Important clinical and laboratory correlates of glomerular filtration rate in sickle cell anemia.

BACKGROUND: Renal impairment is routinely assessed using the estimated glomerular filtration rate (eGFR) and it may be helpful to obtain certain clinical or laboratory markers, which show relationship with glomerular filtration rate (GFR) in sickle cell disease (SCD). AIM: To assess the relationship between important clinical and laboratory parameters in SCD, and the eGFR. PATIENTS AND METHODS: Steady state clinical and laboratory data were obtained from 228 homozygous SCD patients seen over a 7-year period. The GFR was estimated using (isotope dilution mass spectrometry) traceable modification of diet in renal disease (MDRD) and Cockroft-Gault methods. The correlation coefficient and independent t-test were done to assess the level of significance between the eGFR_MDRD and the known indicators of disease severity. RESULTS: The serum alkaline phosphatase (ALP) and serum direct bilirubin levels both showed significant inverse relationship with eGFR_MDRD P = 0.012 and P = 0.24, respectively. The patients' age, Hb, leukocyte count, platelet count, serum direct bilirubin and aspartate transaminase did not show a significant correlation. The eGFR_MDRD was more discriminatory revealing that 20.3% of the patients had suboptimal GFR. Proteinuria in steady state was observed in 20.3% of the patients. CONCLUSION: High serum direct bilirubin and ALP are associated with a deteriorating eGFR_MDRD. Other clinical and laboratory indicators of disease severity in SCD do not show the relationship with the GFR. MDRD_GFR estimation seemed to be a more appropriate method of estimating GFR in SCD.

Multiple myeloma in Nigeria: an insight to the clinical, laboratory features, and outcomes.

AIM: In developing African nations, late presentation and occurrence of complications adversely affects survival. This study aims at identifying initial clinical and basic laboratory features of multiple myeloma (MM), which will aid the physician to entertain a high index of suspicion and therefore target his investigations in order to prevent late presentation and avert complications. MATERIALS AND METHODS: A retrospective analysis of 32 patients diagnosed and managed in Nigeria, West Africa was done. Information on the clinical, laboratory, and radiological data as well as response to treatment was obtained at presentation, 3, 6, 12, and 24 months and analyzed. RESULTS: The median age at diagnosis was 62 years, 17 (53.1%) males and 15 (46.9%) females. The median duration of follow-up was 24 weeks (range, 2-288 weeks). The average percentage of bone marrow plasmacytosis at diagnosis was 38%. Clinical features at presentation were anemia (71.9%) and bone pains (78.1%), while pathological fractures were found in 69%, and nephropathy in 13.8%. The longest duration of survival of 288 and 252 weeks were recorded in patients on melphalan and prednisolone with or without thalidomide. CONCLUSION: Presence of bone pain and anemia in elderly patients should alert the clinician to investigate along the lines of MM. Majority of patients have osteolytic lesions on X-ray and pathological fractures, and benefit from melphalan based combinations in situations where facilities for transplant are not available.

Coagulation profile of children with sickle cell anemia in steady state and crisis attending the university of Nigeria teaching hospital, Ituku-Ozalla, Enugu.

BACKGROUND: Sickle cell anemia is associated with a hypercoagulable state that may lead to alterations in a coagulation profile. Measurements of coagulation factors are known to have some predictive value for clinical outcome. OBJECTIVES: To determine the coagulation profile of children with SCA in steady state and crisis and compare it with those with normal HbAA genotype. MATERIALS AND METHODS: This is a prospective observational study involving 50 children with SCA in steady state, 50 in crises, and 50 with HbAA genotype, carried out from June to October 2009. All the values of coagulation profile were matched for age and sex. RESULTS: The mean Prothrombin time (PT) (12.5 ± 1.2 secs), Activated partial thromboplastin time (aPTT) (41.6 ± 1.0 secs), and Thrombin time (TT) (12.3 ± 1.2 secs) of subjects with SCA in steady state as well as those during crises [PT (12.6 ± 1.8 secs), aPTT (45.6 ± 1.3 secs), TT (12.5 ± 1.7 secs)] were significantly prolonged compared to those of subjects with HbAA genotype. The mean bleeding time (BT) of 3.4 ± 1.0 mins was significantly shorter in children with SCA in steady state compared to those with HbAA genotype (3.7 ± 1.1 mins), (P < 0.038). CONCLUSION: Coagulation profile of patients with SCA is prolonged both in steady state and during crisis and when compared to those with HbAA genotype, though all values are within normal range.

Reduced-intensity conditioning allogeneic stem cell transplantation for relapsed/refractory mantle cell lymphoma: a multicenter experience.

BACKGROUND: Despite therapeutic approach that combines rituximab-containing chemotherapy, followed or not by autologous stem cell transplantation (auto-SCT), mantle cell lymphoma (MCL) patients experience relapses. Reduced-intensity conditioning allogeneic stem cell transplantation (RIC-allo-SCT) at time of relapse may represent an attractive strategy. PATIENTS AND METHODS: We report a multicenter retrospective analysis. Seventy MCL patients underwent RIC-allo-SCT in 12 centers. RESULTS: Median age at transplantation was 56 years and median time from diagnosis to transplantation was 44 months. The median number of previous therapies was 2 (range, 1-5) including autologous transplantation in 47 cases. At time of transplantation, 35 patients were in complete remission, 20 were in partial response and 15 in stable disease or progressive disease. The median follow-up for living patients was 24 months. The 2-year event-free survival (EFS) and overall survival (OS) rates were 50% and 53%, respectively. The 1- and 2-year transplant-related mortality rates were 22% and 32%, respectively. The statistical analysis demonstrated that disease status at transplantation was the only parameter influencing EFS and OS. CONCLUSIONS: These results suggest that RIC-allo-SCT may be an effective therapy in MCL patients with a chemo-sensitive disease at time of transplantation, irrespective of the number of lines of prior therapy. Studies are warranted to investigate the best type of RIC regimen.

Coinfection with hepatitis B and C viruses among HIV positive pregnant women in Enugu south east, Nigeria.

BACKGROUND: Hepatitis B and C viruses coinfection in HIV positive pregnant women is a common public health problem and recognized worldwide. The consequences of this problem in our poor resource setting with the risk of mother to child transmission is obvious with increased morbidity and mortality in our environment. OBJECTIVE: To determine the prevalence of coinfection patterns of HBV and HCV among HIV positive pregnant women in Enugu Nigeria. METHODS: A retrospective survey conducted on 401 Nigeria HIV positive pregnant women seen at Prevention of Mother To Child Transmission (PMTCT) clinic at the UNTH Enugu Nigeria over a 3 year period between 1st January 2007 and 31st December 2009. RESULTS: The prevalence of hepatitis B and C viruses coinfection among HIV positive pregnant women in Enugu is 6.5%. HIV/HBV coinfection was commoner than HIV/HCV coinfection. There was no significant association between hepatitis B and C viruses coinfection and the age, ethnic group, marital or educational status of the women (P > 0.05). CONCLUSION: There is high prevalence of hepatitis B and C coinfection among HIV positive pregnant women in Enugu. This high burden of these hepatotropie virus coinfection calls for continued need to screen for these infections and vaccinate the affected babies for hepatitis B and/or C where appropriate.

The prevalence of Rhesus negativity among pregnant women in Enugu, Southeast Nigeria.

BACKGROUND: Hemolytic disease of the newborn, secondary to rhesus D (Rh D) iso-immunization, contributes significantly to perinatal morbidity and mortality. Prevalence data in Nigeria, and Southeast Nigeria in particular, is very scanty. This study was carried out to provide our experience in this preventable clinical condition in Enugu, Southeast Nigeria. OBJECTIVE: To determine the prevalence and trends of Rh D negativity among pregnant women in Enugu, Southeast Nigeria. MATERIALS AND METHODS: A 5-year retrospective study of rhesus negative women was carried out at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 1 st January 2000 and 31 st December 2004. RESULT: The prevalence rate of Rh D negative women in Enugu, Nigeria, is 4.5%. Out of 6306 women who booked for antenatal care, 282 (4.5%) were Rh D negative women. One hundred and eighty-two (182) (64.5%) of the Rh D negative women were of blood group O followed by blood group A 20%, blood group B 12.1%, and blood group AB 3.2%, respectively. CONCLUSION: There is a need for adequate counseling of pregnant women on the importance of Rh D negative factor during the antenatal period in order to prevent hemolytic disease of the newborn.

Haemogram pattern at diagnosis of malignant disorders and variations post-chemotherapy.

A total of eighty patients with various malignancies seen between September 2008 and April 2009 at the University of Nigeria Teaching Hospital, (UNTH) Ituku-Ozalla Enugu Nigeria had their haemogram values done at Days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed of various malignancies, consisting of Breast cancer 36 patients (45%), Non-Hodgkin's iymphoma 8 (10%), Hodgkin's lymphoma 13 (16.25%), Colorectal carcinoma 6 (7.5%), Multiple myeloma 7 (8.75%), Cervical carcinoma 1 (1.25%) and other malignancies 9 (11.25%). Haematological indices evaluated include: packed cell volume, haemoglobin concentration; total white blood cell count, platelet count and erythrocyte sedimentation rate. The socio demographic data of the patients were assessed from a questionnaire. There were 27 males (33.75%) and 53 females (66.25%). The age of the patients ranged from 18-80 years with a median of 45 years. Haematological parameters which were found to be significantly reduced include: haemoglobin concentration, packed cell volume and total white cell count.

Absolute neutrophil values in malignant patients on cytotoxic chemotherapy.

A total of eighty patients with various malignancies seen between September 2008 and April 2009 at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla, Enugu, Nigeria, had their absolute neutrophil counts, done at Days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed of various malignancies, consisting of Breast cancer 36 (45%), Non-Hodgkin's lymphoma 8 (10%), Hodgkin's lymphoma 13 (16.25%), Colorectal carcinoma 6 (7.5%), Multiple myeloma 7 (8.75%), Cervical carcinoma 1 (1.25%) and other malignancies 9 (11.25%), Manual counting of absolute neutrophil count was done using Turks solution and improved Neubauer counting chamber and Galen 2000 Olympus microscope. The socio demographic data of the patients were assessed from a questionnaire. There were 27 males (33.75%) and 53 females (66.25%). Their ages ranged from 18 - 80 years with a median of 45 years. The mean absolute neutrophil count of the respondents pre-and post chemotherapy was 3.7 +/- 2.1 x 10(9)/L and 2.5 +/- 1.6 x 10(9)/L respectively. There were significant differences in both the absolute neutrophil count (p=0.00) compared to the pre-chemotherapy values. Chemotherapeutic combinations containing cyclophosphamide and Adriamycin were observed to cause significant reduction in absolute neutrophil.

EBV reactivation and post transplant lymphoproliferative disorders following allogeneic SCT.

Fatal problems encountered in allogeneic stem cell transplantation include EBV reactivation and post transplant lymphoproliferative disorders (PTLDs) with high mortality rates. We performed a retrospective analysis in all consecutive adult and pediatric EBV reactivations and PTLD during a period of 8.5 years. There were 26 patients with EBV reactivation/PTLD out of a total of 854 transplantations giving an overall incidence of 3.0%. Specifically, the incidence of EBV-PTLD was 1.3%, whereas that of EBV reactivation was 1.8%. Median age was 46.0 and 11.0 years in the adult and pediatric patients, respectively. There were high rates (54%) of concomitant bacterial, viral, fungal and parasitic infections at the time of EBV manifestation. Variable treatment regimens were applied including in most cases an anti-CD20 regimen often in combination with virustatic compounds, polychemotherapy or donor lymphocytes. The mortality rates were 9 of 11 (82%) in patients with EBV-PTLD and 10 of 15 (67%) in patients with reactivation. Only 7 of 26 patients (27%) are alive after a median follow-up of 758 days (range 24-2751). The high mortality rates of EBV reactivation and of EBV-PTLD irrespective of multimodal treatment approaches emphasize standardization and optimization of post transplant surveillance and treatment strategies to improve control of these often fatal complications.

Changing pattern of childhood malignancies in Eastern Nigeria.

BACKGROUND: Childhood cancers constitute important causes of morbidity and mortality in Nigeria. There is a need for us to continue to analyse the patterns of these neoplasms. OBJECTIVE: To review the major studies on childhood malignancies in Enugu, Nigeria and identify trends in paediatric malignancies in this environment. METHODS: We compared the results of four major studies on childhood malignancies in Enugu, Eastern Nigeria between 1976 and 2004 and assessed the patterns in the frequencies of paediatric cancers in this environment. RESULTS: Lymphomas were the most common childhood malignancy in this environment with Burkitt's lymphomas being the most common specific paediatric cancer. Nephroblastomas and sarcomas have been on the increase. The pattern of changes in the relative percentage frequencies of leukaemias, retinoblastoma and neuroblastomas has not been consistent. Leukaemias appear to be on the decline but occurrences of retinoblastomas and neuroblastomas have been fluctuating. CONCLUSION: Since Burkitt's lymphoma is associated with high prevalence of malaria, Epstein Barr Virus infection, and malnutrition, its persistent high rates suggest strongly that the control of these infections and malnutrition should be intensified.

Pregnancy outcomes in patients with sickle cell disease in Enugu, Nigeria.

BACKGROUND: Pregnancy in patients with sickle cell disease (SCD) is associated with increased maternal and foetal morbidity and mortality. The objective of this study was to review the pregnancy outcomes in patients with SCD as seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-eastern Nigeria. METHODS: This is a retrospective study. The data extracted from the patients' case files include the age, parity, gestational age at booking and complications of disease and pregnancy during the antenatal period, labour and puerperium. Fetal outcomes were also reviewed. RESULTS: During the 30-year period under study (1975-2004), only 10 pregnant women with sickle cell disease were documented to have been attended to. Pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications identified were maternal mortality, lobar pneumonia, HIV and recurrent malaria infections, candidiasis, bone pain crises, haemolytic crises, pseudotoxaemia and pre-eclampsia. Fetal complications included intra-uterine fetal deaths, still births, low birth weights, and breech presentation. CONCLUSION: From this study, it seems that female SCD patients present more rarely with pregnancy in South-eastern compared to South-western Nigeria. However, the spectrum of complications seen is similar to that recorded in other studies.

Pregnancy outcomes in patients with sickle cell disease in Enugu, Nigeria.

BACKGROUND: Pregnancy in patients with sickle cell disease (SCD) is associated with increased maternal and foetal morbidity and mortality. The objective of this study was to review the pregnancy outcomes in patients with SCD as seen at the University of Nigeria Teaching Hospital(UNTH), Enugu, South-eastern Nigeria. METHODS: This is a retrospective study. The data extracted from the patients' case files include the age, parity, gestational age at booking and complications of disease and pregnancy during the antenatal period, labour and puerperium. Fetal outcomes were also reviewed. RESULTS: During the 30-year period under study (1975-2004), only 10 pregnant women with sickle cell disease were documented to have been attended to. Pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications identified were maternal mortality, lobar pneumonia, HIV and recurrent malaria infections, candidiasis, bone pain crises, haemolytic crises, pseudotoxaemia and pre-eclampsia. Fetal complications included intra-uterine fetal deaths, still births, low birth weights, and breech presentation. CONCLUSION: From this study, it seems that female SCD patients present more rarely with pregnancy in South-eastern compared to South-western Nigeria. However, the spectrum of complications seen is similar to that recorded in other studies.

Benefit of modified plasmapheresis in the management of myasthenia gravis: a case report.

BACKGROUND: Myasthenia gravis is an autoimmune disease condition caused by the generation of antibodies against the acetylcholine receptor sites at the neuromuscular junction. The treatment modalities include anticholinesterase drugs, corticosteroids, immunotherapy, thymectomy and plasmapheresis. However, because of the poor financial state of our patients and the dearth of appropriate equipment in our centres modifications are made to standard treatment modalities including plasmapharesis. METHOD: We report a case of myasthenia gravis who was on various occasions on neostigmine, pyridostigmine and prednisolone. After about 18 months of treatment, he developed myasthenic crises on two occasions. He was admitted in the ICU for respiratory support where he also had modified plasmapheresis. RESULTS: The patient had remarkable improvement following the modified plasmapheresis with reversal of symptoms of the myasthenic crises. CONCLUSION: In the absence of facilities for standard plasmapheresis in this environment, the use of modified plasmapheresis is hereby recommended.

Tuberculous Lymphadenitis in South-Eastern Nigeria; A 15 Years Histopathologic Review (2000-2014).

BACKGROUND: The human immunodeficiency virus (HIV) pandemic has brought about a resurgence in tuberculosis (TB), especially in developing countries. Previous studies on TB lymphadenitis (TBLN) in South-Eastern Nigeria were done before the advent of the HIV pandemic making a review pertinent. AIM: To evaluate the role of TBLN as a cause of superficial lymphadenopathy in the post-HIV/acquired immune deficiency syndrome (AIDS) era of South-Eastern Nigeria. MATERIALS AND METHODS: This is a 15 years (2000-2014) retrospective review of all superficial lymph node biopsies (SLNBs) received at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria. RESULTS: One hundred and seventy-two cases of TBLN were identified in this study constituting 14.6% (172/1,180) of SLNBs received at our Hospital's Morbid Anatomy Department during the 15 years period under review. Twenty-eight cases of TBLN were clinically screened for HIV, 23 of which tested positive, representing 82.1% (23/28) of clinically screened cases. Acid fast bacilli demonstration was positive in 15.1% (26/172) of cases using Ziehl-Neelsen stain. 48.8% (84/172) of TBLN cases were males, and 51.2% (88/172) were females with most (22) cases received in 2012 and least (5) cases in 2000. Most TBLN occurred in the 21-25 years age group with a total of 21.5% (37/172) of cases and a male to female ratio of 1:1.5 The most common biopsy site for TBLN was the cervical group followed by the axillary and inguinal groups with 73.8% (127/172), 14% (24/172), and 4.7% (8/172) of cases, respectively. CONCLUSIONS: There is a remarkable decline in the prevalence of TB lymphadenitis in South-Eastern Nigeria indicating a change in trend from the pre- to the post-HIV/AIDS era with slightly more females now presenting with TBLN and most TB lymphadenitis patients now presenting with associated HIV/AIDS disease. There is an urgent need to provide modern diagnostic facilities in our medical laboratories.

Spectrum of childhood malignancies in Enugu, Nigeria (1999-2004).

A retrospective analysis of childhood malignancies in Enugu, Nigeria was carried out using data obtained from the Cancer Registry of the University of Nigeria Teaching Hospital (UNTH), Enugu between 1st January 1999 and 30th June 2004. A total of 79 childhood cancers were recorded during the period. There were 48 males (60.8%) and 31 females (39.2%) with a male female ratio of 1.5:1. The three commonest malignancies were lymphomas 33 (41.2%), sarcomas 12 (15.2%) and nephroblastomas 12 (15.2%). The less common tumours included the leukaemias 6(7.6%), retinoblastomas 6 (7.6%), neuroblastomas 4 (5.1%), and carcinomas 2 (2.5%). Burkitt's lymphoma remains the commonest specific childhood malignancy in this environment constituting 19 (57.6%) of all the lymphomas and 24.1% of all the cancers seen.

Association between HIV/AIDS and malignancies in a Nigerian tertiary institution.

BACKGROUND: Following the outbreak of the Human Immunodeficiency Virus (HIV) infection in 1981, there has been a widespread increase in the incidence of many malignancies including non-Hodgkin's lymphoma, cervical carcinoma and Kaposi's sarcoma. The scarcity of reports linking HIV infection with malignancies in Nigeria necessitated this study. We prospectively screened one hundred patients with various forms of malignancies seen at the University College Hospital Ibadan, Nigeria between October 2001 and June 2002 for HIV infection by the Enzyme Linked Immunosorbent Assay (ELISA) method and confirmed with the Western Blot method. RESULTS: Six of the patients were found to be seropositive for HIV antibodies. There were 41 males (41%) and 59 females (59%) with age ranging from 7 months to 80 years and a median of 46 years. The HIV seropositive patients were between 29 and 35 years of age. Two patients with non-Hodgkin's lymphoma (NHL) and one patient each with carcinoma of the cervix, Kaposi's sarcoma. Hodgkin's lymphoma and carcinoma of the breast were HIV seropositive. All the p values were greater than 0.05. CONCLUSION: The seroprevalence of HIV infection in patients with malignancies in this study was 6%. Despite the HIV/AIDS epidemic, there is yet no significant statistical relationship between HIV infection and malignancies in this environment. Larger, preferably multicenter studies need to be carried out to ascertain the relationship between HIV infection and malignancies in Nigeria.

Waldenstrom's macrogloblinaemia: modified plasmapheresis as treatment option in a Nigeria setting.

We describe a case of Waldenströms macroglobulinaemia in a 56 year old Negroid male, to whom modified plasmapheresis/plasma exchange was offered with good control of symptomatic hyperviscosity Amelioration of the clinical status and objective assessment of response was evident by dramatic reduction in monoclonal immunoglobulins M (IgM) from 100g/L to 14.7 g/L and a fall in erythrocyte sedimentation rate from 130 mm/hr to 80 mm/hr with this therapy. This highlights the need to adopt a modification of manual plasmapheresis in the treatment of the hyperviscosity syndrome complicating this B-cell disease in this environment.

Utilization of oral anticoagulation in a teaching hospital in Nigeria.

BACKGROUND: Anticoagulation is an essential lifesaving management practice indicated for arterial, venous and intracardiac thromboembolism. AIM: This study was undertaken to examine the utilization of anticoagulation services in University of Nigeria Teaching Hospital, Enugu (UNTH) Nigeria. MATERIALS AND METHODS: This retrospective study involved assessing data from folders of subjects on anticoagulation and monitoring in UNTH, Enugu. Patients' profile, risk factors, diagnosis, indication for oral anticoagulation, anticoagulant used; target, monitoring, outcome and complications of anticoagulation were recorded. RESULTS: A total of 26 patients over a period of 5 years were on anticoagulation and laboratory monitoring done in UNTH. The mean age of the patients was 53.4 years and more females than males were on anticoagulation and monitoring (F14:M12). The most common indications for anticoagulation include deep venous thrombosis/pulmonary embolism, congestive heart failure with atrial fibrillation and mitral valve disease with atrial fibrillation. Desired clinical outcome was achieved in eight patients 8/26 (30.8%). Minor bleeding was the only complication reported in three patients 3/26 (11.5%). CONCLUSION: The absence of diagnostic tools and anticoagulation monitoring clinics and the apprehension of adverse effects have combined to make this lifesaving treatment inaccessible to many patients in Nigeria.

Pattern of CD4 T-lymphocyte Values in Cancer Patients on Cytotoxic Therapy.

BACKGROUND: Assessment of patients prior to cytotoxic chemotherapy usually includes absolute neutrophils count. Other cellular markers of susceptibility to infection as well as immunocompetence include the T Helper lymphocyte count. In cancer patients, decrease in these lymphocytes has been observed to be associated with decreased overall survival. AIM: To assess the degree of CD4 lymphopenia encountered during cytotoxic chemotherapeutic treatment for cancer and evaluate the differences observed for the various drug combinations. SUBJECTS AND METHODS: Eighty patients with various histologically diagnosed malignancies had their CD4 lymphocyte counts carried out at days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed with breast cancer 36/80 cases (45%), non-Hodgkin's lymphoma 8/80 cases (10%), Hodgkin's lymphoma 13/80 cases (16.3%), multiple myeloma 7/80 cases (8.8%), colorectal carcinoma 6/80 cases (7.5%), and other malignancies 10/80 cases (12.5%). CD4 lymphocyte count was done using the Partec Cyflow(®) 2000 CD4 cell counter, and their socio-demographic data of the patients were assessed using a questionnaire. RESULTS: The mean (sd) CD4 lymphocyte count pre- and post-chemotherapy was observed to be 567 (341) cells/µLand 349 (207) cells/µL while the median values were 454 cells/µLand 349 cells/µL respectively. There were significant differences in CD4 lymphocyte counts after chemotherapy compared to the pre-chemotherapy values. CONCLUSION: Epirubicin combinations used in breast cancer patients as well as (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) ABVD regimen used in treatment of Hodgkin's lymphoma were found to be significantly less lymphotoxic than other chemotherapeutic combinations. These drugs or their combinations may be less immunotoxic than other known regimen used for these malignancies.