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Dlamini Z, Mbele M, Makhafola TJ, Hull R, Marima R. HIV-Associated Cancer Biomarkers: A Requirement for Early Diagnosis. Int J Mol Sci 2021; 22:ijms22158127. [PMID: 34360891 PMCID: PMC8348540 DOI: 10.3390/ijms22158127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
Globally, HIV/AIDS and cancer are increasingly public health problems and continue to exist as comorbidities. The sub-Saharan African region has the largest number of HIV infections. Malignancies previously associated with HIV/AIDS, also known as the AIDS-defining cancers (ADCs) have been documented to decrease, while the non-AIDS defining cancer (NADCs) are on the rise. On the other hand, cancer is a highly heterogeneous disease and precision oncology as the most effective cancer therapy is gaining attraction. Among HIV-infected individuals, the increased risk for developing cancer is due to the immune system of the patient being suppressed, frequent coinfection with oncogenic viruses and an increase in risky behavior such as poor lifestyle. The core of personalised medicine for cancer depends on the discovery and the development of biomarkers. Biomarkers are specific and highly sensitive markers that reveal information that aid in leading to the diagnosis, prognosis and therapy of the disease. This review focuses mainly on the risk assessment, diagnostic, prognostic and therapeutic role of various cancer biomarkers in HIV-positive patients. A careful selection of sensitive and specific HIV-associated cancer biomarkers is required to identify patients at most risk of tumour development, thus improving the diagnosis and prognosis of the disease.
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2
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Rabadão T, Naia L, Ferreira F, Teixeira M, Aveiro M, Eulálio M, Silva F. Not Always (and Only) Heart Failure-A Case Report of Primary Pleural Lymphoma in an Elderly Patient. Clin Pract 2021; 11:32-36. [PMID: 33572698 PMCID: PMC7930994 DOI: 10.3390/clinpract11010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022] Open
Abstract
Pleural involvement in Non-Hodgkin Lymphoma (NHL) is well documented, but primary pleural lymphomas are extremely rare, occurring mostly in immunosuppressed patients or associated with chronic pleural inflammation. Nevertheless, the pathogenesis and therapeutic approaches to counteract primary pleural lymphomas are still matter of debate. The authors present the clinical case of an 81-year-old female with respiratory and constitutional symptoms. A valvular heart disease and bilateral pleural effusion were known. The study carried out showed a large right pleural effusion; the fluid analysis was compatible with Diffuse Large B-cell Lymphoma (DLBCL), and two lymphomatous masses with pleural origin were found at the ipsilateral hemithorax. Primary pleural lymphoma was considered and chemotherapy was initiated with a good response and evolution. The authors report this remarkable clinical case because of its rarity, its excellent clinical evolution and the absence of an immunodeficiency context.
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Affiliation(s)
- Tiago Rabadão
- Medicine Department, Centro Hospitalar do Baixo Vouga, Artur Ravara, 3810-164 Aveiro, Portugal; (L.N.); (F.F.); (M.T.); (M.A.); (M.E.)
- Correspondence:
| | - Leonor Naia
- Medicine Department, Centro Hospitalar do Baixo Vouga, Artur Ravara, 3810-164 Aveiro, Portugal; (L.N.); (F.F.); (M.T.); (M.A.); (M.E.)
| | - Filipa Ferreira
- Medicine Department, Centro Hospitalar do Baixo Vouga, Artur Ravara, 3810-164 Aveiro, Portugal; (L.N.); (F.F.); (M.T.); (M.A.); (M.E.)
| | - Mariana Teixeira
- Medicine Department, Centro Hospitalar do Baixo Vouga, Artur Ravara, 3810-164 Aveiro, Portugal; (L.N.); (F.F.); (M.T.); (M.A.); (M.E.)
| | - Marcelo Aveiro
- Medicine Department, Centro Hospitalar do Baixo Vouga, Artur Ravara, 3810-164 Aveiro, Portugal; (L.N.); (F.F.); (M.T.); (M.A.); (M.E.)
| | - Margarida Eulálio
- Medicine Department, Centro Hospitalar do Baixo Vouga, Artur Ravara, 3810-164 Aveiro, Portugal; (L.N.); (F.F.); (M.T.); (M.A.); (M.E.)
| | - Fernando Silva
- Hematology Department, Centro Hospitalar do Baixo Vouga, Artur Ravara, 3810-164 Aveiro, Portugal;
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3
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Pamoukdjian F, Aparicio T, Zebachi S, Zelek L, Paillaud E, Canoui-Poitrine F. Comparison of Mobility Indices for Predicting Early Death in Older Patients With Cancer: The Physical Frailty in Elderly Cancer Cohort Study. J Gerontol A Biol Sci Med Sci 2020; 75:189-196. [PMID: 30715144 DOI: 10.1093/gerona/glz024] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To assess and compare the ability of five mobility indices to predict 6-month mortality in older patients with cancer. METHODS All consecutive ambulatory older patients with cancer referred for a geriatric assessment before a cancer treatment decision were included in a prospective two-center cohort study (Physical Frailty in Elderly Cancer) between 2013 and 2017. The mobility indices compared were the short physical performance battery, gait speed, hand grip strength, the one-leg stance balance test, and repeated falls. The primary endpoint was 6-month overall mortality. The adjusted hazard ratio (95% confidence interval [CI]) for each mobility index was estimated using a multivariate Cox proportional hazard model adjusted for sex, the Cumulative Illness Rating Scale for Geriatrics, the body mass index, cancer site/extension, and the provision of supportive care alone. The models' predictive performances were assessed in terms of Harrell's C index, net reclassification improvement, and the standardized net benefit. RESULTS A total of 603 patients included (mean age: 81.2 ± 6.1 years; women: 54%; metastatic cancer: 45%). In multivariate analyses, an impairment in any of the mobility indices (with the exception of repeated falls) was independently associated with 6-month mortality following a geriatric assessment; the adjusted hazard ratio [95% CI] ranged from 2.35 [1.34-4.13] for the one-leg stance balance (C index: 0.74) to 3.03 [1.93-4.76] for the short physical performance battery (C index: 0.77). For each mobility index, inclusion in the multivariate model improved significantly the latter's prediction of 6-month mortality. CONCLUSIONS Among mobility tests, short physical performance battery had the best discriminative value for predicting 6-month mortality in older patients with cancer.
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Affiliation(s)
- Frederic Pamoukdjian
- Geriatric Department, Coordination Unit in Geriatric Oncology, Avicenne Hospital, APHP, Bobigny.,DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Université Paris-Est, UPEC, Créteil
| | | | - Sonia Zebachi
- DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Université Paris-Est, UPEC, Créteil
| | - Laurent Zelek
- Department of Medical Oncology, Avicenne Hospital, Bobigny
| | - Elena Paillaud
- DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Université Paris-Est, UPEC, Créteil.,Geriatric Department, Georges Pompidou European Hospital, Paris
| | - Florence Canoui-Poitrine
- DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Université Paris-Est, UPEC, Créteil.,Public Health Department, Henri-Mondor Hospital, APHP, Créteil, France
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4
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Chou WC, Chang H, Wang PN, Kuo MC, Wu JH, Lin TL, Su YJ, Kao HW, Ou CW, Hung CY, Hsueh SW, Hung YS. Application of comprehensive geriatric assessment in predicting early mortality among elder patients with B-cell lymphoma receiving immunochemotherapy. Eur J Haematol 2020; 105:399-407. [PMID: 32472712 DOI: 10.1111/ejh.13457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Early mortality, defined as death within 120 days after initiated antitumor therapy, is an important issue especially for elder patients with B-cell lymphoma. This study aimed to evaluate the clinical value of comprehensive geriatric assessment (CGA) in early mortality prediction in elderly patients with B-cell lymphoma receiving immunochemotherapy. METHODS Seventy-six consecutive patients with newly diagnosed B-cell lymphoma receiving immunochemotherapy from a medical center in Taiwan were prospectively enrolled. Patients were divided into fit (n = 49) and frail (n = 27) groups per pretreatment CGA for early mortality comparison. RESULTS The early mortality rate in our patient cohort was 16% (n = 12): from 6% in patients with no CGA domain impairment to 43% in patients with ≥4 CGA domain impairment. The early mortality rate was 6% and 33% in fit and frail patients (odds ratio, 7.67; 95% CI, 1.86-31.6; P = .005), respectively. Frailty was the significant predictor for early mortality in univariate and multivariate analysis. CONCLUSION In this study, the number of geriatric domain impairment is positively associated with the early mortality risk in elderly patients with B-cell lymphoma. Therefore, CGA can help clinicians to identify the risk of early mortality in elderly patients and provide alternative treatment.
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Affiliation(s)
- Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung Chang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Nan Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chung Kuo
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Hou Wu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tung-Liang Lin
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jiun Su
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Wen Kao
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Che-Wei Ou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hema-oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shun-Wen Hsueh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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5
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Zeremski V, Fischer T, Schalk E. Dose reduction and high-risk disease as risk factors for early death in primary CNS lymphoma. Leuk Lymphoma 2019; 61:240-242. [PMID: 31393196 DOI: 10.1080/10428194.2019.1650176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Vanja Zeremski
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Health Campus Immunology, Infectiology and Inflammation (GC-I³), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Fischer
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Health Campus Immunology, Infectiology and Inflammation (GC-I³), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Health Campus Immunology, Infectiology and Inflammation (GC-I³), Medical Center, Otto-von-Guericke University, Magdeburg, Germany
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6
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Mei M, Wang Y, Zhang M. Causes of mortality in cases with extra nodal natural killer/T-cell lymphoma, nasal type: A cohort study. PLoS One 2019; 14:e0214860. [PMID: 30995261 PMCID: PMC6469770 DOI: 10.1371/journal.pone.0214860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/21/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Extra nodal natural killer/T-cell lymphoma (ENKTL), nasal type is a rare and highly aggressive type of non-Hodgkin's lymphoma (NHL) commonly presented in the nasal cavity or lymphatic system. However, the common causes of mortality in ENKTL remain unclear. We conducted a retrospective population-based cohort study to elucidate the different causes of mortality in ENKTL and illustrate the main causal and associated risk factors leading to death. METHODS The study included patients diagnosed with ENKTL from 1987 to 2014 in the Surveillance, Epidemiology, and End Results (SEER) program. Univariate survival analysis was conducted using Kaplan-Meier analysis, and multivariate analyses were performed using Cox proportional hazards regression model. Competing-risks regression model was applied to estimate specific risks associated with mortality. RESULTS The analysis demonstrated increased mortality in males and patients diagnosed at older age and higher disease stage. NHL was the most common cause of mortality in patients with ENKTL, accounting for 74.13% of deaths in the cohort, followed by other malignant cancers, heart diseases, and infection. However, NHL-specific death events were fewer in patients diagnosed with advanced disease stage compared with incidences of death by other causes such as disease of heart and infections. Significant difference was seen between patients diagnosed earlier than 2000, who showed a higher probability of dying from NHL, and those diagnosed later, who showed propensity to die from other malignant tumors and infection. No differences were found when comparing sex or age at diagnosis. CONCLUSION The most common cause of mortality in cases with ENKTL-NT is NHL. The female sex, diagnosis at young age and early stage are associated with improved prognosis. Further, the classification of Ann Arbor stage and year of diagnosis can provide references of specific causes of death, which might help decrease the mortality rate.
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Affiliation(s)
- Mei Mei
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.,The Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yingjun Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.,The Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.,The Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan Province, China
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7
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Porcel JM, Cuadrat I, García-Cerecedo T, Pardina M, Bielsa S. Pleural Effusions in Diffuse Large B-Cell Lymphoma: Clinical and Prognostic Significance. Lung 2018; 197:47-51. [DOI: 10.1007/s00408-018-0182-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/26/2018] [Indexed: 01/20/2023]
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8
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Silva WFD, Pinho LLDF, Farias CLGD, Torres V, Costalonga EC, Filho GC, Testagrossa LDA, Rocha V, Buccheri V. Renal infiltration presenting as acute kidney injury in Hodgkin lymphoma - A case report and review of the literature. Leuk Res Rep 2018; 10:41-43. [PMID: 30225192 PMCID: PMC6138943 DOI: 10.1016/j.lrr.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 12/02/2022] Open
Abstract
Renal involvement in Hodgkin lymphoma (HL) is rare, although extralymphatic disease is usually found. Acute kidney injury is a recognized presentation of non-Hodgkin lymphoma, with bilateral kidney involvement, promptly requiring specific treatment. Regarding to HL, this manifestation is extremely rare and lacks pathologic description and management experiences. Herein, we describe a case of HL with atypical presentation as well as its management, current evaluation by PET-scan and histologic findings. This case report highlights clinical presentation and a successful experience on managing these cases. Moreover, it is important to drive biologic insights for understanding of kidney infiltration mechanism in HL.
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Affiliation(s)
- Wellington Fernandes da Silva
- Discipline of Hematology, Faculty of Medicine of University of São Paulo (FMUSP), Av. Dr. Arnaldo, 251, 1° andar, ZIP: 01246-000, Brazil
| | | | - Cássio Lins Gil de Farias
- Discipline of Hematology, Faculty of Medicine of University of São Paulo (FMUSP), Av. Dr. Arnaldo, 251, 1° andar, ZIP: 01246-000, Brazil
| | - Verônica Torres
- Discipline of Nephrology, Faculty of Medicine of University of São Paulo (FMUSP), Brazil
| | | | - George Coura Filho
- Radiology and Oncology Department, Faculty of Medicine of University of São Paulo (FMUSP), Brazil
| | | | - Vanderson Rocha
- Discipline of Hematology, Faculty of Medicine of University of São Paulo (FMUSP), Av. Dr. Arnaldo, 251, 1° andar, ZIP: 01246-000, Brazil
| | - Valeria Buccheri
- Discipline of Hematology, Faculty of Medicine of University of São Paulo (FMUSP), Av. Dr. Arnaldo, 251, 1° andar, ZIP: 01246-000, Brazil
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10
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Investigation on treatment strategy, prognostic factors, and risk factors for early death in elderly Taiwanese patients with diffuse large B-cell lymphoma. Sci Rep 2017; 7:44282. [PMID: 28290477 PMCID: PMC5349600 DOI: 10.1038/srep44282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/06/2017] [Indexed: 12/19/2022] Open
Abstract
This study aimed to investigate the treatment strategy, prognostic factors, and risk factors of early death in elderly patients (age ≥ 65 years) with diffuse large B-cell lymphoma (DLBCL) in the rituximab era. Data from elderly patients diagnosed with DLBCL between 2008 and 2014 were collected for analysis. Patients who were younger and had a better performance status were more likely to receive intensive frontline treatment. The median progression-free survival (PFS) and overall survival were 15 and 21 months, respectively. Anthracycline-containing chemotherapy achieved a higher remission rate and showed a trend towards better overall survival but a higher risk of severe neutropenia. Multivariate analysis revealed that very old age (≥81 years), a high-risk age-adjusted international prognostic index (aaIPI) score, and bone marrow involvement were associated with poorer PFS and overall survival. Progression of lymphoma was the major cause of death in the study population. In addition, approximately 25% of patients died within 120 days of being diagnosed. The risk factors for early mortality included very old age, a high-risk aaIPI score, and bone marrow involvement. The appearance of symptoms or signs of tumour lysis syndrome at diagnosis was associated with a trend towards early death.
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11
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Prognostic significance of serum beta-2 microglobulin level in Hodgkin lymphoma treated with ABVD-based therapy. Med Oncol 2014; 31:185. [DOI: 10.1007/s12032-014-0185-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
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12
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Flepisi BT, Bouic P, Sissolak G, Rosenkranz B. Biomarkers of HIV-associated Cancer. BIOMARKERS IN CANCER 2014; 6:11-20. [PMID: 25057241 PMCID: PMC4085100 DOI: 10.4137/bic.s15056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 12/13/2022]
Abstract
Cancer biomarkers have provided great opportunities for improving the management of cancer patients by enhancing the efficiency of early detection, diagnosis, and efficacy of treatment. Every cell type has a unique molecular signature, referred to as biomarkers, which are identifiable characteristics such as levels or activities of a myriad of genes, proteins, or other molecular features. Biomarkers can facilitate the molecular definition of cancer, provide information about the course of cancer, and predict response to chemotherapy. They offer the hope of early detection as well as tracking disease progression and recurrence. Current progress in the characterization of molecular genetics of HIV-associated cancers may form the basis for improved patient stratification and future targeted or individualized therapies. Biomarker use for cancer staging and personalization of therapy at the time of diagnosis could improve patient care. This review focuses on the relevance of biomarkers in the most common HIV-associated malignancies, namely, Kaposi sarcoma, non-Hodgkin’s lymphoma, and invasive cervical cancer.
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Affiliation(s)
- Brian Thabile Flepisi
- Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Patrick Bouic
- Department of Medical Microbiology, Stellenbosch University, Cape Town, South Africa
| | - Gerhard Sissolak
- Division of Clinical Haematology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Bernd Rosenkranz
- Clinical Pharmacology Division, Department of Medicine, Stellenbosch University, Cape Town, South Africa
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13
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Pleural Fluid Cytology of the Polymorphous Variant of EBV-Positive Diffuse Large B-Cell Lymphoma: First Report and Distinction from a Reactive Process. Case Rep Pathol 2013; 2013:459279. [PMID: 24083045 PMCID: PMC3776548 DOI: 10.1155/2013/459279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/02/2013] [Indexed: 11/17/2022] Open
Abstract
EBV-positive diffuse large B-cell lymphoma of the elderly is a newly described aggressive lymphoma predominantly affecting patients >50 years of age. Patients may present with nodal and/or extranodal involvement. The lung is one of the more common extranodal sites. The incidence of pleural fluid involvement is less well described. In one study by Oyama et al., pleural effusions were noted in nine percent of cases. Identification of pleural fluid involvement could be important as it may carry prognostic importance in staging (it typically occurs more often in cases with widespread disease), and it could be a relatively easy means of establishing a diagnosis in newly presenting cases. We report the first description of the pleural fluid cytology in a case of EBV-positive diffuse large B-cell lymphoma of the elderly.
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Obstructive jaundice as an initial manifestation of non-hodgkin lymphoma: treatment dilemma and high mortality. Case Rep Med 2013; 2013:259642. [PMID: 23818904 PMCID: PMC3683444 DOI: 10.1155/2013/259642] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction. Non Hodgkin lymphoma (NHL) presenting with obstructive jaundice is a rare occurrence. Because of rarity of combination, it is seldom considered in differential diagnosis of patients presenting with obstructive jaundice. It is considered treatable due to the chemosensitive nature of the disease and the recent advances in chemotherapy. Case Series. We present a case series of 2 patients with NHL presenting with obstructive jaundice as an initial manifestation. Both patients presented with obstructive jaundice and were diagnosed by CT guided liver biopsy. One patient died of sepsis and multiorgan failure before initiating chemotherapy and the second patient did not choose to undergo chemotherapy. Conclusion. Biliary obstruction is a sign of poor prognosis. The diagnosis of NHL needs to be considered in patients presenting with biliary obstruction. It can be associated with high mortality and poses treatment dilemma.
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