Incidence and mortality trends and geographic patterns of follicular lymphoma in Canada.

Background: Follicular lymphoma (fl) is the most common indolent lymphoma and the 2nd most common non-Hodgkin lymphoma, accounting for 10%-20% of all lymphomas in the Western world. Epidemiologic and geographic trends of fl in Canada have not been investigated. Our study's objective was to analyze incidence and mortality rates and the geographic distribution of fl patients in Canada for 1992-2010. Methods: Demographic and geographic patient data for fl cases were obtained using the Canadian Cancer Registry, the Registre québécois du cancer, and the Canadian Vital Statistics database. Incidence and mortality rates and 95% confidence intervals were calculated per year and per geographic area. Rates were plotted using linear regression models to assess trends over time. Overall data were mapped using Microsoft Excel mapping software (Redmond, WA, U.S.A.) to identify case clusters across Canada. Results: Approximately 22,625 patients were diagnosed with fl during 1992-2010. The age-standardized incidence rate of this malignancy in Canada was 38.3 cases per million individuals per year. Geographic analysis demonstrated that a number of Maritime provinces and Manitoba had the highest incidence rates, and that the provinces of Nova Scotia and Quebec had the highest mortality rates in the nation. Regional data demonstrated clustering of fl within cities or regions with high herbicide use, primary mining, and a strong manufacturing presence. Conclusions: Our study provides a comprehensive overview of the fl burden and its geographic distribution in Canada. Regional clustering of this disease in concentrated industrial zones strongly suggests that multiple environmental factors might play a crucial role in the development of this lymphoma.

Evaluation of herpes simplex virus infection morbidity and mortality in pancreas and kidney-pancreas transplant recipients.

BACKGROUND: Infections remain a major cause of morbidity and mortality in solid organ transplant recipients. An increased risk of up to 50% of herpes simplex virus (HSV) reactivation in transplant recipients in the first months posttransplantation was well-documented during the pre-cytomegalovirus prophylaxis era. Previous reports suggest that these patients are likely to experience a more aggressive disease course and a higher rate of acyclovir-resistant HSV. No data currently exist regarding the course of HSV infection in pancreas or pancreas-kidney transplant (PKT) recipients. The goal of this study was to evaluate the incidence and severity of HSV infections in pancreas transplant and PKT recipients. STUDY DESIGN: We analyzed a transplant patient database of the Royal Victoria Hospital to identify 137 pancreas transplant or PKT performed between January 1999 and October 2010. A retrospective chart review was subsequently performed to evaluate the incidence and severity of herpetic infections post transplantation. RESULTS: Our findings show that the incidence of HSV infection in our patients was approximately 10% (10/98 cases). The majority of infections (80%) took place within the first 2 years after the transplantation. Most patients (90%) experienced a uniform, mild disease course and responded well to treatment. One patient died of an unrelated cause. Six patients were treated in hospital with a mean stay of 12.3 ± 6.35 days. The initial immunosuppressive regimen remained unchanged for half of the affected patients. None of our patients developed a drug-resistant HSV. CONCLUSION: These findings are intriguing and warrant a larger, multicenter, prospective study. Most important, they suggest that the new incidence of HSV reactivation is now much lower in the "cytomegalovirus prophylaxis era" and that with timely diagnosis and proper treatment most patients recover well from their HSV infections and respond to the current treatment regimens.

Evaluation of varicella zoster virus infection morbidity and mortality in pancreas and kidney-pancreas transplant recipients.

BACKGROUND: Solid organ transplant recipients are at increased risk of infection due to chronic immunosuppression. The incidence of varicella zoster virus (VZV) infection is known to be increased in these patients compared with the immunocompetent population. Previous reports suggested that these patients are likely to experience a morbid disease course. Few data currently exist on the course of VZV infections in pancreas or pancreas plus kidney (PK) transplant recipients. OBJECTIVE: The goal of this study was to evaluate the incidence and severity of VZV infections in pancreas or PK recipients. STUDY DESIGN: We analyzed the transplantation patient database of the Royal Victoria Hospital, identifying 137 pancreas or PK transplantation procedures performed between January 1999 and October 2010, among which we included 98 patients in the study. We subsequently performed a retrospective chart review to evaluate the incidence and severity of VZV infections posttransplantation. RESULTS: Our analysis revealed that 11/98 patients developed VZV infections. The majority of infections (~90.9%) occurred within the first 5 years. Most patients (63.6%) were treated on an outpatient basis, whereas only 4 (36.4%) were hospitalized with a mean hospital stay of 9.5 ± 8.42 days. The initial immunosuppressive regimen remained unchanged for the majority of patients. All patients experienced a mild disease course without intensive care unit admission or death. Only 3 patients (27.3%) developed postherpetic neuralgia. CONCLUSION: These findings suggest that with timely diagnosis and proper treatment, most patients recover well from a VZV infection.