EVALUATING TREATMENT TIMELINES AND SURVIVAL OUTCOMES FOR PRIMARY CNS LYMPHOMA: A CROSS-SECTIONAL EVALUATION

Objectives: This study assesses clinical outcomes for primary central nervous system lymphoma (PCNSL) patients, particularly focusing on the timelines from diagnosis to hospital arrival, treatment initiation, and overall survival. It examines the impact of these timelines on patient outcomes and evaluates the effectiveness of a treatment regimen that includes high-dose methotrexate, cytarabine, and rituximab on survival rates in first line. Material and methods: Conducted as a cross-sectional study in the hematology ward of Hospital Geral de Fortaleza, this research evaluates patients diagnosed with PCNSL. Clinical parameters such as age, time to chemotherapy initiation, and time to death are collected. Data are summarized using medians and interquartile ranges (IQR). Group comparisons are facilitated using non-parametric tests, specifically the Mann-Whitney U-test, with p-values < 0.05 considered statistically significant. Overall survival (OS) is assessed using the Kaplan-Meier method, maintaining a 95% confidence interval. Results: Median patient age is 45.5 years (IQR: 39.8 to 52.0), and the median time from diagnosis to hospital arrival is -7.00 days (IQR: -19.0 to 17.0), suggesting some patients were referred before formal diagnosis. The median time from diagnosis to treatment initiation is 36 days (IQR: 31.0 to 55.0). The median survival time post-diagnosis is 7.07 months (IQR: 3.22 to 18.6), with the primary treatment regimen consisting of high-dose methotrexate, cytarabine, and rituximab. The 2-year OS is 25%, with 66.7% of patients dying within one year of diagnosis. Discussion: The variability in the timelines from diagnosis to hospital arrival and treatment initiation among PCNSL patients highlights a critical need for more efficient care processes. The early referral of some patients indicates an urgent referral protocol for highly suspected cases, yet the substantial range in treatment initiation times could impact patient outcomes significantly. The aggressive nature of the disease is underscored by a median survival time of 7.07 months, with a significant percentage of patients dying within the first year post-diagnosis, suggesting potential inadequacies in the treatment protocol. Conclusion: The findings suggest an urgent need for more streamlined diagnostic and treatment protocols to improve the efficacy of lymphoma care. The significant mortality rate within a year of diagnosis and the low overall survival rate necessitate a re-evaluation of the standard treatment regimen to better meet patient needs. This study advocates for further research to optimize treatment timelines and regimen efficacy to enhance patient prognosis and combat the severity of lymphoma more effectively

CLINICAL HETEROGENEITY AND IMPACT OF TREATMENT INITIATION TIME IN NON-HODGKIN LYMPHOMA

Objectives: This study aimed to analyze the clinical presentation of non-Hodgkin lymphoma (NHL) patients, focusing on age distribution, time to treatment initiation, and overall survival. It also sought to identify differences in these parameters across various NHL subtypes, including Burkitt lymphoma. Material and methods: We conducted a cross-sectional study involving NHL patients treated in the hematology ward at Hospital Geral de Fortaleza. Data on clinical parameters such as age, time to chemotherapy, and time to death were collected. We summarized these variables using medians and interquartile ranges (IQR). Non-parametric tests, specifically the Mann-Whitney U-test, were used for group comparisons, with p-values < 0.05 considered statistically significant. Overall survival (OS) was assessed using the Kaplan-Meier method, with a 95% confidence interval and p-values < 0.05 deemed significant. Results: The study included patients with various NHL subtypes, including Burkitt lymphoma (n = 5), diffuse large B-cell lymphoma (DLBCL, n = 11), high-grade B-cell lymphoma (n = 5), NK/T-cell nasal lymphoma (n = 1), plasmablastic lymphoma (n = 1), and primary CNS lymphoma (n = 6). Median ages were as follows: Burkitt lymphoma, 32 years (IQR: 25.0-50.0); DLBCL, 39 years (IQR: 35.0-49.5); high-grade B-cell lymphoma, 26 years (IQR: 20.0-39.0); NK/T-cell nasal lymphoma, 37 years; plasmablastic lymphoma, 26 years; and primary CNS lymphoma, 45.5 years (IQR: 39.8-52.0). These variations underscore the clinical heterogeneity and the need for tailored treatment strategies. Analysis showed significant variability in the median time to initiating chemotherapy among subtypes. Burkitt lymphoma patients had a median initiation time of 32 days, which was later than the 17 days for DLBCL patients. High-grade B-cell lymphoma patients had the longest median time to treatment initiation at 48 days, suggesting possible delays in diagnosis or treatment. These findings highlight the need for improved diagnostic and therapeutic strategies, especially for subtypes with longer initiation times. The overall survival rate was 37.5% at two years, which is lower compared to international data. Time to treatment initiation was particularly associated with worse outcomes in patients with primary CNS lymphoma (PNCSL), with delays in tissue evaluation contributing to challenges. Discussion: The study revealed significant differences in median ages across lymphoma subtypes, reflecting the clinical diversity and the need for personalized treatment approaches. Notably, patients with Burkitt lymphoma and high-grade B-cell lymphoma experienced delays in starting treatment. High-grade B-cell lymphoma patients had the longest median time to treatment initiation, highlighting potential diagnostic and treatment delays. The overall survival rate of 37.5% at two years was concerning, especially when compared to international data. Delays in initiating treatment were linked to poorer outcomes, particularly in PNCSL patients, with issues in tissue evaluation by stereotaxic samples being a significant hurdle. Conclusion: The findings emphasize the critical need for prompt diagnosis and timely treatment initiation to improve patient outcomes. The delays in treatment initiation, particularly for high-grade B-cell lymphoma and Burkitt lymphoma, underscore the importance of streamlining diagnostic and therapeutic processes

CLINICAL PROFILE AND SURVIVAL IN PATIENTS WITH HIGH-GRADE NON-HODGKIN LYMPHOMA

Objectives: This study aims to compare clinical parameters and outcomes between patients with high grade non-Hodgkin lymphomas undergoing intensive chemotherapy schedules. Material and methods: This cross-sectional study included patients diagnosed with High grade non-hogdkin lymphomas (HGNHL) and Burkitt's lymphoma (BL) treated at Hospital Geral de Fortaleza. The treatment regimen was R-CODOX-M/R-IVAC. Data were collected on various clinical parameters, including age, time to chemotherapy, haemoglobin (Hb), white blood cell count (Wbc), neutrophils (Neut), lymphocytes (Linf), platelet count (Plaq), creatinine (Cr), urea (Ur), and lactate dehydrogenase (LDH). Variables were summarised using medians and interquartile ranges (IQR). Comparisons between groups were evaluated using non-parametric tests, specifically the Mann-Whitney U-test, with p-values 0,05). Discussion: The analysis reveals significant variability in clinical presentation and timing of treatment among patients with high-grade non-Hodgkin lymphoma and Burkitt lymphoma. Despite the urgent need for prompt intervention in these high-proliferative lymphomas, the median time to treatment initiation was 48 days, suggesting delays that could negatively impact outcomes. The overall survival rate of 27.5% at two years underscores the aggressive nature of these diseases. The lack of significant differences in survival between HIV-positive and HIV-negative patients indicates that timely and intensive treatment is crucial for all patients, regardless of HIV status. The study highlights the necessity for immediate and aggressive therapy to improve survival rates in these high-grade lymphomas. Conclusion: There are considerable variability in clinical presentation and timing of treatment among patients with high-grade lymphoma and Burkitt lymphoma. The time to iniate treatment was extremely harmful and this group of high proliferative lymphoma must start intensive treatment as soon as possible