Chemotherapy For Treatment Of Lymphoma Research Articles

Management of Orbital Lymphona Using Radiation Therapy

The aim of this study is to retrospectively review disease outcome, survival analysis, and complications experienced by orbital lymphoma patients after completion of radiotherapy. We retrospectively analyzed medical records of 50 patients (36 women and 14 men, age range 33-92, average age 67.7 years with a median age of 71.5 years) dating from 1984 to 2017 from two institutions – Southern California Kaiser Permanente in Los Angeles, California and the Cancer Care Institute in San Jose, California. All patients underwent biopsy for clinically proven diagnosis of orbital lymphoma. 32 patients were diagnosed with Stage 1 orbital lymphoma, one patient with Stage 2, 2 patients with Stage 3, and 15 patients with Stage 4.The histological grade was low in 42 (84%), intermediate in 7 (14%), and high in 1 (2%). For treatment, 41 patients were treated with radiotherapy alone while 9 patients received chemotherapy for treatment of lymphoma at other sites before or after radiotherapy for orbital lymphoma. The median dose for total patients was 3040 cGy (range 2000-4000). Five-year local relapse-free survival was determined using the Kaplan-Meier method. The average follow-up for patients post-radiation was 49 months (range 4 days-325 months) and the median follow-up was 27.5 months. At 5 years, the overall survival rate for total patients was 70%. For Stage 1 patients (n=32), the 5-year survival rates were 82%. Only one patient was diagnosed with Stage 2 (n=1) orbital lymphoma and survived for 22 months. For Stage 3 patients (n=2), the 5- year survival rate was 50%. For Stage 4 (n=15) patients, the 5-year survival rate was 60%. Ten patients reported cataract formation as a result of radiotherapy. Dry eye syndrome was recorded in 6 patients, but none were reported as severe. Twenty-five patients reported no complications after completion of radiation. One patient died during treatment. Other complications amongst patients included conjunctivitis (n=4), diplopia (n=2), ptosis (n=2), keratitis (n=2), tearing (n=1), and decreased vision (n=1). Radiotherapy is a safe and effective treatment option in the management of orbital lymphoma with good response rates. The majority of complications experienced reported by patients from radiation treatment were minimal and did not require medical intervention.

Viral reactivation and clinical hepatitis in patients with hepatitis C who receive rituximab as part of chemotherapy for treatment of lymphoma: A case series.

e18559 Background: Rituximab has been implicated in the reactivation of quiescent viruses, although its impact on Hepatitis C (HCV) remains poorly understood. We report outcomes from a case series of 9 HCV+ patients who received rituximab-based chemotherapy. Methods: We obtained IRB approval to perform a retrospective chart review on HCV+ patients who received rituximab-based chemotherapy for lymphoma from 2001-08. Clinical hepatitis (CH) was defined as either an AST or ALT 2x ULN. Viral reactivation (VR) was defined at a viral load (VL) increase of 10x the pretreatment value. Results: Eight of 9 patients developed a CH within 12 months of exposure to r- chemo, average months to CH was 3.86. Five of 7 patients developed CH before VR, 2 of 7 patients develop CH after VR. Of the 5 patients whose CH occured before their VR, only 1 has a VL that increases at time of CH. Two of 5 patients do not have viral loads reported around the time of CH. Two of 5 do not have increasing VL at time of CH. Four of 6 VR occurred within 12 months, on average 7.25 months post exposure. Six of 8 patients with >2 VL had a VR. Of those 6, 4 had a VR within 12 months of being exposed to r-chemo. Average AST at VR was 89.6, average ALT at VR was 72.5 Two of the 3 HIV+ patients developed VR within 12 months of receiving r-chemo. The average time to VR was similar in the HIV+ (7.5 months) vs. in the HIV- (7 months) patients. One patient's chemo regimen was changed due to HCV reactivation. None of the patients received dose reduction in other chemo agents for hepatitic insufficiency and none developed hepatitic failure. Conclusions: In this study we noted a trend toward increasing LFTs and VLs in HCV+ patients who received rituximab-based chemotherapy. Patients were more likely to have a CH after exposure to rituximab, but were not more likely to have a CH following VR. This pattern makes it difficult to say whether CH was a marker of liver toxicity due to VR vs. ongoing chemo or other co-morbidities. Despite impaired cellular immunity, the 3 HIV+ patients had the same rate of VR as the HIV- patients. Our study illustrates the possible relationship between rituximab exposure and increasing VL, but no clear relationship could be determined between VR and CH. No significant financial relationships to disclose.

What is your diagnosis? Particulate material in peritoneal fluid from a dog

9-year-old castrated male Greyhound dog was presented for evaluation of vomiting and lethargy of 1-week duration. On physical examination, the dog was febrile and dehydrated with a tense abdomen and petechial hemorrhages. Clinicopathologic abnormalities included relative polycythemia, mild lymphopenia with reactive lymphocytes, hypoalbuminemia, hypocholesterolemia, hyperbilirubinemia, increased ALP, mild hypokalemia, hyperamylasemia, hyperlipasemia, increased D-dimer concentration, and hyperfibrinogenemia. Cytologic evaluation of peritoneal fluid revealed marked suppurative inflammation with intracellular barium sulfate particles. The day before presentation, the referring veterinarian had administered oral barium sulfate in an upper gastrointestinal contrast study. Radiographs revealed free contrast material in the peritoneal cavity, consistent with gastrointestinal perforation, and leakage of contrast material. Abdominal exploratory surgery revealed a mid-jejunal perforation and a hepatic nodule. Histopathologic diagnosis of the jejunal and liver lesions was T-cell lymphoma. The patient recovered well postoperatively and received chemotherapy for treatment of lymphoma. Most commercial barium sulfate preparations contain relatively uniform, weakly birefringent, pale yellow particles <1 microm in diameter. Because barium sulfate is found occasionally in clinical specimens, cytopathologists should be familiar with its cytologic appearance.