Incidence of lymphoid malignancies in patients with lymphocytosis identified by general practitioners

Family physicians are currently instructed to refer patients with lymphocyte counts exceeding 5 x109/L to hematologists due to the possibility of chronic lymphocytic leukemia (CLL). This study assessed the usefulness of this procedure through the analysis and evaluation of referrals made to a hematologist over a period of 12 years (2010-2022). During the 12 years, there were 256 patients whose absolute lymphocyte count at least once exceeded 5 x109/L and who were referred to our hospital. There were 145 males and 111 females in this group, and the median age was 66 y. The mean absolute lymphocyte count at the time of referral was 30.0 G/L. It was found that among the 256 patients, a diagnosis was established for 249 (97.3%) of the patients. There were 224 CLL cases, 2 SLL cases, and 5 MBL cases, making 231 cases with CLL phenotype (92.8%). There were 9 cases of other B cell lymphomas (3.6%), including 4 MCL cases, 4 MZL cases, and 1 SLVL case. Furthermore, there were 6 cases of T cell lymphomas (2.4%), including 5 T-LGL cases and 1 T-PLL case. The cohort also had 1 AML case (0.4%) and 3 reactive lymphocytosis cases (1.2%), including one with infectious mononucleosis (0.4%). In the group, 16/224 patients (7.1%) with CLL as well as one with AML required immediate treatment. The absolute lymphocyte count was confirmed as a reliable screening test for diagnosing lymphoid malignancies with peripheral blood involvement

Możliwości leczenia skojarzonego chorych na rozsianego raka jelita grubego

In majority of patients newly diagnosed colorectal cancer is advanced, in vast number of patients presents in metastatic phase. In last decade convenience of new, effective drugs improved expected survival in metastatic phase of disease. Clinical trials of last few years have shown that proficient combination of continuous, sequential systemic treatment with courageous metastases resection increases chance for long survival. In this article authors analyzed the newest reports from trials designed to answer the queries about indications to systemic and surgical treatment in palliative setting as well as intensity and sequence of combination of cytotoxic and targeted therapies. Owing to knowledge gained through these studies the aim of cure is possible instead of only delaying progression in late phase of the disease.U większości chorych raka jelita grubego wykrywa się, gdy choroba jest w stadium zaawansowanym. W wielu przypadkach stwierdza się już przerzuty do narządów odległych. W ostatnim dziesięcioleciu dostępność nowych, skutecznych leków cytotoksycznych i terapii celowanej wyraźnie poprawiła spodziewaną długość przeżycia chorych w fazie uogólnienia choroby. W najnowszych badaniach klinicznych wykazano, że umiejętne połączenie ciągłego, sekwencyjnego leczenia systemowego z odważną kwalifikacją do resekcji przerzutów zwiększa szanse wieloletniego przeżycia chorych. W niniejszej pracy zanalizowano wyniki najnowszych badań obejmujących stosowanie terapii systemowych i zabiegowych w leczeniu paliatywnym oraz intensywność i sekwencyjność stosowanych połączeń chemioterapii i tak zwanych leków celowanych. Dzięki wiedzy nabytej w toku tych badań możliwe jest zmierzanie do wyleczenia zamiast jedynie opóźniania rozwoju choroby w jej zaawansowanych stadiach

Clinical features, etiology, and survival in patients with restrictive cardiomyopathy: A single-center experience

Background: Numerous prognostic factors have been proposed for cardiac amyloidosis (CA). The knowledge about other subtypes of restrictive cardiomyopathy (RCM) is scant.Aims: This study aimed to elucidate the etiology and prognostic factors of RCM as well as assess cardiac biomarkers: high-sensitive troponin T (hs-TnT), growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and soluble suppression of tumorigenicity 2, as mortality predictors in RCM.Methods: We enrolled 36 RCM patients in our tertiary cardiac department. All patients were screened for CA. Genetic testing was performed in 17 patients without CA.Results: Pathogenic or likely pathogenic gene variants were found in 86% of patients, including 5 novel variants. Twenty patients died, and 4 had a heart transplantation during the study. Median overall survival was 29 months (8–55). The univariate Cox models analysis indicated that systolic and diastolic blood pressure, GDF-15, hs-TnT, NT-proBNP, left ventricular stroke volume, the ratio of the transmitral early peak velocity (E) estimated by pulsed wave Doppler over the early mitral annulus velocity (e’), tricuspid annulus plane systolic excursion, early tricuspid valve annular systolic velocity, the presence of pulmonary hypertension, and pericardial effusion influenced survival (P <0.05). A worse prognosis was observed in patients with GDF-15 >1316 pg/ml, hs-TnT >42 ng/l, NT-proBNP >3383 pg/ml, and pericardial effusion >3.5 mm (Kaplan-Meier analysis, log-rank test, P <0.001).Conclusions: Genetic testing should be considered in every RCM patient where light-chain amyloidosis has been excluded. Survival remains poor regardless of etiology. Increased concentrations of GDF-15, hs-TNT, NT-proBNP, and pericardial effusion are associated with worse prognosis. Further studies are warranted

A rare CD5-positive subgroup of diffuse large B-cell lymphoma – clinical, morphological and immunophenotypic features in Polish patients

The aim of the study was to assess the incidence of CD5-positive diffuse large B-cell lymphoma (DLBCL) in the Polish population and to describe its morphologic and clinical characteristics. The study included 36 patients with CD5-positive DLBCL, diagnosed and treated in the Maria Skłodowska-Curie Institute and Oncology Centre, Warsaw, Poland and the Medical University of Warsaw, Poland in the years 2002-2013. The control group consisted of 28 patients with CD5-negative DLBCL. CD5-positive DLBCL accounted for 6.26% of all DLBCL cases diagnosed in the Maria Skłodowska-Curie Institute and Oncology Centre in the years 2008-2012. The incidence is comparable to other European countries, lower than noted in Japan and higher than in the US. Patients with CD5-positive DLBCL, in comparison to the CD5-negative group, were characterized by: (1) older age (≥ 60 vs. younger) and worse general status (ECOG ≥ 2 vs. < 2), (2) lower frequency of complete remission (CR), (3) higher expression of unfavorable prognostic factors (BCL2, FOXP1, CD44) and MMP-9, and (4) lower expression of favorable prognostic factors (CD30, cyclin D1, cyclin D3) and TIMP-2