Kakoli Lahkar, (2013) A Prospective single center study of the frequency and patterns of Anemia in Non-Hodgkin Lymphoma, with special reference to its impact on response to treatment and chemotherapy related toxicity. Masters thesis, Cancer Institute (WIA), Chennai.
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Abstract
BACKGROUND: Anemia is widely prevalent in lymphoproliferative diseases even in patients without involvement of bone marrow and prior to initiation of chemotherapy. The prognostic significance of anemia in Hodgkin lymphoma (HL) is well known .However, the prognostic significance of anemia in most subtypes of non-Hodgkin lymphoma (NHL) is not known and few studies have looked into this. The present study titled “A prospective single-center study of the frequency and patterns of anemia in non-Hodgkin Lymphoma, with special reference to its impact on response to treatment and chemotherapy related toxicity” was conducted to assess the patterns of different types of anemia and its impact on attainment of response and chemotherapy induced toxicity in patients with NHL in our population. MATERIALS AND METHODS: This study is a prospective single - center study from June 2011 to November 2012.All patients with newly diagnosed NHL at our institute were screened for anemia. Anemia was defined as a hemoglobin level less than 13g/dl in men and 12 g/dl in women as per WHO definition of anemia. Patients included in the study were subjected to various investigations to determine the cause of anemia. Patients were subjected to complete re-staging investigations after four cycles of planned chemotherapy to assess response. Patients were assessed for toxicity after each cycle of chemotherapy. Frequency of anemia in patients with newly diagnosed NHL at our Institute was analyzed with age and sex distribution., different subtypes of NHL, different patterns of anemia, causes of anemia in patients, frequency of anemia in different stages of NHL and any significant association of anemia with bone marrow involvement, B symptoms or elevated LDH in NHL (chi-square test) was determined. Association of anemia with attainment of complete response and partial response and chemotherapy related toxicity was determined (chi-square test/ Fishers’ exact test as applicable.) RESULTS AND OBSERVATIONS: A total of two hundred (200) patients with newly diagnosed NHL were screened for anemia. Anemia was present in 144 / 200 (72%) patients. Median age was 59 years (range 18-75). There was a statistically significant association of anemia with age > 60 years (p value 0.02, chi square = 7.83) in patients with NHL. Among 144 patients diagnosed with anemia, 102 (71%) were males and 42 were females (29%).No particular subtype of NHL was found to be significantly associated with anemia in the study. Majority of the patients (86%) were in stage II and stage III. The mean hemoglobin (Hb) was 10.7g/dl and median hemoglobin was 10.4 g/dl (range 6.5-14.5). Normocytic normochromic anemia was the most common morphologic type of anemia observed in the study (75%). Anemia of chronic disease (ACD) was the most common cause of anemia. This was followed by multi factorial causes and nutritional causes. CRP was elevated in all cases diagnosed to have ACD. Complete Response (CR) in patients with anemia was much less compared to those without anemia and this association was statistically significant on univariate analysis. It was found that both age > 60 years and presence of anemia were independently associated with a higher risk of not attaining CR. Grade 3 or higher toxicity was seen in 40% and these were neutropenia / febrile neutropenia. There was no significant association of anemia with neutropenia or grade 3 and higher toxicity including febrile neutropenia. CONCLUSIONS: Anemia is a common hematological abnormality in non-Hodgkin lymphoma. There are very few studies reporting on the frequency, distribution and prognostic impact of anemia on NHL. This study is relevant in the Indian context as the prevalence of anemia is much higher in India compared to western countries. It is essential to explore the possibility of anemia as an independent prognostic factor in NHL in future prospective studies. This can have a major impact on the overall management of patients with non-Hodgkin lymphoma.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 16104302 |
| Uncontrolled Keywords: | Anemia, Non-Hodgkin lymphoma, Response. |
| Subjects: | Respiratory Medicine > Medical Oncology > Respiratory Medicine > Medical Oncology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 13 Jan 2020 03:22 |
| Last Modified: | 30 May 2022 08:45 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11810 |
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