Pattern of extranodal involvement and its impact on survival in diffuse large B-cell lymphoma from a tertiary cancer center in rural India.

INTRODUCTION: Extranodal (EN) involvement in diffuse large B-cell lymphoma (DLBCL) carries poor prognosis. Both the number and the specific sites of EN involvement are important in predicting prognosis. Given that the epidemiologic pattern of DLBCL in India is different from the rest of the world and such data correlations are scarce from developing countries, we aimed to find out if specific site and number of EN involvement could predict survival in DLBCL. METHODS: Patients with DLBCL treated with combination chemotherapy plus rituximab were included. Site and number of EN involvement were noted. Univariate analysis for survival was performed for EN involvement or not, specific site of involvement, and number of EN involvement (0/1 vs. ≥2). RESULTS: Among a total of 177 patients, 92 (52%) patients had EN disease. When patients with 2 or more EN sites were compared against patients with 0 or 1 site, there was significant reduction in both progression-free survival (PFS) and overall survival (OS) (3-year OS of 55% vs. 79%, P = 0.001, 3-year PFS of 42% vs. 65%, P = 0.001). When specific EN sites were studied for correlation with survival, involvement of skin/soft tissue, and serosa were associated with significant reduction in 3-year OS (33% vs. 74%, P = 0.011, and 63% vs. 75%, P = 0.03, respectively) and 3-year PFS (25% vs. 62%, P < 0.001, and 46% vs. 62%, P = 0.01, respectively). CONCLUSION: Two or more EN sites in DLBCL predicted inferior survival. Serosal and skin/soft tissue involvement also predicted poor survival.

Impact of early reduction in paraprotein on survival in transplant ineligible myeloma: Lesson from a tertiary cancer center in rural India.

INTRODUCTION: The impact of rapid reduction in paraprotein levels, with induction chemotherapy in myeloma, on treatment outcomes is less clear. There are very few studies in transplant ineligible patients treated with novel agents, correlating an early reduction in paraprotein with survival duration. METHODS: In this retrospective analysis of newly diagnosed multiple myeloma, ineligible for stem cell transplant, paraprotein levels at baseline and 3 months were noted with percentage reduction. Survival analysis was performed with Kaplan-Meier curves and Cox proportional hazard model. RESULTS: Among a total of 121 patients, 42 (35%), 29 (24%), and 50 (41%) had paraprotein reduction of 100%, 90%-99%, and <90%, respectively from baseline levels at 3 months. Patients with complete disappearance of paraprotein (100% reduction) when compared against those with <100% reduction at 3 months had a trend toward higher overall survival (OS) (3-year OS of 81% vs. 69%, hazard ratio [HR] = 0.54, P = 0.182). However, the progression-free survival (PFS) was significantly higher when these two groups were compared (median PFS of 51 vs. 17 months, HR = 0.33, P ≤ 0.001). When patients with ≥90% reduction were compared with <90% reduction at 3 months, there was significant improvement in both OS and PFS (3-year OS of 80% vs. 48%, HR = 0.24, P = 0.001, median PFS of 38 vs. 14 months, HR = 0.13, P < 0.001). CONCLUSIONS: Achieving a faster and deeper reduction in paraprotein as early as 3 months could lead to significant improvement in PFS.

Limiting factors for autologous transplantation among transplant-eligible multiple myeloma patients: Lesson from a Tertiary Cancer Centre in rural India.

There is limited data from low and middle income countries on the exact proportion of Myeloma patients undergoing transplant even if they are eligible for the same. In this retrospective analysis of all newly diagnosed transplant eligible Myeloma treated between January 2011 to June 2017, number of patients undergoing transplant were recorded and among those not opting for transplant, reasons for the same were noted. Among 89 eligible patients, 23 (26%) patients could undergo transplantation. Most common reasons for not undergoing transplant were fear of the complications in 42 (47%) and financial reasons in 41 (46%) of patients. The transplanted group had better progression free survival when compared against the non-transplanted group (3 year PFS of 80% versus 36%, HR = 0.09, 95%CI 0.02-0.4, p = 0.001). Future studies may be conducted to arrive at measures, for correcting the transplant related concerns and fears, through psycho-social interventions.

Impact of early reduction in paraprotein on survival in transplant ineligible myeloma: Lesson from a tertiary cancer center in rural India

Introduction: The impact of rapid reduction in paraprotein levels, with induction chemotherapy in myeloma, on treatment outcomes is less clear. There are very few studies in transplant ineligible patients treated with novel agents, correlating an early reduction in paraprotein with survival duration. Methods: In this retrospective analysis of newly diagnosed multiple myeloma, ineligible for stem cell transplant, paraprotein levels at baseline and 3 months were noted with percentage reduction. Survival analysis was performed with Kaplan–Meier curves and Cox proportional hazard model. Results: Among a total of 121 patients, 42 (35%), 29 (24%), and 50 (41%) had paraprotein reduction of 100%, 90%–99%, and <90%, respectively from baseline levels at 3 months. Patients with complete disappearance of paraprotein (100% reduction) when compared against those with <100% reduction at 3 months had a trend toward higher overall survival (OS) (3-year OS of 81% vs. 69%, hazard ratio [HR] = 0.54, P = 0.182). However, the progression-free survival (PFS) was significantly higher when these two groups were compared (median PFS of 51 vs. 17 months, HR = 0.33, P ≤ 0.001). When patients with ≥90% reduction were compared with <90% reduction at 3 months, there was significant improvement in both OS and PFS (3-year OS of 80% vs. 48%, HR = 0.24, P = 0.001, median PFS of 38 vs. 14 months, HR = 0.13, P < 0.001). Conclusions: Achieving a faster and deeper reduction in paraprotein as early as 3 months could lead to significant improvement in PFS