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PO41 Rapidly progressive transformed follicular lymphoma, a case report
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Meeting abstracts / Critical Reviews in Oncology/Hematology 82 S1 (2012) S15−S30
PO40 Bacterial contamination of platelets for transfusion in transplanted lymphoma patients A. Fouad1 *. 1 National Cancer Institute, Cairo University, Department of Medical Oncology, Cairo, Egypt MNE is a 34 years old Egyptian male with no past medical history of medical importance. Diagnosed as stage IIb diffuse large B-cell NHL 2010. After R-CHOP × 8 he achieved partial response (PR) then very good PR after Salvage ICE × 3 and IFRTH. The patient then underwent Autologous SCT on 7th of Jun 2011: Mobilization by GCSF followed by PBSC pharesis. Conditioning with TBI/Cy. Then PBSCT with no major complications. The patient was discharged home on 22 Jul 2011. On 30 Jul 2011 the patient presented with thrombocytopenia where PLT count was 10,000/Cmm. Initial examination at presentation PS I, vitally stable, afebrile, no relevant clinical findings and with no active bleeding. Laboratory investigations done CBC: TLC 1200, HB 9.5 and PLT 10,000 and within normal LFTs and KFTs. 12 units irradiated platelets were ordered at 04:00 pm, and were available for transfusion at 08:00 pm. The patient received PLTs but just after transfusion of platelets he developed fever Temp 39ºC, rigors, severe diarrhea and became vitally unstable with BP 70/30 and Pulse 130. Immediate resuscitation with fluid challenge and empirical IV antibiotics was started then samples for blood C&S were collected. But the patient remained vitally unstable and started to be oliguric. So, the patient was transferred to ICU. In ICU the condition deteriorated rapidly where he became impaired conscious (CT brain was normal). Severe Respiratory distressed and Hypoxic (CT Chest was free). SO, Levofed infusion was started and he was mechanically ventilated with continuation of antibiotics and supportive measures. Blood C&S from patient and C&S from the bag of PLTs showed Staph coagulase negative. LFTs and KFTs started gradual deterioration after 3 days where the patient passed into stage of irreversible shock with SIRS and MODS. The patient died from septic shock that occurs shortly after platelet transfusion due to bacterial contamination of platelets. PO41 Rapidly progressive transformed follicular lymphoma, a case report C. Moreira1 *, A. Esp´ırito Santo1 , J.-M. Mariz1 . 1 Instituto Portuguˆes de Oncologia do Porto, Department of Onco-Hematology, Porto, Portugal Introduction: The clinical course of follicular lymphoma is that of a progressing and regressing disease. Quality and duration of response decline with repeated treatments, particularly after transformation to high grade lymphoma, with death generally resulting from disease.
Case report: A 59-year-old man presented in May 2009 with a two-month history of right flank pain, lower limb edema and B-symptoms. A CT scan revealed an extensive right retroperitoneal mass from the right suprarenal gland to the seminal gland. The biopsy was compatible with Follicular Lymphoma, classified as II-B, FLIPI 2. The patient was treated with 6 cycles of R-CHOP (May–Sep 2009) with complete response. In January 2010, he developed right abdominal pain along with B symptoms; a CT scan showed a mass at the right renal hilum with pyelocaliceal ectasia consistent with relapse. In February, second line therapy with ICE was started and suspended after 4 cycles due to grade IV hematologic toxicity with persistence of disease (23 mm) for which he was submitted to low dose radiotherapy. On June 29th, bone marrow was negative. Three weeks later, the patient presented with recurring abdominal pain, impaired renal function and fever. The CT scan revealed a 4 cm lombo-aortic adenopathy causing moderate right hydronephrosis and acute pyelonephritis; antibiotic therapy was begun. After 2 days, he complained of persistent pain on the right hip and femur with refractory fever; LDH was 4473 IU/L. An MRI revealed alteration of the medullary bone of all hip, sacrum and femur with heterogeneous lesions suspect of secondary nature; bone marrow biopsy showed involvement by disease; flow cytometry suggested transformation to Diffuse Large B-cell Lymphoma. Later, he developed lymphocytosis. Therapy with MINE was started with no evidence of response, persistence of renal function impairment and pain of difficult management. He died a month later. PO42 Non-Hodgkin’s lymphoma of bone A. Surendran1 *, G. Narayanan1 , F. James2 . 1 Regional Cancer Centre, Department of Medical Oncology, Kerala, India, 2 Regional Cancer Centre, Department of Radiation Oncology, Kerala, India Non Hodgkin’s lymphoma (NHL) occurring primarily in the bones is rare. We share our experience with this tumor. Aim: To study the pattern of presentation and treatment of NHL of the bones. Material and Methods: Patients with NHL occurring primarily in the bones seen and treated at our department at Regional Cancer Centre, Trivandrum, India during the period 2000 to 2009, form the subjects of our study. The case records were studied and necessary data collected. Results: During the study period, 57 patients were diagnosed as having NHL involving the bones. The median age of these patients at presentation was 50 years. There were 36 males and 21 females. The presenting symptoms were mainly pain and swelling. B symptoms were present in 10 patients. The duration of symptoms ranged from 1−9 months. The histologic subtype of lymphoma was predominantly diffuse large B cell seen in 36 cases, diffuse mixed in 6, Diffuse small cell in 2, anaplastic large cell in 3, lymphoblastic in 3,
Meeting abstracts / Critical Reviews in Oncology/Hematology 82 S1 (2012) S15−S30
PO40 Bacterial contamination of platelets for transfusion in transplanted lymphoma patients A. Fouad1 *. 1 National Cancer Institute, Cairo University, Department of Medical Oncology, Cairo, Egypt MNE is a 34 years old Egyptian male with no past medical history of medical importance. Diagnosed as stage IIb diffuse large B-cell NHL 2010. After R-CHOP × 8 he achieved partial response (PR) then very good PR after Salvage ICE × 3 and IFRTH. The patient then underwent Autologous SCT on 7th of Jun 2011: Mobilization by GCSF followed by PBSC pharesis. Conditioning with TBI/Cy. Then PBSCT with no major complications. The patient was discharged home on 22 Jul 2011. On 30 Jul 2011 the patient presented with thrombocytopenia where PLT count was 10,000/Cmm. Initial examination at presentation PS I, vitally stable, afebrile, no relevant clinical findings and with no active bleeding. Laboratory investigations done CBC: TLC 1200, HB 9.5 and PLT 10,000 and within normal LFTs and KFTs. 12 units irradiated platelets were ordered at 04:00 pm, and were available for transfusion at 08:00 pm. The patient received PLTs but just after transfusion of platelets he developed fever Temp 39ºC, rigors, severe diarrhea and became vitally unstable with BP 70/30 and Pulse 130. Immediate resuscitation with fluid challenge and empirical IV antibiotics was started then samples for blood C&S were collected. But the patient remained vitally unstable and started to be oliguric. So, the patient was transferred to ICU. In ICU the condition deteriorated rapidly where he became impaired conscious (CT brain was normal). Severe Respiratory distressed and Hypoxic (CT Chest was free). SO, Levofed infusion was started and he was mechanically ventilated with continuation of antibiotics and supportive measures. Blood C&S from patient and C&S from the bag of PLTs showed Staph coagulase negative. LFTs and KFTs started gradual deterioration after 3 days where the patient passed into stage of irreversible shock with SIRS and MODS. The patient died from septic shock that occurs shortly after platelet transfusion due to bacterial contamination of platelets. PO41 Rapidly progressive transformed follicular lymphoma, a case report C. Moreira1 *, A. Esp´ırito Santo1 , J.-M. Mariz1 . 1 Instituto Portuguˆes de Oncologia do Porto, Department of Onco-Hematology, Porto, Portugal Introduction: The clinical course of follicular lymphoma is that of a progressing and regressing disease. Quality and duration of response decline with repeated treatments, particularly after transformation to high grade lymphoma, with death generally resulting from disease.
Case report: A 59-year-old man presented in May 2009 with a two-month history of right flank pain, lower limb edema and B-symptoms. A CT scan revealed an extensive right retroperitoneal mass from the right suprarenal gland to the seminal gland. The biopsy was compatible with Follicular Lymphoma, classified as II-B, FLIPI 2. The patient was treated with 6 cycles of R-CHOP (May–Sep 2009) with complete response. In January 2010, he developed right abdominal pain along with B symptoms; a CT scan showed a mass at the right renal hilum with pyelocaliceal ectasia consistent with relapse. In February, second line therapy with ICE was started and suspended after 4 cycles due to grade IV hematologic toxicity with persistence of disease (23 mm) for which he was submitted to low dose radiotherapy. On June 29th, bone marrow was negative. Three weeks later, the patient presented with recurring abdominal pain, impaired renal function and fever. The CT scan revealed a 4 cm lombo-aortic adenopathy causing moderate right hydronephrosis and acute pyelonephritis; antibiotic therapy was begun. After 2 days, he complained of persistent pain on the right hip and femur with refractory fever; LDH was 4473 IU/L. An MRI revealed alteration of the medullary bone of all hip, sacrum and femur with heterogeneous lesions suspect of secondary nature; bone marrow biopsy showed involvement by disease; flow cytometry suggested transformation to Diffuse Large B-cell Lymphoma. Later, he developed lymphocytosis. Therapy with MINE was started with no evidence of response, persistence of renal function impairment and pain of difficult management. He died a month later. PO42 Non-Hodgkin’s lymphoma of bone A. Surendran1 *, G. Narayanan1 , F. James2 . 1 Regional Cancer Centre, Department of Medical Oncology, Kerala, India, 2 Regional Cancer Centre, Department of Radiation Oncology, Kerala, India Non Hodgkin’s lymphoma (NHL) occurring primarily in the bones is rare. We share our experience with this tumor. Aim: To study the pattern of presentation and treatment of NHL of the bones. Material and Methods: Patients with NHL occurring primarily in the bones seen and treated at our department at Regional Cancer Centre, Trivandrum, India during the period 2000 to 2009, form the subjects of our study. The case records were studied and necessary data collected. Results: During the study period, 57 patients were diagnosed as having NHL involving the bones. The median age of these patients at presentation was 50 years. There were 36 males and 21 females. The presenting symptoms were mainly pain and swelling. B symptoms were present in 10 patients. The duration of symptoms ranged from 1−9 months. The histologic subtype of lymphoma was predominantly diffuse large B cell seen in 36 cases, diffuse mixed in 6, Diffuse small cell in 2, anaplastic large cell in 3, lymphoblastic in 3,