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Lymphoma
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Seven important prognostic factors have been identified, which now comprise the international prognostic index. These are: Age >45 yearsMaleStage IV diseaseHaemoglobin <10.5 g/dLTotal white blood cell count >16 × 109/LLymphocyte count <0.6 × 109/LSerum albumin <40 g/L
Diagnosis of Leukemia, Lymphoma, and Myeloma
Published in Tariq I Mughal, John M Goldman, Sabena T Mughal, Understanding Leukemias, Lymphomas, and Myelomas, 2017
Tariq I Mughal, John M Goldman, Sabena T Mughal
Gene microarray tests have confirmed that within certain subtypes, for example, diffuse large B-cell lymphoma, there are at least three distinct signatures, suggesting that there are different subgroups within this subtype. It is of note that this clinical distinction was evident even after the patients were classified according to the International Prognostic Index and, therefore, has important prognostic relevance and should lead to better stratification of patients for appropriate treatments (Fig. 5.21). Similar efforts were very recently reported in patients with fol-licular lymphoma, which has a widely variable clinical course. Interestingly, in follicular lymphomas the genes that best defined prognosis were expressed in the microenvironment (such as T cells, macrophages, and dendritic cells), but not the follicular lymphoma cells themselves. This clearly differentiates follicular lymphoma from, for example, diffuse large B-cell lymphoma, in which the prognostic signatures are based on genes expressed by the lymphoma cells. We will discuss these aspects further in chapter 8.
Non-Hodgkin lymphoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Piers Blombery, Adrian Bloor, David C. Linch
The International Prognostic Index (IPI) has been established for more than two decades as the most widely used prognostic system for patients with aggressive lymphoma (Table 30.4).19 It is based on five clinical variables – age, stage, serum lactate dehydrogenase (LDH), performance status and the number of extra-nodal sites involved which allows subdivision of patients according to the number of prognostic factors into low risk (none or one factor), low-intermediate risk (two factors), high-intermediate risk (three factors), or high risk (four or five factors) with predicted 5-year survival in the pre-rituximab era of 73%, 51%, 43% and 26%, respectively. Initially developed with reference to intermediate grade disease within the working formulation, and for all stages of disease, it has subsequently been validated in patients with DLBCL.20 When applied to cohorts of patients treated on large prospective randomized trials in the rituximab era, the IPI retains its prognostic value with 3-year overall survival (OS) predicted for low risk, low-intermediate, high-intermediate and high risk at 91%, 81%, 65% and 59%, respectively.21 In addition, an age-adjusted IPI was validated as a useful prognosis stratification tool in patients below 60 years and was subsequently adapted for those above 60 years of age19 (Table 30.4). A number of modifications have been made to the original IPI,22 but the benefits are minor and the original IPI facilitates comparability between studies over a wider time-frame.
Non-Hodgkin lymphoma treatment in middle-income countries in Latin America: perspective of the Latin American Study Group of Lymphoproliferative Disorders [Grupo de Estudio de Linfoproliferativos de Latino América (GELL)]
Published in Hematology, 2022
Luis Villela, María Torre-Viera, Henry Idrobo-Quintero, Brady E. Beltran
Peripheral T-cell lymphoma (PTCL) is a very heterogeneous disease and accounts for approximately 15% of all non-Hodgkin lymphoma cases in the world. PTCL is divided into several subtypes, and PTCL-NOS is the most frequent, representing 26% of all PTCL cases [24]. In Mexico, Hernández-Ruiz et al published data on NHL and reported that 6.3% of total cases were PTCL-NOS [25], a very similar percentage to that reported by Laurini et al. in Central and South America [6]. The RWS obtained by GELL showed a total of 200 patients with a diagnosis of PTCL-NOS. Fifty percent of patients were ≥60 years, 57% were male, 50% had an ECOG ≥2, 40% had elevated serum lactate dehydrogenase (LDH) levels, 37% had bone marrow involvement, > 60% were diagnosed in advanced stages (Stage III/IV), and had developed B symptoms (sweats, weight loss, nocturnal diaphoresis). When divided into risk groups, we observed that The International Prognostic Index (IPI) score was high-intermediate and high in 47% of cases. The Prognostic Index in the PTCL-U (PIT) risk score was high-intermediate and high in 58% of cases.
Identifying aggressive subsets within diffuse large B-cell lymphoma: implications for treatment approach
Published in Expert Review of Anticancer Therapy, 2022
Timothy J Voorhees, Narendranath Epperla
The international prognostic index (IPI) and age-adjusted IPI were first proposed in 1993 to risk stratify patients with aggressive non-Hodgkin lymphoma [3]. This study composed of patients with either DLBCL, immunoblastic lymphoma, centroblastic lymphoma, or unclassifiable high-grade lymphoma. In a dataset of over two thousand patients, age, tumor stage (Ann Arbor staging), serum lactate dehydrogenase (LDH), performance status (PS), and extranodal (EN) sites were identified and used to classify four risk groups with 5-year overall survival (OS) of 73% (low risk), 51% (low-intermediate risk), 43% (high-intermediate risk), and 26% (high risk) respectively (Table 1). This represented a significant improvement in the identification of high-risk subsets of aggressive large B-cell lymphoma as compared to Ann Arbor staging alone.
Clinical aspects in patients with rheumatoid arthritis complicated with lymphoproliferative disorders without regression after methotrexate withdrawal and treatment for arthritis after regression of lymphoproliferative disorders
Published in Modern Rheumatology, 2021
Kazuhisa Nakano, Kazuyoshi Saito, Aya Nawata, Kentaro Hanami, Satoshi Kubo, Ippei Miyagawa, Yoshihisa Fujino, Shingo Nakayamada, Yoshiya Tanaka
Among 3666 patients with RA who were treated with MTX in our hospital, 51 patients developed LPD, which comprised 26 cases of Regressive-LPD and 25 cases of Persistent-LPD. With regard to patient characteristics, there were no differences in age, gender, disease duration of RA, or activity of RA between the two types of LPD. However, lactate dehydrogenase (LDH) was significantly higher (p = .028) and soluble IL-2 receptor (sIL-2R) level tended to be higher (p = .068) in cases of Persistent-LPD. In addition, the frequency of TNFi use at the time of LPD onset was high in both Regressive-LPD (30.8%) and Persistent-LPD (44.0%) cases (Table 1). In seven patients with Regressive-LPD, CT revealed lymph node swelling, but lymph node biopsy was not feasible because the enlarged lymph nodes reduced too quickly after MTX withdrawal. Pathologic examination showed that DLBCL was frequent, accounting for 76% of Persistent-LPD cases. In the Persistent-LPD group, the presence of stages III and IV LPD was significantly more frequent than in the Regressive-LPD group (p = .001). This was reflected in the difference between the actual prognosis and the vital prognosis obtained using international prognostic index (IPI), consisting of age greater than 60 years; stage III or IV disease; elevated serum LDH; performance status of 2, 3, or 4; and more than 1 extranodal site [20] (Table 1). The EBER-positive rate was 46.7% for Regressive-LPD and 52.2% for Persistent-LPD, suggesting the possibility that infection with EBV is involved in the development of LPD in about half of the patients (Table 1).