CD 5+ Peripheral B Cell Lymphoma With Transformation to CD 5+ Diffuse Large B Cell Lymphoma in the CNS: A Case Report Treated With Rituximab, High Dose Methotrexate, Cytarabine, and Intrathecal Methotrexate.

B-cell non-Hodgkin's lymphoma includes several subtypes, notably Diffuse Large B-Cell Lymphoma (DLBCL), the most common B-cell subtype. Each presentation has its defining characteristic, of which CD5 positivity is notoriously known for being a poor prognostic factor. CD5 positivity has a high female preponderance, more commonly involves the bone marrow, presents with higher LDH levels and B symptoms on presentation, and stage 3-4 on the diagnosis. The exact incidence of CD5+ DLBCL arising from Chronic Lymphocytic Leukemia (CLL) is not explicitly defined in the literature, but it can be expected in about 5-10% of cases on average. Our patient is a 52-year-old female with no previous history of malignancy who presented with bilateral lower extremity weakness progressing to paraplegia and was found to have a CD5+ B-cell lymphoma in the peripheral blood with a CD5+ Diffuse Large B-cell lymphoma in the central nervous system (CNS). Treatment consisted of Rituximab, High dose Methotrexate (HD-MTX), and Cytarabine/intrathecal Methotrexate for CNS involvement for four cycles. Our patient tolerated therapy with improved neurological symptoms and no evidence of blasts on her peripheral smear or malignant cells on Cerebral Spinal Fluid Flow Cytometry after treatment. Her presentation and response to treatment highlight a possible treatment scheme for this rare and aggressive disease subtype.

Prechemotherapy Education: Reducing Patient Anxiety Through Nurse-Led Teaching Sessions
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BACKGROUND: Patients with cancer experience stress surrounding diagnosis and treatment. Many cancer centers employ a nurse-led education session to alleviate patient anxiety and confusion.
. OBJECTIVES: The goal was to evaluate the effect of a nurse-led chemotherapy teaching session on patients' knowledge, anxiety, and preparedness for cancer-directed therapy.
. METHODS: After discussing treatment with their oncologist, participants completed a survey assessing their perceived understanding of various treatment topics. After, they underwent a teaching session with an oncology nurse. The survey was readministered when patients returned for their first and second treatment cycles.
. FINDINGS: Significant increases were observed in patients' understanding of their treatment schedule, potential adverse effects, and antiemetic medication regimen by the first cycle of therapy and a reduction in treatment-related anxiety by the second cycle of therapy.

TAFRO Syndrome Associated with EBV and Successful Triple Therapy Treatment: Case Report and Review of the Literature.

TAFRO syndrome is a rare constellation of symptoms: thrombocytopenia, anasarca, reticulin fibrosis of the bone marrow, renal dysfunction, and organomegaly. Its pathogenesis involves an excessive and inappropriate cytokine storm, most notably from IL-6, causing multiorgan failure; however, its etiology is undetermined. Starting in 2012, TAFRO syndrome was first identified in Japan as an atypical variant of Castleman's disease. Previous reports include various different treatment protocols with inconsistent survival outcomes. Here we report the first known American, EBV positive but HIV and HHV-8 negative, male with TAFRO syndrome. He was successfully treated with an unusual three-drug regimen including tocilizumab, etoposide, and rituximab. We review the literature of TAFRO syndrome, discuss its possible viral etiology, and propose an original treatment regimen.

FOLFOX+Nab-Paclitaxel (FOLFOX-A) for Advanced Pancreatic Cancer: A Brown University Oncology Research Group Phase I Study.

BACKGROUND: The Brown University Oncology Research Group performed a phase I study to remove irinotecan from FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin) and substitute nab-paclitaxel. METHODS: Patients with newly diagnosed advanced pancreatic adenocarcinoma were eligible. Patients received oxaliplatin 85 mg/m, leucovorin 400 mg/m, and 5-fluorouracil 2400 mg/m with 3 dose levels of nab-paclitaxel (125, 150, and 175 mg/m) every 2 weeks. Dose-limiting toxicities were assessed in the first 2 cycles of treatment. The final dose level was expanded to assess cumulative neurotoxicity. RESULTS: Thirty-five patients were entered; 24 with metastatic and 11 with locally advanced pancreatic cancer. The maximum tolerated dose of nab-paclitaxel was 150 mg/m every 2 weeks with FOLFOX. Cumulative neuropathy was the most important toxicity. Grade 3 neuropathy developed in 2 of the first 6 patients at 10 and 11 cycles of FOLFOX-A. Following an amendment to reduce oxaliplatin to 65 mg/m if grade 2 neuropathy developed, no additional patients developed grade 3 neurotoxicity. Twenty-one of 35 patients (60%) had a partial response. The median survival for patients with metastatic disease was 15 months. CONCLUSIONS: The maximum tolerated dose of nab-paclitaxel is 150 mg/m every 2 weeks with FOLFOX. The regimen of FOLFOX-A represents a promising treatment for pancreatic cancer.

Systemic lupus erythematosus is associated with increased incidence of hematologic malignancies: a meta-analysis of prospective cohort studies.

Our objective was to define the risk of lymphoma, leukemia and myeloma in adult patients with SLE with a meta-analysis of prospective cohort studies. A literature search from 1995 to 2013 revealed eight studies evaluating this association. The outcome of interest was the standardized incidence ratio (SIR). Our study included 401 cases in a cohort of approximately 68,000 SLE patients, and showed an increased incidence of all hematologic malignancies (SIR 2.9), non-Hodgkin lymphoma (SIR 5.7), Hodgkin lymphoma (SIR 3.1), leukemia (SIR 2.3) and myeloma (SIR 1.5) in SLE patients compared with the general population. The increased SIR was consistent regardless of age, sex or geographical region.

Viral lymphomagenesis: from pathophysiology to the rationale for novel therapies.

The association between viruses and lymphomas has long been recognized; however, the pathophysiological phenomena behind this relationship are unclear, and have been the object of intense research. Although our understanding of such mechanisms is slowly improving, much is still left to learn. With the recent advances in cancer biology, a diversity of biological pathways and novel targets and agents have been described in patients with haematological malignancies and successfully put into clinical practice. Clear examples are rituximab and brentuximab vedotin in patients with B cell lymphomas and Hodgkin lymphoma respectively. The main purpose of this review is not only to succinctly summarize what we know regarding the pathogenesis and pathophysiology of virally induced lymphomas and to describe the current practices in terms of diagnosis of treatment of such lymphomas, but also to provide a scientific rationale for the use of novel therapies that are likely to improve the outcomes of patients with these conditions.