RESUMEN
In this multi-institutional retrospective study, we examined the characteristics and outcomes of 160 patients with high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS)-a rare category defined by high-grade morphologic features and lack of MYC rearrangements with BCL2 and/or BCL6 rearrangements ("double hit"). Our results show that HGBL-NOS tumors are heterogeneous: 83% of patients had a germinal center B-cell immunophenotype, 37% a dual-expressor immunophenotype (MYC and BCL2 expression), 28% MYC rearrangement, 13% BCL2 rearrangement, and 11% BCL6 rearrangement. Most patients presented with stage IV disease, a high serum lactate dehydrogenase, and other high-risk clinical factors. Most frequent first-line regimens included dose-adjusted cyclophosphamide, doxorubicin, vincristine, and etoposide, with rituximab and prednisone (DA-EPOCH-R; 43%); rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 33%); or other intensive chemotherapy programs. We found no significant differences in the rates of complete response (CR), progression-free survival (PFS), or overall survival (OS) between these chemotherapy regimens. CR was attained by 69% of patients. PFS at 2 years was 55.2% and OS was 68.1%. In a multivariable model, the main prognostic factors for PFS and OS were poor performance status, lactate dehydrogenase >3 × upper limit of normal, and a dual-expressor immunophenotype. Age >60 years or presence of MYC rearrangement were not prognostic, but patients with TP53 alterations had a dismal PFS. Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R vs R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS.
Asunto(s)
Linfoma de Células B Grandes Difuso , Humanos , Persona de Mediana Edad , Rituximab/uso terapéutico , Estudios Retrospectivos , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/genética , Prednisona/uso terapéutico , Vincristina/uso terapéutico , Proteínas Proto-Oncogénicas c-bcl-2/genética , Proteínas Proto-Oncogénicas c-myc/genética , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Etopósido , Lactato DeshidrogenasasRESUMEN
Elevated serum pancreatic enzymes have been described among patients with small bowel obstruction (SBO) initially misdiagnosed as having pancreatitis. We studied whether serum lipase elevation carries prognostic value in patients with SBO. Patients with SBO and at least one serum lipase level measured were included. Demographic, laboratory, and imaging information, as well as need for surgery or intensive care unit and mortality, were evaluated. Of 344 patients, 38 (11%) had elevated serum lipase levels. Patients with radiographic diagnosis of pancreatitis were excluded. Patients with elevated lipase had significantly higher levels of creatinine and lactic acid levels, length of stay, need for intensive care monitoring, and death than patients with normal lipase levels. The need for surgical intervention was not significantly different between the two groups. Logistic regression analysis showed elevated serum lipase and serum creatinine >1.5 mg/dL as predictors for mortality. We conclude that, in SBO, elevated serum lipase is a risk factor for higher serum creatinine and lactate, use of intensive care unit, and mortality. The strength of this association justifies studying it prospectively.
