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This study investigated the development of Hodgkin lymphoma (HL) above and below the diaphragm. Patients with HL above the diaphragm had better survival and response to treatment. HL is a type of cancer which affects the lymph nodes. HL may develop above or below the diaphragm (a muscle which helps you breathe). Patients with HL below the diaphragm appear to have worse outcomes. However, there has been little research into this. It is important to research HL below the diaphragm. Two trials which studied HL above and below the diaphragm were analysed. Between 2003 and 2009, 2903 patients with early stage HL were evaluated. Patients were followed for an average of 51 months. The development of HL above or below the diaphragm was monitored. The treatment outcomes were also analysed.   Almost 8% of patients developed HL below the diaphragm. These patients tended to be older. Patients with HL below the diaphragm were also less likely to respond to treatment. Patients with HL above the diaphragm were less likely to experience disease worsening.  In general, they were also more likely to survive. Of the patients with HL below with diaphragm, almost 92% survived and 80% did not experience disease worsening after 5 years. Whereas almost 98% of patients with HL above the diaphragm survived and 91% did not experience disease worsening. Treatment with two cycles of strong chemotherapy improved survival with HL below the diaphragm. The main finding was that patients with HL above the diaphragm had better survival than those with HL below the diaphragm.

This study investigated the safety and effectiveness of stem cell transplantation (SCT) on survival in patients with unresponsive Hodgkin’s lymphoma (HL). This study found that SCT was safe and effective in patients with HL that is unrepsonsive to treatment. Hodgkin’s Lymphoma is a type of cancer of the bone marrow that can lead to abnormal immune cells. Patients with Hodgkin’s lymphoma (HL) are often cured by cancer treatments. However, some may not respond to therapy (refractory), while others may lose response over time (relapsing). Common therapy for refractory/relapsing (RR) HL patients is stem cell transplantation. This involves the transfer of stem cells to the patient from a donor. In many cases, stem cell transplantation can cure RR-HL but side effects can occur such as Graft vs Host Disease (GVHD – transplant rejection). It is important to research of SCT is a safe and effective treatment for patients with RR-HL This study aimed to investigate the effect of stem cell transplantation on survival in RR-HL patients. This study included 70 RR-HL patients who had undergone stem cell transplantation.  Patients were observed for 6.2 years on average. Twenty-three percent of patients had refractory disease. Overall survival, progression-free survival (survival without the cancer getting worse), the development of GVHD and relapse-free survival were analysed.After five years, overall survival was 59%. Progression-free survival was 49%.  Sixty-six percent of patients did not develop GVHD. At year 5, 26% of patients had survived without developing GVHD or relapsing and 48% survived without developing GVHD. Having refractory HL before stem cell transplant influenced survival, the development of GVHD, and disease relapse.  This study suggesed that stem cell transplantation may be a safe and effective treatment for patients with Hodgkin’s Lymphoma that is unresponsive to cancer chemotherapy. This study selected patients with Hodgkin’s Lymphoma who had no additional diseases/conditions. Therefore, the results may not apply to all patients with HL, with other diseases.

Treatment with rituximab plus a regimen of cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) for patients with diffuse large B-cell lymphoma (DLBCL) has proven efficacy in clinical trials. The present study investigated its application in clinical practice. This single-center, retrospective database analysis included patients with DLBCL treated at the Slovenian Institute of Oncology Ljubljana between 2004 and 2013. Overall survival (OS) and progression-free survival (PFS) were assessed according to International Prognostic Index (IPI) and revised IPI (R-IPI) categories. Overall, 573 patients with DLBCL were included in the study (median follow-up, 45.3 months; range, 0.1–143.0). Patients were categorized as IPI ‘low’ (n=170; 30%), ‘low-intermediate’ (n=134; 23%), ‘high-intermediate’ (n=129; 23%) and ‘high’ (n=140; 24%) risk. R-IPI groups were indicated with ‘very good’ (n=59; 10%), ‘good’ (n=245; 43%) and ‘poor’ (n=269; 47%) prognosis. Ten-year OS and PFS rates were 51 and 72%, respectively; median OS was 124 months and median PFS was not reached. Ten-year OS rates were 80 and 87% in low-risk and ‘very good’ prognosis groups, respectively, and 30 and 37% in high-risk and poor prognosis patients, respectively. This analysis of patients with DLBCL indicated that many patients treated with R-CHOP and R-CHOP-like regimens in the real-world setting have excellent outcomes. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphomas, constituting up to 40% of cases globally (1). Global epidemiological data on DLBCL are limited, but the estimated incidence is 7 per 100,000 in the USA (2). In Slovenia, the annual incidence of non-Hodgkin lymphomas was 374 in 2013 (3); 36% of these cases are believed to be DLBCL (3) Although most commonly observed in older patients, DLBCL can affect any age group, including children (4). DLBCL is an aggressive condition and many patients have advanced disease at diagnosis (5). The prognosis of a patient with DLBCL can be predicted using their International Prognostic Index (IPI) score. The IPI score is calculated based on age, serum lactate dehydrogenase level, Eastern Cooperative Oncology Group performance score, disease stage, and the number of extranodal disease sites (6). Treatment for patients with DLBCL generally consists of a combination of chemotherapy [cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)] and rituximab (R-CHOP). Although many clinical trials have demonstrated the efficacy and tolerability of R-CHOP in patients with DLBCL, (7–9) less is known about the use of this regimen in the real-world setting. Real-world studies can complement the results of clinical trials and provide additional information that can help guide physicians making treatment decisions. Clinical trial data may not be generalizable to the broad range of patients commonly encountered in the clinical setting, as they may be limited to younger patients with good baseline characteristics. Patients encountered in real-world clinical practice may be older and have comorbidities that would have excluded their participation in rigorously designed clinical trials. Consequently, real-world studies can provide a valuable insight into these less widely studied patients. We previously described the real-world use of R-CHOP in patients with DLBCL in Slovenia (10). We now present the results of extended follow-up in an expanded patient group. Records were searched for all patients with DLBCL who were treated at the Institute of Oncology Ljubljana between 2004 and 2013 for inclusion in this analysis. All procedures followed in this study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1975, as revised in 2000. Individual patient consent was not collected for this study as this was a retrospective database analysis and the institutional informed consent form for treatment included consent to use the patient’s data, materials and/or test results for research purposes. The study was approved as such by the institutional review board of the Institute of Oncology Ljubljana. Patient characteristics, pathohistological diagnosis, disease stage, and response to treatment were taken from patient records. Survival data were retrieved from the Cancer Registry of the Republic of Slovenia [www.slora.si]. Treatment response was evaluated according to Cheson criteria, with the exception of criteria regarding positron-emission tomography (PET) evaluation, which was not routinely used in Slovenia before January 2016 (11). Progression-free survival (PFS) and Overall survival (OS) were calculated using Kaplan-Meier survival curves. PFS, which was determined for patients receiving first-line treatment only, was defined as the time from the beginning of treatment to disease progression for patients achieving complete or partial remission; OS was defined as the time from the beginning of treatment to the time of death or the end of observation for all patients. Patients were categorized according to IPI (6) and revised IPI (R-IPI) (12) scores. We also compared younger patients (aged <60 years) with good (IPI 0 or 1) vs. poor (IPI ≥2) prognosis and we compared older (aged ≥60 years) vs. younger (aged <60 years) patients. Statistically significant differences were calculated using log-rank and χ2 tests. Between 2004 and 2013, 624 patients with DLBCL were treated at the Institute of Oncology Ljubljana, Slovenia. The diagnosis of DLBCL was established histologically in 523 patients (84%) and cytologically in 101 patients (16%). Patient characteristics are summarized in Table I. Long-term follow-up data for patients with DLBCL are scarce, particularly among patients treated in the real-world setting. We have described the use of rituximab-based regimens in over 600 patients of varying ages and disease stages over a prolonged follow-up period. To the best of our knowledge, no other studies have assessed outcomes in patients with DLBCL in the real-world setting. In our patient population, an overall 10-year PFS rate of 72% was observed, ranging from 64% in patients classed according to IPI as ‘high-intermediate’ risk (IPI 3) to 75% in patients with low risk (IPI 0 or 1) and from 66% in patients with R-IPI poor prognosis (R-IPI 3–5) to 84% in those with very good prognosis (R-IPI 0). Median PFS was not reached in any of the IPI risk categories. PFS rates were numerically but not statistically significantly higher in patients aged <60 years compared with those aged ≥60 years, with 79% of younger patients and 70% of older patients

This study examined genetic abnormalities monoclonal B-cell lymphocytosis (MBL). Researchers concluded that MBL was associated with similar genetic abnormalities observed in chronic lymphocytic leukemia (CLL). CLL is cancer of the blood and bone marrow. Normally, the body makes blood stem cells (immature cells) that become mature blood cells over time. In CLL, too many blood stem cells become abnormal lymphocytes. There are two types of lymphocytes: B cells and T cells. CLL affects B cells, which originate in the bone marrow and are responsible for making antibodies to fight infection. In CLL, B cells grow in an uncontrolled manner and accumulate in the bone marrow and blood, where they crowd out healthy blood cells. An important test used in diagnosing CLL is flow cytometry. This test examines the blood for CLL cells. Blood samples may also be used to look for certain changes in the chromosomes of the CLL cells and genetic abnormalities that can affect how aggressive the disease may be. For the diagnosis of CLL, an abnormal B cell count of 5,000 or more per cubic millimeter is needed. Higher than normal lymphocytes (lymphocytosis) with a B cell count below 5,000 per cubic millimeter and no CLL symptoms is known as monoclonal B-cell lymphocytosis (MBL). It is not known whether MBL is associated with some of the genetic abnormalities seen in CLL patients.  The aim of this study was to examine the presence and impact of genetic abnormalities in MBL. The presence of MBL was investigated using flow cytometry in two groups of participants aged between 60 and 80 years. 1,520 participants had normal blood counts. 2,228 participants had lymphocytosis. 185 of the patients with lymphocytosis and MBL were monitored for an average of 6.7 years. MBL was detected in 5.1% of participants with a normal blood count and in 13.9% with lymphocytosis. CLL was diagnosed in 1031 of the 2228 lymphocytosis patients (46.3%). The frequency of specific genetic abnormalities in patients with lymphocytosis was comparable to that of CLL. These included deletions in the chromosome 13q14, additional copies of the chromosome 12, and abnormalities in IGHV genes. Of the 185 monitored patients presenting with lymphocytosis and MBL, it further progressed in 51 (28%) patients and progressive CLL developed in 28 (15%). Chemotherapy was required in 13 patients (7%). A higher B-cell count predicted progressive lymphocytosis. 34% of patients died during the study period. Of these, 4 deaths were due to CLL. Age above 68 years and low red blood cell counts were predictive factors for death.