ALBERT

Description: Incidence and etiology of lympho node enlargement in adults patients referred to hematologist by primary care doctors for diagnosis are not reported. The aim of this study was to retrospectively evaluate incidence and causes of lymphadenopathy in adults patients evaluated at our Hematology division. Between January 2004 and December 2005 we evaluated 550/7200 (7.6%) consecutively patients referred because of lymphadenopathy. The clinical work up for these patients initially consisted of clinical history and physical examination. According to our previous published criteria, patients showing superficial lymphadenopathy (firmer and rigidly elastic with deep mobility less than normal) underwent to laboratory examinations (blood cell counts, erythrocytes sedimentation rate, serum lactate dehydrogenase, electrophoresis, and serology for main related infective diseases) and instrumental investigations (standard chest X-ray, ultrasonography, and computer axial tomography) (Cancer1999:85, 2488). Patients showing abnormal laboratory values and/or pathological instrumental parameters without a known etiology, underwent to bone marrow needle aspiration/biopsy and/or lympho node biopsy. We evaluated in two years 29% (160/550) of our patient population by lympho node biopsy, while this approach was not utilized in the remaining 71%. Hystopathological lympho node examination allowed identification of the causes of lympho node enlargement in the following patients: 51.9% (83/160) had Non Hodgkin and Hodgkin lymphomas (53 and 30 cases respectively), 16.8% (27/160) had a metastatic solid tumors lympho node involvement, 21.8% (35/160) had inflammatory reactive lympho nodes, and 7.5% (12/160) were classified as infective and granulomatosis diseases; in the remaining 2 (1.2%) patients biopsy revealed neurinoma. Among the 390 patients in which the lympho node biopsy was not performed, 94.2% (367) of them showed spontaneous resolution of lympho node enlargement during clinical follow-up (1–3 months), 2.5% (10/367) were classified according to the bone marrow biopsy as low grade Non Hodgkin Lymphoma, 2.8% (11/367) were represented by a miscellaneous of benign pathologies which emerged by further diagnostic not invasive examinations, 0.5% (2/367) were identified as metastatic solid tumors (lung and neck cancer) by both clinical and instrumental examination. In conclusion, lympho node enlargement is a relatively frequent clinical problem for hematologists, in fact among a large series of adult patients examined in two years at our division the incidence was of 7%. However, among patients presenting lympho node enlargement, the majority of them (two third) did not achieve a defined etiological diagnosis, while one third of the remaining cases were classified as mainly Non Hodgkin and Hodgkin lymphomas, including a discrete percentage of metastatic solid tumors. This retrospective evaluation demonstrates that the clinical, physical and instrumental approach to lympho node enlargement, especially based on ultrasonography criteria, may provide useful information to define patients requiring lympho node biopsy.

Description: Backgroung: Anthracyclines-based regimens remain the gold standard for the treatment of Lymphomas, although the associated cardiac toxicity may limit their use, especially in frail and elderly patients. Patients and Methods: From October 2008 to January 2015 we treated 51 newly diagnosed patients B cell with poor-risk non Hodgkin lymphoma and cardiovascular comorbidities using the R-COMP regimen (rituximab, cyclophosphamide, non-pegylated liposome-encapsulated doxorubicin, vincristine and prednisone). Median age was 72 years (range:46-82 yrs ; 62% ≥ 70 years). As for histology, 26/51 (50%) were Diffuse Large B-cell Lymphoma; 10/51 (20%) Follicular Lymphoma; 8/51 (16%)mantle cell lymphoma; 5/51 (10%) Nodal Marginal Zone Lymphoma; 2/51 (4%) other B-cell indolent Lymphoma. IPI and FLIPI prognostic scores were Intermediate to High in the majority (39/51 = 76%) of the patients. Stage III and IV according to Ann-Arbor staging system was present in 40/51 patients (78%). The median age adjusted Charlsons comorbidity index was 6 (range: 3 to 11). Cardiovascular risk factors were considered: hypertension (39/51pts = 76%), a history or recent acute myocardial infarction (9/51 pts = 17%) and Atrial fibrillation (4/51 = 8%). According to National Institute of Aging/National Cancer Institute (NIA/NCI index), a large portion of patients (39%) presented high-impact conditions mainly consisting of ischemic and arrhythmic diseases, under active treatment. Treatment was well tolerated and toxicities were limited grade III/IV cytopenia. RESULTS: Complete remission was achieved in 37/51 (72%) and partial response in 8/51 (15%). The remaining 12% of patients had a progressive disease . As of July 2015, after a median follow up period of 25 months (range 3-79), the OS, RD, EFS, TTF were not reached ( Figure 1, panel A,B,C respectively). In particular, at 5 years from the treatment starting, OS and RD are both 70% and EFS is 54% .Cardiac toxicity was observed in one patients who died for pulmonary edema, while two patients developed arrhythmias. Conclusions: This study confirm the efficacy and tolerability of R-COMP regimen in elderly patients with cardiovascular comorbidities. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.