ABSTRACT
CONTEXT: Support for non-Hodgkin's lymphoma (NHL) with large cells that is refractory or relapsed after first-line chemotherapy poses a greater therapeutic problem with bone marrow transplant therapy or when old age is a contra-indication for high-dose chemotherapy, especially among developing countries such as Algeria. AIM: To show that the regimen, including gemcitabine, could be more effective in treating elderly patients with diffuse large B-cell lymphoma (DLBCL) in relapse / refractory, without complete remission, when compared with the ESHAP (etoposide, cisplatine, solumedrol, aracytine) regimen. MATERIALS AND METHODS: Ninety-six patients in the age group of 60-70 years were volunteers for a prospective randomized single-blind study, carried out for three years. Patients were divided into two groups by the drawing of lots. The first group (GA, n = 48, relapse; n = 27 [56.3%], refractory; n = 21 [43.7%]) received treatment with ESHAP protocol and the second one (GB, n = 48, relapse; n = 28 [58%], refractory; n = 20 [42%]) with GPD (gemcitabine, dexamethasone, cisplatine) protocol. RESULTS: The overall response rates and mean survival at three years were significantly higher among patients subjected to GPD treatment compared with those subjected to ESHAP treatment (63% vs. 55%, P = 0.01 and 20.5% [95% CI 16.5-24.5] vs. 11.8% [8.9-14.6], respectively). Additionally, three-year progression-free and event-free survival rates were 20.5% (16.3-24) and 19.7% (15.9-23.5), respectively, for the GPD regimen and 10.9% (8.2-13.7) and 11.1% (95% CI 8.5-13.7), respectively, for the ESHAP regimen. Moreover, the GPD regimen was associated with improving overall survival (RR=2.02, 95% CI 1.59-2.56; P = 0.000), event-free survival (2.03, 1.64-2.52; P < 0.001) and progression-free survival (1.86, 1.46-2.37; P < 0.001). CONCLUSION: In cases of contra-indication for high-dose chemotherapy for elderly patients with DLBCL, without complete remission, the Gemcitabine-based therapy protocol represents a more effective and less toxic than that of ESHAP.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Deoxycytidine/analogs & derivatives , Lymphoma, Large B-Cell, Diffuse/drug therapy , Neoplasm Recurrence, Local/drug therapy , Aged , Cisplatin/administration & dosage , Cisplatin/adverse effects , Cytarabine , Deoxycytidine/administration & dosage , Deoxycytidine/adverse effects , Dexamethasone/administration & dosage , Dexamethasone/adverse effects , Disease-Free Survival , Etoposide , Female , Humans , Kaplan-Meier Estimate , Lymphoma, Large B-Cell, Diffuse/mortality , Male , Methylprednisolone , Middle Aged , Neoplasm Recurrence, Local/mortality , GemcitabineABSTRACT
Diabetes mellitus has become a major international health problem in recent decades. In this study we report a prevalence of diabetes of 14.2% in a set of 7,656 subjects in urban and rural areas of Tlemcen (in western Algeria), higher among men (20.4%) than women (10.7%). The prevalence of type 2 diabetes (initially non-insulin-dependent diabetes mellitus: NIDDM) was 10.5% and of type 1 diabetes (insulin-dependent diabetes mellitus: IDDM) 3.7%. Overall prevalence was higher in urban (15.3%) than rural (12.9%) areas. More than half of all patients with diabetes had family members with the disease. Estimating the obesity rate according to body mass index (BMI), we found that 56.7% of all men and more than half of all women in urban areas were obese. Degenerative complications were found in 60% of diabetes patients. A policy for tracking, treating and preventing diabetes and obesity is strongly needed.
