Prophylactic high-dose methotrexate (HD-MTX) is often used for diffuse large B-cell lymphoma (DLBCL) patients at high risk of central nervous system (CNS) relapse, despite limited evidence demonstrating efficacy or the optimal delivery method. We conducted a retrospective, international analysis of 1,384 patients receiving HD-MTX CNS prophylaxis either intercalated (i-HD-MTX) (n=749) or at the end (n=635) of R-CHOP/R-CHOP-like therapy (EOT). There were 78 CNS relapses (3-year rate 5.7%), with no difference between i-HD-MTX and EOT; 5.7% vs 5.8%, p=0.98, 3-year difference: 0.04% (-2.0% to 3.1%). Conclusions were unchanged on adjusting for baseline prognostic factors or on 6-month landmark analysis (n=1,253). In patients with high CNS international prognostic index (n=600), 3-year CNS relapse rate was 9.1% with no difference between i-HD-MTX and EOT. On multivariable analysis, increasing age and renal/adrenal involvement were the only independent risk factors for CNS relapse. Concurrent intrathecal prophylaxis was not associated with reduction in CNS relapse. R-CHOP delays of ≥7 days were significantly increased with i-HD-MTX versus EOT, with 308/1573 (19.6%) i-HD-MTX treatments resulting in delay to subsequent R-CHOP (median 8 days). Increased risk of delay occurred in older patients when delivery was later than day 10 in the R-CHOP cycle. In summary, we found no evidence that EOT delivery increases CNS relapse risk versus i-HD-MTX. Findings in high-risk subgroups were unchanged. Rates of CNS relapse in this HD-MTX-treated cohort were similar to comparable cohorts receiving infrequent CNS prophylaxis. If HD-MTX is still considered for certain high-risk patients, delivery could be deferred until R-CHOP completion.
Objectives: Determine the frequency of malignancies diagnosed in myelogram seen in hematology services of Campus and Sylvanus Olympio Teaching Hospitals in Lome from 1992 to 2013. Study the epidemiology profile of these diseases. Materials and methods: It was an analytical retrospective study of 469 cases of malignancies diagnosed in 1511 myelograms during 21 years in both teaching hospital of Lome. Results: Blood disorders represent 31.70% of the results of myelogram performed during 21 years in the Teaching Hospital of Lome. Each year, there is an average of 22.3 cases diagnosed hematological malignancies. The most hematological malignancies were Kahler's disease (28.57%), chronic myeloid leukemia (24.52%), chronic lymphocytic leukemia (22.17%), acute lymphoblastic leukemia (12.58%) and acute myeloid leukemia (8.10%). Other (4.05%) were represented by the essential hypereosinophilic syndrome (4 cases), hairy cell leukemia (4 cases), Sezary lymphoma (3 cases), essential thrombocythemia (3 cases), Waldenstrom's disease (2 cases), acute myelomonocytic leukemia (1 case), prolymphocytic leukemia (1 case) and plasma cell leukemia (1 case). By gender, the CLL is most predominant in women against CML in men. Hemopathies were observed at all ages of life. Conclusion: Hematological malignancies are diagnosed in the Teaching Hospital of Campus and Sylvanus Olympio in Lome with a high relatively frequency. This prevalence must be higher if all cases of malignancies diagnosed in Togo were recorded in a national cancer register. This study aims to knowledge of epidemiological aspects of hematological malignancies and improve the care of patients with hematological malignancies by the provision of adequate anti-mitotic drugs.
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