Clinical profile, prognostication and treatment outcomes in non Hodgkins lymphoma
DOI:
https://doi.org/10.18203/2349-3933.ijam20173255Keywords:
DLBCL, FL, NHLAbstract
Background: Non Hodgkins lymphoma is the most prevalent hematopoietic neoplasm, representing approximately 4% of all cancer diagnoses and ranking seventh in frequency among all cancers. Most of the data that we have is of west and data pertaining to Indian subcontinent is lacking. The aim of this study was to study clinical profile, prognostication, and assess treatment outcome in DLBCL patients in a tertiary care hospital.
Methods: 100 patients of DLBCL reporting to a tertiary care hospital between 2013 to 2016 were chosen for the study. All patients were subjected to routine investigation and specialized investigation including bone marrow examination and Positron emission tomography. Patients were treated with standard treatment protocol and their response to treatment were assessed.
Results: Study revealed male predominance with median age of onset was 45.6. Anorexia was the most common symptom. Lymphadenopathy was the most common sign. Bone marrow involvement and anemia commensurate each other. Only16% cases presented in IPI score 4 and 5. Complete remission achieved with treatment in stage l and ll disease were beyond 90% and steep decline in complete remission with treatment was noted in stage lll and lV (~70%). 76% patients with DLBCL showed CR, 12.5% showed PR.
Conclusions: The present study revealed male preponderance with relatively early age of onset compared to western population. B- cell lymphoma (DLBCL) constituted maximum number of NHL cases (89%). We have found a higher proportion of B cell subtype as compared to other Indian studies, at the same time it corroborated with the findings of western studies. Complete remission achieved with treatment in stage l and ll disease were beyond 90% and steep decline in complete remission with treatment was noted in stage lll and lV (~70%).
References
Yeole BB. Trends in the incidence of Non-Hodgkin's lymphoma in India. Asian Pac J Cancer Prev. 2008;9(3):433-6.
Wang SS, Vose JM. Epidemiology and prognosis of T-cell lymphoma. InT-cell Lymphomas. 2013:25-39.
Erdal Kurtoğlu, Mustafa Yıldırım. Humana Press Clinicopathological properties of non-Hodgkin lymphomas in the south-west of Turkey. Yonsei Med J. 2006;47(1):22-33.
Morton LM, Wang SS, Devesa SS, Hartge P, Weisenburger DD, Linet MS. Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood. 2006;107(1):265-76.
Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375-90.
Leeuwen MT, Turner JJ, Joske DJ, Falster MO, Srasuebkul P, Meagher NS, et al. Lymphoid neoplasm incidence by WHO subtype in Australia 1982-2006. Int J Cancer. 2014;135(9):2146-56.
Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: a report from the haematological malignancy research network. Br J Cancer. 2011;105(11):1684-92.
Sant M, Allemani C, Tereanu C, De Angelis R, Capocaccia R, Visser O, et al. Incidence of hematological malignancies in Europe by morphological subtype: results of the Haemacare project. Blood. 2010:blood-2010.
Shirley MH, Sayeed S, Barnes I, Finlayson A, Ali R. Incidence of haematological malignancies by ethnic group in England, 2001-7. Br J Haematol. 2013;163(4):465-77.
Møller MB, Pedersen NT, Christensen BE. Diffuse large B-cell lymphoma: clinical implications of extranodal versus nodal presentation: a population-based study of 1575 cases. Br J Haematol. 2004;124:151.
Laurini JA, Perry AM, Boilesen E, Diebold J, MacLennan KA, Müller-Hermelink HK, et al. Classification of non-Hodgkin lymphoma in Central and South America: a review of 1028 cases. Blood. 2012;120(24):4795-801.
Shenoy PJ, Malik N, Nooka A, Sinha R, Ward KC, Brawley OW, et al. Racial differences in the presentation and outcomes of diffuse large B‐cell lymphoma in the United States. Cancer. 2011;117(11):2530-40.
Goldin LR, Landgren O, McMaster ML, Gridley G, Hemminki K, Li X, et al. Familial aggregation and heterogeneity of non-Hodgkin lymphoma in population-based samples. Cancer Epidemiol Prevention Biomarkers. 2005;14(10):2402-6.
Chakrabarti S, Sarkar S, Goswami BK, Mondal S, Roy A, Das S. Hodgkin’s and Non-Hodgkin’s lymphomas in an Indian rural medical institution: comparative clinicopathologic analysis. Asian Pac J Cancer Prev. 2010;11(6):1605-8.
Goldin LR, Björkholm M, Kristinsson SY, Turesson I, Landgren O. Highly increased familial risks for specific lymphoma subtypes. Br J Haematol. 2009;146(1):91-4.
Hui D, Proctor B, Donaldson J, Shenkier T, Hoskins P, Klasa R, et al. Prognostic implications of extranodal involvement in patients with diffuse large B-cell lymphoma treated with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone. Leukemia and lymphoma. 2010;51(9):1-0.
Armitage JO, Weisenburger DD. New approach to classifying non-Hodgkin's lymphomas: clinical features of the major histologic subtypes. Non-Hodgkin's Lymphoma Classification Project. J Clin Oncol. 1998;16:2780.
A clinical evaluation of the international lymphoma study group classification of non-Hodgkin's lymphoma. The Non-Hodgkin's lymphoma classification project. Blood. 1997;89:3909.
Sehn LH, Scott DW, Chhanabhai M, Berry B, Ruskova A, Berkahn L, et al. Impact of concordant and discordant bone marrow involvement on outcome in diffuse large B-cell lymphoma treated with R-CHOP. J Clin Oncol. 2011;29(11):1452-7.
Avilés A, Neri N, Huerta-Guzmán J. Large bowel lymphoma: an analysis of prognostic factors and therapy in 53 patients. J Surg Oncol. 2002;80:111.
