Four PAX5 Negative Nodular Sclerosing Hodgkins Lymphoma Case Series

Introduction/Objective Hodgkins lymphoma is a B cell lymphoproliferative disease, with most cases showing PAX5 positivity. Very few PAX5 negative hodgkins lymphoma cases have been described. We describe four PAX5 negative nodular sclerosing hodgkins lymphoma cases. All received standard chemotherapy, three received additional chemotherapeutic agents. Exploring these rare cases can be invaluable in characterizing and later treating his atypical presentation. Methods/Case Report Four cases of Hodgkins Lymphoma were diagnosed between 2017 and 2020. Two males and two females between 31 and 80 year old. Case 1 was a 31 year old male with a left neck lymphadenopathy that revealed nodular sclerosing Hodgkins lymphoma without bone marrow involvement. IHC staining revealed CD15, CD30, fascin and MUM-1 positivity, and PAX5 negativity. He received Doxorubicin, Vinblastine, Dacarbazine (AVD) and Brentuximab with radiation, and later brentuximab with bendamutine. Follow up PET-CT and left axillary node excisional biopsy found nodular sclerosing classic hodgkins. He received Ifosfamide, Carboplatin, and Etoposide. Case 2 was a 37 year old male with bilateral mediastinal lymphadenopathy that demonstrated nodular sclerosing Hodgkins lymphoma on biopsy. The cells were CD15, CD30 positive, and PAX5 negative. He received AVD with bleomycin (ABVD), and field radiation with excellent response and is currently under surveillance. Case 3 was a 31 year old female with a left chest mass that demonstrated nodular sclerosing Hodgkins lymphoma. The cells were positive for MUM1, CD30 and fascin and negatively for CD15 and PAX5. She received ABVD. Case 4 was an 80 year old female with prior stage IV gastric diffuse large B cell lymphoma treated with Rituximab, Cyclophophamide, Vincristine, and Prednisone and achieved remission. She later developed neck masses that were biopsied revealing classic Hodgkins lymphoma. The cells stained for CD30, for CD15, and were negative for PAX5. She was started on AVD and is on palliative care. Results (if a Case Study enter NA) NA Conclusion Most hodgkins lymphomas are PAX5 positive. We found four cases of PAX5 negative Hodgkins lymphoma. Incidentally, all were of the nodular sclerosing subtype. All cases were treated with recommended chemotherapy and/or radiation. All four cases had good response with reduction in disease burden. This finding suggests that PAX5 negativity still allows the nodular sclerosing hodgkins lymphoma to be responsive to standard treatment modalties.

Non-Hodgkins Lymphoma Presenting as a Skull Metastases: Case Report

The incidence of cerebral metastases has increased over the last few decades mainly due to the successful treatment of extra neural cancers and the prolonged survival of patients. The common causes of metastases are lung, kidney, breast and thyroid cancers. We present an interesting case of cerebral metastases that was managed as cerebral abscess, then as lung metastases before finally arriving to the correct diagnosis of Non-Hodgkin’s Lymphoma.

A CASE OF UPPER LIMB DEEP VEIN THROMBOSIS IN A KNOWN HIV PATIENT WITH NON HODGKINS LYMPHOMA

This is a case of upper limb deep vein thrombosis in a HIV positive patient who had also been diagnosed of Non-Hodgkins Lymphoma. This case highlights the importance of thromboprophylaxis and thrombotic risk assessment in all HIV positive as well as cancer patients particularly in low resource setting which are at risk of increased morbidity and mortality.

Therapy with of RCHOP-14 Versus RCHOP-21 for People With Aggressive or Advanced Stage Indolent B-Cell Non-Hodgkins Lymphoma: A Systematic Review and Meta-Analysis

Background: With the advent of rituximab, RCHOP is considered the appropriate chemotherapy for aggressive or advanced stage indolent B-cell Non-Hodgkins Lymphoma(NHL). RCHOP-14 seems to achieve better outcomes than RCHOP -21 in aggressive or advanced stage indolent B-cell NHL patients in recent years.Methods: To verify the befitting chemotherapy regimens for B-cell NHL patients, we searched the electronic databases for relevant English-language literature published through January 2020. The primary outcomes were complete response(CR),progression-free survival (PFS), overall survival(OS), and Adverse events (AEs). Six eligible Phase II and III clinical randomized controlled trials (RCTs) and two high-quality observational comparative studies (OCSs)were extracted, and 5565 B-cell NHL patients involved in evaluable.Results: The analysis demonstrated no significant difference for CR rate (OR= 0.98,95%CI 0.77-1.24，P=0.85)between RCHOP-14 and RCHOP-21. Compared with RCHOP-21, the merged hazard ratio (HR) for PFS and OS was, respectively, 0.94 (95% CI: 0.84-1.06, P=0.32) and 0.91(95% CI: 0.83-1.01, P= 0.08) after treatment with RCHOP-14.A subgroup analysis based on the international prognostic index(IPI) score showed that both chemotherapy regimens were applicable in B-cell NHL patients with different prognosis. The frequency of toxic side-effects was similar between schemes.Conclusions: Therefore, the data presented suggest that the efficacy and safety of both regimens are comparable and that R-CHOP14 remains a viable plan in B-cell NHL patients who prefer a shorter therapy course.

Primary extranodal non-Hodgkin lymphoma: Clinical characteristics and outcome.

e20027 Background: According to the National Cancer Registry Program, the Indian Council of Medical Research reports that the estimated Incidence rate of Non-Hodgkins Lymphoma in India is 2-3 per 100,000 people. The incidence rate of extranodal Non-Hodgkins Lymphoma (NHL) in Asia is higher than that of the United States. We illustrate a single center review of the clinical characteristics of all the primary extranodal NHL. Methods: We retrospectively identified patients diagnosed with primary extranodal NHL out of 269 NHL patients diagnosed at the department of medical oncology, Kasturba Medical College hospital, Mangalore, India from August 1999 and September 2015. Results: A total of 43 patients(15.9%) with primary extranodal NHL were identified out of which 25 patients (58%) were male with a median age of 49 years (5-92). 11patients (25%) had tonsil as the extranodal location and 10 patients (23%) had musculoskeletal involvement. Lung, thyroid, ovary, nasopharynx, gastrointestinal, paranasal sinuses and central nervous system were the other sites. 17 patients (39.5%) were presented at stage 4. The most common subtype was diffuse large B cell Lymphoma (DLBCL)-25 patients (58%). 2 patients had HIV infection. Some CD 20+ patients could not afford the cost of Rituximab and hence resorted to the CHOP regimen for 6 cycles. Rest received RCHOP 6-8 cycles depending on the stage and response. Follicular Lymphoma patient received 6 cycles of RCHOP and Rituximab maintenance for 12 cycles once in 2 months. Burkitts lymphoma patient received MCP 842. 3 patients denied treatment. 6 patients had recurrence who received DHAP +/- Rituximab or ICE +/- Rituximab. 1 patient-reported progression treated with supportive care. 6 patients (14%) died and 22 (55%) patients attained complete remission. Conclusions: In our cohort, DLBCL was the most common subtype and tonsil, the most involved site. The prognosis was impacted by the stage at which the patient was presented, HIV infections and the higher cost of Rituximab. Primary extranodal NHL must be considered in the differential diagnosis as the current treatments can achieve complete remission.