3 articles
The gastrointestinal tract (GIT) is the most common site of extranodal primary non-Hodgkin lymphoma (NHL), accounting for 20% to 40% of all extranodal lymphomas. The advanced stages at diagnosis and complications remain significant issues in NHL management, imposing a substantial disease burden on patients and healthcare systems.
Material and methods
We performed a descriptive cross-sectional and cohort study of patients with gastrointestinal NHL and a narrative review of the literature in the Discussion section. This study included 50 prospective and retrospective patients with NHL treated between 2015-2024 in the Institute of Oncology in Moldova. A bibliographic search was conducted using databases such as PubMed, Hinari, SpringerLink, the National Center for Biotechnology Information, and Medline. The final bibliography included 18 relevant sources deemed to be representative of the literature published on the topic of this article.
According to the International Clinical Classification, most patients (22, 44.0%) were diagnosed with clinical stage IV. B symptoms occurred in 38 (76.0%) patients. The overwhelming predominance of diffuse large B-cell lymphomas (46 cases - 90.2%) was observed. The complete blood count, bone marrow aspiration and biopsy of the iliac crest did not detect any specific changes in cases without bone marrow involvement, with the exception of a decrease in hemoglobin and erythrocyte counts observed in cases of posthemorrhagic anemia. The overall survival (OS) of all patients with gastrointestinal NHL was 78.1% at 1 year, 59.4% at 3 years, and 35.9% at 5 years. In patients with stage IE NHL, the 1-, 3-, and ≥5-year OS was 93.4%, 76.5%, and 69.9%, respectively. In patients with stage IIE, the OS was 91.2% at 1 year, 71.4% at 3 years, and 63.8% at ≥5 years. In patients with stage IIIE-IV, the OS was 75.1% at 1 year, 54.8% at 3 years, and 28.5% at ≥5 years with combined chemotherapy.
Our study demonstrated that non-Hodgkin lymphomas with primary involvement of the gastrointestinal tract exhibited distinct histopathological, clinical-evolutionary and hematological features, which influenced treatment outcomes. The aggressive histological types and the advanced stages IIIE and IV prevailed within the structure of non-Hodgkin lymphomas with primary gastrointestinal involvement, and, thus, negatively impacted the survival and prognosis.
Lung cancer exhibits high global incidence and mortality rates. Surgical resection remains crucial to diagnosis, staging, and treatment of non-small cell lung cancer (NSCLC). However, advanced stages often require multimodal approaches. Prehabilitation, innovative perioperative techniques, and the exploration of immunotherapy hold promise for improving outcomes.
This two-phase observational cohort study included a retrospective arm (100 patients, traditional treatment) and a prospective arm (100 patients, innovative perioperative management, and risk stratification). Descriptive and inferential statistics were used to evaluate data, identify risk factors, and compare the 2-year survival between treatment groups.
Despite advances, lung cancer prognosis remains poor, with limited cure rates. Mean survival in the traditional approach was 1.3 years with a 5-year survival of only 1%. While prehabilitation and innovative techniques showed potential, no statistically significant differences in survival times were observed between the treatment groups. Patients with stage III (Charlson score 0-4) and stage I-II (Charlson score 5-12) demonstrated comparable outcomes, highlighting the importance of comorbidity burden.
Targeted screening protocols are of paramount importance for early detection and intervention. Population-wide smoking cessation programs, environmental protection measures, and the promotion of healthy lifestyles are vital for prevention and reducing incidence. Standard chemotherapy and radiotherapy offer limited therapeutic benefits in advanced lung cancer. This highlights a pressing need for breakthroughs in basic research to develop novel treatment paradigms that significantly improve outcomes. While this study did not reveal statistically significant survival differences between traditional and innovative perioperative approaches, prehabilitation and optimization techniques hold promise and deserve further research. The development of anti-tumor immunotherapy offers a significant potential in non-surgical lung cancer treatment, especially given the limitations in advanced-stage disease management. Harnessing the immune system to fight cancer represents a promising new frontier.
Chronic myeloid leukemia (CML) comprises 15-20% of all leukemia cases in adults, being the most common chronic myeloproliferative neoplasm, with the patients’ immunocompromised status in the advanced phases. The international periodical literature stipulates the increased susceptibility of patients with malignant tumors to SARS-CoV-2 infection, but the contagion risk is not determined in regard to the histological type of hematologic malignancies. The aim of the study was the comparative evaluation of the current epidemiological patterns and the contemporary diagnostics output in CML, axed on the optimization of tactics of diagnosis management in the context of the pandemic with COVID-19 infection.
An analytical, qualitative, secondary study was performed – the narrative review of literature in the form of a synthesis article. Fifty three relevant primary sources were identified and selected, according to the significance of the impact score, with the subsequent and scientific data extraction and analysis.
CML varies between 0.8 - 2.0 cases per 100000 population. The total number of patients diagnosed with CML increased annually by 2% during 2007-2016. In 2017, a comparatively high level of the age-standardized death rate (ASDR) (0.6 per 100,000 population, 95% IU) and the DALYs (disability-adjusted life-years) age-standardized rate (ASR) (16.71 per 100,000 population, 95% IU) were registered in quintiles with low SDI. By the quantitative RT-PCR analysis of blood cells for BCR-ABL p210 gene transcript, the published studies highlight its large variations: 21.84 - 100% IS. FISH and PCR are able to detect rare BCR-ABL gene variants and breakpoints that may go unnoticed by conventional cytogenetics.
Despite the declining overall trend of ASIR, ASDR and age-standardized DALYs at the expense of high SDI quintiles, the CML burden remains stable due to the growing population in developing countries and the aging population in developed countries. Management of patients with primary diagnosed CML, with high risk factors, should include enhanced surveillance for SARS-CoV-2 infection. Diagnostics management of patients with CML includes morphological, cytogenetic and molecular-genetic investigations of the peripheral blood and bone marrow regardless of the phase of clinical evolution, with FISH and RT-PCR as proving resolutive modalities.