الفهرس 
EPIDEMIOLOGYOnly 14 pages are availabe for public view
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Abstract
Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) represent a heterogeneous group of malignant lymphoid proliferations of extra medullary origin. The etiology of non-Hodgkin lymphoma, as well as its global dramatic rise in incidence during the past decades, remains largely unexplained. The non-Hodgkin lymphomas (NHL) make up around 90%, and Hodgkin lymphoma (HL) account for the remaining 10% percent of all malignant lymphomas. NHL (excluding CLL and plasma cell malignancies) is more common in the developed world, with the highest incidence rates in the USA, Australia and New Zealand, and Europe, and the lowest in Eastern and South Central Asia. The most common NHL subtypes in developed countries (disregarding CLL and plasma cell entities) are diffuse large B-cell lymphoma (about 30%) and follicular lymphoma (about 20%). Egypt has one of the highest incidence rates of lymphoma in the world, mainly NHL, which is higher than even the United States as well as other developed nations where HCs are more common. In Egypt, NHL is the second most common cancer in adults and lymphoma is the most common cancer in children. Risk factors for lymphoma include immunosuppression, organ transplantation, infections like HCV, Helicobacter pylori & EBV & exposure to radiation and chemicals. The aim of this work is to update the frequencies of lymphoid malignancies in the past 5 years in our center in Gharbya, describe the epidemiology of lymphoma to summarize current evidence of associations with an array of known and possible etiologic factors. In addition, evaluate the different prognostic factors that affect the treatment results and to assess different treatment modalities, statistical analysis, treatment response and survival. This is a retrospective cohort study of patients with lymphoma .It was carried out on patients who attended Tanta university hospitals from January 2010 to December 2014. Inclusion criteria: 1. Patients with lymphoma who had been treated in Tanta university hospitals. 2. Age above 18 years Exclusion criteria: Any other blood malignancies. Patients with lymphoma who had been treated according to the NCC guidelines were retrospectively analyzed. We checked the files of the patients and determined: 1. The epidemiological data including age, sex. 2. Investigations including: past viral infections, tumor histology, immunophenotyping, lactate dehydrogenase, complete blood picture & bone marrow aspirate if done. 3. ECOG performance status. 4. Stage of the malignancy according to Ann Aarbor staging system. 5. Size of the primary lesion. 6. Treatment received and response to treatment. 7. Prognosis acoording to international prognostic index. 8. Overall survival (OAS) & progression free survival (PFS). We found no significant increase in the incidence of lymphoma over the years studied. NHL was found to be more common in the age group 40-60 years, which was against most other studies. This could be attributed to the lack of diagnostic facilities in rural areas. While HL was found to be more common below 40 years of age. Males were more affected with NHL, while HL was more common in females, although this is against most studies and could be attributed to the small size of our study. Most patients with NHL presented with a poor performance status (PS) of (2-3) 56%. NHL was more common in rural areas which was against most studies this is probably related to the improper handling of pesticides. Most Patients with HL presented with a good PS of (0-1) (64%).Stage upon presentation was mostly (I-II) 55% in NHL & 78% in HL. Most the patients presented with International prognostic index of (0-1) (35%) in NHL & (61%) for patients with HL. Most of the patients had no B symptoms 60%. In NHL 15% of patients showed extra nodal disease either alone or combined with nodal disease. Tumor size was less than 10 cm in 75% of NHL patients & in 78% of HL patients. In NHL 35% patients were found to be HCV positive vs only 5.5% of HL patients. The most common subtype of NHL was DLBCL 68.5% (100 cases), while in HL mixed cellularity was the most common subtype 71.5 (25 cases). All of our patients received chemotherapy. After the introduction of RCHOP for the treatment of NHL our CR rate increased from 50% to 80% vs CHOP only regimen, which agrees with most other studies. OS & PFS were 78% & 75% respectively at 3 years. Regarding HL Complete response rate was 84% after ABVD. CR was better in patients treated with RCHOP & CR, OAS & PFS were better in HCV –ve lymphoma patients.