Adult Weight Gain and Risk of Developing Non-Hodgkin Lymphoma (NHL): Results from a Large Prospective Cohort Study of Older Women.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2389-2389
Author(s):  
Aditya Bardia ◽  
Thomas M. Habermann ◽  
Robert A. Vierkant ◽  
Alice H. Wang ◽  
James R. Cerhan

Abstract Background: Obesity has been associated with risk of non-Hodgkin lymphoma (NHL) in several recent studies. However, the effect of weight gain during adulthood, a potentially modifiable risk factor, on the incidence of NHL is not clear. We therefore examined the association of weight gain since age 18 years with the risk of NHL among older women. Methods: We examined this association in the Iowa Women’s Health Study, a prospective study of 37,762 Iowa women aged 55 to 69 years at enrollment in 1986. Lifestyle and other risk factors, including weight at age 18 and at enrollment, were self-reported on a mailed questionnaire. We defined stable weight as no increase in weight or up to a 10% weight loss from age 18 to enrollment, while percent weight gain was divided into tertiles based on the distribution observed in the cohort. NHL incidence through 18 years of follow-up was ascertained by linkage with the Iowa SEER Cancer Registry. Cox proportional hazards models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) of percent weight gain with NHL incidence, adjusting for age (Age-adjusted model) and age, marital status, farm residence, transfusion history, diabetes, use of hormone replacement therapy, alcohol use, smoking, and intake of red meat and fruits (Multivariate model). Results: The mean age of the women in the cohort in 1986 was 62.1 years. During 593,474 person-years of follow-up, 379 incident cases of NHL were observed. The mean age at diagnosis was 72.6 years (range 58–87 years). The main results are reported in the table. Similar results were found for absolute weight gain. Stratification of these results on body mass index at age 18 (using a cutpoint of 21 kg/m2) showed similar results, with the exception of >10% weight loss for women with a BMI of <21 at age 18 where we could not estimate a RR (no cases observed). Conclusions: Weight gain or large weight loss (>10% of body weight) during adulthood were both associated with increased risk of NHL, although the RRs for percent weight gain were not statistically significant and there was no dose-response. This study suggests another potential benefit of avoiding adult weight gain, although further studies are needed to confirm these novel findings. Association of percent weight change during adulthood (age 18 to age 55–69 years) and risk of NHL % Weight Change NHL Cases Person-years Age-Adjusted RR(95% CI) Multivariate RR (95% CI) >10% weight loss 15 17053 2.06 (1.05–4.02) 2.02 (1.03–3.95) Stable 20 45973 1 (reference) 1 (reference) 0–18.2% gain 115 175883 1.50 (0.94–2.42) 1.50 (0.93–2.41) 18.3–34.8% gain 119 176258 1.54 (0.96–2.47) 1.53 (0.95–2.47) >34.8% gain 110 178308 1.40 (0.87–2.25) 1.32 (0.82–2.14).

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2972-2972
Author(s):  
Arun Ganti ◽  
Katiuscia O'Brian ◽  
Weijian Liu ◽  
Suhong Luo ◽  
Kenneth R. Carson

Abstract Introduction Prior studies have demonstrated weight gain among recipients of chemotherapy for various solid tumors, though there is little evidence describing weight changes during and after treatment in patients with non-Hodgkin lymphoma (NHL). Weight gain during and after treatment can contribute to an increased risk of chronic conditions including: diabetes, coronary disease, and hypertension. This is important for long-term health in patients with diseases that are potentially curable or associated with long-disease free intervals, such as diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). We investigated the magnitude of weight change during and after treatment in a cohort of DLBCL and FL patients. Methods DLBCL and FL patients diagnosed between 1998 and 2008 and treated with combination chemotherapy +/- rituximab, were identified in the Veterans Health Administration database. Data on weight at time of first treatment (baseline) and at all recorded weight measurements up to 5 years after treatment initiation was obtained. Additional data included: height, age, race, co-morbidities, date of diagnosis, disease stage, LDH at diagnosis, B-symptoms, and treatment details (drugs, dates, and dosages). Only patients treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) +/- rituximab or CVP (cyclophosphamide, vincristine, and prednisone) +/- rituximab were included in the study cohort. Patients were categorized as gaining or losing 0-2.5%, 2.5-5%, 5-7.5%, 7.5-10%, or >10% of baseline weight. Weight change during treatment was calculated utilizing baseline and weight measurement at or near 3 months following treatment initiation. B-spline modeling was applied to further evaluate trends in weight change over time within the cohort. Results 2,159 patients met inclusion criteria. Mean age at diagnosis was 63.1 years, 96.6% of patients were men, and 59.5% of patients had stage III/IV disease. Mean Charlson co-morbidity score was 2.2. B-symptoms were noted at diagnosis in 48.4% of patients and LDH was elevated in 47.2% of patients. Mean and median weight change at 3 months after treatment initiation were -1.9 kg and -1.1 kg respectively, or -2.1% and -1.3% of baseline weight. Figure 1 illustrates the distribution of weight change during treatment within the cohort. In B-spline analysis, weight loss was maximal at 4.14 months after first treatment, with subsequent weight gain until reaching a plateau at 22 months (Figure 2). Among patients with 24 months or more of follow-up data, 45.7% had gained weight at 3 months and 60.5% had gained weight at 24 months. Only 4.3% of patients had gained >10% of baseline weight at 3 months, while 23.0% had gained >10% at 24 months. Similarly, 15.4% of patients had gained >5% of baseline weight at 3 months, while 38.5% had gained >5% at 24 months. Of the patients that gained weight at 3 months, 9.3% had gained >10% of baseline weight, while of the patients that gained weight at 24 months, 38.0% had gained >10%. Patients who gained weight in the first 3 months after treatment initiation were more likely to gain >10% baseline weight at 24 months compared to those who lost weight in the first 3 months. Discussion These results suggest that in contrast to other malignancies, most patients with NHL who are treated with multi-agent chemotherapy actually experience weight loss rather than weight gain over the course of treatment. Despite this initial trend, a majority of these patients undergo significant weight gain after the conclusion of therapy and in subsequent months. This poses a long-term health risk, particularly to patients who achieve a complete remission and long-term disease control. The timing of greatest weight gain in the 6-18 months after treatment initiation suggests an opportune time for initiation of a diet or exercise intervention to reduce weight gain shortly after the end of treatment. Disclosures: No relevant conflicts of interest to declare.


Open Medicine ◽  
2011 ◽  
Vol 6 (6) ◽  
pp. 788-794 ◽  
Author(s):  
Magdalena Kwaśniewska ◽  
Dorota Kaleta ◽  
Anna Jegier ◽  
Tomasz Kostka ◽  
Elżbieta Dziankowska-Zaborszczyk ◽  
...  

AbstractIntroduction: Data on long-term patterns of weight change in relation to the development of metabolic syndrome (MetS) are scarce. The aim of the study was to evaluate the impact of weight change on the risk of MetS in men. Material and Methods: Prospective longitudinal observation (17.9 ± 8.1 years) of apparently healthy 324 men aged 18–64 years. Metabolic risk was assessed in weight gain (⩾ 2.5 kg), stable weight (> −2.5 kg and < 2.5 kg) and weight loss (⩽ −2.5 kg) groups. Adjusted relative risk (RR) of MetS was analyzed using multivariate logistic regression. Results: The prevalence of MetS over follow-up was 22.5%. There was a strong relationship between weight gain and worsening of MetS components among baseline overweight men. Long-term increase in weight was most strongly related with the risk of abdominal obesity (RR=7.26; 95% CI 2.98–18.98), regardless of baseline body mass index (BMI). Weight loss was protective against most metabolic disorders. Leisure-time physical activity (LTPA) with energy expenditure > 2000 metabolic equivalent/min/week was associated with a significantly lower risk of MetS. Conclusions: Reducing weight among overweight and maintaining stable weight among normal-weight men lower the risk of MetS. High LTPA level may additionally decrease the metabolic risk regardless of BMI.


Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Susan van Dieren ◽  
Andre Pascal Kengne ◽  
John Chalmers ◽  
Joline Beulens ◽  
Yvonne van der Schouw ◽  
...  

Background/Aim: To determine the baseline characteristics and glucose lowering therapies associated with weight change among subjects with type 2 diabetes. Methods: 11,140 participants in the ADVANCE trial, were randomly assigned to an intensive (aiming for an HbA 1c ≤ 6.5%) or a standard blood glucose control strategy. Weight was measured at baseline and every 6 months over a median follow-up of 5 years. Multivariable linear regression and linear mixed effect models were used to examine predictors of weight change. Results: The mean difference in weight between the intensive and standard glucose control arm during follow-up was 0.75 kg (95% CI: 0.56 to 0.94), p-value<0.001. The mean weight decreased by 0.70 kg (95% CI: 0.53 to 0.87), p <0.001 by the end of follow-up in the standard arm but remained stable in the intensive arm, with a non-significant gain of 0.16 kg (95% CI: -0.02 to 0.34), p=0.075. Baseline factors associated with weight gain were younger age, higher HbA 1c , Caucasian ethnicity and number of glucose lowering medications. Treatment combinations including insulin [3.20 kg (95% CI: 2.90 to 3.50)] and thiazolidinediones [3.05 kg (95% CI: 2.68 to 3.42)] were associated with the greatest weight gain whilst treatment combinations including sulphonylureas were associated with less weight gain [0.71 kg (95%CI: 0.39 to 1.03)] (Figure 1). Conclusion: Intensive glucose control regimens are not necessarily associated with substantial weight gain. Patient characteristic associated with weight change were age, ethnicity, smoking and HbA1c. The main treatment strategies predicting weight gain were the use of insulin and thiazolidinediones. Acknowledgements: This research was supported by a program grant from the National Health and Medical Research Council of Australia, the Center for Translational Molecular Medicine (CTMM) and the Netherlands Heart Foundation, Dutch Diabetes Research Foundation and Dutch Kidney Foundation (PREDICCt).


PLoS Medicine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. e1003486
Author(s):  
Helene Kirkegaard ◽  
Mette Bliddal ◽  
Henrik Støvring ◽  
Kathleen M. Rasmussen ◽  
Erica P. Gunderson ◽  
...  

Background One-fourth of women experience substantially higher weight years after childbirth. We examined weight change from prepregnancy to 18 months postpartum according to subsequent maternal risk of hypertension and cardiovascular disease (CVD). Methods and findings We conducted a cohort study of 47,966 women with a live-born singleton within the Danish National Birth Cohort (DNBC; 1997–2002). Interviews during pregnancy and 6 and 18 months postpartum provided information on height, gestational weight gain (GWG), postpartum weights, and maternal characteristics. Information on pregnancy complications, incident hypertension, and CVD was obtained from the National Patient Register. Using Cox regression, we estimated adjusted hazard ratios (HRs; 95% confidence interval [CI]) for hypertension and CVD through 16 years of follow-up. During this period, 2,011 women were diagnosed at the hospital with hypertension and 1,321 with CVD. The women were on average 32.3 years old (range 18.0–49.2) at start of follow-up, 73% had a prepregnancy BMI <25, and 27% a prepregnancy BMI ≥25. Compared with a stable weight (±1 BMI unit), weight gains from prepregnancy to 18 months postpartum of >1–2 and >2 BMI units were associated with 25% (10%–42%), P = 0.001 and 31% (14%–52%), P < 0.001 higher risks of hypertension, respectively. These risks were similar whether weight gain presented postpartum weight retention or a new gain from 6 months to 18 months postpartum and whether GWG was below, within, or above the recommendations. For CVD, findings differed according to prepregnancy BMI. In women with normal-/underweight, weight gain >2 BMI units and weight loss >1 BMI unit were associated with 48% (17%–87%), P = 0.001 and 28% (6%–55%), P = 0.01 higher risks of CVD, respectively. Further, weight loss >1 BMI unit combined with a GWG below recommended was associated with a 70% (24%–135%), P = 0.001 higher risk of CVD. No such increased risks were observed among women with overweight/obesity (interaction by prepregnancy BMI, P = 0.01, 0.03, and 0.03, respectively). The limitations of this observational study include potential confounding by prepregnancy metabolic health and self-reported maternal weights, which may lead to some misclassification. Conclusions Postpartum weight retention/new gain in all mothers and postpartum weight loss in mothers with normal-/underweight may be associated with later adverse cardiovascular health.


Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2141-2141
Author(s):  
Juan F Garza ◽  
Michelle Janania Martinez ◽  
Prathibha Surapaneni ◽  
Tyler W Snedden ◽  
Snegha Ananth ◽  
...  

Introduction: Historically, a lack of health insurance has been reported to correlate with decreased access to medical care, a delay in cancer treatment and poorer outcomes overall. Furthermore, access to preventive services for cancer screening also decrease with lack of medical insurance (1, 2). Also, studies report that an increase in Medicaid expansion help reduce racial disparities previously seen between African American and Caucasian patients (3). The aim of this study was to present and analyze vitality data based on insurance coverage among Hispanic (HI) and non-Hispanic (NH) population at the only NCI designated cancer center of South Texas primarily serving Hispanics. Methods: This is a retrospective observational study of a cohort of patients seen with diagnosis of lymphoma by International Classification of Diseases (ICD) codes from 2008 to 2018 at UT Health San Antonio. Diffuse Large B Cell Lymphoma (DLBCL) cases were not included. Variables included age of diagnosis, lymphoma subtype, stage at diagnosis, comorbidities, treatment received, lines of therapy, B symptoms present, death, and cause of death and current vitality status. Continuously distributed outcomes were summarized with the mean and standard deviation and categorical outcomes were summarized with frequencies and percentages. The significance of variation in the mean with disease category was assessed with one-way ANOVA and the significance of associations between categorical outcomes was assessed with Pearson's Chi Square or Fisher's Exact test as appropriate. Multivariate logistic regression was used to model binary outcomes in terms of covariates and indicators of disease. All statistical testing was two-sided with a significance level of 5%. R1 was used throughout. Primary end point was to characterize insurance status. Secondary end points - overall 3 and 5-year survival based on insurance and demographics. Results: A total of 477 patients with lymphoma were identified. Hodgkin lymphoma (HL)( n = 116, 24%), non-Hodgkin lymphoma (NHL) (n = 308, 65%), T cell lymphoma (TCL) ( n = 53, 11%). Subtypes for all indolent lymphomas ( n = 217), of which included; Follicular lymphoma (FL) ( n = 123), Marginal Zone lymphoma (MZL) ( n = 53), Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) (n = 8), Small lymphocytic lymphoma (SLL) ( n = 28). Overall mean age of diagnosis for all lymphoma subtypes was 51, male patients (n = 244, 51%), female patients (n = 232, 49%), HI (n = 263, 56%) vs NH (n = 204, 44%), Mean BMI at diagnosis was 29 across all lymphoma groups. Most patients identified had Medicare (MC) (n = 115, 24%), or commercial insurance (CI) ( n = 222, 47%), others were approved for indigent care coverage (ICC) (n = 85, 18%), for Medicaid (MI) (n = 17, 4%), or unfunded (UF)( n = 35, 7%). Of those diagnosed with HL (n = 116); 60% (70) had MC or CI, 40% (46) had ICC, MI or were UF. Of those with Indolent Lymphomas (n = 217), 77% (166) had MC or CI and 23% (49) had ICC, MI or UF; and among patients with T cell lymphomas (n = 53), 63% (22) had MC or CI and 37% (13) ICC, MI or UF respectively. Overall number of HI patients alive at 3 years with MC or CI was 98 and 5 recorded deaths. Those with ICC or MI/UF were 52 and 11 respectively. Comparison of vitality data at 3 years follow up among both groups did not show a difference with a fisher p value of 0.056. Overall number of NH alive at 3 years with MC or CI was 90 and 11 recorded deaths. Those with ICC or MI/UF were 21 and 3 respectively. Comparison of vitality data at 3 years follow up among both groups did not show a difference with a fisher p value of 0.173. Overall number of HI alive at 5 years with MC or CI was 78 and 7 recorded deaths. Those with ICC or MI/UF were 36 and 11 respectively. Comparison of vitality data at 5 years follow up among both groups did not show a difference with a fisher p value of 0.064. Overall number of NH alive at 5 years with MC or CI was 70 and 14 recorded deaths and those with ICC or MI/UF were 16 and 4 respectively. Comparison of vitality data at 5 years follow up among both groups did not show a difference with a fisher p value of 0.169. Conclusion: Across all HI and NH, at the 3 and 5 year follow up mark, there was no significant vitality difference shown in our patient population between those with CI and or MC vs those with MI, ICC or UF. This study demonstrated that across all lymphoma subtypes, patients with access to healthcare had similar outcomes in vitality irrespective of demographics or insurance. Disclosures No relevant conflicts of interest to declare.


2020 ◽  
Author(s):  
Anna-Leena Vuorinen ◽  
Elina Helander ◽  
Julia Pietilä ◽  
Ilkka Korhonen

BACKGROUND Frequent self-weighing is associated with successful weight loss and weight maintenance during and after weight loss interventions. Less is known about self-weighing behaviors and associated weight change in free-living settings. OBJECTIVE This study aimed to investigate the association between the frequency of self-weighing and changes in body weight in a large international cohort of smart scale users. METHODS This was an observational cohort study with 10,000 randomly selected smart scale users who had used the scale for at least 1 year. Longitudinal weight measurement data were analyzed. The association between the frequency of self-weighing and weight change over the follow-up was investigated among normal weight, overweight, and obese users using Pearson’s correlation coefficient and linear models. The association between the frequency of self-weighing and temporal weight change was analyzed using linear mixed effects models. RESULTS The eligible sample consisted of 9768 participants (6515/9768, 66.7% men; mean age 41.5 years; mean BMI 26.8 kg/m2). Of the participants, 4003 (4003/9768, 41.0%), 3748 (3748/9768, 38.4%), and 2017 (2017/9768, 20.6%) were normal weight, overweight, and obese, respectively. During the mean follow-up time of 1085 days, the mean weight change was –0.59 kg, and the mean percentage of days with a self-weigh was 39.98%, which equals 2.8 self-weighs per week. The percentage of self-weighing days correlated inversely with weight change, <i>r</i>=–0.111 (<i>P</i>&lt;.001). Among normal weight, overweight, and obese individuals, the correlations were <i>r</i>=–0.100 (<i>P</i>&lt;.001), <i>r</i>=–0.125 (<i>P</i>&lt;.001), and <i>r</i>=–0.148 (<i>P</i>&lt;.001), respectively. Of all participants, 72.5% (7085/9768) had at least one period of ≥30 days without weight measurements. During the break, weight increased, and weight gains were more pronounced among overweight and obese individuals: 0.58 kg in the normal weight group, 0.93 kg in the overweight group, and 1.37 kg in the obese group (<i>P</i>&lt;.001). CONCLUSIONS Frequent self-weighing was associated with favorable weight loss outcomes also in an uncontrolled, free-living setting, regardless of specific weight loss interventions. The beneficial associations of regular self-weighing were more pronounced for overweight or obese individuals.


Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Woon-Puay Koh ◽  
Jian-min Yuan ◽  
An Pan

Introduction: While epidemiologic studies have established overweight and obesity as risk factors of cardiovascular disease (CVD) mortality, findings on the relationship of change in body weight with CVD mortality are inconsistent. Hypothesis: We assessed the hypothesis that weight change was related to CVD mortality among middle-aged to elderly Chinese in Singapore. Methods: We used prospective data from the Singapore Chinese Health Study, a population-based cohort of 63,257 Chinese men and women aged 45-74 years at recruitment (1993-1998). After 5.7 [standard deviation (SD) 1.4] years, we conducted a follow-up interview (1999-2004) among 52,322 surviving subjects in the cohort. Body weight and height were self-reported among 42,328 participants at both baseline and follow-up interviews. Weight change was computed by percentage difference in weight at both assessments relative to weight at baseline, and categorized as moderate-to-large loss (≥10%), small loss (5.1 to 9.9%), stable (±5%), small gain (5.1-9.9%), and moderate-to-large gain (≥10%). Cox proportional hazards regression model was applied to estimate hazard ratio (HR) after controlling for age, gender, dialect group, dietary pattern, smoking status, alcohol consumption, physical activity, hours of sleep and history of diabetes and hypertension. Results: A total of 1,805 CVD deaths were identified during the follow-up until December 31, 2013 [follow-up duration of 11.5 (SD 2.9) years]. Compared to participants with stable weight, those with moderate-to-large weight loss had a 42% higher risk of CVD mortality (HR: 1.42; 95% CI: 1.25-1.61), while those with moderate-to-large weight gain had a 19% higher risk (HR: 1.19; 95% CI: 1.02-1.37). The HR (95% CI) for stroke mortality was 1.77 (1.44-2.18) for moderate-to-large weight loss, and 1.42 (1.12-1.80) for moderate-to-large weight gain. Conversely, for coronary heart diseases (CHD) mortality, only moderate-to-large weight loss was associated with an increased risk (HR: 1.24; 95% CI: 1.05-1.47). The associations were not different by gender or age-group. When stratified by BMI at baseline using 23 kg/m 2 as cutoff for overweight, moderate-to-large weight loss was associated with increased risks of CHD and stroke mortality in both BMI groups. In contrast, moderate-to-large weight gain was only associated with increased risk of stroke mortality but not with CHD mortality in both BMI groups. Conclusions: In conclusion, this study suggested that both moderate-to-large weight loss and weight gain significantly increased risk of CVD mortality among middle-aged to elderly Chinese. This study emphasizes the importance of maintaining stable body weight in middle-aged and elderly populations.


2020 ◽  
Vol 40 (4) ◽  
pp. 310-315
Author(s):  
Hakan Seyit ◽  
Halil Alis

ABSTRACT BACKGROUND: There are no long-term results for laparoscopic sleeve gastrectomy (LSG) from Turkey. OBJECTIVES: Assess the outcomes of LSG at 5 years. DESIGN: Retrospective. SETTING: Training and research hospital. PATIENTS AND METHODS: The study included patients with LSG performed from August 2012 to December 2013. The data was prospectively collected with the aim of providing 5-year outcomes. MAIN OUTCOME MEASURES: Changes in percentage excessive weight loss (%EWI) and BMI. Changes in the pharmacological treatment status of patients with type 2 diabetes mellitus and hypertension. SAMPLE SIZE AND CHARACTERISTICS: 120 patients (89 female) completed follow up; mean age 37 years (range, 19-63 years), mean preoperative BMI 48.3 kg/m 2 (range 40-80.4 kg/m 2 ). RESULTS: After a mean 5.6-year follow-up, the mean (SD) postoperative weight loss was 43.5 (11.8) kg and the mean (SD) BMI loss was 16.1 (4.4). The mean %EWL value was 62.9% (range, 30-101%). Most patients (87.5%, n=105) achieved satisfactory %EWL values. The major complication rate was 6.6%. After surgery, 74.2% of patients taking medication for hypertension were able to stop treatment, while 12.9% reduced the dose, of patients that took medication for diabetes, all had a dosage reduction. CONCLUSIONS: We showed that LSG is an acceptable bariatric procedure, but in the long-term there may be weight gain and frequent reflux symptoms. We think renewed weight gain can be partially prevented by close clinical follow-up. There is a need for long-term randomized controlled studies with long-term follow-up to clearly define the indications for LSG. LIMITATIONS: Retrospective, incomplete clinical visits, GERD symptoms not objectively assessed. CONFLICT OF INTEREST: None.


MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 1-6
Author(s):  
Truc Phan ◽  
Tram Huynh ◽  
Tuan Q. Tran ◽  
Dung Co ◽  
Khoi M. Tran

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam. Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed. Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens. Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Christina Bergqvist ◽  
François Hemery ◽  
Arnaud Jannic ◽  
Salah Ferkal ◽  
Pierre Wolkenstein

AbstractNeurofibromatosis 1 (NF1) is an inherited, autosomal-dominant, tumor predisposition syndrome with a birth incidence as high as 1:2000. A patient with NF1 is four to five times more likely to develop a malignancy as compared to the general population. The number of epidemiologic studies on lymphoproliferative malignancies in patients with NF1 is limited. The aim of this study was to determine the incidence rate of lymphoproliferative malignancies (lymphoma and leukemia) in NF1 patients followed in our referral center for neurofibromatoses. We used the Informatics for Integrated Biology and the Bedside (i2b2) platform to extract information from the hospital’s electronic health records. We performed a keyword search on clinical notes generated between Jan/01/2014 and May/11/2020 for patients aged 18 years or older. A total of 1507 patients with confirmed NF1 patients aged 18 years and above were identified (mean age 39.2 years; 57% women). The total number of person-years in follow-up was 57,736 (men, 24,327 years; women, 33,409 years). Mean length of follow-up was 38.3 years (median, 36 years). A total of 13 patients had a medical history of either lymphoma or leukemia, yielding an overall incidence rate of 22.5 per 100,000 (0.000225, 95% confidence interval (CI) 0.000223–0.000227). This incidence is similar to that of the general population in France (standardized incidence ratio 1.07, 95% CI 0.60–1.79). Four patients had a medical history leukemia and 9 patients had a medical history of lymphoma of which 7 had non-Hodgkin lymphoma, and 2 had Hodgkin lymphoma. Our results show that adults with NF1 do not have an increased tendency to develop lymphoproliferative malignancies, in contrast to the general increased risk of malignancy. While our results are consistent with the recent population-based study in Finland, they are in contrast with the larger population-based study in England whereby NF1 individuals were found to be 3 times more likely to develop both non-Hodgkin lymphoma and lymphocytic leukemia. Large-scale epidemiological studies based on nationwide data sets are thus needed to confirm our findings.


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