A retrospective observational study to evaluate the reliability of staging and risk stratification of adolescent and adult patients with Hodgkin's lymphoma registered at the lymphoma clinic of a tertiary cancer center in Western India

Background: The treatment for Hodgkin's lymphoma is based on risk stratification of the disease, which is determined by staging, clinical, and laboratory parameters. The current staging systems are highly prone to error due to overlapping components and inter-observer variability. Objectives: We aimed to assess the reliability of staging and risk stratification performed by the clinicians at our busy multidisciplinary clinic. Materials and Methods: We conducted a retrospective analysis of 115 patients with newly diagnosed Hodgkin's lymphoma at the Tata Memorial Hospital, Mumbai, India, from 2016-2018. Patients who underwent baseline staging and risk stratification in the multidisciplinary lymphoma clinic were included in the analysis. The multidisciplinary lymphoma clinic is a collaboration between medical oncologists, radiation oncologists, nurses, social workers, and patient navigators. The staging and risk stratification performed during the multidisciplinary clinic were compared with those of a team of independent experts from medical oncology, radiation oncology, and nuclear medicine based on standard references (guidelines established by the German Hodgkin Study Group and the Ann Arbor Staging). Results: Discordance rates of 11.3% (n = 13) in disease staging and 7.8% (n = 9) in risk stratification were observed between the multidisciplinary clinic and the independent expert team. In all the discordant cases, there was up-staging of patients by the multidisciplinary clinic; all nine patients in early favorable risk category were misclassified as early unfavorable. The discordance rates were not significant, with a kappa score of 0.841 for staging and 0.855 for risk stratification. Conclusion: Misclassification of patients with Hodgkin's lymphoma based on the staging, and risk stratification may lead to over- or under-treatment. There is a need for a simpler, objective, and technology-driven risk stratification process

Clinical Utility of Stepwise Bronchoalveolar Lavage Fluid Analysis in Diagnosing and Managing Lung Infiltrates in Leukemia/Lymphoma Patients With Febrile Neutropenia

PURPOSEFebrile neutropenia (FN) is a serious complication in hematologic malignancies, and lung infiltrates (LIs) remain a significant concern. An accurate microbiological diagnosis is crucial but difficult to establish. To address this, we analyzed the utility of a standardized method for performing bronchoalveolar lavage (BAL) along with a two-step strategy for the analysis of BAL fluid.PATIENTS AND METHODSThis prospective observational study was conducted at a tertiary cancer center from November 2018 to June 2020. Patients age 15 years and older with confirmed leukemia or lymphomas undergoing chemotherapy, with presence of FN, and LIs observed on imaging were enrolled.RESULTSAmong the 122 enrolled patients, successful BAL was performed in 83.6% of cases. The study used a two-step analysis of BAL fluid, resulting in a diagnostic yield of 74.5%. Furthermore, antimicrobial therapy was modified in 63.9% of patients on the basis of BAL reports, and this population demonstrated a higher response rate (63% v 45%; P = .063).CONCLUSIONOur study demonstrates that a two-step BAL fluid analysis is safe and clinically beneficial to establish an accurate microbiological diagnosis. Given the crucial impact of diagnostic delays on mortality in hematologic malignancy patients with FN, early BAL studies should be performed to enable prompt and specific diagnosis, allowing for appropriate treatment modifications