10 research outputs found
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?
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