الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 112 |  |  |
| | | from | 112 | | |
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common
form of NHL, accounting for about 22 % of newly diagnosed cases of Bcell
NHL in the United States. DLBCL occurs in both men and women,
although it is slightly more common in men. Although DLBCL can occur
in childhood, its incidence generally increases with age, and roughly half
of patients are over the age of 60 . DLBCL is an aggressive (fastgrowing)
lymphoma that can arise in lymph nodes or outside of the
lymphatic system, in the GIT, testes, thyroid, skin, breast, bone, or brain.
High dose chemotherapy supported by autologous stem cell
transplantation (HDT/ASCT) has been a standard of care over the last
two decades in patients with relapsed or refractory DLBCL sensitive to
salvage chemotherapy.
In the current study we aimed to study the outcome of autologous
stem cell transplantation in DLBCL in Egypt according to the experience
of two centers Naser Institute and Sheikh Zayed BMT units where 123
patients diagnosed as DLBCL (according to the 2008 WHO classification
of lymphoma) during the period from 2012-2018 were included.
Patients were staged at time of diagnosis according to the Ann
Arbor staging system by physical examination , CT of neck , chest ,
abdomen and pelvis and bone marrow examination .Performance status
was assessed according to ECOG PS scale.
Before ASCT all patients were subjected to : thorough medical
history taking & complete physical examination , Routine investigations
(CBC, ESR , Blood grouping , Complete virological markers including :-
PCR for HCV , HBcAb , HIV Ab , Toxoplasma IgG&IgM , CMV IgG&IgM , LDH , Liver function tests (AST , ALT , Albumin ,Bilirubin
total & direct) and Renal function tests.
Mobilization protocol in all patients who underwent HDC/ASCT
was G-CSF 10microgram/Kg for 5 days and stem cells were collected
from either bone marrow or peripheral blood through daily apharesis
sessions to reach a dose of at least 3.4x10`6 CD 34 cells / Kg.
Response assessment of HDC/ASCT was done with physical
examination , CT assessment and engraftment speed of neutrophils &
platelets.
The current study revealed :- the age of patients with DLBCL
who underwent HDC/ASCT range between 20y-74y,with Male/Female
ratio was about 1.8/1 .
There is no statistical significance regarding the blood group of
studied patients.
There is no statistical significance regarding the virological
profile of studied patients except HCV PCR (P-value 0.006).
There is no statistical significance regarding the bone marrow
involvement& cellularity of the studied patients.
There is statistical significance (P value = 0.002) regarding Ann-
Arbor stage of the disease in the studied patients , and also , there is
statistical significance (P value 0.0001) regarding the degree of the
disease at time of ASCT in the studied patients.
There is no statistical significance regarding the conditioning
regimen used before ASCT in the studied patients .
There is no statistical significance regarding the engraftment
speed of neutrophils in relation to virological state of the studied patients. There is no statistical significance regarding the engraftment
speed of platelets in relation to virological state of the studied group .
There is stastical significance (p-value 0.039) in the 5yrs overall
survival of studied patients in relation to the ABO system.
There is no stastical significance in the 5yrs OS of studied
patients in relation to of bone marrow cellularity or bone marrow
infiltration .
There is no stastical significance of the 5yrs OS in relation to the
disease status at time of transplant and the Ann Arbor stage at time of
diagnosis .
There is stastical & clinical significance (P-value= 0.002) in the
5yrs OS of studied patients in relation to the conditioning regimen used in
the pre-transplant phase.
There is no stastical significance of the 5yrs OS of studied
patients in relation to the engraftment speed of neutrophils but there is
stastical significance (P-value=0.018) in relation to the engraftment speed
of platelets.
from the current study, we concluded that : HDC/ASCT
increases the survival rates in patients with relapsed DLBCL in
chemosensitive patients.
The outcomes of HDC/ASCT in DLBCL depend on :-
1- Blood group ( especially for blood group B)
2- The conditioning regimens used (especially the BEAM regimen)
3- The engraftment speed of platelets (especially the time of ≥15
days)
While the outcomes of HDC/ASCT in DLBCL don’t depend on :-
1- Virological profile of the patient.
2- Bone marrow involvement and bone marrow cellularity.
3- Ann Arbor stage at time of diagnosis.
4- Disease status at time of ASCT.
5- The engraftment speed of neutrophils.
Recommendations:-
1- HDC/ASCT is the standard therapy for adults with relapsed
DLBCL as it increases the survival rates.
2- Better documentation of data obtained from patients before , during
and after the process of hematopoietic stem cell transplantation.
3- Include more BMT units in national studies.