Linfoma no Hodgkin y leucemia mieloide crónica metacrónica en una paciente: reporte de un caso / Non Hodgkin´s lymphoma and metachronus chronic myeloid leukemia in a patient: case report

INTRODUCCIÓN: Los linfomas no Hodgkin son neoplasias linfáticas de incidencia creciente en el mundo y que en Chile representan la séptima causa de muerte por cáncer. El tratamiento con quimioterapia de los linfomas de alto grado de malignidad ha significado que globalmente se logren sobrevidas de 60 por ciento a cinco años. La ocurrencia de segundas neoplasias en pacientes con linfomas tratados es aproximadamente un 7 por ciento, correspondiendo la mayoría a tumores sólidos de pulmón, mama y leucemias agudas. No se ha descrito la leucemia mieloide crónica como complicación del tratamiento o forma secundaria en pacientes tratados por linfoma. PRESENTACIÓN DEL CASO: Paciente que un año y medio después de ser tratada de una recaída tardía de un Linfoma no Hodgkin de alto grado, avanzado, presenta leucemia mieloide crónica confirmada por cariograma y reacción de polimerasa en cadena. Recibe tratamiento con Imatinib con respuesta citogenética completa. DISCUSIÓN: Revisada la literatura no se encontró reportado otro caso similar. Está descrita la asociación entre ambas entidades, pero siempre el linfoma sigue o se presenta simultáneamente con la leucemia mieloide crónica. Esto podría tratarse de diferentes formas de expresión de una alteración de la stem cell pluripotente o bien de una ocurrencia al azar en una persona con defecto en los mecanismos antioncogénicos.

INTRODUCTION: Non-Hodgkin´s lymphoma is lymphatic neoplasms with increasing incidence in the world and in Chile represents the 7th cause of cancer death. Chemotherapy treatment of lymphomas of high malignancy has meant that overall survivals are prolonged in approximately 60 percent of all patients. The occurrence of second malignancies in patients after treatment of lymphoma is approximately 7 percent, beeing mostly solid tumors of lung, breast and acute leukemias. It has not been reported chronic myeloid leukemia as a complication of treatment or secondarily in patients treated of lymphoma. CASE REPORT: Patient that one and a half year after treatment of a late relapse of non-Hodgkin lymphoma of high grade, advanced, presents a chronic myeloid leukemia confirmed by karyotype and by polymerase chain reaction. After treatment with Imatinib the patient achieved a complete cytogenetic response. DISCUSSION: Review of the literature found no similar case report. It describes the association between both entities but lymphoma always following or occurring simultaneously with chronic myeloid leukemia. This could be different forms of expression of an alteration of the pluripotent stem cell or a random occurrence in a person with antioncogénicos defect mechanisms.

Linfoma de Hodkin en Chile: Experiencia de 15 años del Programa Nacional de Cáncer del Adulto / Hodgkin lymphoma in Chile: Experience of the national adult cancer program

Background: Hodgkin lymphoma is a highly curable disease. Aim: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. Patients and methods: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. Results: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61 percent of cases. Age over 40 was an adverse prognostic factor (p <0.001). The rate of PFS at 5 and 10 years for early stages was 73 percent and 66 percent with RT, 80 percent and 74 percent with C-MOPP+RT, 73 percent and 71 percent with C-MOPP/ABV, 59 percent and 59 percent with NOVP+RT, and 81 percent with ABVD+RT, at 5 years, being significantly lower for NOVP (p =0.02). The rate of OS at 5 and 10 years for advanced stages was 82 percent and 70 percent with RT, 82 percent and 76 percent with C-MOPP+RT, 82 percent and 80 percent with C-MOPP/ABV, 68 percent and 60 percent with NOVP, and 85 percent with ABVD at 5 years, also significantly lower for NOVP (p =0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49 percent and 43 percent with C-MOPP, 69 percent and 62 percent with C-MOPP/ABVD or C-MOPP/ABV, and 71 percent at 5 years with ABVD, significantly lower for C-MOPP (p =0.01). The rate of OS at 5 and 10 years was 52 percent and 46 percent with C-MOPP, 70 percent and 63 percent with C-MOPP/ABVD or C-MOPP/ABV and 76 percent with ABVD at 5 years, significantly lower for C-MOPP (p =0.0002). Conclusions: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early...

Enfermedad de von Willebrand como manifestación clínica inhabitual del hipotiroidismo primario: Caso clínico / Acquired von Willebrand disease as an unusual manifestation of primary hypothyroidism: Report of two cases

Patients with hypothyroidism may have a minor increase in their bleeding tendency, causing easy bruising and menorrhagia. There is a positive correlation between factor VIII coagulant activity and thyroxin serum levels. Thus, patients with hypothyroidism have an acquired coagulation defect that is reversible with thyroxin supplementation. We report two sisters, aged 13 and 11 years, who met the criteria for von Willebrand's disease at the age of eight. Both sisters had a primary hypothyroidism due to Hashimoto's thyroiditis, diagnosed three years later. Thyroid hormone replacement normalized von Willebrand factor, factor VIII, and the bleeding diathesis disappeared. Acquired von Willebrand's disease is an unusual manifestation of hypothyroidism. However the possibility of hypothyroidism should be considered in patients presenting with von Willebrand disease.

Ocurrencia de leucemia mieloide crónica y linfoma no Hodgkin en un mismo paciente: caso clínico / Simultaneous occurrence of chronic myeloid leukemia and non Hodgkin lymphoma: clinical case

Chronic myeloid leukemia is a myeloproliferative disorder caused by a clonal disturbance of the trunk cell and the accumulation of granulocytic series in the marrow, blood and other organs. We report a 63 years old male, carrier of a chronic myeloid leukemia whose clinical condition was complicated by the appearance of a T cell lymphoma. He was subjected to chemotherapy, that reduced the size of adenopathies and improved his general condition. Further studies are required to determine if there is a relationship between these two clinical entities

Enfermedad de Hodgkin: recaída tras 16 años de remisión continuada / Hodgkin's disease: relapse after 16 years of continous remission

We report a boy in whom an advanced Hodgkin's disease, nodular sclerosis variety was diagnosed at 5 yeras of age and treated with exclusive chemotherapy. After 16 years of remission, he presented with a relapsed of the disease with a different histological pattern and was subjected to chemotherapy (C-MOPP/AVB) and unilateral axillary irradiation, obtaining a complete remission of the disease. Four months later, the patients is asymptomatic and without evidences of relapse