Background: Extranodal NK/T-cell lymphoma (ENKTL) nasal type, is relatively rare, although the incidence has risen over the past century, the frequency varies in different geographic regions and racial populations, representing only 10-15% of all non-Hodgkin lymphomas. It is usually clinically aggressive, originating from post-thymic T-lymphocytes and NK-cells Aims: Our interest in ENKTCL nasal type is due to the prevalence of this entity in Mexico, which is comparable to that of countries with the most cases reported. This study aims to report our experience with ENKTCL nasal type, their main clinical and analytical characteristics and the impact they may have on response in a third level reference hospital in central Mexico Methods: A retrospective observational study was conducted, we collected all cases of patients with histopathological diagnosis of extranodal NK/T cell lymphoma nasal type from January 2013 to January 2019 in an attempt to examine clinical and analytical features, 56 patients were included. Data on clinical history, physical examination, performance status, baseline hematological and biochemical parameters, histology, imaging and bone marrow studies were collected from the computer database. The study included biopsy/excision material of patients registered within the hospital. Treatment records and responses were collected Results: Information was obtained from 56 patients (30 men, 26 women) with a mean age of 39.6 years (16-78 years); 58.9% of patients had B symptoms, in 57% some infection was identified, 7% had some hemorrhagic event, none of the patients had thrombotic manifestations, 3.6% were identified with infiltration to bone marrow, in 7.1% patients CNS infiltration was identified through cytological analisis, 69.6% presented with early clinical stages, all this at the time of diagnosis. Regimens that included L-Asparginase were administered to 28 patients (50%), 5 did not receive treatment due to early mortality related to the disease and the rest received CHOP-like regimens, 67.7% received radiochemotherapy as first line treatment. Median overall survival was 6 years. In the univariate analysis of prognostic factors, it was identified that hemoglobin less than 10 gr/dL (p < 0.01) and albumin less than 3.4 gr/dL (p < 0.02) had an impact on survival. No difference was observed in overall survival (OS) based on the received chemotherapy regimen, we did however observed OS was better in those who received concomitant radiotherapy with the first-line regimen (p < 0.05). Summary/Conclusion: Extranodal nasal T-cell / NK cell lymphoma is arelatively common neoplasm in Mexico, it is aggressive and with a high mortality. Our study did identify differences in overall survival in terms of some readily available tests, and since Mexico is a region with a higher prevalence in this type of lymphoma, more and better epidemiological and translational studies would be beneficial in our understanding of this entitiy in order to identify prognostic factors and potential therapeutic targets
Philadelphia chromosome-positive Acute Myeloid Leukemia (AML) is a de novo acute leukemia in which patients show no evidence of Chronic Myeloid Leukemia (CML) before or after their treatment. This kind of leukemia has an aggressive clinical course, with poor response to traditional chemotherapy or monotherapy with Tyrosine Kinase Inhibitors (TKI), and a high risk of early relapse after induction therapy. We report a rare case of de novo ALM with t(9;22). A 26-year-old male patient was referred to our hospital for an examination of anemia, thrombocytopenia (hemoglobin 5.7 g/dL and platelets 110 000/L) and elevated White Blood Cell (WBC) count (11 600 μ/L, 24% segmented, 63% lymphocytes, 11% monocytes). Bone marrow smear was compatible with AML. Cytogenetic study revealed t(9;22)(q34;q11). Our patient was treated with chemotherapy for AML and a second-generation TKI and remains in complete remission pending a bone marrow transplant.
Background:The use of all-transretinoic acid together with chemotherapy has improved the prognosis of patients with acute promyelocytic leukemia (APL). However, less than 20% still die prematurely, mainly from hemorrhage. Objective: The objective of this study was to identify the utility of the PETHEMA score and complete blood count (CBC) score for the detection of patients with APL at risk of premature death. Materials and methods: A retrospective observational study in patients with de novo APL treated between 2001 and 2015 at Hospital General de México. Results: Among the 79 patients studied, the mean age was 35 years (17-57 years). According to the PETHEMA score, most patients were deemed low risk (n = 34, 42.5%) followed by high-risk (n = 25, 31%) and intermediate-risk patients (n = 21, 26.3%). As per the CBC score, 16.3% (n = 13), 31.3% (n = 25) and 52.5% of patients (n = 42) were considered as low-risk (0 points), intermediate-risk (1 and 2 points), and high-risk patients, respectively (3 points). Overall survival at 5 years was 73%, with a lower rate in those patients considered as high risk for the two scales. Individually, both thrombocytopenia and elevated fibrinogen levels were associated with premature death. Conclusion: The PETHEMA score, like the CBC score, allows for the identification of patients at risk of premature death, with as thrombocytopenia is an independent risk factor.
La infección por coronavirus 2 del síndrome respiratorio agudo grave condiciona un gran número de anormalidades pulmonares y sistémicas que basan su fisiopatogenia en la inmunotrombosis. Específicamente para el área de la hematología desde los primeros estudios de caracterización clínica y paraclínica se identificaron anormalidades hematológicas y de la hemostasia que se han documentado de forma consistente en diferentes publicaciones y cuyo conocimiento es trascendente desde el punto de vista de pronóstico. Durante el curso de la enfermedad, la evaluación longitudinal de algunos parámetros hematológicos es primordial para la identificación temprana de pacientes potencialmente complicables. El conteo absoluto de leucocitos, la depleción linfoide y la trombocitopenia son los marcadores hematológicos principalmente alterados. La linfopenia severa es un hallazgo cardinal en la fase temprana de la infección y su persistencia durante la progresión de la enfermedad tiene mayor impacto pronóstico adverso. La determinación de los índices hemáticos neutrófilo:linfocito y linfocito:plaqueta también ha demostrado su utilidad como predictores de complicaciones respiratorias y mortalidad. Un estado de hipercoagulabilidad demostrado por niveles altos de dímero D y/o productos de degradación de fibrinógeno y diversas alteraciones hemostásicas en el perfil de coagulación se asocian a una mayor tasa de morbimortalidad. Otros biomarcadores inflamatorios, incluidos proteína C reactiva, procalcitonina y ferritina, podrían identificar tempranamente aquellos casos que requieren de soporte ventilatorio y/o hemodinámico avanzado. En esta revisión se abordan los antecedentes históricos de la patología y las principales alteraciones hematológicas y de la hemostasia y sus implicaciones pronósticas.
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