Impact of rituximab and IPI on survival in diffuse large B cell lymphoma patients treated at a tertiary level cancer centre in Pakistan: a single-centre experience

To determine the impact of Rituximab and international prognostic index score on survival in diffuse large B-cell lymphoma patients. The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January to May 2013 and comprised record of patients with diffuse large B-cell lymphoma who were treated from 2007 to 2010. Baseline international prognostic index score, stage at presentation were noted and the records were divided into two groups A and B on the basis of the type of chemotherapy. SPSS 19 was used for statistical analysis. Of the 93 patients in the study whose records were reviewed, 54[58%] were men. Overall median age was 43 years [range: 18-76]. Stages at presentation were stage-I 14 [15.1%], stage-II 41 [44.1%], stage-III 20 [21.5%] and stage-IV 18 [19.4%]. International prognostic index risk categorisation was low risk 59[63.4%], low intermediate risk 23[24.7%], high intermediate risk 10[10.8%] and high risk 1[1.1%]. There were 31[33%] patients in Group A and 62[67%] in Group B. Median follow-up was 3.9 years [range: 1.2-6.1]. Overall survival at 4 years was 66.4%; for Group A 65.3% and for Group B 66.7% [p<0.4]. On the basis of risk categories, overall survival was statistically significant [p<0.001] between the groups. International prognostic index risk categorisation had statistically significant impact on survival. However, there was no evidence of a significant survival benefit between types of chemotherapy. Further controlled trials are needed in this regard

Secondary malignant melanoma in primary mediastinal germ cell tumour

Secondary transformation in Germ Cell Tumours [GCT] is an extremely rare event. We report here a case of malignant melanoma arising in primary mediastinal GCT. A young male presented with new onset dyspnoea and a mediastinal mass. As serum alpha fetoprotein was raised, a diagnosis of primary mediastinal GCT was made. He achieved remission with standard chemotherapy and resection of the mass. After a year, he relapsed with widespread disease which on work-up revealed malignant melanoma. As examination for cutaneous melanoma was unremarkable, a diagnosis of mediastinal GCT with secondary transformation to melanoma was made. Exact origin of melanoma in GCTs is unknown, but these may occur from transformation of dermal elements or de-differentiation of germ cells to melanomas. Before making such a diagnosis, search for primary cutaneous melanoma is mandatory. No clear guidelines exist in literature for the treatment of secondary melanomas, so current management guidelines for cutaneous melanoma may be followed