incidence of gemcitabine induced HUS in our population of pancreatic cancer patients receiving adjuvant treatment and to ascertain potential risk factors. Methods: We reviewed 187 patients on adjuvant gemcitabine for pancreatic carcinoma. We collected data about haemoglobin, platelets, white cells count, creatinine clearance before each cycle. We calculated the maximum drop between baseline and minimum level of haemoglobin and creatinine clearance for all these patients. Results: We found that two patients developed HUS (1.06%). 185 patients developed a maximum drop in haemoglobin of 22% (18-27%) and around 19% in creatinine clearance (10-45%). The HUS patients had a drop in haemoglobin of 37% and 34% and a drop in creatinine clearance of 41% and 31%. We carried out a logistic regression analysis. This showed that a drop in haemoglobin >25% and in creatinine clearance >30% from baseline, increased significantly the chances of developing HUS (p 0.0001). Conclusion: Our data point to a significant drop in hemoglobin and creatinine clearance as two significant risk factors to develop HUS induced by gemcitabine. We recommended that in cases with high index of suspicion, gemcitabine should be stopped or delayed until we receive the results of extra tests such as haptoglobin, lactate dehydrogenase, test de Coombs, to confirm or rule out this diagnosis.
Their clinical features, pathological characteristics, base line IPI score, stage at presentation, type of treatment and outcome were analyzed. Results: Median age was 41.5 years (range 20-77yrs). B-symptoms were present in 42 (60%) patients and 35 (50%) patients were presented with poor performance status (ECOG 3/4). According to Ann Arbor staging, 49 patients (70%) were in stage I, 14 (20%) stage II, 02 (2.8%) stage III and 05 (7%) in stage IV. IPI risk categorizations, low risk 30%, low intermediate risk 20%, high intermediate risk 20% and high risk 30%. Sixty three cases (90%) were non germinal center/Activated B cell type (ABC). Twenty eight patients were treated with CHOP, 27 patients with R (Rituximab) þCHOP and rest were treated with CVP þ/-R. Radiation therapy (RT) was received as consolidative treatment in 50% of cases. Complete remission (CR) was observed in 75% of cases. Median event free (EFS) and overall survival (OS) was 72% and 58% with median follow up period of 42 months. Helicobacter pylori (HP) antibody testing was positive in 14 cases (20%) and all patients received anti-HP treatment. HP associated PGDLBCL were associated with less B symptoms, low IPI, better CR rate (P Conclusion: PGDLBCL consists 60% of all gastric lymphoma at our centre. Around half of them are presented with B symptoms and poor performance status. H. Pylori positivity is seen in 20% of cases and associated with low risk IPI with good survival. Addition of rituximab to CHOP has a statistical significant survival impact in patients with PGDLBCL. RT may be omitted in selective cases of PGDLBCL, where RCHOP/ RCVP (rituximab based chemotherapy) is being considered, to avoid radiation induced side effect with same survival. Chemotherapy may be omitted in some selected cases of HP associated PGDLBCL.
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