A single unit lymphoma experience - Outcome in a Cape Town academic centre

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dc.contributor.authorWood L.
dc.contributor.authorRobinson R.
dc.contributor.authorGavine L.
dc.contributor.authorJuritz J.
dc.contributor.authorJacobs P.
dc.date.accessioned2011-05-15T16:18:15Z
dc.date.available2011-05-15T16:18:15Z
dc.date.issued2007
dc.description.abstractTo document outcome in Hodgkin and other lymphomas from a privately based academic centre the clinical records from 253 consecutive referrals were analysed. Diagnosis was according to World Health Organization criteria, prognosis assigned by the international index and therapy risk-stratified with results subject to appropriate statistical methodology. None of these patients underwent transplantation. For the cohort the median age was 55 years (range 11-94) and 63% were male. Constitutional symptoms were present in 22%; a quarter had previous chemotherapy and a third some form of irradiation prior to referral. Fifty-seven percent were stage I or II and 21% had nodal disease above and below the diaphragm whilst in the remainder cells were present in the circulation and this included the subset of chronic lymphocytic leukaemia - small lymphocytic lymphoma. Positron emission scanning was not available for these studies. Median survival for the cohort is 3.2 years and reduced to 1.3 years by the presence of unexplained fever, sweating or inappropriate weight loss. Further adverse factors included any prior treatment, intermediate or high-grade histopathology, risk factors defined by the International Prognostic Index as well as late Rai stages. Analysed by disease category Hodgkin lymphoma (n = 17) when managed according to the German Study Group protocols and hairy cell leukaemia (n = 10) treated with two chlorodeoxyadenosine - both had a stable plateau in excess of 90%. The corresponding figures for follicular variants (n = 31) was 72% in the low risk and 58% in the remainder when treated with cyclophosphamide, vincristine and prednisone. Curves for the aggressive or diffuse large B-cell lymphoma (n = 44) fell initially to 48%, but relapse continued in stages III and IV to the current level of 18% when receiving cyclophosphamide, hydroxydaunorubicin, vincristine and prednisone on the 21-day schedule. Chronic lymphocytic leukaemia - small lymphocytic lymphoma (n = 58) were initially given pulsed chlorambucil and sustained response was over 90% with low bulk, but declined to reach 30% as prognostic score rose. The miscellaneous categories (n < 5 each) managed variably, but using the same criteria, were pooled and are presently at 62% and 30% for high and low grades. It is concluded that precise diagnosis, accurate staging and therapy on standardised risk-stratified programmes, delivered uniformly by a single multidisciplinary group, creates the all-important centre effect; matching figures are unlikely to apply outside these disciplined circumstances. The expectation from patients and referring physicians alike is that, since lymphomas are potentially curable, such an approach to comprehensive management will be regarded as standard even in an under resourced or Third World country. It follows that late referral and prior therapy will adversely affect performance status and compromise life span: These alternative approaches are inappropriate and strongly discouraged. © 2007 Elsevier Ltd. All rights reserved.
dc.description.versionArticle
dc.identifier.citationTransfusion and Apheresis Science
dc.identifier.citation37
dc.identifier.citation1
dc.identifier.issn14730502
dc.identifier.other10.1016/j.transci.2007.06.002
dc.identifier.urihttp://hdl.handle.net/10019.1/14577
dc.subjectchlorambucil
dc.subjectcyclophosphamide
dc.subjectdoxorubicin
dc.subjectprednisone
dc.subjectvincristine
dc.subjectadult
dc.subjectage distribution
dc.subjectarticle
dc.subjectcancer chemotherapy
dc.subjectcancer radiotherapy
dc.subjectcancer survival
dc.subjectchronic lymphatic leukemia
dc.subjectcontrolled study
dc.subjectfemale
dc.subjectfollow up
dc.subjecthairy cell leukemia
dc.subjectHodgkin disease
dc.subjecthuman
dc.subjectlymphocytoma
dc.subjectlymphoma
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectpatient referral
dc.subjectsex ratio
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAntineoplastic Combined Chemotherapy Protocols
dc.subjectChild
dc.subjectCohort Studies
dc.subjectDeveloping Countries
dc.subjectDisease-Free Survival
dc.subjectFemale
dc.subjectHospitals, Private
dc.subjectHumans
dc.subjectLeukemia, Lymphocytic, Chronic, B-Cell
dc.subjectLymphoma
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectNeoplasm Staging
dc.subjectRisk Factors
dc.subjectSouth Africa
dc.subjectSurvival Rate
dc.titleA single unit lymphoma experience - Outcome in a Cape Town academic centre
dc.typeArticle
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