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Management of Anaplastic Thyroid Cancer and Lymphoma
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Thyroid lymphoma with aggressive histology is the most common, accounting for 65–70% of cases. Patients are more often female, with the mean age at presentation being 65. Patients typically present with a rapidly enlarging mass that is often as much as 10 cm+ when diagnosed. Cervical lymph nodes are frequently involved. Aggressive lymphoma can arise de novo or in pre-existing Hashimoto's thyroiditis. Diffuse large B-cell lymphoma is the most frequent histology, for which there is a well-established treatment, combining chemotherapy and radiotherapy. Systemic treatment is used, given the high rate of occult systemic disease. Patients will typically receive the CHOP-R regimen (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab), with chemotherapy given for 3–6 cycles followed by radiotherapy (30–40 Gy) 3–6 weeks later. This systemic treatment can achieve cure rates of 70–85%. Radiotherapy coverage and volume are dependent on the stage at presentation; stage IE patients can have radiotherapy limited to the primary thyroid disease only, without cover of the cervical lymph nodes, while stage IIE patients will typically have radiotherapy coverage of the thyroid primary site and the draining lymph nodes (Levels III–VI). Long-term cure is 75%.
Non-Melanoma Skin Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Irene De Francesco, Sean Whittaker, Stephen L. Morris
There has been considerable debate over the difference between the previous EORTC and WHO classifications of primary cutaneous B-cell lymphoma.174,177 Under the previous EORTC classification, primary cutaneous follicle center cell lymphoma (PCFCCL) defined a group of cutaneous lymphomas highly responsive to RT with an excellent prognosis. The same type of lymphoma with a diffuse growth pattern of large cells was classified under the previous WHO classification as a diffuse large B-cell lymphoma, leading to over-treatment with multi-agent chemotherapy. The other main group debated was primary cutaneous large B-cell lymphoma of the leg (PCLBCL-leg), which was recognized under the EORTC classification as a separate subgroup, reflecting its unfavorable prognosis. Recent clinicopathological and genetic studies support the contention that PCFCCL and PCLBCL-leg are distinct groups, and a consensus was agreed in the WHO-EORTC classification with PCFCCL being defined as primary cutaneous follicle center lymphoma (PCFCL) distinct from nodal follicular lymphoma and PCLBCL-leg as primary cutaneous diffuse large B-cell lymphoma, leg type (see Table 24.2).
Primary adrenal malignancy
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Ayshea Hameeduddin, Anju Sahdev, Rodney H Reznek
Less than 200 cases of PAL have been reported in the literature. Typically elderly men are affected, although the age varies between 27 and 89 (37). Half of patients present with adrenal insufficiency. The commonest subtype is diffuse large B-cell lymphoma with sporadic cases of anaplastic and T-cell lymphoma. In 70%–80% of cases, there is bilateral involvement of the adrenal glands. Typically, imaging findings include large masses with both homogeneous and heterogeneous appearances due to haemorrhage and necrosis. On MRI, lesions are low on T1 and high on T2. On both CT and MRI, the lesions do not demonstrate significant enhancement post-contrast. Intense tracer uptake is present on 18F-FDG PET-CT (Figure 14.21). Treatment options include debulking surgery prior to chemotherapy; however, the prognosis is poor with overall survival reported at 12–15 months (102).
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.
Model-free slice screening for ultrahigh-dimensional survival data
Published in Journal of Applied Statistics, 2021
As an illustration, we apply the fused S-SIS method to the diffuse large-B-cell lymphoma (DLBCL) data. The DLBCL is one of the most common types of lymphoma in adults of the United States. Roughly 22] collected a dataset which consists of the survival time T and p = 7399 gene expression levels of n = 240 patients after certain medical treatment. They summarized the characteristics of patients with diffuse large-B-cell lymphoma in Table 1 of their paper. In this data set, all gene expression levels are standardized to have mean zero and standard deviation one during the exploratory data analysis. Our goal is to find the important genes which related to T among these 7399 genes. Observed survival times ranged from 0 to 21.8 years, with a median of 2.8 years across all samples. Of the 240 patients, 102 were still alive at the final follow-up visit, which led to the censoring rate of p = 7399 gene expression levels, ith patient and 22] randomly divided the dataset into a training set with 8.
An evaluation of polatuzumab vedotin for the treatment of patients with diffuse large B-cell lymphoma
Published in Expert Review of Hematology, 2020
Moneeza Walji, Sarit Assouline
There are currently two approved anti-CD19 CAR T therapy products for R/R DLBCL in Europe and the United States, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel. A third product, lisocabtagene maraleucel (liso-cel), is pending approval. Data supporting the use of these agents come from three clinical trials. The ZUMA-1 trial was a single arm-multicenter, phase 2 trial of axi-cel. Eligible patients were aged 18 years or older and had histologically confirmed large B-cell lymphoma. Patients were required to have an ECOG performance status of 0 or 1, an absolute neutrophil count of at least 1,000 × 10−9/L, platelet count of at least 75,000 × 10−9/L, and have previously received rituximab and an anthracycline-containing chemotherapy regimen [32]. This trial enrolled 111 patients, and infused 101 patients. The median age at the time of therapy was 58 years (range 23 to 76). Sixty-nine percent of patients had received 3 or more lines of therapy and 21% had received an ASCT. After a median follow up of 27.1 months, 83% (84) of patients had an objective response, 58% (59) had a complete response with 25% (25) a partial response. The median progression free survival was 5.9 months but was not reached for patients who had either a complete or partial response [32].