RESUMO
To address the lack of contemporary population-based epidemiological studies of hepatosplenic T-cell lymphoma (HSTCL), we undertook a population-based study of ICD-O-3-coded HSTCL in England. We used the National Cancer Registration Dataset and linked datasets on hospital admissions, Systemic Anti-Cancer Therapy, socio-demographics, comorbidities and death, identifying cases from 1 January 2013 to 31 December 2019 with survival data up to 5 January 2021. Crude and directly age-standardised incidence rates per million persons per year were calculated. Crude and adjusted incidence rate ratios compared incidence between groups using Poisson regression. A Cox proportional hazards model estimated mortality risks adjusted for age, sex, ethnicity, deprivation and allogenic stem cell transplant (allo-SCT; time varying). We identified 44 patients, mean age 42 years. Median survival was 11 months, and 1 and 5 year survivals were 48% (95% CI 29%-43%) and 22% (95% CI 12%-42%) respectively. The age-standardised incidence was 0.1 per million/year. Incidence was higher in areas with greater deprivation (0.15 per million/year), and more cases than expected were in non-White patients (39%). Non-Whites had a twofold increased risk of death (adjusted hazard ratio 2.21 [95% CI 1.03-4.78]) even after adjusting for deprivation, younger age and allo-SCT. In conclusion, ethnicity and socio-economic status affect both the incidence and survival of HSTCL.
Assuntos
Linfoma de Células T , Neoplasias Esplênicas , Humanos , Masculino , Feminino , Incidência , Adulto , Pessoa de Meia-Idade , Linfoma de Células T/mortalidade , Linfoma de Células T/epidemiologia , Linfoma de Células T/terapia , Neoplasias Esplênicas/mortalidade , Neoplasias Esplênicas/epidemiologia , Idoso , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Classe Social , Etnicidade/estatística & dados numéricos , Inglaterra/epidemiologia , Adulto Jovem , AdolescenteAssuntos
Neoplasias Hepáticas/epidemiologia , Linfoma de Células T/epidemiologia , Neoplasias Esplênicas/epidemiologia , Adulto , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Incidência , Renda , Cobertura do Seguro , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Linfoma de Células T/patologia , Linfoma de Células T/terapia , Masculino , Morbidade/tendências , Prognóstico , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/terapia , Transplante de Células-Tronco/estatística & dados numéricos , Taxa de Sobrevida , Viagem , Estados Unidos/epidemiologiaRESUMO
There are limited data available supporting the use of the recombinant granulocyte colony-stimulating factor (G-CSF), tbo-filgrastim, rather than traditionally used filgrastim to mobilize peripheral blood stem cells (PBSC) or to accelerate engraftment after autologous stem cell transplantation (ASCT). We sought to compare the efficacy and cost of tbo-filgrastim to filgrastim in these settings. Patients diagnosed with lymphoma or plasma cell disorders undergoing G-CSF mobilization, with or without plerixafor, were included in this retrospective analysis. The primary outcome was total collected CD34(+) cells/kg. Secondary mobilization endpoints included peripheral CD34(+) cells/µL on days 4 and 5 of mobilization, adjunctive use of plerixafor, CD34(+) cells/kg collected on day 5, number of collection days and volumes processed, number of collections reaching 5 million CD34(+) cells/kg, and percent reaching target collection goal in 1 day. Secondary engraftment endpoints included time to neutrophil and platelet engraftment, number of blood product transfusions required before engraftment, events of febrile neutropenia, and length of stay. A total of 185 patients were included in the final analysis. Patients receiving filgrastim (n = 86) collected a median of 5.56 × 10(6) CD34(+) cells/kg, compared with a median of 5.85 × 10(6) CD34(+) cells/kg in the tbo-filgrastim group (n = 99; P = .58). There were no statistically significant differences in all secondary endpoints with the exception of apheresis volumes processed (tbo-filgrastim, 17.0 liters versus filgrastim, 19.7 liters; P < .01) and mean platelet transfusions (tbo-filgrastim, 1.7 units versus filgrastim, 1.4 units; P = .04). In conclusion, tbo-filgrastim demonstrated similar CD34(+) yield compared with filgrastim in mobilization and post-transplantation settings, with no clinically meaningful differences in secondary efficacy and safety endpoints. Furthermore, tbo-filgrastim utilization was associated with cost savings of approximately $1406 per patient utilizing average wholesale price.
Assuntos
Filgrastim/farmacologia , Mobilização de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas , Linfoma de Células B/terapia , Linfoma de Células T/terapia , Mieloma Múltiplo/terapia , Neoplasias de Plasmócitos/terapia , Adulto , Idoso , Antígenos CD34/imunologia , Benzilaminas , Plaquetas/citologia , Plaquetas/efeitos dos fármacos , Plaquetas/imunologia , Análise Custo-Benefício , Ciclamos , Feminino , Filgrastim/análogos & derivados , Filgrastim/economia , Sobrevivência de Enxerto , Mobilização de Células-Tronco Hematopoéticas/métodos , Compostos Heterocíclicos/uso terapêutico , Humanos , Tempo de Internação/economia , Linfoma de Células B/economia , Linfoma de Células B/imunologia , Linfoma de Células B/patologia , Linfoma de Células T/economia , Linfoma de Células T/imunologia , Linfoma de Células T/patologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/economia , Mieloma Múltiplo/imunologia , Mieloma Múltiplo/patologia , Neoplasias de Plasmócitos/economia , Neoplasias de Plasmócitos/imunologia , Neoplasias de Plasmócitos/patologia , Neutrófilos/citologia , Neutrófilos/efeitos dos fármacos , Neutrófilos/imunologia , Estudos Retrospectivos , Transplante AutólogoRESUMO
Although a few studies have evaluated the utility of ¹8F-fluorodeoxyglucose positron emission tomography (FDG-PET) in treatment-naive T-cell non-Hodgkin's lymphomas (T-NHLs), a few studies had been conducted to evaluate the role of FDG-PET in patients after treatment. A total of 41 patients with T-NHLs were included who underwent post-autologous stem cell transplantation (ASCT) PET for response assessment in addition to contrast-enhanced CT. The impact of post-ASCT PET on response assessment and predicting prognosis was retrospectively evaluated. Of the 41 patients, 11 (26.8%) patients showed discordant response between two image modalities (Cohen's κ = 0.465). The additional PET study actually guides changing the post-ASCT response in six (54.5%) of these 11 patients. Moreover, positive post-ASCT PET was associated with worse prognosis in event-free survival and overall survival than negative post-ASCT PET (P = 0.003 and P = 0.044, respectively). Excluding four patients in whom further confirmation was not available due to early mortality, in 22 lesions showing discrepancy between two image modalities, 12 lesions were true positive (N = 4) or true negative (N = 8) for PET and ten lesions were false positive (N = 7) or false negative (N = 3). The accuracy for the discrepant lesions was 54.5% (12 of 22), the overall accuracy for the detected lesions was 76.7% (33 of 43), and the overall accuracy for patients was 89.2% (33 of 37). Post-ASCT PET was useful in response assessment after ASCT, and the positive post-ASCT PET result was associated with worse prognosis than the negative post-ASCT PET in patients with T-NHLs.
Assuntos
Fluordesoxiglucose F18 , Linfoma de Células T/diagnóstico , Linfoma de Células T/terapia , Tomografia por Emissão de Pósitrons/métodos , Transplante de Células-Tronco , Transplante Autólogo , Feminino , Humanos , MasculinoRESUMO
Flow cytometric T-cell receptor (TCR)-V(ß) repertoire analysis (TCR-V(ß)-R) is a sensitive method for detection of T-cell clonality; however, no uniform approach exists to define clonality in neoplastic T cells. TCR-V(ß)-R was evaluated in patients with a diagnosis of T-cell neoplasia in initial diagnostic specimens from 41 patients and for minimal residual disease (MRD) monitoring in 61 sequential samples from 14 patients with mature T-cell neoplasia. Gating strategies and criteria for detection of T-cell clonality were determined. In all 41 initial specimens, T-cell clonality was demonstrated via TCR-V(ß)-R. The frequency of V(ß) usage was consistent with random neoplastic transformation of TCR-V(ß) subsets. MRD was successfully detected in follow-up samples from all 14 patients evaluated, Furthermore, MRD after therapy was quantitated in 48 peripheral blood specimens. TCR-V(ß)-R analysis is a sensitive method for detection of T-cell clonality and is useful for diagnosis and MRD detection in multiple specimen types.
Assuntos
Citometria de Fluxo , Imunofenotipagem/métodos , Leucemia de Células T/patologia , Linfoma de Células T/patologia , Neoplasia Residual/diagnóstico , Receptores de Antígenos de Linfócitos T alfa-beta/sangue , Linfócitos T/metabolismo , Linfócitos T/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transformação Celular Neoplásica/patologia , Células Clonais/metabolismo , Células Clonais/patologia , Feminino , Rearranjo Gênico da Cadeia beta dos Receptores de Antígenos dos Linfócitos T , Infecções por HTLV-I/complicações , Humanos , Leucemia de Células T/metabolismo , Leucemia de Células T/terapia , Leucemia de Células T/virologia , Linfoma de Células T/metabolismo , Linfoma de Células T/terapia , Linfoma de Células T/virologia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/sangue , Neoplasia Residual/genética , Reação em Cadeia da Polimerase , Adulto JovemRESUMO
T-cell and natural-killer (NK)-cell lymphomas are neoplasms with geographical variations in frequencies. T-cell lymphomas are more prevalent in Asia than in Europe and North America, and NK-cell lymphomas occur almost exclusively in Asia and South America. These low frequencies mean that the diagnosis and optimum treatment of patients with T-cell and NK-cell lymphomas have not been studied prospectively in randomised controlled trials. Because T-cell and NK-cell lymphomas are more prevalent in Asia, the establishment of management recommendations by Asian oncologists in collaboration with international experts is pertinent. This review outlines guidelines commensurate with different levels of health-care resources and expertise. Consensus statements were formulated for diagnosis, staging, follow-up, and treatment approaches in patients with T-cell and NK-cell lymphomas--aimed at unifying the design of studies and interpretation of results. For patients not in clinical trials, consensus opinions offer useful guidelines on optimum management.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Países em Desenvolvimento , Células Matadoras Naturais/patologia , Linfoma de Células T/terapia , Linfoma/terapia , Oncologia , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Ásia/epidemiologia , Congressos como Assunto , Países em Desenvolvimento/economia , Medicina Baseada em Evidências , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Imunoterapia , Linfoma/diagnóstico , Linfoma/mortalidade , Linfoma/patologia , Linfoma de Células T/diagnóstico , Linfoma de Células T/mortalidade , Linfoma de Células T/patologia , Oncologia/economia , Oncologia/normas , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Radioterapia Adjuvante , Resultado do TratamentoRESUMO
OBJECTIVE: We examined the relationship between the response to treatment and prognosis of patients with aggressive lymphoma. METHODS: We reviewed 33 patients with aggressive lymphoma treated with chemotherapy consisting of the CHOP regimen followed by radiotherapy. Twelve patients had Stage I, 13 had Stage II, 6 had Stage III and 2 had Stage IV disease. According to the International Prognostic Index (IPI), 13 had low, 15 had low-intermediate, 2 had high-intermediate and 3 had high IPI. After three to six cycles of chemotherapy, involved-field radiotherapy was performed. We evaluated the response to treatment by computed tomography (CT), magnetic resonance imaging (MRI) and gallium scintigraphy (Ga-67) at the time of completion of chemotherapy and at the time of completion of radiation therapy. The median follow-up period was 48 months (4-80). RESULTS: The 2-year progression-free survival rates of the patients with Ga-67 positive uptake and Ga-67 negative uptake after completion of chemotherapy were 78 and 26% (P = 0.009), respectively. However, there were no statistically significant correlations between progression-free survival and the response after completion of chemotherapy determined by CT (P = 0.75) or MRI (P = 0.19). The response to treatment at the time of completion of overall treatment was not useful for prediction of prognosis. CONCLUSIONS: Ga-67 positive uptake at the completion of chemotherapy before radiotherapy may be associated with poor prognosis.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Difuso de Grandes Células B/terapia , Linfoma Imunoblástico de Células Grandes/terapia , Linfoma de Células T/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Feminino , Radioisótopos de Gálio , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Imunoblástico de Células Grandes/diagnóstico por imagem , Linfoma Imunoblástico de Células Grandes/tratamento farmacológico , Linfoma Imunoblástico de Células Grandes/radioterapia , Linfoma de Células T/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prednisona/uso terapêutico , Prognóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vincristina/uso terapêuticoRESUMO
The authors presented 27 cases of primary extranodal non-Hodgkin's malignant lymphomas of the head and neck area in patients treated surgically in the ENT Department in the years 1996-2001. We observed tumors in the various areas: palatine tonsil, naso-pharynx, eye socket, paranasal sinuses, parapharyngeal space and lingual base. In the course of the diagnostic process we examined the patients carefully to be sure that the cancer had not disseminated. We used some imaging techniques such as: ultrasonography, CT and MRI. We also used the needle aspiration biopsy, as a additional examination. However the material was not significant in the most cases and we were unable to make a definitive diagnosis on the basis of this method alone. After prior examinations we performed the radical operations and removed the tumours. In each case the postoperative material was examined using immunohistochemical methods. Afterwards the pathomorphological diagnosis was made by the specialists. Next the patients were observed and treated in the Haematological Department and Radiotherapy Department. In all cases pathomorphological diagnosis were performed on the base of usage postoperative histochemical examinations. All treated patients were performed as diagnostic preoperative USG, CT, MRI and fine-needle biopsy aspiration exam. All patients for further treatment were observed at Haematological Department.