Satu tahun kesintasan penderita limfoma non-hodgkin berdasarkan klasifikasi histopatologi working formulation

Latar belakang: Limfoma Non-Hodgkin (LNH) memiliki manifestasi dan gambaran histologi yang heterogen. Berdasarkan klasifikasi Working Formulation, LNH dibagi menjadi 3, yaitu derajat keganasan rendah, menengah, dan tinggi, yang mencerminkan derajat agresifitas LNH berdasarkan gambaran histopatologiknya. Pada beberapa studi dikatakan LNH tipe indolen cenderung tumbuh lambat dan memiliki kesintasan lebih panjang dibanding tipe yang lebih agresif Tujuan: Membandingkan median kesintasan penderita LNH dari jenis sel B berdasarkan derajat keganasannya sesuai dengan klasifikasi Working Formulation Metode: Penelitian ini menggunakan desain kohort retrospektif, antara bulan Januari 2013 sampai Juli 2017 di RSUP Sanglah Denpasar. Analisis menggunakan Kaplan meier dan seluruh data dianalisis menggunakan SPSS. Hasil: Dari 88 penderita LNH, diambil 38 subyek yang eligible. Dari data didapatkan sebanyak 21 penderita (55,3%) berjenis kelamin laki-laki, dengan gambaran histopatologi terbanyak berupa Diffuse Large Cell (36,8%). Sebanyak 3 penderita (7,9%) termasuk dalam derajat keganasan rendah, 25 penderita (65,8%) termasuk dalam derajat keganasan menengah, dan 10 penderita (26,3%) dengan derajat keganasan tinggi. Median kesintasan pada LNH derajat keganasan rendah di atas 1 tahun (IK 95%), derajat keganasan menengah 271 hari (IK 95%), dan derajat keganasan tinggi 31 hari (0-72,837, IK 95%), dengan nilai p=0,133, namun kelompok dengan derajat keganasan tinggi cenderung memiliki kesintasan yang lebih rendah dibanding 2 kelompok yang lain. Simpulan: Tidak terdapat perbedaan yang signifikan kesintasan penderita LNH dengan derajat keganasan rendah, sedang, dan tinggi.

Classificação de 86 casos de linfoma em bovinos de acordo com a Working Formulation (WF) of Non-Hodgkin's Lymphomas for Clinical Usage e a Revised European-American Classification of Lymphoid Neoplasms (REAL)

Resumo Por meio de um estudo retrospectivo, realizou-se avaliação fenotípica (histologia) e imunofenotípica (imuno-histoquímica [IHQ]) de 86 casos de linfoma bovino. Quanto ao padrão de distribuição, todos os linfomas foram incluídos como difusos. Em relação à dimensão dos linfócitos neoplásicos, 83,8% dos linfomas foram considerados como de grandes células e 11,6% como de pequenas células. Linfomas mistos, ou seja, constituídos por grandes e pequenas células, representaram apenas 4,6% dos casos. Quanto ao número de mitoses, 84,9% dos linfomas foram incluídos como de grau intermediário, 10,5% como de baixo grau e 4,6% como de alto grau. No que se refere à morfologia do núcleo, linfomas em que predominavam linfócitos não clivados (58,2%) ou linfócitos clivados (37,2%) foram mais frequentes do que aqueles em que havia uma mistura igualmente proporcional de linfócitos clivados e não clivados (4,6%). Com base nestes resultados, os 86 linfomas foram assim distribuídos utilizando-se a classificação proposta pela Working Formulation (WF) of Non-Hodgkin's Lymphomas for Clinical Usage: difuso de grandes células não clivadas (46,5%), difuso de grandes células clivadas (33,7%), difuso de pequenas e grandes células (4,6%), difuso de pequenas células - tipo plasmocitoide (7%), imunoblástico (3,5%), difuso de pequenas células - tipo intermediário (2,3%), difuso de pequenas células não clivadas (1,2%) e difuso de pequenas células não clivadas - tipo Burkitt (1,2%). Na imuno-histoquímica, 27 dos 86 (31,4%) linfomas foram positivos para o anticorpo monoclonal CD79αcy, utilizado para detecção de linfócitos B, e nenhum caso foi positivo para o anticorpo policlonal CD3, utilizado para detecção de linfócitos T. Com base nestes resultados, os 27 linfomas B foram assim distribuídos utilizando-se a Revised European-American Classification of Lymphoid Neoplasms (REAL): linfoma difuso de grandes células B (81,5%), linfomas imunoblásticos de grandes células (11,1%) e linfomas linfoplasmocíticos (7,4%). Os resultados aqui apresentados permitem concluir que à semelhança do que vem sendo descrito em outras partes do mundo, os linfomas bovinos são basicamente difusos e predominantemente de grau intermediário, de grandes células, com núcleos clivados ou não clivados. Esses linfomas são decorrentes da proliferação neoplásica de linfócitos B e correspondem, em sua quase totalidade (92,6%), ao que atualmente é incluído na REAL como linfoma difuso de grandes células B.

Subtypes and Treatment Outcomes of Adolescent and Adult Non-Hodgkins Lymphoma in a Resource Poor Setting

Introduction: Non- Hodgkins lymphomas (NHL) are a heterogeneous group of clonal malignant diseases arising from the lymphoid system with many subtypes showing both biological and clinical heterogeneity. However, the diagnosis and treatment outcomes of NHL in resource poor countries still remain a challenge in the absence of routine immunohistochemistry and molecular studies. In Ghana, a low middle-income West African country, there has been no previous systematic study of the distribution of the major subtypes of NHL. Methods: A retrospective review of case folders of all patients age 13 years and above, diagnosed with NHL between January 1, 2008 and October 31, 2013, at Korle Bu Teaching Hospital (KBTH), Accra, the largest hospital in Ghana, and one of only two hospitals in the country with a cancer unit. Information obtained from the case folders included age, sex, histological subtype, subtypes using the Working Formulation and WHO classifications. Treatment given and follow up information were also evaluated. Results: A total of 279 cases of NHL were identified within the study period. The mean overall age of the patients was 48.8 ± 17.0 years with a minimum age of 13 years and maximum 87 years. There were 156 males (55.7 %) and 123 females (43.9 %) with a male to female ratio of approximately 1.5:1. The majority of cases seen (53%) were diffuse large B-cell lymphoma. Chronic lymphocytic leukaemia/small lymphocytic lymphoma (22.2%) was the next commonest subtype. Other sub types seen, in order of frequency, included diffuse mixed cell lymphoma (6.4%), gastric lymphomas (3.9%), mediastinal B-cell lymphoma (2.9%), Burkitts lymphoma (1.8%), splenic marginal zone B-cell lymphoma (1.1%), lymphoblastic lymphoma (1.1%), mucosa-associated lymphoid tissue (MALT) type B- cell lymphoma (0.7%) and follicular lymphoma (0.7%). Others, which included anaplastic large cell lymphoma, mantle cell lymphoma, lymphoplasmacytic lymphoma and mycosis fungoides, collectively accounted for 3.6% of the NHL cases reviewed. Based on the Working Formulation classification with broad histologic categories of low-, intermediate-, and high-grade lymphomas, 83 out of 279 (29.7%) had low grade NHL, 170 (60.7%) intermediate and 26(9.4%) had aggressive/high grade NHL. Table 1 shows chemotherapy regimens administered and first year treatment outcomes. One-year survival for cases of NHL in the study was found to be high (98.6%). However, only 115/279(41.2%) of patients were seen for follow up in the second year post-treatment, with 85 of these (73.9%) still in clinical remission. In the third year only 37/279(13.3%) reported for follow up. Conclusions: This study provides a baseline overview of the distribution of NHL subtypes and their outcomes in adolescent and adult patients in a resource constrained setting. Patient loss to follow up in the 2nd and 3rd year post treatment was very high and the reasons for this should be explored in a future study. Immunohistochemistry, cytogenetics and specific molecular studies, which are important in characterization of NHL, should be made affordable and accessible in low-income countries. Table 1. FIRST YEAR OUTCOME FOR ALL NHL SUBTYPES AND TREATMENT GIVEN TYPE OF CHEMOTHERAPY GIVEN CHOP CVP R-CHOP CHLORAMBUCIL + PREDNISOLONE CODOX-M/ IVAC TOTAL INDOLENT TYPE NHL CR 37 34 2 2 0 75 (26.9%) PR 3 1 0 0 0 4 (1.4%) NR 1 0 0 0 0 1 (0.4%) LTF 2 0 0 0 0 2 (0.7%) TOTAL 43 (15.5%) 35 (12.5%) 2 (0.7%) 2 (0.7%) 0 (0.0%) 82(29.4%) INTERMEDIATE TYPE NHL CR 120 3 9 0 0 132 (47.3%) PR 32 4 0 0 0 36 (12.9%) NR 1 0 0 0 0 1 (0.4%) LTF 2 0 0 0 0 2 (0.7%) TOTAL 155 (55.6%) 7 (2.5%) 9 (3.2%) 0 (0.0%) 0 (0.0%) 171 (61.3%) AGGRESSIVE TYPE NHL CR 9 0 3 0 1 13 (4.65%) PR 12 0 0 0 1 13 (4.65%) NR 0 0 0 0 0 0 (0.0%) LTF 0 0 0 0 0 0 (0.0%) TOTAL 21 (7.5%) 0 (0.0%) 3 (1.1%) 0 (0.0%) 2 (0.7%) 26 (9.3%) GRAND TOTAL 219 (78.5%) 42 (15.1%) 14 (5.0%) 2 (0.7%) 2 (0.7%) 279 (100%) CR: CLINICAL REMISSION, PR: POOR RESPONSE, NR: NO RESPONSE, LTF: LOST TO FOLLOW-UP Disclosures No relevant conflicts of interest to declare.

Occupation Bedbug: Or, the Urgency and Agency of Professional Pragmatism

This essay draws on fieldwork with American social workers, whose primary charge is to engage what they view as particularly recalcitrant human problems and populations. All the while, these workers find themselves in intensive engagements with bedbugs, which have recently infested the American imaginary, as well as the destitute sites of American social work. As every professional effort at elimination is met with bedbugs’ seeming multiplication, eradicating bedbugs comes to be understood as both professional responsibility and practical impossibility—yet another example that themagnitude of the problems with which social workers are charged exceeds their abilities to resolve them. And yet these professionals neither succumb to burnout nor suffer a sustained sense of futility. Rather, bedbugs help them cultivate a sustaining occupational ethic, one that resonates with American systems theories and American Pragmatism. More specifically, human-bedbug engagements inspire a working formulation of agency that acknowledges the efficacies of non-human actors, understands human intention as the framing of, rather than fuel for what actually happens, and privileges the means over the ends of (professional) labor. With a focus on how human-bedbug engagements contribute to the development of folk theories of agency, this article demonstrates the fluidity with which social actors think about the possibilities for effective, meaningful (re)action and thereby contributes to the anthropology of agency.