Contributions
Abstract: PB1794
Type: Publication Only
Background
Diffuse B cell lymphoma, the most common type of Non-Hodgkin’s lymphoma, typically presents as a clinically aggressive and heterogeneous group of disorders with a variable response rate to standardised rituximab; cyclophosphamide, doxorubicin, vincristine, prednisone(R-CHOP) chemotherapy.
Recent BSH guidelines have addressed diagnostic work up and prognostic dependent management steps with emphasis on high risk and frail individuals. Patients with a poor performance ability are recommended for G-CSF prophylaxis in patients above the age of 65 years. Those with high numbers of comorbidities and impaired performance should also be considered for a steroid course prior to chemotherapy or modified treatment. The International Prognostic index (IPI) takes into account age at diagnosis, raised serum Lactate dehydrogenase, stage, bulky disease and performance status and gives an indication for low risk and high risk mortality.
Aims
To evaluate departmental adherence to national guidelines specifically focusing on the management of high risk and frail individuals. Also to study the trends between the prognostic scores and characteristics of patients who developed complications and mortality.
Methods
Data was collected from electronic records of 48 patients at Wigan Royal Infirmary. 32 Patients before Guidelines and 17 patients post guidelines
Results
93 %(14 of 15) of WHO performance scores were not calculated post guidelines as compared to 66%(21 of 32) pre guidelines. 86% of patients above 65 years, did not have scores but incidentally had above stage three disease and more than two comorbidities, classing them frail. 33% of these did not receive GCSF or steroid prophylaxis. 29% of patients without a score died and 14% relapsed. 67% (10 of 15) of patients developed complications such as Neutropenic sepsis, oesophageal ulcers, recurrent infections, pulmonary embolisms and superior vena cava thromboses. No prognostic scores were calculated in this group hence the difficulty in understanding whether certain individuals would have benefited from appropriate prophylaxis. However 60% (6 of 10) of patients with complications had high co-morbidities numbers and were complicated by 3 deaths. There was a 19% mortality (6 of 32) pre guidelines of which 34% had an IPI score of Intermediate risk and 33% were under the age of 51. Mortality post guidelines were 46 %( 7 of 15) of which 57% (4) were under the age of 51years. Out of these young mortalities, one case was given steroid prophylaxis and 1 case had a low risk IPI.
Conclusion
This small capture of data may give an indication of how the current IPI score may not encompass all the key characteristics that predict high mortality. With surplus deaths in ages below 65; this may also indicate the need to expand the criteria for individuals who might benefit from prophylaxis treatment. Further study into characteristics of young mortality, associated family history, autoimmune disease, weight and occupational exposures can guide better management of potential high risk individuals. The numbers of non-adherence to the guidelines in this data set may also indicate the need to evaluate how long it takes for guidelines to be practiced and whether alternate means of education and delivery is needed apart from publishing.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Abstract: PB1794
Type: Publication Only
Background
Diffuse B cell lymphoma, the most common type of Non-Hodgkin’s lymphoma, typically presents as a clinically aggressive and heterogeneous group of disorders with a variable response rate to standardised rituximab; cyclophosphamide, doxorubicin, vincristine, prednisone(R-CHOP) chemotherapy.
Recent BSH guidelines have addressed diagnostic work up and prognostic dependent management steps with emphasis on high risk and frail individuals. Patients with a poor performance ability are recommended for G-CSF prophylaxis in patients above the age of 65 years. Those with high numbers of comorbidities and impaired performance should also be considered for a steroid course prior to chemotherapy or modified treatment. The International Prognostic index (IPI) takes into account age at diagnosis, raised serum Lactate dehydrogenase, stage, bulky disease and performance status and gives an indication for low risk and high risk mortality.
Aims
To evaluate departmental adherence to national guidelines specifically focusing on the management of high risk and frail individuals. Also to study the trends between the prognostic scores and characteristics of patients who developed complications and mortality.
Methods
Data was collected from electronic records of 48 patients at Wigan Royal Infirmary. 32 Patients before Guidelines and 17 patients post guidelines
Results
93 %(14 of 15) of WHO performance scores were not calculated post guidelines as compared to 66%(21 of 32) pre guidelines. 86% of patients above 65 years, did not have scores but incidentally had above stage three disease and more than two comorbidities, classing them frail. 33% of these did not receive GCSF or steroid prophylaxis. 29% of patients without a score died and 14% relapsed. 67% (10 of 15) of patients developed complications such as Neutropenic sepsis, oesophageal ulcers, recurrent infections, pulmonary embolisms and superior vena cava thromboses. No prognostic scores were calculated in this group hence the difficulty in understanding whether certain individuals would have benefited from appropriate prophylaxis. However 60% (6 of 10) of patients with complications had high co-morbidities numbers and were complicated by 3 deaths. There was a 19% mortality (6 of 32) pre guidelines of which 34% had an IPI score of Intermediate risk and 33% were under the age of 51. Mortality post guidelines were 46 %( 7 of 15) of which 57% (4) were under the age of 51years. Out of these young mortalities, one case was given steroid prophylaxis and 1 case had a low risk IPI.
Conclusion
This small capture of data may give an indication of how the current IPI score may not encompass all the key characteristics that predict high mortality. With surplus deaths in ages below 65; this may also indicate the need to expand the criteria for individuals who might benefit from prophylaxis treatment. Further study into characteristics of young mortality, associated family history, autoimmune disease, weight and occupational exposures can guide better management of potential high risk individuals. The numbers of non-adherence to the guidelines in this data set may also indicate the need to evaluate how long it takes for guidelines to be practiced and whether alternate means of education and delivery is needed apart from publishing.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical