A descriptive study of plasma cell dyscrasias in Egyptian population

AbstractBackgroundPlasma cell dyscrasias (PCDs) refer to a spectrum of disorders characterized by the monoclonal proliferation of lymphoplasmacytic cells in the bone marrow and, sometimes, tissue deposition of monoclonal immunoglobulins or their components. These disorders include multiple myeloma (MM) and Waldenström’s macroglobulinemia, as well as rare conditions such as light-chain deposition disease (LCDD) and heavy-chain diseases (HCDs). The worldwide annual incidence of MM is estimated at 86,000, which is approximately 0.8% of all new cancer cases.PurposeOur retrospective study aims to highlight the immunologic and epidemiological features of PCDs mainly MM in Egyptian patients and compare our results with those of other populations.MethodsTwo hundred seventeen Egyptian patients with PCD were enrolled in the study. Serum, urine protein electrophoresis and immunofixation were used to demonstrate M protein.ResultsOne hundred thirty-eight patients (63.6%) had IgG monoclonal band, 38 patients (17.5%) had IgA, 12 patients (5.5%) had Waldenström’s macroglobulinemia (IgM monoclonal band) and 29 patients (13.4%) were light chain myeloma. One hundred fifty-one (70%) were Kappa chain positive and 66 patients (30%) were lumbda positive. Conventional cytogenetics was available for 40 patients; of them12 patients (30%) showed 13q-. Mean OS was 37.5months (1–84months). Survival analysis was statistically insignificant according to age, sex and ISS or type of treatment (P value>0.05).ConclusionLong term follow up is required to further define the role of different therapeutic lines of treatment including ASCT in the various stages of PCD based on OS data

DA-R-EPOCH versus R-CHOP in intermediate and high risk IPI diffuse large B-cell lymphoma, a randomized controlled trial

Background: Diffuse large B-cell lymphoma is a challenging disease in management. Although most patients are cured with the standard R-CHOP, one third of them remains refractory to this regimen. As prognosis of refractory disease is worse than primarily responding one, several trials investigated other more intense frontline regimens tailored based upon risk and biological characteristics. Patients & Methodology: This is a prospective randomized trial investigating the more intensive DA-R-EPOCH regimen as frontline therapy in intermediate and high risk DLBCL patients in comparison to the standard R-CHOP regimen. We compared both regimens in these risk categories as well as undergoing a subgroup analysis according to cell of origin (Germinal center versus activated B cell) and according to BCL2 and C-myc expression (double expressor lymphoma). Toxicities in both arms have been analyzed according to common terminology criteria for adverse events (CTCAE). Results:  In spite of being more toxic and complex, there was no significant improvement in DFS or response rate with DA-R-EPOCH. No significant benefit for DA-R-EPOCH over R-CHOP in both germinal center and activated B-cell DLBCL. Conclusion: Tailoring upfront treatment of DLBCL based upon risk classification or BCL2/c-myc expression remains an area of unanswered questions and warrants further investigations