Search

Summary: Management of classical Hodgkin lymphoma in older patients is challenging due to poor tolerance of the chemotherapy regimens used in younger patients. We modified the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone), whereby bleomycin and etoposide were removed and cyclophosphamide dose was reduced, for older patients with co‐morbidities. Here we present data from the first 41 patients treated with 'ACOPP' across 3 centres, demonstrating that it can be delivered, with a favourable toxicity profile (TRM 2%) and promising efficacy (2‐year PFS and OS, 73% (95% CI: 52–94) and 93% (95% CI: 80–100) respectively). [ABSTRACT FROM AUTHOR]

The article discusses a guideline compiled by the British Society for Haematology (BSH) for the management of mantle cell lymphoma (MCL). Topics covered include first line management for early stage and advanced stage MCL as well as indications for treatment, how to determine patients fit for autologous stem cell transplant, and therapeutic algorithm for alternative immunochemotherapy, Bruton tyrosine kinase (BTK) inhibitor or other targeted therapy.

The article discusses the diagnosis and investigation of patients with mantle cell lymphoma (MCL. Topics covered include the latest information on molecular pathology, the use of positron emission tomography/computed tomography (PET/CT) scanning in staging and response assessment, and biological prognostic factors of MCL.

Thrombosis is a well-recognized complication of asparaginase therapy for acute lymphoblastic leukemia (ALL), associated with the depletion of antithrombin (AT). Following a high incidence of thrombotic episodes during induction therapy for ALL in our tertiary referral center, we prospectively instituted a protocol of AT replacement. Forty-five consecutive adolescents and adults with ALL treated with asparaginase-containing phase I induction protocols were included in this observational study. Fifteen received standard therapy with no replacement; the subsequent 30 were managed with the protocol described. One or more low AT levels (<70 iu/dl) were recorded in 76% of patients in the cohort managed using the protocol, resulting them in receiving an AT replacement. There was a significant reduction in the incidence of thrombosis with this strategy (0/30 vs. 5/15,p < 0.001). We suggest that such a strategy should be studied in a prospective randomized sub-study within the context of a national ALL trial. [ABSTRACT FROM PUBLISHER]

The article discusses the Safety and diagnostic yield of splenic core biopsy and discusses an approach using combined Haematology/Radiology assessment in a tertiary referral centre. Topics include how the core biopsy of the spleen is performed less often than in other solid organs due to a perceived increased risk of post-procedure haemorrhage.

The article discusses a study which identified a series of 5 consecutive patients presenting with hypomegakaryocytic thrombocytopenia (HMT) and low-to-intermediate risk myelodysplastic syndrome (MDS). Topics covered include the clinical characteristics of patients, the role of immune dysregulation in the pathophysiology of MDS, and the response of patients to ciclosporin (CsA) therapy.

Positron emission tomography-computed tomography (PET-CT) scanning has been shown to be more sensitive than bone marrow biopsy (BMB) in detecting bone marrow involvement (BMI) in classical Hodgkin lymphoma (cHL). In this 5-year retrospective series, 93 (54%) of all new cases of cHL were staged using PET-CT and BMB. PET-CT identified focal bone marrow uptake in 17/93 (18.3%), whilst only five of these (29.4%) were confirmed by BMB. Abnormal pelvic uptake was seen on PET-CT in these five cases. The other 12 cases were missed, giving BMB a sensitivity of 29.4% and a specificity of 100%. PET-CT upstaged 9.7% of patients compared to CT alone. BMB upstaged only one patient; however, this patient was already stage IV on PET-CT. BMB did not alter clinical management in any case. Bone positivity on PET-CT appeared to correlate with anemia, raised lactate dehydrogenase (LDH) and B symptoms. BMB has little or nothing to offer staging cHL in the PET-CT era. [ABSTRACT FROM AUTHOR]

Clinically and biologically, nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) has much more in common with germinal-center derived B-cell non-Hodgkin lymphoma (NHL) than with classical Hodgkin lymphoma (cHL). Management of NLPHL remains controversial. In a 14-year multicenter series, 69 cases were analyzed, and the median follow-up was 53 months (range 11-165.) B-symptoms were present in only 4.3%% of patients, and 81.1%% of patients had stage I/II disease. Treatment was with radiotherapy (53.6%%), chemotherapy (21.7%%), combined modality (17.4%%), and observation (7.2%%). In all, 10.1%% of patients relapsed and 2.9%% of patients developed high-grade transformation to DLBCL. All relapses and transformations were salvageable. No patient died of their disease. The 5-year relapse-free survival was 92%%, transformation-free survival 98.4%%, and overall survival 100%%. We conclude that NLPHL behaves as a distinct clinical entity, often presenting at an early stage without risk factors. It has an excellent outcome. It may be possible, in early-stage disease, to reduce the intensity of therapy in NLPHL, to single-modality radiotherapy, without affecting OS. [ABSTRACT FROM AUTHOR]

Central nervous system relapse of primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma There was no evidence of systemic disease on computed tomography (CT) imaging and therefore a diagnosis of primary cutaneous CD8 SP + sp aggressive epidermotropic cytotoxic T-cell lymphoma was made. Cutaneous CD8 SP + sp T-cell lymphoma is a rare and aggressive lymphoma. [Extracted from the article]

GLO:1XW/01may20:bjh16464-fig-0001.jpg PHOTO (COLOR): . gl A 32-year-old male with a history of stage 1A nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) treated four years previously with radiotherapy presented with weight loss. Contrast computed tomography (CT) of neck, thorax, abdomen and pelvis demonstrated widespread small-volume lymphadenopathy and 17-cm splenomegaly. Bone marrow trephine biopsy sections showed a hypercellular marrow with numerous large paratrabecular lymphoid aggregates. [Extracted from the article]

Contrast magnetic resonance imaging (MRI) of brain and spinal cord demonstrated abnormal thickening and leptomeningeal enhancement of all visible cranial nerves, most striking in cranial nerves III (top left) and V (top right). Whilst leptomeningeal involvement can occur synchronously with primary central nervous system lymphoma, or as a feature of relapsed systemic lymphoma, isolated primary leptomeningeal lymphoma with no parenchymal lesions is extremely rare. MRI with contrast is often the only imaging modality that demonstrates meningeal enhancement and should be used in combination with CSF analysis to confirm the diagnosis. [Extracted from the article]

A 35-year-old man was referred after thrombocytopenia was detected at occupational health screening. Full blood count showed Hb 154 g/l, WBC 6 x 10 SP 9 sp /l, platelet count 94 x 10 SP 9 sp /l, mean platelet volume 14 fl (normal range [NR] 7-11). Haemolytic anaemia may occur due to incorporation of phytosterols into red cell membranes causing stomatocytosis and reduced red cell deformability and survival. [Extracted from the article]