jsmc-10183

ADULT LYMPHOMA IN THE PROVINCE OF SULAIMANI: DEMOGRAPHY, HISTOLOGY AND TREATMENT PLANS

Bamo Mohammed Muhsin a and Anwar Sheikha b

a Zhianawa Cancer Center, Kurdistan Board Candidate. 

b Hiwa Teaching Hospital.

Submitted: 15/7/2018; Accepted: 21/11/2018; Published 21/12/2018

DOI Link: https://doi.org/10.17656/jsmc.10183 

ABSTRACT

Background 

Lymphomas are the third commonest adult malignancies in Iraqi Kurdistan. Geographic variation in the distribution of different histologic types of lymphoma is well known. Management has been a contest between radiation and medical oncologists.

Objectives 

The aim of the study is to give an account about demographic and histologic distribution of adult lymphomas and to find out the proportion of the lymphoma treated with radiation in Kurdistan compared to the western world.

Patients and Methods

Data were collected for all patients with adult lymphomas from the two main cancer centers in the city of Sulaimani from 2013 to 2017. Six hundred forty five patients could be retrieved. Data included were age, sex, histology, and management plans. Descriptive analysis using frequencies was used to describe the study variables.

Results

A total of 645 adult lymphomas were enrolled. One third of patients had Hodgkin lymphoma, whose 138 cases were male (63%). Nodular Sclerosis histology comprised 70% of all Hodgkin lymphoma cases. Treatment plan for Hodgkin lymphoma was either chemotherapy (83%) or combined modality treatment. The commonest histologic type of Non-Hodgkin lymphoma (NHL) was diffuse large B-Cell lymphoma and it accounted for 62% of cases. Follicular lymphoma was extremely rare and encountered for only 2% of all cases. Unlike Hodgkin Lymphoma, only 8% of Non-Hodgkin Lymphoma patients were treated by combined modality approach.

Conclusion

Age distribution and histologic pattern of lymphomas are different in our region compared with other regional and western countries. Unlike the developed western world follicular lymphoma is not a common type of NHL. Although combined modality approach was a standard therapy for quite a while now most of the lymphoma cases are treated by chemotherapy alone.

KEYWORDS

Demography, Histology, Sulaimani, Treatment, Adult lymphoma.

References 

1. Maxwell SA, Mousavi-Fard S. Non-Hodgkin Lymphoma: advances in molecular strategies targeting drug resistance. Experimental Biology and Medicine. 2013 Sep;238(9):971-90.

2.  Khoshnaw N, Mohammed HA, Abdullah DA. Patterns of cancer in Kurdistan-results of eight years cancer registration in Sulaymaniyah Province-Kurdistan-Iraq. Asian Pac J Cancer Prev. 2015;16(18):8525-31

3.  Hodgkin D. Absorbent Glands and Spleen: On Some Morbid Appearances of the Absorbent Glands and Spleen. The Boston Medical and Surgical Journal. 1832 Mar 28;6(7):101-4.

4. Küppers R, Klein U, Schwering I, Distler V, Bräuninger A, Cattoretti G, Tu Y, Stolovitzky GA, Califano A, Hansmann ML, Dalla-Favera R. Identification of Hodgkin and Reed-Sternberg cell-specific genes by gene expression profiling. The Journal of clinical investigation. 2003 Feb 15;111(4):529-37.

5.  Vardiman JW, Harris NL, Brunning RD. The World Health Organization (WHO) classification of the myeloid neoplasms. Blood. 2002 Oct 1;100(7):2292-302.

6.  Grufferman SE, Delzell EL. Epidemiology of Hodgkin disease. Epidemiologic reviews. 1984;6:76-106.

7.  Gunderson LL. Clinical radiation oncology. Elsevier Health Sciences; 2015 Aug 12.

8.  Engert A, Plütschow A, Eich HT, Lohri A, Dörken B, Borchmann P, Berger B, Greil R, Willborn KC, Wilhelm M, Debus J. Reduced treatment intensity in patients with early-stage Hodgkin lymphoma. New England Journal of Medicine. 2010 Aug 12;363(7):640-52.

9.  Johnson PWM, Sydes MR, Hancock BW, et al. Consolidation radiotherapy in patients with advanced Hodgkin lymphoma: survival data from the UKLG LY09 randomized controlled trial (ISRCTN97144519). J Clin Oncol 2010;28(20):3352.

10.  Kostakoglu L, Cheson BD. Current role of FDG PET/CT in lymphoma. European journal of nuclear medicine and molecular imaging. 2014 May 1;41(5):1004-27.

11.  Halperin EC, Brady LW, Perez CA. Perez & Brady’s principles and practice of radiation oncology. Lippincott Williams & Wilkins; 2013 May 6.

12.  Ilica AT, Kocacelebi K, Savas R, Ayan A. Imaging of extranodal lymphoma with PET/CT. Clinical nuclear medicine. 2011 Oct 1;36(10):e127-38.

13.  Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, Lister TA. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. Journal of Clinical Oncology. 2014 Aug 11;32(27):3059-67.

14.  Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD, Jaffe ES. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016 May 19;127(20):2375-90.

15.  Specht L, Yahalom J, Illidge T, Berthelsen AK, Constine LS, Eich HT, Girinsky T, Hoppe RT, Mauch P, Mikhaeel NG, Ng A. Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG). International Journal of Radiation Oncology• Biology• Physics. 2014 Jul 15;89(4):854-62.

16.  Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World journal of gastroenterology: WJG. 2011 Feb 14;17(6):697.

17.  Martinelli G, Hsu Schmitz SF, Utiger U, Cerny T, Hess U, Bassi S, Okkinga E, Stupp R, Stahel R, Heizmann M, Vorobiof D. Long-term follow-up of patients with follicular lymphoma receiving single-agent rituximab at two different schedules in trial SAKK 35/98. Journal of clinical oncology. 2010 Aug 9;28(29):4480-4.

18.  Murawski N, Pfreundschuh M, Zeynalova S, Poeschel V, Hänel M, Held G, Schmitz N, Viardot A, Schmidt C, Hallek M, Witzens-Harig M. Optimization of rituximab for the treatment of DLBCL (I): dose-dense rituximab in the DENSE-R-CHOP-14 trial of the DSHNHL. Annals of oncology. 2014 Jun 13;25(9):1800-6.

19.  Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, Glick JH, Coltman Jr CA, Miller TP. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. New England Journal of Medicine. 1993 Apr 8;328(14):1002-6.

20.  Mustafa M, Maysoon Al Ruhaibeh MD, Ahmad Al Issa MD, Kamal N, Elhawwari B. Lymphoma at King Hussein Medical Center: A Histopathologic Review. JRMS. 2013 Sep;20(3):27-32

21.  Chiu BC, Hou N. Epidemiology and etiology of non-hodgkin lymphoma. InNon-Hodgkin Lymphoma 2015 (pp. 1-25). Springer, Cham.

22.  Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA: a cancer journal for clinicians. 2015 Jan 1;65(1):5-29.

23.  Engert A, Franklin J, Eich HT, Brillant C, Sehlen S, Cartoni C, Herrmann R, Pfreundschuh M, Sieber M, Tesch H, Franke A. Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin’s lymphoma: final results of the GHSG HD7 trial. Journal of Clinical Oncology. 2007 Aug 10;25(23):3495-502.

24.  Cokkinides V, Albano J, Samuels A, Ward ME, Thum JM. American cancer society: Cancer facts and figures. Atlanta: American Cancer Society. 2005.

25.  Vargo JA, Gill BS, Balasubramani GK, Beriwal S. Treatment selection and survival outcomes in early-stage diffuse large B-cell lymphoma: Do we still need consolidative radiotherapy?. Journal of clinical oncology. 2015 Aug 10;33(32):3710-7.

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