Long Term Clinical Outcomes in Patients with Massive Splenomegaly and Non-Hodgkin's Lymphoma Treated with Splenectomy.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2692-2692 ◽  
Author(s):  
Jacob Smeltzer ◽  
Thomas M Habermann ◽  
Taner Timucin ◽  
David Nagorney ◽  
Kay Ristow ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
Clinical Outcomes ◽  
Hodgkin’S Lymphoma ◽  
Median Overall Survival ◽  
Hodgkin's Lymphoma ◽  
Massive Splenomegaly ◽  
Abdominal Symptoms ◽  
Non Hodgkin's Lymphoma

Abstract Abstract 2692 Background: Massive splenomegaly is occasionally encountered in patients with Non-Hodgkin's Lymphoma (NHL) and can be associated with abdominal symptoms, anemia and thrombocytopenia. The spleen may also be a primary focus of the disease itself. Splenectomy offers the benefit of localized treatment of the disease as well as relief of symptoms from splenomegaly and associated cytopenias. The safety and long term clinical outcomes of splenectomy for massive splenomegaly (>1500 gm) in patients with various histologies of NHL was analyzed. Methods: Data was obtained from clinical records of 90 patients with a diagnosis of NHL who underwent a splenectomy at Mayo Clinic Rochester from January 1998 to December 2007. Demographics, previous treatments, histology, post- surgical complications were collected and analyzed for the entire cohort. Additionally, median overall survival, improvement in symptoms, anemia and thrombocytopenia were analyzed by NHL type. Results: Median age at splenectomy was 67 years (range 42–84 yrs.) and 56 (62%) of patients were male. Average time from diagnosis to splenectomy was 3 months (range 0–217 months). Splenectomy was the first treatment in 56 (62%) patients; the other 34 patients were treated with chemotherapy with an average of two previous regimens. Most patients had involvement outside of the spleen, 65 (72%) with concurrent bone marrow involvement and 35 (50%) with lymph node involvement. Various different NHL histologies were represented: marginal zone (MZ) (34%), mantle cell (MC) (26%), diffuse large B-cell lymphoma (DLBCL) (10%), follicular (FL) (11%), lymphoplasmacytic (LP) (6%) and T cell NOS (4%). With a median follow-up time of 25 months, the median overall survival differed by histology type of NHL (Table 1). Indolent lymphomas such as FL, LP and MZ had more favorable survival compared with more aggressive lymphomas such as DLBCL and T cell NOS. Splenectomy was safe and well tolerated with only one treatment related death. There were no reported post-splenectomy septic events. Two patients did develop a portal vein thrombosis. 95% of patients had relief in pressure and abdominal symptoms post-splenectomy. With the exception of patients with DLBCL and T-cell NHL, a majority of patients had improvement in anemia and thrombocytopenia related to splenomegaly (Table 2). Conclusions: This represents the largest reported series of patients with lymphoma treated with splenectomy. Our results indicate that median overall survival after splenectomy is determined by the underlying type of NHL. Patients with LP, FL, MZ and MCL have a favorable outcomes following splenectomy. Splenectomy remains a safe and effective treatment option for massive splenomegaly in selected patients during the course of their disease management. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clinical Features and Long-term Outcomes of Lymphoma Patients Initially Presenting as Fever With Unknown Origin

2021 ◽  
Author(s):  
Min Wu ◽  
Fulati Wulipan ◽  
Jiexian Ma ◽  
Wensi Qian ◽  
Shunrong Sun ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
Clinical Features ◽  
Hodgkin’S Lymphoma ◽  
Unknown Origin ◽  
Response Rates ◽  
Hodgkin's Lymphoma ◽  
Overall Response ◽  
Non Hodgkin's Lymphoma

Abstract BackgroundLymphoma is found to be the main source of non-infectious fever of unknown origin (FUO). However, there is a lack of clinical features and outcomes in lymphoma patients initially presenting as FUO.MethodsFrom January 1, 2013 to December 31, 2019, our center enrolled 185 patients who initially presented as FUO then confirmed to be lymphoma in Huadong Hospital of Fudan University. During the same study period, 332 lymphoma patients without FUO received treatment in our center. After the exclusion, 509 patients were included in the retrospectively study. The differences in clinical manifestations, laboratory examinations, overall response rates and survival rates between the FUO and non-FUO groups were analyzed. The clinical endpoints were overall survival (OS) and progress-free survival (PFS).ResultsIn the non-FUO group (329 in total), Hodgkin’s lymphoma (HL) was 17 (5.2%), B cell non-Hodgkin’s lymphoma (B-NHL) was 276 (83.9%), T cell non-Hodgkin’s lymphoma (T-NHL) was 32 (9.7%) and NK/T cell lymphoma (NK/T-CL) was 4 (1.2%). In the FUO group (180 in total), B-NHL was 88 (48.9%), T-NHL was 60 (33.3%), NK/T-CL was 24 (13.3%) and HL was 8 (4.4%). During the hospitalization, the maximum body temperature of the FUO group diagnosed with B-NHL, T-NHL and NK/T-CL was statistically higher than that of the non-FUO group (all P<0.05). Concerning the overall response rates, there was no difference between the FUO and non-FUO groups, whatever the pathological subtype was. The differences in OS between the FUO and non-FUO groups were significant for HL (P=0.006), B-NHL (P=0.007) and T-NHL (P=0.013). No difference in overall survival was observed in the two groups for the subtype of NK/T-CL (P=0.141). In terms of PFS, there was no significant difference between FUO and non-FUO groups for any subtype (all P>0.05).ConclusionWe found that the major subtypes of lymphoma initially presenting as FUO were B-NHL and T-NHL. The main diagnostic biopsy sites were subcutaneous lymphnodes, bone marrow and spleen for lymphoma patients with FUO. Patients with FUO suffered from a higher risk of all-cause death in the long term.

scholarly journals Rate of Primary Refractory Disease in B and T-Cell Non-Hodgkin’s Lymphoma: Correlation with Long-Term Survival

PLoS ONE ◽  
2014 ◽  
Vol 9 (9) ◽  
pp. e106745 ◽  
Author(s):  
Corrado Tarella ◽  
Angela Gueli ◽  
Federica Delaini ◽  
Andrea Rossi ◽  
Anna Maria Barbui ◽  
...  
Keyword(s):  
T Cell ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Refractory Disease ◽  
Term Survival ◽  
Long Term Survival ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

scholarly journals A Population-Based Study of Prognosis and Survival in Primary Hepatobiliary Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4863-4863
Author(s):  
Ariel Sindel ◽  
Taha Al-Juhaishi ◽  
Roy Sabo ◽  
Victor Youssef Yazbeck
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
B Cell ◽  
Survival Time ◽  
Hodgkin’S Lymphoma ◽  
Median Overall Survival ◽  
Hodgkin's Lymphoma ◽  
Seer Database ◽  
Stage 1 ◽  
End Results

Abstract Background: Primary Hepatobiliary Lymphoma (PHBL) is a rare disease. In review of the literature, there are only few retrospective studies. On prior studies, the median age at presentation was 62 years and was associated with a median overall survival of 162 months. In this study, we sought to characterize standard prognostic factors and their effects on overall survival utilizing the Surveillance, Epidemiology and End Results (SEER) database. Methods The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients diagnosed with PHBL between 1973 and 2014. B-Cell and T-Cell lymphomas of all stages were included. Patient characteristics and demographics are summarized. Overall survival (OS) was estimated using the Kaplan-Meier method for all patients and for sub-groups. Comparisons are made between the survival functions between the levels of these categorical measurements using the log-rank test, where we adjust the significance level to account for multiple comparisons using the Bonferroni correction. Results: A total of 1751 patients were included. The mean age was 64 years (2-97), with the majority of patients being male (n=1081, 62%) and Caucasian (n=1278, 73%). B-cell Non-Hodgkin's Lymphoma was the predominant lymphoma (n=1297, 75%), followed by Not Otherwise Specified (n=338, 19%), and T-cell NHL and Hodgkin's Lymphoma were nearly identical at n=54 and 50 respectively. Staging at presentation varied with the majority being 1 and 4 (n=703, 40% and n=698, 40%), this was followed by stage 2 (n=196, 11%). The median overall survival time was 16 months (95% CI; 12, 23). By diagnoses, the median survival time (Figure 1) for B-Cell NHL was 23 months (95% CI; 17, 33) and was significantly longer survival than patients with T-Cell NHL (1 month, 95% CI; 0, 8, p=0.0014) and NOS (9 months, 95% CI; 6, 12, p=0.0076) but was not significantly different than patients with Hodgkin's Lymphoma (12 months, 95% CI; 1, 71 p=0.15). By staging, patients with stage 1 (38 months, 95% CI; 24, 52) did not have a statistically significant difference in survival in comparison to stage 2 (15 months, 95% CI; 9, 48, p=0.85) or 3 (10 months, 95% CI; 2, 34, p=0.0173). Results were not statistically significant regarding gender nor ethnicity. On a multivariant analysis, surgery, chemotherapy, or radiation were all associated with better survival when adjusted for patient age, sex, race, disease type and cancer stage. However, there did not appear to be a statistical significance when compared to each other. Conclusion PHBL is a rare lymphoma affecting mostly elderly, Caucasian males. B-Cell NHL subtype and stage 1 were associated with a more favorable prognosis. However, compared to DLBCL, PHBL seem to have a poorer outcome. While treatment alone conferred a longer survival, the type of treatment option did not have an overall change to prognosis. Disclosures No relevant conflicts of interest to declare.

High-dose intense doxorubicin-based regimens in aggressive non-Hodgkin's lymphoma: A systematic overview

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19528-e19528
Author(s):  
H. A. Azim ◽  
R. A. Malek ◽  
L. Santoro ◽  
S. Gandini ◽  
R. G. Bociek ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Randomized Trials ◽  
Outcome Measure ◽  
Chemotherapy Regimen ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

e19528 Background: Aggressive non-Hodgkin's lymphoma represents around 60% of lymphomas in the Western world and even more in Egypt. CHOP has been long been recognized as the standard chemotherapy regimen in this disease. The addition of rituximab (R) to CHOP in the treatment of B-cell subtypes has resulted in a significant improvement in all treatment endpoints. Nevertheless, still a significant fraction of patients in the developing world are not offered R due to economical reasons. Thus CHOP is still offered to these patients as well as those with T-cell subtypes. Data from the early 1990s have suggested that the dose intensity (DI) of doxorubicin may have a prognostic value. Hence we conducted a metaanalysis on chemotherapy regimens incorporating higher DI doxorubicin and compare them to CHOP in terms of complete response (CR) rate, event free survival (EFS) and overall survival (OAS). Methods: A MEDLINE and COCHRANE library search was performed using the search terms ‘CHOP‘, ‘lymphoma‘ and ‘randomized trials‘. Eligible trials were randomized trials, having CHOP as a control arm and any chemotherapy regimen administering doxorubicin at a higher DI than that of CHOP (16mg/m2/week) as the investigational arm. Pooling of data was performed using the mixed effect model. The outcome measure for pooling the CR rate was the odds ratio (OR) while the hazard ratio (HR) was the outcome measure for EFS and OAS. Confidence intervals were estimated according to the method developed by Parmar. Results: Eight trials published until February 2008 met the inclusion criteria. They included 3,668 patients randomly assigned to either CHOP (1,660 patients) or DI doxorubicin-based regimen (2008 patients). Patients receiving DI doxorubicin-based regimen had a significantly better overall survival (HR; 0.79; 95% CI: 0.66–0.94). As for the EFS and CR analyses, there was a trend in favor of patients who received the DI regimens; however the difference was not statistically significant (HR: 0.86; 95% CI: 0.71–1.03 & OR: 0.8; 95% CI: 0.63–1.02 respectively). Conclusions: High DI doxorubicin-based regimens are associated with a better OAS compared to CHOP. Such approach should be considered in patients with aggressive B-cell lymphomas not offered R as well as those with T-cell lymphomas. No significant financial relationships to disclose.

Prognostic Factors in Patients With Aggressive Non-Hodgkin's Lymphoma Treated by Front-Line Autotransplantation After Complete Remission: A Cohort Study by the Groupe d'Etude des Lymphomes de l'Adulte

2004 ◽  
Vol 22 (14) ◽  
pp. 2826-2834 ◽  
Author(s):  
N. Mounier ◽  
C. Gisselbrecht ◽  
J. Brière ◽  
C. Haioun ◽  
P. Feugier ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
T Cell ◽  
Complete Remission ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Cell Phenotype ◽  
Extranodal Site ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Purpose Improved survival has been observed in aggressive non-Hodgkin's lymphoma (NHL) patients with adverse prognostic factors when autotransplantation (ASCT) was performed after complete remission. However, there is no agreement on the prognostic factors for patients treated with ASCT. We aimed to estimate the prognostic effect of clinical and biologic variables on relapse and survival rates by pooling the data from two trials. Patients and Methods Of the patients treated in the LNH87 and LNH93 trials, 330 under age 60 years achieved complete remission after high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone, and received consolidative ASCT; 16% of patients had T-cell NHL. The International Prognostic Index (IPI) score was 0 for 11%, 1 for 23%, 2 for 51%, and 3 for 15%. Univariate and Cox multivariate survival analyses were retrospectively performed on this population. Results Overall survival was 75 ± 5% at 5 years and disease-free survival (DFS) 67 ± 5%. For T-cell NHL, these scores were 54% and 44%, respectively. The IPI score had no prognostic value and only the following parameters adversely affected overall survival and DFS (P < .05): marrow involvement; more than one extranodal site; histology (nonanaplastic T-cell v others); and type of anthracycline (mitoxantrone v doxorubicin, for DFS only). Conclusion These results suggest that ASCT can prevent relapse in patients with adverse IPI factors. However, patients presenting with a nonanaplastic T-cell phenotype, more than one extranodal site, or marrow involvement still have a higher risk of relapse. These factors should be taken into account when designing post-ASCT maintenance studies.

scholarly journals Secondary Skin Involvement in Non-Hodgkin's Lymphoma Does Not Impact Outcomes: SEER Database Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2895-2895
Author(s):  
Arushi Khurana ◽  
Taha Al-Juhaishi ◽  
Danielle Shafer
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
B Cell ◽  
Cell Population ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Secondary Site ◽  
Seer Database ◽  
Skin Involvement ◽  
Non Hodgkin's Lymphoma

Abstract Background: Non-Hodgkin's Lymphoma (NHL) comprises a diverse group of malignancies with varied presentations and clinical behavior. Different prognostic factors have been defined including age, LDH, gender, CNS involvement and molecular/genetic characteristics. We aim to study the incidence and impact of skin involvement as a secondary site in patients with mature B and T-cell NHLs. Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients (≥18 years) diagnosed with mature B/T/NK-cell NHL with skin as secondary site of involvement between 1973 and 2014. B-cell and T-cell lymphomas of all stages were included. Overall survival (OS) was estimated using the Kaplan-Meier method, and compared using Log-Rank test. Results: Total of 6429 patients were included with secondary skin involvement. B-cell NHL was more common with 76%. Median age for B-cell and T-cell NHL was 65 years (48-82), and 64 years (46-82), respectively. Slight male preponderance was noted in both subtypes (B-cell-56.7%% and T-cell-61.7%). Diffuse large B cell lymphoma (DLBCL) was the most common histology among B-cell NHLs, (DLBCL, N=1920 39.6%), followed by follicular (FL, N=1381, 28.5%) and extra nodal marginal zone (EN MZL, N=1314, 27.1%) Among T cell NHL histologies, peripheral T-cell NOS was the most common (PTCL, N=819, 51.6%) followed by anaplastic large cell ALK+ (ALCL+, N=341, 21.5%), and Sezary syndrome (N=293, 18.5%) Median overall survival was 6.1 [5.2 - 7.2.; 95% CI] years in T-cell population compared to B-cell population which was 13.3 [12.6-14.0; 95% CI] years. Survival was different by histologic subtype and correlated with SEER database relative survival for the overall population described in the SEER Cancer Statistics Review 1973-2011. Conclusion:- Skin involvement is relatively common in both B and T-cell NHLs. DLBCL, FL, MZL, PTCL-NOS and ALCL+ are the more commonly involved subtypes, correlating with their relative incidences. Outcomes in patients with secondary skin involvement tends to mimic known survival patterns in different histological subtypes conferring no additional prognostic significance. Skin as an extra nodal site of involvement should not change management for these patients. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

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