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Khvorost D, Kendall B, Jazirehi AR. Immunotherapy of Hematological Malignancies of Human B-Cell Origin with CD19 CAR T Lymphocytes. Cells 2024; 13:662. [PMID: 38667277 PMCID: PMC11048755 DOI: 10.3390/cells13080662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL) are hematological malignancies with high incidence rates that respond relatively well to conventional therapies. However, a major issue is the clinical emergence of patients with relapsed or refractory (r/r) NHL or ALL. In such circumstances, opportunities for complete remission significantly decline and mortality rates increase. The recent FDA approval of multiple cell-based therapies, Kymriah (tisagenlecleucel), Yescarta (axicabtagene ciloleucel), Tecartus (Brexucabtagene autoleucel KTE-X19), and Breyanzi (Lisocabtagene Maraleucel), has provided hope for those with r/r NHL and ALL. These new cell-based immunotherapies use genetically engineered chimeric antigen receptor (CAR) T-cells, whose success can be attributed to CAR's high specificity in recognizing B-cell-specific CD19 surface markers present on various B-cell malignancies and the subsequent initiation of anti-tumor activity. The efficacy of these treatments has led to promising results in many clinical trials, but relapses and adverse reactions such as cytokine release syndrome (CRS) and neurotoxicity (NT) remain pervasive, leaving areas for improvement in current and subsequent trials. In this review, we highlight the current information on traditional treatments of NHL and ALL, the design and manufacturing of various generations of CAR T-cells, the FDA approval of Kymriah, Yescarta Tecartus, and Breyanzi, and a summary of prominent clinical trials and the notable disadvantages of treatments. We further discuss approaches to potentially enhance CAR T-cell therapy for these malignancies, such as the inclusion of a suicide gene and use of FDA-approved drugs.
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Affiliation(s)
- Darya Khvorost
- Department of Life Sciences, Los Angeles City College (LACC), 855 N. Vermont Ave., Los Angeles, CA 90029, USA or (B.K.)
| | - Brittany Kendall
- Department of Life Sciences, Los Angeles City College (LACC), 855 N. Vermont Ave., Los Angeles, CA 90029, USA or (B.K.)
| | - Ali R. Jazirehi
- Department of Life Sciences, Los Angeles City College (LACC), 855 N. Vermont Ave., Los Angeles, CA 90029, USA or (B.K.)
- Department of Biological Sciences, College of Natural and Social Sciences, California State University, Los Angeles (CSULA), Los Angeles, CA 90032, USA
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2
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Ramdany H, Lofaro T, Deplano S. The Haemato-Oncology Frailty (HOF) score to assess frailty in lymphoma. Eur J Haematol 2024; 112:611-620. [PMID: 38112247 DOI: 10.1111/ejh.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
Morbidity and mortality during chemotherapy in older adults with haematological malignancy can be unpredictable. The Haemato-Oncology Frailty (HOF) score was previously found to predict outcomes in a cohort of patients with plasma cell myeloma. In this study, we assess its utility in assessing frailty in patients with lymphoma, and compare its performance to that of two other frailty scores. The HOF score was able to predict progression-free survival in this population, and was also shown to have potential in assessing the dynamism of frailty during chemotherapy. It performed well when compared to the Charlson Comorbidity Index (CCI) score and the Haematopoietic Cell Transplantation-Specific Comorbidity Index (HCTCI), although the study was not powered to assess for non-inferiority. The HOF score is a new score with the potential for application in different haematological malignancies.
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Affiliation(s)
- Hena Ramdany
- Imperial College London, Isle of Wight NHS Trust, Newport, UK
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Chan JY, Somasundaram N, Grigoropoulos N, Lim F, Poon ML, Jeyasekharan A, Yeoh KW, Tan D, Lenz G, Ong CK, Lim ST. Evolving therapeutic landscape of diffuse large B-cell lymphoma: challenges and aspirations. Discov Oncol 2023; 14:132. [PMID: 37466782 PMCID: PMC10361453 DOI: 10.1007/s12672-023-00754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) represents the commonest subtype of non-Hodgkin lymphoma and encompasses a group of diverse disease entities, each harboring unique molecular and clinico-pathological features. The understanding of the molecular landscape of DLBCL has improved significantly over the past decade, highlighting unique genomic subtypes with implications on targeted therapy. At the same time, several new treatment modalities have been recently approved both in the frontline and relapsed settings, ending a dearth of negative clinical trials that plagued the past decade. Despite that, in the real-world setting, issues like drug accessibility, reimbursement policies, physician and patient preference, as well as questions regarding optimal sequencing of treatment options present difficulties and challenges in day-to-day oncology practice. Here, we review the recent advances in the therapeutic armamentarium of DLBCL and discuss implications on the practice landscape, with a particular emphasis on the context of the healthcare system in Singapore.
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Affiliation(s)
- Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore.
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Nicholas Grigoropoulos
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Francesca Lim
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Michelle Limei Poon
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Anand Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Kheng Wei Yeoh
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Division of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Daryl Tan
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Georg Lenz
- Department of Medicine A, Department of Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Choon Kiat Ong
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore.
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore.
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
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Bocci G, Pelliccia S, Orlandi P, Caridi M, Banchi M, Musuraca G, Di Napoli A, Bianchi MP, Patti C, Anticoli-Borza P, Battistini R, Casaroli I, Lanzolla T, Tafuri A, Cox MC. Remarkable Remission Rate and Long-Term Efficacy of Upfront Metronomic Chemotherapy in Elderly and Frail Patients, with Diffuse Large B-Cell Lymphoma. J Clin Med 2022; 11:7162. [PMID: 36498736 PMCID: PMC9739472 DOI: 10.3390/jcm11237162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/19/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
The upfront treatment of very elderly and frail patients with diffuse large B-cell lymphoma (DLBCL) is still a matter of debate. Herein, we report results of the metronomic all-oral DEVEC [prednisolone/deltacortene®, vinorelbine (VNR), etoposide (ETO), cyclophosphamide] combined with i.v. rituximab (R). This schedule was administered as a first line therapy in 22 elderly/frail DLBCL subjects (median age = 84.5 years). In 17/22 (77%) patients, the Elderly-IPI-score was high. After a median follow-up of 24 months, 15 patients had died: seven (50%) for causes unrelated to DLBCL or its treatment, six (40%) for progression, and two (13%) for multiorgan failure. Six treatment-pertinent serious-adverse-events occurred. At the end of induction, 14/22 (64%) achieved complete remission; overall survival and event-free survival at 24 months were both 54% (95% CI = 32−72%), while the time to progression was 74% (95% CI = 48−88%). Furthermore, antiproliferative and proapoptotic assays were performed on DLBCL/OCI-LY3 cell-line using metronomic VNR and ETO and their combination. Both metronomic VNR and ETO had concentration-dependent antiproliferative (IC50 = 0.036 ± 0.01 nM and 7.9 ± 3.6 nM, respectively), and proapoptotic activities in DLBCL cells. Co-administration of the two drugs showed a strong synergism (combination index < 1 and dose reduction index > 1) against cell proliferation and survival. This low-dose schedule seems to compare favourably with intravenous-CHEMO protocols used in the same subset. Indeed, the high synergism shown by metronomic VRN+ETO in in vitro studies, explains the remarkable clinical responses and it allows significant dose reductions.
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Affiliation(s)
- Guido Bocci
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Sabrina Pelliccia
- UOC Ematologia, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
| | - Paola Orlandi
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Matteo Caridi
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, 06125 Perugia, Italy
| | - Marta Banchi
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gerardo Musuraca
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) Srl—IRCCS, 47014 Meldola, Italy
| | - Arianna Di Napoli
- UOC Anatomia Patologica, Azienda Ospedaliera Universitaria Sant’Andrea & Department of Clinical and Molecular Medicine Sapienza University, 00185 Rome, Italy
| | - Maria Paola Bianchi
- UOC Ematologia, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
| | - Caterina Patti
- UOC Oncoematologia, Azienda Villa Sofia-Cervello, 90146 Palermo, Italy
| | | | | | - Ivana Casaroli
- Haematology Department, San Gerardo Hospital Monza, 20900 Monza, Italy
| | - Tiziana Lanzolla
- UOC Medicina Nucleare, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
| | - Agostino Tafuri
- UOC Ematologia, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
| | - Maria Christina Cox
- UOC Ematologia, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
- Hematology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
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Chuang TM, Liu YC, Hsiao HH, Wang HC, Du JS, Yeh TJ, Gau YC, Ke YL, Yang CI, Lee CP, Hsu CM, Cho SF. Low Geriatric Nutritional Risk Index Is Associated with Poorer Prognosis in Elderly Diffuse Large B-Cell Lymphoma Patients Unfit for Intensive Anthracycline-Containing Therapy: A Real-World Study. Nutrients 2021; 13:nu13093243. [PMID: 34579119 PMCID: PMC8468689 DOI: 10.3390/nu13093243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
Nutritional assessments, including the Geriatric Nutritional Risk Index (GNRI), have emerged as prediction tools for long-term survival in various cancers. This study aimed to investigate the therapeutic strategy and explore the prognostic factors in the elderly patients (≥65 years) with diffuse large B cell lymphoma (DLBCL). The cutoff value of the GNRI score (92.5) was obtained using the receiver operating characteristic curve. Among these patients (n = 205), 129 (62.9%) did not receive standard R–CHOP chemotherapy. Old age (≥80 years), poor performance status, low serum albumin level, and comorbidities were the major factors associated with less intensive anti-lymphoma treatment. Further analysis demonstrated that a lower GNRI score (<92.5) was linked to more unfavorable clinical features. In the patients who received non-anthracycline-containing regimens (non-R–CHOP), multivariate analysis showed that a low GNRI can serve as an independent predictive factor for worse progression-free (HR, 2.85; 95% CI, 1.05–7.72; p = 0.039) and overall survival (HR, 2.98; 95% CI, 1.02–8.90; p = 0.045). In summary, nutritional evaluation plays a role in DLBCL treatment and the GNRI score can serve as a feasible predictive tool for clinical outcomes in frail elderly DLBCL patients treated with non-anthracycline-containing regimens.
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Affiliation(s)
- Tzer-Ming Chuang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Yi-Chang Liu
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hui-Hua Hsiao
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hui-Ching Wang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jeng-Shiun Du
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Tsung-Jang Yeh
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Yuh-Ching Gau
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Ya-Lun Ke
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Ching-I Yang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Specialist Nurse and Surgical Nurse Practitioner Office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Ping Lee
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Chin-Mu Hsu
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Shih-Feng Cho
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-312-1101
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Ulu BU, Yiğenoğlu TN, Başcı S, Bakırtaş M, Şahin D, Darçın T, Yaman S, Bozan E, Seçilmiş S, Candır BA, Yıldız J, İskender D, Baysal NA, Çakar MK, Dal MS, Altuntaş F. Factors affecting survival in elderly patients with diffuse large B-Cell lymphoma. Leuk Res 2021; 110:106700. [PMID: 34481125 DOI: 10.1016/j.leukres.2021.106700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Diffuse large B cell lymphoma (DLBCL) has an increasing incidence in elderly patients with poorer prognosis than in younger patients. Clinicians should clearly identify the characteristics and prognostic factors of elderly patients. We analyzed the outcome of elderly DLBCL patients, especially factors affecting survival in real-life clinical practice. MATERIALS AND METHODS The data of 330 DLBCL patients at our center were retrospectively evaluated by dividing three groups; younger than 65 years, between 65-79 years, and 80 years and older. We examined the factors affecting survival in DLBCL patients ≥ 65 years old. RESULTS The median age of the patients was 61 years (range 16-87). 192 (58.2 %) of our patients were younger than 65 years old, 112 (33.9 %) were between 65-79 years, and 26 (7.9 %) patients were 80 years old or older. The median follow-up was 15 (1-120) months. Median PFS was 38 months in the 65-79 years group, ten months in the ≥ 80 years group; meanwhile, median OS was 43 months in the 65-79 years group, 25 months in the ≥80 years group. The number of patients who relapsed within 12 months of the first-line treatment was 69 (35.9 %) in the <65 years group, it was 60 (53.6 %) in 65-79 years group, and 22 (84.6 %) in ≥80 years group (p < 0.001). The median OS was 9 (7.1-10.9) months in DLBCL patients older than 65 years old who relapsed within 12 months. Early relapse, failure to achieve CR after first-line chemotherapy, and high IPI score were associated with poor survival in patients ≥ 65 years old (p:0.001). CONCLUSION Advancing age was a poor prognostic factor for survival of DLBCL. Relapsing within the first year, or failure to achieve complete remission were associated with poorer survival of the elderly DLBCL patients. R-CHOP is the standard treatment in DLBCL, and the best responses are obtained regardless of age. Due to difficulty in receiving standard treatments, novel treatment modalities are needed for better outcomes in elderly patients with DLBCL.
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Affiliation(s)
- Bahar Uncu Ulu
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Tuğçe Nur Yiğenoğlu
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Semih Başcı
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Bakırtaş
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Derya Şahin
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tahir Darçın
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Samet Yaman
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ersin Bozan
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sema Seçilmiş
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Burcu Arslan Candır
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Jale Yıldız
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Dicle İskender
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nuran Ahu Baysal
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Merih Kızıl Çakar
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fevzi Altuntaş
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Diffuse Large B Cell Lymphoma in Patients 80 Years and Older: Worse Survival After Treatment Without Increased Relapse Rates. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:799-804. [PMID: 34321189 DOI: 10.1016/j.clml.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/05/2021] [Accepted: 06/19/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Age is an adverse prognostic factor in diffuse large B cell lymphoma (DLBCL), but there are limited data on the outcomes of patients' ≥80 years, including those treated with dose reduced chemoimmunotherapy. PATIENTS AND METHODS We conducted a retrospective analysis of 542 patients, 85 (16%) were ≥80 years of age. RESULTS Although the very elderly group had more frequent comorbidities and decreased performance status, 89% received therapy. Four-year PFS was 42% vs. 61% (P < .001) in patients ≥80 years vs. younger patients, while 4-year OS was 42% vs. 72% (P < .0001), respectively. In patients treated with anthracycline-containing regimens (n = 416) 4-year cumulative incidence of relapse with death as competing risk was not different between age groups. Median survival for DLBCL patients ≥80 years treated with R-CHOP or R-miniCHOP was 4.5 years. Survival after first relapse was significantly different between age groups: 5 vs. 19 months (P = .002), respectively. CONCLUSION Very elderly DLBCL patients have worse OS and PFS compared with younger patients but can achieve long term disease control and potentially be cured with chemoimmunotherapy. Older DLBCL patients treated with effective regimens do not have increased rates of relapse, but outcomes after relapse remain poor.
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Castelli R, Gidaro A, Deliliers GL, Bergamaschini L. Bendamustine in association with rituximab for first-line treatment of diffuse large B-cell lymphoma in frail patients ineligible for R-CHOP/R-CHOP-like treatments. Anticancer Drugs 2021; 32:323-329. [PMID: 33534413 DOI: 10.1097/cad.0000000000001027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) has been considered the standard of care for diffuse large B cell lymphoma (DLBCL) patients, including in the elderlies, and represent the current standard treatment. Ineligibility for R-CHOP-like treatments seems to be associated with shorter survival. Recent studies have shown that bendamustine and rituximab is linked, in elderly patients affected by DLBCL. Here we report our experience with BR in 40 elderly frail patients affected by DLBCL ineligibles for R-CHOP. The OOR was 77.5%, with 22 complete responses and 9 partial responses statistical analysis showed no significant difference in overall survival (OS) between patients aged 80 years and older and patients younger than 80 years (6·4 vs. 10·2 months, respectively, P = 0·43). Complete responders were more likely patients with good performance status, (ECOG 0-1) 13 patients (60%), 9 patients (40%) were ECOG 2; of the 9 patients who achieved partial response, 7 patients had ECOG 0-1 and 2 patients had ECOG 2. Four patients had stable disease. Progression-free survival (PFS) median PFS was 13.5 months. These preliminary results showed that bendamustine and rituximab has been associated with high response rates, acceptable toxicity in frail DLBCL patients and high rate of OSS. In older patients with advanced IPI scores, no significant difference in OS were observed between patients aged 80 years and older and patients younger than 80 years. We conclude that bendamustine and rituximab seems to be a reasonable alternative for frail DLBCL patients.
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Affiliation(s)
- Roberto Castelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy
| | - Giorgio L Deliliers
- UOC di Medicina Interna IRCCS Istituto Auxologico Italiano Milano, Fondazione Matarelli Milan
| | - Luigi Bergamaschini
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy
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9
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Freudenberger F, Ohler A, Theobald M, Hess G. Cure rate in the elderly patients with diffuse large B cell lymphoma deteriorates after the age of 80-results from a single-center survey. Ann Hematol 2021; 100:1013-1021. [PMID: 33634349 PMCID: PMC7960616 DOI: 10.1007/s00277-021-04461-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/10/2021] [Indexed: 01/23/2023]
Abstract
The prognosis of elderly patients diagnosed with diffuse large B cell lymphoma (DLBCL) is considered to be clearly inferior to that of younger patients. Besides tumor biology and comorbidities, treatment selection due to an assumed reduced tolerability may contribute to this difference. With increasingly more patients diagnosed at advanced age, current treatment selections need to be reviewed carefully. Hence, we analyzed the results of patients above the age of 70 in whom a diagnosis of DLBCL was made. Whereas patients up to 80 were frequently selected for and were able to tolerate standard treatment (86% intended use, 74% completion), patients above the age of 80 years were not only treated more cautiously (67 and 60%, respectively) but did show inferior response to treatment with standard treatment (CR rate for intended R-CHOP use 64% vs. 43%). However, on an individual level, patients receiving and completing standard treatment obtained results that resemble the results of younger patients, irrespective if aged more than 80 and impose superior to prior reports in this age cohort. Median PFS for the entire group of patients was 3.44 years, with 4.83 years for patients below 80 and only 1.09 years for patients above the age of 80. The corresponding figures for OS were 7.38 years (estimated); after 2 years, OS was 81% in the younger cohort in contrast to 68% in patients > 80 years. However, for patients not planned to receive or not tolerating R-CHOP, results remain poor; tailored approaches for these patients are required.
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Affiliation(s)
- Felix Freudenberger
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Anke Ohler
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Matthias Theobald
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Georg Hess
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
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10
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Wästerlid T, Oren Gradel K, Eloranta S, Glimelius I, El-Galaly TC, Frederiksen H, Smedby KE. Clinical characteristics and outcomes among 2347 patients aged ≥85 years with major lymphoma subtypes: a Nordic Lymphoma Group study. Br J Haematol 2020; 192:551-559. [PMID: 33236363 PMCID: PMC7894517 DOI: 10.1111/bjh.17250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
There is a lack of data regarding treatment and prognosis for the growing group of oldest old patients with lymphoma. Therefore, we studied 2347 patients aged ≥85 years from the Danish and Swedish lymphoma registers 2000–2016 (Denmark) and 2007–2013 (Sweden). Outcome was assessed using relative survival (RS). The 2‐year RS overall for patients with aggressive lymphomas was 38% [95% confidence interval (CI) 35–42%], of whom 845 (66%) patients received active treatment (chemotherapy, radiotherapy, immunotherapy, other). For aggressive lymphomas, not receiving active treatment was associated with an inferior 2‐year RS of 12% (95% CI 9–17%) compared to 49% (95% CI 45–53%) for patients who received active treatment (excess mortality rate ratio 2·84, 95% CI 2·3–3·5; P < 0·0001). For patients with indolent lymphoma, the 2‐year RS was 77% (95% CI 72–82%). Here, 383 (46%) patients received active treatment at diagnosis, but did not have better 2‐year RS (75%, 95% CI 67–81%) compared to those who did not receive active treatment (83%, 95% CI 74–89%). We conclude that outcomes for the oldest old patients with lymphoma are encouraging for several subtypes and that active treatment is associated with improved outcome amongst the oldest old patients with aggressive lymphomas, indicating that age itself should not be a contraindication to treatment.
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Affiliation(s)
- Tove Wästerlid
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Kim Oren Gradel
- Centre for Clinical Epidemiology, OUH and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN- Odense Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Sandra Eloranta
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden
| | | | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital (OUH), Odense, Denmark.,Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
| | - Karin E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
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11
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A potential treatment option for elderly non-Hodgkin lymphoma patients with multiple comorbidities: Two case reports and literature review. Explore (NY) 2020; 17:265-269. [PMID: 33132079 DOI: 10.1016/j.explore.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 01/22/2023]
Abstract
Non-Hodgkin lymphoma (NHL) is a heterogeneous lymphoproliferative malignancy. More than half of the NHL cases occur in patients over 65 years of age. As elderly patients have a poor performance status and multiple comorbidities, the use of standard chemotherapy is often limited, leading to poor clinical outcomes and an increasing need for an alternate therapeutic modalities. A 73-year-old man was diagnosed with extranodal NK/T-cell lymphoma concurrently combined with recurrent gastric adenocarcinoma and metastatic prostate cancer. A 79-year-old woman was diagnosed with T-cell and B-cell dual-phenotype NHL on the right chest wall showing tumor thrombosis and multiple enlarged lymph nodes under chronic emphysema with extensive pleural calcification. Both elderly patients had multiple comorbidities and pathologically confirmed non-Hodgkin lymphoma. Both patients achieved tumor responses following anticancer treatment with Korean medicine (KM), suggesting that the extracts of Angelica gigas Nakai and Geopungtang are potential options for treating NHL in elderly patients with multiple comorbidities. Considering the clinical outcomes of KM treatment in the two elderly patients with NHL and multiple comorbidities, this study generates a research hypothesis for future prospective clinical studies in patients with NHL who are ineligible for conventional anticancer therapy.
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12
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Persson Skare T, Sjöberg E, Berglund M, Smith RO, Roche FP, Lindskog C, Sander B, Glimelius I, Gholiha AR, Enblad G, Amini R, Claesson‐Welsh L. Marginal zone lymphoma expression of histidine‐rich glycoprotein correlates with improved survival. EJHAEM 2020; 1:199-207. [PMID: 35847718 PMCID: PMC9175683 DOI: 10.1002/jha2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 11/24/2022]
Abstract
Purpose The abundant hepatocyte‐expressed plasma protein histidine‐rich glycoprotein (HRG) enhances antitumor immunity by polarizing inflammatory and immune cells in several mouse models, however, the clinical relevance of HRG in human cancer is poorly explored. The expression and role of HRG in human B‐cell lymphomas was investigated in order to find new tools for prognosis and treatment. Findings Immunohistochemical (IHC) analysis and RNA hybridization of tissue microarrays showed that (i) HRG was expressed by tumor cells in marginal zone lymphoma (MZL), in 36% of 59 cases. Expression was also detected in follicular lymphoma (22%), mantle cell lymphoma (19%), and indiffuse large B‐cell lymphoma (DLBCL;5%) while primary CNS lymphoma (PCNSL) lacked expression of HRG. (ii) MZL patients positive for HRG showed a superior overall survival outcome (HR = 0.086, 95% CI = 0.014‐0.518, P‐value = .007), indicating a protective role for HRG independent of stage, age and sex. (iii) HRG‐expressing MZL displayed significantly increased transcript and protein levels of the host defense peptide alpha defensin 1. In addition, global transcript analyses showed significant changes in gene ontology terms relating to immunity and inflammation, however, infiltration of immune and inflammatory cells detected by IHC was unaffected by HRG expression. Conclusion HRG expression by MZL tumor cells correlates with an altered transcription profile and improved overall survival.
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Affiliation(s)
- Tor Persson Skare
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Elin Sjöberg
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Mattias Berglund
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Ross O Smith
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Francis P Roche
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Cecilia Lindskog
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Birgitta Sander
- Dept of Laboratory MedicineDivision of PathologyKarolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - Ingrid Glimelius
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Alex R Gholiha
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Gunilla Enblad
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Rose‐Marie Amini
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
| | - Lena Claesson‐Welsh
- Department of ImmunologyGenetics and PathologyScience for Life and Beijer Laboratoriesand Unit of Experimental and Clinical OncologyUppsala University Uppsala Sweden
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13
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Sonnevi K, Wästerlid T, Melén CM, Harrysson S, Smedby KE, Wahlin BE. Survival of very elderly patients with diffuse large B-cell lymphoma according to treatment intensity in the immunochemotherapy era: a Swedish Lymphoma Register study. Br J Haematol 2020; 192:75-81. [PMID: 32400004 DOI: 10.1111/bjh.16737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) incidence rises with increasing age. Rituximab-anthracycline-based regimens offer a potential cure but also risks of adverse events, especially in the elderly. Using Swedish registers, we conducted a nationwide, population-based study of DLBCL in the very elderly. We obtained information on clinical characteristics, residence, comorbidity, therapy and survival for the 1194 patients aged ≥80 years diagnosed in Sweden 2007-2014. To address selection bias, we also investigated treatment differences between Sweden's Healthcare Regions and whether there were survival differences between the Regions. The 2-year overall and relative survivals were better in patients aged ≥80 years given treatment with curative intent (54%; 64%) than low-intensity (26%; 33%), or palliative treatment (6%; 7%). The fraction of patients treated with curative intent varied between the Healthcare Regions (45-76%). Survival was significantly inferior in Regions with few patients treated with curative intent (multivariable hazard ratio 1.3, 95% confidence interval 1.1-1.6). When treatment intensity and Regions competed, Regions were no longer independent, suggesting that Regional survival differences are due to therapeutic differences. Furthermore, we found that the age-adjusted International Prognostic Index was independently associated with survival. We conclude that patients aged ≥80 years with DLBCL appear to benefit from rituximab-anthracycline-based treatment given with curative intent.
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Affiliation(s)
- Kristina Sonnevi
- Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Hematology Dept, Karolinska University Hospital, Stockholm, Sweden
| | - Tove Wästerlid
- Hematology Dept, Karolinska University Hospital, Stockholm, Sweden.,Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Christopher M Melén
- Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Hematology Dept, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Harrysson
- Hematology Dept, Karolinska University Hospital, Stockholm, Sweden.,Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Hematology Dept, Karolinska University Hospital, Stockholm, Sweden.,Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Björn E Wahlin
- Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Hematology Dept, Karolinska University Hospital, Stockholm, Sweden
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14
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Drozd-Sokolowska J, Zaucha JM, Biecek P, Giza A, Kobylinska K, Joks M, Wrobel T, Kumiega B, Knopinska-Posluszny W, Spychalowicz W, Romejko-Jarosinska J, Fischer J, Wiktor-Jedrzejczak W, Dlugosz-Danecka M, Giebel S, Jurczak W. Type 2 diabetes mellitus compromises the survival of diffuse large B-cell lymphoma patients treated with (R)-CHOP - the PLRG report. Sci Rep 2020; 10:3517. [PMID: 32103128 PMCID: PMC7044262 DOI: 10.1038/s41598-020-60565-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/10/2020] [Indexed: 12/01/2022] Open
Abstract
Comorbidities impair the prognosis of diffuse large B-cell lymphoma (DLBCL). Type 2 diabetes mellitus (DMT2) increases the risk of other comorbidities, e.g., heart failure (HF). Thus, we hypothesized that pre-existing DMT2 may negatively affect the outcome of DLBCL. To verify this, DLBCL patients treated with (R)-CHOP were enrolled. 469 patients were eligible, with a median age of 57 years; 356 patients had advanced-stage DLBCL. 126 patients had high-intermediate and 83 high-risk international prognostic index (IPI). Seventy-six patients had DMT2, 46 HF; 26 patients suffered from both DMT2 and HF. In the analyzed group DMT2 or HF significantly shortened overall survival (OS) and progression free survival (PFS): the 5-year OS for patients with DMT2 was 64% vs 79% and for those with HF: 49% vs 79%. The 5-year PFS for DMT2 was 50.6% vs 62.5% and for HF 39.4% vs 63.2%. The relapse/progression incidence was comparable between groups; the non-relapse/progression mortality (NRPM) was significantly higher solely in DMT2 patients (5-year NRPM 22.5% vs 8.4%). The risk of death was higher in patients with higher IPI (HR = 1.85) and with DMT2 (HR = 1.87). To conclude, pre-existing DMT2, in addition to a higher IPI and HF, was a negative predictor for OS and PFS.
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Affiliation(s)
- Joanna Drozd-Sokolowska
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Banacha 1a Str, 02-097, Warszawa, Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdansk, Smoluchowskiego 17 Str., 80-214, Gdansk, Poland.
| | - Przemyslaw Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa 75 Str., 00-662, Warszawa, Poland
| | - Agnieszka Giza
- Department of Hematology, Jagiellonian University, Mikołaja Kopernika 17 Str., 30-501, Krakow, Poland
| | - Katarzyna Kobylinska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa 75 Str., 00-662, Warszawa, Poland
| | - Monika Joks
- Department of Hematology, University of Medical Sciences of Poznan, Szamarzewskiego 84 Str., 60-569, Poznan, Poland
| | - Tomasz Wrobel
- Department of Hematology, Wroclaw Medical University, Wybrzeże L. Pasteura 4 Str., 50-367, Wroclaw, Poland
| | - Beata Kumiega
- Department of Hematooncology, Markiewicz Memorial Oncology Center Brzozow, Ks. Bielawskiego 18 Str., 36-200, Brzozow, Poland
| | - Wanda Knopinska-Posluszny
- Hematology Department, Independent Public Health Care Ministry of the Interior of Warmia and Mazury Oncology Center, Aleja Wojska Polskiego 37 Str., 10-228, Olsztyn, Poland
| | - Wojciech Spychalowicz
- Internal Medicine and Oncology Clinic, Silesian Medical University, Reymonta 8 Str., 40-027, Katowice, Poland
| | - Joanna Romejko-Jarosinska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Roentgena 5 Str., 02-781, Warszawa, Poland
| | - Joanna Fischer
- Department of Hematology, Jagiellonian University, Mikołaja Kopernika 17 Str., 30-501, Krakow, Poland
| | - Wieslaw Wiktor-Jedrzejczak
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Banacha 1a Str, 02-097, Warszawa, Poland
| | - Monika Dlugosz-Danecka
- Department of Hematology, Jagiellonian University, Mikołaja Kopernika 17 Str., 30-501, Krakow, Poland
| | - Sebastian Giebel
- Maria Sklodowska-Curie Institute-Cancer Center, Gliwice Branch, Wybrzeże Armii Krajowej 15 Str., 44-101, Gliwice, Poland
| | - Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Mikołaja Kopernika 17 Str., 30-501, Krakow, Poland
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15
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Older adults in hematologic malignancy trials: Representation, barriers to participation and strategies for addressing underrepresentation. Blood Rev 2020; 43:100670. [PMID: 32241586 DOI: 10.1016/j.blre.2020.100670] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/15/2022]
Abstract
Despite a high incidence of hematologic malignancies in older adults, available data indicate that there is disproportionately low representation of adults ≥65 years with hematologic malignancies (greater in patients ≥75 years) in clinical trials. Biological and clinical differences between older and younger adults and diversity within older patients necessitate adequate representation of the older subpopulation in hematologic malignancy trials. This would allow trial results to be generalizable and inform treatment decisions in the older patient population. Restrictive eligibility criteria may be barriers to adequate representation, as older adults do not typically meet these criteria. Efforts to broaden eligibility criteria in clinical trials have been proposed and may promote enrollment of a representative older population with hematologic malignancies. Collaboration among a diverse group of stakeholders will be needed to implement current proposals and evaluate their impact on increasing representation of older adults in trials evaluating therapies for hematologic malignancies.
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16
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Albarmawi H, Onukwugha E, Keating KN, Appukkuttan S, Yared J. Survival benefit associated with treating follicular lymphoma in patients 80 years or older. J Geriatr Oncol 2019; 11:55-61. [PMID: 31706831 DOI: 10.1016/j.jgo.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the overall survival benefit associated with follicular lymphoma (FL)-directed therapy among patients diagnosed with FL at 80+ years. PATIENTS AND METHODS This retrospective cohort study utilized the linked Surveillance, Epidemiology and End Results-Medicare dataset to identify patients 80+ years, diagnosed with FL between 2000 and 2013. We identified FL-directed treatments based on published guidelines. We utilized a propensity-score matched sample to compare treated and untreated groups who had similar observed characteristics. We reported the median overall survival time and the 3-year restricted mean survival time (RMST) of the study groups as well as the hazard ratio (HR) of death associated with treatment receipt. RESULTS We identified 3705 older patients with FL (mean [SD] age, 84 [3.6] years). Over a median follow-up of 2.9 years, 68% of the sample received FL-directed therapy and the most common regimen was rituximab monotherapy (N = 768, 21%). The matched sample included 2306 patients. The median overall survival for the treated group was 4.31 years (95% confidence interval [CI], 4.00-4.61) compared to 2.86 years (95% CI, 2.59-3.16) for the untreated group. The 3-year RMST for the treated group was 2.36 years (95% CI, 2.30-2.41), while it was 2.05 years (95% CI, 1.98-2.11) for the untreated group. Treatment was associated with a 23% reduction in the hazards of death (HR: 0.77, 95% CI: 0.70-0.85; p < .001). CONCLUSION FL-directed therapy was associated with improved survival among patients diagnosed with FL at 80+ years. These findings can support treatment decision-making for individuals diagnosed with FL at older ages.
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Affiliation(s)
- Husam Albarmawi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | | | - Jean Yared
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
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17
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Considerations for the Treatment of Diffuse Large B Cell Lymphoma in the Elderly. Curr Hematol Malig Rep 2019; 14:228-238. [DOI: 10.1007/s11899-019-00519-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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18
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Adıyaman SC, Alacacıoğlu İ, Ersen Danyeli A, Türkyılmaz D, Sevindik ÖG, Demirkan F, Pişkin Ö, Özcan MA, Ündar B, Özkal S, Özsan GH. Prognostic Factors in Elderly Patients with Diffuse Large B-Cell Lymphoma and Their Treatment Results. Turk J Haematol 2019; 36:81-87. [PMID: 30724061 PMCID: PMC6516089 DOI: 10.4274/tjh.galenos.2019.2018.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). The treatment of older NHL patients has always been a struggle; however, treatment statistics have begun showing favorable results similar to those of younger DLBCL patients thanks to newer treatment protocols. Here, we analyze the progress of our own elderly DLBCL patients who were followed between 2000 and 2016 in our center. Materials and Methods: Eighty-seven DLBCL patients, who were diagnosed and treated in the Dokuz Eylül University Department of Hematology between 2000 and 2016, were included in this study. Median age was 72 (65-89) years and 13 (14.9%) patients were older than 80 years. Results: Median follow-up time was 19 months and 45 patients (51.7%) died during the follow-up period. Median overall survival (OS) was 55 months and median progression-free survival was calculated as 27 months. Sixty-three patients (72.4%) received standard R-CHOP therapy. Complete response was seen in 46 (52.9%) patients. The median survival time for patients who had complete response was 136 months (p<0.001); however, OS was not statistically different between older (>80 years) and younger patients (p=0.236). Conclusion: According to our findings, we think that being able to complete standard R-CHOP therapy is vital for the survival rate of elderly DLBCL patients.
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Affiliation(s)
- Süleyman Cem Adıyaman
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, İzmir, Turkey
| | - İnci Alacacıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Ayça Ersen Danyeli
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Doğuş Türkyılmaz
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Ömür Gökmen Sevindik
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Fatih Demirkan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Özden Pişkin
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Mehmet Ali Özcan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Bülent Ündar
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Sermin Özkal
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Güner Hayri Özsan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
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19
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Ferraro MP, Gimeno-Vazquez E, Subirana I, Gómez M, Díaz J, Sánchez-González B, García-Pallarols F, Martínez L, Ble M, Molina L, Belarte LC, Abella E, Elosua R, Comín-Colet J, Salar A. Anthracycline-induced cardiotoxicity in diffuse large B-cell lymphoma: NT-proBNP and cardiovascular score for risk stratification. Eur J Haematol 2019; 102:509-515. [PMID: 30972815 DOI: 10.1111/ejh.13234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the role of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and a cardiovascular (CV) risk score named FRESCO for predicting anthracycline-induced cardiotoxicity (AIC) in diffuse large B-cell lymphoma (DLBCL). METHODS A total of 130 consecutive DLBCL patients treated in first-line with anthracycline-containing immunochemotherapy. Competitive risk between NT-proBNP, FRESCO, and time to AIC was considered. RESULTS Cumulative incidence of AIC was 12.2% and 17.5% at 1 and 5 years, respectively. Median time to development cardiotoxicity was 6.4 months, with half of the cases showing heart failure and the other half silent AIC. Both NT-proBNP levels and FRESCO score were independently associated with higher risk of AIC (P = 0.001 and P = 0.03, respectively). Patients with NT-proBNP ≥600 pg/mL or those with FRESCO ≥4.5% had 3.97 or 2.54 times higher risk of AIC than those with lower values (P = 0.001 and P = 0.048, respectively). According to the previous cutoffs, three groups of patients with a significantly different risk of AIC could be identified (P < 0.0001). CONCLUSIONS Doxorubicin-containing chemotherapy is associated with increased risk of silent and overt AIC. Baseline NT-proBNP levels and FRESCO CV risk score are accurate predictors of AIC and can identify groups of patients at different risk, in which personalized cardiologic evaluation should be offered.
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Affiliation(s)
- Mariana Paola Ferraro
- Department of Hematology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Clinical Hematology Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Eva Gimeno-Vazquez
- Department of Hematology, Hospital del Mar, Barcelona, Spain.,Clinical Hematology Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Isaac Subirana
- CIBER of Epidemiology and Public Health, Barcelona, Spain.,Cardiovascular Epidemiology and Genetics Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Miquel Gómez
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Javier Díaz
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Blanca Sánchez-González
- Department of Hematology, Hospital del Mar, Barcelona, Spain.,Clinical Hematology Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Francesc García-Pallarols
- Department of Hematology, Hospital del Mar, Barcelona, Spain.,Clinical Hematology Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Laia Martínez
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Mireia Ble
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Lluis Molina
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Eugenia Abella
- Department of Hematology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Clinical Hematology Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,CIBER of Cardiovascular Disorders, Barcelona, Spain
| | - Josep Comín-Colet
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Cardiovascular Research Group, Bellvitge Biomedical Research Institute, Hospitalet, Barcelona, Spain
| | - Antonio Salar
- Department of Hematology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Clinical Hematology Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
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20
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Wästerlid T, Mohammadi M, Smedby KE, Glimelius I, Jerkeman M, Bottai M, Eloranta S. Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B-cell lymphoma: a Swedish lymphoma register study. J Intern Med 2019; 285:455-468. [PMID: 30368947 DOI: 10.1111/joim.12849] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comorbidity impacts overall survival amongst patients with diffuse large B-cell lymphoma (DLBCL). However, associations of comorbidity with lymphoma characteristics, treatment selection and lymphoma-specific mortality are less well known. OBJECTIVE To examine the impact of comorbidity on DLBCL characteristics, treatment intent and cause of death. METHODS We identified 3905 adult patients diagnosed with DLBCL 2007-2013 through the Swedish Lymphoma Register. We assessed comorbid disease history according to the Charlson comorbidity index (CCI). Comorbidity data and causes of death were collected through register linkage. Associations were estimated using multinomial regression and flexible parametric survival models. RESULTS Overall, 45% of the patients (n = 1737) had a history of at least one comorbidity at DLBCL diagnosis (cardiovascular disease, diabetes and solid cancer were most frequent), and 997 (26%) had a CCI score of ≥2. The relative probability of presenting with poor performance status (PS > 2) was higher amongst comorbid patients [Relative Risk Ratio (RRR)PS>2 : 2.02, 95% CI: 1.63-2.51]. Comorbid patients had a substantially lower relative probability of receiving curative treatment (RRR: 0.48, 95% CI: 0.38-0.61). Amongst all patients, CCI ≥ 1 was associated with a significantly increased risk of all-cause and lymphoma-specific death after adjustments. Amongst patients selected for curative treatment, comorbidity was associated with an increased risk of all-cause death (HRCCI>1 : 1.54, 95% CI: 1.32-1.80), but not with lymphoma-specific death (HRCCI>1 : 1.05, 95% CI: 0.86-1.28). CONCLUSION Comorbidity is associated with inferior DLBCL outcome, mainly due to a lower likelihood of receiving treatment with curative intent. Possibly, more comorbid DLBCL patients could be treated with curative intent if comorbid conditions were optimized in parallel.
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Affiliation(s)
- T Wästerlid
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - M Mohammadi
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - K E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - I Glimelius
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden
| | - M Jerkeman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - M Bottai
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - S Eloranta
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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21
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Cetin G, Ece Dogan E, Samanci NS, Ayer M, Ozkan T, Ekinci I, Bag R, Turgut S, Uysal O. Treatment modalities of non-Hodgkin lymphoma patients over 65 years of age: A two-center experience. J Oncol Pharm Pract 2019; 26:99-104. [PMID: 30924740 DOI: 10.1177/1078155219839460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study was conducted with the aim of making the contribution to a decision for treatment and determination of the modalities in patients diagnosed with non-Hodgkın lymphoma which increasingly become widespread in the geriatric population. MATERIALS AND METHODS Ninety-one patients aged over 65 years diagnosed with lymphoma and treated in Bezmialem Vakıf University Medical Faculty Hospital and Haseki Training and Research Hospital between 2008 and 2013 were retrospectively evaluated. Finally, 63 patients for whom data could be reached were included in the study. RESULTS Examining the results, histological diagnoses of our patients were as follows: diffuse large B-cell lymphoma (50.8%), follicular lymphoma (23.8%), marginal zone lymphoma (12.7%), mantle cell lymphoma (4.8%), T-cell lymphoma (4.8%), lymphoplasmacytic lymphoma (1.6%) and small lymphocytic lymphoma (1.6%). Stages at the time of diagnosis were early stage by 33.3% and late stage by 66.7%. Of the patients, 36.5% had a low-intermediate and 63.5% a high-intermediate International Prognostic Index score. According to the Eastern Cooperative Oncology Group scoring, 34.9% of the patients have an Eastern Cooperative Oncology Group score of 2-4. Activities of daily living score of 33.3% patients was under 5. Looking at the responses to treatment, the complete response was found in 50.8%, partial response in 4.8%, stable disease in 1.6% and progressive disease in 9.5% of the patients. The mean follow-up duration of patients was found as 25.2 months and disease-free survival after remission as 20.2 months. CONCLUSION We found that we have achieved a complete remission in more than half of our patients (50.8%). Based on this, treatment should aim remission in elderly patients.
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Affiliation(s)
- Guven Cetin
- Department of Hematology, Bezmialem Vakif University, Istanbul, Turkey
| | - Elif Ece Dogan
- Department of Internal Medicine, Bayrampaşa Hospital, Istanbul, Turkey
| | - Nilay Sengul Samanci
- Department of Medical Oncology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mesut Ayer
- Department of Hematology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Tuba Ozkan
- Department of Internal Medicine, Yahyalı Hospital, Kayseri, Turkey
| | - Iskender Ekinci
- Department of Internal Medicine, Kanuni Training and Research Hospital Istanbul, Turkey
| | - Rabia Bag
- Department of Geriatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Seda Turgut
- Department of Internal Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Omer Uysal
- Department of Biostatistics and Medical Informatics, Bezmialem Vakif University, Istanbul, Turkey
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22
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Cao YW, Shi Q, Zhang MC, Xu PP, Chen S, Zhao WL, Wang L. [Efficacy of RCDOP regimen in the treatment of patients with diffuse large B-cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:485-490. [PMID: 30032566 PMCID: PMC7342927 DOI: 10.3760/cma.j.issn.0253-2727.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the efficacy of RCDOP (Rituximab, cyclophosphamide, liposome doxorubicin, vincristine and prednisone) regimen in patients with de novo diffuse large B-cell lymphoma (DLBCL), especially in those patients with multiple extra-nodal involvement or Bulky diseases. Methods: A total of 87 newly diagnosed DLBCL patients who received RCDOP regimen from October 2012 to October 2017 were enrolled into this study. Survival functions were estimated using the Kaplan-Meier method and compared by the log-rank test, and χ(2) tests were used for categorical data. Results: Among the 87 DLBCL patients treated with RCDOP regimen, 81 patients achieved complete remission (CR) or partial remission (PR), with ORR as 93.1%. Patients were further classified into groups, according to the risk factors, such as IPI scores, multiple extra-nodal involvement, bulky disease, age>60, tumor Ki-67>80%, elevated serum LDH level and advanced Ann Arbor stage. The progression-free survival (PFS, P=0.084) and overall survival (OS, P=0.515) had no statistical difference among the IPI low risk (0-1 score) group, intermediate risk (2-3 scores) group and high risk (4-5 scores) group. Similarly, no statistical difference were fou nd in PFS and OS of patients with extra-nodal involvements ≥2 (P=0.303 and P=0.624), with bulky disease (P=0.518 and P=0.466), with age>60 (P=0.600 and P=0.183), with elevated serum LDH level (P=0.054 and P=0.880), with advanced Ann Arbor stage (P=0.075 and P=0.286), and with tumor Ki-67 over 80% (P=0.190 and P=0.109), when compared with those of patients without these risk factors. Conclusion: RCDOP can improve the therapeutic effect and prognosis of DLBCL patients with certain high risk factors, such as intermediate and high IPI risks, multiple extra-nodal involvements, bulky disease, age over 60, elevated LDH level, advanced Ann Arbor stage and tumor Ki-67 over 80%.
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Affiliation(s)
- Y W Cao
- State Key Laboratory of Medical Genomics; Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai 200025, China
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23
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Tanimura A, Hirai R, Nakamura M, Takeshita M, Hagiwara S, Miwa A. The Prognostic Impact of Dose-attenuated R-CHOP Therapy for Elderly Patients with Diffuse Large B-cell Lymphoma. Intern Med 2018; 57:3521-3528. [PMID: 30101910 PMCID: PMC6355403 DOI: 10.2169/internalmedicine.0990-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective Although R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone) is a standard therapy for diffuse large B-cell lymphoma (DLBCL), the optimal dose for elderly patients remains unclear. Methods and Patients We retrospectively verified our R-CHOP dose-attenuation system implemented from 2005 for DLBCL patients. Among the 115 DLBCL patients treated during 2001-2010, 33 patients treated during 2001-2005 received R-CHOP doses adjusted according to physicians' decisions (PHY group). Eighty-two patients treated after 2005 received adjusted R-CHOP doses according to a unified dose-attenuation system (UNI group). Patients aged <60, 60-69, 70-79, and ≥80 years received the standard R-CHOP, 100% R-CHO+P (50 mg/m2), 100% R+75% CHO+P (40 mg/m2), and 100% R+50% CHO+P (30 mg/m2), respectively. We compared the responses, survival, and treatment cessation between the PHY and UNI groups. Results The patients' characteristics between both groups were closely comparable. All PHY patients received randomly adjusted R-CHOP doses; 94% of UNI patients received scheduled doses. The complete response rates differed significantly between the UNI (77%) and PHY patients (50%) (p=0.011). The two-year event-free survival rates were 50% and 32% in the UNI and PHY groups, respectively (p=0.0083). The two-year OS rates were 77% and 72% in the UNI and PHY group (p=0.16). Among the patients aged >70 years (n=59) overall survival was shorter in the PHY group (62%) than in the UNI group (72%; p=0.02). The UNI group received higher anti-tumor agent doses than the PHY group. The therapy discontinuation rates were 5% in the UNI group and 24% in the PHY group. Conclusion Carrying out unified dose reduction may improve the efficacy and prognosis among elderly DLBCL patients.
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Affiliation(s)
- Akira Tanimura
- Department of Hematology, Tokyo-Kita Medical Center, Japan
| | - Risen Hirai
- Department of Hematology, Tokyo-Kita Medical Center, Japan
| | - Miki Nakamura
- Division of Hematology, National Center for Global Health and Medicine, Japan
| | | | - Shotaro Hagiwara
- Division of Hematology, National Center for Global Health and Medicine, Japan
- Division of Hematology, Tokyo Women' s Medical University, Japan
| | - Akiyoshi Miwa
- Department of Hematology, Tokyo-Kita Medical Center, Japan
- Division of Hematology, National Center for Global Health and Medicine, Japan
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24
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Geriatric screening tools predict survival outcomes in older patients with diffuse large B cell lymphoma. Ann Hematol 2018; 98:669-678. [DOI: 10.1007/s00277-018-3551-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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25
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Maybury B, Kimpton G, Otton S. A retrospective multicentre study of COCKLE, an oral chemotherapy regimen, as palliative treatment for high grade lymphoma. Br J Haematol 2018; 185:803-806. [PMID: 30407622 DOI: 10.1111/bjh.15637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bernard Maybury
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - George Kimpton
- Department of Postgraduate Medicine, North Bristol NHS Trust, Bristol, UK
| | - Sophie Otton
- Department of Haematology, North Bristol NHS Trust, Bristol, UK
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26
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Chen B, Zhu SY, Shi M, Su H, Wang Y, He X, Xu LM, Yuan ZY, Zhang LL, Wu G, Qu BL, Qian LT, Hou XR, Zhang FQ, Zhang YJ, Zhu Y, Cao JZ, Lan SM, Wu JX, Wu T, Qi SN, Yang Y, Liu X, Li YX. Risk-dependent curability of radiotherapy for elderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma: A multicenter study from the China Lymphoma Collaborative Group (CLCG). Cancer Med 2018; 7:5952-5961. [PMID: 30358175 PMCID: PMC6308086 DOI: 10.1002/cam4.1849] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the curability of early-stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) in response to radiotherapy and non-anthracycline-based chemotherapy in elderly patients. METHODS In this multicenter study from the China Lymphoma Collaborative Group (CLCG) database, 321 elderly patients with early-stage NKTCL were retrospectively reviewed. Patients received radiotherapy alone (n = 87), chemotherapy alone (n = 59), or combined modality therapy (CMT, n = 175). Patients were classified into low- or high-risk groups using four prognostic factors. Observed survival in the study cohort vs expected survival in age- and sex-matched individuals from the general Chinese population was plotted using a conditional approach and subsequently compared using a standardized mortality ratio (SMR). RESULTS Radiotherapy conveyed a favorable prognosis and significantly improved survival compared to chemotherapy alone. The 5-year overall survival (OS) and progression-free survival (PFS) were 61.2% and 56.4%, respectively, for radiotherapy compared with 44.7% and 38.3%, respectively, for chemotherapy alone (P < 0.001). The combination of a non-anthracycline-based chemotherapy regimen and radiotherapy significantly improved PFS compared to combination of an anthracycline-based chemotherapy regimen and radiotherapy (71.2% vs 44.2%, P = 0.017). Low-risk patients following radiotherapy (SMR, 0.703; P = 0.203) and high-risk patients who achieved PFS at 24 months (SMR, 1.490; P = 0.111) after radiotherapy showed survival equivalent to the general Chinese population. CONCLUSIONS Our findings indicate a favorable curability for this malignancy in response to radiotherapy and non-anthracycline-based chemotherapy, providing a risk-adapted follow-up and counsel scheme in elderly patients.
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Affiliation(s)
- Bo Chen
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.,Center for Cancer Precision Medicine, CAMS and PUMC, Beijing, China.,National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, China
| | - Su-Yu Zhu
- Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hang Su
- Department of Oncology, 307 Hospital, Academy of Military Medical Science, Beijing, China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing Cancer Hospital & Cancer Institute, Chongqing, China
| | - Xia He
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Li-Ming Xu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Zhi-Yong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, China
| | - Li-Ling Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bao-Lin Qu
- Department of Radiation Oncology, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Li-Ting Qian
- Department of Radiation Oncology, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China
| | - Xiao-Rong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Fu-Quan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yu-Jing Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuan Zhu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jian-Zhong Cao
- Department of Radiation Oncology, Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, China
| | - Sheng-Min Lan
- Department of Radiation Oncology, Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun-Xin Wu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Tao Wu
- Department of Lymphoma, Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, China
| | - Shu-Nan Qi
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.,Center for Cancer Precision Medicine, CAMS and PUMC, Beijing, China.,National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, China
| | - Yong Yang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.,Center for Cancer Precision Medicine, CAMS and PUMC, Beijing, China.,National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, China
| | - Xin Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.,Center for Cancer Precision Medicine, CAMS and PUMC, Beijing, China.,National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, China
| | - Ye-Xiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.,Center for Cancer Precision Medicine, CAMS and PUMC, Beijing, China.,National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, China
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27
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Schelker RC, Herr W, Reichle A, Vogelhuber M. Low-dose trofosfamide plus rituximab is an effective and safe treatment for diffuse large B-cell lymphoma of the elderly: a single center experience. BMC Cancer 2018; 18:1000. [PMID: 30340554 PMCID: PMC6195694 DOI: 10.1186/s12885-018-4885-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/01/2018] [Indexed: 02/03/2023] Open
Abstract
Background Rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is broadly accepted as standard for the treatment of diffuse large B-cell lymphoma (DLBCL). Nevertheless, there is sparsely data concerning the management of elderly patients. Methods We performed a retrospective study of treatment with rituximab and low-dose trofosfamide in elderly patients (≥ 75 years) with DLBCL who were not suitable for R-CHOP or R-CHOP-like regimens or who did not consent to aggressive treatment. The choice regarding the qualification for R-CHOP or R-CHOP-like regimen was left to the estimation of the treating physicians. Results Eleven patients with a median age of 83 years (range, 75–90 years) were included. The age-adjusted international prognostic index was low risk in one patient, low-intermediate in four patients, high-intermediate in three patients, and high risk in 3 patients. All patients were evaluable for response. Five patients (45%) achieved a complete response, three (27%) a partial response, one (9%) stable disease, and two (18%) progressive disease. The estimated 1-yr overall survival was 54.5%, and the estimated 1-yr progression-free survival 45.5%, however, three patients (27%) were alive without evidence of disease at 16–20 months from start of treatment. Main toxicity was leukopenia (36% grade III or IV), whereas grade III/IV non-hematological adverse events did not occur. Conclusions Due to its potency and low toxicity, trofosfamide/rituximab might represent an alternative therapy for DLBCL of elderly patients not suitable for R-CHOP. This observation, however, should be confirmed in a larger patient population within a prospective clinical trial.
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Affiliation(s)
- Roland Christian Schelker
- Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Albrecht Reichle
- Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Martin Vogelhuber
- Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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28
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Kumar A, Fraz MA, Usman M, Malik SU, Ijaz A, Durer C, Durer S, Tariq MJ, Khan AY, Qureshi A, Faridi W, Nasar A, Anwer F. Treating Diffuse Large B Cell Lymphoma in the Very Old or Frail Patients. Curr Treat Options Oncol 2018; 19:50. [PMID: 30173370 DOI: 10.1007/s11864-018-0565-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OPINION STATEMENT R-CHOP has been the standard of care for diffuse large B cell lymphoma (DLBCL), curing approximately 60% of patients for more than 2 decades. However, the optimal treatment of patients who are too frail to tolerate this regimen and/or are not candidates for anthracycline therapy continues to be debated. MInT and GELA trials established addition of rituximab to CHOP in DLBCL but excluded patients older than 80 years. Multiple regimens have been tried with varying success in the very elderly, including R-mini-CHOP, R-mini CEOP, R-split CHOP, pre-phase strategies, and R-GCVP. However, there has not been a randomized trial among these strategies. Although addition of novel agents including ibrutinib, brentuximab vedotin, lenalidomide, and many others on the horizon holds promise in this population, none have been tested in a randomized setting or have results awaited. There is also a lack of a validated and easy to use clinical tool in this population to predict patients who will not tolerate R-CHOP. Identifying patients who will not tolerate R-CHOP early with the help of tools like CGA, along with integrating biology-based treatment (ibrutinib, lenalidomide in activated B cell type DLBCL) is being investigated in this population.
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Affiliation(s)
- Abhijeet Kumar
- College of Medicine, Hematology/Oncology, University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ, 85724, USA.
| | - Muhammad Asad Fraz
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Muhammad Usman
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Saad Ullah Malik
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Awais Ijaz
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Ceren Durer
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Seren Durer
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Muhammad Junaid Tariq
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Ali Younas Khan
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Anum Qureshi
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Warda Faridi
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
| | - Aboo Nasar
- Department of Geriatrics, Tri-City Medical Center, 4002 Vista way, Oceanside, CA, 92056, USA
| | - Faiz Anwer
- Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA
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Krok‐Schoen JL, Fisher JL, Stephens JA, Mims A, Ayyappan S, Woyach JA, Rosko AE. Incidence and survival of hematological cancers among adults ages ≥75 years. Cancer Med 2018; 7:3425-3433. [PMID: 29654631 PMCID: PMC6051144 DOI: 10.1002/cam4.1461] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/16/2018] [Accepted: 02/28/2018] [Indexed: 11/07/2022] Open
Abstract
Evaluating population-based data of hematologic malignancies (HMs) in older adults provides prognostic information for this growing demographic. Incidence rates and one- and five-year relative survival rates were examined for specific HMs among adults ages ≥75 years using data from the Surveillance, Epidemiology and End Results (SEER) Program. Hematologic malignancy cases (Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), multiple myeloma (MM), acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML)) were reported to one of 18 SEER registries. Recent average annual (2010-2014) incidence rates and incidence trends from 1973 to 2014 were examined for cases ages ≥75 years. One- and five-year relative cancer survival rates were examined for adults ages ≥75 years diagnosed 2007-2013, with follow-up into 2014. From 1973 to 2014, incidence rates increased for NHL, MM, and AML, decreased for HL, and remained relatively stable for ALL, CLL, and CML among adults ages ≥75 years. The highest one- and five-year relative survival rates were observed among adults with CLL ages 75-84 years (1 year: 91.8% (95% CI = 91.8-90.8)) and 5 years: 76.5% (95% CI = 74.2-78.6)). The lowest one- and five-year survival rates were observed among adults with AML ages 75-84 (1 year: 18.2% (95% CI = 74.2-78.6) and 5 years: 2.7% (95% CI = 2.0-3.6)). Survival for older adults ages ≥75 years with HMs is poor, particularly for acute leukemia. Understanding the heterogeneity in HM outcomes among older patients may help clinicians better address the hematological cancer burden and mortality in the aging population.
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Affiliation(s)
- Jessica L. Krok‐Schoen
- Division of Medical Dietetics and Health SciencesSchool of Health and Rehabilitation SciencesCollege of MedicineThe Ohio State UniversityColumbusOhio
- Comprehensive Cancer CenterThe Ohio State UniversityColumbusOhio
| | - James L. Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
| | | | - Alice Mims
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
- Division of HematologyDepartment of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - Sabarish Ayyappan
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
- Division of HematologyDepartment of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - Jennifer A. Woyach
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
- Division of HematologyDepartment of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - Ashley E. Rosko
- Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteColumbusOhio
- Division of HematologyDepartment of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhio
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Frequency and impact of grade three or four toxicities of novel agents on outcomes of older patients with chronic lymphocytic leukemia and non-Hodgkin lymphoma (alliance A151611). J Geriatr Oncol 2018; 9:321-328. [PMID: 29673807 DOI: 10.1016/j.jgo.2018.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/05/2018] [Accepted: 03/30/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Older patients with cancer suffer from chemotherapy-related toxicities more frequently than younger patients. As novel agents are being used more commonly in chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL), toxicities of these agents in older patients have not been well studied. Further, impact of these toxicities on outcomes in the elderly is unknown. This study aimed to answer both questions. PATIENTS AND METHODS We reviewed 14 Alliance for Clinical Trials in Oncology trials that enrolled CLL and/or NHL patients between 2004-2014. Toxicity was assessed per the NCI-CTCAE (version 3-5). Probabilities of experiencing grade three or four hematologic and non-hematologic toxicities were modeled as a function of clinical and disease-related factors using logistic regression. RESULTS 1199 patients (409 age ≥ 65; 790 age < 65) were analyzed; 438 received only biologic therapy (145 age ≥ 65; 293 age < 65), and 761 received biologic + chemotherapy (264 age ≥ 65; 497 age < 65). The odds of grade three or four hematologic [odds ratio (OR) 1.70; p = 0.009: 95% CI (1.57-1.84)] and non-hematologic toxicities [OR 1.47; p = 0.022; 95% CI (1.39-1.55)] were increased in older patients with CLL, as well as odds of grade three or four non-hematologic toxicities [OR 1.89; p = 0.017; 95% CI (1.64-2.17)] in older patients with NHL. Grade three or four hematologic toxicities were associated with inferior OS and PFS in older patients with NHL [HR 3.14; p = 0.006; 95% CI (2.25-4.39) for OS and 3.06; p = 0.011; 95% CI (2.10-4.45) for PFS], though not in CLL. A prognostic model predicting grade three or four toxicities was also developed. CONCLUSIONS CLL and NHL patients ≥ 65 year encounter more toxicities than younger patients even when treated with novel biologic agents. Development of grade three or four hematologic toxicities lead to inferior PFS and OS in NHL but not in CLL.
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Cheng CL, Liu JH, Chou SC, Yao M, Tang JL, Tien HF. Retrospective analysis of frontline treatment efficacy in elderly patients with diffuse large B-cell lymphoma. Eur J Haematol 2018; 101:28-37. [PMID: 29603428 DOI: 10.1111/ejh.13069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effectiveness of 2 chemotherapeutic regimens, bendamustine plus rituximab (BR) or reduced-dose cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (RD-R-CHOP), in elderly patients with treatment-naïve diffuse large B-cell lymphoma. METHODS A retrospective study was conducted to investigate the efficacy and safety of 2 frontline regimens, BR and RD-R-CHOP, in patients aged ≥75 years unfit for R-CHOP. RESULTS From January 2011 to December 2015, 26 patients received BR and 34 RD-R-CHOP. No significant difference was found in clinical background comparisons. The overall response rate was 50% and 79.4% for BR and RD-R-CHOP, respectively (P = .027). Compared with patients in RD-R-CHOP, those in BR had a lower complete remission rate (42.3% vs 70.6%, P = .036), higher progressive disease rate (38.5% vs 8.8%, P = .01), and poorer median overall survival (11.2 months vs 39 months, P = .035). The prognostic difference was mainly observed in patients with limited stage. By contrast, BR had better toxic profiles. Some patients in BR certainly showed long-term survivals. CONCLUSIONS This study demonstrated better efficacy of RD-R-CHOP, indicating its administration might be considered whenever possible, especially for limited stage. However, BR is a reasonable alternative for those ineligible for anthracycline-containing regimens. Further studies are needed to guide treatment decisions.
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Affiliation(s)
- Chieh-Lung Cheng
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan.,Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Jia-Hau Liu
- Taicheng Stem Cell Therapy Center, National Taiwan University, Taipei City, Taiwan
| | - Sheng-Chieh Chou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Jih-Luh Tang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
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Moore AS, Frimberger AE. Usefulness of chemotherapy for the treatment of very elderly dogs with multicentric lymphoma. J Am Vet Med Assoc 2018; 252:852-859. [DOI: 10.2460/javma.252.7.852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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33
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Cabannes-Hamy A, Peyrade F, Jardin F, Emile JF, Delwail V, Mounier N, Haioun C, Perrot A, Fitoussi O, Lara D, Delarue R, André M, Offner F, Ghesquières H, Pascal L, Soussain C, Lazarovici J, Schiano JM, Gaulard P, Tilly H, Thieblemont C. Central nervous system relapse in patients over 80 years with diffuse large B-cell lymphoma: an analysis of two LYSA studies. Cancer Med 2018; 7:539-548. [PMID: 29473343 PMCID: PMC5852369 DOI: 10.1002/cam4.1139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 06/09/2017] [Indexed: 11/28/2022] Open
Abstract
CNS relapse is reported in 2–5% of diffuse large B‐cell lymphoma (DLBCL) patients, dramatically decreasing overall survival (OS). Very few studies address incidence and risk factors of CNS relapse in very elderly patients, a challenging population to treat given their commonly associated comorbidities. A retrospective analysis was performed of 270 DLBCL patients >80 years treated between 2004 and 2013 in two multicentre phase II LYSA trials (LNH03‐7B, LNH09‐7B) evaluating the addition of rituximab or ofatumumab to mini‐CHOP as front‐line therapy. No patients received CNS prophylaxis. CNS relapse was evaluated according to cumulative incidence, patient characteristics, risk factors, and survival. Median age was 83 years (range: 79–95). After a median follow‐up of 28.7 months, eight patients had CNS relapse (3.0%). Median time between inclusion and CNS relapse was 19.2 months (range: 3.2–32.6). Patients survived a median of 1.5 months after CNS relapse (range: 0.4–4.1). Median OS from relapse was significantly lower in CNS relapse patients (1.5 months, 95% CI: 0.4–3.5) compared to patients with non‐CNS relapse (6.6 months; 95% CI: 4.6–11.9). No baseline characteristics were associated with CNS relapse. The proportion of patients with CNS disease did not differ significantly between patients with low‐intermediate risk according to CNS‐IPI and patients with high risk (3% vs. 2.8%, P = 1.00). CNS relapse cumulative incidence in very elderly treatment‐naive patients is 1.8% at 2 years and is associated with poor survival. This population had a long median time to CNS relapse. Absence of prophylaxis did not strongly impact CNS relapse incidence.
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Affiliation(s)
- Aurélie Cabannes-Hamy
- APHP, Hôpital Saint-Louis, Hemato-Oncologie, Paris, France.,Université Diderot, Sorbonne Paris-Cité, Paris, France.,EA7324, Université Descartes, Paris, France
| | | | - Fabrice Jardin
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, INSERMU1245, Rouen, France
| | - Jean-François Emile
- APHP, Hôpital universitaire Ambroise Paré, Service d'anatomie pathologique, Boulogne, France
| | - Vincent Delwail
- Department of Oncology-Hematology and Cell Therapy, University Hospital, CIC INSERM 1402, Poitiers, France
| | | | - Corinne Haioun
- Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Mondor, Créteil, France
| | - Aurore Perrot
- Hematology Department, University Hospital, Vandoeuvre Les Nancy, France
| | - Olivier Fitoussi
- Polyclinique Bordeaux-Nord, Service d'onco-hématologie, Bordeaux, France
| | - Diane Lara
- Service d'Hematologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | | | - Marc André
- Department of Hematology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Fritz Offner
- CHU, Department of internal medicine, Ghent, Belgium
| | - Hervé Ghesquières
- Hematologie, Centre hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Benite, France
| | - Laurent Pascal
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Hematologie, Lille, France
| | - Carole Soussain
- Hematologie, CLCC Hôpital René Huguenin - Institut Curie, Saint-Cloud, France
| | - Julien Lazarovici
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif
| | | | - Philippe Gaulard
- Département de Pathologie, Hôpital Henri Mondor, AP-HP, Créteil, France.,INSERM U955, Créteil, France.,Université Paris-Est, Créteil, France
| | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, INSERMU1245, Rouen, France
| | - Catherine Thieblemont
- APHP, Hôpital Saint-Louis, Hemato-Oncologie, Paris, France.,Université Diderot, Sorbonne Paris-Cité, Paris, France.,EA7324, Université Descartes, Paris, France
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Combination of ofatumumab and reduced-dose CHOP for diffuse large B-cell lymphomas in patients aged 80 years or older: an open-label, multicentre, single-arm, phase 2 trial from the LYSA group. LANCET HAEMATOLOGY 2018; 4:e46-e55. [PMID: 28041583 DOI: 10.1016/s2352-3026(16)30171-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND In 2011 we reported a rituximab plus miniCHOP (reduced-dose cyclophosphamide, doxorubicin, vincristine, and prednisone) combination for patients older than 80 years with diffuse large B-cell lymphoma (DLBCL). The 2-year overall survival was 59% (95% CI 49-67) with an excess of early toxicity. To improve those results we tested the same chemotherapy protocol in combination with ofatumumab and a pre-phase treatment. METHODS For this open-label, multicentre, single-group, phase 2 trial, we recruited patients older than 80 years with untreated histologically-proven CD20-positive DLBCL, Ann Arbor stage I to IV, from 41 academic and hospital centres in France and Belgium. Patients received a pre-phase with oral vincristine (1 mg total dose 1 week before cycle 1 [day -7]) and oral prednisone (60 mg total dose starting 1 week before cycle 1, for 4 days [day -7 to day -4]) before the first cycle of the ofatumumab plus miniCHOP regimen. The regimen consisted of 1000 mg total dose of intravenous ofatumumab, 25 mg/m2 of intravenous doxorubicin, 400 mg/m2 of intravenous cyclophosphamide, and 1 mg of intravenous vincristine, on day 1 of each cycle; and 40 mg/m2 of oral prednisone on days 1-5. Ofatumumab was administered with 1000 mg of paracetamol and 50 mg of diphenhydramine. The primary endpoint was overall survival in the intention-to-treat population. The statistical analysis has been done on an intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT01195714. FINDINGS Between June 2, 2010, and Nov 4, 2011, we enrolled 120 patients. Age-adjusted International Prognostic Index was 2-3 in 68 (57%) of them. The median follow-up time was 26·8 months (IQR 24·5-30·1). The 2-year overall survival was 64·7% (95% CI 55·3-72·7) and median overall survival was not reached (95% CI 30·2-not reached). 45 patients died during the treatment, of whom 28 (62%) died due to lymphoma. The most common side-effect was haematological toxicity. Among the 120 patients, grade 3-4 neutropenia was reported in 24 (21%) patients and thrombocytopenia in two (2%), during the treatment period. Grade 3-4 anaemia was reported in six (5%) patients; seven (6%) patients had one episode of febrile neutropenia. 17 (15%) of 115 patients in the modified intention-to-treat population had red blood cell transfusions and three (3%) had platelet transfusions. INTERPRETATION Our result suggest that, in patients older than 80 years with DLBCL, ofatumumab and pre-phase treatment seem to improve overall survival compared with the previously reported data. The combination of pre-phase treatment, a monoclonal antibody against CD20, and miniCHOP can be considered a new treatment platform for use in randomised clinical trial design for DLBCL treatment in patients older than 80 years. FUNDING The Lymphoma Study Association, GlaxoSmithKline.
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Cho SF, Wu WH, Yang YH, Liu YC, Hsiao HH, Chang CS. Investigation of treatment pattern, medical resource utilization and demographic prognostic factors in older patients with non-Hodgkin lymphoma: A nationwide population-based study. J Geriatr Oncol 2018; 9:315-320. [PMID: 29396235 DOI: 10.1016/j.jgo.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/21/2017] [Accepted: 01/04/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND This nationwide population study aimed to investigate treatment patterns, medical resource utilization and demographic prognostic factors in older Taiwanese patients with non-Hodgkin lymphoma (NHL). PATIENTS AND METHODS This study was conducted using the National Health Insurance Research Database (NHIRD) of Taiwan. The older patients (65years or older) diagnosed with NHL between 1997 and 2008 were identified for analysis. RESULTS A total of 5136 patients (3049 males and 2087 females) with a median age of 74.1years were identified for analysis. Among these patients, 3267 patients (63.6%) received various combinations of systemic therapies. The older the patient, the less likely it was for intensive curative treatment to be given. Regarding medical resource usage, younger patients or patients living in more urbanized areas were more likely to receive NHL treatment in medical centers. The median overall survival of all patients with NHL was 49.41months (range, 0.03 to 143.97). The investigation for prognostic factors by multivariate analysis revealed that more advanced age, treatment in non-medical centers and living in less urbanized areas were associated with poorer outcomes. CONCLUSION Treatment of older patients with NHL is still a challenge. For better outcomes, it is very important to evaluate the patient and tailor treatment modalities. Additionally, health policy makers should help to narrow discrepancies in survival based on demographics.
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Affiliation(s)
- Shih-Feng Cho
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Hsuan Wu
- Division of Hematology and Oncology, E-Da Hospital, Kaohsiung, Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chang Liu
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Hua Hsiao
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Sung Chang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan; Division of Hematology and Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan.
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Gobba S, Moccia AA, Gulden-Sala W, Conconi A, Diem S, Cascione L, Iacoboni G, Margiotta-Casaluci G, Aprile von Hohenstaufen K, Stathis A, Hitz F, Pinotti G, Gaidano G, Zucca E. Outcome of patients older than 80 years with diffuse large B-cell lymphoma (DLBCL) treated with “standard” immunochemotherapy: A large retrospective study from 4 institutions. Hematol Oncol 2017. [DOI: 10.1002/hon.2447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Stefania Gobba
- ASST Sette Laghi; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Alden A. Moccia
- Istituto Oncologico della Svizzera Italiana; Bellinzona Switzerland
| | | | - Annarita Conconi
- SCDU Ematologia, Dipartimento di Medicina Traslazionale; Università degli Studi del Piemonte Orientale; Novara Italy
- Unit of Hematology; Ospedale degli Infermi; Biella Italy
| | - Stefan Diem
- Klinik für Onkologie und Hämatologie; Kantonsspital St Gallen; St Gallen Switzerland
| | - Luciano Cascione
- Istituto Oncologico della Svizzera Italiana; Bellinzona Switzerland
- Lymphoma and Genomics Research Program; Institute of Oncology Research (IOR); Bellinzona Switzerland
| | - Gloria Iacoboni
- Istituto Oncologico della Svizzera Italiana; Bellinzona Switzerland
| | - Gloria Margiotta-Casaluci
- SCDU Ematologia, Dipartimento di Medicina Traslazionale; Università degli Studi del Piemonte Orientale; Novara Italy
| | | | | | - Felicitas Hitz
- Klinik für Onkologie und Hämatologie; Kantonsspital St Gallen; St Gallen Switzerland
| | - Graziella Pinotti
- ASST Sette Laghi; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Gianluca Gaidano
- SCDU Ematologia, Dipartimento di Medicina Traslazionale; Università degli Studi del Piemonte Orientale; Novara Italy
| | - Emanuele Zucca
- Istituto Oncologico della Svizzera Italiana; Bellinzona Switzerland
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Choi JH, Kim TM, Kim HJ, Koh SA, Mun YC, Kang HJ, Jung YH, Shim H, Chong SY, Sun DS, Lee S, Park BB, Kwon JH, Nam SH, Yi JH, Yuh YJ, Jin JY, Han JJ, Kim SH. Multicenter Retrospective Analysis of Clinical Characteristics, Treatment Patterns, and Outcomes in Very Elderly Patients with Diffuse Large B-Cell Lymphoma: The Korean Cancer Study Group LY16-01. Cancer Res Treat 2017; 50:590-598. [PMID: 28602052 PMCID: PMC5912125 DOI: 10.4143/crt.2017.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose The treatment strategy for elderly patients older than 80 years with diffuse large B-cell lymphoma (DLBCL) has not been established because of poor treatment tolerability and lack of data. Materials and Methods This multicenter retrospective study was conducted to investigate clinical characteristics, treatment patterns and outcomes of patients older than 80 years who were diagnosed with DLBCL at 19 institutions in Korea between 2005 and 2016. Results A total of 194 patients were identified (median age, 83.3 years). Of these, 114 patients had an age-adjusted International Prognostic Index (aaIPI) score of 2-3 and 48 had a Charlson index score of 4 or more. R-CHOP was given in 124 cases, R-CVP in 13 cases, other chemotherapy in 17 cases, radiation alone in nine cases, and surgery alone in two cases. Twenty-nine patients did not undergo any treatment. The median number of chemotherapy cycles was three. Only 37 patients completed the planned treatment cycles. The overall response rate from 105 evaluable patientswas 90.5% (complete response, 41.9%). Twentynine patients died due to treatment-related toxicities (TRT). Thirteen patients died due to TRT after the first cycle. Median overall survival was 14.0 months. The main causes of death were disease progression (30.8%) and TRT (27.1%). In multivariate analysis, overall survival was affected by aaIPI, hypoalbuminemia, elevated creatinine, and treatment. Conclusion Age itself should not be a contraindication to treatment. However, since elderly patients show higher rates of TRT due to infection, careful monitoring and dose modification of chemotherapeutic agents is needed.
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Affiliation(s)
- Jung Hye Choi
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Ae Koh
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hye Jin Kang
- Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea
| | - Yun Hwa Jung
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeok Shim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - So Young Chong
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Der-Sheng Sun
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Soonil Lee
- Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Byeong Bae Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seung-Hyun Nam
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Jun Ho Yi
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Young Jin Yuh
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jong-Youl Jin
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jae Joon Han
- Devision of Hematology-Oncology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seok-Hyun Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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38
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Thieblemont C, Bernard S, Molina T. Management of aggressive lymphoma in very elderly patients. Hematol Oncol 2017; 35 Suppl 1:49-53. [PMID: 28591412 PMCID: PMC5873382 DOI: 10.1002/hon.2413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Catherine Thieblemont
- Hemato-Oncologie, APHP, Hôpital Saint-Louis, Paris, France.,Sorbonne Paris-Cité, Diderot University, Paris, France.,EA7324, Descartes University, Paris, France
| | - Sophie Bernard
- Hemato-Oncologie, APHP, Hôpital Saint-Louis, Paris, France.,Sorbonne Paris-Cité, Diderot University, Paris, France.,EA7324, Descartes University, Paris, France
| | - Thierry Molina
- EA7324, Descartes University, Paris, France.,Anatomie-Pathologie, APHP, Hôpital Necker, Paris, France.,Sorbonne Paris-Cité, Descartes University, Paris, France
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Pinnix CC, Andraos TY, Dabaja B, Milgrom S, Smith G, Chihara D, Ng A, Fayad LE, Oki Y, Neelapu S, Westin J, Rodriguez MA, Nastoupil LJ. Diffuse large B-cell lymphoma in very elderly patients over 80 years old: Incorporating consolidative radiation therapy into management decisions. Adv Radiat Oncol 2017; 2:370-380. [PMID: 29114605 PMCID: PMC5605286 DOI: 10.1016/j.adro.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 01/16/2023] Open
Abstract
Purpose The population of patients aged 80 years or older who are diagnosed with diffuse large B-cell lymphoma (DLBCL) continues to increase, but an optimal treatment strategy has not been established. We sought to examine the influence of consolidative radiation therapy (RT) on outcome and toxicity among the very elderly diagnosed with stage I-IV DLBCL. Methods and materials We evaluated 131 patients treated at a single institution between 2002 and 2014 who were eligible for RT after successful treatment with chemotherapy. Results The median age was 83 years (range, 80-96). Advanced-stage disease was present in 61.8% of patients. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone was administered to 80% of patients (n = 108), and 23.7% of patients received consolidative RT. Among early-stage (ES) patients treated with 3 to 4 cycles of chemotherapy and RT (n = 12) versus 6 to 8 cycles of chemotherapy alone (n = 17), there were no statistically significant differences in 3-year disease-free, progression-free, or overall survival rates. The 3 year disease-free survival was 91.7% versus 88.2% among patients treated with combined modality therapy versus chemotherapy alone (P = .78). The 3-year overall survival was 82.5% versus 87.5% among patients treated with combined modality therapy compared with chemotherapy alone (P = .852). Anemia and neuropathy occurred more frequently among ES patients who received 6 to 8 cycles of chemotherapy alone. Among advanced-stage patients with bulky disease (n = 35), consolidative RT to sites of bulky disease may have improved local control (3-year local control, 100% vs 60.3%, P = .160). Conclusions Among patients aged 80 years or older who have with ES DLBCL, 3 to 4 cycles of chemotherapy followed by RT is at least equivalent in efficacy to chemotherapy alone and is associated with lower levels of toxicity, which suggests that it may be a better choice for therapy when trying to balance treatment efficacy and tolerability.
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Affiliation(s)
- Chelsea C. Pinnix
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
- Corresponding author. MD Anderson Cancer Center, Department of Radiation Oncology, 1515 Holcombe Boulevard, Unit #97, Houston, TX 77030.MD Anderson Cancer CenterDepartment of Radiation Oncology1515 Holcombe BoulevardUnit #97HoustonTX77030
| | - Therese Y. Andraos
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina Dabaja
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sarah Milgrom
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Grace Smith
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Dai Chihara
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Andrea Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Luis E. Fayad
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Yasuhiro Oki
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sattva Neelapu
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jason Westin
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - M. Alma Rodriguez
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
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40
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Survival outcomes in the very elderly with DLBCL prior to and after the introduction of rituximab: a US population-based study. Blood Adv 2017; 1:615-618. [PMID: 29296703 DOI: 10.1182/bloodadvances.2016002675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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41
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Investigation on treatment strategy, prognostic factors, and risk factors for early death in elderly Taiwanese patients with diffuse large B-cell lymphoma. Sci Rep 2017; 7:44282. [PMID: 28290477 PMCID: PMC5349600 DOI: 10.1038/srep44282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/06/2017] [Indexed: 12/19/2022] Open
Abstract
This study aimed to investigate the treatment strategy, prognostic factors, and risk factors of early death in elderly patients (age ≥ 65 years) with diffuse large B-cell lymphoma (DLBCL) in the rituximab era. Data from elderly patients diagnosed with DLBCL between 2008 and 2014 were collected for analysis. Patients who were younger and had a better performance status were more likely to receive intensive frontline treatment. The median progression-free survival (PFS) and overall survival were 15 and 21 months, respectively. Anthracycline-containing chemotherapy achieved a higher remission rate and showed a trend towards better overall survival but a higher risk of severe neutropenia. Multivariate analysis revealed that very old age (≥81 years), a high-risk age-adjusted international prognostic index (aaIPI) score, and bone marrow involvement were associated with poorer PFS and overall survival. Progression of lymphoma was the major cause of death in the study population. In addition, approximately 25% of patients died within 120 days of being diagnosed. The risk factors for early mortality included very old age, a high-risk aaIPI score, and bone marrow involvement. The appearance of symptoms or signs of tumour lysis syndrome at diagnosis was associated with a trend towards early death.
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Ricciuti G, Finolezzi E, Luciani S, Ranucci E, Federico M, Di Nicola M, Zecca IAL, Angrilli F. Combination of rituximab and nonpegylated liposomal doxorubicin (R-NPLD) as front-line therapy for aggressive non-Hodgkin lymphoma (NHL) in patients 80 years of age or older: a single-center retrospective study. Hematol Oncol 2017; 36:44-48. [DOI: 10.1002/hon.2386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/28/2016] [Accepted: 01/08/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Giuseppina Ricciuti
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
| | - Erica Finolezzi
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
| | - Stefania Luciani
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
| | - Elena Ranucci
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
| | | | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences; “G. D'Annunzio” University; Chieti Italy
| | - Isaia Antonio Luca Zecca
- Department of Medical, Oral and Biotechnological Sciences; “G. D'Annunzio” University; Chieti Italy
| | - Francesco Angrilli
- Center for the Diagnosis and Treatment of Lymphomas, Department of Hematology, Transfusion Medicine and Biotechnology; Spirito Santo Hospital; Pescara Italy
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Laribi K, Denizon N, Bolle D, Truong C, Besançon A, Sandrini J, Anghel A, Farhi J, Ghnaya H, Baugier de Materre A. R-CVP regimen is active in frail elderly patients aged 80 or over with diffuse large B cell lymphoma. Ann Hematol 2016; 95:1705-14. [DOI: 10.1007/s00277-016-2768-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/23/2016] [Indexed: 11/24/2022]
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44
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Chihara D, Westin JR, Oki Y, Ahmed MA, Do B, Fayad LE, Hagemeister FB, Romaguera JE, Fanale MA, Lee HJ, Turturro F, Samaniego F, Neelapu SS, Rodriguez MA, Fowler NH, Wang M, Davis RE, Nastoupil LJ. Management strategies and outcomes for very elderly patients with diffuse large B-cell lymphoma. Cancer 2016; 122:3145-3151. [PMID: 27351173 DOI: 10.1002/cncr.30173] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/26/2016] [Accepted: 06/02/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND The number of elderly patients with diffuse large B-cell lymphoma (DLBCL) in our aging society continues to rise, although the optimal management of very elderly patients with DLBCL is unknown. METHODS This study evaluated 207 patients who were 80 years old or older at the diagnosis of DLBCL from 2002 to 2014 at The University of Texas MD Anderson Cancer Center. Analyzed features included clinical characteristics, treatment outcomes, and tolerability of therapy. Cox proportional hazards models examined relations between the treatment regimen and survival. RESULTS The median age was 83 years (range, 80-96 years). Fifty-four percent of the patients had intermediate- to high-risk or high-risk International Prognostic Index scores. Fifteen percent had scores of 4 or higher on the Charlson Comorbidity Index (CCI). The initial therapies included rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 70%); rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH; 6%); and non-anthracycline-based therapies, including rituximab, cyclophosphamide, etoposide, vincristine, and prednisone (R-CEOP) and rituximab, cyclophosphamide, vincristine, and prednisone (R-CVP; 10%). With a median follow-up of 38.1 months, the 3-year failure-free survival (FFS) and overall survival (OS) rates were 55% and 54%, respectively. Eighty-eight patients experienced relapse during the follow-up, but only 3 patients (3.4%) experienced relapse beyond 3 years. Patients who received R-CHOP or R-EPOCH had significantly longer FFS than those who received R-CEOP or R-CVP, with 3-year FFS rates of 63% for R-CHOP, 74% for R-EPOCH, and 23% for R-CEOP and R-CVP. Male sex, a monocyte count ≥ 500 × 107 /L, and a CCI score ≥ 4 were significantly associated with inferior OS. Extranodal disease (≥2) and a higher CCI score were associated with a high risk of treatment-related mortality. CONCLUSIONS With anthracycline-based regimens such as R-CHOP and R-EPOCH, very elderly patients with DLBCL had superior outcomes similar to those achieved for younger patients with DLBCL. Cancer 2016;122:3145-51. © 2016 American Cancer Society.
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Affiliation(s)
- Dai Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mohamed A Ahmed
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bryan Do
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Luis E Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fredrick B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorge E Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hun J Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sattva S Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - M Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathan H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Hitz F, Zucca E, Pabst T, Fischer N, Cairoli A, Samaras P, Caspar CB, Mach N, Krasniqi F, Schmidt A, Rothermundt C, Enoiu M, Eckhardt K, Berardi Vilei S, Rondeau S, Mey U. Rituximab, bendamustine and lenalidomide in patients with aggressive B-cell lymphoma not eligible for anthracycline-based therapy or intensive salvage chemotherapy - SAKK 38/08. Br J Haematol 2016; 174:255-63. [DOI: 10.1111/bjh.14049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/22/2016] [Indexed: 12/19/2022]
Affiliation(s)
| | - Emanuele Zucca
- IOSI (Istituto Oncologico della Svizzera Italiana); Bellinzona Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ulrich Mey
- Kantonsspital Graubünden; Chur Switzerland
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Zhao H, Wang T, Wang Y, Yu Y, Wang X, Zhao Z, Yang H, Yan B, Wu X, Da W, Zhang Y. Comorbidity as an independent prognostic factor in elderly patients with peripheral T-cell lymphoma. Onco Targets Ther 2016; 9:1795-9. [PMID: 27069369 PMCID: PMC4818048 DOI: 10.2147/ott.s93687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to investigate the role of comorbidities in the outcomes of patients with peripheral T-cell lymphoma (PTCL) in a Chinese population. Fifty-six newly diagnosed PTCL patients aged >60 years were enrolled in our institution between April 2008 and August 2014. Medical record details including clinical parameters, pathological status, and treatment were reviewed. Prognostic factors were assessed using univariate and multivariate analyses. Forty-one (73.2%) patients with PTCL, not otherwise specified (PTCL-NOS), nine (16.1%) with angioimmunoblastic T-cell lymphoma, and six (10.7%) with anaplastic large cell lymphoma were recruited in this study. Twenty-eight (50%) had at least one comorbidity. Univariate analysis showed that an Eastern Cooperative Oncology Group score of 2-4, the presence of B symptoms, an International Prognostic Index (IPI) score of 3-5, and a Charlson Comorbidity Index (CCI) score ≥2 were significantly associated with shortened overall survival (OS), whereas the presence of B symptoms, an IPI of 3-5, and a CCI ≥2 were associated with worsened progression-free survival (PFS). Multivariate analysis indicated that a high CCI (≥2) and a high IPI (3-5) were poor independent prognostic factors for OS and PFS in the elderly patients with PTCL. Comorbidity was identified as a new independent poor prognostic factor for elderly patients with PTCL.
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Affiliation(s)
- Haifeng Zhao
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Tengteng Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Yafei Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Yong Yu
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Xiaofan Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Zhigang Zhao
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Hongliang Yang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Bei Yan
- Department of Hematology, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Xiaoxiong Wu
- Department of Hematology, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Wanming Da
- Department of Hematology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Yizhuo Zhang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
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Jo JC, Choi Y, Shin HJ, Yhim SN, Lee HS, Lee WS, Lee JH, Kim H, Oh SY. Peripheral T cell lymphomas in elderly patients: a retrospective analysis from the Hematology Association of South East Korea (HASEK). Ann Hematol 2016; 95:619-24. [PMID: 26779714 DOI: 10.1007/s00277-016-2597-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022]
Abstract
Limited data are available on the clinical features and the outcomes of elderly patients with peripheral T cell lymphomas (PTCLs). We identified PTCL patients of age 60 years or older from the records of the Hematology Association of South East Korea between 2001 and 2014. The median age of the patients (70.4 % male) was 71 years (range 60-88 years). The majority (80.2 %) had stage III/IV disease, and 61.7 % of patients had Charlson comorbidity index (CCI) score 0. Out of 74 patients treated with chemotherapy, 62 were administered anthracycline-based combination chemotherapy (CHOP: 47 patients, CHOEP: 15 patients), and 12 received non-anthracycline-based combination chemotherapy (IMEP: 8 patients, and CVP: 4 patients). The overall response rate for the 74 patients treated with chemotherapy was 70.2 % (CR 37.8 % and PR 32.4 %). With a median follow-up of 23.8 (range 0.5-156) months, the estimated 5-year progression-free survival (PFS) and overall survival (OS) were 16.6 and 45.9 %, respectively. There were no significant differences in PFS and OS between patients treated with anthracycline-based and non-anthracycline-based combination chemotherapy. In the univariate analysis, increased age, elevated serum lactate dehydrogenase, Eastern Cooperative Oncology Group performance status >1, higher CCI, high or high-intermediate IPI, and PIT groups 3-4 were associated with shorter OS. Our findings may provide valuable information on the management and outcomes of elderly patients with PTCL in clinical practice.
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Affiliation(s)
- Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yunsuk Choi
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ho-Jin Shin
- Department of Hematology and Oncology, Busan National University Hospital, Busan, South Korea
| | - Sung Nam Yhim
- Department of Hematology and Oncology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ho Sup Lee
- Department of Hematology and Oncology, Kosin University Gospel Hospital, Busan, South Korea
| | - Won-Sik Lee
- Department of Hematology and Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ji-Hyun Lee
- Department of Hematology and Oncology, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, South Korea
| | - Hawk Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Sung Yong Oh
- Department of Hematology and Oncology, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, South Korea.
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Millar A, Ellis M, Mollee P, Cochrane T, Fletcher J, Caudron A, Webster B, Trotman J. Deliverability and efficacy of R-CHOP chemotherapy in very elderly patients with diffuse large B-cell lymphoma: an Australian retrospective analysis. Intern Med J 2015; 45:1147-53. [DOI: 10.1111/imj.12889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/09/2015] [Indexed: 12/26/2022]
Affiliation(s)
- A. Millar
- University of Sydney; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - M. Ellis
- Princess Alexandra Hospital; Brisbane Queensland Australia
| | - P. Mollee
- Princess Alexandra Hospital; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - T. Cochrane
- Gold Coast University Hospital; Gold Coast Queensland Australia
| | - J. Fletcher
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - A. Caudron
- Princess Alexandra Hospital; Brisbane Queensland Australia
| | - B. Webster
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - J. Trotman
- University of Sydney; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Sydney New South Wales Australia
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49
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Carver JR. Cardiac toxicity in the elderly and the role of cardio oncology. PROGRESS IN PEDIATRIC CARDIOLOGY 2015. [DOI: 10.1016/j.ppedcard.2015.10.003] [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: 10/22/2022]
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50
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Iioka F, Izumi K, Kamoda Y, Akasaka T, Ohno H. Outcomes of very elderly patients with aggressive B-cell non-Hodgkin lymphoma treated with reduced-dose chemotherapy. Int J Clin Oncol 2015; 21:498-505. [DOI: 10.1007/s10147-015-0912-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/30/2015] [Indexed: 01/17/2023]
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