Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study

ABSTRACT Introduction: People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim: To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods: Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results: Eighty-four patients were included. The most common histological types were Burkitt's lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin's lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion: The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.

Clinical characteristics of primary extranodal versus nodal diffuse large B-Cell Lymphoma: A retrospective cohort study in a cancer center

Background The outcome of patients with primary extranodal diffuse large B-cell lymphoma (PE-DLBCL) varies according to the primary site involved. Primary gastrointestinal, breast, bone, craniofacial, and testicular DLBCL are rare extranodal manifestations of DLBCL. Objective The objective of the study was to describe the clinical course of patients with PE-DLBCL disease in a referral cancer center. Results From 637 patients, 51 (8.77%) were considered as having PE-DLBCL (25 gastrointestinal, 12 craniofacial, 6 breast, 5 bone, and 3 with primary testicular DLBCL). Complete remission was higher in all PE-DLBCL sites (100% in testicular, 92.6% craniofacial, 83.3% breast, 80% bone, and 80% gastrointestinal) compared with 73.3% in nodal DLBCL. Although 2 cases with breast PE-DLBC relapsed, they achieved a complete response with chemotherapy. The overall survival at 5 years was 100%, 80%, 78%, 58%, 58%, and 62% for patients with primary breast, primary bone, gastrointestinal, primary craniofacial, primary testicular, and nodal DLBCL, respectively. Conclusions PE-DLBCLs constitute rare, primary sites of lymphoproliferative disorders in most cases, with localized disease and good prognosis. They require a combined chemoimmunotherapy with radiotherapy in most cases to improve local and systemic disease.

Time-to-treatment of diffuse large B-cell lymphoma in São Paulo

OBJECTIVE: Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma, accounting for nearly 50% of the cases in the Hematology Department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and Instituto do Câncer do Estado de São Paulo. The treatment outcome is influenced by age, abnormal lactate dehydrogenase levels, extranodal infiltration, the disease stage and the patient's performance status. In this study, we sought to report the time-to-treatment of diffuse large B-cell lymphoma in São Paulo's public health system network and its impact on patient outcomes. METHODS: We prospectively followed a cohort of 42 consecutive patients with de novo diffuse large B-cell lymphoma between 2008 and 2012. RESULTS: Our patients had more advanced disease than that reported in the literature (61.9% vs. 46%). In São Paulo's public health system network, it took an average of 7.4 months for a diagnosis to be made and an additional 1.4 months to obtain an appointment with a specialist. Once at our Hematology Department, it took less than 20 days for staging, confirmation of the diagnosis and treatment initiation. An interval from signs or symptoms to treatment of more than 6 months was associated with inferior progression-free survival in 3 years (p = 0.049). CONCLUSION: A delay in the diagnosis of diffuse large B-cell lymphoma is a public health problem and may be associated with worse progression-free survival. .

Comparación entre CHOP-like y R-CHOP en pacientes con linfoma no Hodgkin difuso de grandes células B y folicular: 10 años de experiencia del Hospital de Clínicas de Montevideo, Uruguay / Comparison between CHOP-like and R-CHOP in diffuse large B cell and follicular lymphoma

Background: The most common types of non-Hodgkin lymphoma (NHL) are diffuse large B cell (DLBCL) and follicular (FL). Aim: To analyze the benefit ofRituxi-mab in overall survival (OS) of patients with NHL. Material and Methods: Review of medical record of 230 adult patients with afirst episode of NHL admitted between 2002 and 2011. We included 67 patients with DLBCL and 36 patients with FL. Results: The overall response (OR) was 64% with 39% complete remissions (CR) in DLBCL treated with CHOP-like and 100% with 89% CR with R-CHOP. The median OS with CHOP-like was 21 months versus not attained R-CHOP (p = 0.016). There was a statistically significant difference in median event-free survival (EvFS) in favor of R-CHOP: not attained versus 8.3 months for CHOP-like (log rank (p = 0.002)). In FL, the OR in patients treated with R-CHOP or R-CHOP-like was 85%) with 54% CR. With CHOP-like the OR was 59%> with 18% CR. The OS at 24 and 36 months in patients treated with R-CHOP or R-CHOP-like was 83 and 65%. The figures for patients treated with CHOP-like were 80 and 66%> respectively. The progression free survival (PFS) was 21 months with CHOP-like versus not attained with R-QT (p = 0,043). Conclusions: When Rituximab was added to CHOP, there was a higher CR, EvFS and OS in DLBCL and higher CR and PFS in FL.

Linfoma no Hodgkin gástrico asociado a intoxicación por metales pesados / Gastric non-Hodgkin lymphoma associated with heavy metal exposures

El Linfoma no Hodgkin (LNH) extraganglionar es una neoplasia maligna que corresponde al 40% de los casos de LNH, siendo el tracto gastrointestintal (TGI) la localización más común. Dentro del TGI es el estómago el órgano más afectado (60%). Presentamos el caso de un hombre de 52 años trabajador en empresa minera por más de 10 años, el cual es derivado al Servicio de Gastroenterología por presentar un cuadro de epigastralgia, náuseas y baja de peso. La endoscopía digestiva mostró una lesión ulcerada en cuerpo gástrico a la cual se le tomaron múltiples biopsias. El estudio histológico y el posterior análisis inmunohistoquímico permitieron realizar el diagnóstico de LNH B difuso de células grandes. Asimismo, el paciente presentó compromiso de múltiples órganos en relación a exposición crónica de metales pesados, lo cual fue comprobado en el mineralograma, siendo las de mayor concentración el uranio, talio, arsénico, plomo y mercurio. En la literatura se ha descrito la asociación de exposición laboral crónica a Uranio y Arsénico con la presentación de LNH de compromiso gastrointestinal. Por tal motivo, el compromiso gástrico no se puede considerar como un daño aislado, sino más bien parte del compromiso sistémico asociado a concentraciones elevadas de metales. La minería constituye el principal motor de ingresos económicos para el Perú, sin embargo, no existen reportes hasta la fecha de la asociación de LNH de compromiso gastrointestinal en relación a exposición laboral a metales pesados.

Primary extranodal Non-Hodgkin lymphoma (NHL) is a non epithelial tumours that accounts for 40% of cases of NHL. Spread of nodal lymphomas to the gastrointestinal tract (GIT) is the most common location. Within the GIT is the stomach the most affected organ (60%). We report the case of 52-year- old man, mining company worker for over 10 years, which is derived to the Service of Gastroenterology with history of epigastric pain, nausea, vomiting and weight loss. Upper gastrointestinal endoscopic examination revealed an ulcerated lesion on greater curve of stomach and histopathological examination and subsequent immunohistochemical analysis showed diffuse large B cell gastric NHL. Also, the patient had multiple organ involvement in relation to chronic exposure to heavy metals, which was found in the mineralograma, with the highest concentration of uranium, thallium, arsenic, lead and mercury. The literature has described the association of chronic occupational exposure to uranium and arsenic with NHL presenting gastrointestinal involvement. Therefore, gastric commitment can not be considered as an isolated injury, but rather part of systemic involvement associated with elevated concentrations of metals. Mining is a key driver of income for Peru; however, there are no reports to date of the association of gastrointestinal NHL commitment regarding occupational exposure to heavy metals.

Significado prognóstico da expressão da survivina e do p53 no linfoma de grandes células B difuso / Meaning prognostic of the expression of the survivin and of p53 in the Diffuse Large B Ceel Lymphoma

Histórico: Linfoma de Grandes Células B Difuso (LGCBD) é uma entidade clínica e morfológica, definida nas classificações REAL e OMS como tipo mais comum de linfoma não Hodgkin em adultos. A busca de marcadores biológicos que determinem subgrupos de pacientes com evolução favorável é incessante. A p53 é muita estudada em associação com a manutenção da integridade celular submetidas ao stress, enquanto a super expressão Survivina tem merecido atenção especial nas malignidades linfóides. Objetivo: A imuno expressão Survivina e da p53 foi investigada de maneira retrospectiva, utilizando imunohistoquímica nos biópsias de diagnóstico de LGCBD, buscando o potencial prognóstico destas Ímuno expressões. Casuística: 75 pacientes com LGCBD, oriunda do serviço de Onco Hematologia, CEPON, SC, sul do Brasil, foram acompanhados de 1997 á 2001. Estima-se que neste período mais de 90% dos pacientes utilizou este serviço de alta complexidade, portanto, a amostragem escolhida serve como um estudo de sobrevida populacional. Resultados: A expressão da Survivina foi observada em 44 % dos pacientes e P53 em 41%. Observou-se que os pacientes Survivina positivos não entravam em remissão completa (p menor que 0,0001) e o tempo de sobrevida não ultrapassou 540 dias. Nos casos p53 positivos e negativos, observou-se uma distribuição equilibrada (p maior que 0.05) Discussão: A imuno expressão do Survivina predizia uma menor sobrevida, independente de qualquer fator prognóstico bem estabelecido. Estes resultados demonstram a importância da expressão das proteínas sinalizadoras da apoptose como alvos terapêuticos nos LGCBD e como indicadores de subgrupos de pacientes que possam vir a receber os mais atuais esquemas quimioterápicos, assim, aumentando chances de remissão e sobrevida...

Tumores de testículos: experiência pessoal com 15 pacientes e 16 tumores / Testis tumor: personal experience with 15 patients and 16 tumors

Os autores analisam retrospectivamente 16 casos de tumores de testículo diagnosticados em 15 pacientes de outubro de 1983 a janeiro de 1994. Diagnosticaram-se 14 casos de tumores germinativos de testículo em 13 pacientes. Um dos pacientes foi acometido de seminoma bilateral em épocas distintas. Dos 14 casos, 7 foram seminomas e 7 foram tumores nao-seminomatosos de tipos histológicos diversos. Houve 2 casos de tumores nao-germinativos do tipo linfoma (localizaçao secundária). Analisaram-se aspectos epidemiológicos, clínicos, métodos de diagnósticos, estadiamento e tratamento, bem como os resultados, que sao comparados com os da literatura mundial. O objetivo deste trabalho é demonstrar a experiência pessoal adquirida e comparar os resultados da análise com os das grandes séries disponíveis na literatura.