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Lymphoma
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
This form of high-grade lymphoma has a particularly aggressive course and resembles acute lymphoblastic leukaemia in many of its features, for example a propensity to spread to the CNS. Results from standard lymphoma chemotherapy are poor and most of these patients will be treated in protocols similar to those for acute lymphoblastic leukaemia (ALL), including CNS prophylaxis.
The Non-Hodgkin’s Lymphomas and Plasma Cell Dyscrasias
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Lynne V. Abruzzo, L. Jeffrey Medeiros
Most patients reported with localized MBCL respond well to localized therapy, either surgical excision or local irradiation. Patients with generalized disease respond more poorly to therapy, similar to patients with other types of low-grade nodal NHL. Patients with high clinical stage disease are also at greater risk for transformation to high-grade lymphoma, and patients may develop composite lymphoma (i.e., MBCL coexistent with another type of NHL).
Career Stories
Published in John D Engel, Lura L Pethtel, Joseph Zarconi, Mark Savickas, Developing Clinicians’ Career Pathways in Narrative and Relationship-Centered Care, 2018
John D Engel, Lura L Pethtel, Joseph Zarconi, Mark Savickas
He was telling me all the right things, but because I was going to be the one that was either going to live or die with it, and the decision to me was really difficult, I was very emotional. It was hard for me to really agree, which made him upset, but it was just because I had this limited information. Was the high-grade lymphoma arising from a low-grade malignancy, or not? I didn’t know what the best thing to do was. I was the one that was going to die if it didn’t work out. I wasn’t trying to annoy him. I had a very difficult time trying to explain, and of course I was very upset at the time anyway.
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.
Aggressive Non-Hodgkin lymphomas: risk factors and treatment of central nervous system recurrence
Published in Expert Review of Hematology, 2019
Elisa Santambrogio, Maura Nicolosi, Francesco Vassallo, Alessia Castellino, Mattia Novo, Annalisa Chiappella, Umberto Vitolo
Because of very poor outcome in SCNSL, it is important to recognize the high-risk patients’ subgroup that could early develop CNS relapse. Based on the reported high incidence of CNS relapse in BL or B-LL [5,11,13,14], CNS prophylaxis is usually incorporated into protocols for these patients, but not in all patients with DLBCL. The risk of recurrence of CNS has been reported in several series in DLBCL. Clinical features have been considered to identify patients with high risk of CNS recurrence, including the high international prognostic index score (IPI), increased lactate dehydrogenase (LDH) serum level [15,45–47], Eastern Cooperative Oncology group (ECOG) performance score greater than 1 [48] and the involvement of extranodal site as testis [40,49–51], kidney, adrenal gland, uterine, breast, nasal, paranasal and bone marrow [46,47,52]. In a retrospective series of 1220 patients with high-grade lymphoma, age < 60 years, high LDH serum level, the number of extranodal sites, low albumin, and retroperitoneal involvement have been identified as risk factors. Patients having four or five risk factors represented 12% of all patients, with a CNS recurrence risk at 5 years >25% and comprised 54% of those with a later CNS relapse [16]. These characteristics have been differently combined into various studies, however, there is neither a clear definition of high-risk patients nor consensus on prediction of CNS involvement.
Complete Eye Ophthalmoplegia: the unusual initial presentation of Leptomeningeal Carcinomatosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Lakshpaul Chauhan, Ateeq Mubarik, Abdulmagid Eddib, Mohammad Eid, Ali Vaziri, Salman Muddassir
At this point, the axillary mass was highly suspicious for malignancy however, we could not explain the neurologic finding as a connective entity thus the patient was admitted for further workup of both the mass and eye findings. Biopsies were scheduled of both the axillary and liver mass. Both sampled returned as high-grade lymphoma and a bone marrow biopsy was scheduled for further differentiation. The bone marrow biopsy showed similar results with flow cytometry confirming the diagnosis of large b-cell lymphoma. In regards to the ophthalmoplegia, further imaging was ordered to rule out other etiologies that included CT Brain and MRI Brain. Both CT and MRI were unremarkable so an additional MRI of the eye orbit was ordered that was unexceptional as well. We performed lumbar puncture for further evaluation that demonstrated elevated protein with numerous atypical lymphocytes. Cytology of the cerebrospinal fluid confirmed CNS involvement with lymphoma as seen in Figure 1, that lead to the diagnosis of LC secondary to Large B-Cell Lymphoma.