Clinicopathologic Characteristics of HIV-Associated Peripheral T-Cell Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3924-3924
Author(s):  
Jorge Castillo ◽  
Brady Beltran ◽  
Jaime Collins ◽  
Jose L Diez-Martin ◽  
Francisco Hernandez-Ilizaliturri ◽  
...  
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Median Survival ◽  
Cell Lymphoma ◽  
Performance Status ◽  
Bone Marrow Involvement ◽  
The United States ◽  
Response To Therapy ◽  
T Cell Lymphoma ◽  
Cd4 Count

Abstract Abstract 3924 Poster Board III-860 Introduction The incidence of lymphomas is increased in HIV-infected individuals. Most of the cases are B-cell subtypes of non-Hodgkin lymphoma. Although the incidence of mature or peripheral T-cell lymphomas (PTCL) seems to be increased in HIV-positive cases, clinicopathological data is lacking. The objective of this study is to describe the characteristics of non-cutaneous PTCL in HIV-infected individuals and identify potential prognostic factors. Methods Institutions within and outside of the United States were invited to submit original data on cases of HIV-associated PTCL. Data on each case included country of origin, age, sex, ethnicity, CD4 count, use of highly active antiretroviral therapy (HAART), B symptoms, lymphoma subtype according to the WHO classification of lymphoid neoplasms, expression of ALK, EBV and Ki-67, T-cell gene rearrangement, number of extranodal sites, bone marrow involvement, clinical stage, performance status, lactate dehydrogenase (LDH) levels, frontline therapy, response, use of stem cell transplantation (HSCT), final outcome, survival in months and cause of death; these will be presented using descriptive statistics. Univariate analyses were performed using Kaplan-Meier survival estimates compared using the log-rank test. Cox proportional-hazard regression test was used for the multivariate analysis. P-values of less than 0.05 were considered significant. Results Thus far, data on 24 cases have been obtained from 7 institutions. From these cases, 13 (54%) are from South America, 5 (21%) from Europe, 3 (12.5%) from North America and 3 (12.5%) from Asia. Thirteen cases (54%) are Hispanic, 5 (21%) are Caucasian, 3 (12.5%) are Black and 3 (12.5%) are Asian. Median age is 39 years (range 26 to 58 years) and the male-to-female ratio is 7:1. Sixteen cases (70%) presented with B symptoms. Median CD4 count is 129 cells/mm3 (range 4 to 305 cells/mm3). Twelve cases (63%) reported use of HAART. Fourteen cases (58%) are PTCL, unspecified (PTCLU), 4 cases (17%) anaplastic large cell lymphoma (ALCL), 4 cases (17%) of NK/T-cell lymphoma (NKTCL) and 2 cases (8%) angioimmunoblastic lymphoma (AITL). All ALCL cases were ALK-negative; EBV was expressed in 50% of NKTCL cases but in none of the AITL cases. Four of 15 cases (27%) had involvement of more than 2 extranodal sites, 3 of 11 cases (27%) had bone marrow involvement, 19 of 24 cases (79%) presented with advanced stage, 5 of 12 cases (42%) had an elevated LDH level and 8 of 24 cases (33%) had a performance status higher than 2. Thirteen of 24 cases (54%) were treated with chemotherapy alone from which 8 cases (62%) received CHOP therapy; six of 24 cases (25%) did not receive any therapy. Nine of 14 cases (65%) responded to therapy (29% CR and 36% PR); 35% of cases did not respond to therapy. Five cases of 14 (36%) underwent HSCT; 4 cases (29%) in the frontline and 1 case (7%) in the salvage setting. At the time of this report, 63% of cases have died; 53% due to infectious complications and 40% due to lymphoma progression. The median survival for the group was 10 months. The median survival for treated (n=19) and untreated cases (n=5) were 10.5 and 1 month, respectively (p=0.005). Conclusions HIV-associated PTCL tends to affect younger men with CD4 counts of less than 200 cells/mm3. PTCLU is the most common subtype reported in HIV-infected individuals. HIV-associated ALCL cases do not appear to express ALK. The survival of treated HIV-associated PTCL cases is short at 10.5 months despite a 65% initial response to therapy. Accumulation of data continues. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Prognostic Value of the Neutrophil to Lymphocyte Ratio in 209 Patients with Peripheral T-Cell Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1675-1675
Author(s):  
Brady E Beltran ◽  
Denisse Castro ◽  
Julio C Chavez ◽  
Eduardo M. Sotomayor ◽  
Jorge J. Castillo
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Prognostic Value ◽  
Cell Lymphoma ◽  
Performance Status ◽  
Bone Marrow Involvement ◽  
T Cell Lymphoma ◽  
Neutrophil To Lymphocyte Ratio ◽  
Advanced Stage ◽  
Lymphocyte Ratio

Abstract Introduction: Peripheral T-cell lymphomas (PTCL) are rare hematologic malignancies with a poor prognosis when treated with current standard therapies. Several factors have been developed to prognosticate survival in PTCL patients; however, more refined, easy to use and reliable prognostic tools are needed. The neutrophil to lymphocyte ratio (NLR) has been reported prognostic in patients with diffuse large B-cell lymphoma (Troppan et al. BJC 2014). We have investigated the prognostic value of the NLR in the overall survival (OS) of patients with untreated PTCL. Methods: We included patients with a pathological diagnosis of PTCL who were diagnosed and treated at our institution between 2001-2013. We excluded cases with primary cutaneous PTCL, CNS involvement, and patients with >50% incomplete data. IRB approval was obtained prior to research. Pathological samples were reviewed by expert hematopathologists to confirm a diagnosis of PTCL. Pertinent clinicopathological data such as age, sex, performance status, LDH levels, stage, bone marrow involvement, extranodal sites of disease, PTCL subtype, and absolute neutrophil and lymphocyte countswere collected through chart review, and are presented using descriptive statistics. The NLR was calculated by dividing the absolute neutrophil by the lymphocyte count, and dichotomized in NLR>=4 and NLR<4. The Prognostic Index for PTCL (PIT) was estimated using the clinical data above. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses were performed using Cox proportional-hazard regression models. Results: A total of 209 patients were included in our analysis from which 93 (44.5%) were PTCL, not otherwise specified (NOS), 83 (40%) were adult T-cell leukemia/lymphoma (ATLL), 22 (10.5%) were anaplastic large cell lymphoma (ALCL), 7 (3%) were extranodal NK/T-cell lymphoma (NKTCL), and 4 (2%) angioimmunoblastic T-cell lymphoma (AITL). The median age was 57 years (range 3-87 years) with equal distribution among men (52%) and women (48%). Poor performance status (ECOG >1) was seen in 85 (49%), elevated LDH levels in 116 (64%), >1 extranodal site in 31 (19%), bone marrow involvement in 64 (31%), and advanced stage (stage 3 and 4) in 151 (74%) of patients. Based on the NLR, 91 patients (59%) had NLR<4 and 62 (n=41%) had NLR>=4. Patients with NLR >=4 were more likely men (67% vs. 44%, p=0.005), and tended to present with elevated LDH (73% vs. 47%, p=0.002), advanced stage (87% vs. 61%, p=0.001) but lower bone marrow involvement (19% vs. 37%, p=0.02). There were no differences in age, performance status and number of extranodal sites. NLR>=4 was associated with a worse OS (HR 2.27, 95% CI 1.40-3.69; p=0.001). Specifically, NLR>=4 was associated with a worse OS in patients with non-ATLL PTCL (HR 2.99, 95% CI 1.67-5.37; p<0.001) but not in patients with ATLL (HR 1.16, 0.48-2.81; p=0.75). In the multivariate analysis, NLR>=4 was independently associated with worse OS when adjusting for the PIT score in non-ATLL PTCL patients (HR 2.12, 95% CI 1.06-4.26; p=0.03). Conclusion: The NLR appears as a novel and easy to use prognostic factor for OS in patients with untreated non-ATLL PTCL, independent of the PIT score. The NLR did not seem to be prognostic in ATLL patients. Our findings support the need for validation of the NLR in larger retrospective or prospective studies in patients with PTCL. Disclosures No relevant conflicts of interest to declare.

scholarly journals Subcutaneous Panniculitis-Like T-Cell Lymphoma With Bone Marrow Involvement

2015 ◽  
Vol 143 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Noah A. Brown ◽  
Charles W. Ross ◽  
Johann E. Gudjonsson ◽  
Daniel Wale ◽  
Attaphol Pawarode ◽  
...  
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
T Cell Lymphoma

A case of angioimmunoblastic T-cell lymphoma with bone marrow involvement, polyclonal hypergammaglobulinemia and skin rash

Skin Cancer ◽  
2011 ◽  
Vol 26 (2) ◽  
pp. 134-138
Author(s):  
Norihiro SUZUKI ◽  
Daisuke SUZUKI ◽  
Atsushi FUJITA ◽  
Chiyo NOMURA ◽  
Kazuyasu FUJII ◽  
...  
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Skin Rash ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
T Cell Lymphoma ◽  
Angioimmunoblastic T Cell Lymphoma ◽  
Polyclonal Hypergammaglobulinemia

Retrospective Study on T Cell Malignent Lymphoma: Classification, Manifestation, Laboratory Finding and Survival.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4652-4652
Author(s):  
Hongyan Tong ◽  
Feng Xiao ◽  
Tieying Dai ◽  
Jie Jin ◽  
Haitao Meng ◽  
...  
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
Autologous Bone Marrow Transplantation ◽  
T Cell Lymphoma ◽  
World Health ◽  
Clinical Staging ◽  
T Cell Lymphomas

Abstract T-cell lymphoma is the special malignant type of non-Hodgkin’s lymphoma. The diagnosis and the treatment were usually troublesome for physician in clinical practice. We retrospectively reviewed 63 cases of T-cell lymphomas from 360 cases of lymphomas in our hospital during the period from January 2000 to July 2006. This study is to determine the clinicopathological characteristics of T cell lymphomas. The patients were reclassified according to the World Health Organization classification system. Clinical data, including age, gender, clinical staging, and follow-up, were scrutinized. The median follow-up duration was 5 months (range 21days to 36 months). There were slightly more males than females (36 versus 27), and the median age at the onset were 40 years (range 13 to 77 years). The major subtype was peripheral T-cell lymphoma, which accounted for 78% (49/63). Besides, there were 5 cases of anaplastic T large cell lymphoma, 3 lymphoblastic lymphoma, 2 T/NK-cell lymphoma, 2 angioimmunoblastic lymphoma, 1 mycosis fungoides and 1 pre-T cell lymphoma. The most common manifestation was fever, which accounted for 60% (38/63). 27% (17/63) patients presented with obvious enlargement of lymphonodes. Other manifestation included skin rash or phymata, pruritus, jaundice, abdominal pain, rhinorrhagia, puffiness, diarrhea, hoarseness and ulcus. Interestingly, we found that only 32% obvious enlarged lymphonodes could be confirmed by physical examination, hepatomegaly 33% and Splenomegaly 44% respectively. Besides, there were several significant laboratory findings: 40% cases had cytopenia of at least 2 cell lines, 68% had high level of LDH, 70% had elevated β2-microglobulin and 68% were detected T-cell receptor (TCR) and immunoglobulin heavy chain (IgH) gene rearrangement. Furthermore, 53% (33/63) patients had bone marrow involvement at the onset and 27% were diagnosed only by bone marrow biopsy. We also observed 20 cases of lymphoma associated hemophagocytic syndromes (LAHS). The median age for this disease was 37 year. The median life span was 39 days (range 21days to 10 months). The initial manifestations included fever (19/20), splenohepatomegaly (18/20), and cytopenias in all patients. Only 15% patients had enlargement of lymphonodes, which was suggested to be infrequent in LAHS. Immatural T-cell infiltration in bone marrow was detected in 75% (15/20) cases. Chromosome disorder of [der(21)(p11), −22] was detected in 3 cases. We also found that 2 cases which underwent plasmapheresis got much better after chemotherapy. 19 cases were under our follow-up. 17 patients could not survival longer than 6 months. The 6-month overall survival (OS) for LAHS was merely 2 of all 20. Furthermore, nobody survived more than 1 year, which indicated the poor prognosis of LAHS. There were 11 out of 63 cases had received trial chemotherapy including liposomal Doxorubicin, L-asparaginase, velcade, autologous bone marrow transplantation, or plasmapheresis before chemotherapy. The median survival time prolonged obviously from 2 months up to 8 months, which suggested the encouraging efficiency of these methods.

Clinical Characteristics of T-Cell Lymphoma Associated Hemophagocytic Syndrome: Comparison of T-Cell Lymphoma with and without Hemophagocytic Syndrome.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3576-3576
Author(s):  
Hongyan Tong ◽  
Yanling Ren ◽  
Feng Xiao ◽  
Wenyuan Mai ◽  
Haitao Meng ◽  
...  
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Median Survival ◽  
Clinical Characteristics ◽  
Hemophagocytic Syndrome ◽  
Cell Lymphoma ◽  
Initial Therapy ◽  
T Cell Lymphoma ◽  
Β2 Microglobulin ◽  
Significant Difference

Abstract T-cell lymphoma associated hemophagocytic syndrome (T-LAHS) has been regularly reported in Asia countries and is considered with extremely poor prognosis. The rate of definite diagnosis during early stage is low and the therapeutic outcome has been disappointed. We therefore compared T-cell lymphoma patients with and without hemophagocytic syndrome (HPS) in order to have a better understanding of the clinical characteristics of T-LAHS. One hundred and thirteen patients (66 men and 47 women, age from 12 to 80 years with the median age of 42) with aggressive T-cell lymphoma admitted to our department between January 2000 and December 2005 were included in this study, while 28 of them were with T-LAHS. The patients were divided into LAHS group and no-LAHS group. The clinical data including clinical manifestations and laboratory findings were compared between the two groups by using Chi-square test. The method of Kaplan and Meier was used to analyze overall survival (OS). The results showed that LAHS occured in about 1/4 of all the patients with T-cell lymphoma, which were all aggressive type. The elevated rates of lactate dehydrogenase (LDH) and ferritin were much higher in LAHS group than in no-LAHS group. β2-microglobulin and ovarian cancer antigen (CA125) were also elevated in both groups, but there was no significant difference. The rate of hypo-fibrinogen and liver dysfunction were higher in LAHS group than that in no-LAHS group. The rate of bone marrow infiltration in LAHS group is remarkably higher than that in no-LAHS group (57% vs 32%, p&lt;0.05). The median survival was 40 days (16 days - 22 months) in the LAHS group, and the median survival of 11 patients accepted chemotherapy more than 2 courses was 6 months. By contrast, the 2-year survival for no-LAHS group was 43%. There was significant difference between the two groups. Three patients undergoing plasmapheresis as initial therapy had survived for 3–6 months. These results indicate that high suspicion is required for early diagnosis of T-LAHS. In patients with fever, hepatosplenomegaly and cytopenia, simultaneously with serum markers such as LDH, ferritin, TG, CA125, and β2-microglobulin constantly increasing, T-LAHS should be considered. For patients without extranodal invasion or enlargement of lymph nodes, repeating biopsy of multiple sites of bone marrow may help improving the diagnosis rate. As for treatment, other more intensive regimens were not superior to CHOP regimen. While the overall outcome of treatment is still unsatisfied, plasmapheresis as initial therapy is worth considering.

Extranodal NK T Lymphoma, Nasal Cell Type: A Retrospective Analysis of 25 Patients from an Academic Center

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5446-5446
Author(s):  
Ragisha Gopalakrishnan ◽  
Harris V. Naina
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Median Survival ◽  
Poor Prognosis ◽  
Bone Marrow Involvement ◽  
Cervical Lymphadenopathy ◽  
The United States ◽  
Proliferation Index ◽  
Nasal Type ◽  
Nk T Cell

Abstract Background: Extranodal natural killer T (NK/T) -cell lymphoma, nasal-type, is a recognized entity within the WHO classification of lymphoid tumors. This neoplasm is a rare, and is well documented in East Asia. It is not commonly seen in the United States; however the overall prevalence and incidence of this lymphoma has started to increase. Due to its rare prevalence in the United States, a standardized chemotherapy regimen and a prognostic model have yet to be established in patients diagnosed with this lymphoma. Methods: In this retrospective study, we reviewed a total of 25 patients with a diagnosis of extranodal NK T cell lymphomas nasal type. Several variables were assessed including international prognostic index (IPI), performance status, regional lymph node involvement, bone marrow involvement, and proliferation index (high proliferation index defined as Ki67/MIB expression in > 50% cells). We assessed the clinical outcome using various treatment modalities over the last 2 decades. Results The majority of the patients in this study were males 20 (80%). The median age of patients was 46 (20-72), and most patients were Hispanic (80%). Ann Arbor staging was performed and was noted as follows: stage I (12), stage II (5), stage III (3), and stage IV (5). Patient were risk stratified into IPI score and ECOG PS score: IPI score < 2 (17), IPI > 2 (8), ECOG < 2 (19) and ECOG >2 (6). Nine patients were treated with RCHOP + radiation (XRT) and 10 patients were treated with hyper CVAD therapy + XRT. Seven patients were treated with a non-anthracycline based approach: VIPD+ XRT (2), DEVIC + XRT (3), and SMILE+ XRT (2). The five year overall survival of this group was 38.4%. An IPI score > 2 was noted to have significant poor prognosis with a median survival of 15 months in comparison to 22 months (p< 0.001) for IPI < 2. Bulky cervical lymphadenopathy and bone marrow involvement at diagnosis were poor prognostic indicators of overall survival. Patients who presented with bulky cervical lymphadenopathy or evidence of bone marrow involvement at diagnosis were noted to have a median survival time of 12 months, as compared to no involvement had a median survival of 22 months ( p<0.001). A high proliferation index was also associated with a poor prognosis as well. Patients who were noted to have a high proliferation index had a median survival of 15 months as compared to 22 months in patients who were noted to have a low proliferation index (p< 0.001). Median survival in patients treated with RCHOP + XRT was noted be 12 months in comparison to patients with HYPER-CVAD+ XRT (24 months) and non-anthracycline approach (28 months) (p< 0.001). In addition, patients treated with RCHOP +XRT were noted to have increased incidence of disease progression comparison to patients treated with HYPERCVAD+ XRT and non-anthracycline based therapy +XRT (p< 0.0001) (Figure 1). Conclusions: In this retrospective analysis, we demonstrated that extra-nodal NK T cell, nasal type has a poor prognosis. Preliminary data from this study suggests hyperCVAD or a non-anthracycline based chemotherapy approach with concomitant radiation are superior to RCHOP with concomitant radiation. The results of this study also provided promising results for a prognostic model against this lymphoma in the future. These results underscore the need for further investigation for this lymphoma in the future. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Evaluation of bone marrow involvement in extranodal NK/T cell lymphoma by FDG-PET/CT

2014 ◽  
Vol 94 (6) ◽  
pp. 963-967 ◽  
Author(s):  
Zhiyuan Zhou ◽  
Changying Chen ◽  
Xiang Li ◽  
Zhaoming Li ◽  
Xudong Zhang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
T Cell Lymphoma ◽  
Pet Ct ◽  
Nk T Cell ◽  
Fdg Pet Ct

scholarly journals Bone marrow involvement of primary cutaneous γ/δ T-cell lymphoma

Blood ◽  
2016 ◽  
Vol 128 (18) ◽  
pp. 2274-2274
Author(s):  
Hiromichi Matsushita ◽  
Dai Maruyama
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
T Cell Lymphoma

scholarly journals A Clinical Prognostic Index for Angioimmunoblastic T Cell Lymphoma in an Asian Multi-Centre Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2453-2453
Author(s):  
Esther Chang ◽  
Valerie Shiwen Yang ◽  
Shin Yeu Ong ◽  
Hilda Kang ◽  
Ya Hwee Tan ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
White Cell Count ◽  
Performance Status ◽  
Bone Marrow Involvement ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
Ann Arbor ◽  
Progression Of Disease ◽  
Advanced Stages

Abstract Background and aims: Angioimmunoblastic T cell Lymphoma (AITL) is a subtype of peripheral T cell lymphoma that is generally felt to be aggressive and of poor prognosis. It is characterized as a lymphoma associated with inflammatory and immune conditions, typically seen in the older population and presenting at more advanced stages. The International T-Cell Lymphoma project recently reported a novel AITL score comprising of age, ECOG performance status, serum CRP level and serum B2-microglobulin level; the latter 2 variables suggesting a pro-inflammatory state. They also found that progression of disease within 24 months (POD24) to be strongly prognostic. In our Asian multicenter study, we aim to investigate the clinical prognostic factors affecting the outcomes of our AITL patients and attempt to identify a prognostic index that would be relevant to our Asian population. Methods: Patients who were consecutively diagnosed with AITL and seen at National Cancer Centre Singapore and Singapore General Hospital between June 1999 and Dec 2019 were retrospectively analyzed. Relevant demographical and clinical characteristics were collected. Median duration of follow up was 19.7 months. Outcomes of interest were that of 5-year overall survival (OS) and 5-year progression free survival (PFS). POD24 as defined by progression of disease within 24 months was also analyzed for its prognostic significance. Kaplan meier curves were plotted to estimate survival for each individual clinical parameter. Parameters found to be significant on univariate analysis were subsequently used in generation of multivariate cox regression models. Results: A total of 166 patients were included. The median age was 62.1 years. The majority of our patients (92.8%) had good performance status of ECOG 0-1 and 77.7% presented at advanced stages (Ann Arbor stage 3-4). The median PFS and OS was 1.5 years and 5.5 years respectively. The estimated 5-year PFS and OS was 40% and 53% respectively. Univariate analyses of various parameters were significant for age &gt;60 years, presence of B symptoms, ECOG &gt;1, Ann Arbor stage 3-4, bone marrow involvement, elevated serum lactate dehydrogenase &gt; upper limit normal, elevated total white cell count &gt; 12 x 10 9/L and low platelet count &lt; 150,000/mm 3. In the multivariate analyses, age &gt;60 years, bone marrow involvement, elevated total white cell count and low platelet count were associated with poorer PFS and OS. This allowed for a prognostic index (AITL-PI) differentiating patients into low (0-1 factors, n=62), moderate (2 factors, n=54) and high (3-4 factors, n=48) risk subgroups with 5-year OS of 83%, 41% and 26% respectively. The corresponding 5-year PFS of the low, moderate and high risk subgroups are 69%, 29% and 14%. Likewise, POD24 proved to be strongly prognostic in our cohort as patients with POD24 had a 5-year OS of 24%, whereas those without POD24 had a 5-year OS of 90% (p&lt;0.0001). Conclusion: We validated POD24 as a strong prognostic factor. Our AITL-PI was able to identify 3 different subgroups of patients with disparate outcomes based on their presenting clinical parameters. Further work can be done to elucidate if there are unique pathological or molecular characteristics in these individual risk groups that can further guide treatment choices. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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