Sphincter preservation is feasible in more than 75% of patients with tumors < or = 8 cm from the anal verge after preoperative chemoradiotherapy. Sphincter-sparing surgery with distal margins < or = 1 cm can be used without adversely influencing local recurrence or DFS. Limited radial margins (< or = 3 mm), however, are associated with increased disease recurrence.

From 1996 to April 2006, 174 consecutive patients with relapsed or refractory diffuse large cell lymphoma (DLCL) and Hodgkin lymphoma (HL) received ESHAP as salvage and for mobilisation. Males 92, females 76. DLCL 64: HL 104, prior radiation in 35%. First relapse 45%, second relapse 12%, induction failure 43%. Median prior chemotherapy cycles were 6. Median age at apheresis was 26.5 years. Six patients failed mobilisation and 21 patients had CD34+ cells collection < 2 x 10(6)/kg on first apheresis. Median CD34+ cells/kg collection was 5.5 x 10(6)/kg for first apheresis and 6.7 x 10(6)/kg for all apheresis. We evaluated impact of histology, gender, age, stage, marrow involvement, prior radiation and chemotherapy cycles, timing (relapse1: relapse > 1: refractory), platelet count and weight. For first apheresis collection; all patients, younger age (p = 0.004), for DLCL (64), younger age (p = 0.021) and higher platelet count (p = 0.013) and for HL (104), younger age (p = 0.036) and male gender had better CD34+ cells collection. For all apheresis product, for all patients, age (p = 0.001) and no prior radiation therapy (p = 0.051) had better CD34+ cells collection. Higher first harvest CD34+ cells collection also resulted in early neutrophil (p < or = 0.001) and platelet (p = 0.004) engraftment.

T-cell/histiocyte-rich B-cell lymphoma (TC/HRBCL) is a rare subtype of diffuse large B-cell non-Hodgkin's lymphoma (DLBCL) with characteristic morphologic and immunophenotypic features, often misdiagnosed as Hodgkin's lymphoma and peripheral T-cell lymphoma. Few and conflicting clinical data are available in the literature addressing optimal treatment, prognosis and outcome. We retrospectively reviewed all patients diagnosed and managed at our institution between 1995 and 2004 diagnosed with T-cell-rich-B-cell lymphoma by WHO criteria. Sixty-one patients were identified. Initial pathology was incorrect in 82% of referred cases. The median age was 30 years. Seventy-one patients were males. Stage distribution was I - II in 21 patients, and III - IV in 40. Fifty-two percent of patients (32) had splenic involvement and thirty-seven patients (61%) presented with extranodal disease (22 >or= 2 sites). The International Prognostic Index (IPI) score was >or=2 in 62% of patients. All 59 newly diagnosed TC/HRBCL patients were treated with CHOP or R-CHOP combination chemotherapy +/- radiation therapy. The overall response rate was 85% and nine patients progressed on therapy. Fourteen patients relapsed with a median time of relapse of 6 months (range, 2 - 28). At a median follow-up of 22 months (range 1 - 132); 32 patients (52%) are alive with no evidence of disease. The 5-year overall survival and event free survival rates were 46% and 39% respectively. To conclude, TC/HRBCL is difficult to recognize without immunohistochemistry. It has an aggressive course and poor outcome; with most of patients presenting with advanced disease stage together with high IPI score. Treatment outcome seems to be similar to IPI matched DLBCL counterpart.

Hodgkin's lymphoma (HL) patients with positive 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) post salvage chemotherapy or before high-dose chemotherapy and auto-SCT (HDC ASCT) have inferior outcomes. We reviewed 21 prognostic factors before salvage chemotherapy (at relapse/progression) and integrated post salvage FDG-PET results to develop a prognostic model for post HDC ASCT outcome. We used Fine and Gray method for competing risk analysis and regression model for risks assessment and outcome. One hundred and forty-one patients had post salvage FDG-PET before HDC ASCT (median age 25.5 years); male/female 55%:45%, relapsed/refractory 43%:57%, median follow-up 33 months. Multivariate analysis identified HL International Prognostic Score X3 (P ¼ 0.001; hazard ratio (HR): 3.7 (1.6-8.3)) and post salvage positive FDG-PET (P ¼ 0.011; HR: 3.4 (1.3-8.9)) with higher hazard of disease-specific death (model P ¼ 0.0001). Cumulative incidence of disease-specific death with 0, 1, 2 risk factors was 7%:29%:52%, respectively (P ¼ 0.00003). For disease-specific event (persistent, progressive or relapsed disease), mediastinal involvement (P ¼ 0.024; HR: 2.7 (1.14-6.5)), B symptoms (P ¼ 0.027; HR: 2.1 (1.09-4.2)) and positive post salvage FDG-PET (P ¼ 0.001; HR: 3.3 (1.7-6.7)) were significant (model P ¼o0.00001). Cumulative incidence of disease-specific event with 0, 1, 2, 3 risk factors was 8%:31%:50%:75%, respectively (P ¼ 0.0000006). Patients with higher scores have higher risk of treatment failure. They are potential candidates for newer therapies along with HDC ASCT.