Increasing Incidence of Non-Hodgkinีs Lymphoma in Karachi, 1995-2002

This first population-based study of non- Hodgkin lymphoma (NHL) from any region in Pakistan, provides an ‍overview of the incidence pattern and time trends in Karachi and generates hypotheses for future experimental ‍research. Epidemiological data for 429 incident (1st Jan 1995 to 31st Dec 2002), microscopically verified nodal and ‍extra-nodal NHL cases, registered at the Karachi Cancer Registry (KCR) for Karachi South, were reviewed. The ‍age standardized incidence rate (ASIR) was 5.3/100,000 in males (M) and 4.1/100,000 in females (F), in 1995. A ‍gradual increase in the annual incidence was observed during the study period, with NHL incidence rate increasing ‍in 2002 to 8.4/100,000 in men and 6.5/100,000 in women, almost double the 1995 rates. NHL affected all age groups ‍in both genders and for each group the ASIR was higher among men than women, with an overall gender ratio of ‍1.9. The mean ages of the patients were 41.5 years (95% CI 39.1; 43.8) in males and 44.0 years (95% CI 40.8; 47.1) ‍in females. The adult to childhood ratios were 8.6 (M) and 10.7 (F). B-cell NHL comprised 81.0% of NHL in males ‍and 87.3% in females. One fourth of the NHL cases were extra-nodal, the largest group was of gastrointestinal ‍origin (54.1% M, 38.5% F). The gastric component was 21% M and 25.6% F. ‍Odds Ratios for sex, age-groups, ethnicity, religion, and subdivision by socio-economic categories were calculated ‍by considering all malignancies, except lymphoproliferative disorders as controls. The odds ratio (OR) in men was ‍2.2 (95% CI 0.6; 3.0). Children and adolescents were at the highest risk of developing NHL, especially the 5-9 year ‍olds, in both genders. A marginally higher risk was observed for the lower socioeconomic categories and for ethnicities ‍belonging to Northern and North–Western Pakistan (Punjabi, Pushtu and Baluch) residing in Karachi South. ‍The incidence rates of NHL registered in Karachi South are likely to be a reflection of non-AIDS-associated ‍NHL. Estimated HIV/AIDS incidence was too low during the study period in this population to have an impact on ‍NHL incidence. The preponderance of low and intermediate grade lymphomas, paucity of central nervous system ‍NHL and a higher childhood NHL component support this hypothesis. As yet unpublished reports, however, are ‍raising the alarm on rising HIV positivity. NHL correlation with HIV/AIDS status and studies identifying risk ‍factors of non- HIV/AIDS associated NHL (childhood viral infections, Hepatitis C virus, and Helicobacter pylori) ‍are potential areas for future experimental and epidemiological research.     

Trends in the Incidence of Kaposi’s Sarcoma and Non-Hodgkin Lymphoma in Northern Thailand during the Time Period of Universal Access to Antiretroviral Treatment, 1998-2017

Purpose: We evaluated the trends in incidence of Kaposi’s sarcoma (KS) and Non-Hodgkin’s lymphoma (NHL)  over the two decades in northern Thailand during which access to antiretroviral treatments (ART) in Thailand was scaled up. Methods: This is retrospective observational study. Data from 1998 to 2017 of patients diagnosed with KS and NHL from three long-standing, population-based cancer registries in northern Thailand (Chiang Mai, Lampang and Lamphun) were used to describe trends in age-adjusted incidence rate (ASR) of these cancers. The annual percent change (APC) of incidence rates were evaluated over this timeframe. Results: The incidence of KS significantly increased from 1998 to 2017 in males (APC of 6.9%) and very low incidence for evaluating change in female. NHL incidence significantly increased from 1998 to 2017, 2.2% and 1.8% per year in males and females, respectively (p<0.001). Conclusion: In the last two decades, the incidence of KS in male and NHL in both sexes have increased in northern Thailand, while the incidence of KS in female remained low. The change in incidences in opposite to the decline in HIV prevalence and increase ART coverage rate supported that other associated factors attributable to the development of KS and NHL should be looked for i.e., environmental, occupational exposures and other infections.     

Therapeutic Efficacy of L-asparaginase in the Treatment of Refractory Midfacial Peripheral T-Cell Non-Hodgkin’s Lymphoma

Primary midficial peripheral T-cell non-Hodgkin's lymphoma (PMPTC-NHL) of the nasal cavity, paranasal sinuses, palate and nasopharynx occurs relatively high among Orientals. The incidence comprises approximately 3% of NHL in Hong Kong Chinese.[1] Previously, PMPTC-NHL has been designated by the names of lethal midline granuloma, midline reticulosis or polymorphic reticulosis, but recently it is considered as a distinct clinicopathological entity of NHL because the lesions show NK/T…     

Emerging Non-transplant-based Strategies in Treating Pediatric Non-Hodgkin’s Lymphoma

Lymphomas represent the third most common cancer in children and adolescents. The non-Hodgkin’s lymphomas comprise a heterogeneous group of tumors, with distinct clinical and pathologic features. Although intensive multi-agent chemotherapy has made non-Hodgkin’s lymphoma one of the most curable malignancies in children and young adults, there is room for improvement in treatment, particularly for those with advanced-stage disease and those who relapse after conventional therapy. New approaches are now attempting to reduce the burden of treatment, to focus on novel and more specific biologic targets, and to improve outcomes for patients with advanced-stage disease while reducing the potential for late effects. A comprehensive review of all potential agents is beyond the scope of this review, which will focus on some of the newer strategies for treating non-Hodgkin’s lymphoma that are coming into clinical use today.     

Spotlight on Rituximab in Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia

Rituximab is an anti-CD20 monoclonal antibody that has demonstrated efficacy in patients with various lymphoid malignancies, including indolent and aggressive forms of B-cell non-Hodgkin’s lymphoma (NHL) and B-cell chronic lymphocytic leukemia (CLL). While the optimal use of the drug in many clinical settings has yet to be clarified, two pivotal trials have established rituximab as a viable treatment option in patients with relapsed or refractory indolent NHL, and as a standard first-line treatment option when combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy in elderly patients with diffuse large B-cell lymphoma (the most common type of aggressive NHL). The former was a noncomparative trial in relapsed indolent NHL (follicular and small lymphocytic subtypes) with clinical responses achieved in about half of patients treated with rituximab 375 mg/m² intravenously once weekly for 4 weeks, which was similar to some of the most encouraging results reported with traditional chemotherapeutic agents. The latter was a randomized comparison of eight cycles of CHOP plus rituximab 375 mg/m² intravenously (one dose per cycle) versus CHOP alone in previously untreated elderly patients (60 to 80 years of age) with diffuse large B-cell lymphoma. In this pivotal trial, 2-year event-free and overall survival were significantly higher with rituximab plus CHOP, and there was no increase in clinically significant adverse effects compared with CHOP alone. Treatment with rituximab is generally well tolerated, particularly in terms of adverse hematological effects and serious or opportunistic infections relative to standard chemotherapy. Infusion-related reactions occur in the majority of patients treated with rituximab; these are usually mild to moderate flu-like symptoms that decrease in frequency with subsequent infusions. In approximately 10% of patients, however, severe infusion-related reactions develop (e.g. bronchospasm, hypotension). These reactions are usually reversible with appropriate interventions and supportive care but there have been rare reports of fatalities. Conclusion: Clinical trials with rituximab indicate that the drug has broad application to B-cell malignancies, although further clarification is needed to determine its optimal use in many of these clinical settings. Importantly, rituximab in combination with CHOP chemotherapy has emerged as a new treatment standard for previously untreated diffuse large B-cell lymphoma, at least in elderly patients. Compared with conventional chemotherapy, rituximab is associated with markedly reduced hematological events such as severe neutropenia, as well as associated infections. Rituximab may be particularly suitable for elderly patients or those with poor performance status, and its tolerability profile facilitates its use in combination with cytotoxic drugs.     

Evaluation of Significance of Lymphocyte Subpopulations and Non-specific Serologic Markers in B-cell Non-Hodgkin’s Lymphoma Patients

The use of rituximab brought attention to the hosts’ immune system and to the microenvironment in non-Hodgkin’s lymphoma cases. Our aim was to identify prognostic factors that can be measured easily to indicate the current state of the patient’s immune status and possible reaction against malignant cells. In the retrospective analysis (2000–2008), 66 patients diagnosed with B-cell non-Hodgkin’s lymphomas were enrolled (40 women, 26 men; mean age: 51 years). White blood cells, lymphocytes, CD3 +; CD4 +; CD8?+?T-cells, immunoglobulin types A; G; M, anti-cardiolipin antibody isotypes A; G; M; and levels of beta-2-microglobulin were measured before the initiation of the first cycle of chemotherapy, during and after 4-weeks treatment. As for CD 3+ T-lymphocytes, the absolute CD 3+ T –lymphocyte numbers were higher before (0.78?×?10⁹/L) versus during (0.27?×?10⁹/L) treatment, and increased percentages were detected in pre- (66.57 %) and post-treatment (75.32 %). Absolute numbers of CD 8+ T-lymphocyte levels showed reduction before (0.26?×?10⁹/L) versus during (0.10?×?10⁹/L) therapy, but were elevated after (0.28?×?10⁹/L) treatment, while increased percentage before (21.99 %) versus after (29.85 %), and during (24.56 %) versus after (29.85 %) therapy were seen. Average white blood cell numbers were increased before (9.71?×?10⁹/L) versus during (12.07?×?10⁹/L) treatment, while decreased numbers could be observed, after (5.47?×?10⁹/L) treatment. IgA levels were decreased before (2.51 g/L) versus after (1.63 g/L) therapy. IgG levels were higher before (12.25 g/L) vs. after (8.64 g/L) treatment. IgM levels were decreased before (1.76 g/L) and after (0.83 g/L) as well as before (1.76 g/L) versus during (0.73 g/L) treatment. Anti-cardiolipin antibody type A level were decreased before (2.76 U/ml) versus after (2.49 U/ml) treatment. Decreased level of beta-2-microglobulin could be observed before (2.91 mg/L) versus post (2.28 mg/L) chemotherapy. Findings may provide better insight into the effects of immuno-chemotherapy on the hosts’ immune system.     

Serum Levels of Interleukin-6 and Interleukin- 10 in Turkish Patients with Aggressive Non-Hodgkin ’ s Lymphoma

There exists strong evidence that tumor growth can be actively controlled by the host immune system andinterleukins are known to play a significant role in immune response regulation. Inflammatory cytokines playimportant roles in the pathogenesis of lymphomas. This study was conducted to investigate the serum levels ofIL-6 and IL-10 in patients with aggressive non-Hodgkin’s lymphoma (A-NHL) and the relationships withprognostic parameters and therapy. These serum factors were measured in 46 A-NHL patients pathologicallyverified before and after chemotherapy in comparison with 21 healthy controls using enzyme-linkedimmunosorbent assays (ELISAs). There were significant differences in the serum IL-10 and IL-6 levels betweenA-NHL patients and controls (p=0,038 and p<0,001, respectively). None of the prognostic parameters analyzedwas significantly correlated with the serum IL-6 concentrations. This was also true for serum IL-10 values,except for LDH and bone marrow involvement. Serum IL-10 levels were elevated in the group of patients withhigh level LDH compared with the group of patients with a normal level (p=0,017). Also, serum IL-10 levelswere significantly different in the presence or absence of bone marrow involvement (p=0,016). In addition, wefound a significant relationship between the serum levels of serum levels of IL-6 and IL-10 in patients with ANHL(r=0,47, p<0,001). We found that serum IL-10 levels decreased due to chemotherapy effect independent ofthe chemotherapy response (p=0,027). However, serum IL-6 levels were not changed. In conclusion, our datasuggest that higher serum IL-6 and IL-10 levels can be useful for diagnosis of A-NHL. However, our sample sizeis small, and larger scale research is needed in this field to provide new knowledge.     

Imaging Anatomy of Waldeyer’s Ring and PET/CT and MRI Findings of Oropharyngeal Non-Hodgkin’s Lymphoma

Background: This study was conducted to analyze positron emission tomography (PET) / computedtomography (CT) and magnetic resonance imaging (MRI) performance with oropharyngeal non-Hodgkin’slymphoma (ONHL).Materials and Methods: The complete image data of 30 ONHL cases were analyzed, allpatients were performed PET / CT and MRI examination before the treatment, with the time interval of thesetwo inspections not exceeding 14 days. The distribution, morphology, MRI signal characteristics, enhancementfeature, standardized uptake value (SUV) max value and lymph node metastasis way of the lesions were analyzed.Results: Among the 30 cases, 23 cases were derived from the B-cell (76.7%), 5 cases were derived from theperipheral T cells (16.7%) and 2 cases were derived from the NK/T cells (6.7%). 19 cases exhibited the palatinetonsil involvement (63.3%). As for the lesion appearance, 10 cases appeared as mass, 8 cases were the diffusedtype and 12 cases were the mixed type. 25 cases exhibited the SUVmax value of PET / CT primary lesions as 11or more (83.3%). MRI showed that all patients exhibited various degrees of parapharyngeal side-compressednarrowing, but MRI still exhibited the high-signal fat, and the oropharyngeal mucosa was intact. 25 cases wereassociated with the neck lymph node metastasis, among who 22 cases had no necrosis in the metastatic lymphnodes, while the rest 3 cases exhibited the central necrosis in the metastatic lymph nodes. Conclusions: PET /CT and MRI have important value in diagnosing and determining the lesion extent of ONHL.     

Clinical and Pathological Features of Primary Gastrointestinal Non-Hodgkin＇s Lymphoma

OBJECTIVE The study was initiated to obtain histologic distribution, clinical features, and treatment results in patients with primary gastrointestinal non-Hodgkin‘s lymphomas.METHODS Between January 1990 and January 2000, 89 PGI NHL patients were eligible to evaluate clinical features. Histological and immunohistological studies were routinely used and all the specimens were reclassified according to the recently published WHO classification system.RESULTS (1)Clinically, among the 89 patients, there were 24 patients in stage IE,33 in stage IIE,19 in stage IIIE,and 13 in stage IVE. (2)Immunohistological studies revealed 72 patients were with B-cell type and only 17 with T-cell type. (3)Altogether, 15 MALT lymphoma were diagnosed among 89 PGI NHL patients, and 14/15 were found primary in the stomach.(4)The 3-year and 5-year overall survival were 77.0% (57/74) and 53.6% (30/56)for the total group.CONCLUSION No clinical symptoms and signs were found to be specific for the diagnosis of PGI NHL. Most patients were in stage IE and liE when diagnosed and the intermediate grade and B-cell type were more common than the others. Surgical resection of the tumor and standard combined chemotherapy post surgery were suggested to be the most effective measures for the long term survival of the PGI NHL patients.     

Signs,Symptoms and Complications of Non-Hodgkin’s Lymphoma According to Grade and Stage in South Iran

Background: Non-Hodgkin’s lymphoma (NHL) is a heterogeneous type of neoplasm of the lymphatic system.To have a more accurate and early diagnosis we need to know signs, symptoms and complications of lymphomain early stages besides pathology and immunohistochemistry. Materials and Methods: This prospective studyincluded 110 cases of NHL that were followed since February 2012 till November 2013. Biopsies were takenfrom all the patients besides bone marrow study. Signs and symptoms were categorized into “B” symptoms,general, lymphadenopathy and extranodal involvement and we compared the frequencies by stage and grade.Results: Of 110 cases, 88.9% had B-cell and 11.1% T-cell type with mean age 48.5±18.6 years. “B” symptomsand lymphadenopathy were more common in men. Cervical lymphadenopathy was the most common sign(44.8%). and hematologic, bone marrow, bone and neurologic lesions were the most common complications.All complications were more common in males. “B” symptoms were seen mostly in stage III, general signs andsymptoms in stage IV, and lymphadenopathy in stage II. Intermediate grade was also the most common in allsigns and symptoms. In this study 12 (10.9%) patients had relapse, with neurologic and bone marrow as themost common sites of tumor recurrence. Conclusions: There is a meaningful relationship between male genderfor NHL and anemia that can be due in part to higher incidence of bone marrow involvement and stage IVdisease in male cases. We also found a strong relationship between low grade NHL and age. On the other handextranodal involvement is more common in female groups.     

Prognostic Significance of Cell Proliferation and Apoptosis-Regulating Proteins in Epstein-Barr Virus Positive and Negative Pediatric Non-Hodgkin’s Lymphoma

Apoptosis-related proteins and proliferation activity and their relationship with Epstein-Barr Virus (EBV) are contemporary issues in pediatric non-Hodgkin’s lymphoma (pNHL). In this study prognostic or pathogenetic role of EBV latent infection, proliferating activity, and apoptosis-regulating proteins in pNHL were explored. EBV-EBER, lmp-1, ki-67, bcl-2, survivin, bax, fas, c-myc, p53 and apoptotic index by TUNEL method were explored in 70 pNHL cases and evaluated statistically. Of the 70 cases evaluated, 24 were female and 46 were male. Seven cases were stage I/II and 63 cases were stage III/IV. The mean age was 7.16 ± 3.72(1–15). EBV was positive in (25.7%) cases. Overall survival was 82%, while event free survival was 75%. Bax was expressed in 40% of the cases, while the expression of bcl-2,was 50%, survivin 42.9%, p53 8.6%, fas 18.6% and c-myc in 45.7%. Mean apoptotic index was 131.29 ± 96.69 per 5,000 cells. Mean proliferation index was 55.97% (12–92%). Fas positivity was high in EBV positive cases (p = 0.0001). EBV positivity was not related with prognosis. Apoptotic index was found to be an independent prognostic factor (p = 0.017). Our results suggest that apoptosis-regulating proteins have a role in the pathogenesis of pNHL. EBV was correlated with apoptotic index and fas, bcl-2. No correlation was observed with proliferation index and studied factors. High apoptotic index was related with good prognosis.     

Non-Hodgkin’s lymphoma in children and adolescents

Lymphoma is the third most common cancer in children and adolescents. Non-Hodgkin’s lymphomas comprise a heterogeneous group of tumors with distinct pathologic and clinical characteristics. Over the past three decades, significant advancements have been made in the molecular characterization of these disorders. With the use of intensive multiagent chemotherapy, non-Hodgkin’s lymphomas are now among the most successfully treated cancers in the pediatric population. Future goals of therapy include reduction of treatment duration for early-stage patients and identification of novel targets and therapeutics for advanced-stage patients.     

Incidence and Characteristics of Childhood Hodgkin’s Lymphoma in Greece: A Nationwide Study (Greece)

Objectives To estimate the incidence and epidemiological profile of childhood (0–14 years) Hodgkin’s lymphoma in Greece derived by the network of childhood Hematology–Oncology departments on the basis of all 95 newly diagnosed cases during a seven-year period. Methods Seventy-one of these cases were individually age and gender matched to an equal number of controls. Results The incidence of childhood Hodgkin Lymphoma reached a relatively high figure of 7.8 per million children-years, with an age distribution (2.2 for children 0–4; 6.3 for those 5–9 and 13.9 for those 10–14-years-old) and male to female ratio (1.7:1) similar to that reported from other cancer registries. Childhood Hodgkin’s lymphoma was more common among children living in less crowded quarters (odds ratio (OR): 6.5 and 95% confidence intervals (95% CI): 1.4–30.7), among those who have changed residence 60 to 18 months before the onset of the index disease (OR: 4.4, and 95% CI = 1.4–14.0), among those whose families owned a cat (OR: 5.5, 95% CI = 1.2–25.6) but not among those whose families owned a dog and marginally more common, among those with a history of infectious mononucleosis (OR: 5.0, 95% CI = 0.6–42.8). Conclusions Our results point to infectious agent(s) as playing an etiological role but do not allow discrimination among the delayed establishment of the herd immunity hypothesis, the population mixing hypothesis or that invoking transmission of the agent(s) from the non-human reservoir. The Childhood Hematology–Oncology Group. Maria Moschovi, Hematology–Oncology Unit, First Department of Pediatrics, Athens University Medical School, ‘Aghia Sophia’ General Children’s Hospital, Athens, Greece Fani Athanassiadou- Piperopoulou, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, Greece Sophia Polychronopoulou, Department of Pediatric Hematology–Oncology, ‘Aghia Sophia’ General Children’s Hospital Athens, Greece Apostolos Pourtsidis, Department of Pediatric Hematology–Oncology, ‘Pan.&Agl. Kyriakou’ Children’s Hospital Athens, Greece Maria Kalmanti, Department of Pediatric Hematology–Oncology, University Hospital of Heraklion, Heraklion, Greece     

Population-based Assessment of Hospitalizations for Neutropenia from Chemotherapy in Older Adults with Non-Hodgkin’s Lymphoma (United States)

Objective To study neutropenia hospitalization (NH) incidence and risk factors in a population-based sample of older adults with non-Hodgkin’s lymphoma (NHL) and evaluate the validity of inferences from Surveillance, Epidemiology and End Results (SEER)-Medicare linked databases. Methods NHL cases receiving first-course chemotherapy were identified from Iowa SEER-Medicare. Survival methods evaluated NH risk factors. Medical record and Medicare claims data on chemotherapy and NH were compared. Results Of 761 subjects, 165 (21.7%, 95% CI: 18.8, 24.6) were hospitalized for neutropenia. Of those hospitalized, 41% were hospitalized in cycle 1 and 22% in cycle 2. Significant multivariable risk factors for NH were diffuse large cell histology, renal disease, Charlson comorbidity index, and anthracycline chemotherapy but not patient age. Medicare and medical records agreed on month of chemotherapy initiation 95% of the time and chemotherapy type 95% of the time. ICD-9 code 288.0 sensitivity for NH was 80%. Conclusions Neutropenia hospitalizations were common in the first 2 chemotherapy cycles, especially among older adults with comorbidity. Findings conflict with a prior medical records study in which age was a risk factor for NH and dose intensity a negative confounder. Valid inferences about age effects on chemotherapy toxicity require more clinical detail than is available in administrative data.     

Extranodal Non-Hodgkin’s Lymphomas - A Retrospective Review of Clinico-Pathologic Features and Outcomes in Comparison with Nodal Non-Hodgkin’s Lymphomas

Objective: The primary objective of this study was to analyze the anatomic distribution, clinical featuresand outcome of Diffuse large B-cell lymphoma (DLBCL) patients according to the primary site (extranodal vs.nodal) with applicability of International Prognostic Index (IPI). Methodology: A retrospective review (1988 to2004) of 557 cases of DLBC. Results: The median age was 48.7 ± 15.3 years; M:F ratio was 2:1. The distributionaccording to the primary site was: lymph node (N-NHL), 322 cases (58%) of which 145(44%) were stage IV, 76(23%) stage III, 60 (18%) stage II and 47 (15%) stage I. The extra nodal sites (EN-NHL) 235 (42%) casesincluded gastro-intestinal tract (44%), upper aerodigestive tract (19%), bones (8%), spine (5%), and unusualsites less than 3% each as breast, CNS, testis, lungs and skin. The median survival rate was 4.8 years and 6.3years in N-NHL and EN-NHL respectively. In the latter this varied greatly depending on the primary site andstage of disease at presentation. In the univariate analysis factors associated with good prognosis were: age lessthan 60 years, early stage (I-II), extranodal involvement primarily gastric or bone, 0-1 extranodal site, 0-1performance status, lack of B symptoms and normal LDH level. In the multivariate analysis age, performancestatus, stage of disease and level of LDH were the main variables predicting overall survival; no nodal or extranodalsite maintained their prognostic value. Conclusion: Patients with EN-NHL present more frequently with earlystage disease then those with N-NHL; overall survival in both groups largely depended on IPI and not on the siteof origin of the malignancy.     

Analysis of Clinical Manifestations and Prognosis of 92 Cases with Non-Hodgkin＇s Lymphoma

Objective  To analyze the risk factors and influence of various treatments on the prognosis of non-Hodgkin’s lymphoma (NHL). Methods  Clinical data of 92 patients with NHL from our hospital were retrospectively reviewed. Kaplan-Meier statistics were used to analyze the differences in survival times of the patients receiving various treatments. Cox regression model was employed for analyzing the prognostic factors. Results  Among our patients, the 2 and 5-year disease-free survivals (DFS) were respectively 68% and 51%. The 5-year cancer-specific survival (CSS) was 55%. Mono-factorial analysis showed that the main independent prognostic factors included Ann Arbor Staging, B symptoms, lactate dehydrogenase (LDH), the international prognostic index (IPI) and age. Concerning the IPI, the 5-year CSS for the low-risk factors (0–1), lower-moderate risk (2), higher-moderate (3) and high-risk (4–5) were respectively 60%, 62%, 42% and 33%. Analysis of the prognoses, based on treatment of the patients with different stages, was as follows: the 5-year survival rates of the Stage-I and II patients, receiving surgery or chemotherapy alone, or a combined therapy, were respectively 19%, 72% and 68%, showing that the survival rates of the group with a combined therapy and the chemotherapy alone were superior to the group with surgery alone; the 5-year survival rates of the Stage-III and IV patients, receiving surgery or chemotherapy alone or a combined therapy, were respectively 50%, 35% and 60%, indicating that the survival rate of the group with a combined therapy was superior compared to the group with chemotherapy alone. Conclusion  Long-term survival of non-Hodgkin’s lymphoma patients is closely related with multiple factors. Rational detection and assessment of the risk factors may prolong the living time of the patients. Different methods of treatment can influence the patient’s prognosis. Correct evaluation of the prognostic factors, and rational and effective therapy can prolong the patient’s survival.     

Involvement of Abdominal and Pelvic Lymph Nodes in Non-Hodgkin Lymphoma： the Nodal Distribution in Chinese Patients

Objective To study the distribution of abdominal and pelvic lymphadenopathy in non-Hodgkin lymphoma (NHL) in Chinese patients. Methods CT images of 241 NHL patients with abdominal and/or pelvic lymphadenopathy were reviewed. Among them, clinical and image data from 96 patients fulfilled the requirements for the analysis: 1. Abdominal and/ or pelvic lymphadenopathy detected by CT in untreated patients (n=74). 2. Recurrent patients: new lesions in abdominal or pelvic lymph nodes who never had any nodular lesion by previous abdominal and/or pelvic CT (n = 14). 3. Treated patients who did not have abdominal and/or pelvic CT previously, showed regression of initial disease for at least 6 months after chemotherapy and subsequently showed abdominal and/or pelvic lymphadenopathy (n=8). According to the Clinical Schema for Lymphoid Tissue, these patients were divided into 3 histologic subtypes: indolent (IL; n=31), aggressive (AL; n=61) and very aggressive (VAL; n=2) lymphoma. The remaining 2 cases were unclassified lymphoma (UCL). Both abdominal and pelvic CT scans were undertaken in 46 patients, abdominal CT only in 47 patients and pelvic CT only in 3 patients. Enhanced CT was obtained in 80 patients. The anatomic sites involved were designated as retroperitoneal (ie. paraaortic), mesenteric, abdominal (i.e. celiac, paracardiac, gastrohepatic and hepatic hilum, etc.), retrocrural, subdiaphragmatic, common iliac, internal iliac, external iliac and inguinal nodes respectively. Results The lesions located in the retroperitoneum were most common for IL and AL, the incidences being 83.3% (18/25) and 83.1% (49/59) respectively, results being similar. Among those, lymphadenopathy distributed mainly in the retroperitoneum, superior and inferior renal hila, with an incidence of 72.0% (18/25) in IL and 67.3% (33/49) in AL. Pelvic lymphadenopathy came next, with the overall incidence of 41.9% (126/301), 57.5% (50/87) in IL and 35.5% (76/214) in AL respectively. Mesenteric lymph nodes stood third with the overall incidence of 37.1 % (33/89), 43.3% (13/30) in IL and 33.9% (20/59) in AL. Statistical analysis showed that external iliac lymph node involvement to be more common in IL than in AL (P<0.05), while comparisons of other groups showed no statistical significance. Conclusion For Chinese NHL patients, retroperitoneal lymph nodes were mostly involved, followed by iliac and mesenteric lymphadenopathy, which was different from that of the Western countries. The involved retroperitoneal lymph nodes in NHL of Chinese patients were predominantly located in the superior and inferior renal hilum.     

State-of-the-art Issues in Hodgkin’s Lymphoma Survivorship

The prognosis of Hodgkin’s lymphoma (HL) has markedly improved as management strategies evolved. In the modern era, less than 15% of patients with early-stage, non-bulky HL will relapse, and less than one third of those with advanced disease will relapse. As therapy for HL intensified, and as disease-related outcomes improved, the impact of the late effects of therapy has become increasingly important. There is a growing body of literature describing the late morbidity experienced by survivors of HL, including risks of second primary malignancy, cardiac disease, pulmonary disease, and endocrine dysfunction. Additionally, the impact of disease and treatment on psychosocial function and quality of life has been a subject of investigation, with survivors often suffering from impairment. An understanding of these risks and the management implications inherent to them is central to the care of survivors of HL.