Therapeutic and survival outcomes following treatment of primary central nervous system lymphoma: a 12-year case study.

AIM: The study primarily aimed to investigate therapeutic and survival outcomes following definitive treatment of primary central nervous system lymphoma (PCNSL). METHODS: All patients with histopathologically proven PCNSL at our institute between 1998 and 2009 were recruited. The collated data included demographic, laboratory, neuroimaging, therapeutic and survival aspects. RESULTS: Of 85 participants with the mean age of 52.8 years, 79 underwent neurosurgical procedures endeavoring for diagnosis or decompression. Fifty patients who received definitive treatment in our institute were evaluated for therapeutic response. In multivariate analysis, there was no variable associated with good response rate. Eastern Cooperative Oncology Group (ECOG) performance status >1 and elevated cerebrospinal fluid (CSF) protein level >45 mg/dL were significant prognostic factors of poor survival outcome as estimated by Cox regression analysis. The patients treated by high-dose methotrexate (HD-MTX)-based protocols with or without radiotherapy (RT) achieved significantly longer median survival than those treated by RT alone or other kinds of chemotherapy. CONCLUSION: Neurosurgical procedure plays an important role for diagnosis of PCNSL. Surgical resection has no role in curative treatment and should be discarded unless considerable mass effect develops. HD-MTX should be considered as the primary chemotherapy for individuals agonizing from the disease.

The association of prothrombin A19911G polymorphism with plasma prothrombin activity and venous thrombosis: results of the MEGA study, a large population-based case-control study.

BACKGROUND: Prothrombin (FII) G20210A mutation and elevated plasma prothrombin activity are known risk factors for venous thrombosis. The risk of venous thrombosis among 19911G carriers of the prothrombin A19911G polymorphism has not been extensively investigated. OBJECTIVES AND METHODS: We assessed prothrombin activity, FIIG20210A, and FIIA19911G polymorphisms in a large population-based case-control study, the Multiple Environmental and Genetic Assessment (MEGA) study of risk factors for venous thrombosis. Four thousand three hundred and sixty-five consecutive patients with a first episode of deep vein thrombosis of the leg or pulmonary embolism were included. The control group (n = 4779) consisted of partners of patients or persons gathered using a random-digit dialing method. We studied the effect of FIIA19911G polymorphism on prothrombin activity and thrombosis risk, also in combination with factor V Leiden. RESULTS: Among FII20210-GG control subjects, FII19911-GG carriers had 7.1% [95% confidence interval (CI): 5.7-8.5] higher mean prothrombin activity than FII19911-AA carriers and the risk for GG carriers was 1.43-fold increased compared to AA carriers [odds ratio (OR) 1.43; 95% CI: 1.27-1.61]. Among FII20210-GA control carriers, the mean prothrombin activity in both FII19911-AA and -AG carriers was nearly equivalent [131.7% and 133.4%; mean difference (95% CI) = 1.7% (-7.2-10.7)]. Because of genetic linkage, FII19911-GG carriers were very rare on a FII20210-GA background, as only one FII20210A carrier had FII19911-GG. In FII20210-GA carriers, the OR increased from 3.05 (95% CI: 2.17-4.27) in subjects with FII19911-AA to 3.33 (2.28-4.85) in subjects with FII19911-AG, compared to those with FII20210-GG and FII19911-AA. CONCLUSIONS: The FIIA19911G polymorphism is associated with mildly elevated prothrombin activity and is a risk factor for venous thrombosis.

Inappropriate use of protein C, protein S, and antithrombin testing for hereditary thrombophilia screening: an experience from a large university hospital.

INTRODUCTION: Deficiencies of protein C, protein S, and antithrombin are the main inherited risk factors in Thai patients with venous thromboembolism, although the prevalence is not high. METHODS: To evaluate the appropriate use of the testing for these proteins, the test orders of 503 patients were retrospectively reviewed using the proposed guidelines. Inter-rater reliability between two investigators was also calculated. RESULTS: Of 503, 459 (91%; 95% confidence interval 88-93%) of the test orders were inappropriate. The most common cause of inappropriateness was testing during acute thrombosis (42.5%). Results were inconclusive in 105 (20.9%) patients who had isolated decrease in one of the proteins, mostly owing to lack of confirmation of the abnormal results. Kappa index for the reliability of two investigators was 0.79. CONCLUSION: To enhance the appropriate use of hereditary thrombophilia screening tests, physician education concerning the patient selection, suitable timing for testing and repetition of the tests with abnormal results should be emphasized.