Retrospective Analysis of Primary Mediastinal Large B-Cell Lymphoma (PMBCL) Treated with Rituximab and CHOP (R-CHOP).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4634-4634
Author(s):  
Amory V. Novoselac ◽  
Raghu K. Kunamneni ◽  
Malgorzata McMasters ◽  
Miroslav R. Radevic ◽  
Randy L. Levine
Keyword(s):  
Retrospective Analysis ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
Early Stage Disease ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Svc Syndrome ◽  
Stage Disease ◽  
Outcome Improvement

Abstract Background: PMBCL is a recognized separate entity within the group of diffuse large B-cell lymphoma (DLBCL) (Harris et al, Blood, 1994) with clinical, pathological and recently described molecular distinctiveness. It typically presents as a bulky mediastinal mass with the SVC syndrome, early stage disease, occurring predominantly in young females. The therapeutic approach has paralleled that of DLBCL consisting of anthracycline based regimens with or without the addition of radiation therapy (RT). In recent years, the use of rituximab has become part of the treatment of DLBCL, with outcome improvement demonstrated in patients >60 years of age (Coiffier et al, NEJM 2002) and recently <60 years of age (Sehn et al, ASH 2003, and Pfreundschuh et al, ASCO 2004). Though commonly used as part of the initial treatment, outcome benefit has not as of yet been established in PMBCL. Methods: Retrospective analysis of 10 patients with PMBCL diagnosed and/or treated in our institution from September 2000 to October 2003 with R-CHOP. Results: The median age was 30 (range 22–56). There were 7 female and 3 male patients. Eight patients had a low/low intermediate IPI, and all but one had an elevated LDH. Eight patients had early stage disease (I and II), two had stage III. Beta2 microglobulin was not elevated in the 6 patients for whom results were available. Two patients had B symptoms. Bulky disease (> 10 cm or > 1/3 of the thoracic diameter) was present in 7 patients; SVC syndrome was seen in 3. None of the patients had marrow involvement. Median follow up was 13 months (range 9–47). All patients received 4–6 cycles of R-CHOP. Two patients received maintenance rituximab (one received 4 weekly treatments at 6 months and the other received 4 weekly treatments at 3 and 6 months). RT was given to 6 patients. Eight patients had a complete remission (CR) following R-CHOP and two patients had near CR (> 90% reduction); they subsequently achieved CR after the RT. Conclusions: Great variations of CR rates in the treatment of PMBCL, ranging from 10 to 95% for anthracycline containing regimens have been reported in the literature. Reported CR rates for CHOP alone range from 45–80% and optimal anthracycline based therapies are still being debated. Regardless of the initial regimen, failure patterns most commonly described in PMBCL were either no response to initial treatment or early progression, typically seen within 6 to 12 months. All of our patients achieved and remain in CR with a median follow up of 13 months. We recognize the limitations of our study (i.e. short median follow up, absence of control group, heterogeneous therapeutic approaches). However, this retrospective analysis demonstrates that the addition of rituximab could potentially contribute to the initial response to CHOP in comparison to traditionally reported CR rates found in the literature. Long term follow up in a larger series is necessary for the assessment of outcome improvement with the addition of rituximab in PMBCL patients. Charcteristics of 10 PMBCL patients treated with R-CHOP Median age (yrs) (range) 30 (22–56) Female/Male 7/3 Low IPI Score (total) (%) 8 (80%) High LDH (total) (%) 9 (90%) B Symptoms (total) (%) 2 (20%) Stage I and II (total) (%) 8 (80%) Bulky Disease (total) (%) 7 (70%) SVC Syndrome (total) (%) 3 (30%) High Beta2 microglobulin (total) (%) 0 (0%) Bone Marrow Involvement (total) (%) 0 (0%) RT (total) (%) 6 (60%) CR (total) (%) 10 (100%) Median Follow up (mts) (range) 13 (9–47)

scholarly journals A Retrospective Analysis of Outcomes of Diffuse Large B Cell Lymphoma (DLBCL) in the Elder Patients in China

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5410-5410
Author(s):  
Peng Liu ◽  
Ying Han ◽  
Jianliang Yang ◽  
Xiaohui He ◽  
Changgong Zhang ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
Disease Stage ◽  
Early Stage Disease ◽  
Large B Cell Lymphoma ◽  
Elder Patients ◽  
Stage Disease ◽  
Ann Arbor ◽  
Advanced Disease Stage

Abstract Background: Elderly patients with diffuse large B-cell lymphoma (DLBCL) have a worse prognosis compared to the younger population, since older age is associated with comorbidity and suboptimal performance status leading to intolerance of chemo-immunotherapy. The outcome of DLBCL in the older patients (> 60 years) was well described in clinical trials with reported 5-year overall survival (OS) of 50-80% (Coiffier et al., N Engl J Med 2002). Since this group is often precluded from clinical trials and population-based studies are limited, optimal treatment strategy for the old patients with DLBCL remains controversial. Here, we describe a Chinese real-world experience of management of elderly DLBCL patients treated at National Cancer Hospital, China. Methods: This is a single-center, retrospective analysis of consecutive DLBCL patients aged ≥60 who planned to receive chemotherapy +/- rituximab. The standard regimens included 3-4 cycles (early stage disease) or 6 cycles (advanced) of R-CHOP like regimens (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) followed by two rituximab doses in fit patients; R-miniCHOP for unfit and R-CE(etoposide)OP for frail elder patients. Patient data including baseline characteristics, histology, clinical parameters, and treatment outcomes were extracted from hospital medical records. The primary endpoint was progression-free survival (PFS); secondary endpoint was OS. Statistical analyses included descriptive statistics and Kaplan Meier estimates. Results: From June 2006 to December 2012, 349 patients aged ≥60 years were included, in which 204 patients were aged <70 years (Table 1). 326 patients received chemotherapy or chemo-immunotherapy with rituximab. Median follow up was 82 months. Five year PFS and OS of the elder patients were 45.8% and 51.9%, respectively. Significant difference was seen between patients < 70 years and those ≥70 years in terms of PFS (51.0% vs 38.6%, p=0.030) and OS (58.3% vs 42.8%, p=0.007) (Figure 1). Patients with early-stage disease (Ann Arbor StageⅠ/Ⅱ) had better 5-year PFS (60.1% vs 23.5%, p<0.001) and OS (65.3% vs 30.9%, p<0.001) than patients with advanced disease stage (Ann Arbor Stage III/IV) (Figure2). In addition, regimen including rituximab significantly improved the survival than chemotherapy alone (5-year PFS: 37.3% vs 64.0%, p<0.001; 5-year OS: 44.5% vs 69.3%, p<0.001), especially in patients ≥70 years, which almost doubled 5-year PFS and OS (5-year PFS: 25.4% vs 50.7%, p<0.001; 5-year OS: 28.8% vs 56.0%, p<0.001) (Figure3). Conclusions: Elder age (≥70 years) and advanced disease stage (Ann Arbor Stage III/IV) are associated with poor PFS and OS in Chinese elder DLBCL patients. The addition of rituximab significantly improves the survival compared to chemotherapy alone, especially in patients aged ≥70 years. These findings underscore the importance of personalized evaluation and treatment in elder patients with DLBCL. Disclosures No relevant conflicts of interest to declare.

Lymphocyte-predominant Hodgkin lymphoma: what is the optimal treatment?

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 406-413 ◽  
Author(s):  
Michelle Fanale
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
B Cell Lymphomas ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Relapsed Disease

AbstractNodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a unique diagnostic entity, with only ∼ 500 new cases in the United States per year with a similar infrequent incidence worldwide. NLPHL also has distinctive pathobiology and clinical characteristics compared with the more common classical Hodgkin lymphoma (cHL), including CD20 positivity of the pathognomic lymphocytic and histiocytic cells and an overall more indolent course with a higher likelihood of delayed relapses. Given the limited numbers of prospective NLPHL-focused trials, management algorithms historically have typically been centered on retrospective data with guidelines often adopted from cHL and indolent B-cell lymphoma treatment approaches. Key recent publications have delineated that NLPHL has a higher level of pathological overlap with cHL and the aggressive B-cell lymphomas than with indolent B-cell lymphomas. Over the past decade, there has been a series of NLPHL publications that evaluated the role of rituximab in the frontline and relapsed setting, described the relative incidence of transformation to aggressive B-cell lymphomas, weighed the benefit of addition of chemotherapy to radiation treatment for patients with early-stage disease, considered what should be the preferred chemotherapy regimen for advanced-stage disease, and even assessed the potential role of autologous stem cell transplantation for the management of relapsed disease. General themes within the consensus guidelines include the role for radiation treatment as a monotherapy for early-stage disease, the value of large B-cell lymphoma–directed regimens for transformed disease, the utility of rituximab for treatment of relapsed disease, and, in the pediatric setting, the role of surgical management alone for patients with early-stage disease.

scholarly journals Single Centre Retrospective Analysis: Transformation of Waldenström's Macroglobulinemia to Diffuse Large B-Cell Lymphoma

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-11
Author(s):  
Bert Heyrman ◽  
Nikki Granacher ◽  
Ka Lung Wu
Keyword(s):  
B Cell ◽  
Retrospective Analysis ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Single Centre ◽  
The Past ◽  
Large B Cell Lymphoma ◽  
End Of Treatment ◽  
Large B Cell

Introduction: The incidence and outcome of Waldenström's macroglobulinemia (WM) patients with transformation to diffuse large B-cell lymphoma (DLBCL) are unclear. We performed a retrospective analysis to determine the incidence, clinicopathological characteristics and treatment outcome of WM patient with histologic transformation to DLBCL in our centre. Methods: Single centre chart review of WM patients in the past 10 years. Patients with histologic diagnosis of DLBCL after the diagnosis WM were included in our analysis. Results: Three of the 79 WM patients had histological transformation to DLBCL, two male and one female. Mean age at DLBCL development was 76,6 years. The mean time to transformation since diagnosis of WM was 8,3 years (14, 8 and 3 years). All three patients received at least one prior line of treatment in relation to WM (2, 1 and 3 prior lines). Different regimens used were cyclophosphamide/dexamethasone, rituximab/bendamustin, chlorambucil monotherapy, fludarabine monotherapy, R-CVP and ibrutinib monotherapy. The patients were in clinical CR from WM at the time of transformation, two patients were still on treatment. All three patients presented with advanced disease (stage IIIB, IVB, and IVA) non-GCB subtype DLBCL with at least 2 extra nodal sites. R-IPI scores were 4,5 and 4. Two patients were treated with R-miniCHOP, one patient received R-CHOP. The first patient achieved a CR at the end of treatment and is now 1,5 years in follow-up. The second patient died from pneumonia one year after achieving a CR. The third patient is in follow op since 3 months after reaching a CR at the end of treatment. Conclusion: Over the past decade transformation of WM to DLBCL was 3.7% in our centre. This is in accordance with previous data suggesting an 2.4% risk of transformation over 10 years.Time to transformation varies and no association with prior WM therapy and response to treatment can be found.All patients presented with more aggressive DLBCL in an advanced stage.All three patients achieved a CR following treatment for DLBCL, one patient died from pneumonia, two others are now in follow-up 1,5 years and 3 months respectively. Disclosures Heyrman: Celgene:Research Funding.

SO091URINE-TO-PLASMA UREA RATIO, AS SURROGATE MARKER FOR URINE CONCENTRATING CAPACITY, IS ASSOCIATED WITH DISEASE PROGRESSION IN ADPKD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Judith E Heida ◽  
Ronald Gansevoort ◽  
Lianne Messchendorp ◽  
Esther Meijer ◽  
Niek F Casteleijn ◽  
...  
Keyword(s):  
Disease Progression ◽  
Water Deprivation ◽  
Early Stage ◽  
Early Stage Disease ◽  
Plasma Urea ◽  
Final Model ◽  
Stage Disease ◽  
Observational Cohort ◽  
Egfr Decline

Abstract Introduction Predicting disease progression in autosomal dominant polycystic kidney disease (ADPKD) patients poses a challenge, especially in early stage disease when renal function is not yet affected. The ongoing formation and growth of cysts causes the urine concentrating capacity to decrease from early on in the disease. We therefore hypothesized that the easy and inexpensive to measure urine-to-plasma urea ratio (UPU ratio), which is assumed to be surrogate for maximal urine concentrating capacity, can be used as marker to predict disease progression in ADPKD. Methods The UPU ratio was calculated by dividing urea concentration in a fasting morning spot urine sample by plasma urea concentration adjusted for plasma creatinine concentration. First, we validated the UPU ratio in 30 ADPKD patients who underwent a prolonged water deprivation test to measure the maximal urine concentrating capacity. Thereafter, the association of the UPU ratio with renal outcome was evaluated in 583 ADPKD patients participating in the DIPAK observational cohort (inclusion criteria: age&gt;18 years, eGFR &gt;15 mL/min/1.73m2, no concomitant diseases affecting eGFR, without V2 receptor antagonist prescription). Kidney function was assessed as eGFR by the creatinine based CKD-EPI formula, height adjusted total kidney volume (htTKV) by MRI and copeptin (surrogate for vasopressin) by ELISA. Results In the water deprivation test participants (n=30), the UPU ratio was strongly correlated with maximal urine concentrating capacity (R = 0.67, p&lt;0.001). This association remained significant after correcting for sex, age, htTKV and eGFR (st. β = 0.53, p = 0.007). In these subjects maximal urine concentrating capacity as well as UPU ratio were associated with the rate of eGFR decline during a median follow-up of 6.3 yr (12 eGFR assessments per patient) assessed using linear mixed modeling, also when corrected for sex, baseline age and eGFR (β = 0.009, p = 0.04, and β = 5.56, p&lt;0.001, resp.). We subsequently corroborated in the larger DIPAK observational cohort (n=583, 58% female, mean age 47 yr median eGFR 60 mL/min/1.73m2 and htTKV 898 ml/m), that the UPU ratio was significantly associated with rate of eGFR decline during a median follow-up of 4.0 yr (6 eGFR assessments per patient): β = 0.23, p = 0.005. This association remained significant when corrected for sex, baseline age and eGFR (β = 0.32, p&lt;0.001) and even when additionally corrected for Mayo class, PDK mutation and copeptin (β = 0.40, p &lt;0.001). Stepwise backward multivariate regression analysis resulted in a final model including the UPU ratio, PKD mutation, Mayo Class and copeptin. Cox survival analysis showed that a lower baseline UPU ratio (indicating less urine concentrating capacity) was significantly associated with a higher risk to develop the combined renal endpoint of incidence of start of kidney replacement therapy, eGFR &lt;15 mL/min/1.73m2 or eGFR decrease &gt;40% during follow-up (adjusted Hazard Ratio per SD = 1.39, p = 0.007). Limiting the aforementioned analyses to the subgroup of patients with relative early stage disease (n=122, age &lt;40 yr and eGFR &gt;60 mL/min/1.73m2) rendered essentially similar results, with an adjusted β for UPU ratio in the final model of 0.33 (p = 0.04). In this subgroup with a limited number of events (n=10), Cox survival analysis did not reach formal significance (adjusted HR per SD: 2.67, p = 0.055). Conclusion The UPU ratio, which is calculated from routine laboratory measurements, predicts renal prognosis in ADPKD in addition to other, more laborious to measure and expensive risk markers. Notably, this marker of urine concentrating capacity also shows promise in early-stage disease.

Favorable Results of Rituximab in Combination with CHOP in the Front-Line Treatment of Follicular Lymphoma Grade 3.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2770-2770
Author(s):  
Luis Fayad ◽  
Michael Overman ◽  
Barbara Pro ◽  
Peter McLaughlin ◽  
Felipe Samaniego ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
B Cell ◽  
Response Rate ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Grade 3 ◽  
Large B Cell

Background: Follicular lymphoma grade 3 has a natural history that is more akin to that of diffuse large B-cell lymphoma. The addition of rituximab to standard CHOP has resulted in improved response and survival in diffuse large B-cell lymphoma. Information about outcomes in follicular lymphoma grade 3 is lacking. Methods: A single institution retrospective review of patients with follicular grade 3 lymphoma evaluated at the UTMDACC from 1999 to 2004. Patients were located from the UTMDACC lymphoma database. All patients were initially treated with R-CHOP. Results: Forty-five patients were identified: 51% male, 47% ≥60 years, and 87% follicular grade 3b. The LDH was elevated in 24%, ECOG performance status was >1 in 2%, and >1 site of extranodal involvement was present in 10%. Stage distribution was 11% stage I, 11% stage II, 42% stage III, and 36% stage IV, bulky disease (>7cm) was present in 11%, and B symptoms occurred in 13%. Beta-2 microglobulin was elevated in 57% with values >3 μg/dL in over 50%. IPI distribution was: 46% IPI Low, 38% LI, 11% IH, and 4% IPI High. Overall response rate was 100% with 96% complete responses. Relapse rate by IPI category was 24% for Low IPI, 18% for IPI LI, and 40% for IPI IH, and 100% for the two patients with High IPI. With median follow-up of 33 months, three year failure-free survival (FFS) is 73% (95% CI: 59 to 87%). One patient died (2%) with an overall survival (OS) at three years of 97% (95% CI: 93 to 100%). Conclusion: The addition of rituximab to CHOP provided a high response rate and excellent early survival in this group of mostly good prognosis patients. Relapses were still seen; longer follow-up is needed.

Cell Of Origin Does Not Affect Outcomes In Early Stage Non-Bulky Diffuse Large B-Cell Lymphoma Treated With Short-Course Combined Modality Therapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3017-3017 ◽  
Author(s):  
Matthew A. Lunning ◽  
Jocelyn C. Maragulia ◽  
Anita Kumar ◽  
Martin Bast ◽  
Philip Bierman ◽  
...  
Keyword(s):  
B Cell ◽  
Early Stage ◽  
Combined Modality Therapy ◽  
B Cell Lymphoma ◽  
Cell Of Origin ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Short Course ◽  
Ann Arbor ◽  
Disease Free

Abstract Introduction Early stage non-bulky disease accounts for approximately 25% of all cases of diffuse large B-cell lymphoma (DLBCL). An effective treatment regimen for early stage non-bulky DLBCL is short-course combined modality therapy (CMT) as evidenced by the SWOG 0014 study that reported 4-year PFS and OS of 88% and 92%, respectively (Persky D et al. JCO 2008). The cell of origin (COO) of DLBCL can be classified based on immunohistochemistry (Hans criteria) and gene expression profiling (GEP) into two clinically recognized cohorts: germinal center B-cell-like (GCB) and non-GCB phenotypes. The Hans immunohistochemistry-based algorithm reproduced the GEP classification in 71% of GCB and 88% of non-GCB cases (Hans CP Blood 2004). In patients with advanced stage DLBCL, patients with a non-GCB phenotype had a significantly worse 5-year overall survival. There is a paucity of data regarding the prognostic significance of COO in early stage non-bulky DLBCL. In one report of early stage DLBCL by GEP, GCB phenotype accounts for approximately 77% of cases (Rosenwald et al. NEJM 2002). The outcomes of early stage non-bulky DLBCL patients treated with CMT segregated by COO is unknown. Methods To investigate the outcomes of early stage non-bulky DLBCL and impact of COO, we conducted a retrospective review of all patients with DLBCL or follicular lymphoma grade 3b treated with short-course rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy plus involved-field radiation therapy (IFRT) between 2000 and 2012 at Memorial Sloan-Kettering Cancer Center (MSKCC) and the University of Nebraska Medical Center (UNMC). Individual chart review was performed to extract the clinical presentation, pathological features, treatments, and outcomes. Early stage non-bulky DLBCL was defined as Ann Arbor stage I or stage II, non-bulky (without a mass ≥ 10 cm). The stage-modified international prognostic index (SM-IPI) defined as stage lI (vs.I), age>60, elevated LDH, and ECOG performance status ≥ 2 was calculated if all variables were available. The Hans algorithm and/or GEP were used to classify patients as either GCB or non-GCB. Short-course CMT was defined as R-CHOP for 3 or 4 cycles plus IFRT. Disease free survival and overall survival were calculated using Kaplan Meier analysis. Results In total 97 patients were evaluated with a median age of 58 (range 19 to 83) with 52% woman. The majority (90%) of patients had DLBCL (versus follicular lymphoma grade 3b) and 79% had Ann Arbor stage I/IE disease. There were no patients with bulky disease in this series. The SM-IPI characteristics are listed in Table 1a. COO was determined by the Hans algorithm in 94 of 97 cases (97%), by Hans and GEP in 2 cases, and by GEP alone in one case. A GCB phenotype was seen in 76% of the patients. In the 74 (76%) patients with all SM-IPI variables extracted, 31% patients had 0 risk factors, 50% had 1 risk factor, and 19% had 2 or 3 risk factors. The SM-IPI was not significant (p> 0.05; NS) between the GCB and non-GCB cohorts (See Table 1b). The majority (68%) received R-CHOP for 3 cycles with the remaining receiving 4 cycles. One patient had a contraindication to vincristine thus etoposide was substituted (R-CHEP). Subsequent IFRT was given to all patients. At a median follow-up among survivors of 52 months, 97% of patients remained alive and 94% remained disease free. At 52 months, all patients in the non-GCB cohort remained disease free and in the GCB cohort 92% were disease free (p=0.821). Overall, 6 deaths have occurred: 2 related to disease, 2 of unknown cause, and 2 unrelated to disease. Conclusions Patients with early stage non-bulky DLBCL treated with short-course CMT continue to have an excellent prognosis. Our data confirms prior GEP data that the GCB phenotype, by immunohistochemistry-based Hans algorithm, is predominantly seen in early stage non-bulky DLBCL. In contrast to advanced stage DLBCL, COO does not appear to influence outcomes in early stage non-bulky DLBCL with this treatment approach. Disclosures: Horwitz: Celgene, Allos, Seattle Genetics, Bristol-Myers Squibb, Genzyme, Kyowa, Janssen, Johnson & Johnson, Millenium: Consultancy; Celgene, Allos, Seattle Genetics, Kyowa, Infinty, Millenium: Research Funding.

scholarly journals Spilled gallstones during laparoscopic cholecystectomy

2014 ◽  
Vol 96 (5) ◽  
pp. e18-e20 ◽  
Author(s):  
J Ahmad ◽  
AIW Mayne ◽  
Y Zen ◽  
MB Loughrey ◽  
P Kelly ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallbladder Cancer ◽  
Histological Examination ◽  
Early Stage ◽  
Recurrent Pain ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Symptomatic Gallstones ◽  
Incidental Gallbladder Cancer

Introduction Incidental gallbladder cancer is found in 0.6–2.1% of patients undergoing laparoscopic cholecystectomy for symptomatic gallstones. Patients with Tis or T1a tumours generally undergo no further intervention. However, spilled stones during surgery may have catastrophic consequences. We present a case and suggest aggressive management in patients with incidental gallbladder cancer who had spilled gallstones at surgery. Case History A 37-year-old woman underwent a laparoscopic cholecystectomy for symptomatic gallstones, during which some stones were spilled into the peritoneal cavity. Subsequent histological examination confirmed incidental pT1a gallbladder cancer. Hepatopancreatobiliary multidisciplinary team discussion agreed on regular six-monthly follow-up. The patient developed recurrent pain two years after surgery. Computed tomography revealed a lesion in segment 6 of the liver. At laparotomy, multiple tumour embedded gallstones were found on the diaphragm. Histological examination showed features (akin to the original pathology) consistent with a metastatic gallbladder tumour. Conclusions This case highlights the potential for recurrence of early stage disease resulting from implantation of dysplastic or malignant cells carried through spilled gallstones. It is therefore important to know if stones were spilled during original surgery in patients with incidental gallbladder cancer following a laparoscopic cholecystectomy. Aggressive and early surgical management should be considered for these patients.

R-CHOP compared with CHOP in patients with diffuse large B-cell lymphoma (DLCL): Russian experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18536-18536 ◽  
Author(s):  
I. Poddubnaya ◽  
E. Osmanov ◽  
L. Babicheva ◽  
G. Tumyan ◽  
E. Sorokin ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Event Free Survival ◽  
Relapse Free Survival ◽  
Bulky Disease ◽  
Free Survival ◽  
Large B Cell Lymphoma

18536 Background: R-CHOP is regarded as the best available treatment for untreated patients with aggressive and indolent B- NHL. Methods: 184 previously untreated patients with DLCL were included in retrospective study: 92 patients were treated by CHOP, 92 patients were treated by CHOP plus rituximab ( R-CHOP ). Age of patients ranged 16–87 years (median 50 years). The median follow- up was 18 months. Compared groups were balanced in all parameters. The advanced stage of disease (III-IV) at diagnosis had 66% patients treated with CHOP and 67,5 % patients treated with R-CHOP. =2 extranodal zones were initially revealed at 35% in CHOP group vs 47% in R- CHOP group. PS of 25 % patients in R-CHOP group and 30% patients in CHOP group was regarded as appropriate 3–4 degrees on ECOG. Increased LDH level was marked at 60% in CHOP-group vs 54% in R-CHOP. 29% patients in R-CHOP group and 21% patients in CHOP group had B-symptoms at diagnosis; bulky disease took place in 53% cases in R-CHOP group and 62% cases in CHOP. High IPI score had 47 % patients in CHOP-group vs 48 % in R-CHOP. Results: Complete response was achieved in 74% of the patients treated with R- CHOP, as compared to 56% of those treated with CHOP alone (p<0,05). Disease progression during treatment was reported in 25% of patients in CHOP group and 18,5% in R-CHOP group. Median overall survival in patients treated with R-CHOP was NS, in patients treated with CHOP alone was 16 months. With a median follow-up of 18 months, 29 (31,5%) events (progression - 18,5%, relapse - 10%, death - 3% ) were observed in the R-CHOP group and 48 (52%) events ( progression - 25%, relapse - 20%, death - 7%) in the CHOP group (p<0,05). Median event-free survival and relapse-free survival in the CHOP group was 12 months, in R-CHOP group NS. Toxicity was equivalent in both groups. Conclusions: We have established better direct efficiency and outcome of R-CHOP in any age of pts. No significant financial relationships to disclose.

Clinical and molecular characteristics of non-small cell lung cancer patients from rural Maine.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18237-e18237
Author(s):  
Antoine Harb ◽  
Adam Curtis ◽  
Laura Skacel ◽  
Michael Babcock ◽  
Marek Skacel
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
P53 Mutation ◽  
Small Cell ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Disease Free

e18237 Background: Non-Small Cell Lung Cancer (NSCLC) is the most common malignancy worldwide and the leading cause of malignancy-related mortality in the United States. The state of Maine in particular, has one of the highest rates of lung cancer in the country. Methods: We reviewed all NSCLC patients (adenocarcinoma (AC) and squamous cell (SC) histology) diagnosed between January 2017 and June 2018 at Northern Light Cancer Institute. 261 patients with clinical follow-up were identified. We correlated their clinical characteristics with molecular abnormalities identified by Next Generation Sequencing (NGS) and Fluorescence in situ hybridization, PD-L1 status by immunohistochemistry, disease-free and overall survival. Results: 210 patients had AC and 51 SC. They were evenly split between men and women. The median age at diagnosis was 68 years. 99% of patients were Caucasian. 15 patients were never smokers, the rest were equally divided between active and previous smokers. 44% had early stage disease (I/II) and 56% had late stage disease (III/IV) on presentation. 36.4% had a PD-L1 high status. The frequencies of the molecular aberrations identified in AC and SC are listed in the table below: Treatment differed by stage, including surgery/Radiation +/- adjuvant chemotherapy for early stage disease, definitive chemo-radiation followed by immunotherapy for stage III disease. Stage IV patients were treated with immunotherapy, combination chemo-immunotherapy, targeted therapy, palliative radiation and hospice referral. After a median follow-up of 10.6 months, overall survival (OS) was 66%. Disease free survival (DFS) was 33%. Using univariate (chi-square), multivariate (logistic regression) and Kaplan-Meier (log rank) analyses, we identified that in addition to a high clinical stage, which was associated with shorter OS and DFS, high PD-L1 status, and the presence of p53 mutation, were independent predictors of shorter OS, and p53 mutation of shorter DFS. Conclusions: NGS-based molecular testing deployed in real-time non-academic setting proved to be a valuable tool to identify therapeutic and prognostic targets in NSCLC. Besides those endorsed by the NCCN guidelines, p53 mutation is a common abnormality associated with adverse outcomes. While high PD-L1 expression is a desirable immunotherapy marker, its presence also predicted adverse overall outcomes in our patients.[Table: see text]

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