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Characteristics and Results of the Management of Diffuse Large B-Cell Lymphomas: The Experience of C?te d'Ivoire

DOI: 10.1155/2012/945138

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Abstract:

Diffuse large B-cell lymphomas have been little studied in black Africans. The purpose of our study was to determine the characteristics and results of the management of these lymphomas. Patients and Methods. In a descriptive and analytic retrospective study we studied the medical records of 63 patients with diffuse large B-cell lymphoma hospitalized during the period from 1991 to 2007. The diagnosis was made after lymph node or organ biopsy. Response to treatment, OS, PFS, and toxicity were studied. The complete response has been analyzed univariate and multivariate analysis. Results. The median age was 42 years. The sex ratio was 2. The HIV serology was positive in 11 cases, and 8 patients had antiretroviral therapy. In 71% the lymphoma was at stages III and IV of Ann Arbor. IPI was ≥3 in 65%. Complete remission was achieved in 43%. Only 43% of patients had had a good compliance. Progression-free survival at 3 years was 32%, and overall survival at 3 years was 50%. 13% of patients were lost to follow up, and 51% of them died. In terms of analysis the complete remission rate was influenced by the stage of Ann Arbor ( ), biological b symptoms ( ), the IPI ( ), and the socioeconomic standing ( ). In multivariate analysis, only IPI and stage of Ann Arbor influence the complete remission. 1. Introduction Diffuse large B-cell lymphomas are clonal proliferations of B-lymphocytes. It is the most common form of non-Hodgkin’s lymphomas accounting for 30 to 40% of lymphomas in adults [1, 2]. They are aggressive because the cells are young and express the proliferation marker Ki 67+. Thus, the doubling of the tumor mass is rapid, in the order of 15 days to one month. Diffuse large B-cell lymphomas constitute a heterogenous group with at least 15 entities according to the 2008 World Health Organization (WHO) classification and two molecular subtypes: those of germinal center type and those of activated B-cells type [3, 4]. These lymphomas may originate in the lymph nodes or in extranodal sites; they can be localized or disseminated. In terms of therapy, these lymphomas are usually sensitive to chemotherapy including CHOP protocol (Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone), which has been used since 1973 [5]. Then appeared the 3rd and 2nd generation protocols, which improved the complete remission rate. At the moment, Rituximab combined with CHOP, used in the first line, has further improved complete remission rate and survival. This treatment is adapted to the Internal Prognostic Index (IPI), which consists of 5 factors: age, performance score,

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