Non-Hodgkin's lymphoma: Is India ready to incorporate recent advances in day to day practice?

Background : Non Hodgkin\u2032s Lymphoma (NHL) cure rates are increasing and morbidities are decreasing, with more active pharmacological agents and technological advancements. In spite of this, India is still battling with the prejudices of an economically and educationally impoverished patient base. Methods and Results : We analyzed NHL cases from 2000 to 2006 using data from case sheets. Of 303 cases, only 100 patients had complete workup and received some form of treatment. For 203 patients, reasons for non-compliance were: financial constraint (119), distance from center (38), inability of physician to provide guarantees of cure (13), poor prognosis/fear of recurrence (28)), preferences for alternate medicine (5). Most common investigations that could not be afforded for staging were whole body CT scans and bone marrow aspiration and biopsy. Thirteen patients were in stage III and 53 in Stage IV. The most common regimen was CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). Forty-five patients did not complete six courses of CHOP and 35 patients had significant delay. Reasons for delay were intermittent availability of cash (35), intolerable toxicities (30), absence of supportive care (21), given-up attitudes (17). Eighty-three patients suffered Grade III/IV debilitating toxicities. Overall survival at five years was 50%. Conclusions : NHL in India is no different from the developed world. However, there are disparities in survivorship and outcomes, due to un-affordability and attitudes of the patients. Therefore, we suggest the development of Community Health Insurance Schemes (CHIs), with the hospital as the nodal center to address the above mentioned issues

Diffuse large B-cell lymphoma of the uterine cervix: A rare case managed novelly

Non-Hodgkin′s lymphoma (NHL) of the uterine cervix is exceedingly rare. The management of the disease is not standardized. A 44-year-old lady presented with a history of bleeding pervaginum and a foul-smelling discharge of 2 months′ duration. A 7 x 7 growth was seen in the cervix. A biopsy revealed it to be a CD20-positive diffuse large B-cell (DLBCL)-type NHL. She was diagnosed as stage IE after staging work-up, and managed with three courses of rituximab, cyclophosphamide, vincristine, adriamycin, and prednisolone followed by external beam radiotherapy (46 Gy in 23 fractions) by 3D conformal technique. She attained a complete response, and has been in remission for 1 year 3 months

Diffuse large B-cell lymphoma of the uterine cervix: A rare case managed novelly

Non-Hodgkin\u2032s lymphoma (NHL) of the uterine cervix is exceedingly rare. The management of the disease is not standardized. A 44-year-old lady presented with a history of bleeding pervaginum and a foul-smelling discharge of 2 months\u2032 duration. A 7 x 7 growth was seen in the cervix. A biopsy revealed it to be a CD20-positive diffuse large B-cell (DLBCL)-type NHL. She was diagnosed as stage IE after staging work-up, and managed with three courses of rituximab, cyclophosphamide, vincristine, adriamycin, and prednisolone followed by external beam radiotherapy (46 Gy in 23 fractions) by 3D conformal technique. She attained a complete response, and has been in remission for 1 year 3 months

Non-Hodgkin's lymphoma: Is India ready to incorporate recent advances in day to day practice?

Background : Non Hodgkin′s Lymphoma (NHL) cure rates are increasing and morbidities are decreasing, with more active pharmacological agents and technological advancements. In spite of this, India is still battling with the prejudices of an economically and educationally impoverished patient base. Methods and Results : We analyzed NHL cases from 2000 to 2006 using data from case sheets. Of 303 cases, only 100 patients had complete workup and received some form of treatment. For 203 patients, reasons for non-compliance were: financial constraint (119), distance from center (38), inability of physician to provide guarantees of cure (13), poor prognosis/fear of recurrence (28)), preferences for alternate medicine (5). Most common investigations that could not be afforded for staging were whole body CT scans and bone marrow aspiration and biopsy. Thirteen patients were in stage III and 53 in Stage IV. The most common regimen was CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). Forty-five patients did not complete six courses of CHOP and 35 patients had significant delay. Reasons for delay were intermittent availability of cash (35), intolerable toxicities (30), absence of supportive care (21), given-up attitudes (17). Eighty-three patients suffered Grade III/IV debilitating toxicities. Overall survival at five years was 50%. Conclusions : NHL in India is no different from the developed world. However, there are disparities in survivorship and outcomes, due to un-affordability and attitudes of the patients. Therefore, we suggest the development of Community Health Insurance Schemes (CHIs), with the hospital as the nodal center to address the above mentioned issues