HIV+ pts have a 25-fold higher risk of developing NHL. Two independent prognostic factors influence incidence and prognosis: highly active antiretroviral therapy (HAART) and CD4+ lymphocyte count. Diagnosis of NHL can occur simultaneously (naive pts), or after diagnosis of HIV infection (experience-pts).
Single institution retrospective cohort study conducted in ASST FBF-Sacco Polo Luigi Sacco (Milan, Italy). Pts aged > =18 years, diagnosis of HIV infection and NHL, on HAART treated with first line R-CHOP-like chtp from Jan 2007 to Jan 2017. Chi-square, Fisher’s exact or Wilcoxon Rank-sum test, log-rank test or Cox regression model for OS, PFS and RR were used.
We enrolled 46 HIV+ pts: 11 naive-pts, 35 experience-pts (exp-pts). No difference in median age at diagnosis (49vs48ys p = 0.40), sex (male 72.7vs85.7% p = 0.37), histological types: DLBCL (2vs24), BL (3vs3), PEL (1vs0), PCNSL (1vs0), PBL (2vs2) low-grade NHL (2vs4) T-cell NHL(0 vs 2) (p = 0.13). Naïve-pts higher stage (stage IV 90.9vs41.2% p = 0.05). No difference in frequency of B symptoms (40vs41% p = 0.99), bulky masses (18.2vs20.6% p = 0.99), ≥2 extranodal sites (45.5vs40% p = 0.61), CNS involvement (44.4vs38.2% p = 0.99), AIDS-definig diseases (44.4vs28.6% p = 0.43) HCV/HBV infection (p = 0.08/0.99). Naive-pts aaIPI intermediate-high risk (90.0vs58.1% p = 0.11). CD4+ count at NHL diagnosis(102vs222/mcl p = 0.05). During R-CHOP-like chtp naïve-pts more infectious toxicity (50% vs 10.7% p = 0.02). During a median (IQR 2-44) follow-up of 12 mts no difference in RR (CR 60% vs 62.5% p = 0.85), median OS (67 mts vs 69.4 mts p = 0.3) and PFS (p = 0.8).
The compromised immune status in naïve-pts may explain their worst NHL conditions at diagnosis and toxicity during chtp. The immediate start of HAART in combination with chemotherapy probably reduce the impact of these factors in term of response to treatment and survival (RR, PFS and OS). CD4+ count together with HAART remain the independent prognostic factor with the greatest influence on OS [exp vs naïve-pts: OS HR 0.83 (95% CI); OS/CD4+ HR 1.80 (95% CI)]. Naive-pts should be treated with standard chtp regimens, without modification of dose or schedule.
ASST-FBF-SACCO.
Has not received any funding.
All authors have declared no conflicts of interest.
The purpose of this study was to assess obstetric and maternal outcome of pregnant patients with diagnosis of Hodgkin lymphoma (HL) registered by the International Network on Cancer, Infertility and Pregnancy (INCIP) to guide physicians in clinical management.
Clinical data of pregnant patients diagnosed with HL between 1969 and 2018 were collected from the INCIP registry. For survival analysis of classical HL treated with an ABVD-based regimen, non-pregnant controls were selected based on stage and prognostic score at diagnosis.
The median gestational age at diagnosis of 134 eligible patients was 20 weeks (range: 3 – 37). Antenatal chemotherapy was initiated in 53.7% of patients. Ten (7.5%) early pregnancies were terminated. One foetus deceased in the third trimester after three cycles of chemotherapy. In total, 120 (89.6%) pregnancies ended in a live birth. Preterm delivery was observed in 47 (40.1%) singleton pregnancies. Birth weight percentiles were lower in children prenatally exposed to oncological treatment and 17.9% were small for gestational age at birth. Four children (3.5%) had major congenital malformations. Five-year progression-free survival (PFS) for HL during pregnancy was 82.5% and 90.9% for early (n = 62) and advanced stage (n = 15). Five-year overall survival (OS) was 97.3% and 100%, respectively. Although not significant, patients with early stage HL appeared to have inferior PFS compared with matched non-pregnant controls (n = 62), more clearly seen in the subgroup that initiated chemotherapy during pregnancy (n = 45). OS was comparable between both groups, supporting the effectiveness of salvage therapy. For advanced stage HL survival was similar to controls, albeit small numbers.
Although further prospective research on the efficacy of chemotherapy during pregnancy is necessary, survival of patients diagnosed with early stage HL during pregnancy appears not to be statistically different from matched non-pregnant controls, Awareness of complications as preterm delivery and low birth weight is important in this population.
NTC00330447.
The authors.
European Union’s Horizon 2020 Research and Innovation Program under grant agreement No 647047 Research Foundation-Flanders (FWO., grant no G070514N) and ESGO (European Society of Gynaecological Oncology) Charles University Research Project Progres Q28 and Q34 and by grant MH CZ - DRO ("Kralovske Vinohrady University Hospital - FNKV, 00064173").
All authors have declared no conflicts of interest.
Vitreoretinal lymphoma (VRL), previously known as intraocular lymphoma, is a rare form of malignancy. Although the disease is highly aggressive with elevated mortality rate, there are no standard of differential diagnosis from posterior uveitis when the amount of vitreous is so limited. MYD88 L265P mutation is reported to be identified in the vitreous of approximately 70% of patients with VRL. In view of the need of establishing new procedures to support the diagnosis of VRL, we explored the exome of lymphoma cells and the prevalence of MYD88 L265P mutation in Korean VRL patients.
We performed the exome sequencing of vitreous of 8 patients with matched germline blood or buccal swab samples. The patients suspicious of VRL and underwent standard vitrectomy between July 2016 and September 2018 were enrolled. Sequencing data were analyzed and compared with those of CNS lymphoma. We established real-time PCR system for MYD88 L265P mutations. Vitreous of eight patients and an additional patient were subjected to the test.
Approximately 400 somatic mutations were identified for each patient through whole exome sequencing. Most frequetly mutated gene was MYD88. Previously reported frequently mutated genes such as PIM1 and CD79B were found to be mutated. Mutational profile of VRL showed similarity to that of PCNSL or DLBCL. Most VRL showed complex karyotype. The detection limit of MYD88 L265P real-time PCR was approximately 2%, and 5 out of 9 patients had MYD88 L265P mutation.
MYD88 L265P real-time PCR could be a good diagnostic tool for the patients with VRL harboring MYD88 L265P mutation. We concluded that exome or gene panel testing of VRL and confirmation of the presence of a number of somatic mutation and mutation profile may facilitate the diagnosis of VRL in a subset of patients.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.
The optimal treatment for primary gastric diffuse large B cell lymphoma (DLBCL) is unclear. The treatment for primary gastric DLBCL is in accordance with the principle of treatment for general DLBCL. We aimed to evaluate the treatment outcomes and pattern of failure in primary gastric DLBCL.
Between April 2001 and November 2018, 120 patients with stage I–IV primary gastric DLBCL were retrospectively reviewed in this study. All patients had been in complete remission after receiving rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Ninety patients (75%) were treated with R-CHOP alone, and the other 30 patients (25%) underwent R-CHOP with local treatment for gastric lesions. Twelve patients (10%) underwent gastrectomy, and 18 patients (15%) received consolidation radiotherapy (RT).
The median follow-up time was 49 (range, 5 to 197) months. The 5-year locoregional failure-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 85.6%, 86.5%, 83.4%, and 90.3%, respectively. During the follow-up, 17 patients (14.2%) experienced disease recurrence. Only 3 patients developed distant metastasis without locoregional failure (LRF). All except two cases of LRF included gastric failure. There was no LRF in patients who received R-CHOP with local treatment. On multivariate analysis, poor performance status was an independent prognostic factor for LRFS, and multiple gastric lesions influenced LRFS, DMFS, DFS, and OS.
The main pattern of initial failure is LRF, especially in the stomach in patients with primary gastric DLBCL. Gastric local treatment such as consolidation RT can effectively prevent gastric failure. Therefore, gastric local treatment should be considered for patients at high risk of LRF, such as multiple gastric lesions.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.