Subject(s)
Leukemia, Plasma Cell/genetics , Leukemia, Plasma Cell/therapy , Adult , Aged , Aged, 80 and over , Humans , Karyotyping , Middle AgedABSTRACT
Haematodermic neoplasm is a recently recognized condition, characterized by tumour cells expressing CD4, CD56 and CD123. This phenotype is strongly suggestive of a plasmacytoid dendritic cell origin. This haematopoietic malignancy is a distinct clinicopathological condition with frequent skin involvement, an evolution toward leukaemia and a rapidly aggressive course. We report the case of a 64-year-old woman who presented with a haematodermic CD4+CD56+CD123+ neoplasm affecting the left cheek; the initial staging was otherwise negative. Despite this early stage of the disease, aggressive treatment including methotrexate-asparaginase and local radiotherapy was proposed as first-line therapy. Complete clinical remission was rapidly reached and the patient was still alive after > 30 months of follow-up. To date there is no consensus on the first-line treatment for such patients but intensive treatment is probably needed immediately even in cases of localized disease. The response obtained with CHOP (cyclophosphamide, doxyrubicin, vincristine, prednisone) or CHOP-like chemotherapy regimens is disappointing. Other regimens, such as those used in acute leukaemia, may improve the outcome of these patients.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Facial Neoplasms/drug therapy , Lymphoma, Non-Hodgkin/drug therapy , Skin Neoplasms/drug therapy , Asparaginase/administration & dosage , Facial Neoplasms/pathology , Female , Humans , Lymphoma, Non-Hodgkin/pathology , Methotrexate/administration & dosage , Middle Aged , Skin Neoplasms/pathologyABSTRACT
BACKGROUND: Non-Hodgkin's lymphoma (NHL) in patients older than 80 years is not a rare disease and treatment strategies are often difficult because of associated comorbidities. PATIENTS AND METHODS: We entered 205 NHL patients older than 80 years treated in a single institution in a retrospective analysis to describe clinical presentation and outcome and to identify specific prognostic factors. RESULTS: The median age was 83 years, and 91% of the cases were B-cell lymphomas consisting mainly of diffuse large B-cell lymphoma and marginal zone lymphoma. Among patients presenting comorbidities (87%), Charlson index was low in almost half of the patients (43%). Patients did not receive any treatment or received corticosteroids alone in 15%, surgery, radiotherapy, or monochemotherapy in 35%, polychemotherapy without anthracycline in 18%, and anthracycline based in 32%. Median overall survival was of 2.2 years. Main reason for death was disease progression (57%). Independent prognostic factors of survival were poor performance status (P < 10(-4)) and high lactate dehydrogenase level (P < 10(-5)). Comorbidities were not found to influence survival. CONCLUSIONS: Very elderly NHL patients showed similar features and prognostic factors than younger patients. Death was related mainly to the disease, meaning that these patients should be more frequently treated with standard treatments.
Subject(s)
Antineoplastic Agents/therapeutic use , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/therapy , Adrenal Cortex Hormones/therapeutic use , Aged, 80 and over , Anthracyclines/administration & dosage , Antibiotics, Antineoplastic/administration & dosage , Antineoplastic Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Comorbidity , Diagnosis, Differential , Disease Progression , Female , Humans , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Large B-Cell, Diffuse/therapy , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/mortality , Lymphoma, Non-Hodgkin/radiotherapy , Lymphoma, Non-Hodgkin/surgery , Male , Prognosis , Radiotherapy, Adjuvant , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
One hundred de novo multiple myeloma patients with t(4;14) treated with double intensive therapy according to IFM99 protocols were retrospectively analyzed. The median overall survival (OS) and event-free survival (EFS) were 41.4 and 21 months, respectively, as compared to 65 and 37 for patients included in the IFM99 trials without t(4;14) (P<10(-7)). We identified a subgroup of patients presenting at diagnosis with both low beta(2)-microglobulin <4 mg/l and high hemoglobin (Hb) >/=10 g/l (46% of the cases) with a median OS of 54.6 months and a median EFS of 26 months, respectively, which benefits from high-dose therapy (HDT); conversely patients with one or both adverse prognostic factor (high beta(2)-microglobulin and/or low Hb) had a poor outcome. The achievement of either complete response or very good partial response after HDT was also a powerful independent prognostic factor for both OS and EFS.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Genetic Heterogeneity , Multiple Myeloma/drug therapy , Multiple Myeloma/genetics , Translocation, Genetic , Adult , Aged , Chromosomes, Human, Pair 14 , Chromosomes, Human, Pair 4 , Cytarabine/administration & dosage , Dexamethasone/administration & dosage , Disease-Free Survival , Female , Follow-Up Studies , Hemoglobins , Humans , Male , Middle Aged , Multiple Myeloma/mortality , Multivariate Analysis , Prognosis , Retrospective Studies , Vincristine/administration & dosage , beta 2-Microglobulin/bloodSubject(s)
Cardiac Output, Low/diagnosis , Fluoroimmunoassay/methods , Immunoglobulin M/blood , Natriuretic Peptide, Brain/blood , Paraproteins/analysis , Aged, 80 and over , Antibodies, Monoclonal/immunology , Diagnosis, Differential , False Positive Reactions , Humans , Immunoglobulin kappa-Chains/blood , Lung Diseases/diagnosis , MaleABSTRACT
Rituximab, an anti-CD20 monoclonal antibody, is increasingly used in the treatment of B-cell non-Hodgkin's lymphoma. Late-onset neutropenia in relation to rituximab has been recently described. In this report, we present six cases occurring after stem cell transplantation and discuss the potential impact of this complication.
