51
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Chen CY, Huang SY, Cheng A, Chou WC, Yao M, Tang JL, Tsay W, Sheng WH, Tien HF. High Risk of Hepatitis B Reactivation among Patients with Acute Myeloid Leukemia. PLoS One 2015; 10:e0126037. [PMID: 25973905 PMCID: PMC4431821 DOI: 10.1371/journal.pone.0126037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/27/2015] [Indexed: 12/18/2022] Open
Abstract
Background Hepatitis B virus (HBV) infections are common and associated with significant morbidity and mortality in cancer patients. However, the incidence and risk factors of HBV reactivation in patients with acute myeloid leukemia (AML) are rarely investigated. Methods AML patients followed-up at the National Taiwan University Hospital between 2006 and 2012 were analyzed. The clinical characteristics and laboratory data were retrospectively reviewed. Results Four hundred and ninety patients comprising 265 men and 225 women were studied. The median age was 52 years (range, 18 - 94). Chronic HBV carriage was documented at the time of leukemia diagnosis in 57 (11.6%) patients. Forty-six (80.7%) of the 57 HBV carriers received prophylaxis with anti-HBV agents. Sixteen HBV carriers (28.1%) developed hepatitis B reactivation during or after chemotherapy, including 7 patients who had discontinued antiviral therapy. The incidence of hepatitis B reactivation among AML patients with HBV carriage was 9.5 per 100 person-years. Prophylaxis with anti-HBV agents significantly decreased the risk of hepatitis B reactivation among HBV carriers (13% vs. 61%, p<0.001). Four (2.8%) of 142 patients with initial positive anti-HBsAb and anti-HBcAb experienced hepatitis B reactivation and lost their protective anti-HBsAb. Multivariate analysis revealed that diabetes mellitus (p=0.008, odds ratio (OR) = 2.841, 95% confident interval (CI): 0.985-8.193) and carriage of HBsAg (p<0.001, OR=36.878, 95% CI: 11.770-115.547) were independent risk factors for hepatitis B reactivation in AML patients. Conclusions Hepatitis B reactivation is not uncommon in the HBsAg positive AML patients. Prophylaxis with anti-HBV agent significantly decreased the risk of hepatitis B reactivation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Viral/blood
- Antineoplastic Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Female
- Follow-Up Studies
- Hepatitis B/complications
- Hepatitis B/diagnosis
- Hepatitis B/drug therapy
- Hepatitis B/epidemiology
- Hepatitis B virus/drug effects
- Hepatitis B virus/isolation & purification
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/virology
- Male
- Middle Aged
- Taiwan/epidemiology
- Virus Activation/drug effects
- Young Adult
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Affiliation(s)
- Chien-Yuan Chen
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Yi Huang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Aristine Cheng
- Division of Infectious disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chien Chou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Luh Tang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Tai- Cheng stem cell therapy center, National Taiwan University Hospital, Taipei, Taiwan
| | - Woei Tsay
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Division of Infectious disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Shrestha R, Bhatt VR, Guru Murthy GS, Armitage JO. Clinicopathologic features and management of blastoid variant of mantle cell lymphoma. Leuk Lymphoma 2015; 56:2759-67. [PMID: 25747972 DOI: 10.3109/10428194.2015.1026902] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The blastoid variant of mantle cell lymphoma (MCL), which accounts for less than one-third of MCL, may arise de novo or as a transformation from the classical form of MCL. Blastoid variant, which predominantly involves men in their sixth decade, has frequent extranodal involvement (40-60%), stage IV disease (up to 85%) and central nervous system (CNS) involvement. Diagnosis relies on morphological features and is challenging. Immunophenotyping may display CD23 and CD10 positivity and CD5 negativity in a subset. Genetic analysis demonstrates an increased number of complex genetic alterations. Blastoid variant responds poorly to conventional chemotherapy and has a short duration of response. Although the optimal therapy remains to be established, CNS prophylaxis and the use of aggressive immunochemotherapy followed by autologous stem cell transplant may prolong the remission rate and survival. Further studies are crucial to expand our understanding of this disease entity and improve the clinical outcome.
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Affiliation(s)
- Rajesh Shrestha
- a Department of Internal Medicine , Memorial Hospital of Rhode Island , Pawtucket , RI , USA
| | - Vijaya Raj Bhatt
- b Department of Internal Medicine , Division of Hematology-Oncology, University of Nebraska Medical Center , Omaha , NE , USA
| | | | - James O Armitage
- b Department of Internal Medicine , Division of Hematology-Oncology, University of Nebraska Medical Center , Omaha , NE , USA
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53
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Martin N, Borchiellini D, Coso D, Gastaud L, Boscagli A, Saudes L, Re D, Gutnecht J, Garnier G, Petit E, Barriere J, Naman H, Rossignol B, Thyss A, Peyrade F. High-dose chemotherapy with carmustine, etoposide, cytarabine and melphalan followed by autologous stem cell transplant is an effective treatment for elderly patients with poor-prognosis lymphoma. Leuk Lymphoma 2015; 56:2379-87. [PMID: 25563428 DOI: 10.3109/10428194.2014.1001987] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Autologous stem cell transplant (ASCT) after high-dose chemotherapy (HDT) increases overall survival when used in relapsed non-Hodgkin lymphoma (NHL) in patients under 65 years old. Limited experience is available for older patients. We present a retrospective analysis of 73 consecutive patients aged over 65 years treated for aggressive or relapsed lymphoma by HDT with carmustine, etoposide, cytarabine and melphalan (BEAM) at full dosage followed by ASCT. Patient data were obtained from medical charts from two institutions. Median age was 67 years (65-74). Significant comorbidities were present in 24.7% of patients. The median number of days for grade 4 neutropenia was 9 (5-18). The early treatment-related mortality rate (<100 days) was 2.7%. The estimated 2-year progression-free survival and overall survival rates were 67.2% and 78.5%, respectively. In conclusion, the full-dose HDT-ASCT regimen is feasible, safe and efficient in selected patients over 65 years old.
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Affiliation(s)
- Nicolas Martin
- a Department of Oncology , Antoine-Lacassagne Center , Nice , France
| | | | - Diane Coso
- b Department of Hematology , Paoli-Calmettes Institute , Marseille , France
| | - Lauris Gastaud
- a Department of Oncology , Antoine-Lacassagne Center , Nice , France
| | - Annick Boscagli
- a Department of Oncology , Antoine-Lacassagne Center , Nice , France
| | | | - Daniel Re
- d Department of Oncology , Antibes-Juan-les-Pins Hospital , France
| | - Jean Gutnecht
- e Department of Oncology , Frejus-Saint Raphael Hospital , France
| | - Georges Garnier
- f Department of Oncology , Princesse Grace Hospital Center , Monaco
| | - Emmanuel Petit
- g Department of Oncology , Oxford Clinic , Cannes , France
| | - Jèrôme Barriere
- h Department of Oncology , St-Jean Polyclinic , Cagnes-sur-Mer , France
| | - Hervé Naman
- i Azurean Center of Oncology , Mougins , France
| | | | - Antoine Thyss
- a Department of Oncology , Antoine-Lacassagne Center , Nice , France
| | - Frederic Peyrade
- a Department of Oncology , Antoine-Lacassagne Center , Nice , France
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Abstract
Mantle cell lymphoma as a rare non-Hodgkin B-cell lymphoma can present in different clinical presentations such as an aggressive form or a more indolent picture. Treatment modality is based on multiple factors including age, presence or absence of symptoms, and comorbidities. Watchful waiting is a reasonable approach for asymptomatic patients especially in elderly. In symptomatic patients, treatment is chemo-immunotherapy followed by maintenance immunotherapy or autologous bone marrow transplant. Allogeneic bone marrow transplant has a potential benefit of cure for relapsed/refractory cases, but it has a high mortality rate. Novel treatment with agents such as ibrutinib, a Bruton tyrosine kinase inhibitor, has shown promising results in relapse/refractory cases. We extensively review the most recent data on diagnostic and therapeutic management of mantle cell lymphoma through presenting two extreme clinical scenarios.
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Affiliation(s)
- Babak Rajabi
- University of Nevada School of Medicine, 2040 West Charleston Boulevard, Las Vegas, NV 89102, USA
| | - John W Sweetenham
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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55
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Lifting the mantle: Unveiling new treatment approaches in relapsed or refractory mantle cell lymphoma. Blood Rev 2014; 29:143-52. [PMID: 25468719 DOI: 10.1016/j.blre.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/06/2014] [Accepted: 10/10/2014] [Indexed: 11/20/2022]
Abstract
The management of relapsed/refractory mantle cell lymphoma (MCL) remains a clinical challenge. A standard second-line treatment for relapsed/refractory MCL does not exist. Management of relapsed/refractory MCL requires an individualized treatment approach, incorporating factors such as: functional status, prior treatments, response to prior therapies, and disease biology. Generally, there are two categories of salvage therapy; the first, non-cross-resistant cytotoxic chemotherapeutic agents and, the second, pathway-targeted agents. For transplant eligible patients, the optimal therapy usually consists of salvage, remission re-induction phase followed, whenever possible, by a consolidation phase. Bendamustine and/or high dose cytarabine plus rituximab based chemotherapy represent the most common salvage therapy with an overall response rate of 70-80%. Consolidation with a reduced intensity conditioning allogeneic stem cell transplantation represents the only potentially curative treatment. Overall survival ranges from 30% to 50% at 5 years with this approach. For transplant ineligible patients, ibrutinib is the most effective treatment with an overall response rate of almost 70% and median response duration of 17.5 months. Lacking an effective consolidation, this approach is not considered curative. In this review we characterize the main therapeutic approaches available in this setting and summarize our preferred clinical treatment approach.
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56
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Sun D, Smith MR. Bortezomib for the treatment of mantle cell lymphoma. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.974553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Iams W, Reddy NM. Consolidative autologous hematopoietic stem-cell transplantation in first remission for non-Hodgkin lymphoma: current indications and future perspective. Ther Adv Hematol 2014; 5:153-67. [PMID: 25324956 DOI: 10.1177/2040620714547327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The non-Hodgkin lymphomas (NHLs) are a heterogeneous group of diseases with variable clinical outcomes. Autologous hematopoietic stem-cell transplantation (ASCT) as frontline, consolidative therapy has been evaluated based upon histological subtype of NHL. In this review, we summarize the major clinical trials guiding the use of frontline ASCT in NHL. With the constantly changing landscape of upfront therapy and multiple promising novel agents, the ability to conduct randomized trials to evaluate the benefit of consolidative ASCT is not only challenging but may be considered by some an inept utilization of resources. Our recommendation for consolidative ASCT is based on analyzing the current available data.
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Affiliation(s)
- Wade Iams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nishitha M Reddy
- Vanderbilt University Medical Center, 3927 The Vanderbilt Clinic, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
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58
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Furtado M, Johnson R, Kruger A, Turner D, Rule S. Addition of bortezomib to standard dose chop chemotherapy improves response and survival in relapsed mantle cell lymphoma. Br J Haematol 2014; 168:55-62. [PMID: 25146720 DOI: 10.1111/bjh.13101] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/26/2014] [Indexed: 11/28/2022]
Abstract
The proteasome inhibitor, bortezomib, potentially increases cell sensitivity to chemotherapy. This study was performed to determine the overall response rate (ORR), overall survival (OS), progression-free survival (PFS) and toxicity of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) compared to CHOP + bortezomib chemotherapy in mantle cell lymphoma (MCL) patients at first relapse. Forty-six patients were randomly assigned to standard dose CHOP ± bortezomib 1·6 mg/m(2) given on a 21-d cycle for up to eight cycles of treatment. Median age was 71 years (CHOP arm) and 69 years (CHOP-bortezomib arm). Median Eastern Cooperative Oncology Group performance status was 1 (CHOP) and 0 (CHOP-bortezomib) with 65% and 52%, respectively, having a disease stage of IV. ORR was 47·8% (CHOP) and 82·6% (CHOP-bortezomib). Complete response rate was 21·7% (CHOP) vs. 34·8% (CHOP-bortezomib); partial response rate was 26·1% (CHOP) vs. 47·8% (CHOP-bortezomib). Median OS was 11·8 months (CHOP) and 35·6 months (CHOP-bortezomib) (P = 0·01, Hazard ratio [HR] 0·37 [95% confidence interval (CI) 0·16-0·83)] and there was a non-significant improvement in PFS: 8·1 months (CHOP) and 16·5 months (CHOP-bortezomib) [P = 0·12, HR 0·60 (95% CI 0·31-1·15)]. Severe (≥grade 3) sensory neuropathy was similar in both arms (4·3% CHOP vs. 6·5% CHOP-bortezomib). We conclude that the addition of bortezomib to CHOP chemotherapy for relapsed MCL significantly improves outcome with a manageable increase in toxicity.
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59
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Nastoupil LJ, Shenoy PJ, Ambinder A, Koff JL, Nooka AK, Waller EK, Langston A, Seward M, Kaufman JL, Bernal-Mizrachi L, King N, Lechowicz MJ, Lonial S, Sinha R, Flowers CR. Intensive chemotherapy and consolidation with high dose therapy and autologous stem cell transplant in patients with mantle cell lymphoma. Leuk Lymphoma 2014; 56:383-9. [PMID: 24828864 DOI: 10.3109/10428194.2014.921296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mantle cell lymphoma (MCL) remains incurable with conventional chemotherapy without consensus on the optimal initial treatment. We examined our single center experience with frontline therapy for patients with MCL in consecutive cases diagnosed 1995-2011. Among 81 patients, median age was 59 (28% were ≥65 years of age), 95% had stage III/IV disease and 54% had a low risk MCL International Prognostic Index score. Thirty-five percent (n=28) received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and 65% received R-HCVAD (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with high-dose methotrexate/cytarabine; n=53). Forty-one patients were consolidated with autologous stem cell transplant (ASCT). There were no significant differences in 2-year survival for R-CHOP versus R-HCVAD (p=0.10) or for ASCT versus observation (p=0.06). After controlling for clinical factors, R-HCVAD followed by ASCT was associated with superior progression-free survival (hazard ratio 0.26, 95% confidence interval 0.09-0.75).
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Affiliation(s)
- Loretta J Nastoupil
- Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine , Atlanta, GA , USA
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Chen Y, Wang M, Romaguera J. Current regimens and novel agents for mantle cell lymphoma. Br J Haematol 2014; 167:3-18. [PMID: 24974852 DOI: 10.1111/bjh.13000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 05/28/2014] [Indexed: 02/02/2023]
Abstract
Mantle cell lymphoma is a heterogeneous subtype of non-Hodgkin lymphoma. Conventional treatment with immunochemotherapy followed by autologous stem cell transplantation or intensive immunochemotherapy alone has improved outcomes, but the disease remains incurable. Recent advances in basic and translational research have significantly enhanced our understanding of disease pathogenesis and have sparked the development of novel therapies. Novel agents include the proteasome inhibitor bortezomib, the immunomodulatory agent lenalidomide, the phosphatidylinositol-4,5-bisphosphate 3-kinase pathway inhibitor idelalisib and the Bruton tyrosine kinase inhibitor ibrutinib. Preliminary results from clinical trials, especially from studies of ibrutinib, have proven these agents to be effective. In ongoing studies, these agents are being integrated into conventional immunochemotherapy regimens to hopefully improve patient outcomes.
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Affiliation(s)
- Yiming Chen
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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61
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Desai M, Newberry K, Ou Z, Wang M, Zhang L. Lenalidomide in relapsed or refractory mantle cell lymphoma: overview and perspective. Ther Adv Hematol 2014; 5:91-101. [PMID: 24883181 PMCID: PMC4031905 DOI: 10.1177/2040620714532124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Lenalidomide, a novel immunomodulatory agent, was approved by the US Food and Drug Administration for the treatment of myelodysplastic syndrome and relapsed multiple myeloma. Data from preclinical studies paved the way for clinical trials of lenalidomide in mantle cell lymphoma (MCL). Initial phase I and II clinical trials of lenalidomide alone and as part of combination regimens in patients with relapsed/refractory MCL have shown promising results. Its immunomodulatory, T cell costimulatory, anti-inflammatory and anti-angiogenic actions working together in the tumor cell microenvironment seem to be responsible for its enhanced antitumor efficacy. Lenalidomide's nature of action and safety profile favor it over other agents studied in relapsed/refractory MCL. This review summarizes the data from preclinical and clinical studies of lenalidomide in relapsed/refractory MCL and compares the results with those of other novel agents being used for relapsed/refractory MCL.
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Affiliation(s)
- Madhav Desai
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate Newberry
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhishuo Ou
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liang Zhang
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit Number: 0429, Houston, TX 77030, USA
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Shah N, Rule S. Management perspective for mantle cell lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.13.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Mantle cell lymphoma (MCL) is genetically characterized by the t(11;14) (q13;q32) translocation resulting in the overexpression of cyclin D1. It generally has an aggressive clinical course with a poor prognosis. However, there is now a recognized subgroup with clinically indolent MCL. Management of MCL can be challenging. Early recognition of young and fit patients for potential intensive therapy and autologous stem cell transplant is important. Combination of rituximab with high-dose cytarabine should be used in upfront therapy for appropriate patients. In elderly and/or less fit patients, chemoimmunotherapy may be considered. Novel agents offer promising potential in the management of MCL and are likely to change the way it is treated.
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Affiliation(s)
- Nimish Shah
- Department of Haematology, Derriford Hospital, Derriford, Plymouth, PL6 8DH, UK
| | - Simon Rule
- University of Plymouth, Schools of Medicine & Dentistry, UK
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63
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Yuan S, Wang S, Salhotra A, Nademanee A. Plerixafor to the rescue: boosting peripheral blood stem cell mobilization in patients previously treated with hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate, cytarabine (Hyper-CVAD) chemotherapy. Leuk Lymphoma 2013; 55:1557-62. [PMID: 24067136 DOI: 10.3109/10428194.2013.847937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate, cytarabine (Hyper-CVAD) chemotherapy exerts deleterious effects on peripheral blood stem cell (PBSC) mobilization. We retrospectively reviewed the use of plerixafor to salvage mobilization in 18 Hyper-CVAD treated patients who initially mobilized poorly with chemotherapy and granulocyte colony stimulating factor (G-CSF). After plerixafor administration the median peripheral blood (PB) CD34 + count rose from 3.74/μL (0-17/μL) to 6.85/μL (0-47.2/μL). The patients collected a median of 1.64 (0.21-5.56) × 10(6) CD34 + cells/kg with a median number of 3 (1-4) doses in the same collection cycle, and 11 patients reached the 2.0 × 10(6) CD34 + cells/kg minimum required for transplant. Six patients were remobilized later with G-CSF and plerixafor, and three additional patients reached this goal. For these 14 patients the median number of doses of plerixafor required to reach 2.0 × 10(6) CD34 + cells/kg was 3 (range 1-4). In conclusion, plerixafor can be utilized successfully in many cases to overcome the effects of Hyper-CVAD on PBSC mobilization.
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Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine
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64
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Doorduijn JK, Kluin-Nelemans HC. Management of mantle cell lymphoma in the elderly patient. Clin Interv Aging 2013; 8:1229-36. [PMID: 24072968 PMCID: PMC3783516 DOI: 10.2147/cia.s35082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Mantle cell lymphoma is a relatively rare B-cell lymphoma with a specific genetic lesion and a typical immunophenotypic profile. The median age is 65 years. There is no curative treatment, except allogeneic stem cell transplantation for a selected group of patients. For the majority of patients, especially the elderly, the aim of therapy should therefore be a long progression-free survival. Age and comorbidity may hamper the use of the most active treatment regimen, such as high dose cytarabine and autologous stem cell transplantation. Therefore, it is a challenge to select the most appropriate therapy for an elderly patient. Studies specifically designed for elderly patients are rare. A recently performed large randomized study for elderly patients, however, has shown that R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy followed by maintenance rituximab can result in a long progression-free survival. For patients too frail for R-CHOP chemotherapy, a treatment should be offered that benefits the patient in reducing the symptoms of the disease without causing too many side effects. Progression or relapse will occur in all patients sooner or later. Second-line treatment should again be carefully selected. Several options are mentioned. New drugs are being developed, and new combinations are investigated. Further improvement in the outcome of patients with mantle cell lymphoma is expected. Participation in well-designed clinical trials, also by elderly patients, is important to find the real benefit that can be achieved, and to get information on the tolerability of these treatments in this age group.
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Goy A, Sinha R, Williams ME, Kalayoglu Besisik S, Drach J, Ramchandren R, Zhang L, Cicero S, Fu T, Witzig TE. Single-agent lenalidomide in patients with mantle-cell lymphoma who relapsed or progressed after or were refractory to bortezomib: phase II MCL-001 (EMERGE) study. J Clin Oncol 2013; 31:3688-95. [PMID: 24002500 DOI: 10.1200/jco.2013.49.2835] [Citation(s) in RCA: 267] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Although dose-intensive strategies or high-dose therapy induction followed by autologous stem-cell transplantation have improved the outcome for patients with mantle-cell lymphoma (MCL), most eventually relapse and subsequently respond poorly to additional therapy. Bortezomib (in the United States) and temsirolimus (in Europe) are currently the only two treatments approved for relapsed disease. Lenalidomide is an immunomodulatory agent with proven tumoricidal and antiproliferative activity in MCL. The MCL-001 (EMERGE) trial is a global, multicenter phase II study examining the safety and efficacy of lenalidomide in patients who had relapsed or were refractory to bortezomib. PATIENTS AND METHODS Lenalidomide 25 mg orally was administered on days 1 through 21 every 28 days until disease progression or intolerance. Primary end points were overall response rate (ORR) and duration of response (DOR); secondary end points included complete response (CR) rate, progression-free survival (PFS), overall survival (OS), and safety. RESULTS In all, 134 patients were enrolled with a median age of 67 years and a median of four prior therapies (range, two to 10 prior therapies). The ORR was 28% (7.5% CR/CR unconfirmed) with rapid time to response (median, 2.2 months) and a median DOR of 16.6 months (95% CI, 7.7 to 26.7 months). Median PFS was 4.0 months (95% CI, 3.6 to 5.6 months), and median OS was 19.0 months (95% CI, 12.5 to 23.9 months). The most common grade 3 to 4 adverse events were neutropenia (43%), thrombocytopenia (28%), anemia (11%), pneumonia (8%), and fatigue (7%). CONCLUSION The MCL-001 study demonstrated durable efficacy of lenalidomide with a predictable safety profile in heavily pretreated patients with MCL who had all relapsed or progressed after or were refractory to bortezomib.
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Affiliation(s)
- Andre Goy
- Andre Goy, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack; Lei Zhang, Sherri Cicero, and Tommy Fu, Celgene, Summit, NJ; Rajni Sinha, Emory University Winship Cancer Institute, Atlanta, GA; Michael E. Williams, University of Virginia Health System, Charlottesville, VA; Sevgi Kalayoglu Besisik, Istanbul University Faculty of Medicine, Istanbul, Turkey; Johannes Drach, Medical University of Vienna, Vienna, Austria; Radhakrishnan Ramchandren, Karmanos Cancer Institute, Detroit, MI; and Thomas E. Witzig, Mayo Clinic, Rochester, MN
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66
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Autologous stem cell transplantation in mantle cell lymphoma: a report from the SFGM-TC. Ann Hematol 2013; 93:233-42. [DOI: 10.1007/s00277-013-1860-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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Clinical practice guidelines for diagnosis, treatment, and follow-up of patients with mantle cell lymphoma. Recommendations from the GEL/TAMO Spanish Cooperative Group. Ann Hematol 2013; 92:1151-79. [PMID: 23716187 DOI: 10.1007/s00277-013-1783-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/02/2013] [Indexed: 12/22/2022]
Abstract
Mantle cell lymphoma (MCL) is considered a distinct type of B-cell lymphoma genetically characterized by the t(11;14) translocation and cyclin D1 overexpression. There is also a small subset of tumors negative for cyclin D1 expression that are morphologically and immunophenotypically indistinguishable from conventional MCL. Although in the last decades, the median overall survival of patients with MCL has improved significantly, it is still considered as one of the poorest prognoses diseases among B-cell lymphomas. Election of treatment for patients with MCL is complex due to the scarcity of solid evidence. Current available data shows that conventional chemotherapy does not yield satisfactory results as in other types of B-cell lymphomas. However, the role of other approaches such as autologous or allogenic stem cell transplantation, immunotherapy, the administration of consolidation or maintenance schedules, or the use of targeted therapies still lack clear indications. In view of this situation, the Spanish Group of Lymphomas/Autologous Bone Marrow Transplantation has conducted a series of reviews on different aspects of MCL, namely its diagnosis, prognosis, first-line and salvage treatment (both in young and elderly patients), new targeted therapies, and detection of minimal residual disease. On the basis of the available evidence, a series of recommendations have been issued with the intention of providing guidance to clinicians on the diagnosis, treatment, and monitoring of patients with MCL.
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Abstract
Mantle cell lymphoma (MCL) represents about 5% to 9% of all non-Hodgkin lymphomas according to the World Health Organization. The clinical presentation typically consists of diffuse lymphadenopathy and frequent extranodal involvement of the gastrointestinal tract, blood, and bone marrow, as well as frequent splenomegaly. The median survival with standard immunochemotherapy is approximately 3 to 5 years. High-dose chemotherapy and autologous stem cell transplantation (ASCT) have been used either in first partial or complete remission or at the time of relapse in an attempt to prolong the survival for patients with MCL. Autologous SCT has had disappointing results in patients with relapsed MCL with the expected progression-free survival approximately 20% to 40% in most trials. Therefore, most centers now consider ASCT for eligible MCL patients during first remission. If a complete remission can be obtained with the induction chemotherapy, the clinical results following ASCT in complete remission 1 are improved to 60% to 80% progression-free survival greater than 5 years. However, the median age of patients with MCL is older than 60 years, which does not allow ASCT to be used in all patients with MCL. Research is now focused on reducing the relapse rate after transplantation.
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Williams ME, Bernstein SH, Jares P, Kahl BS, Witzig TE, Gordon LI. Recent advances in mantle cell lymphoma: report of the 2012 Mantle Cell Lymphoma Consortium Workshop. Leuk Lymphoma 2013; 54:1882-90. [PMID: 23363271 DOI: 10.3109/10428194.2013.771400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma characterized by overexpression of cyclin D1 and the t(11;14)(q13;q32) chromosomal translocation. MCL is biologically and clinically heterogeneous and frequently disseminates to extranodal areas. While a subset of patients have an indolent clinical course, the overall outcome for patients with MCL remains poor. There is no proven curative therapy, and no standard of care has been established for initial or subsequent lines of therapy. Several regimens are highly active in previously untreated patients, and recent research has led to improvements in currently available therapy. Moreover, investigational agents have recently demonstrated promising activity in clinical trials. A workshop was held to review recent data on MCL pathogenesis, novel molecular targets and alternative approaches to immunotherapy, and to discuss recent and ongoing clinical trials in MCL. The presentations are summarized in this article, which is intended to highlight areas of active investigation and identify important avenues for future research.
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Forbes A, Farrell K, McKay P, Bolam S, Rule S. High dose cytarabine with rituximab is an effective first-line therapy for mantle cell lymphoma and produces ample stem cell harvest yields after multiple chemotherapy cycles. Leuk Lymphoma 2013; 54:2303-5. [DOI: 10.3109/10428194.2013.769536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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71
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Li ZM, Zucca E, Ghielmini M. Open questions in the management of mantle cell lymphoma. Cancer Treat Rev 2013; 39:602-9. [PMID: 23415066 DOI: 10.1016/j.ctrv.2012.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/28/2012] [Accepted: 12/31/2012] [Indexed: 11/25/2022]
Abstract
Mantle cell lymphoma (MCL) is one of the lymphomas with the worse prognosis (median survival 3-5years) as it has an aggressive evolution and at the same time is incurable. Biologically it is characterized by the t(11;14)(q13;q32) translocation leading to overexpression of cyclin D1. This review focuses on a number of controversial issues in the management of this disease, as how to stage patients with a disease which often has extranodal localizations, how to recognize the small subgroup of cases with an indolent course, which treatment is suggested for the young and fit or for the elderly, the role of CNS prophylaxis, rituximab maintenance and radiotherapy, the indications to allogeneic transplantation and the place of new active anti-lymphoma drugs.
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Affiliation(s)
- Zhi-Ming Li
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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72
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McKay P, Leach M, Jackson R, Cook G, Rule S. Guidelines for the investigation and management of mantle cell lymphoma. Br J Haematol 2012; 159:405-26. [PMID: 22994971 DOI: 10.1111/bjh.12046] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- P McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Gartnavel Hospital, Glasgow, UK
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74
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Deng C, Lee S, O'Connor OA. New Strategies in the Treatment of Mantle Cell Lymphoma. Clin Cancer Res 2012; 18:3499-508. [DOI: 10.1158/1078-0432.ccr-11-3152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Mantle cell lymphoma (MCL) represents a subtype of non-Hodgkin's lymphoma (NHL) which has a relatively poor prognosis compared to other forms of NHL. Despite multiple options for cytotoxic chemotherapy, attempts to prolong the survival of patients with this disease have not yet met with success. Consequently, the development of targeted approaches to therapy which minimize toxicities has potentially important implications for MCL. Proteasome inhibitors preferentially kill transformed cells through diverse mechanisms. The proteasome inhibitor bortezomib was initially approved for patients with relapsed or refractory multiple myeloma and now has been approved for relapsed or refractory MCL. The introduction of newer proteasome inhibitors with activity in bortezomib-resistant disease and reduced toxicity profiles may yield further benefits. Multiple ongoing studies are building on the known efficacy of proteasome inhibitors in MCL by evaluating combination regimens involving either cytotoxic or targeted therapies, with the ultimate goal of prolonging survival in this patient population.
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Affiliation(s)
- Beata Holkova
- Division of Hematology/Oncoloogy, Department of Internal Medicine, Virginia Commonwealth Health Sciences System
| | - Steven Grant
- Division of Hematology/Oncoloogy, Department of Internal Medicine, Virginia Commonwealth Health Sciences System
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Houot R, Le Gouill S, Ojeda Uribe M, Mounier C, Courby S, Dartigeas C, Bouabdallah K, Alexis Vigier M, Moles M, Tournilhac O, Arakelyan N, Rodon P, El Yamani A, Sutton L, Fornecker L, Assouline D, Harousseau J, Maisonneuve H, Caulet-Maugendre S, Gressin R. Combination of rituximab, bortezomib, doxorubicin, dexamethasone and chlorambucil (RiPAD+C) as first-line therapy for elderly mantle cell lymphoma patients: results of a phase II trial from the GOELAMS. Ann Oncol 2012; 23:1555-61. [DOI: 10.1093/annonc/mdr450] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Geisler CH. Autologous transplantation and management of younger patients with mantle cell lymphoma. Best Pract Res Clin Haematol 2012; 25:211-20. [DOI: 10.1016/j.beha.2012.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cassaday RD, Gopal AK. Allogeneic hematopoietic cell transplantation in mantle cell lymphoma. Best Pract Res Clin Haematol 2012; 25:165-74. [PMID: 22687452 DOI: 10.1016/j.beha.2012.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mantle cell lymphoma (MCL) is a high-risk non-Hodgkin lymphoma that is considered incurable with standard chemotherapy. While autologous hematopoietic cell transplantation (autoHCT) can provide lengthy disease-free survival in select patients, cure generally is not an expected outcome with this approach. Allogeneic hematopoietic cell transplantation (alloHCT), which can exploit the potential benefits of graft-versus-lymphoma (GVL) effect, has been shown in multiple studies to yield a small but reproducible portion of patients with long-term remission more suggestive of cure. Historically, alloHCT for MCL was administered after myeloablative conditioning, but this approach was limited by early non-relapse mortality. Development of reduced-intensity (RI)-alloHCT has abrogated some of the early post-transplant risks, allowing this potentially effective therapy to be offered to a larger number of affected individuals. The trends in published data reflect a preference toward using RI-alloHCT for MCL, often because patients in whom alloHCT is being considered have relapsed disease following myeloablative autoHCT. Further efforts to spare the effects of graft-versus-host disease (GVHD) while still evoking GVL remain a focus of investigation in this area. In this review, we will discuss the application of alloHCT in the management of MCL, the factors associated with outcome, the different methods in which it can be performed, and the strategies that can be employed in post-alloHCT relapse.
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Affiliation(s)
- Ryan D Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA
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79
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Räty R, Honkanen T, Jantunen E, Jyrkkiö S, Karjalainen-Lindsberg ML, Kuittinen O, Lehto M, Mikkola M, Poikonen E, Rauhala A, Rimpiläinen J, Räsänen A, Siitonen S, Suominen M, Vapaatalo M, Elonen E. Prolonged immunochemotherapy with rituximab, cytarabine and fludarabine added to cyclophosphamide, doxorubicin, vincristine and prednisolone and followed by rituximab maintenance in untreated elderly patients with mantle cell lymphoma: a prospective study by the Finnish Lymphoma Group. Leuk Lymphoma 2012; 53:1920-8. [PMID: 22397313 DOI: 10.3109/10428194.2012.672736] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is no consensus on treatment strategies for elderly patients with mantle cell lymphoma (MCL). In this prospective phase II study we investigated whether the poor outcome could be improved, with reasonable toxicity, by prolonging the immunochemotherapy. Ten cycles of alternating cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)/cytarabine (AraC) with eight doses of rituximab (R) were given as induction. The potential synergism of intermediate-dose AraC and fludarabine was tested in cycles 6-8. Induction was followed by bimonthly rituximab maintenance for 2 years. The median age of the 60 included patients was 74 years, and the Mantle Cell Lymphoma International Prognostic Index (MIPI) was intermediate or high risk in 98% of the patients. The overall response rate was 95% (complete response/complete response unconfirmed 87%). The response of 11 patients improved with cycles 6-8 (R-fludarabine-AraC). Progression-free survival was 70% and overall survival 72% at 4 years, respectively. Treatment related mortality was 2%. Severe infections were rare, with only one grade 4 infection. More dose reductions were needed during fludarabine-containing courses as compared to R-AraC. In 20 patients a transient grade 4 neutropenia without severe infections was recorded during maintenance. In conclusion, elderly patients with MCL can be treated relatively intensively with acceptable toxicity.
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Affiliation(s)
- Riikka Räty
- Department of Hematology, Helsinki University Central Hospital, Helsinki, Finland.
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Alonso JJ, Cánovas A, Barreiro JG, Aguirre C. Infectious complications of chemotherapy in clinically aggressive mature B and T cell lymphomas. Eur J Intern Med 2012; 23:255-60. [PMID: 22385884 DOI: 10.1016/j.ejim.2011.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Scientific literature on infectious complications of chemotherapy in lymphomas is often based on retrospective studies or clinical trials performed with selected patients. This population may not be representative of the routine clinical practice. We aimed to analyse the incidence and type of infections associated to standard chemotherapy in clinically aggressive mature B and T cell lymphomas (AMBTL) and to detect baseline variables predictive of the risk of infection in a cohort of unselected patients. METHODS A prospective observational study of all the patients treated with first line chemotherapy for AMBTL in our Lymphoma Unit, in the setting of a community based teaching hospital, was performed. The statistical methods were univariate and multivariate analyses. RESULTS 183 infectious episodes were registered in 97 (49%) of the 198 patients. Seventy-nine of them (43%) were associated to febrile neutropenia (27% of the patients). Microbiological documentation was obtained in 46% and only clinical documentation in 15%; 39% were classified as fever of unknown origin. Gram negative bacilli were the predominant aetiology. There were several variables related to risk of infection, but in multivariate analysis only a poor initial performance status was predictive of the risk of febrile neutropenia and infection during the first line chemotherapy. CONCLUSIONS In our cohort of AMBTL patients treated with first line chemotherapy, more than half of the relevant infections occurred without febrile neutropenia. A poor performance status was the only independent variable associated with the risk of febrile neutropenia or infection in the course of first line chemotherapy.
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Affiliation(s)
- Juan José Alonso
- Department of Internal Medicine, Hospital de Cruces, Osakidetza, Vizcaya, Spain.
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81
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Le Gouill S, Kröger N, Dhedin N, Nagler A, Bouabdallah K, Yakoub-Agha I, Kanouni T, Bulabois CE, Tournilhac O, Buzyn A, Rio B, Moles MP, Shimoni A, Bacher U, Ocheni S, Milpied N, Harousseau JL, Moreau P, Leux C, Mohty M. Reduced-intensity conditioning allogeneic stem cell transplantation for relapsed/refractory mantle cell lymphoma: a multicenter experience. Ann Oncol 2012; 23:2695-2703. [PMID: 22440229 DOI: 10.1093/annonc/mds054] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite therapeutic approach that combines rituximab-containing chemotherapy, followed or not by autologous stem cell transplantation (auto-SCT), mantle cell lymphoma (MCL) patients experience relapses. Reduced-intensity conditioning allogeneic stem cell transplantation (RIC-allo-SCT) at time of relapse may represent an attractive strategy. PATIENTS AND METHODS We report a multicenter retrospective analysis. Seventy MCL patients underwent RIC-allo-SCT in 12 centers. RESULTS Median age at transplantation was 56 years and median time from diagnosis to transplantation was 44 months. The median number of previous therapies was 2 (range, 1-5) including autologous transplantation in 47 cases. At time of transplantation, 35 patients were in complete remission, 20 were in partial response and 15 in stable disease or progressive disease. The median follow-up for living patients was 24 months. The 2-year event-free survival (EFS) and overall survival (OS) rates were 50% and 53%, respectively. The 1- and 2-year transplant-related mortality rates were 22% and 32%, respectively. The statistical analysis demonstrated that disease status at transplantation was the only parameter influencing EFS and OS. CONCLUSIONS These results suggest that RIC-allo-SCT may be an effective therapy in MCL patients with a chemo-sensitive disease at time of transplantation, irrespective of the number of lines of prior therapy. Studies are warranted to investigate the best type of RIC regimen.
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Affiliation(s)
- S Le Gouill
- Division of Hematology, University of Nantes, Hôtel-Dieu, Nantes; Centre de recherches en Cancérologie Nantes/Angers, INSERM, UMR 892, équipe 10, UFR Médecine et Techniques Médicales, Université de Nantes, Nantes; Centre d'Investigation Clinique en Cancérologie (CI2C); Unité de Recherche clinique en onco-hématologie, University of Nantes, Nantes, France.
| | - N Kröger
- Bone Marrow Transplantation Unit, University of Hamburg, Hamburg, Germany
| | - N Dhedin
- Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - A Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - K Bouabdallah
- Division of Hematology, University of Bordeaux, Pessac
| | | | - T Kanouni
- Division of Hematology, University of Montpellier, Montpellier
| | | | - O Tournilhac
- Division of Hematology, University of Clermont-Ferrand, Clermont-Ferrand
| | - A Buzyn
- Hôpital Necker-Enfants malades
| | | | - M P Moles
- Division of Hematology, University of Angers, Angers
| | - A Shimoni
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - U Bacher
- Bone Marrow Transplantation Unit, University of Hamburg, Hamburg, Germany
| | - S Ocheni
- Bone Marrow Transplantation Unit, University of Hamburg, Hamburg, Germany
| | - N Milpied
- Division of Hematology, University of Bordeaux, Pessac
| | | | - P Moreau
- Division of Hematology, University of Nantes, Hôtel-Dieu, Nantes; Unité de Recherche clinique en onco-hématologie, University of Nantes, Nantes, France
| | - C Leux
- Cancer Registry of Loire-Atlantique and Vendée, Nantes, France
| | - M Mohty
- Division of Hematology, University of Nantes, Hôtel-Dieu, Nantes; Centre d'Investigation Clinique en Cancérologie (CI2C); Unité de Recherche clinique en onco-hématologie, University of Nantes, Nantes, France
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82
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Holman PR, Costello C, deMagalhaes-Silverman M, Corringham S, Castro J, Ball ED. Idiotype Immunization Following High-Dose Therapy and Autologous Stem Cell Transplantation for Non-Hodgkin Lymphoma. Biol Blood Marrow Transplant 2012; 18:257-64. [DOI: 10.1016/j.bbmt.2011.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/27/2011] [Indexed: 11/26/2022]
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83
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Jantunen E, Canals C, Attal M, Thomson K, Milpied N, Buzyn A, Ferrant A, Biron P, Crawley C, Schattenberg A, Luan JJ, Tilly H, Rio B, Wijermans PW, Dreger P, Sureda A. Autologous stem-cell transplantation in patients with mantle cell lymphoma beyond 65 years of age: a study from the European Group for Blood and Marrow Transplantation (EBMT). Ann Oncol 2012; 23:166-171. [PMID: 21467125 DOI: 10.1093/annonc/mdr035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Limited experience is available on the feasibility and efficacy of autologous stem-cell transplantation (ASCT) in patients with mantle cell lymphoma (MCL) beyond 65 years. DESIGN AND METHODS We analysed 712 patients with MCL treated with ASCT from 2000 to 2007 and reported to the European Group for Blood and Marrow Transplantation registry. Patients>65 years were compared with patients<65 years for the end points non-relapse mortality (NRM), relapse incidence, progression-free survival (PFS), and overall survival (OS). RESULTS Seventy-nine patients were ≥65 years old. Median time from diagnosis to ASCT was longer in the elderly patients (11 versus 9 months, P=0.005); they had more commonly received at least two treatment lines (62.0% versus 47.9%, P=0.02) and were less commonly in first complete remission at ASCT (35.4% versus 51.2%, P=0.002). Median follow-up after ASCT was 19 and 25 months, respectively. NRM was comparable at 3 months (3.8% versus 2.5%) and at 5 years (5.6% versus 5.0%). There were no differences in relapse rate (66% versus 55% at 5 years), PFS (29% versus 40%) and OS (61% versus 67%) between both populations of patients. CONCLUSION ASCT beyond 65 years of age is feasible in selected patients with MCL and results in similar disease control and survival as in younger patients.
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Affiliation(s)
- E Jantunen
- Department of Medicine, Institute of Clinical Medicine, University of Eastern Finland and Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - C Canals
- EBMT Lymphoma Working Party, Barcelona, Spain
| | - M Attal
- Department of Hematology, Hopital de Purpan, CHU, Toulouse, France
| | - K Thomson
- Department of Hematology, University College London Hospital, London, UK
| | - N Milpied
- Department of Hematology, Hopital Haut-Leveque, CHU Bordeaux, Pessac, France
| | - A Buzyn
- Department of Hematology, Hopital Necker, Paris, France
| | - A Ferrant
- Department of Hematology, Cliniques Universitaires St Luc, Brussels, Belgium
| | - P Biron
- Department of Hematology, Centre Leon Bernard, Lyon, France
| | - C Crawley
- Department of Hematology, Addenbrookes Hospital, Cambridge, UK
| | - A Schattenberg
- Department of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J J Luan
- EBMT Data Office, Faculté de Médecine Saint-Antoine, Paris, France
| | - H Tilly
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - B Rio
- Department of Hematology, Hotel Dieu, Paris, France
| | - P W Wijermans
- Department of Hematology, Hague Hospital, The Hague, The Netherlands
| | - P Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A Sureda
- Department of Hematology, Addenbrookes Hospital, Cambridge, UK; Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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84
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Chan A, Ng TRD, Yap KYL. Clinically–relevant anticancer-antidepressant drug interactions. Expert Opin Drug Metab Toxicol 2011; 8:173-99. [DOI: 10.1517/17425255.2012.645804] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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85
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Mato AR, Svoboda J, Feldman T, Zielonka T, Agress H, Panush D, Miller M, Toth P, Lizotte PM, Nasta S, Goldberg S, Chong E, Schuster S, Pecora AL, Goy A. Post-treatment (not interim) positron emission tomography-computed tomography scan status is highly predictive of outcome in mantle cell lymphoma patients treated with R-HyperCVAD. Cancer 2011; 118:3565-70. [DOI: 10.1002/cncr.26731] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/17/2011] [Accepted: 10/11/2011] [Indexed: 11/09/2022]
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86
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Merli F, Luminari S, Ilariucci F, Petrini M, Visco C, Ambrosetti A, Stelitano C, Caracciolo F, Di Renzo N, Angrilli F, Carella AM, Capodanno I, Barbolini E, Galimberti S, Federico M. Rituximab plus HyperCVAD alternating with high dose cytarabine and methotrexate for the initial treatment of patients with mantle cell lymphoma, a multicentre trial from Gruppo Italiano Studio Linfomi. Br J Haematol 2011; 156:346-53. [PMID: 22145911 DOI: 10.1111/j.1365-2141.2011.08958.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study investigated the clinical activity and toxicity of R-HCVAD-AM [rituximab plus HyperCVAD (R-HCVAD) alternating with high-dose cytarabine and methotrexate (AM)] in patients with newly diagnosed Mantle Cell Lymphoma (MCL). Patients aged ≤70years with confirmed MCL received four alternating cycles each of R-HCVAD and AM. Patients who obtained a partial response proceeded to autologous stem cell transplant. Sixty-three patients were enrolled and 60 were fully eligible. Median age was 57years (22-66); 60%, 33% and 7% were classified at low (L)-, intermediate (I)- or high (H)-risk, respectively, according to the MCL International Prognostic Index (MIPI). Only 22 patients (37%) completed the four cycles and three patients died during therapy. Overall response and complete response rates were 83% and 72% respectively. After a median follow-up of 46months (range 1-72) the estimated 5-year overall survival (OS) and progression-free survival rates were 73% [95% confidence interval (CI) 59-83%], and 61% (95%CI 45-73%) respectively. MIPI maintained the prognostic value with an estimated 5-year OS of 89%, 80% and 24% for L, I, and H groups respectively (P<0·001). This multicentre study confirms that R-HCVAD-AM is an active regimen for the initial treatment of patients with MCL, but is associated with significant toxicity.
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Affiliation(s)
- Francesco Merli
- Ematologia, Dipartimento Oncologico, Azienda Ospedaliera Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.
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87
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Liu H, Johnson JL, Koval G, Malnassy G, Sher D, Damon LE, Hsi ED, Bucci DM, Linker CA, Cheson BD, Stock W. Detection of minimal residual disease following induction immunochemotherapy predicts progression free survival in mantle cell lymphoma: final results of CALGB 59909. Haematologica 2011; 97:579-85. [PMID: 22102709 DOI: 10.3324/haematol.2011.050203] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the present study, the prognostic impact of minimal residual disease during treatment on time to progression and overall survival was analyzed prospectively in patients with mantle cell lymphoma treated on the Cancer and Leukemia Group B 59909 clinical trial. DESIGN AND METHODS Peripheral blood and bone marrow samples were collected during different phases of the Cancer and Leukemia Group B 59909 study for minimal residual disease analysis. Minimal residual disease status was determined by quantitative polymerase chain reaction of IgH and/or BCL-1/JH gene rearrangement. Correlation of minimal residual disease status with time to progression and overall survival was determined. In multivariable analysis, minimal residual disease, and other risk factors were correlated with time to progression. RESULTS Thirty-nine patients had evaluable, sequential peripheral blood and bone marrow samples for minimal residual disease analysis. Using peripheral blood monitoring, 18 of 39 (46%) achieved molecular remission following induction therapy. The molecular remission rate increased from 46 to 74% after one course of intensification therapy. Twelve of 21 minimal residual disease positive patients (57%) progressed within three years of follow up compared to 4 of 18 (22%) molecular remission patients (P=0.049). Detection of minimal residual disease following induction therapy predicted disease progression with a hazard ratio of 3.7 (P=0.016). The 3-year probability of time to progression among those who were in molecular remission after induction chemotherapy was 82% compared to 48% in patients with detectable minimal residual disease. The prediction of time to progression by post-induction minimal residual disease was independent of other prognostic factors in multivariable analysis. CONCLUSIONS Detection of minimal residual disease following induction immunochemotherapy was an independent predictor of time to progression following immunochemotherapy and autologous stem cell transplantation for mantle cell lymphoma.
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Affiliation(s)
- Hongtao Liu
- University of Chicago Medical Center 5841, S. Maryland Ave, MC2115 Chicago, IL 60637, USA
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Jantunen E, Sureda A. The evolving role of stem cell transplants in lymphomas. Biol Blood Marrow Transplant 2011; 18:660-73. [PMID: 21963876 DOI: 10.1016/j.bbmt.2011.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 09/10/2011] [Indexed: 10/17/2022]
Abstract
Autologous stem cell transplantation (ASCT) is an established therapeutic modality in the treatment of lymphomas, especially in the relapse setting. It is also under investigation after first-line therapy, for example, in patients with mantle cell or T cell lymphomas. Each year more than 6000 autotransplants for lymphomas are reported to the European Blood and Marrow Transplantation (EBMT) registry. The number of allogeneic stem cell transplantations (alloSCT) in lymphoma patients has increased over the last decade, with about 1200 transplanted lymphoma patients annually reported to the registry. Optimal timing and indications for alloSCT are not well defined because of absence of randomized trials. Developments in the treatment of lymphomas including immunotherapy have changed the clinical scenarios in regard to ASCT, and many published studies are now outdated. On the other hand, patients relapsing after immunochemotherapy may derive less benefit from ASCT. Consequently, there is an increasing interest in using alloSCT not only in lymphoma patients relapsing after ASCT but also in earlier phases in specific circumstances. Although curative potential is higher with alloSCT compared with ASCT, its wider use has been hindered by excessive nonrelapse mortality (NRM). Along with decreasing NRM figures, popularity of alloSCT may increase in the near future, possibly with the expense of ASCT. Prospective, randomized studies are needed to evaluate feasibility and efficacy of alloSCT in several clinical settings, as most published evidence is based on retrospective registry data or single-center experiences.
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Affiliation(s)
- Esa Jantunen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
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Budde LE, Guthrie KA, Till BG, Press OW, Chauncey TR, Pagel JM, Petersdorf SH, Bensinger WI, Holmberg LA, Shustov AR, Green DJ, Maloney DG, Gopal AK. Mantle cell lymphoma international prognostic index but not pretransplantation induction regimen predicts survival for patients with mantle-cell lymphoma receiving high-dose therapy and autologous stem-cell transplantation. J Clin Oncol 2011; 29:3023-9. [PMID: 21730271 DOI: 10.1200/jco.2010.33.7055] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High-dose therapy (HDT) and autologous stem-cell transplantation (ASCT) are frequently used in an attempt to improve outcome in patients with mantle-cell lymphoma (MCL); however, the importance of intensive induction regimens before transplantation is unknown. PATIENTS AND METHODS To address this question, we evaluated baseline characteristics, time to treatment, induction regimen, disease status at the time of transplantation, and MIPI score at diagnosis and their associations with survival in 118 consecutive patients with MCL who received HDT and ASCT at our centers. RESULTS The MIPI was independently associated with survival after transplantation in all 118 patients (hazard ratio [HR], 3.5; P < .001) and in the 85 patients who underwent ASCT as initial consolidation (HR, 7.2; P < .001). Overall survival rates were 93%, 60%, and 32% at 2.5 years from ASCT for all patients with low-, intermediate-, and high-risk MIPI, respectively. Low-risk MIPI scores were more common in the intensive induction group than the standard induction group in all patients (64% v 46%, respectively; P = .03) and in the initial consolidation group (66% v 45%, respectively; P = .03). After adjustment for the MIPI, an intensive induction regimen was not associated with improved survival after transplantation in all patients (HR, 0.5; P = .10), the initial consolidation group (HR, 1.1; P = .86), or patients ≤ 60 years old (HR, 0.6; P = .50). Observation of more than 3 months before initiating therapy did not yield inferior survival (HR, 2.1; P = .12) after adjustment for the MIPI in patients receiving ASCT. CONCLUSION An intensive induction regimen before HDT and ASCT was not associated with improved survival after adjusting for differences in MIPI scores at diagnosis.
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Le Gouill S, Mohty M, Guillaume T, Gastinne T, Moreau P. Allogeneic Stem Cell Transplantation in Mantle Cell Lymphoma: Where Are We Now and Which Way Should We Go? Semin Hematol 2011; 48:227-39. [DOI: 10.1053/j.seminhematol.2011.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Harel S, Delarue R, Ribrag V, Dreyling M, Hermine O. Treatment of Younger Patients With Mantle Cell Lymphoma. Semin Hematol 2011; 48:194-207. [DOI: 10.1053/j.seminhematol.2011.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Cortelazzo S, Ponzoni M, Ferreri AJM, Dreyling M. Mantle cell lymphoma. Crit Rev Oncol Hematol 2011; 82:78-101. [PMID: 21658968 DOI: 10.1016/j.critrevonc.2011.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 05/02/2011] [Accepted: 05/04/2011] [Indexed: 10/25/2022] Open
Abstract
MCL is a well-characterized clinically aggressive lymphoma with a poor prognosis. Recent research findings have slightly improved the outcome of this neoplasm. The addition of rituximab to conventional chemotherapy has increased overall response rates, but it does not improve overall survival with respect to chemotherapy alone. The use of intensive frontline therapies including rituximab and consolidated by ASCT ameliorates response rate and prolongs progression-free survival, but any impact on survival remains to be proven. Furthermore, the optimal timing, cytoreductive regimen and conditioning regimen, and the clinical implications of achieving a disease remission even at molecular level remain to be elucidated. The development of targeted therapies as the consequence of better dissection of pathogenetic pathways in MCL might improve the outcome of conventional chemotherapy in most patients and spare the toxicity of intense therapy in a minority of MCL patients characterized by a relatively indolent disease. Patients not eligible for intensive regimens, such as hyperC-VAD, may be considered for less demanding therapies, such as the combination of rituximab either with CHOP or with purine analogues, or bendamustine. Allogeneic SCT can be an effective option for relapsed disease in patients who are fit enough and have a compatible donor. Maintenance rituximab may be considered after response to immunochemotherapy for relapsed disease, although there are currently no data to recommend this approach as the first-line strategy. As the optimal approach to the management of MCL is still evolving, it is critical that these patients be enrolled in clinical trials to identify better treatment options.
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Affiliation(s)
- Sergio Cortelazzo
- Hematology and Bone Marrow Transplantation Unit, Azienda Ospedaliera Bolzano, Italy
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93
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Williams ME, Dreyling M, Winter J, Muneer S, Leonard JP. Management of mantle cell lymphoma: key challenges and next steps. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 10:336-46. [PMID: 21030346 DOI: 10.3816/clml.2010.n.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mantle cell lymphoma (MCL) is regarded as an aggressive lymphoid malignancy that exhibits varied clinical behavior and prognoses, reflecting the biologic heterogeneity of the disease. In most cases, patients with MCL achieve a shorter median survival compared with more common B-cell lymphomas, such as follicular lymphoma, and are less likely to achieve a durable response with chemotherapy. Currently, there is no defined standard of care for patients with MCL. Rituximab-containing immunochemotherapy strategies are commonly used, but the addition of rituximab to conventional induction chemotherapy has produced suboptimal responses that are relatively short-lived and have not resulted in a survival advantage. Further intensification of the chemotherapy component, including autologous stem cell transplantation, has increased response and survival rates but has not proven to be curative while being associated with higher toxicity. Clearly, there is a need for developing novel agents and strategies that will improve clinical outcomes for patients with MCL. Targeted therapies and new cytotoxic agents are showing great promise and may have a role in maintenance and/or initial therapy. This summary highlights current challenges in the management of MCL, and outlines expert perspectives, key questions, and future directions. For the third consecutive year, a panel of global experts in MCL assembled to deliberate on topical issues in MCL including advances in pathobiology, strategies for risk-adapted therapy, front-line treatment options, consolidation approaches, and novel therapeutic strategies. The proceedings of this workshop, held December 3, 2009 in New Orleans, LA, are summarized here. It must be emphasized that this synopsis is not meant to serve as an exhaustive review of MCL biology and management, but is a distillation of the expert discussions, highlighting key questions and future directions identified.
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Matsuki E, Miyakawa Y, Asakawa S, Tsukada Y, Yamada T, Yokoyama K, Kudoh J, Ikeda Y, Okamoto S. Identification of Loss of p16 Expression and Upregulation of MDR-1 as Genetic Events Resulting from Two Novel Chromosomal Translocations Found in a Plasmablastic Lymphoma of the Uterus. Clin Cancer Res 2011; 17:2101-9. [DOI: 10.1158/1078-0432.ccr-10-2945] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Mantle cell lymphoma (MCL) is an uncommon subtype of B-cell lymphomathat is characterized by monoclonal B cells that express CD5 on their surface, but not CD23, and harbor the t(11:14) chromosomal translocation that leads to dysregulated expression of cyclin D1. MCL is a biologically and clinically heterogeneous disease. It has the unfavorable characteristics of both aggressive and indolent lymphoma in that MCL is not curable with current standard therapy, yet patients have a shorter survival compared with other indolent histology. MCL is incurable, yet more intensive therapy does lead to longer disease-free intervals; therefore, treatment must be designed to optimize survival while maintaining quality of life. Thus, therapy should be individualized based on both the clinical behavior of the lymphoma and the patient’s status. While there is no clear standard therapy that can be recommended for all patients, there may be an optimal choice for each patient. Knowledge of the expected clinical benefits and toxicities of various approaches will allow the physician and patient to appropriately select the therapy.
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Affiliation(s)
- Mitchell R Smith
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, PA 19111 USA
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Andorsky DJ, Cohen M, Naeim A, Pinter-Brown L. Outcomes of auto-SCT for lymphoma in subjects aged 70 years and over. Bone Marrow Transplant 2010; 46:1219-25. [PMID: 21151188 DOI: 10.1038/bmt.2010.289] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The safety and efficacy of auto-SCT for lymphoma in older patients is not well established, particularly in those ≥70 years old. We performed a retrospective analysis comparing 17 auto-SCT recipients ≥70 years old with 39 recipients aged 65-69 years. Hematopoietic cell transplantation comorbidity index (HCT-CI) scores were similar in both groups. Nonrelapse mortality (NRM) was increased in patients aged 70 years and older (hazard ratio (HR) 6.04, P=0.0029), and OS was decreased (HR 1.98, P=0.082). 1-year NRM was 35% in patients aged ≥70 years vs 8% in those aged 65-69 years (P=0.017). The incidence of in-hospital falls was higher in those aged ≥70 years (29 vs 8%, P=0.047). In a secondary exploratory analysis, we found that the occurrence of in-hospital falls was strongly associated with inferior OS (HR 3.36, P=0.0023) and NRM (HR 4.60, P=0.009) among all patients of aged 65 years and older. We conclude that auto-SCT is feasible in older patients but that mortality rates appear increased in those over age of 70 years. In-hospital falls were correlated with higher mortality, and prevention of falls may improve outcomes. Susceptibility to falls may indicate underlying frailty and should be explored prospectively as a means of selecting older patients for auto-SCT.
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Affiliation(s)
- D J Andorsky
- Division of Hematology and Oncology, UCLA Medical Center, Los Angeles, CA 90035, USA
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Dietrich S, Tielesch B, Rieger M, Nickelsen M, Pott C, Witzens-Harig M, Kneba M, Schmitz N, Ho AD, Dreger P. Patterns and outcome of relapse after autologous stem cell transplantation for mantle cell lymphoma. Cancer 2010; 117:1901-10. [PMID: 21509767 DOI: 10.1002/cncr.25756] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 09/09/2010] [Accepted: 09/21/2010] [Indexed: 12/28/2022]
Abstract
BACKGROUND Autologous stem cell transplantation (autoSCT) has improved the outcome of patients with mantle cell lymphoma (MCL) considerably. However, little is known about the patterns and outcome of MCL recurrence after autoSCT. METHODS The authors conducted a retrospective study of 118 patients with MCL who underwent autoSCT from August 1992 to August 2008 at 3 different referral centers in Germany. RESULTS Fifty-two relapses occurred for a cumulative incidence of 46% after 5 years. Only 3 patients relapsed after 5 years (at 90 months, 91 months, and 171 months) after undergoing autoSCT. A Cox regression analysis of the incidence of relapse identified not receiving rituximab before autoSCT and undergoing salvage autoSCT as predictive factors for relapse, whereas cytosine arabinoside intensification; a total body irradiation-based, high-dose regimen; patient age; and year of transplantation had no influence. The median overall survival (OS) after relapse was 23 months. Twenty patients (39%) underwent allogeneic stem cell transplantation (alloSCT) for relapse, and 11 of those patients remained in ongoing complete remission at the time of the current report. It is noteworthy that there were 4 long-term survivors who lived for >5 years after relapse even without undergoing alloSCT. A Cox regression analysis of OS after relapse revealed that the response duration after autoSCT was an adverse predictor of OS, whereas alloSCT was associated with a significantly longer OS after relapse. CONCLUSIONS The current results indicated that autoSCT was capable of inducing long-term remission up to 16 years after treatment, but the outcome of patients with MCL who relapsed after autoSCT was poor, especially if their response duration after autoSCT was short. However, for a subset of patients with relapsed MCL, alloSCT may offer the possibility of durable survival, and individual patients can enjoy long-term survival after relapse even without undergoing alloSCT.
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Affiliation(s)
- Sascha Dietrich
- Department of Hematology, University of Heidelberg, Heidelberg, Germany.
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Rodriguez J, Gutierrez A, Obrador-Hevia A, Fernandez de Mattos S, Cabanillas F. Therapeutic concepts in mantle cell lymphoma. Eur J Haematol 2010; 85:371-86. [DOI: 10.1111/j.1600-0609.2010.01515.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Iwamuro M, Okada H, Kawahara Y, Shinagawa K, Morito T, Yoshino T, Yamamoto K. Endoscopic features and prognoses of mantle cell lymphoma with gastrointestinal involvement. World J Gastroenterol 2010; 16:4661-9. [PMID: 20872966 PMCID: PMC2951516 DOI: 10.3748/wjg.v16.i37.4661] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the endoscopic manifestations and prognoses of gastrointestinal (GI) mantle cell lymphoma (MCL).
METHODS: A database search at the Department of Pathology of Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences revealed 57 MCL patients with GI involvement. Clinical records were available for 35 of the 57 patients from 21 institutions, and those 35 patients were enrolled in this study. We summarized the gross types of endoscopic features, event-free survival (EFS), and overall survival (OS) of those patients.
RESULTS: Of the 35 patients, GI involvement in the esophagus, stomach, and duodenum was found in 2 (5.7%), 26 (74.3%), and 12 (34.3%) patients, respectively. Twenty-one of the 35 patients underwent colonoscopy; among them, GI involvement in the ileum, cecum, colon, and rectum was found in 10 (47.6%), 3 (14.3%), 12 (57.1%), and 10 (47.6%), respectively. Various lesions, such as superficial, protruded, fold thickening, or ulcerative, were found in the stomach, whereas multiple lymphomatous polyposis (MLP) was dominant from the duodenum to the rectum. Twelve patients were treated with a hyper-CVAD/MA regimen, and they had better OS (3-year rate, 88.3% vs 46.4%, P < 0.01) and better EFS (3-year rate, 66.7% vs 33.8%, P < 0.05) than the remaining 23 patients who were not treated with this regimen.
CONCLUSION: MLP was a representative form of intestinal involvement, whereas a variety of lesions were found in the stomach. The hyper-CVAD/MA regimen may improve survival in these patients.
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Zain J, O'Connor O. Pralatrexate: basic understanding and clinical development. Expert Opin Pharmacother 2010; 11:1705-14. [PMID: 20509772 DOI: 10.1517/14656566.2010.489552] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Pralatrexate (PDX; 10-propargyl 10-deazaaminopterin), is an exciting new chemotherapeutic agent that is approved for the treatment of relapsed and refractory peripheral T-cell lymphomas (PTCL). This is the only approved therapy for patients with PTCL. AREAS COVERED IN THIS REVIEW This review describes the clinical development of PDX from its synthesis to its FDA approval. It details the biochemical basis of the differences between PDX and other antifolates that form the basis of the superiority of its activity. This is followed by a description of the preclinical data that led to early-phase clinical trials in lung cancer and lymphoma and, finally, the definitive trial that led to its approval in PTCL. The review also describes how PDX is being combined with other agents in both the preclinical and clinical arenas. WHAT THE READER WILL GAIN These trials have been instrumental in defining a safe dose as well as the safety profile of the agent. FDA approval for the use of PDX in PTCL has been granted based on the results of the pivotal Phase II trial of this agent in relapsed and refractory PTCL patients. TAKE HOME MESSAGE PDX is a unique antifolate that has been rationally designed to have a high affinity for the reduced folate receptor (RFC-1) and the enzyme folylpolyglutamy synthetase. It is active in T-cell lymphomas and non-small-cell lung cancer. It is now being studied in combination with other chemotherapeutic and targeted agents for the treatment of hematological malignancies.
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Affiliation(s)
- Jasmine Zain
- NYU Langone Medical Center-Hematology/Oncology, 160 East 34th Street, New York 10016, USA.
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