Comparison between hybrid MOPPABV and ABVD chemotherapy protocols for Hodgkin’s lymphoma in public hospitals of the largest South American city—a retrospective 14-year study

The behavior of Hodgkin’s lymphoma (HL) is different in developing countries, perhaps due to differences in epidemiology and population access to health care. We performed a retrospective study comparing the efficacy of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPPABV) versus adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy protocols as first-line therapy for HL in a Brazilian population. A hundred and eighty-six HL patients were retrospectively analyzed regarding their first-line treatment with MOPPABV and ABVD at two public hospitals in São Paulo, Brazil. Eligible patients were either previously untreated or at first relapse after being treated with only radiotherapy with confirmed HL diagnosis. At a median follow-up of 9 years, complete remission is 89.5 and 85.9 (P?=?0.3), overall survival 93.8% and 89.6% (P?=?0.68), disease-free survival 85.6% and 81.6% (P?=?0.41), and relapse ratios 20.9% and 26.4% (P?=?0.17) for ABVD and MOPPABV, respectively. Extended-field radiation therapy postchemotherapy was mostly used in the MOPPABV group. There were three cases of secondary neoplasm (colon adenocarcinoma, myeloid chronic leukemia, and non-Hodgkin’s lymphoma), all associated with MOPPABV. ABVD and MOPPABV protocols as first-line treatment for HL resulted in similar therapeutic outcomes and did not influence overall survival, disease-free survival, and relapse ratio. MOPPABV was related to a higher risk of secondary malignancy and, therefore, ABVD should be considered a better option for HL therapy. These findings corroborate recent data in literature.     

Complete weaning off immunosuppression in HCV liver transplant recipients is feasible and favourably impacts on the progression of disease recurrence

BACKGROUND/AIMS: HCV-related disease recurrence progresses rapidly after liver transplantation. We hypothesised that withdrawal of immunosuppression might favourably impact on disease progression. METHODS: Weaning off immunosuppression was attempted in 34 HCV-RNA positive patients (mean age 62+/-6.4 years) transplanted 63.5+/-20.1 months earlier, under cyclosporine A monotherapy. Patients were followed for 3 years including yearly protocol liver biopsies. Primary endpoints were feasibility of weaning off immunosuppression and its impact on disease progression. Secondary endpoint was to identify predictors of an immunosuppression-free state and fibrosis progression. RESULTS: Complete and permanent immunosuppression withdrawal was achieved in 8 patients (23.4%), whereas 14 (41.2%) developed rejection within eight months despite an initial response and 12 (35.2%) rejected during tapering. After a mean follow-up 45.5+/-5.8 months weaned patients showed stabilisation/improvement of histological fibrosis (P<0.01), lower necro-inflammation (P<0.02) and improved liver function (P<0.05) compared to weaning-intolerants. Multiple logistic regression identified low blood cyclosporine A trough levels during the first post-transplant week (P=0.004) and initial steroid-free immunosuppression (P<0.008) as independent predictors of sustained weaning. Achievement of immunosoppression freedom (P=0.02) and baseline staging score (P<0.0001) were independently associated with stabilisation/improvement of histological fibrosis. CONCLUSIONS: Reconstitution of immune-competence in the host improves the natural history of HCV recurrence in the graft.     

Extranodal NK/T Cell Lymphoma,Nasal Type (ENKTL-NT): An Update on Epidemiology,Clinical Presentation,and Natural History in North American and European Cases

Purpose of Review

Extranodal NK/T cell lymphoma, nasal type (ENKTL-NT) is an aggressive extranodal non-Hodgkin lymphoma most commonly occurring in East Asia and Latin America but with increasing incidence in the United States. Data on epidemiology, disease presentation, and outcome for European and North American (“Western”) cases are very limited. We review published landmark clinical studies on ENKTL-NT in the West and report in detail recent data, including our institutional experience.

Recent Findings

We highlight key observations in its epidemiology, natural history, and trends in clinical management. In the USA, ENKTL-NT is more common among Asian Pacific Islanders (API) and Hispanics compared to non-Hispanic whites. Published studies indicate less heterogeneity in clinical presentation in Western ENKTL-NT compared to Asian patients. While there is variation in age at diagnosis, presence of antecedent lymphoproliferative disorders, and outcomes among racial/ethnic groups, the universal association of ENKTL-NT with EBV and the poor response of this neoplasm to anthracycline-based therapy is consistent across all geographic areas.

Summary

Data on epidemiology, disease presentation, and clinical outcomes in mature T cell and NK cell (T/NK cell) neoplasms, including ENKTL-NT, in Europe and North America are very limited. As the classification and diagnostic characterization of the currently recognized T/NK cell lymphoma disease entities continue to evolve, gaps and inconsistencies in data reporting across different studies are being recognized. Despite these limitations, several studies from the USA suggest that the incidence of ENKTL-NT is higher in Asian Pacific Islanders (API) and non-white Hispanics and that outcomes may be worse in non-whites. However, the universal association of ENKTL-NT with Epstein-Barr virus (EBV) across all ethnic groups suggests a common pathogenesis. Given the overlap between the entities included in the category of T/NK cell neoplasms, there is a need to further define biological and clinical differences that may affect diagnosis, treatment, and outcome.

     

Horse metabolism and the photocatalytic process as a tool to identify metabolic products formed from dopant substances: the case of sildenafil

Two horses were treated with sildenafil, and its metabolic products were sought in both urine and plasma samples. Prior to this, a simulative laboratory study had been done using a photocatalytic process, to identify all possible main and secondary transformation products, in a clean matrix; these were then sought in the biological samples. The transformation of sildenafil and the formation of intermediate products were evaluated adopting titanium dioxide as photocatalyst. Several products were formed and characterized using the HPLC/HRMS(n) technique. The main intermediates identified in these experimental conditions were the same as the major sildenafil metabolites found in in vivo studies on rats and horses. Concerning horse metabolism, sildenafil and the demethylated product (UK 103,320) were quantified in blood samples. Sildenafil propyloxide, de-ethyl, and demethyl sildenafil, were the main metabolites quantified in urine. Some more oxidized species, already formed in the photocatalytic process, were also found in urine and plasma samples of treated animals. Their formation involved hydroxylation on the aromatic ring, combined oxidation and dihydroxylation, N-demethylation on the pyrazole ring, and hydroxylation. These new findings could be of interest in further metabolism studies.     

Matrix metalloproteinase-9 is consistently expressed in Hodgkin/Reed-Sternberg cells and has no impact on survival in patients with Epstein–Barr virus (EBV)-related and non-related Hodgkin lymphoma in Brazil

Clinical and histological features of classical Hodgkin lymphoma (cHL) are primarily due to the effects of cytokines and enzymes produced by Hodgkin/Reed-Sternberg (HRS) cells and their surrounding inflammatory cells. In EBV-related cancers, the expression of viral latent membrane protein 1 correlates with an increased MMP9 expression. In this study, we evaluated the prognostic relevance of MMP9 expression and EBV status in HRS cells in patients with cHL in Brazil. We selected 97 patients with cHL for EBV and MMP9 detection. EBV was detected in 52.5%, and MMP9 expression positivity was found in 87.6%. Of all cases, there was no correlation between MMP9 expression and EBV status. Response to treatment and relapse rate was independent of MMP9 expression and EBV status. MMP9 positivity did not influence overall survival and event-free survival. The consistent and increased intensity of MMP9 expression in HRS cells make this enzyme a potential target for therapy.     

Intraoperative ultrasound for benign cystic teratoma. Report of two cases

Purpose  

Teratoma is one of the most common ovarian neoplasms and frequently leads to laparoscopic surgical procedure. When this tumor is small and the ovarian surface seems regular during the surgery, it is difficult to localize the tumor.