Recent Advances in Diffuse Large B Cell Lymphoma

More recently, DLBCL has witnessed advances in the molecular profiling and treatment of patients with refractory and relapsed disease. DLBCL is biologically and clinically a heterogeneous disease. Despite its aggressive behavior, DLBCL is a potentially curable disease with overall survival of 94 and 55% in patients with low and high rIPI scores, respectively. The combination of anti-CD 20 monoclonal antibody rituximab and cyclophosphamide, doxorubicin, oncovin (vincristine) and prednisone (R-CHOP) chemotherapy every 3 weeks is the first line treatment. Radiotherapy is reserved for the patients with bulky disease who fail to achieve complete remission after first line treatment. CNS prophylaxis is reserved for the patients with high lactate dehydrogenase (LDH) levels and involvement of more than one extranodal sites and for the patients with involvement of selective extranodal sites like testes and orbits (the sanctuary sites). Patients who suffer relapse after first line treatment receive high-dose chemotherapy supported by autologous stem cell transplantation (HDC/ASCT). Variants of DLBCL like double-hit (presence of MYC and BCL2/BCL6) and triple-hit (presence of MYC, BCL2 and BCL6) lymphomas are treated differently and these patients have worse outcome. Several novel immunotherapeutic agents like checkpoint inhibitors and chimeric antigen receptor T cell (CART) are being investigated in randomized trials on patients with DLBCL

Early predisposition to osteomalacia in Indian adults on phenytoin or valproate monotherapy and effective prophylaxis by simultaneous supplementation with calcium and 25-hydroxy vitamin D at recommended daily allowance dosage: A prospective study

Background: Long-term therapy with antiepileptic drugs (AED) may be associated with increased total serum alkaline phosphatase (ALP) levels and reduced serum calcium, inorganic phosphorous, and vitamin D levels. These adverse biochemical alterations have an adverse effect on bone health Objective: To determine (a) onset of derangements in serum total ALP and its isoenzymes (liver, bone), calcium and 25-hydroxy vitamin D (25-OHD) concentrations after initiation of treatment with phenytoin or valproic acid monotherapy and (b) the effect of simultaneous supplementation with calcium and 25-OHD at recommended daily allowance (RDA) dosage, on these biochemical parameters. Materials and Methods: Study was a prospective, case-controlled study in adults. Serum biochemical parameters were estimated at baseline, 30, 60, and 90 days of starting AED treatment in the study subjects: Groups--A (only calcium supplementation) and Group B (both calcium and 25-OHD supplementation). Statistical Analysis: Mean±SD, and students′ paired t test (between groups A and B) unpaired students′ t test (drug-wise). Results: At 60 days of AED therapy Group A showed a significant increase in serum total ALP (78.83±11.04 to101.75 ± 9.56 IU/l) (P < 0.001), ALP-liver isoenzyme, (41.97± 10.81 to 68.83 ±7.81 IU/L) (P < 0.001), significant decrease in calcium (9.30 ± 0.36 to 8.80 ± 0.38 mg%) (P < 0.001), ALP-bone isoenyzme (36.84 ± 5.01 to 32.92 ± 6.46 IU/L) (P < 0.001), and a significant decrease in 25-OHD (25.19 ± 5.98 to 19.76 ± 5.35 ng/ml) (P < 0.001) at 90 days. In contrast Group B, at 60 days, showed a significant decrease in serum total ALP (81.92 ± 19.63 to 54.77. ± 11.53 IU/L) (P < 0.0001), ALP-liver isoenzyme (48.01. ± 13.53 to 28.12. ± 5.88 IU/L) (P < 0.0001), significant increase in calcium ((9.24 ± 0.31 to 9.93 ± 0.26 mg%) (P < 0.001) and ALP-bone isoenzyme levels (33.93 ± 12.2 to 26.25 ± 8.23 IU/L). In Group B, 25-OHD levels showed a significant increase at 90 days (24.36 ± 3.42 to 31.53 ± 327 ng/ml) (P < 0.0001). Conclusion: Biochemical derangements in calcium metabolism involving the bone are seen by 60 days after starting AED monotherapy, indicating predisposition to development of osteomalacia in these patients. This is preventable by simultaneous oral supplementation with calcium and 25-OHD