RESUMO
The aim of the study is to see the frequency and severity of neutropenia after first or subsequent cycles of chemotherapy in patients of Non Hodgkin's lymphoma [NHL]. Descriptive cross sectional study. This study was carried in the Radiotherpay and Oncology Department, Bolan Medical Complex Hospital, Quetta, from March 2010 to February 2012, Forty two patients of different types of NHL diagnosed on lymph node biopsy presenting for the first time at Radiotherapy and Oncology Department in collaboration with Haematology Section [Pathology Deptt:], Bolan Medical Complex Hospital. Quetta, were included. They were admitted in the ward and evaluated with history, physical examination and for staging investigations. Patients were then planned for chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon [CHOP] and with rituximab [R CHOP]. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data were entered on a designed data sheet. Forty two patients of NHL were included in this study, of which 34 patients received CHOP, and 08 patients R-CHOP, from March, 2010 to February, 2012. According to WHO classification, 24[57.1%] patients were of Diffuse large B-cell lymphoma [DLBCL], 08[19.0%] were follicular lymphoma [FL] and 04[9.5%] patients were Mantle cell lymphoma [MCL] and remaining 06[1430] are other types of NHL's. 2[4.7%] of patients suffered from grage IV neutropenia [absolute neutrophil count of <0.5 x 10[9]7L], 3[7.1%] had grade III Neutropenia [absolute: Neutrophil count of 0.5 x 10[9]L-0.9 x 10[9]/L], 3[71%] had Grade II neutropenia [absolute netrophil count 1.5 x 10[9] /L-1.4 x 10[9]/L] and 5[11.9%] had Grad I neutropenia [absolute netrophil count 1.5 x 10[9]/L-1.900/L]. Other risk factors noted, i.e., cardiac, Liver and Renal comorbidities in 3[7.1%], 5[11.9%] and 4[9.5%] of patients respectively. Overall 30.8% of patients of NHL's suffered from neutropenia of all grades post first cycle of chemotherapy comprising CHOP and R-CHOP
RESUMO
Traditionally lymphomas are classified into Hodgkin's disease [HD] and Non Hodgkin's lymphoma [NHL] depending upon histo-pathological evidence on biopsy taken from an enlarged lymph node. Delayed diagnosis in lymphoma deteriorates the health eminence resulting in poor outcome. The aim of the study is to estimate the incidence and clinical presentation of malignant lymphomas in Balochistan. Prospective Study. This study was carried in the Department of Radiotherapy and Oncology, Bolan Medical Complex Hospital, Quetta from June, 2006 to May, 2012. A total of 263 newly diagnosed patients of both types of lymphoma from different parts of Balochistan were registered in Bolan Medical Complex Hospital in Department of Radiotherapy and Oncology. Followed by histopathology, WHO classification and Ann Arbor staging was done to assign subtype and extent of disease. It was found that the incidence of Non Hodgkin's lymphoma a [64.7%] was greater than Hodgkin's disease [35.2%] and both present bimodal distribution in age. Male patients dominate female patients in both cases [2.5:1]. Lymph-adenopathy of cervical region was primary site in 44 % of cases while 27.6 % were extra nodal. Histopathology shows 57.4 % mixed cellularity variant in Hodgkin's lymphoma and 25.5% diffuse B cell pattern in Non Hodgkin's lymphoma. Ann Arbor staging reveals that 3.4% cases present with stage I and 64.5% show stage IV. To conclude Non Hodgkin's lymphoma is two times more frequent than Hodgkin's lymphoma with greater male contribution. Due to delayed diagnosis resulted in late stage presentation ,health awareness is needed for physicians and general population for availability of patients at a due time for management