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Introduction: Extranodal (EN) involvement in diffuse large B-cell lymphoma (DLBCL) carries poor prognosis. Both the number and the specific sites of EN involvement are important in predicting prognosis. Given that the epidemiologic pattern of DLBCL in India is different from the rest of the world and such data correlations are scarce from developing countries, we aimed to find out if specific site and number of EN involvement could predict survival in DLBCL. Methods: Patients with DLBCL treated with combination chemotherapy plus rituximab were included. Site and number of EN involvement were noted. Univariate analysis for survival was performed for EN involvement or not, specific site of involvement, and number of EN involvement (0/1 vs. ≥2). Results: Among a total of 177 patients, 92 (52%) patients had EN disease. When patients with 2 or more EN sites were compared against patients with 0 or 1 site, there was significant reduction in both progression-free survival (PFS) and overall survival (OS) (3-year OS of 55% vs. 79%, P = 0.001, 3-year PFS of 42% vs. 65%, P = 0.001). When specific EN sites were studied for correlation with survival, involvement of skin/soft tissue, and serosa were associated with significant reduction in 3-year OS (33% vs. 74%, P = 0.011, and 63% vs. 75%, P = 0.03, respectively) and 3-year PFS (25% vs. 62%, P < 0.001, and 46% vs. 62%, P = 0.01, respectively). Conclusion: Two or more EN sites in DLBCL predicted inferior survival. Serosal and skin/soft tissue involvement also predicted poor survival.

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Background. The role of systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) remains to be defined. This prospective, observational study was designed to analyse the hypothesis that inflammatory biomarkers in stable COPD can be used as measure of disease severity and risk of exacerbation.Methods. We conducted a case-control study in a tertiary care, university-affiliated hospital. COPD patients and controls were matched for sex and age in a 1:1 matching ratio. All COPD patients included in the study had to be clinically stable without a history of exacerbation in the last four weeks and should not have been on oral steroid therapy (in the last 4 weeks) or on long-term oxygen therapy. We included only those patients who had quit smoking. Fibrinogen levels and pulmonary function tests were performed in both the groups. Results.The mean plasma fibrinogen level, total leucocyte count, neutrophil count and erythrocyte sedimentation rate in patients with COPD were significantly higher than that of controls (p=0.001). The study also showed a significant association between plasma fibrinogen levels with severity of COPD (p<0.001) and number of exacerbations in the previous year (p=0.001).Conclusions. Patients with COPD had significantly higher levels of inflammatory markers than healthy individuals. Plasma fibrinogen level was significantly higher in higher Global Initiative for Chronic Obstructive Lung Disease GOLD class and with more number of prior exacerbations. Hence, fibrinogen may act as a surrogate marker of disease activity in patients with COPD and may help to risk stratify COPD patients for future exacerbations.