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Objective: The aim of this study was to evaluate the sociodemographic properties, clinical, laboratory, and radiological findings, and diagnosis of patients with head and neck lymphadenopathy (LAP) who applied to the Department of Pediatric Oncology of Medical Faculty of Gazi University. Material and Methods: Cases who applied to the Gazi University Faculty of Medicine, Department of Pediatric Oncology between January 2009 and December 2019 due to head and neck LAP were evaluated. The sociodemographic properties and clinical, laboratory, and radiologic findings of the patients were retrospectively assessed by scanning their records. Results: Seven hundred patients with head and neck LAP between the ages of 0-18 were included in this study. Four hundred seventy nine (68.4%) of the cases were males and 221 (316%) were females. The mean age of the patients was 7.08±4.25 years. Localized LAP was present in 509 (72.7%) cases and generalized LAP were present 191 (27.3%) cases. Of 700 cases, benign causes were detected in 581 (83.1%) cases, malignant causes were detected in 54 (7.7%) cases, and LAP-like masses were detected in 65 (9.2%) cases. Lymph node diameter over 3 cm, accompanying fever and weight loss, supraclavicular region involvement, fixed, firm, and rubbery lymph nodes, leukocytosis, elevation of C-reactive protein, erythrocyte sedimentation rate, and uric acid levels, accompanying hepatomegaly, weakness, itching, and hearing loss were significant malignancies. The most frequent cause in the benign group was upper respiratory tract infections. The most frequent cause in the malignant group was Hodgkin's lymphoma. Biopsy was performed from 125 of the cases for diagnosis. Malign causes were detected in 54 (43.2%) patients and benign causes were detected in the remaining 71 (56.8%). Conclusion: Head and neck LAP is a frequently encountered finding in childhood. Benign causes are the more frequently detected causes in its etiology. However, malignant causes are detected less frequently; therefore, early diagnosis is important in the prognosis of the patient. [ABSTRACT FROM AUTHOR]

Background: The principle of treatment of pediatric tumors is to kill tumors to the greatest extent and improve long-term quality of life through surgery, radiotherapy, chemotherapy, and other means combined according to the specific disease and pathological type. Radiotherapy is an important means for the treatment of pediatric tumors. With the development of radiotherapy technology, it plays an increasingly important role in clinical work. This paper briefly summarizes the characteristics of radiotherapy in pediatric tumors and introduces the application of radiotherapy in some major pediatric tumors. Materials and Methods: Relevant articles published in the PubMed database between 2010 and 2022 were searched. The researchers then looked at the data one by one and looked at the citation, which was their reference at the end of each paper. Inclusion criteria were, articles describing radiation therapy for pediatric tumors; experimental and clinical studies of different radioactive means; and standard methods and rigorous thinking. Exclusion criteria were, meta-analysis article; the literature was published before 2010. Results: In this paper, radiation therapy for acute lymphoblastic leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma, neuroblastoma, retinoblastoma, glioma, Wilms's tumor and rhabdomyosarcoma is summarized and their characteristic radiation conditions are analyzed. Conclusions: Radiotherapy for children with tumors should not blindly pursue high-dose radiotherapy, but the combination of different therapeutic methods should be adopted to achieve the purpose of tumor treatment and minimize the impact on the growth and quality of life of patients. [ABSTRACT FROM AUTHOR]

Introduction: Despite the existence of standard risk classification systems and effective treatment approaches, 34% to 37% of advanced-stage Hodgkin lymphomas (HLs) either relapse or progress. Our goal in our study was to show the relationship between initial lymphocyte count and stage, while examining their effects on prognosis. The initial lymphocyte count, which is proven in advanced stage patients, could be an important factor in terms of showing the prognosis in the early stage. Materials and Methods: Our study included 190 patients diagnosed with HL in our hospital between January 2010 and September 2020. HL subtypes, diagnosis stages, presence of bulky or mediastinal masses, lymphadenopathy areas, and demographic data of patients, such as age and sex. The aim was to obtain a cutoff in the statistical analysis performed to explore the relationship between lymphocyte level and stage, which is the main hypothesis of the study. Results: Of the 190 patients evaluated, 77 were female (40.5%) and 113 were male (59.5%). To obtain a cutoff in terms of lymphocyte level and stage relationship, a value of 2380/mm3 and below was found to be associated with stage 3-4 disease with a sensitivity of 86.44% and a specificity of 33.3% (AUC: 0.613 (0.539-0.682), p<0.007). Conclusion: This result can be improved in combination with conventional imaging methods used for staging purposes. Further studies may shed light on staging and especially the diagnosis of advanced stage disease with high sensitivity. [ABSTRACT FROM AUTHOR]

Objectives CLIPPER2 was an 8-year, open-label extension of the phase 3b, 2-year CLIPPER study on the safety and efficacy of etanercept in patients with JIA, categorized as extended oligoarticular arthritis (eoJIA), enthesitis-related arthritis (ERA) or PsA. Methods Participants with eoJIA (2–17 years old), ERA or PsA (each 12–17 years old) who received ≥1 etanercept dose (0.8 mg/kg weekly; maximum 50 mg) in CLIPPER could enter CLIPPER2. Primary end point was occurrence of malignancy. Efficacy assessments included proportions achieving JIA ACR 30/50/70/90/100 criteria and ACR inactive disease criteria, and clinical remission (ACR criteria) or Juvenile Arthritis DAS (JADAS) ≤1. Results Overall, 109/127 (86%) CLIPPER participants entered CLIPPER2 [ n  = 55 eoJIA, n  = 31 ERA, n  = 23 PsA; 99 (78%) on active treatment]; 84 (66%) completed 120 months' follow-up [32 (25%) on active treatment]. One malignancy (Hodgkin's disease in 18-year-old patient with eoJIA treated with methotrexate for 8 years) was reported; there were no cases of active tuberculosis or deaths. Numbers and incidence rates (events per 100 patient-years) of TEAEs (excluding infections/ISRs) decreased from 193 (173.81) in Year 1 to 9 (27.15) in Year 10; TE infections and serious infections also decreased. Over 45% of participants (n  = 127) achieved JIA ACR50 responses from Month 2 onwards; 42 (33%) and 34 (27%) participants achieved JADAS and ACR clinical remission, respectively. Conclusions Etanercept treatment up to 10 years was well tolerated, consistent with the known safety profile, with durable response in the participants still on active treatment. The benefit–risk assessment of etanercept in these JIA categories remains favourable. Trial registration ClinicalTrials.gov IDs: CLIPPER (NCT00962741); CLIPPER2 (NCT01421069) [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinomas (HCC) represent approximately 50% of primary liver neoplasms and can be localized or distributed throughout the parenchyma. Lymphoma is the clonal proliferation of lymphocytes, with the multicentric form being the most common in dogs. Metronomic chemotherapy consists of the administration of low-dose antineoplastic agents at short, regular intervals. However, no effective treatment for nodular or disseminated HCC nor reports of metronomic chemotherapy in dogs with lymphoma exist. Thus, this study aimed to report the use of antineoplastic therapies in 2 dogs diagnosed with inoperable nodular HCC and multicentric lymphoma. Cases: The 1st patient was a 16-year-old bitch mixed breed weighing 7.4 kg that was treated at the Veterinary Hospital of the Federal University of Santa Maria (HVU-UFSM). Ultrasound examination revealed nodular structures measuring approximately 1 cm throughout the hepatic parenchyma, with the largest one measuring approximately 4.48 x 3.07 cm located in the left lateral lobe. An increased uterine volume was also observed. Exploratory celiotomy showed pyometra and hepatic nodules. Liver biopsy confirmed the diagnosis of HCC. Owing to the impossibility of surgical resection, the treatment of choice was metronomic chemotherapy with cyclophosphamide at 15 mg/mm2 every 48 h with follow-up imaging and blood tests. Nine months after diagnosis, a nodular area of approximately 1.5 x 1.3 cm was identified in the greater curvature of the stomach. The patient remained clinically stable, with stable neoplasm progression. However, at the age of 19 years, the bitch died 2 years and 5 months after the metronomic administration of cyclophosphamide, and the causa mortis was elderliness. The 2nd patient was a 10-year-old bitch Shih Tzu weighing 3.7 kg, referred for suspected lymphoma and also examined at the HVU-UFSM. The patient manifested with enlarged mandibular and popliteal lymph nodes and lymphocytic leukocytosis. A multicentric lymphoma was confirmed via fine-needle aspiration cytology (FNAC) and through clinical signs and blood tests. Chemotherapy treatment was initiated with the CHOP regimen, which included cyclophosphamide [200 mg/m2], vincristine [0.6 mg/m2], doxorubicin [25 mg/m2], and prednisone [5 mg/kg]. However, this regimen was not effective and changed to chlorambucil [3 mg/m2), VO, SID, for 4 days] and prednisone [1 mg/kg, VO, SID]. However, this protocol was not feasible due to the unavailability of the drug on the market; therefore, metronomic chemotherapy was initiated. The bitch received cyclophosphamide 15 mg/m2 every 48 h, showing clinical improvement in the lymphocytic leukocytosis. Chronic anemia, weight loss, leukemia, and chronic kidney disease occurred as complications and were treated accordingly. The bitch lived for 3 years and 6 months after the diagnosis and eventually died due to years of treatment and worsening general condition due to the acquired complications. Discussion: Veterinary Medicine is faced with several challenges in designing effective metronomic chemotherapy regimens, including the selection of appropriate drugs and the establishment of effective doses. Both patients in this report received cyclophosphamide [15 mg/m2, every 48 h]. In human medicine, metronomic chemotherapy is considered a safe and potentially useful treatment, which was observed in the reported patients since it presented few side effects and an increased survival period of 880 days in the patient with HCC and 1,275 days in the patient with multicentric lymphoma. This regimen can be considered for inoperable tumors and in cases of refractory to conventional regimens. [ABSTRACT FROM AUTHOR]

Purpose: Radiotherapy is integral in the management of hematological malignancies (HM). Standard radiotherapy dose fractionation regimens range between 20 and 50 Gy in 10–25 fractions over 2–5 weeks. This study presents the outcomes of patients with HM treated with hypofractionation radiotherapy (HFRT) during the COVID-19 pandemic. Methods: Patients (n = 36) were treated with HFRT between January 2020 and September 2022. The outcomes measured were the overall response rate (ORR), freedom from local progression (FFLP), and overall survival (OS). Results: The median follow-up was 13.2 months. Thirty-three patients (92%) had non-Hodgkin (NHL) or Hodgkin lymphoma (HL). Eighteen patients (50%) had aggressive and nine (25%) had indolent NHL. Nineteen patients (53%) presented with stage I/II and fifteen (42%) with stage III/IV disease. Twenty-five (69.4%) and eleven (30%) received consolidative and definitive RT, respectively. Twenty patients (56%) received treatment to the neck and/or thorax and nine (25%) to the abdomen or pelvis. The total dose ranged from 18 to 42.5 Gy in 6–17 fractions/2.67–5 Gy per fraction. The median dose in 2 Gy fractions for an alpha/beta (α/β) ratio of 10 amounted to 39 Gy (SD ± 13.86) and 43.6 Gy (SD ± 12) for an α/β of 3. The most commonly used fractionation scheme was 39 Gy in 13 fractions. ORR was 94.4% for the entire cohort, and 100, 94.4, and 83.3% for indolent NHL, aggressive NHL, and HL patients. The two-year FFLP was 76% (95% CI: 34–93%) for the entire cohort and 100, 87 (95% CI: 56.4–96.5%), and 42% (95% CI: 1.1–84.3%) for the indolent NHL, aggressive NHL, and HL patients. Two-year OS for the entire cohort was 80% (95% CI: 59.9–90.5%) and 100, 66.1 (95% CI: 36.4–84.4%), and 100% for the indolent NHL, aggressive NHL, and HL patients. Only one patient presented with grade two pulmonary toxicity. Conclusions: HFRT in HM provides excellent local control to be validated in a larger prospective study. [ABSTRACT FROM AUTHOR]

Non-Hodgkin lymphoma (NHL) are a diverse group of tumors of lymphocytes, originating in lymphnodes and sometime from sites other than primary lymphatic organs called extra nodal disease . There is a surge seen in the cases of extra nodal Non-Hodgkin lymphoma, attributed to many factors namely HIV, use of immunos uppressant medications as well as indolent viral infections. There are many subcategories and histological subtypes that are the most important predictor of the outcome. Some of the Non-Hodgkin lymphoma, have site specific predilection as well. Extra nodal Non-Hodgkin lymphoma can present with diverse manifestations and attimes it is difficult to differentiate from other organ related pathologies. That is why thorough knowledge of various imaging presentations of extra nodal Non-Hodgkin lymphoma is crucial. The purpose of this article is to look at a few chosen cases of Non-Hodgkin lymphoma and observe different visceral involvements in those patients, and to find out how lymphomas affect organs other than lymphnodes. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the global trends in the burden of lymphoma from 1990 to 2019. The data used in this study were from the Global Burden of Disease 2019 study. This study described the age-standardised rates of incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of lymphoma (non-Hodgkin and Hodgkin's lymphoma, NHL and HL, respectively) annually from 1990 to 2019, stratified by sociodemographic index (SDI) and 21 world regions. The estimated annual percentage changes in these indexes were calculated. In 2019, the age-standardised rates of HL per 100,000 population were lower than those of NHL in terms of incidence (1.1 vs 6.7 per 100,000 person-years, respectively) and prevalence (0.3 vs 5.7 per 100,000 person-years, respectively) but not mortality (21.6 vs 3.2 per 100,000 person-years, respectively). From 1999 to 2019, the global incidence of HL decreased and the incidence of NHL increased, and the prevalence of both HL and NHL increased, but the mortality rates decreased. When stratified by SDI, the incidence of HL decreased in all but middle-SDI regions, the mortality rate of HL decreased in all regions, and both the incidence and mortality rate of NHL increased in all but high-SDI regions. The prevalence of HL and NHL increased in all SDI regions, especially in middle-SDI regions. YLLs and DALYs of HL in all SDI regions and those of NHL in high-SDI regions decreased. YLDs slightly increased in middle- to high-SDI regions. Lymphoma remains a major public health issue, and better prevention, precise identification, and promising treatments are vitally important. [ABSTRACT FROM AUTHOR]

Background: Positron emission tomography (PET) with the use of 18F-fluorodeoxyglucose (FDG), implemented with low-dosage computer tomography, is to be considered as the most important evolution of imaging in the management and assessment of classical Hodgkin lymphoma patients. Summary: According to Lugano response criteria, FDG-PET is mandatory to define metabolic response to frontline therapy and moreover it is important in the definition of nonresponders or refractory disease patients. Refractory disease is reported in about 15% of patients, with some variations based on the choice of first-line chemotherapy, and particularly in advanced stages, up to 40% eventually relapse within 3 years. Key Messages: The aim of this review was to highlight a practical way to use FDG-PET in the subset of HL, with some notes of its use in first-line patients, and particularly centered on relapsed or refractory setting with a final focus of the evaluation of response by FDG-PET in the new treatment era of immunocheckpoint inhibitors. [ABSTRACT FROM AUTHOR]

Computed tomography scans were assessed for subcutaneous fat area and density at thoracic vertebra 4 in 65 adolescent and young adult (AYA) patients with Hodgkin lymphoma. Subcutaneous fat was quantified over 3 timepoints; (1) baseline, (2) end of initial anthracycline treatment (EOT) and (3) 1 year. Fat area increased at EOT (62.3 ± 5.4 cm/m2 vs 53.5 ± 5.0 cm/m2, p < 0.01) and 1 year (65.8 ± 5.6 cm/m2 vs 53.5 ± 5.0 cm/m2, p < 0.01) compared to baseline. Fat density significantly decreased at EOT (-91.2 ± 1.4 HU vs −86.5 ± 1.4 HU, p < 0.01) and at 1 year (-90.3 ± 1.6 HU vs −86.5 ± 1.4 HU, p = 0.01) compared to baseline. Female, radiation receiving, and anthracycline dosage >250mg/m2subgroups experienced significant fat gain (p < 0.05 for all). Female AYA Hodgkin lymphoma patients receiving radiation, and/or high-dose anthracyclines may be at higher risk of subcutaneous fat gain during therapy. [ABSTRACT FROM AUTHOR]

This article discusses the importance of magnetic resonance imaging (MRI) in diagnosing and differentiating spondyloarthritis (SpA) from other conditions. The authors emphasize that bone marrow edema in the sacroiliac joint, commonly associated with SpA, can also be seen in tumors, infections, degeneration, and sacroiliac joint gout. To avoid misdiagnosis and mistreatment, rheumatologists need to be familiar with the clinical characteristics and imaging features of different diseases. The article presents a retrospective analysis of 10 cases of lymphoma that mimicked SpA, providing clinical data, laboratory examinations, and imaging features of these patients. It highlights the importance of imaging techniques, such as x-rays, CT scans, and MRI, in diagnosing SpA and detecting bone lymphoma, a rare condition that can mimic the symptoms of SpA. Rheumatologists should be aware of the similarities between SpA and bone lymphoma to ensure accurate diagnosis and appropriate treatment. [Extracted from the article]

Key Clinical Message: We presented a patient, diagnosed with lymphoma‐associated CLIPPERS, 11 years after lymphoma treatment. Therefore, CLIPPERS may be paraneoplastic neurological syndrome of lymphoma, which needs to be considered in the follow‐up of lymphoma cases. Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare central nervous system disorder with a recent increase in incidence. There are few reports of lymphoma‐associated CLIPPERS, although the relationship between these two diseases and the pathophysiology of CLIPPERS in general need further investigation. Here, we present a patient with a history of Hodgkin's lymphoma (HL) more than 10 years before the onset of CLIPPERS, in contrast to the majority of previously reported lymphoma‐associated cases, and discuss the possibility that CLIPPERS is the paraneoplastic neurological syndrome of HL. This highlights the need to consider CLIPPERS as a differential diagnosis during follow‐up of patients with a history of lymphoma. [ABSTRACT FROM AUTHOR]

Tenosynovial giant cell tumors represent a group of typically non-malignant tumors found within the joints and soft tissues. The occurrence of tenosynovial giant cell tumor alongside hematologic malignancies is an infrequent finding. Herein, we report a patient who presented with coinciding Hodgkin Lymphoma (HL) and tenosynovial giant cell tumor before chemotherapy initiation. The case was discovered during initial assessment using [18FF]fluorodeoxyglucose ([18FF]FDG) positron emission tomography/computed tomography (PET/CT) imaging for HL staging. An unrelated hypermetabolic mass within the left knee joint led to the discovery of this unusual case, which led to a CT-guided biopsy and tenosynovial giant cell tumor discovery. This was clearly demonstrated in interim and end-of-therapy PET/CT studies when all lymphomatous lesions had resolved but the tenosynovial giant cell tumor remained. This case serves as a reminder of the intricate nature of oncological pathology and emphasizes the need for thorough and vigilant diagnostic evaluation for optimal management plan. [ABSTRACT FROM AUTHOR]

Objective: To compare tumor therapy response assessments with whole-body diffusion-weighted imaging (WB-DWI) and 18F-fluorodeoxyglucose ([18F]FDG) PET/MRI in pediatric patients with Hodgkin lymphoma and non-Hodgkin lymphoma. Materials and methods: In a retrospective, non-randomized single-center study, we reviewed serial simultaneous WB-DWI and [18F]FDG PET/MRI scans of 45 children and young adults (27 males; mean age, 13 years ± 5 [standard deviation]; age range, 1–21 years) with Hodgkin lymphoma (n = 20) and non-Hodgkin lymphoma (n = 25) between February 2018 and October 2022. We measured minimum tumor apparent diffusion coefficient (ADCmin) and maximum standardized uptake value (SUVmax) of up to six target lesions and assessed therapy response according to Lugano criteria and modified criteria for WB-DWI. We evaluated the agreement between WB-DWI- and [18F]FDG PET/MRI–based response classifications with Gwet's agreement coefficient (AC). Results: After induction chemotherapy, 95% (19 of 20) of patients with Hodgkin lymphoma and 72% (18 of 25) of patients with non-Hodgkin lymphoma showed concordant response in tumor metabolism and proton diffusion. We found a high agreement between treatment response assessments on WB-DWI and [18F]FDG PET/MRI (Gwet's AC = 0.94; 95% confidence interval [CI]: 0.82, 1.00) in patients with Hodgkin lymphoma, and a lower agreement for patients with non-Hodgkin lymphoma (Gwet's AC = 0.66; 95% CI: 0.43, 0.90). After completion of therapy, there was an excellent agreement between WB-DWI and [18F]FDG PET/MRI response assessments (Gwet's AC = 0.97; 95% CI: 0.91, 1). Conclusion: Therapy response of Hodgkin lymphoma can be evaluated with either [18F]FDG PET or WB-DWI, whereas patients with non-Hodgkin lymphoma may benefit from a combined approach. Clinical relevance statement: Hodgkin lymphoma and non-Hodgkin lymphoma exhibit different patterns of tumor response to induction chemotherapy on diffusion-weighted MRI and PET/MRI. Key Points: • Diffusion-weighted imaging has been proposed as an alternative imaging to assess tumor response without ionizing radiation. • After induction therapy, whole-body diffusion-weighted imaging and PET/MRI revealed a higher agreement in patients with Hodgkin lymphoma than in those with non-Hodgkin lymphoma. • At the end of therapy, whole-body diffusion-weighted imaging and PET/MRI revealed an excellent agreement for overall tumor therapy responses for all lymphoma types. [ABSTRACT FROM AUTHOR]

Background: The Non-Hodgkin Lymphoma (NHL) are a heterogeneous group of lymphoproliferative malignancies, with distinct causes and shows distinctive patterns of behaviour and response to treatment consists of many subtypes, each with distinct epidemiology, aetiology, morphology, immunophenotypic, and clinical features. The present study was conducted with the aim of investigating the epidemiology of various subtype of NHL by using immunohistochemistry. Materials and methods: This prospective observational study was conducted in the department of pathology, Kidwai memorial institute of oncology, Bengaluru between the periods of November 2019 to May 2021. The epidemiology and various immunomorphological subtypes of Non-Hodgkin Lymphoma were studied. All de novo cases clinically suspected of NHL sample received in the department of pathology were included in the study. Clinical details and patients' history was recorded and immunohistochemistry staining was done. Result: We had a total of 136 cases of lymphoma out of which 56 cases were of Hodgkin lymphoma and 80 cases were of non-Hodgkin lymphoma. Mean age was 51.96 ± 17.17 years, with male majority including 46 males (57.5%). Most commonly we had B-cell type of NHL in 65 cases (81.2%) followed by T-cell in 13 cases (16.2%) and NK/T - cell in 1 case (1.25 %). Conclusion: We found that NHL cases were common in 5th decade with male predominance, with most common involvement in cervical lymph nodes. We conclude that a detailed clinical and histopathological evaluation of NHL cases is important for better patient management and prognosis. [ABSTRACT FROM AUTHOR]

In the current study, we report the prevalence of male testosterone deficiency in a cohort of 60 male long-term survivors of malignant lymphoma with normal total testosterone but in the lower part of the reference level. Testosterone deficiency was defined as subnormal concentrations of total testosterone or subnormal concentrations of calculated free testosterone. The aim was to clarify whether total testosterone was sufficient for identification of testosterone deficiency in male survivors of malignant lymphoma. Hormonal analyses taken at follow-up were compared with samples taken at diagnosis for a subgroup of 20 survivors, for evaluation of changes in hormones over time. Another group of 83 similar survivors of malignant lymphoma with testosterone in the high end of reference levels were also used for comparison, to identify groups of increased risk of testosterone deficiency. A total group of 143 survivors were therefore included in the study. Our findings indicate that for screening purposes an initial total testosterone is sufficient in some survivors because sexual hormone binding globulin concentration was found stable over time. However, 15% were found with subnormal calculated free testosterone. Survivors intensely treated for Hodgkin lymphoma and older survivors were identified as high-risk groups for testosterone deficiency necessitating endocrinological attention during follow-up. Some evidence of pituitary downregulation was also found, because of uncompensated decreases in testosterone concentration over time. In conclusion, longitudinal measurements of total testosterone alone do not seem adequate for the screening of testosterone deficiency for all long-term lymphoma survivors. [ABSTRACT FROM AUTHOR]

Currently, analysis of interim PET (iPET) according to the Deauville score (DS) is the most important predictive factor in Hodgkin lymphoma (HL); however, there is room for improvement in its prognostic power. This study aimed to evaluate the prognostic value of quantitative PET analysis (maximum standard uptake value [SUVmax], total metabolic tumor volume [TMTV] and total lesion glicolysis [TLG]) at baseline (PET0) and iPET in a retrospective cohort of newly diagnosed classical HL. For positive iPET (+ iPET), the reduction of quantitative parameters in relation to PET0 (ΔSUVmax, ΔTMTV and ΔTLG) was calculated. Between 2011 and 2017, 234 patients treated with ABVD were analyzed. Median age was 30 years-old, 59% had advanced stage disease, 57% a bulky mass and 25% a + iPET (DS 4–5). At baseline, high TLG was associated with an increased cumulative incidence of failure (CIF) (p = 0.032) while neither SUVmax, TMTV or TLG were associated with overall survival (OS) or progression-free survival (PFS). In multivariate analysis, only iPET was associated with CIF (p < 0.001). Among ΔSUVmax, ΔTMTV and ΔTLG, only a ΔSUVmax ≥ 68.8 was significant for PFS (HR: 0.31, CI95%: 0.11–0.86, p = 0.024). A subset of patients with improved PFS amongst + iPET was identified by the quantitative (ΔSUVmax ≥ 68.8%) analysis. In this real-world Brazilian cohort, with prevalent high-risk patients, quantitative analysis of PET0 did not demonstrate to be prognostic, while a dynamic approach incorporating the ΔSUVmax to + iPET succeeded in refining a subset with better prognosis. These findings warrant validation in larger series and indicate that not all patients with + iPET might need treatment intensification. [ABSTRACT FROM AUTHOR]

Background: The lymph node is a very important structure in the haemopoietic and lymphatic systems. The lesions are wide-ranging and include non-neoplastic conditions, benign and malignant neoplastic diseases, to metastatic deposits. Histopathology is considered the gold standard in its diagnosis. Objectives: To determine the spectrum of lesions in both peripheral and visceral lymphadenopathies in a tertiary hospital in Nnewi and compare it with other studies. Methodology: This is a retrospective study involving 207 cases of histologically diagnosed lymph node biopsies in the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria, over a 9-year period. Cases with incomplete biographic data such as age, sex, nature of tissue, and unrepresentative or inadequate tissue were excluded from the study. Few fine needle aspiration cytology of lymph nodes done within this study period were excluded because of inconclusive results in the majority of the cases, however, biopsies requested in those cases were used. Results: Two hundred and seven lymph node biopsies were studied. The age of these patients ranged from 0.9 to 89 years, with a mean age of 41.4 years (SD±20.9) and median age of 41.0 years. Females slightly outnumbered males with a ratio of 1.1:1. Neoplastic lesions were more common: comprising of 58.4% (121/207) and including metastatic deposits to the lymph nodes 31.9% (66/207), non-Hodgkin lymphoma 23.7.1% (49/207), Hodgkin lymphoma 2.4% (5/207) and one case of Kaposi sarcoma: 0.5%(1/207). Non-neoplastic lesions were the second commonest and included: majorly inflammatory lesions 41.5% (85/207) such as non-specific reactive hyperplasia accounting for 24.6% (52/207), other specific reactive hyperplasia 2.8% (6/207), 9.7% (20/207) of Tuberculous lymphadenitis, 3.4% (7/207) of other chronic necrotizing granulomatous lymphadenitis, and one case of ectopic thyroid inclusion accounting for 0.5%(1/207). Conclusion: Histopathology plays an important role in establishing the cause of lymphadenopathy. Among the lymph nodes examined, neoplastic lesions were the most prevalent cases in our environment, which is contrary to the popular belief, that infectious diseases of lymph nodes are more common in developing countries. This study also concluded that the cervical group of lymph nodes was the most frequently encountered palpable nodal swelling, followed by the axillary group. Further studies are also required, where extensive immunohistochemical stains and molecular studies would be applied for further classifications of lymphomas. [ABSTRACT FROM AUTHOR]

Globally, malignancies cause one out of six mortalities, which is a serious health problem. Cancer therapy has always been challenging, apart from major advances in immunotherapies, stem cell transplantation, targeted therapies, hormonal therapies, precision medicine, and palliative care, and traditional therapies such as surgery, radiation therapy, and chemotherapy. Natural products are integral to the development of innovative anticancer drugs in cancer research, offering the scientific community the possibility of exploring novel natural compounds against cancers. The role of natural products like Vincristine and Vinblastine has been thoroughly implicated in the management of leukemia and Hodgkin's disease. The computational method is the initial key approach in drug discovery, among various approaches. This review investigates the synergy between natural products and computational techniques, and highlights their significance in the drug discovery process. The transition from computational to experimental validation has been highlighted through in vitro and in vivo studies, with examples such as betulinic acid and withaferin A. The path toward therapeutic applications have been demonstrated through clinical studies of compounds such as silvestrol and artemisinin, from preclinical investigations to clinical trials. This article also addresses the challenges and limitations in the development of natural products as potential anti-cancer drugs. Moreover, the integration of deep learning and artificial intelligence with traditional computational drug discovery methods may be useful for enhancing the anticancer potential of natural products. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to investigate the potential role of tissue osteopontin, also known as secreted phosphoprotein 1 (SPP1), as a contributing factor to an unfavorable prognosis in classical Hodgkin's lymphoma (HL) patients who received the same treatment protocol. The study involved 44 patients aged 4–22 years, with a median follow-up period of 3 years. Patients with higher levels of SPP1 were associated with tissue necrosis and inflammation, and there was a trend toward a poorer prognosis in this group. Before therapy, we found a correlation between positron emission tomography (PET) scans and logarithmic SPP1 levels (p = 0.035). However, the addition of SPP1 levels did not significantly enhance the predictive capacity of PET scans for recurrence or progression. Elevated SPP levels were associated with tissue mRNA counts of chemotactic and inflammatory chemokines, as well as specific monocyte/dendritic cell subtypes, defined by IL-17RB, PLAUR, CXCL8, CD1A, CCL13, TREM1, and CCL24 markers. These findings contribute to a better understanding of the potential factors influencing the prognosis of HL patients and the potential role of SPP1 in the disease. While the predictive accuracy of PET scans did not substantially improve during the study, the results underscore the complexity of HL and highlight the relationships between SPP1 and other factors in the context of HL relapse. [ABSTRACT FROM AUTHOR]

Objective: To review the 10-year experience of pediatric Hodgkin lymphoma at a single center in Türkiye. Material and Methods: This study is a retrospective analysis of 82 pediatric Hodgkin lymphoma patients up to 18 years of age treated between 2009 and 2020. Results: The mean age of the patients was 11 years (range 3-17 years), and 68% of the patients were male. The distribution of patients by stage was as follows: stage I, n=2 (2%); stage II, n=32 (39%); stage III, n=35 (43%); and stage IV, n=13 (16%). The trend in histopathology was predominantly mixed cellularity at 49%. The most common treatment protocol was ABVD (adriamycin, bleomycin, vincristine, doxorubicin), used in 83% of cases. The majority of patients (n=76, 93%) received involved-field radiotherapy following chemotherapy. Complete remission was achieved with firstline chemotherapy in 90% of cases. The 2-year overall survival (OS) and event-free survival (EFS) rates were 97.5% and 92%, respectively. There was no significant difference in OS and EFS in terms of gender, stage, and the presence of B symptoms. Conclusion: Our data shows an excellent outcome for pediatric Hodgkin lymphoma, with results comparable to those of developed countries. Future studies should focus not only on treatment efficacy but also on identifying the best approaches to reduce long-term negative side effects. [ABSTRACT FROM AUTHOR]

Identifying therapy-related AML (t-AML) of newly diagnosed acute leukemias is of great interest. Development of t-AML can occur after cytotoxic chemotherapy and/or radiation. We report a case of t-AML with CBFB::MYH11 fusion in a patient with a distant history of treated stage IIIB nodular sclerosing Hodgkin's lymphoma. We present the clinical course of the patient and the methods used to detect and monitor the rearrangement. Core binding factor AML (CBF-AML) after exposure to treatment is considered to be a good prognostic marker. The identification of these favorable AML subtypes such as CBF-AML highlights the importance of identifying genetic alterations, especially with increasing incidences of t-AML due to changes in choice of treatment and prognosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most Hodgkin lymphoma (HL) patients present with disease in the nodal regions. Extranodal forms are rare. 40% of them present with B symptoms characterized by fever, night sweats and weight loss. This study was carried out to identify the characteristics of patients with primary HL. METHODS: A retrospective analysis was done of 20 patients over a time period of 2 years (2017-2019). RESULTS: Hodgkin's lymphoma is a common type of lymphoma affecting the young to middle aged adults, with mean age being 38-39 yrs. The most common subtype in our cohort was nodular sclerosis. The uncommon presenting complaints like low back ache (due bone involvement by Hodgkin's lymphoma) and pruritus were noted in our study group, apart from the common clinical presentation of B symptoms, and lymph node enlargement. The tumour microenvironment and wise use of immunos like characteristic dim pax 5, negative to very dim cd20 and cd30 Golgi and membrane expression will help in diagnosis of unsuspected and rare presentation of Hodgkin's lymphoma cases. CONCLUSION: CHL (Classical Hodgkin Lymphoma) is a curable disease. However, there is still a lack of understanding of its pathogenesis, which may lead to less effective therapies for the smaller subset of patients who are destined to die of their disease. cHL is a tumour with only variable EBV association. We think it's appropriate to re-examine EBV's involvement in the pathophysiology of cHL in light of current advancements in immunotherapeutics and medicines that target EBV. [ABSTRACT FROM AUTHOR]

Hodgkin lymphoma (HL) affects older and younger patients and includes multiple options for initial treatment. We sought to examine the decision processes of practicing oncologists caring for patients with newly diagnosed HL. Through semi-structured interviews, we explored their perspectives about treatment decisions. We completed thematic analysis using the Anderson Behavioral Model of Health Services framework to identify factors associated with initial decisions. We completed 22 interviews, grouping findings into contextual factors, individual characteristics, and physician preferences. Paternalism was widely cited, along with collaboration between community and academic colleagues. Participants used sequential therapy but not geriatric assessment in care for older patients. Physicians had varied responses about use of frontline brentuximab vedotin (Bv)-based therapy based on perceptions about benefit versus toxicity. Our work suggests a need to further understand the heterogeneity of clinical practices, especially in the post-approval setting of new therapies. [ABSTRACT FROM AUTHOR]

In this case, we describe the potential risk of developing an infectious complication leading to a secondary malignancy after a short course of immunotherapy. We report a patient who presented with Epstein–Barr virus (EBV) driven Hodgkin's lymphoma after treatment with a short course of daratumumab along with pomalidomide and dexamethasone for relapsed multiple myeloma. Although there have been limited documented cases of daratumumab treatment leading to EBV reactivation, in patients presenting with infectious symptoms or neutropenia on a daratumumab-based regimen, testing for EBV should not be overlooked. [ABSTRACT FROM AUTHOR]

Simple Summary: This study compares the presence of coronary artery calcium on coronary computed tomography angiography in relation to cardiovascular events between Hodgkin lymphoma (HL) survivors treated with thoracic radiotherapy and a matched non-cancer control group. HL survivors have a higher prevalence of coronary artery calcium more than ten years after irradiation. However, HL patients with a coronary artery calcium score of zero still have an increased risk of future cardiovascular events, possibly due to rapid progression of atherosclerosis in the coronary arteries following irradiation. Timely treatment with statins should be considered to prevent rapid acceleration of pre-existing atherosclerosis. Background: Thoracic radiotherapy is one of the corner stones of HL treatment, but it is associated with increased risk of cardiovascular events. As HL is often diagnosed at a young age, long-term follow-up including screening for coronary artery disease (CAD) is recommended. Objectives: This study aims to evaluate the presence of coronary artery calcium score (CACS) in relation to cardiovascular events in HL patients treated with thoracic radiotherapy compared to a non-cancer control group. Methods: Consecutive HL patients who underwent evaluation for asymptomatic CAD with coronary computed tomography angiography > 10 years after thoracic irradiation were included. The study population consisted of 97 HL patients matched to 97 non-cancer patients on gender, age, cardiovascular risk factors, and statin use. Results: Mean age during CT scan in the HL population was 45.5 ± 9.9 and in the non-cancer population 45.5 ± 10.3 years. CACS was elevated (defined as >0) in 49 (50.5%) HL patients and 30 (30.9%) control patients. HL survivors had an odds ratio of 2.28 [95% CI: 1.22–4.28] for having a CACS > 0 compared to the matched population (p = 0.006). Prevalence of CACS > 90th percentile differed significantly: 17.1% in HL survivors vs. 4.6% in the matched population (p = 0.009). Non-obstructive coronary artery stenosis was more prevalent in the HL population than in the control population (45.7% vs. 28.4%, respectively, p = 0.01). During follow-up of 8.5 [5.3; 9.9] years, nine HL patients experienced an event including two patients with a CACS of zero. No events occurred in the control population. Conclusion: In a matched study population, HL survivors have a higher prevalence of a CACS > 0 and an increased risk of cardiovascular events after thoracic irradiation compared to a matched non-cancer control group. [ABSTRACT FROM AUTHOR]

The combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) followed by autologous stem cell transplantation (ASCT) is a commonly used intensification regimen for patients with Hodgkin lymphoma. As etoposide and cytarabine dosing are not defined, we conducted a retrospective, multicenter study, to compare efficacy and toxicity in 130 patients with Hodgkin lymphoma receiving etoposide and cytarabine at either 200 mg/m2/d (n = 50), 400 mg/m2/d (n = 35), or etoposide 200 mg/m2/d and cytarabine 400 mg/m2/d (n = 45). Progression-free survival and overall survival were not associated with the intensity of conditioning. Increased conditioning intensity was associated with longer duration of thrombocytopenia, a higher number of transfused RBC and platelet units and a higher frequency of mucositis, but serious adverse events or infectious complications were not increased. The intensity of BEAM regimen was not associated with survival but with the rate of cytopenia and mucositis advocating for the use of lower dosing in frail patients. [ABSTRACT FROM AUTHOR]

This letter to the editor published in the journal Leukemia & Lymphoma discusses a rare case of a patient with hypereosinophilic syndrome (HES) and leptomeningeal involvement. The letter provides insights into diagnosing and treating hypereosinophilia, highlights unusual presentations of HES in classical Hodgkin Lymphoma (cHL), and presents a case study of a patient with cHL complicated by hypereosinophilia with multi-organ involvement. The patient experienced symptoms such as fatigue, weight loss, and abdominal bloating, and further evaluation revealed significant eosinophilia and lymphadenopathy. The article emphasizes the challenges of managing secondary complications from HES while treating cHL and suggests the need for further research in optimizing treatment for cHL with HES. [Extracted from the article]

Cost effectiveness analysis of interim positron emission tomography (PET-2, done after 2 cycles of chemotherapy) based response adaptive therapy (RAT) approaches in advanced Hodgkin lymphoma (aHL) are not available from an Indian perspective. We used a five-year decision analytics model to assess the cost-effectiveness of the two RAT approaches [(escalation (RAT-1) or de-escalation (RAT-2)] compared with standard care (SOC) in aHL (mean age:35 years). Modelling data was derived from secondary sources and sensitivity analyses were performed to assess the robustness of the model. Net monetary benefit (NMB) gained from RAT2 in Indian rupees (INR) (INR 2,26,896) was higher than the RAT1 (INR 1,83,138) when compared with SOC. Proportion achieving the complete response after initial treatment (CR1) was the key determining factor for the RAT1/2 dominance over SOC. Despite higher initial input costs, response-adapted therapy of aHL was cost-effective by minimizing the cost incurred and disutility experienced during relapse and salvage. Despite higher initial costs, response-adapted therapy based on the interim PET scan after 2 cycles of chemotherapy was more cost-effective when compared to standard therapy with 6 cycles of ABVD in patients with advanced Hodgkin's lymphoma. Among the RAT approaches, de-escalation (RAT-2) had better cost-effectiveness than the escalation approach (RAT-1). [ABSTRACT FROM AUTHOR]

Human body cells are stem cell (SC) derivatives originating from bone marrow. Their special characteristics include their capacity to support the formation and self-repair of the cells. Cancer cells multiply uncontrollably and invade healthy tissues, making stem cell transplants a viable option for cancer patients undergoing high-dose chemotherapy (HDC). When chemotherapy is used at very high doses to eradicate all cancer cells from aggressive tumors, blood-forming cells and leukocytes are either completely or partially destroyed. Autologous stem cell transplantation (ASCT) is necessary for patients in those circumstances. The patients who undergo autologous transplants receive their own stem cells (SCs). The transplanted stem cells first come into contact with the bone marrow and then undergo engraftment, before differentiating into blood cells. ASCT is one of the most significant and innovative strategies for treating diseases. Here we focus on the treatment of Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma, and AL amyloidosis, using ASCT. This review provides a comprehensive picture of the effectiveness and the safety of ASCT as a therapeutic approach for these diseases, based on the currently available evidence. [ABSTRACT FROM AUTHOR]

Multiple primary cancers (MPC) are characterized by the presence of synchronous and metachronous occurrence of two or more distinct histological tumor types. In this study, an exceptional clinical case was presented, demonstrating the coexistence of rectal adenocarcinoma and pelvic classical Hodgkin lymphoma (cHL). A 65-year-old male patient with a 2- year history of persistent mucous bloody stools was admitted to our hospital. Colonoscopy and subsequent biopsy confirmed the diagnosis of rectal adenocarcinoma. The patient underwent laparoscopic abdominoperineal resection of the rectum and regional lymph node dissection. Postoperative histopathological analysis not only substantiated the presence of rectal adenocarcinoma, but also unexpectedly identified pelvic lymph nodes harboring the features of cHL. [ABSTRACT FROM AUTHOR]

Purpose: C1 lateral mass reconstruction is recommended, in cases of instability caused by tumor involvement or extensive C1 lateral mass resection. However, because of the anatomical complexity of the area and, most importantly, the proximity to vertebral arteries, few cases of reconstruction have been reported to date. The purpose of this report is to present technical details of C1 lateral mass reconstruction in conjunction with vertebral artery preservation from a posterior approach. Methods: Two cases of one stage craniovertebral junction instrumentation and C1 lateral mass reconstruction in conjunction with vertebral artery preservation from a posterior approach are presented. Results: In both cases of extensive resection of lateral mass due to tumor involvement, an expandable cage was used for C1 lateral mass reconstruction, which has been used only in one patient in literature. Complementary pathological examinations of the two cases indicated two rare tumors that had been reported in the upper cervical region so far. The first case became an unknown origin metastatic cancer and the second was reported to be a primary non- Hodgkin lymphoma. Conclusions: C1 lateral mass reconstruction with an expandable cage together with VA preservation is recommended in cases of extensive C1 lateral mass resection to increase the total strength and to shorten the length of the posterior device and probably better fusion. The expandable cage is preferred because of safer placement under compression instead of the lateral mass. [ABSTRACT FROM AUTHOR]

Objectives: The prognostic relevance of metabolic tumor volume (MTV) having recently been demonstrated in patients with early‐stage favorable and advanced‐stage Hodgkin lymphoma. The current study aimed to assess the potential prognostic value of 18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET) in early‐stage unfavorable Hodgkin lymphoma patients treated within the German Hodgkin Study Group HD17 trial. Methods: 18F‐FDG PET/CT images were available for MTV analysis in 154 cases. We used three different threshold methods (SUV2.5, SUV4.0, and SUV41%) to calculate MTV. Receiver‐operating‐characteristic analysis was performed to describe the value of these parameters in predicting an adequate therapy response. Therapy response was evaluated as PET negativity after 2 cycles of eBEACOPP followed by 2 cycles of ABVD. Results: All three threshold methods analyzed for MTV showed a positive correlation with the PET response after chemotherapy. Areas under the curve (AUC) were 0.70 (95% CI 0.53–0.87) and 0.65 (0.50–0.80) using the fixed thresholds of SUV4.0 and SUV2.5, respectively, for MTV‐ calculation. The calculation of MTV using a relative threshold of SUV41% showed an AUC of 0.63 (0.47–0.79). Conclusions: MTV does have predictive value after chemotherapy in early‐stage unfavorable Hodgkin lymphoma, particularly when the fixed threshold of SUV4.0 is used for MTV calculation. Trial registration: ClinicalTrials.gov NCT01356680. [ABSTRACT FROM AUTHOR]

Classical Hodgkin lymphoma (cHL) is a highly curable disease (70–80%), even though long-term toxicities, drug resistance, and predicting clinical responses to therapy are major challenges in cHL treatment. To solve these problems, we characterized two cHL cell lines with acquired resistance to doxorubicin, KM-H2dx and HDLM-2dx (HRSdx), generated from KM-H2 and HDLM-2 cells, respectively. HRSdx cells developed cross-resistance to vinblastine, bendamustin, cisplatin, dacarbazine, gemcitabine, brentuximab vedotin (BV), and γ-radiation. Both HDLM-2 and HDLM-2dx cells had intrinsic resistance to BV but not to the drug MMAE. HDLM-2dx acquired cross-resistance to caelyx. HRSdx cells had in common decreased CD71, CD80, CD54, cyt-ROS, HLA-DR, DDR1, and CD44; increased Bcl-2, CD58, COX2, CD26, CCR5, and invasive capability; increased CCL5, TARC, PGE2, and TGF-β; and the capability of hijacking monocytes. In HRSdx cells less sensitive to DNA damage and oxidative stress, the efflux drug transporters MDR1 and MRP1 were not up-regulated, and doxorubicin accumulated in the cytoplasm rather than in the nucleus. Both the autophagy inhibitor chloroquine and extracellular vesicle (EV) release inhibitor GW4869 enhanced doxorubicin activity and counteracted doxorubicin resistance. In conclusion, this study identifies common modulated antigens in HRSdx cells, the associated cross-resistance patterns, and new potential therapeutic options to enhance doxorubicin activity and overcome resistance. [ABSTRACT FROM AUTHOR]

We report a case of a 24-year-old man who developed angioimmunoblastic T-cell lymphoma (AITL) after treatment for refractory lymphocyte-rich classic Hodgkin lymphoma (LR-CHL). This patient was treated with the BV+AVD (brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine) protocol for LR-CHL but progressed before completing chemotherapy. The pathological imaging showed the typical findings of LR-CHL at the first onset and first progression. Rescue chemotherapy and high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation (AHSCT) were performed for refractory LR-CHL, and complete remission was achieved. However, the recurrence was suspected 6 months after AHSCT. The pathological findings of the lymph node biopsy at this time were different from those of the previous two lymph node biopsies, demonstrating findings of AITL. The finding of the immunohistochemical staining and polymerase chain reaction results supported the diagnosis. Although it has been reported that the risk for the development of non-Hodgkin lymphoma after treatment for Hodgkin lymphoma is increased, most are B-cell lymphomas, and few cases of AITL have been reported. AITL is a type of peripheral T-cell lymphoma that generally occurs in middle-aged and elderly people and that rarely occurs in young people. Here, we were able to make an accurate diagnosis by performing re-examination even when recurrence of LR-CHL was suspected. As there are no detailed case reports of AITL developing into secondary non-Hodgkin lymphoma, here we report on an identified case. [ABSTRACT FROM AUTHOR]

Monoclonal T-cell lymphocytosis has been reported in patients with concomitant autoimmune diseases, viral infections, or immunodeficiencies. Referred to as T-cell large granular lymphocytic leukemia (T-LGLL), most cases cannot identify the triggering cause. Only small case series have been reported in the literature, and no treatment consensus exists. T-cell lymphocytosis may also appear after the transplant of hematopoietic stem cells or solid organs. Rare cases have been reported in patients undergoing autologous stem cell transplant (ASCT) for hematological diseases (including multiple myeloma or non-Hodgkin’s lymphoma). Here, we describe the singular case of a patient who underwent ASCT for Hodgkin’s lymphoma and displayed the onset of T-LGLL with an uncommonly high number of lymphocytes in peripheral blood and their subsequent spontaneous remission. [ABSTRACT FROM AUTHOR]

No consensus has been reached yet concerning treatment strategies for a sequential classic Hodgkin lymphoma (CHL) following gray zone lymphoma (GZL). Prognosis of GZL after a failed autologous hematopoietic stem-cell transplantation (auto-HCT) is poor and treatment strategy is very limited. As yet there are limited data showing clinical outcomes of brentuximab vedotin (BV) for GZL, especially for sequential CHL after GZL. We report a case of CHL following primary refractory GZL after a failed auto-HCT and showed favorable response to first-line CHL-directed chemoradiotherapy consisting of BV plus doxorubicin, vinblastine, and dacarbazin (AVD) followed by irradiation. The sequential cases with an early evolution, whose diagnosis of second lymphoma was made within a year, have been recently reported very poor survival shorter than a year. Whether a sequential CHL following GZL should be treated as a primary or relapsed disease has not been clearly elucidated. Our patient showed favorable response to first-line CHL-directed chemoradiotherapy without allogenic hematopoietic stem-cell transplantation and has in continuous remission for 2 years. The management of our case could help for physicians to make better treatment decisions and provide insights for further exploration in future studies. [ABSTRACT FROM AUTHOR]

Background: Inhibitors of programmed cell death protein 1 (PD-1) and programmed cell death ligand 1 (PD-L1) have been used in the treatment of relapsed and refractory Hodgkin's lymphoma (R/R HL) recently. To further understand the safety and efficacy of PD-1/PD-L1 inhibitors in R/R HL, we conducted this meta-analysis. Methods: Databases and the Clinical Registration Platforms have been systematically searched for related studies by March 2022. For safety analysis, the incidence and exhibition of any grade and grade 3 or higher adverse effects (AEs) were evaluated. Besides, severe AEs (SAEs), treatment-related deaths, and AEs leading to treatment discontinuation were summarized. The overall response rate (ORR), complete response (CR) rate, partial response (PR) rate, progression-free survival (PFS), overall survival (OS), and duration of response (DOR) were calculated for efficacy analysis. All processes were implemented mainly through the package Meta and MetaSurv of software R 4.1.2. Results: Overall 20 studies and 1440 patients were enrolled. The pooled incidence of any grade and grade 3 or higher AEs were 92% and 26%, respectively. The pooled ORR, CR rate and PR rate were 79%, 44% and 34%, respectively. The most common AEs were neuropathy (29%), nausea (27%), pyrexia (26%), and leukopenia (25%), and the most common grade 3 or higher AEs included leukopenia (10%), infusion reaction (8%), weight gain (3%), and neutropenia (2.7%). In survival analysis, pembrolizumab monotherapy appeared to perform better compared to nivolumab monotherapy. Conclusions: PD-1/PD-L1 inhibitors show promising efficacy and tolerable AEs in the treatment of R/R HL. [ABSTRACT FROM AUTHOR]

Sarcoidosis is frequently associated with various hematological and solid tumors; it can be discovered by chance during tumor evaluations. Sarcoidosis can occur before some cancers, coexist with others, or be diagnosed 1 to 2 years later. Sarcoid reaction affecting hilar and mediastinal lymph nodes can pose a diagnostic challenge in patients with histopathological confirmation of Hodgkin lymphoma who are being evaluated using fluorodeoxyglucose-positron emission tomography computed tomography (FDG-PET/CT) scan because it cannot be easily distinguished from lymphoma infiltration. The presence of an increase or persistence of a prominent activity on a follow-up FDG-PET/CT scan after chemotherapy treatment for lymphoma that is associated with a complete metabolic response in the site of the primarily diagnosed lymphomatous disease is highly suggestive of concurrent sarcoidosis and necessitates careful assessment to avoid unnecessary therapy. [ABSTRACT FROM AUTHOR]

We investigated the feasibility of a web-based cognitive-behavioral therapy to reduce cancer-related fatigue (CRF) among survivors of Hodgkin lymphoma. In this before-and-after trial, patients were primarily recruited via the German Hodgkin Study Group (GHSG). We assessed feasibility (response and drop-out rate) and preliminary efficacy including CRF, quality of life (QoL), and depressive symptomatology. T tests compared baseline levels with t1 (post treatment) and t2 (3 months of follow-up). Among 79 patients contacted via the GHSG, 33 provided interest (42%). Among the seventeen participants, four were treated face-to-face (pilot patients), 13 underwent the web-based version. Ten patients completed the treatment (41%). Among all participants, CRF, depressive symptomatology, and QoL improved at t1 (p ≤.03). The effect in one of the CRF measures remained at t2 (p =.03). Except for QoL, post-treatment effects were replicated among the completers of the web-based version (p ≤.04). The potential for this program has been demonstrated, but needs to be re-assessed after identified issues on feasibility have been resolved. Trial registration: The study was registered at ClinicalTrials.gov (Number: NCT03968250). [ABSTRACT FROM AUTHOR]

Introduction: Hodgkin lymphoma is a hematologic malignancy that shows excellent prognosis once accurately diagnosed. Its diagnosis provides a challenge to the pathologists, as it has histopathological features that overlap other lymphoid lesions. As a result confirmatory immune-stains are used to either confirm or exclude Hodgkin Lymphoma before starting therapy. Despite the well-established immune panel approved for diagnosing Hodgkin Lymphoma, still some cases are not fitting in a specific category and hence further investigations to reach more sensitive and specific markers are still required. This requirement is very important in Egypt as morbidity and mortality from Hodgkin Lymphoma is high in Africa. This study investigates the validity of GATA3 coupled with CD79a immune-histochemical markers in diagnosing Hodgkin lymphoma. Material and Methods: Seventy three cases of Hodgkin lymphoma were included in this study: sixty Classic Hodgkin lymphoma cases, ten Nodular Lymphocytic Predominant Hodgkin Lymphoma cases confirmed by the immune staining panel and three Classic Hodgkin Lymphoma cases with atypical immune-staining pattern, excluded from statistics. Results: GATA3 was expressed in forty-nine out of sixty Classic Hodgkin Lymphoma cases and was completely negative in all Nodular Lymphocytic Predominant Hodgkin Lymphoma cases. CD79a was expressed in all cases of Nodular Lymphocytic Predominant Hodgkin Lymphoma and in only seven cases of CHL cases. Two out of the three Classic Hodgkin Lymphoma cases with atypical immune-staining pattern were positive for GATA3 despite being completely negative for CD15. These three cases were also positive for CD79a. Conclusions: GATA3 is a good confirmatory marker for Classic Hodgkin Lymphoma, and when coupled with CD79a forms a good panel to differentiate Nodular Lymphocytic Predominant Hodgkin Lymphoma from Classic Hodgkin Lymphoma (GATA3 negative and CD79a positive). [ABSTRACT FROM AUTHOR]

The aim was to investigate the distribution of health problems in general practice (GP) among adolescent and young adult (AYA) survivors of lymphoma and to compare problem rates with the general population. All GP consultations between 2006 and 2020 were identified from the national GP claims register. Diseases and complaints presented 3–10 years after the cancer diagnosis were identified using the International Classification of Primary Care codes (ICPC-2) and compared by applying logistic regression models, presented with odds ratio (OR) and 95%CI. A total of 2,500,557 AYAs, of whom 1105 were diagnosed with lymphoma, and over 50 million GP consultations were included. The most common causes of consultation among AYA survivors of lymphoma were related to Hodgkin's disease (13%), pregnancy (11%), respiratory diseases (9%), psychological problems (8%), musculoskeletal system (6%) and fatigue (4%). Almost all these problems were significantly higher among AYA lymphoma survivors compared to the general population (OR ranging from 1.1 to 1.5). Compared to the general population, young lymphoma survivors have increased contact with the GP for a considerable number of health problems for up to 10 years post-diagnosis. This emphasizes the importance of robust follow-up and a good flow of information between hospital and primary care. [ABSTRACT FROM AUTHOR]

The article focuses on ulcerative lymphomatoid papulosis (LyP) as a rare immune-related adverse event following immune checkpoint inhibitor (ICI) therapy and autologous stem cell transplant (autoSCT) in a patient with recurrent Hodgkin lymphoma. Topics include the rarity of LyP as an ICI-induced adverse event, the clinical presentation and histopathological features of ulcerative LyP, and the challenges in diagnosis and management of LyP in patients treated with ICIs and autoSCT.

The reliability and safety of front‐line ultrasonography guided core needle biopsy (UG‐CNB) performed with specific uniform approach have never been evaluated in a large series of patients with lymphadenopathies suspected of lymphoma. The aim of this study was to assess the overall accuracy of UG‐CNB in the lymph node histological diagnosis, using a standard reference based on pathologist consensus, molecular biology, and/or surgery. We retrospectively checked the findings concerning the application of lymph node UG‐CNB from four Italian clinical units that routinely utilized 16‐gauge diameter modified Menghini needle under power‐Doppler ultrasonographic guidance. A data schedule was sent to all centers to investigate the information regarding techniques, results, and complications of lymph node UG‐CNB in untreated patients over a 12‐year period. Overall, 1000 (superficial target, n = 750; deep‐seated target, n = 250) biopsies have been evaluated in 1000 patients; other 48 biopsies (4.5%), screened in the same period, were excluded because inadequate for a confident histological diagnosis. Most patients were suffering from lymphomas (aggressive B‐cell non‐Hodgkin lymphoma [aBc‐NHL], 309 cases; indolent B‐cell [iBc]‐NHL, 279 cases; Hodgkin lymphoma [HL], 212 cases; and nodal peripheral T‐cell [NPTC]‐NHL, 30 cases) and 100 cases from metastatic carcinoma; 70 patients had non‐malignant disorders. The majority of CNB results met at least one criterion of the composite reference standard. The overall accuracy of the micro‐histological sampling was 97% (95% confidence interval: 95%–98%) for the series. The sensitivity of UG‐CNB for the detection of aBc‐NHL was 100%, for iBc‐NHL 95%, for HL 93%, and for NPTC‐NHL 90%, with an overall false negative rate of 3.3%. The complication rate was low (6% for all complications); no patient suffered from biopsy‐related complications of grade >2 according to the Common Terminology Criteria for Adverse Events. Lymph node UG‐CNB as mini‐invasive diagnostic procedure is effective with minimal risk for the patient. [ABSTRACT FROM AUTHOR]

Patients with relapsed/refractory classical Hodgkin lymphoma (cHL) achieve complete response (CR) after decitabine‐plus‐camrelizumab therapy, while long‐term outcome especially after treatment discontinuation remains unclear. We present a retrospective analysis of 87 relapsed/refractory cHL patients who acquired CR after decitabine‐plus‐camrelizumab. Patients were divided into two groups and received consolidation treatment every 3–4 or 6–12 weeks, and 1‐year of continuous CR was guaranteed for treatment cessation. At a median follow‐up of 5.3 years, the median relapse‐free survival (RFS) after achieving CR with decitabine‐plus‐camrelizumab therapy was 4.5 years, and patients underwent consolidation per 3–4 weeks might have longer RFS. The baseline percentage of peripheral central memory T cells was not associated with RFS, while patients with higher pretreatment serum levels of interleukin‐6 (IL‐6) and lactate dehydrogenase (LDH) had significantly shorter RFS and increased risk for disease recurrence. Fifty‐seven patients completed and discontinued decitabine‐plus‐camrelizumab, and their median RFS had not been reached. The 2‐year RFS rate after treatment cessation was 78% (95% CI, 67–90%). Patients in the high‐risk subgroup with higher pretreatment IL‐6 and LDH levels showed poor treatment‐free remission. Moreover, decitabine‐plus‐camrelizumab therapy was safe and cost‐effective. In conclusion, patients who obtained CR with decitabine‐plus‐camrelizumab and received consolidation per 3–4 weeks can achieve long‐term remission after treatment discontinuation. [ABSTRACT FROM AUTHOR]

Chronic lymphocytic leukemia (CLL) is a clonal mature B‐cell neoplasm with a typically indolent clinical course. Though most clinicians follow these neoplasms through observation alone, an aggressive transformation to prolymphocytic leukemia, diffuse large‐B‐cell lymphoma (Richter transformation) or classical Hodgkin lymphoma requires immediate attention. We present a case of extreme leukocytosis (>1 million/μL) in a previously diagnosed CLL patient. Due to symptomatic leukostasis, she was started on cytoreductive therapies including leukocytapheresis. After three rounds of leukocytapheresis (LCP) and concurrent chemotherapy, her white blood cell count decreased from a maximum 1262 × 103/μL to 574 × 103/μL. To our knowledge, CLL with symptomatic leukostasis that required therapeutic LCP is rarely reported in literature. We propose that therapeutic LCP is of value in such rare, yet dangerous settings like our case. [ABSTRACT FROM AUTHOR]

Central nervous system (CNS) involvement in Hodgkins lymphoma (HL) is extremely rare. There are only two reported case series of intracranial involvement of HL. CNS HL can be presented at any point in the course of HL, most mimicking with a prominent neurological symptom. This challenges the diagnosis of CNS involvement and stroke. Here, we report four cases of patients having refractory HL with CNS involvement to garner attention among neurologists for this rare disease presents with stroke symptoms and reviews its disease characteristics, prognosis, and treatment. [ABSTRACT FROM AUTHOR]

EBV infection induces the countenance of PD-L1, which limits antitumor T cell responses by different and potential mechanisms, Here we highlight the estimation level of the AP1 transcription factor that acts as a double-edged sword with both oncogenic and tumor suppressive activities by control on the level of PD-L1 checkpoints in EBV-infected Hodgkin lymphoma patients. To our knowledge, This is the first Iraqi research attempt to explore the detailed mechanism of PDL1 upregulation by AP1 which is induced by EBV infection. The research including of 23 cases Hodgkin lymphoma and 10 healthy control, after diagnosis of EBV VCA IgG by using ELISA assay. Our result indicated that, the level EBV VCA IgG was positive in (10 ) cases Hodgkin lymphoma at a percentage (43.47%) while the absence of this antibody in control group at a rate (0.0%). Also, the mean of PDL-1gene significantly higher in Hodgkin lymphoma compared with mean of PD-L1 (2.2±1.84) in control, as well as, the statistical significant increased value of AP-1 in Hodgkin lymphoma (1.37 ±0.94) compared with control (1.07±0.38), addition in this research we found significant correlation between AP-1and PDL-1 in EBV + Hodgkin lymphoma patients with (r= 0.40) at significant (p ≤ 0.05) [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Myasthenia gravis is a neuromuscular disorder that is strongly associated with thymoma. Although the presence of myasthenia gravis with other tumors is uncommon, approximately 50% of patients with thymoma have myasthenia gravis. Thymic Hodgkin lymphoma should be considered due to the multiple reported cases of patients with myasthenia gravis and Hodgkin lymphoma. In this report, we present the case of 24-year-old woman with myasthenia gravis who was incidentally found to have coexisting thymoma with thymic Hodgkin lymphoma. Case Report: A 24-year-old woman with a known case of vitiligo presented with a 2-year history of diplopia and incidental anterior mediastinal mass. Following investigations, myasthenia gravis was diagnosed and managed by pyridostigmine, prednisolone, and azathioprine. Regarding the anterior mediastinal mass, thymoma was suspected based on the presence of myasthenia gravis and radiological findings. She underwent extended transsternal thymectomy. The final histopathological report of the dissected thymus disclosed Hodgkin lymphoma pathology coexisting with thymoma. After the diagnosis of Hodgkin lymphoma nodular sclerosis type IIA was confirmed, 6 cycles of chemotherapy were administered. Four years of follow-up revealed no evidence of Hodgkin lymphoma. However, her symptoms of myasthenia gravis persisted despite Hodgkin lymphoma remission. Conclusions: There is an unclear association between myasthenia gravies and Hodgkin lymphoma. Prior reports revealed regression of myasthenia gravies following Hodgkin lymphoma management, which suggests that myasthenia could be a complication of Hodgkin lymphoma. However, in our case, myasthenia gravis persisted after Hodgkin lymphoma management; therefore, further studies are needed to explore this association. [ABSTRACT FROM AUTHOR]

Simple Summary: Immunotherapy using antibodies against programmed cell death protein 1 (PD-1) or its ligand PD-L1 can restore host antitumor immunity in many types of cancer. Hence, PD-1/PD-L1 blockade therapy has become the standard treatment for various cancer types in the last decade. However, apart from classic Hodgkin lymphoma and primary mediastinal B-cell lymphoma, PD-1/PD-L1 blockade therapy has shown limited efficacy in other lymphomas. To address this gap, several clinical trials of combination therapies with PD-1/PD-L1 inhibitors have been recently conducted or are underway in both frontline and relapsed/refractory settings. Here, we comprehensively review these clinical studies of combination therapies for lymphomas and discuss their outcomes in the hope of providing a perspective to develop novel therapeutic approaches for combination therapy. Immunotherapy with the programmed cell death protein 1 (PD-1)/PD-1 ligand (PD-L1) blockade has revolutionized the treatment of advanced solid cancers. However, these clinical benefits have been limited to cases of malignant lymphomas, showing promising results for only classic Hodgkin lymphoma (cHL) and primary mediastinal B-cell lymphoma (PMBCL). To bring clinical benefits to more patients with lymphoma, numerous combination therapies involving PD-1/PD-L1 blockade have been tested in clinical trials in both frontline and relapsed/refractory settings. This article reviews the current landscape of combination therapies with PD-1/PD-L1 blockade for lymphoma and discusses the potential therapeutic approaches. An interim analysis of a phase 3 study demonstrated increased progression-free survival with nivolumab combination therapy over the current frontline treatment in patients with advanced-stage cHL. The results of combination therapies for aggressive B-cell lymphomas, except for PMBCL, have been disappointing. Several clinical trials of combined PD-1/PD-L1 blockade and Bruton's tyrosine kinase inhibitors are exploring its efficacy in patients with chronic lymphocytic leukemia (CLL) with Richter transformation. Several T-cell lymphoma subtypes respond to PD-1/PD-L1 blockade monotherapy. Further clinical trials are underway to investigate appropriate combination regimens with PD-1/PD-L1 blockade, especially for cHL, CLL with Richter transformation, and T-cell lymphoma, in both frontline and relapsed/refractory settings. [ABSTRACT FROM AUTHOR]