Clinical study of chemotherapy-related cognitive impairment in patients with non-Hodgkin lymphoma

BACKGROUND Chemotherapy for malignant tumors can cause brain changes and cognitive impairment,leading to chemotherapy-induced cognitive impairment(CICI).Current research on CICI has focused on breast cancer and Hodgkin’s lymphoma.Whether patients with non-Hodgkin’s lymphoma(NHL)undergoing chemo-therapy have cognitive impairment has not been fully investigated.therapy have cognitive impairment has not been fully investigated.AIM To investigate whether NHL patients undergoing chemotherapy had cognitive impairments.METHODS The study included 100 NHL patients who were required to complete a compre-hensive psychological scale including the Brief Psychiatric Examination Scale(MMSE)at two time points:before chemotherapy and within 2 wk of two chemo-therapy courses.A language proficiency test(VFT),Symbol Number Pattern Test(SDMT),Clock Drawing Test(CDT),Abbreviated Daily Cognition Scale(ECog-12),Prospective and Retrospective Memory Questionnaire,and Karnofsky Perfor-mance Status were used to assess cognitive changes before and after chemo-therapy.RESULTS The VFT scores for before treatment(BT)and after treatment(AT)groups were 45.20±15.62,and 42.30±17.53,respectively(t-2.16,P<0.05).The CDT scores were 8(3.5-9.25)for BT and 7(2.5-9)for AT groups(Z-2.1,P<0.05).Retrospective memory scores were 13.5(9-17)for BT and 15(13-18)for AT(Z-3.7,P<0.01).The prospective memory scores were 12.63±3.61 for BT and 14.43±4.32 for AT groups(t-4.97,P<0.01).The ECog-12 scores were 1.71(1.25-2.08)for BT and 1.79(1.42-2.08)for AT groups(Z-2.84,P<0.01).The SDMT and MMSE values did not show a significant difference between BT and AT groups.CONCLUSION Compared to the AT group,the BT group showed impaired language,memory,and subjective cognition,but objec-tive cognition and execution were not significantly affected.

The role of radiotherapy in patients with refractory Hodgkin’s lymphoma after treatment with brentuximab vedotin and/or immune checkpoint inhibitors

Background:Approximately 10%–30%of patients with Hodgkin’s lymphoma(HL)experience relapse or refractory(R/R)disease after first-line standard therapy.Brentuximab vedotin(BV)and immune checkpoint inhibitors(ICIs)have important roles in the salvage treatment of R/R HL.However,subsequent treatment for HL refractory to BV and/or ICI treatment is challenging.Methods:We retrospectively analyzed patients in two institutions who had R/R HL,experienced BV or ICI treatment failure,and received radiotherapy(RT)thereafter.The overall response rate(ORR),duration of response(DOR),progression-free survival(PFS),and overall survival(OS)were analyzed.Results:Overall,19 patients were enrolled.First-line systemic therapy comprised doxorubicin,bleomycin,vinblastine,and dacarbazine(ABVD,84.2%);AVD plus ICIs(10.5%);and bleomycin,etoposide,doxorubicin,cyclophosphamide,vincristine,procarbazine,and prednisone(BEACOPP,5.3%).After first-line therapy,15(78.9%)and four patients(21.1%)had refractory disease and relapsed,respectively.After R/R HL diagnosis,six(31.6%),two(10.5%),and 11(57.9%)patients received BV and ICIs concurrently,BV monotherapy,and ICI monotherapy,respectively.All patients received intensity-modulated RT(n=12,63.2%)or volumetric modulated arc therapy(VMAT;n=7,36.8%).The ORR as well as the complete response(CR)rate was 100%;the median DOR to RT was 17.2 months(range,7.9–46.7 months).Two patients showed progression outside the radiation field;one patient had extensive in-field,out-of-field,nodal,and extranodal relapse.With a median follow-up time of 16.2 months(range,9.2–23.2 months),the 1-year PFS and OS were 84.4%and 100%,respectively.PFS was associated with extranodal involvement(P=0.019)and gross tumor volume(P=0.044).All patients tolerated RT well without adverse events of grade≥3.Conclusion:RT is effective and safe for treating HL refractory to BV or ICIs and has the potential to be part of a comprehensive strategy for HL.

Prognostic Value of Semi-Quantitative 18F-FDG PET/CT Parameters in Hodgkin’s Lymphoma

Objective:To assess the prognostic value of maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV),and total lesion glycolysis(TLG)determined by 18F-fluorodeoxyglucose positron emission tomography-computed tomography(18F-FDG PET/CT)imaging in Hodgkin’s lymphoma patients.Methods:A total of 148 Hodgkin’s lymphoma patients diagnosed with lymph node biopsy from October 2014 to October 2015 were retrospectively analyzed followed by categorizing into good(125 cases)and poor(23 cases)prognosis groups.The chi-squared test was used to analyze the clinicopathological characteristics of Hodgkin’s lymphoma patients with the semi-quantitative 18F-FDG PET/CT parameters;the Spearman method was used to analyze the correlation between the semi-quantitative parameters and clinicopathological features of Hodgkin’s lymphoma;receiver operating characteristic curve was used to analyze the predictive value of the semi-quantitative parameters for poor prognosis of Hodgkin’s lymphoma patients.Results:Mean SUVmax,MTV,and TLG of the 148 cases of Hodgkin’s lymphoma were 7.26±2.38,12.46±3.14 cm3,and 76.83±18.56 g,respectively.Significant variations in the Ann Arbor stage and clinical classification were observed with different levels of semi-quantitative parameters(P<0.05).The semi-quantitative parameters were not correlated with age and gender(P>0.05)but positively correlated with Ann Arbor stage and clinical classification(P<0.05).These parameters in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The area under the curve(AUC)of SUVmax,MTV,and TLG in predicting the poor prognosis group was 0.881,0.875,and 0.838,with cut-off values of 7.264,12.898 cm3,and 74.580g,as well as specificity of 88.8%,84.0%,and 78.4%,and sensitivity of 87.0%,87.0%,and 78.3%,respectively;the AUC of the combined prediction was 0.986,with a specificity of 97.6%and sensitivity of 86.3%.Conclusion:The semi-quantitative 18F-FDG PET/CT parameters provide valuable insights for Hodgkin’s lymphoma prognosis assessment.

Composite diffuse large B-cell lymphoma and classical Hodgkin's lymphoma of the stomach:Case report and literature review

The combination of classical Hodgkin’s lymphoma(cHL)and non-Hodgkin lymphoma coexisting in the same patient is not common,especially in one extranodal location.Here we present a rare case of composite diffuse large B-cell lymphoma(DLBCL)and cHL occurring simultaneously in the stomach of a 53-year-old female who presented with upper abdominal discomfort and gas pain.Surgery was performed and the disease was diagnosed pathologically as composite lymphoma of DLBCL and cHL using hematoxylin-eosin and immunohistochemical staining.Epstein-Barr virus(EBV)infection was not detected by in situ hybridization for EBV-encoded RNA or immunohistochemistry for EBV latent membrane protein-1.Polymerase chain reaction analysis from the two distinct components of the tumor demonstrated clonal immunoglobulinκlight chain gene rearrangements.The patient died approximately 11 mo after diagnosis in spite of receiving eight courses of the CHOP and two courses of the rituximab-CHOP(RCHOP) chemotherapy regimen.This case report showed that the two distinct components,DLBCL and cHL,appeared to originate from the same clonal progenitor cell,and that EBV infection was not essential for transformation during the course of tumorigenesis.

Color Doppler sonography and angioscintigraphy in hepatic Hodgkin's lymphoma

AIM： To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography （HRA） in secondary Hodgkin＇s hepatic lymphoma. METHODS： The research included patients with a diagnosis of Hodgkin＇s lymphoma with metastatic focal lesions in the liver and controls. Morphologic characteristics of focal liver lesions and hemodynamic parameters were examined by pulsed and Color Doppler in the portal, hepatic and splenic veins were examined. Hepatic perfusion index （HPI） estimated by HRA was calculated. was observed. Lesions were mostly hypoechoic and mixed, solitary or multiple. Some of the patients presented with dilated splenic veins and hepatofugal blood flow. A pulse wave was registered in the centre and at the margins of lymphoma. The average velocity of the pulse wave was higher at the margins （P 〉 0.05）. A continuous venous wave was found only at the margins of lymphoma. There was no linear correlation between lymphoma size and velocity of pulse and continuous wave （r = 390, P 〈 0.01）. HPI was significantly lower in patients with lymphomas than in controls （P 〈 0.05）, pointing out increased arterial perfusion in comparison to portal perfusion. CONCLUSION： Color Doppler ultrasonography is a sensitive method for the detection of neovascularization in Hodgkin＇s hepatic lymphoma and estimation of its intensity. Hepatic radionuclide angiography can additionally help in the assesment of vascularisation of liver lesions.

Sternal Hodgkin’s lymphoma: A case report and review of literature

BACKGROUND Sternal tumors are difficult to diagnose, and usually need to be differentiated from other diseases such as tuberculosis, osteosarcoma, intrathoracic thyroid and thymoma. The sternum is a rare site of Hodgkin’s lymphoma, which is often misdiagnosed as tuberculosis on routine histopathology.CASE SUMMARY We reported a 47-year-old female patient with chest pain in the upper sternum for 1 mo. Chest computed tomography found a mass in the upper sternum.Pathology and immunohistochemistry of the biopsy confirmed the diagnosis of typical Hodgkin’s lymphoma(mixed cellularity subtype). Patient was diagnosed with primary sternal Hodgkin’s lymphoma and administered 6 cycles of adriamycin, bleomycin, vinblastine, and dacarbazine chemotherapy. Patient had no tumor recurrence and progression at a follow-up visit 2 years later.CONCLUSION This study highlights the rarity of primary sternal Hodgkin’s lymphoma and the challenges of its diagnosis. A Pub Med and Web of Science search revealed 10 reported cases of sternal involvement in Hodgkin’s lymphoma.

Epidemiology of hodgkin’s lymphoma

The epidemiology of Hodgkin’s Lymphoma (HL) varies with age at clinical onset. In developing countries, the disorder appears predominantly during childhood and its incidence decreases with age, while in industrialized countries, the incidence rate increase with age. There has long been a view that the differences in descriptive epidemiology of Hodgkin’s Lymphoma around the world, and also between children, young adults and older adults may reflect differences in etiology between them. Hodgkin’s Lymphoma has long been suspected to have an infectious precursor, and indirect evidence has implicated Epstein-Barr virus (EBV), as a causal agent. The etiology of EBV-negative cases remains obscure. Epidemiological investigation of the etiology of Hodgkin’s Lymphoma is making steady progress, and it leads to a better understanding and hence prevention. This review considers in detail the descriptive and the etiological epidemiology of Hodgkin’s Lymphoma.

Hodgkin's lymphoma coexisting with liver failure secondary to acute on chronic hepatitis B

Acute on chronic liver failure(ACLF) is rarely the initial manifestation of a malignant process or precipitated by the initiation of anti-viral treatment with a nucleoside or nucleotide agent. We report an unusual case of ACLF temporally associated with initiation of Entecavir for treatment of chronic hepatitis B. Early Hodgkin's lymphoma(HL) was unmasked with initiation of the antiviral treatment which may have exacerbated ACLF. To the best of our knowledge, this has not been described in the literature. In reviewing our patients clinical course and liver autopsy, he developed a severe acute exacerbation of his chronic hepatitis B virus coinciding with the institution of antiviral therapy and the underlying HL perhaps modulating the overall degree of hepatic injury.

Clinical features of AIDS patients with Hodgkin's lymphoma with isolated bone marrow involvement:report of 12 cases at a single institution

Objective： To study the main clinical and histopathological features of 12 patients with Hodgkin＇s lymphoma （HL） diagnosed primarily from bone marrow （BM） involvement. Methods： We included 12 acquired immunodeficiency syndrome （AIDS） patients with HL assisted in the F. J. Mufiiz Infectious Diseases Hospital since January 2002 to December 2013. The diagnosis of ilL with primary BM involvement in patients was confirmed by clinical, histopathological, and immunohistochemical findings. Results： All patients presented ＂B＂ symptoms and pancytopenia. All of them had stage IV neoplasm disease because of BM infiltration. The median of CD4＋ T-cell counts was 114 cells/μL, and mixed cellularity （MC） was the most frequent histopathological subtype of 92% cases. Conclusion： When other causes are excluded, BM biopsy should be performed in AIDS patients with ＂B＂ symptoms and pancytopenia to evaluate BM infiltration by atypical lymphocytes.

Metachronous mixed cellularity classical Hodgkin’s lymphoma and T-cell leukemia/lymphoma: A case report

BACKGROUND The development of peripheral T-cell lymphoma(PTCL)after chemotherapy for Hodgkin’s lymphoma(HL)is rare,and highly aggressive TCL/leukemia has not been reported to date.The relationship between HL and PTCL needs further exploration to understand the pathogenesis of metachronous lymphoma(ML)and find effective treatment options.We report a patient with ML,whose biopsy of a right cervical lymph node initially confirmed classical HL(CHL).CASE SUMMARY We report a patient with ML,whose biopsy of a right cervical lymph node initially confirmed CHL,with typical reed–sternberg cells expressing CD30 and PAX-5.T-cell leukemia/lymphoma occurred 3 years after treatment,and a lymph node biopsy at the onset confirmed PTCL,nonspecific type,expressing CD3,CD4 and CD8.The patient was treated with standard doses of chemotherapy,programmed cell death-ligand 1 monoclonal antibody,and chidamide,all of which failed to achieve complete remission.The patient was diagnosed with refractory state,and eventually died of leukocyte stasis.CONCLUSION The accuracy of the diagnosis needs to be confirmed when chemotherapeutic drugs are not effective.

Vanishing bile duct syndrome in Hodgkin's lymphoma: A case report and literature review

Vanishing bile duct syndrome (VBDS) has been described in different pathologic conditions including infection, ischemia, adverse drug reactions, autoimmune diseases, allograft rejection, and humoral factors associated with malignancy. It is an acquired condition characterized by progressive destruction and loss of the intra-hepatic bile ducts leading to cholestasis. Prognosis is variable and partially dependent upon the etiology of bile duct injury. Irreversible bile duct loss leads to significant ductopenia, biliary cirrhosis, liver failure, and death. If biliary epithelial regeneration occurs, clinical recovery may occur over a period of months to years. VBDS has been described in a number of cases of patients with Hodgkin&#x02019;s lymphoma (HL) where it is thought to be a paraneoplastic phenomenon. This case describes a 25-year-old man found on liver biopsy to have VBDS. Given poor response to medical treatment, the patient underwent transplant evaluation at that time and was found to have classical stage IIB HL. Early recognition of this underlying cause or association of VBDS, including laboratory screening, and physical exam for lymphadenopathy are paramount to identifying potential underlying VBDS-associated malignancy. Here we review the literature of HL-associated VBDS and report a case of diagnosed HL with biopsy proven VBDS.

Waldenstrom's macroglobulinemia associated with Hodgkin's lymphoma:a case report

Waldenstrom＇s macroglobulinemia/lymphoplasmacytic lymphoma （WM/LPL） is a low-grade B-cell non- Hodgkin＇s lymphoma with an indolent clinical course. Higher-grade non-Hodgkin lymphoma （NHL） and therapy- related myelodysplasia/acute leukemia （t-MDS/AML） have been reported in patients with WM/LPL in previous studies. However, only two cases with WM/LPL were reported to develop to Hodgkin lymphoma （HL）. Here, we report the first case of WM/LPL who developed classical HL simultaneously 3 years after initial nucleoside analog-based chemotherapy.

Comparison of Dose-dense ABVD and Standard ABVD in the Treatment of Early Unfavorable and Advanced Hodgkin's Lymphoma: A Retrospective Analysis

This retrospective analysis compared standard regimen of doxorubicin, bleomycin, vin- blastine, and dacarbazine （ABVD） with the dose-dense ABVD regimen （ABVD-21） in terms of effi- cacy and toxicity. Patients who had early-stage unfavorable or advanced Hodgkin＇s lymphoma （HL） according to German Hodgkin Study Group criteria from March 1999 to February 2011 were ana- lyzed for treatment response, long-term survival and hematological toxicity. There were 85 patients in the ABVD-21 group and 118 patients in the ABVD group respectively. The complete remission rates aider completion of treatment were 92.9% and 90.7% for ABVD-21 and ABVD, respectively. During a median follow-up period of 62 months, no significant difference was found in projected 10-year progression-free survival （PFS） and overall survival （OS） rates （84.7% and 94.1% respectively for ABVD-21; 81.4% and 91.5% for ABVD）. Subgroup analyses showed that ABVD-21 was signifi- cantly better than ABVD for patients with IPS〉3 in terms of PFS and OS rates. Grade 3 to 4 leuko- penia （51.8% vs. 28.8%, P=0.001） and neutropenia （57.6% vs. 39.0%, P=0.009） were more common with ABVD-21. We were led to conclude that dose-dense ABVD did not result in better tumor con- trol and overall survival than did ABVD for early-stage unfavorable HL. However, patients at high risk, for example, with IPS〉3, may benefit from dose-dense ABVD.

Classical Hodgkin＇s Lymphoma Presenting as Acute Hepatic Failure One Case Report

A 20-year-old boy presenting daily febrile episodes was suspected to have developed acute hepatic failure. Serologic tests ruled out infectious and autoimmune causes apart from drug toxicity. During clinical examinations, he was found to have generalized enlarged lymph nodes that were then taken biopsy. It was diagnosed as classical Hodgkin＇s lymphoma based on histological examination of the lymph node. A bone marrow biopsy showed marrow infiltration by Hodgkin＇s lymphoma with hemophagocytosis and secondary myelofibrosis. A percutaneous liver biopsy demonstrated hepatic involvement of the same disease. After an extensive work-up, the cause of liver failure was figure out to be only attributed to the involvement of the lymphoma. Hodgkin＇s lymphoma as a cause of hepatic failure is rare and young patients diagnosed as Hodgkin＇s lymphoma causing hepatic failure has been reported very rarely so far.

Non-Classical Hodgkin＇s Lymphoma Presenting As Cauda Equina Syndrome a Rare presentation： One Case Report

Nodular lymphocyte predominant Hodgkin＇s disease occurs in 5% of all cases of Hodgkin＇s disease. It occurs more commonly in male. Only 5% of all Hodgkin＇s lymphoma cases develop spinal cord compression and in only 0.2% cases, spinal cord compression occurs as the initial presentation. So our case is rare both in the form of the unique variety of Hodgkin＇s disease and also in the form of presentation.

HIGH DOSE CHEMORADIOTHERAPY WITH AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN THE TREATMENT OF ADVANCED HODGKIN's LYMPHOMA:A REPORT OF 11 CASES

Objective: High dose therapy (HDT) with autologous hematopoietic stem cell transplantation (ASCT) has become one of the important salvage treatments for the Hodgkin抯 Lymphoma patients with relapsed or resistant disease, but its role as the primary treatment remains indefinite. This study was designed to further evaluate its status in the combined modality treatment, especially, to discuss its value in the primary treatment of the patients who had advanced disease with poor prognostic factors. Methods: Eleven patients who had advanced or relapsed disease with poor prognostic factors were enrolled in this study. Among them, 9 cases had primary treatment, and 2 cases had secondary treatment; one patient received autologous bone marrow transplantation (ABMT), and 10 patients received autologous peripheral blood stem cell transplantation (APBSCT). After induction treatment 4 cases achieved complete response (CR) and 7 cases achieved partial response (PR). High dose chemotherapy combined with total body irradiation (TBI) or total lymph node irradiation (TLI)/subtotal lymph node irradiation (STLI) were adopted in 7 cases and only high dose chemotherapy were adopted in 4 cases as the transplant preparative regimens. 5 cases received complementary irradiation in the primary sites after transplant. Results: The patients who had CR before transplantation were given consolidative therapy. Among the rest with PR, 2 cases achieved CR, 1 case PR, and 4 cases SD. Furthermore all these patients who maintained SD had bone involvement. With a median follow-up for all patients of 13(1-80) months, all of them are alive currently. Four cases are event-free survival (EFS); 4 cases with bone involvement are progression-free survival (PFS); 3 cases experienced relapse after transplant, one of them is EFS for 42 months again after a local relapsed site irradiation; the other two cases are being given further salvaged treatment now. According to the Life Tables method, the cumulative probability of 6-year PFS and OS is 55.68% and 100% respectively. The dominating transplant- related toxicity was bone marrow suppression in grades IV. No obvious cardiac, hepatic, and nephritic toxicity was found. No transplant related mortality. Conclusion: HDT combined with ASCT is a method worthwhile to further study for the treatment of the patients with advanced or relapsed Hodgkin抯 Lymphoma with poor prognostic factors.

Rejection of Experimental Hodgkins Lymphoma by T-Cells Engineered with a CD19 Chimeric Antigen Receptor

T cells engineered to express chimeric antigen receptors (CARs) combining an external antibody binding domain with the CD3ζ T cell receptor (TCR) signaling domain for triggering cell activation are being used for immunotherapeutic targeting of tumor cells in a non-HLA restricted manner. In this study we transduced T cells with a CD19-CAR construct containing a truncated CD34 gene (tCD34) marker and used these to target the B cell antigen CD19 on the surface of a Hodgkin’s lymphoma (HL) cell line (L591) both in vitro and in vivo. Levels of tCD34 expression in transduced peripheral blood mononuclear cells (PBMCs) ranged from 6% - 20% and this was increased to 82% after selection for transduced tCD34+ cells. In vitro cytotoxicity testing on a CD19+ HL cell line (L591) showed specific cell lysis initiated by the CD19-CAR transduced PBMCs. Importantly, CD19-CAR T cells prevented the growth of L591 HL tumor cells when co-injected subcutaneously (sc) in 6/6 severe combined immunodeficient (SCID) mice. There was no evidence of anti-tumor activity when CD19-CAR T cells were infused intravenously (iv) at the same time as L591 HL tumor cells were injected sc. However, 3/6 SCID mice showed tumor rejection within 83 days after iv infusion of CD19-CAR T cells 3 - 9 days after establishment of L591 HL tumors, while all control animals succumbed to tumors within 60 days. Interestingly, immuno-histochemical analysis of L591 HL tumors demonstrated that CD19-CAR T cells were detected not earlier than 11 days after infusion within the tumor mass. These results suggest that CD19 is a potentially attractive target for the immunotherapy of HL.

Involved Nodal Radiotherapy vs. Involved Field Radiotherapy after Chemotherapy in the Treatment of Early Stage Hodgkin’s Lymphoma

Aim of work: This study is a prospective randomized trial aiming to investigate whether radiotherapy volume can be reduced without loss of efficacy from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) after four cycles of ABVD chemotherapy in the treatment of early stage Hodgkin’s lymphoma. Patients and Methods: Between September 2009 and January 2012, all patients with newly diagnosed early-stage favorable and unfavorable Hodgkin’s lymphoma attending to the Clinical Oncology department of Cairo University, faculty of medicine were enrolled into this study after a written consent was obtained from those cases enrolled. Patients were assigned to receive (ABVD) for four cycles followed by randomization for radiotherapy into two arms one arm of 30 Gy INRT +/– 6 Gy to residual disease or another arm of 30 Gy IFRT +/– 6 Gy to residual disease. Results: 35 patients were enrolled in this study: 16 patients in the INRT arm and 19 patients in the IFRT arm. The median observation time was 25 months. The overall survival for all eligible patients was 97% and freedom from treatment failure was 85.7%. Survival rates at the end of the study revealed no differences between INRT and IFRT arms. Also, in terms of complete remission post radiotherapy (14 versus 15), relapse (1 versus 4), and death (0 versus 1) respectively the outcome was similar in both arms. As regard acute and sub-acute toxicities no significant difference could be detected between both arms except that IFRT arm was associated with a higher incidence of radiation pneumonitis (4 versus 1 patient). Conclusion: Radiotherapy volume size reduction from IFRT to INRT after ABVD chemotherapy for four cycles produces similar results and less toxicity in patients with early-stage Hodgkin’s lymphoma especially in patients with mediastinal disease.

Post Liver Transplantation Lympho Proliferative Disorder, Classical Hodgkins Lymphoma Type—A Case Report

Post transplantation lymphoproliferative disorder is a lymphoid/plasmacytic proliferation that develops as a consequence of immunosuppression in a recipient of a solid organ/bone marrow/stem cell allograft. The incidence reported in literature in post liver transplant patients is 1% - 2%. This case was of a 16-year-old boy who underwent liver transplantation for fulminant hepatic failure and subsequently developed PTLD. Morphologically and immunohistochemically, it was Hodgkin’s lymphoma like PTLD, which was the least common type reported in literature.

Low Dose Total Body Irradiation for Relapsed Low Grade Non-Hodgkin’s Lymphoma: Experience of National Cancer Institute, Cairo

Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.