RESUMEN
BACKGROUND: Anaplastic large cell lymphoma (ALCL) is the second most common T cell lymphoma and 2% of all non-hodgkin lymphoma (NHL). It is an aggressive lymphoma with three subtypes, primary cutaneous ALCL, primary systemic ALK +ve ALCL and primary systemic ALK-ve ALCL depending upon rearrangement of Anaplastic Lymphoma Kinase (ALK) gene into ALK +ve and ALK -ve ALCL. Purpose of study is to determine the outcome of patients with ALCL treated at our institute. METHODS: In this retrospective analysis, 49 patients with ALCL from 2000 to 2012 were included. Their base line IPI score, stage at presentation, bone marrow involvement, type of chemotherapy, ALK status, extra nodal sites and outcome were recorded. RESULTS: Median age was 34 years (range 20-72 years), with males' predominance, i.e., 75.5%. At presentation, 7 (14.3%), 12 (24.5%), 14 (28.6%) and 16 (32.7%) were in stage I-IV, respectively. According to IPI risk categorization, there were 27 (55.1%) in low risk, 12 (24.5%) in low intermediate risk, 8 (16.3%) in high intermediate risk and 2 (4%) in high risk. Seventeen patients (34.7%) were ALK +ve while 21 patients (43%) were ALK +ve and 11 patients (22.4%) had unknown status. Kaplan Meir overall survival (OS) at 5 years was 49.9%. Five-year OS in ALK +ve tumour was 67.4% compared to 39.7% in ALK -ve, p=0.05. CONCLUSIONS: Based on our study results, ALCL is common in males with a trend towards better outcome in Alk+ disease. The majority of patients are in advanced stage of disease at the time of presentation.
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Linfoma Anaplásico de Células Grandes , Adulto , Anciano , Femenino , Humanos , Estimación de Kaplan-Meier , Linfoma Anaplásico de Células Grandes/epidemiología , Linfoma Anaplásico de Células Grandes/genética , Linfoma Anaplásico de Células Grandes/mortalidad , Linfoma Anaplásico de Células Grandes/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To determine the impact of Rituximab and international prognostic index score on survival in diffuse large B-cell lymphoma patients. METHOD: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January to May 2013 and comprised record of patients with diffuse large B-cell lymphoma who were treated from 2007 to 2010. Baseline international prognostic index score, stage at presentation were noted and the records were divided into two groups A and B on the basis of the type of chemotherapy. SPSS 19 was used for statistical analysis. RESULTS: Of the 93 patients in the study whose records were reviewed, 54(58%) were men. Overall median age was 43 years (range: 18-76). Stages at presentation were stage-I 14 (15.1%), stage-II 41 (44.1%), stage-III 20 (21.5%) and stage-lV 18 (19.4%). International prognostic index risk categorisation was low risk 59 (63.4%), low intermediate risk 23 (24.7%), high intermediate risk 10 (10.8%) and high risk 1 (1.1%). There were 31 (33%) patients in Group A and 62 (67%) in Group B. Median follow-up was 3.9 years (range: 1.2-6.1). Overall survival at 4 years was 66.4%; for Group A 65.3% and for Group B 66.7% (p < 0.4). On the basis of risk categories, overall survival was statistically significant (p < 0.001) between the groups. CONCLUSION: International prognostic index risk categorisation had statistically significant impact on survival. However, there was no evidence of a significant survival benefit between types of chemotherapy. Further controlled trials are needed in this regard.
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Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Adolescente , Adulto , Anciano , Estudios de Cohortes , Ciclofosfamida/uso terapéutico , Supervivencia sin Enfermedad , Doxorrubicina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pakistán , Prednisona/uso terapéutico , Pronóstico , Estudios Retrospectivos , Rituximab , Centros de Atención Terciaria , Resultado del Tratamiento , Vincristina/uso terapéutico , Adulto JovenRESUMEN
OBJECTIVE: To determine the impact of Follicular Lymphoma International Prognostic Index risk categorisation on the survival of patients with follicular lymphoma treated in one centre. METHOD: The retrospective study comprised follicular lymphoma patients treated from 1997 to 2010 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. Their baseline prognostic index score, stage, bone marrow involvement and high-grade transformation were recorded. Risk categorisation was done according to the index score. SPSS 19 was used for statistical analysis. RESULTS: Median age of the 70 patients studied was 54 years (range: 23-98). There were 42 (60%) males. Overall, 58 (83%) patients presented with stage III/IV disease. Bone marrow was involved in 42 (60%) cases. High-grade transformation was reported in 12 (17.1%). According to risk categorisation, 21 (30%) were low risk, 21 (30%) intermediate and 28 (40%) were in high-risk category. Patients were treated with standard chemotherapy. Median follow-up was 3 years (range: 1-9). Median overall survival was 4.1 years (95% Cl: 4.7-6.4).The Kaplan Meier estimated overall survival at 5 years was 26 (43%). Five-year overall survival in the low, intermediate and high risk groups was 14 (66%), 10 (47%) and 7 (25%), respectively (p < 0.02). CONCLUSION: The Follicular Lymphoma International Prognostic Index showed significant prognostic value with high scores having poor overall survival compared to patients with low and intermediate scores.
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Linfoma Folicular/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Multiple myeloma is a heterogeneous disease, with wide survival range and multiple risk factors and staging systems linked to survival. The objective of this study was to assess the overall survival of patients with multiple myeloma (MM) diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital (SKMCH), Lahore with respect to various prognostic factors. METHODS: This was a survival analysis with data collected retrospectively on 82 patients fulfilling the diagnostic criteria of multiple myeloma. Overall survival was studied in relation to International Staging System (ISS), renal failure (Serum creatinine >2 mg/dl), anaemia (Hemoglobin <10 mg/dl), bone involvement (presence of lytic lesion on skeletal survey) and hypercalcemia (serum calcium >11mg/dl) due to multiple myeloma at the time of diagnosis. RESULTS: Mean age of patients was 61 years, including 67% males and 33% females. Median overall survival for ISS stage-I (24%), stage-II (44%) and stage-III (32%) was 58, 41 and 12 months respectively (p=0.01). Patients with renal impairment (16% of total) had median overall survival of 13 months compared to 41 months in patients without renal involvement (p=0.02). Hypercalcemia was noted in 27% patients with median overall survival of 32 months versus 38 months in patients without hypercalcemia, but its impact on survival was statistically insignificant (p=0.79). Similarly no significant impact on survival was noted in patients with bone involvement or anaemia found in 74 % and 38% of patient's respectively. CONCLUSIONS: ISS stage and renal failure due to multiple myeloma at presentation have a significant impact on survival. However, other prognostic factors like bone involvement, anaemia and hypercalcemia were not shown to influence survival significantly.
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Neoplasias Óseas/secundario , Mieloma Múltiple/mortalidad , Mieloma Múltiple/patología , Adulto , Anciano , Anemia/etiología , Femenino , Humanos , Hipercalcemia/etiología , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Estadificación de Neoplasias , Insuficiencia Renal/etiología , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Fever in neutropenic patient is a medical emergency. Timely intervention with antibiotics has been demonstrated to be effective. We assessed Piperacillin-Tazobactem as a cost effective mono-therapy in solid malignancy patients in our institution in relation to dual antibiotic therapy and other monotherapies. METHODS: This study was conducted to determine the efficacy, and cost effectiveness of Piperacillin-Tazobactem as monotherapy in febrile neutropenia. Total 150 patients with chemotherapy induced febrile neutropenia were selected. Piperacillin-Tazobactem was given intravenously 4500 mg every 6 hour. Outcome was assessed as success and failure. Success was defined as afebrile for four consecutive days, clearance of signs of infection, no new cultures, and no recurrence of primary infection after completion of therapy. Failure was defined as modification or addition of antibiotic due to clinical deterioration, cultured organism resistant to Piperacillin-Tazobactem and Death. RESULTS: The mean age was 43 years, 31% males and 69% were females. Out of total 150 patients, 73 patients were of breast carcinoma. There were 143 patients with negative blood cultures, and 7 patients with positive blood cultures, out of which 3 patients were resistant to Piperacillin-Tazobactem. Success was achieved in 83.3% of total patients. Daily cost of Piperacillin-Tazobactem was much less in relation to other monotherapies and dual antibiotic therapy including Gentamicin. None of the patient had adverse effects of Piperacillin-Tazobactem. CONCLUSION: We concluded that Piperacillin-Tazobactem is a safe, well tolerated as well as cost effective monotherapy in patient with febrile neutropenia with solid cancers. Only two percent organisms were resistant to Pipercillin-Tazobactam.