Pilleux L, Carrasco C, Pisón C, Calderón S

Language: Spanish
References: 16
Page: 173-178
PDF size: 82.55 Kb.

ABSTRACT

Non-Hodgkin Lymphoma (NHL) has an age standardized incidence of 5,5 per 100,000 and overall survival(OS) at 10 years of 7,5-25% in Chile. The prognosis depends on many factors being the most importants: stage, histology and prognostic indexes. We decided to characterize and evaluate survival curves in patients with NHL treated in our center with the national protocols used in the public system.
Patients and Methods: We analized retrospectively a cohort of patients 15 or more years old diagnosed and treated at HV with NHL between 1998-2002 with emphasis on demographic clinical, histopathologic and laboratory characteristics. Statistical analysis was descriptive and performed by comparison of Kaplan-Meier actuarial survival curves using log-rank and Wilcoxon tests. A p ‹0.05 was considered statistically significant.
Results: During the study period 96 patients were admitted to the National Adult Antineoplastic Drugs Program at HV. After the histological analysis 82 resulted to be new confirmed cases and 14 were excluded from the study (6 relapses, 4 not NHL histology, 2 without biopsy (just cytology), 2 not evaluable). The median age was 59.5 years (range 20-82), 57.3% male, with a male/female ratio of 1.34. At diagnosis 23.2% were in localized stages (I and II) and 76.8% advanced (III and IV). The immunophenotype was available in 76% of cases corresponding to B line 77% and T 23%. The histological subtypes were: a) According to the WHO classification: diffuse large cell (DLBCL) 35%, follicular 8.7%, marginal zone 7.5%, lymphocytic 5%, mantle cell 3.8%, peripheral Tcell, not-specified 10%, other types 8.9% and not classifiable in 21.3%. b) According to the Working Formulation: low, intermediate and high grades in 12.2%, 62.2% and 25.8%, respectively. Overall survival (OS) at 2 and 5 years was 52.5 and 36% and disease-free survival (DFS) at 2 and 5 years of 76% and 48%, respectively. Significant differences in OS and DFS were observed at both 2 and 5 years between localized and advanced stages (p = 0.0 and 0.03), there were no significant differences according to sex. There were significant differences between the 4 risk levels of International Prognostic Index (IPI) in DLBCL at 2 and 5 years (p = 0.0001).
Conclusions: The age of onset of NHL in our patients was lower and in more advanced-stage at diagnosis than that of developed countries. DLBCL constituted the most frequent histological subtype followed by follicular lymphoma. The OS of DLBCL was similar to the international one in the studied period and the prognostic value of IPI was confirmed. The OS and DFS for all the NHL in whole was lower than that reported in developed countries wich probably was due mainly to less effective chemotherapeutic protocols for indolent lynphomas in the analized period. We consider necessary to implement strategies in order to make diagnosis of NHL in localized stages. We will also need to evaluate protocols that incorporated therapy with anti-CD20 antibodies in Chile’s public health system that started in 2006 for DLBCL and 2010 for follicular lymphoma.

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