Tzung-Chih Tang

Value of surveillance computed tomography in the follow-up of diffuse large B-cell and follicular lymphomas

Computed tomography (CT) as a routine follow-up has been a standard practice for patients with non-Hodgkin lymphoma although it is not recommended in most guidelines. We aimed to describe the value of surveillance CT in detection of disease relapse in patients with diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma grade 3 (FL3) and to evaluate whether relapse detected by different methods influenced outcome. In this retrospective review of consecutive 341 patients with DLBCL or FL3 diagnosed between 2003 and 2009 in complete response (CR) or unconfirmed CR, 113 patients experienced relapses. We found that routine surveillance CT detected asymptomatic relapse in 25 patients (22.1xa0%; group 1), including 22 of 100 patients with DLBCL and three of 13 with FL3. The first presentation of relapse of the other 88 patients (group 2) included patient-reported symptoms (60.2xa0%), physical examination (13.3xa0%), or abnormal laboratory data (4.4xa0%). For 72 patients received chemotherapy after relapse, the overall survival after relapse was not different between groups 1 and 2 (pu2009=u20090.569). The results of our study suggested that routine surveillance CT only has a limited role in the early detection of relapse and the relapse detected by surveillance CT or not has no impact on survival after relapse for patients with DLBCL or FL3.

Primary bone marrow diffuse large B cell lymphoma: a case series and review

Diffuse large cell lymphoma involving bone marrow is not uncommon, but primary, de novo, bone marrow diffuse large B cell lymphoma (DLBCL) is rare. To understand the clinical features and outcomes of this distinct entity, we collected 12 cases in 5xa0years from a single-center database. They accounted for 1.16% of lymphoma, or 2.65% of diffuse large B cell lymphoma. Nine cases presented with fever of unknown origin. Lactate dehydrogenase levels were elevated in all but one case. Nine cases belonged to the high-risk group according to their international prognosis indexes (score 4 or 5). Four patients received no chemotherapy, all of whom died within 1xa0month. Four patients received cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP)-like chemotherapy, and their median survival was 13xa0months. Finally, four patients received rituximab 375xa0mg/m2 in addition to CHOP-like chemotherapy. All of them had complete remission and three are still alive without relapse. We concluded that primary bone marrow DLBCL is a rare but distinctive subtype of lymphoma. The prognosis for this entity is poor but rituximab-based treatment is promising for improving its outcomes.

The impact of age, Charlson comorbidity index, and performance status on treatment of elderly patients with diffuse large B cell lymphoma

Treatment intensity will affect outcome in elderly patients with diffuse large B cell lymphoma (DLBCL). We retrospectively reviewed 333 DLBCL patients aged over 60xa0years who were diagnosed between January 2003 and December 2010 to evaluate the difference between different treatment regimens. The median age was 73xa0years; 56.8xa0% of patients received treatment with rituximab-containing regimens. In univariate analysis, patients with younger age, better performance status, early Ann Arbor stage, lower International Prognostic Index (IPI), normal serum lactate dehydrogenase, normal serum albumin, or normal serum beta-2 microglobulin received more intensive treatment regimens. In multivariate analysis, patients with younger age (pu2009<u20090.001) or better performance status (pu2009=u20090.027) received treatment of more intensive regimens. The treatment regimens were not different between patients with lower and higher Charlson comorbidity index (CCI). Female gender, normal serum beta-2 microglobulin, lower CCI, lower IPI, and treatment with more intensive regimens predicted better progression-free survival and overall survival in multivariate analysis. Patients treated with rituximab-containing regimens had better progression-free survival (median 22.2 vs. 9.9xa0months, pu2009=u20090.005) and better overall survival (median 34.9 vs. 21.8xa0months, pu2009=u20090.042) as compared to those treated without rituximab. In conclusion, our results showed that patients with younger age or better performance status received more intensive treatment. The treatment regimen was not different between patients with lower and higher CCI. Rituximab-containing regimens improved the outcome of elderly patients with DLBCL.

Primary colonic lymphoma: an analysis of 74 cases with localized large-cell lymphoma

Background:u2002 Surgical resection is considered a crucial treatment in patients with primary colonic lymphoma, but combining surgery with chemotherapy has provided additional therapeutic benefits in some studies. To further explore the optimal therapeutic approach in different clinical scenarios, we reviewed cases with localized large‐cell lymphoma and analyzed the factors related to the outcomes.

Complete Response of Myeloid Sarcoma with FIP1L1-PDGFRA-Associated Myeloproliferative Neoplasms to Imatinib Mesylate Monotherapy

Myeloid sarcoma (MS) is a localized, extramedullary tumor of acute myeloid leukemia (AML) that typically presents either de novo or concomitantly with myeloproliferative neoplasms (MPN), AML and myelodysplastic syndrome. Patients who have MS must be treated with intensive chemotherapy, as are patients with AML, because MS usually progresses to a systemic manifestation and leads to dismal outcomes. FIP1L1-PDGFRA-associated MPN, a subtype of myeloid and lymphoid neoplasm, is characterized by eosinophilia and abnormalities in the PDGFRA, PDGFRB or FGFR1 gene. Fusion of the FIP1L1 and PDGFRA genes activates the tyrosine kinase. As a result, imatinib mesylate (IM) is widely used for the treatment of this disorder. The coexistence of FIP1L1-PDGFRA-associated MPN and MS is extremely rare. Patients with this condition fail to achieve durable remission and long-term survival without a combination of intensive chemotherapy and IM. Here, we report a case of MS and FIP1L1-PDGFRA-associated MPN that was successfully treated with IM monotherapy.

Clinical features, outcome and prognostic factors of 87 patients with angioimmunoblastic T cell lymphoma in Taiwan

We retrospectively analyzed 87 patients with angioimmunoblastic T cell lymphoma (AITL) in Taiwan. The median age was 68 (range 18–89)xa0years. Of these patients, 74xa0% was at an advanced stage. The most common extra-nodal site involved was bone marrow (36xa0%). Of these patients, 77xa0% were International Prognostic Index (IPI) >1 and 79xa0% had a prognostic index for peripheral T-cell lymphoma (PIT) >1. Of 75 patients who received systemic chemotherapy, the complete remission rate was 60xa0%, the relapse rate was 47xa0%, and the 2-year progression-free survival rate was 37.4xa0%. The 2-year overall survival (OS) rate for all patients was 51.9xa0%. By multivariate analysis, bone marrow involvement (Pxa0<xa00.001) and ECOG >1 (Pxa0=xa00.007) were independent adverse factors for OS. A simplified prognostic index efficiently stratified patients into the following three groups: 2-year OS rates 79.8xa0% (0 factor), 28.3xa0% (1 factor), and 10.2xa0% (2 factors) by using bone marrow involvement and ECOG >1 (Pxa0<xa00.001). In conclusion, AITL patients were older and had poorer prognosis in Taiwan. Bone marrow involvement, EOCG >1, IPI >1 and PIT >1 had adverse impact on OS. The usefulness of this simplified prognostic index needs further validation.

Classical Hairy Cell Leukemia and Its Variant: A 17-Year Retrospective Survey in Taiwan Chinese

Background: Classical hairy cell leukemia (HCL-C) and its variant (HCL-V) are rare chronic B-cell lymphoproliferative disorders. Only a few reports in Chinese patients are available. Methods: We retrospectively reviewed 16 patients with HCL-C and HCL-V in Taiwan over a 17-year period. Results: Eight were HCL-C and 8 were HCL-V. All HCL accounted for 0.7% of all adult leukemias. Compared to HCL-V, HCL-C was characterized by profound leukopenia, monocytopenia, thrombocytopenia and fewer circulating hairy cells. One HCL-C and 2 HCL-V patients had second malignancies. Seven HCL-C patients achieved hematological remission after splenectomy (n = 1) or 2-chlorodeoxyadenosine (n = 6). Of the 8 HCL-V patients, 6 received splenic irradiation. Only one achieved complete remission and another had partial remission; relapse or disease progression was noted 13.4 or 25.7 months later, respectively. Two of three HCL-V patients who underwent splenectomy had stable disease. All patients with HCL-C were alive while 3 with HCL-V expired. Compared to HCL-C, HCL-V had a significantly shorter leukemia-free survival. Conclusion: A relatively higher proportion of HCL-V in all HCL comparing to Westerners is observed. Second malignancies are common. With an inferior outcome and dismal response to most treatment, enrollment in a clinical trial should be considered for HCL-V.

Aspergillus tracheobronchitis in allogeneic stem cell transplanted recipient.

A 50-year-old man was diagnosed as having very severe aplastic anemia 1 year ago. He subsequently underwent sibling-matched stem cell transplantation 1 month after diagnosis. The course of stem cell transplantation was smooth, and a complete marrow recovery was achieved in 1 month after transplantation. The patient received oral cyclosporine and prednisone for management of grade III graft-versus-host disease in liver. Three months after transplantation, he began to experience aggravating dry cough without association with fever and dyspnea. Serial roentgenograms of chest showed unremarkable findings. The serum galactomannan test was negative. High-resolution computed tomography of chest revealed non-specific infiltration in pulmonary parenchyma, but some protruding vegetations in the tracheal lumen were observed in retrospective inspection of images of CT (Fig. 1A). Examination of bronchoscope demonstrated whitish and nodular lesions scattered in the trachea and bronchus (Fig. 1B). Microscopic findings of specimens from fluid of the bronchoalveolar lavage (Fig. 1C) and biopsy of the endotracheal lesions (Fig. 1D) disclosed presence of fungal hyphae. The culture of lavage yielded Aspergillus fumigatus. Aspergillus tracheobronchitis most occur in immunocompromised patients. The clinical features vary, from subtle to life threatening, which depend upon the degree of invasion in the respiratory system. Because image study or serum galactomannan test is not always pathognomonic, clinicians must be cautious of the high-risk patients who present with acute onset of respiratory symptom. Further study, i.e. bronchoscope should be undertaken early to confirm this disease.

Extranodal NK/T-cell lymphoma, nasal type: Clinical features, outcome, and prognostic factors in 101 cases

We aimed to define the clinical features, outcome, and prognostic factors for extranodal NK/T‐cell lymphoma (ENKTL) patients in Taiwan.

Immune thrombocytopenia: Effectiveness of frontline steroids and comparison of azathioprine, splenectomy, and rituximab as second-line treatment

For immune thrombocytopenia (ITP), efficacy of frontline steroids is well established. However, clinical data comparing various treatment options for refractory or relapsed ITP are limited. We aimed to investigate the outcome of frontline steroid treatment for ITP patients and compare common second‐line modalities in a single institute in Taiwan.