The prognostic role of red cell distribution width on all-cause and cause-specific outcomes in peripheral T-cell lymphoma: a retrospective cohort study.

Readily accessible biomarkers for risk stratification in settings with limited resources are lacking. We evaluated the effect of high red distribution width-coefficient of variation (RDW-CV) values (>14%) on all-cause and lymphoma-specific mortality outcomes among 118 patients with peripheral T-cell lymphoma (PTCL) who received systemic treatment at two tertiary centers between 2010 and 2019. With a median follow-up of 45 months, patients with a high RDW-CV had a lower 4-year overall survival rate (34% vs. 45%, p = 0.015) and higher cumulative incidence of lymphoma mortality (54% vs. 34%, p = 0.007). RDW-CV >14% was associated with all-cause (adjusted Hazard Ratio [aHR] 1.98, 95% confidence interval [CI] 1.10-3.56) and lymphoma-specific mortality (aHR 2.64, 95% CI 1.32-5.29). In our study, RDW-CV emerges as an easily accessible and complementary prognostic biomarker for risk stratification among treated patients with de novo PTCL. Further research should validate the predictive role of RDW-CV in prospective cohorts.

Non-Hodgkin lymphoma treatment in middle-income countries in Latin America: perspective of the Latin American Study Group of Lymphoproliferative Disorders [Grupo de Estudio de Linfoproliferativos de Latino América (GELL)].

INTRODUCTION: Non-Hodgkin lymphomas (NHL) are the most frequently recognized entities among lymphoproliferative syndromes and rank fifth among neoplasms not associated with gender. There is scarce information on the clinical characteristics of the most frequent NHL, and no data on treatment regimens and their outcomes in Latin America. Although many factors affect a patient's possibilities of receiving treatment, the annual income per person/country is pivotal in Latin America. AIM: We present the clinical characteristics, risk groups, and treatment regimens of the three most frequent lymphoma subtypes in Latin America [diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and peripheral T-cell lymphoma (PTCL)], based on the data collected by the largest study group of lymphoproliferative diseases in Latin America: The Latin American Study Group of Lymphoproliferative Disease [Grupo de Estudio de Linfoproliferativos de Latino America (GELL)]. OUTCOMES: The most frequent treatment regimen for B-cell lymphomas is immunochemotherapy (R-CHOP ≥70%), and CHOP for PTCL. Survival is similar to that reported by industrialized nations. We have no solid data on the results of treatment with salvage regimens nor stem cell transplantation in refractory/ relapsed NHL. CONCLUSION: In Latin America, the same treatment regimens are used as in highly developed countries, although we lack the necessary technology to apply CAR T-cell therapies or a network of trials sponsored by the pharmaceutical industry.

Treatment and Survival Outcomes of Waldenstrom Macroglobulinemia in Latin American Patients: A Multinational Retrospective Cohort Study.

PURPOSE: Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features, and data from Latin American patients are lacking. Therefore, we aim to investigate the clinical, therapy, and outcome patterns of WM in Latin America. METHODS: We retrospectively analyzed patients with WM diagnosed between 1991 and 2019 from 24 centers in seven Latin American countries. The study outcomes were overall survival (OS) and progression-free survival (PFS). RESULTS: We identified 159 cases (median age 67 years, male 62%). Most patients (95%) were symptomatic at diagnosis. The International Prognostic Scoring System for WM (IPSSWM) at diagnosis was available in 141 (89%) patients (high-risk 40%, intermediate-risk 37%, and low-risk 23%). Twenty-seven (17%) patients were tested for MYD88L265P, with 89% (n = 24 of 27) carrying the mutation. First-line and second-line therapies were administered to 142 (89%) and 53 (33%) patients, respectively. Chemoimmunotherapy was the most commonly used first-line (66%) and second-line (45%) approach; only 18 (11%) patients received ibrutinib. With a median follow-up of 69 months, the 5-year OS rate was 81%. In treated patients, the 5-year OS and PFS rates were 78% and 59%, respectively. High-risk IPSSWM at treatment initiation was an independent risk factor for OS (adjusted hazard ratio: 4.73, 95% CI, 1.67 to 13.41, P = .003) and PFS (adjusted hazard ratio: 2.43, 95% CI, 1.31 to 4.50, P = .005). CONCLUSION: In Latin America, the management of WM is heterogeneous, with limited access to molecular testing and novel agents. However, outcomes were similar to those reported internationally. We validated the IPSSWM score as a prognostic factor for OS and PFS. There is an unmet need to improve access to recommended diagnostic approaches and therapies in Latin America.

Sphingolipids and Lymphomas: A Double-Edged Sword.

Lymphomas are a highly heterogeneous group of hematological neoplasms. Given their ethiopathogenic complexity, their classification and management can become difficult tasks; therefore, new approaches are continuously being sought. Metabolic reprogramming at the lipid level is a hot topic in cancer research, and sphingolipidomics has gained particular focus in this area due to the bioactive nature of molecules such as sphingoid bases, sphingosine-1-phosphate, ceramides, sphingomyelin, cerebrosides, globosides, and gangliosides. Sphingolipid metabolism has become especially exciting because they are involved in virtually every cellular process through an extremely intricate metabolic web; in fact, no two sphingolipids share the same fate. Unsurprisingly, a disruption at this level is a recurrent mechanism in lymphomagenesis, dissemination, and chemoresistance, which means potential biomarkers and therapeutical targets might be hiding within these pathways. Many comprehensive reviews describing their role in cancer exist, but because most research has been conducted in solid malignancies, evidence in lymphomagenesis is somewhat limited. In this review, we summarize key aspects of sphingolipid biochemistry and discuss their known impact in cancer biology, with a particular focus on lymphomas and possible therapeutical strategies against them.

Real-World Data on Adult T-Cell Leukemia/Lymphoma in Latin America: A Study From the Grupo de Estudio Latinoamericano de Linfoproliferativos.

PURPOSE: Adult T-cell leukemia/lymphoma (ATLL) is an aggressive disease caused by the human T-cell leukemia virus type 1. Real-world data of ATLL in Latin America are lacking. PATIENTS AND METHODS: We analyzed patients with ATLL (acute, lymphomatous, chronic, and smoldering) encountered in 11 Latin American countries between 1995 and 2019. Treatment response was assessed according to the 2009 consensus report. Survival curves were estimated using the Kaplan-Meier method and log-rank test. RESULTS: We identified 253 patients; 226 (lymphomatous: n = 122, acute: n = 73, chronic: n = 26, and smoldering: n = 5) had sufficient data for analysis (median age 57 years). Most patients with ATLL were from Peru (63%), Chile (17%), Argentina (8%), and Colombia (7%). Hypercalcemia was positively associated with acute type (57% v lymphomatous 27%, P = .014). The median survival times (months) were 4.3, 7.9, 21.1, and not reached for acute, lymphomatous, chronic, and smoldering forms, with 4-year survival rates of 8%, 22%, 40%, and 80%, respectively. First-line zidovudine (AZT)-interferon alfa (IFN) resulted in an overall response rate of 63% (complete response [CR] 24%) for acute. First-line chemotherapy yielded an overall response rate of 41% (CR 29%) for lymphomatous. CR rate was 42% for etoposide, cyclophosphamide, vincristine, doxorubicin, and prednisone versus 12% for cyclophosphamide, vincristine, doxorubicin, and prednisone-like regimen (P < .001). Progression-free survival at 1 year for acute type patients treated with AZT-IFN was 67%, whereas 2-year progression-free survival in lymphomatous type patients who achieved CR after chemotherapy was 77%. CONCLUSION: This study confirms Latin American ATLL presents at a younger age and has a high incidence of lymphomatous type, low incidence of indolent subtypes, and worse survival rates as compared with Japanese patients. In aggressive ATLL, chemotherapy remains the preferred choice for lymphomatous favoring etoposide-based regimen (etoposide, cyclophosphamide, vincristine, doxorubicin, and prednisone), whereas AZT-IFN remains a good first-line option for acute subtype.

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin-6 and matrix metalloproteinases.

Systemic embolization has been reported in up to 40% of patients with left atrial myxoma, half of them with cerebral involvement. However, development of intracerebral embolization associated with parenchymal seeding of the myxoma emboli is an extremely rare complication, with only 36 histologically diagnosed cases reported in the published literature. We describe a 69-year-old woman who arrived at the emergency service with hemiparesis associated with drug-resistant epilepsy and a medical history of resection of a left atrial myxoma 10 months previously. Cranial computed tomography revealed multiple large lesions of heterogeneous density and cystic components in the occipital lobes and posterior fossa parenchyma. Histopathological analyses after stereotactic biopsy of the occipital lesion revealed infiltrative myxoma cells with benign histological findings and uniform expression of calretinin similar to that of the primary cardiac myxoma. Additional immunohistochemical studies confirmed brain parenchymal seeding of the myxoma cells with strong expression of interleukin-6 (IL-6) and focal expression of matrix metalloproteinases-2 (MMP-2). Here, we discuss the clinicopathological features of intracerebral embolization of left atrial myxomas associated with progressive parenchymal seeding of the tumor emboli and the potential pathogenic role of IL-6 and MMPs.

Recomendaciones clínicas para el manejo de pacientes oncológicos en el marco de la pandemia COVID-19 / Clinical Recommendations For The Management Of Cancer Patients In The Context Of The COVID-19 Pandemic

La enfermedad por la nueva cepa de Coronavirus (COVID-19) ha sido catalogada como una pandemia por la OMS. En el Perú, se decretó estado de emergencia nacional y aislamiento social obligatorio desde el 15 de marzo. Los sistemas de salud a nivel mundial han sufrido un gran impacto debido la infección por COVID-19, lo cual obligó a los sistemas de salud, sociedades y asociaciones médicas a diseñar estrategias de intervención priorizada para dar continuidad a la atención de los pacientes en áreas COVID-19 y áreas libres de COVID-19. El paciente con cáncer es catalogado como vulnerable y representa un factor de riesgo para complicaciones, como ingreso a unidad de cuidados intensivos, intubación y muerte temprana por infección por COVID-19. Es así como la Asociación de Médicos Ex-Residentes de Oncología Médica (AMEROM), ha realizado esfuerzos para poder realizar recomendaciones adaptables a nuestro sistema de salud, con la finalidad de dar continuidad a la atención priorizada de los pacientes con cáncer. Mediante la metodología modificada de consenso de expertos, bajo el sustento bibliográfico, se han generado recomendaciones en diferentes etapas de la pandemia, llegando a un consenso final con recomendaciones clínicas para el manejo de pacientes oncológicos en el marco de la pandemia COVID-19 en Perú, con el fin de brindar información útil para los profesionales de la salud. El presente artículo indica los procesos con los que se llegaron a los acuerdos para dictar las recomendaciones y generar el orden de prioridad adoptado por AMEROM.

The disease by the new coronavirus strain (COVID-19) has been classified as apandemic by the WHO. In Peru, a state of national emergency and compulsory socialisolation had been declared since 15 March. Global health systems have been greatlyimpacted by COVID-19, which forced health systems, societies and medicalassociations to design prioritized intervention strategies to provide continuity of patientcare in infected areas and COVID-19-free areas. A cancer patient is classified asvulnerable and represents a risk factor for complications due to COVID-19, such asadmission to the intensive care unit, intubation, and early death due to infection due toCOVID-19. This is how the Asociación de Médicos Ex Residentes de OncologíaMédica (AMEROM), has endeavored to give recommendations adaptable to our healthsystem, to continue with the prioritized care of cancer patients. Through the modifiedmethodology of expert consensus, based on the literature, recommendations have beengenerated at different stages of the pandemic, reaching a final consensus of clinicalrecommendations for the management of cancer patients in the framework of theCOVID-19 pandemic in Peru, to provide useful information to health professionals.This article indicates the processes by which agreements were reached to makerecommendations and generate the order of priority adopted by AMEROM.

Linfoma/Leucemia T del adulto: Entidad prevalente en Sudamérica / Adult Lymphoma / Leukemia T: Prevalent Entity In South America

El Linfoma/Leucemia T del adulto es una entidad linfoproliferativa T agresiva asociado al retrovirus, HTLV-1. La infección por HTLV-1 es endémica en Japón, Caribe, África, Sudamérica y en el Medio Este. En Sudamérica, tenemos a Perú, Brasil, Colombia y Chile. El Perú es endémico para este virus. La prevalencia del retrovirus en Europa y USA es menor del 1% pero en Perú se estima alrededor del 3% de la población adulta sana es portadora del retrovirus. De Chile, existen varios reportes de ATLL desde el año 1992 por la Dra. Cabrera y col.

Adult T - lymphoma / leukemia is an aggressive T lymphoproliferative entity associated retrovirus HTLV-1- T. HTLV-1 infection is endemic in Japan, the Caribbean, Africa, South America, and the Middle East. In South America, we have Peru, Brazil, Colombia and Chile. Peru is endemic for this virus. The prevalence of retroviruses in Europe and the USA. USA It is less than 1% but in Peru it is estimated that around 3% of the healthy adult population is a carrier of the retrovirus. From Chile, there have been several ATLL reports since 1992 by Dra. Cabrera et al.

EBV-positive diffuse large B-cell lymphoma, not otherwise specified: 2020 update on diagnosis, risk-stratification and management.

DISEASE OVERVIEW: Epstein Barr virus-positive (EBV+) diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) is an entity included in the 2016 WHO classification of lymphoid neoplasms. EBV+ DLBCL, NOS, is an aggressive B-cell lymphoma associated with chronic EBV infection, and a poor prognosis with standard chemotherapeutic approaches. DIAGNOSIS: The diagnosis is made through a careful pathological evaluation. Detection of EBV-encoded RNA (EBER) is considered standard for diagnosis; however, a clear cutoff for positivity has not been defined. The differential diagnosis includes plasmablastic lymphoma (PBL), DLBCL associated with chronic inflammation and primary effusion lymphoma (PEL), among others. RISK-STRATIFICATION: The International Prognostic Index (IPI) and the Oyama score can be used for risk-stratification. The Oyama score includes age >70 years and presence of B symptoms. The expression of CD30 and PD-1/PD-L1 are emerging as potential adverse but targetable biomarkers. MANAGEMENT: Patients with EBV+ DLBCL, NOS, should be staged and managed following similar guidelines than patients with EBV-negative DLBCL. EBV+ DLBCL, NOS, however, might have a worse prognosis than EBV-negative DLBCL in the era of chemoimmunotherapy. There is an opportunity to study and develop targeted therapy in the management of patients with EBV+ DLBCL, NOS.

Índice linfocito/monocito como factor pronóstico en linfoma células grandes b difuso, hospital Edgardo Rebagliati Martins 2010-2017 / Lymphocyte / monocyte index as pronostic factor in diffuse large b cell lymphoma, Edgardo Rebagliati Martins hospital 2010-2017

Objetivo: Evaluar el valor pronostico del índice linfocito monocito (ILM) en la sobrevida global de los pacientes con Linfoma de células grandes B difuso (LCGBD) del Hospital Edgardo Rebagliati Martins. Métodos: Estudio longitudinal retrospectivo. Se incluyó a los casos de LCGBD diagnosticados en el Hospital Nacional Edgardo Rebagliati Martins durante el período 2010-2017. No se realizó muestreo, se trabajó con la totalidad de la población que cumplió con los criterios de selección por ser esta pequeña y accesible. Se revisó las historias clínicas de los pacientes obteniéndose información del tiempo en meses de supervivencia, del ILM así como de variables sociodemográficas, clínicas y de laboratorio. Resultados: Se incluyó en el análisis a 121 pacientes con LCGBD; de ellos, el 57% eran de sexo femenino y 66.1% eran mayores de 60 años. De acuerdo al Status Zubrod, el 66,5% correspondieron al grado de mejor pronóstico y el 59.5% presento sintomas B asociados. Cerca del 60% fueron diagnosticados en estadios I y II y el 57% presento compromiso extraganglionar. El análisis bivariado con el modelo de riesgos proporcionales de Cox mostró que el ILM<2 constituyó un predictor de la supervivencia global del LCGBD (p=0,011) estimándose un HR=2.2 (IC 95%: 1.2-4.1); asimismo, un ILM< 1,7 también constituyó predictor (p=0,009) estimándose un HR=2.2 (IC 95%: 1.2-4.1). El ILM<2,7 no constituyó predictor de la supervivencia global. Conclusión: El ILM podría utilizarse como un índice pronóstico debido a que constituye un predictor de la supervivencia global de los pacientes con LCGBD del Hospital Nacional Edgardo Rebagliati Martins.

Objetive: To evaluate the prognostic value of the monocyte lymphocyte index (ILM) in the overall survival of patients with diffuse large B-cell lymphoma (LCGBD) of the Edgardo Rebagliati Martins Hospital. Methods: Retrospective longitudinal study. We included cases of LCGBD diagnosed in the National Hospital Edgardo Rebagliati Martins during the period 2010-2017. No sampling was done, we worked with the entire population that met the selection criteria because it is small and accessible. The patients' clinical histories were reviewed, obtaining information about the time in months of survival, ILM, as well as sociodemographic, clinical and laboratory variables. Results: 121 patients with LCGBD were included in the analysis; of them, 57% were female and 66.1% were older than 60 years. According to the Zubrod Status, 66.5% corresponded to the degree of better prognosis and 59.5% presented associated B symptoms. About 60% were diagnosed in stages I and II and 57% presented extranodal involvement. The bivariate analysis with the Cox proportional hazards model showed that the ILM <2 constituted a predictor of the overall survival of the LCGBD (p = 0.011), estimating HR = 2.2 (95% CI: 1.2-4.1); likewise, an ILM <1.7 was also a predictor (p = 0.009) with an estimated HR = 2.2 (95% CI: 1.2-4.1). ILM <2.7 was not a predictor of overall survival.. Conclusion: The ILM could be used as a prognostic index because it is a predictor of the overall survival of patients with LCGBD of the Edgardo Rebagliati Martins National Hospital.

Índice linfocito/monocito como factor pronóstico en linfoma células grandes B difuso en un hospital nacional de Lima-Perú, período 2010-2017 / Index lymphocyte/monocite as a pronosis factor in lymphoma large cells diffuse, Edgardo Rebagliati Martins Hospital 2010-2017

Objetivo: Evaluar el valor pronostico del índice linfocito monocito (ILM) en la sobrevida global de los pacientes con Linfoma de células grandes B difuso (LCGBD) del Hospital Edgardo Rebagliati Martins. Métodos: Estudio longitudinal retrospectivo. Se incluyó a los casos de LCGBD diagnosticados en el Hospital Nacional Edgardo Rebagliati Martins durante el período 2010-2017. No se realizó muestreo, se trabajó con la totalidad de la población que cumplió con los criterios de selección por ser esta pequeña y accesible. Se revisó las historias clínicas de los pacientes obteniéndose información del tiempo en meses de supervivencia, del ILM así como de variables sociodemográficas, clínicas y de laboratorio. Resultados: Se incluyó en el análisis a 121 pacientes con LCGBD; de ellos, el 57% eran de sexo femenino y 66.1% eran mayores de 60 años. De acuerdo al Status Zubrod, el 66,5% correspondieron al grado de mejor pronóstico y el 59.5% presento sintomas B asociados. Cerca del 60% fueron diagnosticados en estadios I y II y el 57% presento compromiso extraganglionar. El análisis bivariado con el modelo de riesgos proporcionales de Cox mostró que el ILM<2 constituyó un predictor de la supervivencia global del LCGBD (p=0,011) estimándose un HR=2.2 (IC 95%: 1.2-4.1); asimismo, un ILM< 1,7 también constituyó predictor (p=0,009) estimándose un HR=2.2 (IC 95%: 1.2-4.1). El ILM<2,7 no constituyó predictor de la supervivencia global. Conclusión: El ILM podría utilizarse como un índice pronóstico debido a que constituye un predictor de la supervivencia global de los pacientes con LCGBD del Hospital Nacional Edgardo Rebagliati Martins.

Objetive: To evaluate the prognostic value of the monocyte lymphocyte index (ILM) in the overall survival of patients with diffuse large B-cell lymphoma (LCGBD) of the Edgardo Rebagliati Martins Hospital. Methods: Retrospective longitudinal study. We included cases of LCGBD diagnosed in the National Hospital Edgardo Rebagliati Martins during the period 2010-2017. No sampling was done, we worked with the entire population that met the selection criteria because it is small and accessible. The patients' clinical histories were reviewed, obtaining information about the time in months of survival, ILM, as well as sociodemographic, clinical and laboratory variables. Results: 121 patients with LCGBD were included in the analysis; of them, 57% were female and 66.1% were older than 60 years. According to the Zubrod Status, 66.5% corresponded to the degree of better prognosis and 59.5% presented associated B symptoms. About 60% were diagnosed in stages I and II and 57% presented extranodal involvement. The bivariate analysis with the Cox proportional hazards model showed that the ILM <2 constituted a predictor of the overall survival of the LCGBD (p = 0.011), estimating HR = 2.2 (95% CI: 1.2-4.1); likewise, an ILM <1.7 was also a predictor (p = 0.009) with an estimated HR = 2.2 (95% CI: 1.2-4.1). ILM <2.7 was not a predictor of overall survival.. Conclusion: The ILM could be used as a prognostic index because it is a predictor of the overall survival of patients with LCGBD of the Edgardo Rebagliati Martins National Hospital.

Response and survival benefit with chemoimmunotherapy in Epstein-Barr virus-positive diffuse large B-cell lymphoma.

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a haematologic malignancy with poor prognosis when treated with chemotherapy. We evaluated response and survival benefits of chemoimmunotherapy in EBV-positive DLBCL patients. A total of 117 DLBCL patients were included in our retrospective analysis; 33 were EBV-positive (17 treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [R-CHOP] and 16 with CHOP), and 84 were EBV-negative (all treated with R-CHOP). The outcomes of interest were complete response (CR) and overall survival (OS) in EBV-positive DLBCL patients (R-CHOP versus CHOP) and in DLBCL patients treated with R-CHOP (EBV-positive vs EBV-negative). There were no differences in the clinical characteristics between EBV-positive and EBV-negative DLBCL patients. Among EBV-positive DLBCL patients, R-CHOP was associated with higher odds of CR (OR 3.14, 95% CI 0.75-13.2; P = .10) and better OS (hazard ratio 0.30, 95% confidence interval [CI] 0.09-0.94; P = .04). There were no differences in CR rate (OR 0.52, 95% CI 0.18-1.56; P = .25) or OS (hazard ratio 0.93, 95% CI 0.32-2.67; P = .89) between EBV-positive and EBV-negative DLBCL patients treated with R-CHOP. Based on our study, the addition of rituximab to CHOP is associated with improved response and survival in EBV-positive DLBCL patients. Epstein-Barr virus status does not seem to affect response or survival in DLBCL patients treated with R-CHOP.

The neutrophil-to-lymphocyte ratio is an independent prognostic factor in patients with peripheral T-cell lymphoma, unspecified.

Peripheral T-cell lymphoma (PTCL) encompasses a group of rare and aggressive lymphomas. PTCL, unspecified (PTCLU) is the most common subtype of PTCL, and carries a poor prognosis. The International Prognostic Index (IPI) and the Prognostic Index for PTCLU (PIT) scoring systems are powerful risk-stratification tools in patients with PTCL. The aim of this study was to evaluate whether the neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in PTCLU. We retrospectively studied 83 patients with diagnosis of PTCLU. In the univariate analysis, NLR ≥ 4 was associated with worse overall survival (HR 3.96, 95% CI 1.92-8.17; p < 0.001). In the multivariate analysis, NLR ≥ 4 was independently associated with worse overall survival after adjustment for the PIT score (HR 4.30, 95% CI 1.90-9.69; p < 0.001), and for the IPI score (HR 2.60, 95% CI 1. 12-6.04; p = 0.03). Our study suggests the NLR could be helpful in refining the survival prognostication in patients with PTCLU.

Follicular lymphoma with leukemic phase at diagnosis: a series of seven cases and review of the literature.

Follicular lymphoma (FL) is a prevalent type of non-Hodgkin lymphoma in the United States and Europe. Although, FL typically presents with nodal involvement, extranodal sites are less common, and leukemic phase at diagnosis is rare. There is mounting evidence that leukemic presentation portends a worse prognosis in patients with FL. We describe 7 patients with a pathological diagnosis of FL who presented with a leukemic phase. We compared our cases with 24 additional cases reported in the literature. Based on our results, patients who present with leukemic FL tend to have higher risk disease. Leukemic FL also seems to be associated with a worse prognosis; however, larger studies are needed to confirm our findings. A discrepancy with previously reported cases of FL in leukemic phase raises the possibility of differences attributable to geographic regions.

Diffuse large B-cell lymphoma in human T-lymphotropic virus type 1 carriers.

We describe the clinical and pathological characteristics of seven patients who were human T-lymphotropic virus type 1 (HTLV-1) carriers and had a pathological diagnosis of de novo diffuse large B-cell lymphoma. Interestingly, three of our cases showed positive expression of Epstein-Barr-virus, (EBV-) encoded RNA within the tumor cells indicating a possible interaction between these two viruses. Furthermore, our three EBV-positive cases presented with similar clinical characteristics such as early clinical stage and low-risk indices. To the best of our knowledge, this is the first case series describing the characteristics of HTLV-1-positive DLBCL patients. The potential relationship between HTLV-1 and EBV should be further explored.