ABSTRACT
Background: Hematopoietic stem cell transplantation (HSCT) has been performed in Singapore since 1985. Currently, more than 100 transplants are performed annually across the public and private sectors. In 2020, the COVID-19 pandemic resulted in unprecedented disruptions to global healthcare systems, and Singapore was no exception. In particular, the field of HSCT faced additional, unique challenges aside from those borne by the healthcare system at large, and appropriate measures were necessary to ensure that HSCT remained available to patients who needed it. Methods: The expert opinions of six hematologists from various institutions across Singapore were gathered through individual interviews and summarized. This was supplemented by a literature review on bone marrow donation and HSCT in Singapore. Main Findings and Conclusion: In Singapore, the COVID-19 pandemic has had significant implications for HSCT, ranging from the implementation of additional infection control measures in hospitals to an accelerated rise in haploidentical transplants. Further research is required to better understand and quantify these impacts, improve existing processes, and investigate the effects of COVID-19 and its treatment modalities on patients with HSCT.
ABSTRACT
Primary mediastinal large B-cell lymphoma (PMBCL) is a distinct clinico-pathological subtype of diffuse large B-cell lymphoma with unclear prognostic factors and limited clinical data. Optimal treatment and role for radiotherapy is not fully defined. We performed a multicenter retrospective review of 124 patients with newly diagnosed PMBCL between 2001 and 2016. Treatment regimens were R-CHOP (n = 41), R-CHOP + RT (n = 37), and DA-EPOCH-R (n = 46). 6% (n = 3) in the DA-EPOCH-R group received RT. With a median follow up of 45 months, the overall 5-year OS and PFS was 89.4% and 82.4%, respectively. The type of chemo-radiotherapy regimen, B symptoms and Ann-Arbor staging showed a significant association with OS on univariate analysis but only B symptoms remained prognostic (P = 0.012) after multivariate analysis. The chemo-radiotherapy regimen, Japanese IPI and Ann-Arbor stage was significantly associated with PFS in univariate analysis, but only chemo-radiotherapy regimen remained significant (P = 0.02) after multivariate analysis. Patients who received R-CHOP + RT or DA-EPOCH-R had better PFS than those receiving R-CHOP alone, with 5-year PFS of 90% vs 88.5% vs 56%, respectively (P = 0.02). In the subgroup analysis of patients with bulk (n = 71), R-CHOP alone (n = 21) had inferior 5-year PFS 56.6% compared to those who received R-CHOP + RT (n = 23) 91.3% or DA-EPOCH-R (n = 27) 92.6% (P = 0.007). In contrast, in patients without bulk (n = 42), there was no impact of treatment regimen on PFS (P = 0.25). In conclusion, R-CHOP + RT and DA-EPOCH-R provide excellent outcomes in patients with PMBCL. In patients with bulky disease, the use of DA-EPOCH-R may be preferable as it allows omission of RT without reduction in efficacy.
