Classificação dos linfomas não-Hodgkin: estudo morfológico e imunoistoquímico de 145 casos

A classificação dos linfomas não-Hodgkin tem sido, ao longo dos últimos trinta anos, motivo de controvérsia. Várias classificações têm sido propostas em busca de um consenso entre patologistas e clínicos. Este trabalho teve como objetivo analisar criticamente três destas classificações através do estudo retrospectivo de 145 casos de linfomas primários de gânglio linfático selecionados do Serviço de Anatomia Patológica do Hospital Universitário Clementino Fraga Filho, entre 1979 e 1995. Os casos revistos foram classificados pelas propostas da Working Formulation, de Kiel e da Real. Testes imunoistoquímicos com os anticorpos anti-CD45, anti-CD20, anti-CD45RO e anti-CD30 foram realizados. Cento e sete casos (73,7%) apresentaram fenótipo B; 33 casos (22,7%), fenótipo T; e quatro casos foram nulos (linfoma anaplásico de grandes células). Foi possível prever o fenótipo pela morfologia em 89,4% dos casos. Os linfomas de alto grau predominaram (59,2%), sendo o linfoma centroblástico o de maior freqüência (31,7% ). Os linfomas foliculares representaram 29 casos (20%), com maior incidência dos de grandes células (31%) do que dos de pequenas células (27,5%). Quando comparadas as três classificações, observamos que determinados grupos da Working Formulation abrigam múltiplas entidades. Isto se deve ao fato de a classificação da Working Formulation ser baseada somente em achados morfológicos e, por isso, deve ter seu uso desaconselhado. Já a classificação de Kiel e a da Real devem ter o seu emprego estimulado, pois apresentam, além de uma boa análise histopatológica, um estudo imunológico que define entidades biológicas correlacionando-se, quando possível, com a célula de origem.The non-Hodgkin's lymphomas classifications have been a controversial reason for the last thirty years. Many classifications have been proposed trying to achieve a consensus among pathologists and clinicians. The objective of this study was to analyse critically three of these classifications by the retrospective study of 145 cases of lymph nodes primary lymphomas, selected from the department of Pathology of the Hospital Universitário Clementino Fraga Filho between 1979 and 1995. The revised cases were classifiedby the proposal of Working Formulation, Kiel and Real. Immunohistochemical detections were employed with antibodies anti-CD45, anti-CD20, anti-CD45RO and anti-CD30. One hundred and seven cases (73.7%) showed B phenotype; thirty three cases (22.7%), T phenotype and 4 cases were null (anaplastic large cell lymphomas). It was possible to predict the phenotype by the morphology in 89,4% of the cases.The high grade lymphomas predominated (59.2%), and the centroblastic lymphoma was more frequent (31.7%). The follicular lymphomas account for 29 cases (20%), the large cell type (31%) have more incidence than the small cell type (20%). Comparing the three classifications, we observed that certain Working Formulation's groups agglomerate multiple entities. This occurs because it is based only on morphologic characteristics, hence should not be used. Kiel and Real classifications should have their employ stimulated because they present a good histopathologic analysis, a immunologic study that defines biologic entities correlating, whenever possible, with the postulated normal counterpart

Advanced Hodgkin's lymphoma: results in 216 patients treated with ABVD in Brazil

The outcome of Hodgkin's lymphoma (HL) has markedly improved over the last few decades, placing HL among the human cancers with highest cure rates. However, data about treatment outcomes in developing countries are scarce. From 1996 to 2005, 370 consecutive patients with HL treated in three public institutions in Rio de Janeiro were identified. A total of 216 patients who presented with advanced stage (IIB-IV) HL were selected for the present analysis. Patients with advanced disease were treated with ABVD, complemented or not by radiation therapy. The median follow-up time of survivors was 6.3 years (1-11.8). Fifteen patients died during first-line treatment. The complete remission rate was 80%. The 5-year progression-free survival (PFS) and the 5-year overall survival (OS) probabilities were 69% and 83%, respectively. The 5-year PFS in low-risk and high-risk patients were 81% and 62% (p=0.003), respectively. The 5-year OS in low-risk and high-risk International Prognostic Score patients were 89% and 78% (p=0.02), respectively. The present study provides a representative estimate of current treatment results for advanced HL in public institutions in an urban area in Brazil. It is clear that full treatment can be given to most patients, although those with very low socio-economic status might require special attention and support. Since Brazil is a large country, with substantial interregional heterogeneity, a nationwide registry of HL patients is currently being implemented

Human Germinal Center-Associated Lymphoma (HGAL) Protein Expression Is Associated with Improved Failure-Free Survival in Brazilian Patients with Classical Hodgkin Lymphoma

Abstract Abstract 4632 BACKGROUND The HGAL gene has prognostic value in diffuse large B-cell lymphoma and expression of its cognate protein is germinal center–specific. A previous study had suggested that HGAL protein expression might also be related to outcome in patients with Hodgkin lymphoma. PATIENTS AND METHODS The aim of the current study was to confirm the prognostic impact of HGAL protein expression in an independent, well-characterized cohort of 232 classic Hodgkin lymphoma patients treated uniformly with the ABVD regimen from 1997 to 2004 in Brazil. The median follow-up was 6.2 years. RESULTS Tissue microarray analysis showed HGAL staining in 188 specimens (81%). The overall survival was better in patients with young age, early-stage, absence of B symptoms, low-risk international prognostic score (IPS) and good performance status. Failure-free survival was superior in patients with early-stage disease, low-risk IPS and HGAL-positive patients. The estimated 5-year failure-free survival for HGAL-positive and HGAL-negative patients was 82% and 67%, respectively (P=0.03). When stage, B symptoms and performance status were included along with HGAL in a multivariate analysis, advanced stage and absence of HGAL staining were independent predictors of a worse failure-free survival. CONCLUSION This study confirms and validates recent findings of a correlation between HGAL expression and outcome in classical Hodgkin lymphoma. Disclosures: No relevant conflicts of interest to declare

Human germinal center-associated lymphoma protein expression is associated with improved failure-free survival in Brazilian patients with classical Hodgkin lymphoma

The human germinal center-associated lymphoma ( HGAL ) gene has prognostic value in diffuse large B-cell lymphoma, and expression of its cognate protein is germinal center-specific. A previous study had suggested that HGAL protein expression might also be related to the outcome in patients with Hodgkin lymphoma (HL). The aim of this study was to confirm the prognostic impact of HGAL protein expression in an independent, well-characterized cohort of 232 patients with classic HL treated uniformly with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD). Tissue microarray analysis showed HGAL staining in 188 specimens (81%). Failure-free survival (FFS) was superior in patients with early-stage disease, low-risk IPS, and HGAL-positive patients. The estimated 5-year FFS for HGAL-positive and HGAL-negative patients was 82% and 67%, respectively ( p = 0.03). In the multivariate analysis, advanced stage and absence of HGAL staining were independent predictors of a worse FFS. This study confirms and validates recent findings of a correlation between HGAL expression and outcome in classical HL

Advanced Hodgkin's lymphoma: results in 216 patients treated with ABVD in Brazil Linfoma de Hodgkin em estádio avançado: resultados do tratamento em 216 pacientes tratados com ABVD no Brasil

The outcome of Hodgkin's lymphoma (HL) has markedly improved over the last few decades, placing HL among the human cancers with highest cure rates. However, data about treatment outcomes in developing countries are scarce. From 1996 to 2005, 370 consecutive patients with HL treated in three public institutions in Rio de Janeiro were identified. A total of 216 patients who presented with advanced stage (IIB-IV) HL were selected for the present analysis. Patients with advanced disease were treated with ABVD, complemented or not by radiation therapy. The median follow-up time of survivors was 6.3 years (1-11.8). Fifteen patients died during first-line treatment. The complete remission rate was 80%. The 5-year progression-free survival (PFS) and the 5-year overall survival (OS) probabilities were 69% and 83%, respectively. The 5-year PFS in low-risk and high-risk patients were 81% and 62% (p=0.003), respectively. The 5-year OS in low-risk and high-risk International Prognostic Score patients were 89% and 78% (p=0.02), respectively. The present study provides a representative estimate of current treatment results for advanced HL in public institutions in an urban area in Brazil. It is clear that full treatment can be given to most patients, although those with very low socio-economic status might require special attention and support. Since Brazil is a large country, with substantial interregional heterogeneity, a nationwide registry of HL patients is currently being implemented.Os resultados do tratamento do linfoma de Hodgkin (LH) melhoraram substancialmente ao longo das últimas décadas e tornaram o LH uma das neoplasias humanas com maior chance de cura. Entretanto, os dados sobre tratamento em países em desenvolvimento são escassos. Entre 1996 e 2005, 370 pacientes consecutivos com LH tratados em três instituições públicas no Rio de Janeiro foram identificados. Destes, 216 em estádio avançado (IIB-IV) foram selecionados para esta análise. Os pacientes foram tratados com o protocolo ABVD (doxorrubicina, bleomicina, vinblastina e dacarbazina). A mediana do tempo de seguimento dos sobreviventes foi de 6,3 anos (1-11,8). Quinze pacientes morreram durante o tratamento de primeira linha. A probabilidade de sobrevida livre de progressão (SLP) em cinco anos e a probabilidade de sobrevida global (SG) em cinco anos foram de 69% e 83%, respectivamente. A SLP nos grupos de baixo risco e de alto risco, de acordo com o "International Prognostic Score", foi de 81% e 62% (p=0,003), respectivamente. A SG em cinco anos nos grupos de baixo risco e de alto risco foi de 89% e 78% (p=0,02), respectivamente. O presente estudo apresenta uma estimativa representativa dos resultados atuais do tratamento do LH avançado em instituições públicas no Brasil. Fica claro que o tratamento completo pode ser oferecido à grande maioria dos pacientes, embora aqueles com baixo status socioeconômico possam exigir atenção especial. Em vista das dimensões continentais do Brasil, com substancial heterogeneidade interregional, um registro nacional de pacientes com LH está sendo implementado