is no correlation with prognosis. Bone marrow biopsy is Indicated in II-B, III stages. The prognosis of patients with BMI is not worse than the prognosis of other advanced stage Hodgkin's lymphoma patient, so BMI does not define a special risk to indicate different treatment