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Munoz J, Deshpande A, Rimsza L, Nowakowski GS, Kurzrock R. Navigating between Scylla and Charybdis: A roadmap to do better than Pola-RCHP in DLBCL. Cancer Treat Rev 2024; 124:102691. [PMID: 38310754 DOI: 10.1016/j.ctrv.2024.102691] [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: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/06/2024]
Abstract
In treating diffuse large B-cell lymphoma (DLBCL), oncologists have traditionally relied on the chemotherapy backbone of R-CHOP as standard of care. The two dangers that the hematologist must navigate between are the aggressive disease (Charybdis that in the absence of therapy systematically destroys all the ships) and the toxicity of the therapies (Scylla with its six monstrous heads that devours six crew members at a time), and hematologists have to navigate very carefully between both. Therefore, three different strategies were employed with the goal of improving cure rates: de-escalating regimens, escalating regimens, and replacement strategies. With a replacement strategy, a breakthrough in treatment was identified with polatuzumab vedotin (anti-CD79B antibody/drug conjugate) plus R-CHP. However, this regimen still did not achieve the elusive universal cure rate. Fortunately, advances in genomic and molecular technologies have allowed for an improved understanding of the heterogenous molecular nature of the disease to help develop and guide more targeted, precise, and individualized therapies. Additionally, new pharmaceutical technologies have led to the development of novel cellular therapies, such as chimeric antigen receptor (CAR) T-cell therapy, that could be more effective, while maintaining an acceptable safety profile. Thus, we aim to highlight the challenges of DLBCL therapy as well as the need to address therapeutic regimens eventually no longer tethered to a chemotherapy backbone. In the intersection of artificial intelligence and multi-omics (genomics, epigenomics, transcriptomics, proteomics, metabolomics), we propose the need to analyze multidimensional biologic datato launch a decisive attack against DLBCL in a targeted and individualized fashion.
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Affiliation(s)
- Javier Munoz
- Department of Hematology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Lisa Rimsza
- Department of Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Grzegorz S Nowakowski
- Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - Razelle Kurzrock
- Medical College of Wisconsin, Milwaukee, WI, USA; WIN Consortium, Paris, France; University of Nebraska, Omaha, Nebraska, USA
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Lakhotia R, Dunleavy K, Abramson JS, Link BK, Powell BL, Melani C, Lucas AN, Steinberg SM, Friedberg JW, Kahl BS, Little RF, Bartlett NL, Noy A, Wilson WH, Roschewski M. Prognostic factors for adult patients with Burkitt lymphoma treated with dose-adjusted EPOCH-R. Blood Adv 2023; 7:5320-5324. [PMID: 37389844 PMCID: PMC10506053 DOI: 10.1182/bloodadvances.2023010223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/15/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- Rahul Lakhotia
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Kieron Dunleavy
- Department of Hematology-Oncology, Georgetown University, Washington, DC
| | - Jeremy S. Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Brian K. Link
- Department of Medicine, University of Iowa, Iowa City, IA
| | - Bayard L. Powell
- Department of Internal Medicine-Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christopher Melani
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Andrea N. Lucas
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Brad S. Kahl
- Lymphoma Program, Washington University School of Medicine Siteman Cancer Center, St. Louis, MO
| | | | - Nancy L. Bartlett
- Lymphoma Program, Washington University School of Medicine Siteman Cancer Center, St. Louis, MO
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wyndham H. Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
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Buege MJ, Drill E, Horwitz SM, LeVoir A, Pak T, Peterson TJ, Dao PH, Matasar MJ. Low incidence of cardiotoxicity in patients with non-Hodgkin lymphoma receiving EPOCH after prior anthracycline exposure. Eur J Haematol 2023; 111:96-102. [PMID: 36971022 PMCID: PMC10634315 DOI: 10.1111/ejh.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To describe the incidence of cardiotoxicity in patients with anthracycline exposure who subsequently receive EPOCH for non-Hodgkin lymphoma (NHL). METHODS We conducted a retrospective cohort study of adults with anthracycline exposure who subsequently received EPOCH for NHL at Memorial Sloan Kettering Cancer Center. The primary outcome was cumulative incidence of arrhythmia, heart failure (HF), left ventricular (LV) dysfunction, or cardiac death. RESULTS Among 140 patients, most had diffuse large B-cell lymphoma. Inclusive of EPOCH, median cumulative doxorubicin-equivalent dose was 364 mg/m2 ; exposure was 400 mg/m2 or higher in 41%. With median 36-month follow-up, 23 cardiac events were noted in 20 patients. Cumulative incidence of cardiac events at 60 months was 15% (95% confidence interval [CI]: 9%-21%). When limited to LV dysfunction/HF, cumulative incidence at 60 months was 7% (95% CI: 3%-13%), with most events occurring after the first year. Univariate analysis indicated only history of cardiac disease and dyslipidemia to be associated with cardiotoxicity; no other risk factors, including cumulative anthracycline dose, were identified. CONCLUSIONS In this retrospective cohort, representing the largest experience in this setting with extended follow-up, cumulative incidence of cardiac events was low. Rates of LV dysfunction or HF were particularly low, suggesting infusional administration may mitigate risk despite prior exposure.
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Affiliation(s)
- Michael J. Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Esther Drill
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Steven M. Horwitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Andréa LeVoir
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Terry Pak
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Tim J. Peterson
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Phuong H. Dao
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Matthew J. Matasar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
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Ohmachi K, Ogura M, Kagami Y, Imai Y, Hirose T, Kinoshita T, Nagai H, Ohnishi K, Hotta T. A multicenter, phase II study of full-dose THP-COP therapy for elderly patients with newly diagnosed, advanced-stage, aggressive non-Hodgkin lymphoma. J Clin Exp Hematop 2022; 62:202-207. [PMID: 36575000 PMCID: PMC9898716 DOI: 10.3960/jslrt.22026] [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: 12/29/2022] Open
Abstract
The cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) regimen, containing doxorubicin (DXR), which is a key drug for aggressive non-Hodgkin lymphoma (NHL), is a standard chemotherapeutic regimen; however, its administration in elderly patients is often intolerable. Pirarubicin (tetrahydropyranyl adriamycin [THP]) is an anthracycline developed in Japan. We have conducted a phase II trial of a full-dose THP-COP (modified CHOP regimen with DXR replaced by THP) regimen for elderly patients with newly diagnosed, advanced-stage, aggressive NHL. Patients aged 70-79 years old with previously untreated NHL according to the Working Formulation (D through H and J), disease stage I with a bulky mass or stage II-IV, and performance status of 0-1 were eligible. The THP-COP regimen, which consisted of 750-mg/m2 cyclophosphamide, 50-mg/m2 THP, 1.4-mg/m2 vincristine (capped at 2.0 mg) on day 1, and 100-mg prednisolone daily on days 1 to 5, was delivered every 3 weeks for 6 cycles. The primary endpoint was complete response (CR) rate. Twenty-nine patients were enrolled in the study. The CR rate was 65.5% (95% confidence interval, 45.7-82.1%). The 3-year failure-free and overall survival rates were 54.1% and 53.9%, respectively. The most frequent observed grade 3 or 4 toxicity was neutropenia, which occurred in 80% of the patients. Grade 3 cardiac dysfunction was observed in one patient. The full-dose THP-COP regimen exhibited similar efficacy and safety, and a tendency for less cardiac toxicity, when compared with the standard CHOP regimen in elderly Japanese patients with newly diagnosed, advanced-stage, aggressive NHL.
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Affiliation(s)
- Ken Ohmachi
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Michinori Ogura
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshitoyo Kagami
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yosuke Imai
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Takayuki Hirose
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tomohiro Kinoshita
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Kazunori Ohnishi
- Department of Hematology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomomitsu Hotta
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Zhan J, Yang S, Zhang W, Zhou D, Zhang Y, Wang W, Wei C. DA-EPOCH-R improves the prognosis of patients with double-expressor lymphoma: A single-center retrospective study and meta-analysis. Medicine (Baltimore) 2022; 101:e30620. [PMID: 36197215 PMCID: PMC9509123 DOI: 10.1097/md.0000000000030620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Double-expressor lymphoma (DEL) is associated with a poor prognosis. The standard treatment for patients with DEL remains controversial. A comparison of the safety and feasibility of R-CHOP and DA-EPOCH-R as the first-line therapy for patients with DEL is urgently needed. METHODS The clinical and treatment outcomes of 75 DEL patients were retrospectively analyzed. The role of DA-EPOCH-R was determined and compared to that of R-CHOP in DEL patients. PubMed, Embase, the Cochrane Central Library, and ClinicalTrials.gov were systematically searched up to November 1, 2021 and were evaluated by Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Articles comparing DA-EPOCH-R versus R-CHOP in patients with DEL were included. RESULTS Overall, 49 and 26 DEL patients received R-CHOP and DA-EPOCH-R, respectively. Although the difference in response for patients who received R-CHOP and DA-EPOCH-R was not significant (P = .347), DA-EPOCH-R may improve the prognosis compared to R-CHOP (P = .056 for progression-free survival [PFS], P = .009 for overall survival [OS]). A systematic review and meta-analysis including 412 DEL patients in six articles were conducted. The event rate for 3-year PFS was significantly lower in patients receiving DA-EPOCH-R treatment than in those undergoing R-CHOP treatment (OR = 0.63, 95% CI = 0.42-0.94, P = .02), whereas no statistically significant difference was found in the HRs for both PFS and OS or the event rate for 3-year OS. CONCLUSION The results of this study indicated that DA-EPOCH-R might improve the prognosis of DEL patients compared with R-CHOP.
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Affiliation(s)
- Jing Zhan
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shijie Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chong Wei
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Taniguchi T, Nakayama S, Tanaka H, Rai S, Hirase C, Morita Y, Tatsumi Y, Ashida T, Matsuda M, Hashimoto S, Matsumura I. Novel prognostic predictor of haemoglobin-platelet index in diffuse large B-cell lymphoma, not otherwise specified: Anaemia and thrombocytopenia are associated with IL-6 production in lymphoma cells. Br J Haematol 2022; 198:360-372. [PMID: 35451502 DOI: 10.1111/bjh.18208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
We previously reported that a novel haemoglobin-platelet index (HPI) based on anaemia and thrombocytopenia was useful to predict the prognosis of patients with diffuse large B-cell lymphoma not otherwise specified (DLBCL NOS). Here, we analyse the utility of HPI in a new validation cohort with DLBCL NOS (n = 94). As a result, we confirm that HPI was effective for differentiating progression-free survival (PFS) and overall survival in this validation cohort. So, we further compare the utility of HPI with previously reported prognostic markers such as the National Comprehensive Center Network-International Prognostic Index (NCCN-IPI), Glasgow prognostic score (GPS), and platelet-albumin (PA) score, using a larger number of 160 patients consisting of the derivation cohort (n = 66) and a validation cohort (n = 94). As a result, the patients with a higher HPI score had significantly worse outcomes, and HPI predicted the prognosis of DLBCL NOS independently of NCCN-IPI. HPI was more sensitive than GPS and almost the same as PA score in predicting PFS. Moreover, the patients whose lymphoma cells were positive for interleukin-6 (IL-6) (75/111 cases) judged by immunohistochemical staining had significantly lower haemoglobin levels and platelet counts than IL-6-negative cases (36/111 cases), suggesting the involvement of IL-6 produced by lymphoma cells in anaemia and thrombocytopenia in DLBCL NOS patients.
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Affiliation(s)
- Takahide Taniguchi
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Shoko Nakayama
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Hirokazu Tanaka
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Shinya Rai
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Chikara Hirase
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Yasuyoshi Morita
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Yoichi Tatsumi
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Takashi Ashida
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Mitsuhiro Matsuda
- Department of Hematology, Perfect Liberty General Hospital, Tondabayashi-shi, Osaka, Japan
| | - Shigeo Hashimoto
- Department of Pathology, Perfect Liberty General Hospital, Tondabayashi-shi, Osaka, Japan
| | - Itaru Matsumura
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
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7
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Hoppe BS, Advani R, Milgrom SA, Bakst RL, Ballas LK, Dabaja BS, Flowers CR, Ha CS, Mansur DB, Metzger ML, Pinnix CC, Plastaras JP, Roberts KB, Smith SM, Terezakis SA, Kirwan JM, Constine LS. Primary Mediastinal B Cell Lymphoma in the Positron-Emission Tomography Era Executive Summary of the American Radium Society Appropriate Use Criteria. Int J Radiat Oncol Biol Phys 2021; 111:36-44. [PMID: 33774076 DOI: 10.1016/j.ijrobp.2021.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Primary mediastinal B cell lymphoma (PMBCL) is a highly curable subtype of non-Hodgkin lymphoma that is diagnosed predominantly in adolescents and young adults. Consequently, long-term treatment-related morbidity is critical to consider when devising treatment strategies that include different chemoimmunotherapy strategies with or without radiation therapy. Furthermore, adaptive approaches using the end-of-chemotherapy (EOC) positron emission tomography (PET)/computed tomography (CT) scanning may help to determine which patients may benefit from additional therapies. We aimed to develop evidence-based guidelines for treating these patients. METHODS AND MATERIALS We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the PubMed database. The ARS expert committee, composed of radiation oncologists, hematologists, and pediatric oncologists, developed consensus guidelines using the modified Delphi framework. RESULTS Nine studies met the full criteria for inclusion based on reporting outcomes on patients with primary mediastinal B cell lymphoma with EOC PET/CT response scored with the 5-point Deauville scale. These studies formed the evidence for these guidelines in managing patients with PMBCL according to the EOC PET response, including after a 5-point Deauville scale of 1 to 3, 4, or 5, and for patients with relapsed and refractory disease. The expert group also developed guidance on radiation simulation, treatment planning, and plan evaluation based on expert opinion. CONCLUSIONS Various treatment approaches exist in the management of PMBCL, including different chemoimmunotherapy regimens, the use of consolidative radiation therapy, and adaptive approaches based on EOC PET/CT response. These guidelines can be used by practitioners to provide appropriate treatment according to different disease scenarios.
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Affiliation(s)
- Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
| | - Ranjana Advani
- Department of Radiation Oncology, Stanford Cancer Center, Palo Alto, California
| | - Sarah A Milgrom
- Department of Radiation Oncology,University of Colorado, Aurora, Colorado
| | - Richard L Bakst
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Leslie K Ballas
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christopher R Flowers
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chul S Ha
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - David B Mansur
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Monika L Metzger
- Department of Oncology, St Jude Children's Research Hospital and University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Chelsea C Pinnix
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Kenneth B Roberts
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Jessica M Kirwan
- Department of Radiation Oncology, University of Florida Department of Radiation Oncology, Gainesville, Florida
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
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Ohmoto A, Fuji S. Clinical feasibility of oral low-dose etoposide and sobuzoxane for conventional chemotherapy-intolerant lymphoma patients. Expert Rev Anticancer Ther 2021; 21:715-722. [PMID: 33656972 DOI: 10.1080/14737140.2021.1898376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: In Japan, etoposide or sobuzoxane, a type of topoisomerase II inhibitor, is orally administered in patients with lymphoma who cannot tolerate conventional combination chemotherapy. However, the related clinical data remain to be fully summarized.Areas covered: We evaluate the efficacy and toxicity of etoposide and sobuzoxane.Expert opinion: Previous studies on etoposide or sobuzoxane monotherapy, including those among patients who could not tolerate conventional chemotherapy, suggested a favorable overall response rate (ORR) with moderate gastrointestinal or liver/renal toxicity. As for adult T-cell leukemia/lymphoma, a clinical trial with a limited sample size exhibited an ORR of >70%. Remarkably, the percentage of patients with a poor performance status was high among those receiving etoposide/sobuzoxane. Given a lack of randomized studies, etoposide/sobuzoxane might be a therapeutic option for lymphoma in a palliative setting. In the future, prospective trials with a homologous treatment schedule are warranted, in which the association between clinical efficacy and characteristics of lymphomas, such as specific gene alterations, should be elucidated.
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Affiliation(s)
- Akihiro Ohmoto
- Division of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
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Sparano JA, Lee JY, Kaplan LD, Ramos JC, Ambinder RF, Wachsman W, Aboulafia D, Noy A, Henry DH, Ratner L, Cesarman E, Chadburn A, Mitsuyasu R. Response-adapted therapy with infusional EPOCH chemotherapy plus rituximab in HIV-associated, B-cell non-Hodgkin's lymphoma. Haematologica 2021; 106:730-735. [PMID: 32107337 PMCID: PMC7927888 DOI: 10.3324/haematol.2019.243386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 12/20/2022] Open
Abstract
Four cycles of rituximab plus CHOP chemotherapy is as effective as 6 cycles in low-risk diffuse large B-cell lymphoma (DLBCL). Here we report a post-hoc analysis of a prospective clinical trial in patients with HIV-associated DLBCL and high-grade lymphoma treated with 4-6 cycles of EPOCH plus rituximab based a response-adapted treatment strategy. 106 evaluable patients with HIV-associated DLBCL or high-grade CD20-positive non-Hodgkin's lymphoma were randomized to receive rituximab (375 mg/m2) given either concurrently prior to each infusional EPOCH cycle, or sequentially (weekly for 6 weeks) following completion of EPOCH. EPOCH consisted of a 96-hour IV infusion of etoposide, doxorubicin, and vincristine plus oral prednisone followed by IV bolus cyclophosphamide every 21 days for 4 to 6 cycles. Patients received 2 additional cycles of therapy after documentation of a complete response (CR) by computerized tomography after cycles 2 and 4. 64 of 106 evaluable patients (60%, 95% CI 50%, 70%) had a CR in both treatment arms. The 2-year event-free survival (EFS) rates were similar in the 24 patients with CR who received 4 or fewer EPOCH cycles (78%, 95% confidence intervals [55%, 90%]) due to achieving a CR after 2 cycles, compared with those who received 5-6 cycles of EPOCH (85%, 95% CI 70%, 93%) because a CR was first documented after cycle 4. A response-adapted strategy may permit a shorter treatment duration without compromising therapeutic efficacy in patients with HIV-associated lymphoma treated with EPOCH plus rituximab, which merits further evaluation in additional prospective trials. Clinical Trials.gov identifier NCT00049036.
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Affiliation(s)
- Joseph A Sparano
- Montefiore-Einstein Cancer Center, Montefiore Medical Center, Bronx, NY, USA
| | - Jeannette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Juan Carlos Ramos
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, USA
| | | | - William Wachsman
- Moores University of California, San Diego Cancer Center, La Jolla, CA, USA
| | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - David H Henry
- University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Lee Ratner
- Washington University, St. Louis, MO, USA
| | - Ethel Cesarman
- Weill Medical College of Cornell University, New York, NY, USA
| | - Amy Chadburn
- Weill Cornell Medical College, New York, NY, USA
| | - Ronald Mitsuyasu
- University of California, Los Angeles Medical Center, Los Angeles, CA, USA
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10
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Jo T, Sakai T, Matsuzaka K, Shioya H, Tominaga H, Kaneko Y, Hayashi S, Matsuo M, Taguchi J, Abe K, Shigematsu K. Successful Treatment of a Patient with Brentuximab Vedotin-Refractory ALK-Negative Anaplastic Large Cell Lymphoma with Romidepsin. Case Rep Oncol 2020; 13:1402-1409. [PMID: 33442363 PMCID: PMC7772834 DOI: 10.1159/000511111] [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: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022] Open
Abstract
We present the case of a 78-year-old male patient who was diagnosed with anaplastic lymphoma kinase (ALK)-negative, CC chemokine receptor 4 (CCR4)-negative, and CD30-positive anaplastic large cell lymphoma (ALCL). The patient had a past medical history of adult T-cell leukemia/lymphoma and colon cancers that had developed simultaneously approximately 2 years prior to the development of ALCL that were treated with immunochemotherapy and resection, respectively. Initial treatment for ALCL included brentuximab vedotin, an anti-CD30 monoclonal antibody-monomethyl auristatin E conjugate; however, we were unable to achieve a sufficient treatment effect. Romidepsin, an oral histone deacetylase inhibitor, was introduced as salvage chemotherapy; complete remission was attained. Interestingly, a reversal of the CD4/CD8 ratio and a reduction in human T-lymphotropic virus type 1 (HTLV-1) virus load was observed after 2 cycles of immunochemotherapy; the patient experienced upregulation of HTLV-1 Tax-specific cytotoxic T lymphocytes after a herpes zoster infection and the completion of immunotherapy. The immunologic status was maintained from the time of diagnosis through the completion of romidepsin therapy. Our findings indicate that romidepsin can be used safely and effectively to treat ALCL without impairing cellular immunity to HTLV-1.
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Affiliation(s)
- Tatsuro Jo
- Department of Hematology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takahiro Sakai
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kaori Matsuzaka
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Haruna Shioya
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Hiroo Tominaga
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Yohei Kaneko
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Shizuka Hayashi
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Masatoshi Matsuo
- Department of Hematology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Jun Taguchi
- Department of Hematology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kuniko Abe
- Department of Pathology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kazuto Shigematsu
- Department of Pathology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
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11
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Li W, Richter KA, Tobon KA, McCarthy KT, Kubal TE. Safety and financial analysis of outpatient dose-adjusted EPOCH for B-cell lymphoma at a tertiary comprehensive cancer center. J Oncol Pharm Pract 2020; 27:1684-1690. [PMID: 33092499 DOI: 10.1177/1078155220967080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dose-adjusted (DA-) EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) is a front-line treatment option for aggressive B-cell lymphomas. Due to regimen complexity, inpatient administration of DA-EPOCH has been historically required. Moffitt Cancer Center (MCC) developed an Inpatient/Outpatient (IPOP) program to facilitate administration of complicated regimens in the outpatient setting. We hypothesized that outpatient administration of DA-EPOCH at a comprehensive cancer center is both safe and cost-effective. METHODS We conducted a single-center, retrospective chart review including B-cell lymphoma patients who were 18 years or older and who had received DA-EPOCH at MCC from April 26, 2017 through August 10, 2019. The primary endpoint was hospital admissions during outpatient chemotherapy administration. Additional safety endpoints included hospitalizations between cycles, infectious complications, extravasations, drug spills, pump-malfunctions, and drug-related adverse events. Financial analysis included drug cost, resource utilization, and impact of hospital bed backfill. RESULTS 56 patients received 219 cycles of DA-EPOCH with 193 cycles administered outpatient. Zero patients required hospitalization during outpatient administration of DA-EPOCH, resulting in 965 saved hospital days. 23 patients (41%) were hospitalized between cycles, most commonly due to neutropenic fever (52%). No extravasations were documented throughout the study period. There were few incidences of drug spills or pump malfunctions. Based on current regimen utilization, the annual transition of 84 cycles of DA-EPOCH to the outpatient setting has a positive impact on margin of $1,444,548. CONCLUSIONS Routine outpatient administration of DA-EPOCH is both safe and feasible with a positive annual impact on margin of $1,444,548 at a comprehensive cancer center.
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Affiliation(s)
- Wenhui Li
- Department of Pharmacy, H. Lee Moffitt Cancer Center
| | | | | | - Kevin T McCarthy
- Financial Analysis and Forecasting, H. Lee Moffitt Cancer Center
| | - Timothy E Kubal
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center
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Jo T, Kaneko Y, Oishi T, Matsuzaka K, Shioya H, Sakai T, Tomoinaga H, Hayashi S, Matsuo M, Taguchi J. Elevation of Memory Cytotoxic T Lymphocytes, Including Human T Lymphotropic Virus Type 1 Tax-Specific and Hepatitis Virus Type C-Specific Cytotoxic T Lymphocytes, in a Patient with Adult T-Cell Leukemia/Lymphoma and Hepatocellular Carcinoma. Case Rep Oncol 2020; 13:802-806. [PMID: 32884522 PMCID: PMC7443665 DOI: 10.1159/000508092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 11/21/2022] Open
Abstract
Herein, we present the case of a patient who suffered from adult T-cell leukemia/lymphoma (ATLL) and hepatocellular carcinoma (HCC) after obtaining a sustained virological response following treatment with a direct-acting antiviral (DAA) at different points in time. The patient went into complete remission (CR) for ATLL. Unfortunately, subsequent relapse of ATLL was observed. This situation was overcome using chemotherapy with pegylated interferon alpha-2b. Human T lymphotropic virus type 1 Tax-specific cytotoxic T lymphocytes (CTLs) were recognized after obtaining second CR, and those CTLs have been maintained for many years. After 4 years from the second CR, chronic hepatitis type C was treated with a DAA, and sustained virological response was attained. However, the occurrence of HCC was detected. Surprisingly, the tumor disappeared spontaneously. Hepatitis virus type C-specific CTLs were also detected in the patient. T-cell receptor (TCR) V beta gene repertoire analyses revealed oligoclonal expansion of effector and memory CTLs. The number of CTLs expressing the TCR V beta 13.1 has increased over the years since HCC occurrence. The activation and maintenance of anticancer cellular immunity may have allowed the patient to obtain long-term survival and overcome two lethal neoplasms.
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Affiliation(s)
- Tatsuro Jo
- Department of Hematology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Yohei Kaneko
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takayuki Oishi
- Department of Gastroenterology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kaori Matsuzaka
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Haruna Shioya
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takahiro Sakai
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Hiroo Tomoinaga
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Shizuka Hayashi
- Department of Laboratory, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Masatoshi Matsuo
- Department of Hematology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Jun Taguchi
- Department of Hematology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
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Tsukamoto Y, Kiyasu J, Choi I, Kozuru M, Uike N, Utsunomiya H, Hirata A, Fujioka E, Ohno H, Nakashima E, Nakashima Y, Miyashita K, Tachikawa Y, Narazaki T, Tsuda M, Haji S, Takamatsu A, Tanaka E, Goto T, Takatsuki H, Oyama M, Muta H, Yagi Y, Ikeda M, Matsushima T, Yufu Y, Suehiro Y. Efficacy and Safety of the Modified EPOCH Regimen (Etoposide, Vincristine, Doxorubicin, Carboplatin, and Prednisolone) for Adult T-cell Leukemia/Lymphoma: A Multicenter Retrospective Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e445-e453. [PMID: 32312633 DOI: 10.1016/j.clml.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We retrospectively analyzed patients with untreated aggressive adult T-cell leukemia/lymphoma who received the modified EPOCH (mEPOCH) regimen. PATIENTS AND METHODS Patients received up to 6 mEPOCH cycles. Etoposide (50 mg/m2/day), doxorubicin (10 mg/m2/day), and vincristine (0.4 mg/m2/day) were each given as a continuous 96-hour infusion on days 1 to 4. Prednisolone (40 mg/m2/day) was given intravenously or orally on days 1 to 4 and then tapered and stopped on day 7, and carboplatin (dose calculated for each patient individually using Calvert's formula according to a target under the curve of 3 mg/mL/min) was given as a 2-hour intravenous infusion on day 6. RESULTS In 103 patients, overall response rate and complete response rate were 58% and 25%, respectively. With a median follow-up of 8.9 months, the median survival time was 9.8 months (95% confidence interval, 7.2-13.9 months). The median progression-free survival (PFS) was 4.2 months (95% confidence interval, 3.4-5.7 months). Patients who completed ≥ 4 cycles experienced significantly better overall survival and PFS compared with those who completed < 4 cycles. Twenty-eight patients underwent allogeneic hematopoietic stem cell transplantation after mEPOCH and demonstrated significantly prolonged overall survival and PFS compared with those who did not undergo transplantation. CONCLUSION The mEPOCH regimen is effective with tolerable adverse effects and may be an alternative treatment option for adult T-cell leukemia/lymphoma.
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Affiliation(s)
- Yasuhiro Tsukamoto
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Junichi Kiyasu
- Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan; Department of Pathology, Kurume University, Kurume-city, Fukuoka, Japan.
| | - Ilseung Choi
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Mitsuo Kozuru
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Naokuni Uike
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hayato Utsunomiya
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Akie Hirata
- Clinical Laboratory Medicine, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Eriko Fujioka
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hirofumi Ohno
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Eriko Nakashima
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Yasuhiro Nakashima
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Kaname Miyashita
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Yoshimichi Tachikawa
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Taisuke Narazaki
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Mariko Tsuda
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Shojiro Haji
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Akiko Takamatsu
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Emi Tanaka
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Tatsuro Goto
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hiroshi Takatsuki
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Makoto Oyama
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Hiroki Muta
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Yu Yagi
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Motohiko Ikeda
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | | | - Yuji Yufu
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Youko Suehiro
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
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14
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Ma L, Xing Z, Alkebsi K, Yang L, Xiao T, Wang Z, Al-Moraissi EA. Primary extranodal non-Hodgkin's lymphoma of the mandibular condyle: A case report and literature review. ORAL AND MAXILLOFACIAL SURGERY CASES 2019. [DOI: 10.1016/j.omsc.2019.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Li J, Yao C, Xu Y, Ping P, Yin H, Sun Y. In vitro compatibility and stability of admixtures containing etoposide, epirubicin hydrochloride and vindesine sulphate in a single infusion bag. J Clin Pharm Ther 2019; 44:875-882. [PMID: 31529525 DOI: 10.1111/jcpt.13007] [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: 10/26/2018] [Revised: 05/21/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES The etoposide, doxorubicin hydrochloride, vincristine sulphate, cyclophosphamide and prednisone (EPOCH) chemotherapy regimen is effective in patients with relapsed or refractory non-Hodgkin's lymphoma. However, vincristine and doxorubicin hydrochloride are relatively toxic, leading to neurovirulence and cardiotoxicity, respectively. In this study, we replaced these drugs with vindesine and epirubicin hydrochloride to reduce the cardiotoxicity and evaluated admixtures containing these drugs along with etoposide in a single infusion bag in vitro. METHODS The appearance and pH of the admixtures were evaluated, and the number of particles was detected. High-performance liquid chromatography was used to measure the concentration and degradation rates of etoposide, epirubicin hydrochloride and vindesine sulphate in each admixture. RESULTS AND DISCUSSION No precipitation occurred when mixing clinically relevant concentrations of etoposide, epirubicin hydrochloride and vindesine sulphate in a 0.9% NaCl injection solution. Furthermore, the delta pH of the admixtures was ≤0.12 throughout the experiment, and the number of particles (≥10 and ≥25 μm) in the solutions over the 24 hours post-preparation period met USP standards. Etoposide, epirubicin hydrochloride and vindesine sulphate were retained at >96% of their initial concentrations in the admixtures at 25°C over the course of the experiment. Etoposide, epirubicin hydrochloride and vindesine sulphate are compatible when mixed in a 0.9% NaCl injection solution, and the admixtures are stable for at least 24 hours when stored in infusion bags. WHAT IS NEW AND CONCLUSION This in vitro analysis indicates the suitability of our novel admixtures containing less toxic drug equivalents in a single infusion bag for clinical application.
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Affiliation(s)
- Jiafei Li
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China.,Department of Pharmacy, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Chong Yao
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Yanping Xu
- Internal Medicine Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Ping Ping
- Internal Medicine Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Hong Yin
- Internal Medicine Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Yan Sun
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
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16
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Wei L, Wang J, Ye J, Yang L, Cong J, Li X, Wu Y, Cui X, Ding J, Yao N, Yang J. Long-term outcomes of patients treated with an EPOCHL regimen as first-line chemotherapy for newly diagnosed extranodal natural killer/T-cell lymphoma: a retrospective single-center study. Leuk Lymphoma 2019; 61:337-343. [PMID: 31517553 DOI: 10.1080/10428194.2019.1663421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We retrospectively evaluated the long-term outcomes of patients receiving an EPOCHL (EPOCH + L-asparaginase) regimen as first-line chemotherapy for newly diagnosed extranodal natural killer/T cell lymphoma, nasal type (ENKTL). Ninety-six patients received 2-8 cycles of EPOCHL. After 2-4 cycles, 55.2% patients had complete response (CR) and 39.6% had partial response (PR). 42.7% patients developed progressive or relapsed disease. The 5-year progression-free survival (PFS) rates were 56.1% overall, 59.8% for stage I/II, and 34.9% for stage III/IV disease, and corresponding 5-year overall survival (OS) rates were 58.7, 65.3, and 39.8%, respectively. OS differed significantly between patients with stage I/II and those with stage III/IV disease (p = 0.018). Patients who achieved CR had better 3-year OS of 92.9%. Advanced stage disease was a poor prognostic factor for OS. All major adverse events associated with the EPOCHL regimen were reversible, and this first-line chemotherapy was safe and effective for patients with ENKTL.
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Affiliation(s)
- Liqiang Wei
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingwen Wang
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jin Ye
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Yang
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jia Cong
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xin Li
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yiping Wu
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xueying Cui
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Ding
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Na Yao
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Yang
- Department of Haematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Joshi M, Taper J, Forsyth C, Rowlings P, Campbell P, Crispin P, Harvey M, Underhill C, Bayley A, Byth K, Huang G, Hertzberg M. Outpatient rituximab, ifosfamide, etoposide (R-IE) in patients older than 60 years with relapsed or refractory diffuse large B-cell lymphoma who are not candidates for stem cell transplantation. Leuk Lymphoma 2019; 61:91-97. [DOI: 10.1080/10428194.2019.1660968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Maansi Joshi
- Department of Haematology, Nepean Hospital, Kingswood, Australia
| | - John Taper
- Department of Haematology, Nepean Hospital, Kingswood, Australia
| | | | - Philip Rowlings
- Calvary Mater Newcastle Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Philip Campbell
- Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Australia
| | - Philip Crispin
- The Canberra Hospital, Canberra, Australia
- Australian National University Medical School, Canberra, Australia
| | | | - Craig Underhill
- Albury Wodonga Health Service and Border Oncology, Albury, Australia
| | | | | | | | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, Australia
- University of NSW, Sydney, Australia
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18
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Keshvani N, Hon M, Gupta A, Brown TJ, Roy L, Marley E, Lindsey S, Johnson DH, Sadeghi N, Li HC. Reducing Hospitalizations: Institution of Outpatient Infusional EPOCH-Based Chemotherapy at a Safety Net Hospital. J Oncol Pract 2019; 15:e644-e651. [DOI: 10.1200/jop.18.00738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) -based chemotherapy is traditionally administered inpatient because of its complex 96-hour protocol and number of involved medications. These routine admissions are costly, disruptive, and isolating to patients. Here, we describe our experience transitioning from inpatient to outpatient ambulatory EPOCH-based chemotherapy in a safety-net hospital, associated cost savings, and patient perceptions. METHODS AND MATERIALS: Guidelines for chemotherapy administration and educational materials were developed by a multidisciplinary team of physicians, nurses, and pharmacists. Data were collected via chart review and costs via the finance department. Patient satisfaction with chemotherapy at home compared with hospitalization was measured on a Likert-type scale via direct-to-patient survey. RESULTS: From January 30, 2017, through January 30, 2018, 87 cycles of EPOCH-based chemotherapy were administered to 23 patients. Sixty-one ambulatory cycles (70%) were administered to 18 patients. Of 26 cycles administered in the hospital, 18 (69%) were the first cycle of treatment. Rates of inappropriate prophylactic antimicrobial prescription and laboratory testing were lower in the outpatient setting. Eight of nine patients surveyed preferred home chemotherapy to inpatient chemotherapy. Per-cycle drug costs were 57.6% lower in outpatients as a result of differences in the acquisition cost in the outpatient setting. In total, the transition to ambulatory EPOCH-based chemotherapy yielded 1-year savings of $502,030 and an estimated 336 days of avoided hospital confinement. CONCLUSION: Multiday ambulatory EPOCH-based regimens were successfully and safely administered in our safety-net hospital. Outpatient therapy was associated with significant savings through avoided hospitalizations and reductions in drug acquisition cost and improved patient satisfaction.
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Affiliation(s)
- Neil Keshvani
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Mary Hon
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Arjun Gupta
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Timothy J. Brown
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Lonnie Roy
- Parkland Health and Hospital System, Dallas, TX
| | | | | | - David H. Johnson
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Navid Sadeghi
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Hsiao C. Li
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
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Karaffa L, Kubicek CP. Citric acid and itaconic acid accumulation: variations of the same story? Appl Microbiol Biotechnol 2019; 103:2889-2902. [PMID: 30758523 PMCID: PMC6447509 DOI: 10.1007/s00253-018-09607-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 01/15/2023]
Abstract
Citric acid production by Aspergillus niger and itaconic acid production by Aspergillus terreus are two major examples of technical scale fungal fermentations based on metabolic overflow of primary metabolism. Both organic acids are formed by the same metabolic pathway, but whereas citric acid is the end product in A. niger, A. terreus performs two additional enzymatic steps leading to itaconic acid. Despite of this high similarity, the optimization of the production process and the mechanism and regulation of overflow of these two acids has mostly been investigated independently, thereby ignoring respective knowledge from the other. In this review, we will highlight where the similarities and the real differences of these two processes occur, which involves various aspects of medium composition, metabolic regulation and compartmentation, transcriptional regulation, and gene evolution. These comparative data may facilitate further investigations of citric acid and itaconic acid accumulation and may contribute to improvements in their industrial production.
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Affiliation(s)
- Levente Karaffa
- Department of Biochemical Engineering, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, Debrecen, H-4032, Hungary.
| | - Christian P Kubicek
- Institute of Chemical, Environmental & Bioscience Engineering, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria.,, 1100, Vienna, Austria
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20
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McBride A, Campen CJ, Camamo J, Maloney M, Persky D, Kurtin SE, Barket NL, Krishnadasan R, Elquza E, Anwer F, Weibel K. Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting. Am J Health Syst Pharm 2019; 75:e246-e258. [PMID: 29691269 DOI: 10.2146/ajhp170138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting is described. SUMMARY The University of Arizona Cancer Center and Banner-University Medical Center Tucson are affiliated not-for-profit academic medical centers in Tucson, Arizona, whose facilities include a hospital and ambulatory care clinics that maintain 3 outpatient infusion centers. The cancer center pharmacy currently employs 25 pharmacists, with 4 clinical pharmacists serving both the inpatient and outpatient treatment sites. A multidisciplinary team of staff members was assembled to address the transition of chemotherapy from inpatient to outpatient that included physicians, ambulatory clinical oncology pharmacists, finance, social workers, pharmacy staff, nursing staff, and information technology. The program was initiated in May 2014, with a 2-year postimplementation evaluation of our transition of chemotherapy to the outpatient setting. Chemotherapy order sets were developed in our electronic medical record for transitioning rituximab to the outpatient setting for inpatient chemotherapy orders as well as transitioning leukemia, lymphoma, and solid tumor chemotherapy regimens to be administered in the outpatient setting. Eighteen rituximab-containing regimens and 14 chemotherapy protocols were switched to the outpatient setting, with numerous variants of these regimens also created for outpatient only administration. The realized savings for high-cost chemotherapy transitioned to the outpatient setting with rituximab and clofarabine was $1,902,890. Over 747 inpatient bed days were saved, with an approximated cost savings to the health system of $1,402,866, with a cumulative cost savings to our health system of $3,305,756. CONCLUSION This model for transitioning chemotherapy from the hospital to the outpatient setting enhanced access to care, decreased bed utilization in the hospital, and improved clinical and financial metrics.
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Affiliation(s)
- Ali McBride
- University of Arizona Cancer Center, Tucson, AZ
| | | | - James Camamo
- Banner-University Medical Center Tucson, Tucson, AZ
| | | | | | - Sandra E Kurtin
- Clinical Assistant Professor of Medicine Adjunct Clinical Assistant Professor of Nursing, University of Arizona Cancer Center, Tucson, Arizona
| | | | | | - Emad Elquza
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ
| | - Faiz Anwer
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ
| | - Kurt Weibel
- Banner-University Medical Center Tucson, Tucson, AZ
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Moore DC, Arnall JR, Plesca DC. Transitioning historically inpatient chemotherapy regimens for hematologic malignancies to the ambulatory care setting. Am J Health Syst Pharm 2018; 75:1824-1830. [PMID: 30131323 DOI: 10.2146/ajhp180060] [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: 12/24/2022] Open
Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Justin R Arnall
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Dragos C Plesca
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
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22
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DA-EPOCH-R improves the outcome over that of R-CHOP regimen for DLBCL patients below 60 years, GCB phenotype, and those with high-risk IPI, but not for double expressor lymphoma. J Cancer Res Clin Oncol 2018; 145:117-127. [DOI: 10.1007/s00432-018-2771-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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Matsukawa T, Suto K, Miyoshi H, Oshimi K, Ohshima K, Miyagishima T. Successful treatment of an elderly Langerhans cell sarcoma patient by EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) chemotherapy. J Clin Exp Hematop 2018; 58:184-187. [PMID: 30305476 PMCID: PMC6407472 DOI: 10.3960/jslrt.18027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
| | - Keito Suto
- Department of Hematology, Kushiro Rosai Hospital, Kushiro, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Kazuo Oshimi
- Department of Hematology, Kushiro Rosai Hospital, Kushiro, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
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Zhang WH, Li GY, Ma YJ, Li ZC, Zhu Y, Chang J, Hao SG, Tao R. Reduced-dose EPOCH-R chemotherapy for elderly patients with advanced stage diffuse large B cell lymphoma. Ann Hematol 2018; 97:1809-1816. [DOI: 10.1007/s00277-018-3369-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 05/07/2018] [Indexed: 11/28/2022]
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Toriyama E, Imaizumi Y, Taniguchi H, Taguchi J, Nakashima J, Itonaga H, Sato S, Ando K, Sawayama Y, Hata T, Fukushima T, Miyazaki Y. EPOCH regimen as salvage therapy for adult T-cell leukemia–lymphoma. Int J Hematol 2018; 108:167-175. [DOI: 10.1007/s12185-018-2455-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 12/12/2022]
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Svirskis D, Behera S, Naidoo N, Beachman J, Raina T, Zhou Y, Berkahn L, Costello I, Gu Y. Stability of vincristine sulfate, doxorubicin hydrochloride and etoposide phosphate admixtures in polyisoprene elastomeric pump supporting transition of the EPOCH regimen to outpatient care. J Oncol Pharm Pract 2018. [DOI: 10.1177/1078155218764285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The EPOCH regimen, consisting of vincristine sulfate, doxorubicin hydrochloride, and etoposide phosphate, is typically administered by continuous infusion over four days to oncology inpatients. If the EPOCH regimen was available to be administered through portable elastomeric pumps, chemotherapy could be transitioned to an outpatient setting, reducing inpatient bed days and overall healthcare costs. However, a lack of stability data for the admixtures in the elastomeric infusion devices currently prevents the transition of the regime to an outpatient setting. The purpose of this study is to determine the physical and chemical stability of the admixture in polyisoprene elastomeric pumps under different storage conditions to support the transition of the EPOCH regime to an outpatient setting. Methods The physico-chemical stability of three admixtures at a range of clinically relevant concentrations compounded in polyisoprene elastomeric infusors was determined when refrigerated at 2–6℃ over a 14-day period followed by 35℃ up to 7 days in the dark, and under standardized fluorescent light to simulate scenarios in clinical practice. Results All tested admixtures were compatible and the drugs were stable in the elastomeric infusors for up to 14 days when stored at 2–6℃ followed by 7 days at 35℃ in the dark, with nominal losses of <5%. The major degradant of etoposide phosphate was its active form etoposide. There was no degradation (<1% loss) found when the admixture was exposed to a standardized fluorescent light dose of 80 klux-h (25℃) for 10 h. The temperature and light conditions the infusors were exposed to during the stability study were more severe than the conditions determine during clinical administration. Conclusion The extended stability of the three infusional admixtures compounded in elastomeric infusion pumps demonstrated herein permits advance preparation and storage of these drugs, reducing pharmacy compounding resources. The demonstrated stability at 35℃ and under light exposure, conditions more severe than those experienced during clinical practice, support continuous infusions for up to seven days from the elastomeric infusors without a loss of potency. The proven stability of the EPOCH regimens in the tested elastomeric infusion device supports the transition of treatment to an outpatient setting which will reduce inpatient bed days and overall healthcare costs.
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Affiliation(s)
- Darren Svirskis
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Sairam Behera
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Neera Naidoo
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | - Tarsha Raina
- Auckland District Health Board, Auckland, New Zealand
| | - Yongzhi Zhou
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | - Ian Costello
- Auckland District Health Board, Auckland, New Zealand
| | - Yongchuan Gu
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
- Auckland Cancer Society Research Centre, The University of Auckland, Auckland, New Zealand
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Chihara D, Fanale MA, Miranda RN, Noorani M, Westin JR, Nastoupil LJ, Hagemeister FB, Fayad LE, Romaguera JE, Samaniego F, Turturro F, Lee HJ, Neelapu SS, Rodriguez MA, Wang M, Fowler NH, Davis RE, Medeiros LJ, Oki Y. The risk of central nervous system relapses in patients with peripheral T-cell lymphoma. PLoS One 2018. [PMID: 29538376 PMCID: PMC5851529 DOI: 10.1371/journal.pone.0191461] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We performed a retrospective analysis to identify risk factors and survival outcome for central nervous system (CNS) relapse of peripheral T-cell lymphoma (PTCL) by histologic type. Records of 600 PTCL patients diagnosed between 1999 and 2014 were analyzed including PTCL not otherwise specified (PTCL-NOS, 174 patients), angoimmunoblastic T-cell lymphoma (AITL, 144), ALK+anaplastic large cell lymphoma (ALCL, 74), ALK-ALCL (103), extranodal NK-cell lymphoma (ENKL, 54), or others (51). With a median follow up of 57 months, 13 patients (4 PTCL-NOS, 1 AITL, 4 ALK+ALCL, 2 ALK-ALCL, 2 ENKL) experienced CNS relapse. One-year and 5-year cumulative incidence of CNS relapse were 1.5% (95%CI: 0.7–2.8%) and 2.1% (95%CI: 1.1–3.5%), respectively. The 5-year cumulative incidence of CNS relapse was 1.8% in PTCL-NOS, 0.7% in AITL, 5.4% in ALK+ALCL, 2.1% in ALK-ALCL and 3.7% in ENKL. Extranodal involvement >1 site was the only significant factor associated with higher chance of CNS relapse (HR: 4.9, 95%CI: 1.6–15.0, p = 0.005). Patients with ALK+ALCL who had extranodal involvement >1 (N = 19) had very high risk of CNS relapse with one year cumulative incidence of 17% (95%CI: 4%-37%), all occurring within six months after diagnosis. All patients with CNS relapse eventually died (median, 1.5 months; range, 0.1–10.1 months). CNS relapse in patients with PTCL is rare event but the risk varies by subtype. ALK+ALCL patients with extranodal involvement >1 site have a very high risk of early CNS relapse, and thus evaluation of CNS involvement at the time of diagnosis and possible CNS-directed prophylaxis may be considered.
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Affiliation(s)
- Dai Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Michelle A. Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Roberto N. Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Mansoor Noorani
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jason R. Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Loretta J. Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Fredrick B. Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Luis E. Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jorge E. Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Hun J. Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sattva S. Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - M. Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Nathan H. Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Richard E. Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
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Rogers KA, Huang Y, Ruppert AS, Salem G, Stephens DM, Heerema NA, Andritsos LA, Awan FT, Byrd JC, Flynn JM, Maddocks KJ, Jones JA. A single-institution retrospective cohort study of first-line R-EPOCH chemoimmunotherapy for Richter syndrome demonstrating complex chronic lymphocytic leukaemia karyotype as an adverse prognostic factor. Br J Haematol 2017; 180:259-266. [PMID: 29193006 DOI: 10.1111/bjh.15035] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/26/2017] [Indexed: 01/23/2023]
Abstract
Richter Syndrome, an aggressive lymphoma occurring in patients with chronic lymphocytic leukaemia (CLL), has a generally poor prognosis and anthracycline-based chemoimmunotherapy regimens designed to treat de novo diffuse large B-cell lymphoma achieve modest clinical benefit. R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) has demonstrated greater activity against aggressive B-cell histologies but has not been studied in Richter Syndrome. We conducted a retrospective cohort study of 46 Richter Syndrome patients treated with first-line R-EPOCH at our institution between 1 January 2006 and 31 May 2014. The median progression-free survival (PFS) was 3·5 months [95% confidence interval (CI): 2·0-7·6] and median overall survival (OS) was 5·9 months (95% CI: 3·2-10·3). Toxicity was high and 30% of patients died without progression or response. Patients with a complex CLL karyotype had significantly shorter PFS and OS (P = 0·005 and P = 0·002, respectively). Multivariable analysis identified complex CLL karyotype as the most significant predictor of decreased survival [Hazard ratio (HR) 2·72, 95% CI: 1·14-6·52, P = 0·025], adjusting for number of prior CLL treatments (P = 0·036). Richter Syndrome patients with complex CLL karyotype experience poor survival with R-EPOCH treatment and novel approaches are needed for these patients. In contrast, survival of patients without a complex CLL karyotype was similar to patients with de novo diffuse large B-cell lymphoma.
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Affiliation(s)
- Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Amy S Ruppert
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Galena Salem
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Nyla A Heerema
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | | | - Farrukh T Awan
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Joseph M Flynn
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kami J Maddocks
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jeffrey A Jones
- Division of Hematology, The Ohio State University, Columbus, OH, USA
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Maeda Y, Nishimori H, Yoshida I, Hiramatsu Y, Uno M, Masaki Y, Sunami K, Masunari T, Nawa Y, Yamane H, Gomyo H, Takahashi T, Yano T, Matsuo K, Ohshima K, Nakamura S, Yoshino T, Tanimoto M. Dose-adjusted EPOCH chemotherapy for untreated peripheral T-cell lymphomas: a multicenter phase II trial of West-JHOG PTCL0707. Haematologica 2017; 102:2097-2103. [PMID: 28971899 PMCID: PMC5709109 DOI: 10.3324/haematol.2017.167742] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 09/20/2017] [Indexed: 01/20/2023] Open
Abstract
The standard CHOP therapy for peripheral T-cell lymphoma has resulted in unsatisfactory outcomes and it is still not clear what is the optimal front-line therapy. We conducted a multicenter phase II study of dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine and prednisone (EPOCH) for untreated peripheral T-cell lymphoma patients. In this prospective study, 41 patients were treated with dose-adjusted-EPOCH as initial therapy: peripheral T-cell lymphoma-not otherwise specified, n=21; angioimmunoblastic T-cell lymphoma, n=17; anaplastic lymphoma kinase-positive anaplastic large cell lymphoma, n=2; and anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, n=1. Median patient age was 64 years (range: 32–79 years). According to the International Prognostic Index criteria, 51.2% were at high-intermediate or high risk. The overall response and complete response rates were 78.0% [95% confidence interval (CI): 62.4–89.4%] and 61.0% (95%CI: 44.5–75.8%), respectively. At the median follow up of 24.0 months, the 2-year progression-free survival and overall survival were 53.3% (95%CI: 36.4–67.5%) and 73.2% (95%CI: 56.8–84.1%), respectively. The younger patients (≤ 60 years old) had a high response rate (overall response 94.1% and complete response 70.6%) and survival rate (progression-free survival 62.5% and overall survival 82.4%). The most common grade ≥ 3 adverse events were neutropenia (74.5%), anemia (40.8%), thrombocytopenia (22.0%), and febrile neutropenia (9.0%). Dose-adjusted-EPOCH had a high response rate with a tolerable toxicity profile. Our results indicate that dose-adjusted-EPOCH is a reasonable first-line approach for peripheral T-cell lymphoma patients and may improve outcomes.
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Affiliation(s)
- Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Isao Yoshida
- Department of Hematologic Oncology, Shikoku Cancer Center, Ehime, Japan
| | - Yasushi Hiramatsu
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Masatoshi Uno
- Department of Internal Medicine, Kaneda Hospital, Okayama, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Japan
| | - Taro Masunari
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Yuichiro Nawa
- Department of Hematology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Hiromichi Yamane
- Department of Internal Medicine, Sumitomo Besshi Hospital, Ehime, Japan
| | - Hiroshi Gomyo
- Department of Hematology, Hyogo Cancer Center, Hyogo, Japan
| | - Tsutomu Takahashi
- Department of Hematology and Oncology, Shimane University Hospital, Japan
| | - Tomofumi Yano
- Department of Hematology, Okayama Rosai Hospital, Nagoya, Japan
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Koichi Ohshima
- Department of Pathology, School of Medicine, Kurume University, Fukuoka, Japan
| | - Shigeo Nakamura
- Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Mitsune Tanimoto
- Department of Hematology and Oncology, Okayama University Hospital, Japan
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Martin AL, Frank JP, Waggoner ML. Making moves: Transitioning R-EPOCH to the ambulatory setting. J Oncol Pharm Pract 2017; 24:617-622. [DOI: 10.1177/1078155217722408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose Ambulatory administration of chemotherapy provides benefit to patients and institutions alike. We hypothesized that transitioning rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (R-EPOCH) from an inpatient to ambulatory setting would reduce inpatient bed days and overall healthcare costs. The purpose of this effort was to create a guideline that would transition R-EPOCH to the ambulatory setting. To assess institutional benefit, we assessed inpatient bed days saved and financial impact. Methods A single center, retrospective analysis of inpatient R-EPOCH administration from January 2013 to December 2015 defined the need for medication use guidelines for ambulatory R-EPOCH administration. While this guideline targeted a reduction in inpatient bed days, it also created desired staff-and-patient education on R-EPOCH. Multidisciplinary collaboration enabled this comprehensive approach to outpatient chemotherapy administration. Results The 42 patients included received 147 cycles of R-EPOCH. Administration was primarily inpatient, amounting to 107 cycles and 799 inpatient days. Concurrently, 40 cycles of R-EPOCH were administered to 11 patients in the ambulatory setting. Only two patients received all cycles as outpatient; the other nine patients received chemotherapy in both settings. Financial analysis showed a 53% reduction in drug acquisition cost and 30% reduction in direct costs with ambulatory R-EPOCH administration. Based on our projection, after guideline implementation, 12 patients will be eligible for ambulatory R-EPOCH annually, resulting in a savings of 360 bed days and approximately $650,000 per year. Conclusion Transitioning R-EPOCH is a viable option to significantly decrease inpatient bed days and overall healthcare costs. Multidisciplinary collaboration is vital to successfully transitioning regimens to the ambulatory setting and to establishing consistent support for ambulatory administration.
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Affiliation(s)
- Allison L Martin
- Pharmacy Department, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joel P Frank
- Pharmacy Department, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mindy L Waggoner
- Pharmacy Department, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA
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31
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Carnevale J, Rubenstein JL. The Challenge of Primary Central Nervous System Lymphoma. Hematol Oncol Clin North Am 2017; 30:1293-1316. [PMID: 27888882 DOI: 10.1016/j.hoc.2016.07.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary central nervous system (CNS) lymphoma is a challenging subtypes of aggressive non-Hodgkin lymphoma. Emerging clinical data suggest that optimized outcomes are achieved with dose-intensive CNS-penetrant chemotherapy and avoiding whole brain radiotherapy. Anti-CD20 antibody-based immunotherapy as a component of high-dose methotrexate-based induction programs may contribute to improved outcomes. An accumulation of insights into the molecular and cellular basis of disease pathogenesis is providing a foundation for the generation of molecular tools to facilitate diagnosis as well as a roadmap for integration of targeted therapy within the developing therapeutic armamentarium for this challenging brain tumor.
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Affiliation(s)
- Julia Carnevale
- Division of Hematology/Oncology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - James L Rubenstein
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, M1282 Box 1270, San Francisco, CA 94143, USA.
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Pejša V, Prka Ž, Lucijanić M, Mitrović Z, Piršić M, Jakšić O, Ajduković R, Kušec R. Rituximab with dose-adjusted EPOCH as first-line treatment in patients with highly aggressive diffuse large B-cell lymphoma and autologous stem cell transplantation in selected patients. Croat Med J 2017; 58:40-48. [PMID: 28252874 PMCID: PMC5346894 DOI: 10.3325/cmj.2017.58.40] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To assess the benefit of rituximab with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-DA-EPOCH) regimen as a first-line treatment for patients with diffuse large B-cell lymphoma (DLBCL) presenting with unfavorable or aggressive features, and autologous stem cell transplantation (ASCT) as a part of the first-line treatment for selected DLBCL patients with additional aggressive features. METHODS We retrospectively analyzed 75 newly diagnosed DLBCL patients with Ki-67+≥80% or International Prognostic Index ≥2 who were treated with R-DA-EPOCH between 2005 and 2015. Of 24 DLBCL patients with additional aggressive features (Ki-67+≥90% or age-adjusted IPI≥2) who were planned to receive consolidation with ASCT, 17 patients underwent the procedure. We determined the overall response rate (ORR), complete remission (CR), partial remission (PR), 5-year overall survival (OS), and progression free survival (PFS) in all DLBCL patients and specifically those planned to receive ASCT. RESULTS All 75 patients included in the analysis started one or more cycles of therapy. The ORR, CR, and PR rates were 80%, 55%, and 25%, respectively. The response was non-evaluable in 10 of 75 patients due to treatment discontinuation. The OS and PFS rates for all 75 patients were 70% and 61%, respectively, and 80% and 79%, respectively, for 24 planned-to-receive-ASCT patients. Age (≤65 vs >65 years) had no prognostic impact on OS and PFS (P=0.994 and P=0.827, respectively). CONCLUSION Our retrospective analysis of one of the largest DLBCL patient cohorts outside the US National Cancer Institute showed that R-DA-EPOCH is a very effective therapeutic option as a first-line treatment of DLBCL patients with unfavorable prognostic features irrespective of their age. ASCT provided additional benefit for DLBCL patients with additional aggressive features.
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Affiliation(s)
- Vlatko Pejša
- Vlatko Pejša, Department of Hematology, University Hospital Dubrava, Av. Gojka Šuška 6, 10000 Zagreb, Croatia,
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Accordino MK, Wright JD, Vasan S, Neugut AI, Hillyer GC, Hershman DL. Factors and Costs Associated With Delay in Treatment Initiation and Prolonged Length of Stay With Inpatient EPOCH Chemotherapy in Patients With Hematologic Malignancies. Cancer Invest 2017; 35:202-214. [PMID: 28165774 DOI: 10.1080/07357907.2016.1276186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Reducing delays related to inpatient chemotherapy may reduce healthcare costs. Using a national database, we identified patients with lymphoma/leukemia with ≥1 etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) chemotherapy claim and evaluated chemotherapy initiation delay (ID), >1 day from admission. Standard tests/procedures prior to initiation were evaluated. Among 4453 inpatient cycles, 19.7% had ID, odds ratio 2.28 (95% confidence interval: 1.83-2.85) with cycle 1 compared to cycle 2, and mean costs were higher in patients with ID than without ID (p < .0001). Prior to cycle 1, patients were more likely to undergo routine diagnostic procedures compared to subsequent cycles. Efforts to perform routine procedures prior to admission may reduce hospital length of stay and costs.
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Affiliation(s)
- Melissa K Accordino
- a Department of Medicine College of Physicians and Surgeons , Columbia University , New York , NY , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Jason D Wright
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,c Department of Obstetrics and Gynecology, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Sowmya Vasan
- d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Alfred I Neugut
- a Department of Medicine College of Physicians and Surgeons , Columbia University , New York , NY , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Grace C Hillyer
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Dawn L Hershman
- a Department of Medicine College of Physicians and Surgeons , Columbia University , New York , NY , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
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34
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Chihara D, Fanale MA, Miranda RN, Noorani M, Westin JR, Nastoupil LJ, Hagemeister FB, Fayad LE, Romaguera JE, Samaniego F, Turturro F, Lee HJ, Neelapu SS, Rodriguez MA, Wang M, Fowler NH, Davis RE, Medeiros LJ, Hosing C, Nieto YL, Oki Y. The survival outcome of patients with relapsed/refractory peripheral T-cell lymphoma-not otherwise specified and angioimmunoblastic T-cell lymphoma. Br J Haematol 2016; 176:750-758. [PMID: 27983760 DOI: 10.1111/bjh.14477] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/10/2016] [Indexed: 12/24/2022]
Abstract
Survival outcome of patients with peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) and angioimmunoblastic T-cell lymphoma (AITL) who experience disease progression/relapse remains very poor. A total of 321 patients, newly diagnosed with PTCL-NOS (n = 180) or AITL (n = 141) between 1999 and 2015, were analysed. Failure-free survival (FFS) and overall survival (OS) were calculated from the time of first disease progression (FFS1, OS1), from second disease progression (FFS2, OS2) and from third progression (FFS3, OS3). With a median follow-up duration of 52 months, 240 patients (135 PTCL-NOS, 105 AITL) experienced progression/relapse. In patients with PTCL-NOS, the median durations of FFS1, FFS2 and FFS3 were 3·1, 2·5 and 2·1 months, respectively. In patients with AITL, they were 5·5, 2·9 and 2·3 months, respectively. There was no improvement in FFS1 and OS1 by the time of recurrence during this period (1999-2004, 2005-2009 and 2010-2015). The median FFS after pralatrexate and romidepsin was only 3·0 and 2·5 months, respectively. The 5-year OS rates after salvage autologous and allogeneic transplant were 32% and 52%, respectively; while the 5-year OS rates for patients who did not undergo transplant was 10%. Further research for novel therapeutic approaches with higher efficacy and better safety profile are needed.
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Affiliation(s)
- Dai Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mansoor Noorani
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge E Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hun J Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chitra Hosing
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yago L Nieto
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Miyashita K, Fujii K, Taguchi K, Shimokawa M, Yoshida MA, Abe Y, Okamura J, Oda S, Uike N. A specific mode of microsatellite instability is a crucial biomarker in adult T-cell leukaemia/lymphoma patients. J Cancer Res Clin Oncol 2016; 143:399-408. [PMID: 27783137 PMCID: PMC5306345 DOI: 10.1007/s00432-016-2294-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022]
Abstract
Purpose Microsatellite instability (MSI) has been a long-standing biomarker candidate for drug resistance in tumour cells. Despite numerous clinical studies, the data in the literature are not conclusive. The complexity of the MSI phenomenon in some malignancies may, at least partly, account for the discrepancy. In addition, methodological problems are also pointed out in the assay techniques. We previously established a unique fluorescent technique in which the major methodological problems in conventional assays are overcome. Application of this technique has revealed two distinct modes of microsatellite alterations, i.e. Type A and Type B. More importantly, we demonstrated that Type A MSI is the direct consequence of defective DNA mismatch repair (MMR) that causes cellular resistance against antineoplastic agents. Method We first applied this technique to adult T-cell leukaemia/lymphoma (ATLL). Results The MSI phenomenon was indeed observed in ATLLs (4/20, 20%). Intriguingly, the observed microsatellite alterations were invariably Type A, which implies that the tumours were MMR-defective. Indeed, clinical outcomes of patients with these MSI+ tumours were significantly worse. Furthermore, multivariate analysis revealed that Type A MSI is an independent prognostic factor. Conclusion These observations strongly suggest the possibility of Type A MSI as a prognostic and potentially predictive biomarker in ATLL.
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Affiliation(s)
- Kaname Miyashita
- Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan.,Department of Hematology, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan.,Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Kei Fujii
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Kenichi Taguchi
- Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Mototsugu Shimokawa
- Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Mitsuaki A Yoshida
- Department of Radiation Biology, Institute of Radiation Emergency Medicine, Hirosaki University, Aomori, 036-8560, Japan
| | - Yasunobu Abe
- Department of Hematology, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Jun Okamura
- Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Shinya Oda
- Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan.
| | - Naokuni Uike
- Department of Hematology, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan
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Ma H, Abdul-Hay M. T-cell lymphomas, a challenging disease: types, treatments, and future. Int J Clin Oncol 2016; 22:18-51. [PMID: 27743148 PMCID: PMC7102240 DOI: 10.1007/s10147-016-1045-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/26/2016] [Indexed: 02/06/2023]
Abstract
T-cell lymphomas are rare and aggressive malignancies associated with poor outcome, often because of the development of resistance in the lymphoma against chemotherapy as well as intolerance in patients to the established and toxic chemotherapy regimens. In this review article, we discuss the epidemiology, pathophysiology, current standard of care, and future treatments of common types of T-cell lymphomas, including adult T-cell leukemia/lymphoma, angioimmunoblastic T-cell lymphoma, anaplastic large-cell lymphoma, aggressive NK/T-cell lymphoma, and cutaneous T-cell lymphoma.
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Affiliation(s)
- Helen Ma
- Department of Internal Medicine, New York University, New York, NY, USA
| | - Maher Abdul-Hay
- Department of Internal Medicine, New York University, New York, NY, USA. .,Perlmutter Cancer Center, New York University, New York, NY, USA.
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Tomono A, Ito K, Hayashi T, Ando M, Ando Y, Tsuge M, Okamoto A, Inaguma Y, Okamoto M, Emi N, Yamada S. Evaluation of a method for calculating carboplatin dosage in DeVIC ± R therapy (combination therapy of dexamethasone, etoposide, ifosfamide and carboplatin with or without rituximab) as a salvage therapy in patients with relapsed or refractory non-Hodgkin lymphoma. Cancer Chemother Pharmacol 2016; 78:305-12. [PMID: 27324021 PMCID: PMC4965483 DOI: 10.1007/s00280-016-3076-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/03/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Several studies have evaluated the utility of extrapolating the Calvert formula in calculating carboplatin (CBDCA) dosages in solid tumours; however, data regarding haematological cancers are less. Therefore, we conducted a preliminary study of the utility of extrapolating the Calvert formula in calculating CBDCA dosages for DeVIC ± R therapy. METHODS A retrospective study on 57 non-Hodgkin lymphoma patients who had received DeVIC ± R therapy was conducted. The area under the curve (AUC) of CBDCA was back-calculated from actual dosages using the Calvert formula. Patients were divided into two groups according to an AUC ≥ 4 or an AUC < 4, respectively. The Revised Response Criteria of the International Working Group and CTCAE version 4.0 were used for assessing the treatment efficacy and adverse events, respectively. RESULTS The use of AUC instead of body surface area had greater utility in calculating CBDCA dosage, with a response rate of greater than 50 % in patients receiving DeVIC ± R therapy with an AUC ≥ 4 for CBDCA. The response rate of the AUC ≥ 4 group was significantly higher than that of the AUC < 4 group. Decreased platelet and neutrophil counts of grade ≥3 occurred at higher rates in the AUC ≥ 4 group. CONCLUSION The extrapolation of the Calvert formula has utility in calculating the CBDCA dosage for DeVIC ± R therapy, and therapeutic efficacy was increased by maintaining the AUC of CBDCA at ≥4.
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Affiliation(s)
- Ayana Tomono
- Department of Pharmacy, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Kaori Ito
- Department of Pharmacy, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
- Department of Hematology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Takahiro Hayashi
- Department of Pharmacy, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
| | - Maiko Ando
- Department of Pharmacy, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
- Department of Hematology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Yosuke Ando
- Department of Pharmacy, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Masahiro Tsuge
- Department of Pharmacy, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Akinao Okamoto
- Department of Hematology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Yoko Inaguma
- Department of Hematology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Masataka Okamoto
- Department of Hematology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Nobuhiko Emi
- Department of Hematology, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Shigeki Yamada
- Department of Pharmacy, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
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Evans SS, Gandhi AS, Clemmons AB, DeRemer DL. Clinical and Cost Comparison Evaluation of Inpatient Versus Outpatient Administration of EPOCH-Containing Regimens in Non-Hodgkin Lymphoma. J Pharm Pract 2016; 30:400-405. [DOI: 10.1177/0897190016659210] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in non-Hodgkin’s lymphoma, however, the incidence of febrile neutropenia (FN) in patients receiving inpatient versus outpatient EPOCH has not been described. Additionally, no comparisons have been made regarding financial implications of EPOCH administration in either setting. This study’s primary objective was to compare hospital admissions for FN in patients receiving inpatient or outpatient EPOCH. Methods: A single-center, institutional review board-approved review was conducted for adults receiving EPOCH beginning January 2010. Clinical and financial data were collected through chart review and the institution’s financial department. Descriptive statistics were utilized for analysis. Results: A total of 25 patients received 86 cycles of an EPOCH-containing regimen (61 [70.9%] inpatient). Five (8.2%) inpatient cycles resulted in an admission for FN compared to 4 (16%) outpatient cycles. Prophylactic antifungal and antiviral agents were prescribed more often after inpatient cycles (>80%) compared to outpatient cycles (<50%). Overall, 27 (31.4%) of 86 cycles did not receive granulocyte colony-stimulating factor support. Outpatient EPOCH administration was associated with a cost savings of approximately US$141 116 for both chemotherapy costs and hospital day avoidance. Conclusion: EPOCH-containing regimens can be safely administered in the outpatient setting, which may result in cost savings for healthcare institutions.
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Affiliation(s)
- Sarah S. Evans
- Department of Pharmacy, The Arthur G. James Cancer Hospital, The Ohio State University, Columbus, OH, USA
| | - Arpita S. Gandhi
- Department of Pharmacy, Georgia Regents Medical Center, Augusta, GA, USA
| | - Amber B. Clemmons
- Department of Pharmacy, Georgia Regents Medical Center, University of Georgia College of Pharmacy, Augusta, GA, USA
| | - David L. DeRemer
- Department of Pharmacy, Georgia Regents University Cancer Center, University of Georgia College of Pharmacy, Augusta, GA, USA
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Yam C, Landsburg DJ, Nead KT, Lin X, Mato AR, Svoboda J, Loren AW, Frey NV, Stadtmauer EA, Porter DL, Schuster SJ, Nasta SD. Autologous stem cell transplantation in first complete remission may not extend progression-free survival in patients with peripheral T cell lymphomas. Am J Hematol 2016; 91:672-6. [PMID: 27012928 DOI: 10.1002/ajh.24372] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 12/31/2022]
Abstract
Patients with peripheral T cell lymphomas (PTCL) generally have a poor prognosis when treated with conventional chemotherapy. Consolidation with autologous stem cell transplantation (ASCT) has been reported to improve progression-free survival. However, these studies have not compared consolidative ASCT with active observation in patients with PTCL achieving first complete remission (CR1) following induction chemotherapy. We conducted a retrospective analysis of PTCL patients treated at the University of Pennsylvania between 1/1/2007 and 12/31/2014. Patients with cutaneous T cell lymphoma, concurrent B cell lymphomas, and anaplastic lymphoma kinase-positive anaplastic large cell lymphoma (ALK-positive ALCL) were excluded from the study. We compared progression-free survival for patients who underwent ASCT in CR1 following CHOP-like induction regimens and patients who underwent active observation during CR1. 48 patients met all inclusion and exclusion criteria and underwent either active observation (28 patients) or consolidative ASCT (20 patients) in CR1. The 1-year cumulative incidence of relapse in the observation and ASCT groups was 50% (95% confidence interval [CI]: 30-67%) and 46% (95% CI: 23-67%), respectively (P = 0.55). Median progression-free survival in the observation and ASCT groups was 15.8 and 12.8 months, respectively (log rank, P = 0.79). Estimated 3-year progression-free survival in the observation and ASCT groups was 37 and 41%, respectively. In conclusion, for PTCL patients achieving CR1 following CHOP-like induction chemotherapy, ASCT does not appear to improve progression-free survival compared to active observation. This finding should be confirmed in a larger, prospective study. Am. J. Hematol. 91:672-676, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Clinton Yam
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Daniel J. Landsburg
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Kevin T. Nead
- Department of Radiation Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Xinyi Lin
- Singapore Institute for Clinical Sciences; Singapore Singapore
| | - Anthony R. Mato
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Jakub Svoboda
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Alison W. Loren
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Noelle V. Frey
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Edward A. Stadtmauer
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - David L. Porter
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Stephen J. Schuster
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Sunita D. Nasta
- Abramson Cancer Center and the Division of Hematology and Oncology; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
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DU HP, Yang QQ, Zhang YE. Bortezomib-based chemotherapy to treat refractory angioimmunoblastic T-cell lymphoma: A case report and review of the literature. Oncol Lett 2016; 11:2310-2314. [PMID: 26998168 DOI: 10.3892/ol.2016.4213] [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: 12/26/2014] [Accepted: 01/12/2016] [Indexed: 11/06/2022] Open
Abstract
The peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of aggressive neoplasms that account for <15% of all non-Hodgkin's lymphoma cases in adults. Angioimmunoblastic T-cell lymphoma (AITL) is a specific subtype of PTCL. The tumor is frequently aggressive and there is currently no general consensus regarding an effective treatment strategy. The present study reports a case in which bortezomib combined with dexamethasone was used to treat refractory AITL. A 63-year-old woman was admitted to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Zhejiang, China) on August 17, 2013. The patient had been diagnosed with AITL for 4 months and had experienced a relapse of symptoms for the 4 days prior to admission. The patient demonstrated fever and dyspnea, accompanied by severe edema in the face and lower limbs, which later spread to the right upper limb. The patient was treated with bortezomib plus dexamethasone, which rapidly relieved the symptoms. The patient was subsequently administered an additional 2 cycles of bortezomib-based chemotherapy and survived for an additional 4 months, prior to succumbing to the disease. Only a small number of studies have reported the use of bortezomib in the treatment of T-cell lymphoma. The present study suggested that bortezomib-based treatment may be a reliable, safe and effective alternative for the treatment of relapsed/refractory PTCL. The efficacy of bortezomib as a treatment for PTCL requires additional evaluation in future studies.
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Affiliation(s)
- Hua-Ping DU
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, P.R. China
| | - Qian-Qian Yang
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, P.R. China
| | - Y E Zhang
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, P.R. China
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Fraser E, Gruenberg K, Rubenstein JL. New approaches in primary central nervous system lymphoma. Chin Clin Oncol 2016; 4:11. [PMID: 25841718 DOI: 10.3978/j.issn.2304-3865.2015.02.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/30/2014] [Indexed: 12/19/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) has long been associated with an inferior prognosis compared to other aggressive non-Hodgkin's lymphomas (NHLs). However, during the past 10 years an accumulation of clinical experience has demonstrated that long-term progression-free survival (PFS) can be attained in a major proportion of PCNSL patients who receive dose-intensive consolidation chemotherapy and avoid whole brain radiotherapy. One recent approach that has reproducibly demonstrated efficacy for newly diagnosed PCNSL patients is an immunochemotherapy combination regimen used during induction that consists of methotrexate, temozolomide, and rituximab followed by consolidative infusional etoposide plus high-dose cytarabine (EA), administered in first complete remission (CR). Other high-dose chemotherapy-based consolidative regimens have shown efficacy as well. Our goal in this review is to update principles of diagnosis and management as well as data regarding the molecular pathogenesis of PCNSL, information that may constitute a basis for development of more effective therapies required to make additional advances in this phenotype of aggressive NHL.
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Affiliation(s)
- Eleanor Fraser
- Division of Hematology/Oncology, University of California, San Francisco, CA 94143, USA
| | - Katherine Gruenberg
- UCSF School of Pharmacy, University of California, San Francisco, CA 94143, USA
| | - James L Rubenstein
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94143, USA.
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Yuan S, Yu J, Haverkos B, Su H. Remission of an extensively pre-treated relapsing/refractory ALK-positive anaplastic large cell lymphoma following metronomic therapy. Leuk Lymphoma 2016; 57:1194-6. [PMID: 26734914 DOI: 10.3109/10428194.2015.1055484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Shunzong Yuan
- a Department of Lymphoma , Head and Neck Cancer, the Affiliated Hospital of Academy of Military Medical Sciences , Beijing , PR China
| | - Jianhua Yu
- b Comprehensive Cancer Center, Division of Hematology , The James Cancer Hospital, The Ohio State University , Columbus , OH , USA
| | - Brad Haverkos
- b Comprehensive Cancer Center, Division of Hematology , The James Cancer Hospital, The Ohio State University , Columbus , OH , USA
| | - Hang Su
- a Department of Lymphoma , Head and Neck Cancer, the Affiliated Hospital of Academy of Military Medical Sciences , Beijing , PR China
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Zinzani PL, Bonthapally V, Huebner D, Lutes R, Chi A, Pileri S. Panoptic clinical review of the current and future treatment of relapsed/refractory T-cell lymphomas: Peripheral T-cell lymphomas. Crit Rev Oncol Hematol 2016; 99:214-27. [PMID: 26811013 DOI: 10.1016/j.critrevonc.2015.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/11/2015] [Accepted: 12/23/2015] [Indexed: 12/11/2022] Open
Abstract
Peripheral T-cell lymphomas (PTCLs) tend to be aggressive and chemorefractory, with about 70% of patients developing relapsed/refractory disease. Prior to 2009, chemotherapies were the only options for relapsed/refractory PTCL, other than hematopoietic transplants. However, chemotherapy only improves survival by about 1 month compared with palliation. Four drugs are now approved in the US to treat relapsed/refractory PTCL: pralatrexate, romidepsin, belinostat, and brentuximab vedotin (for systemic anaplastic large cell lymphoma [sALCL]). Response rates with pralatrexate, romidepsin, and belinostat range from 25 to 54% in mixed relapsed/refractory PTCL populations, while 86% of sALCL patients respond to brentuximab vedotin. Here, we critically evaluate the evidence supporting the current drug treatment of relapsed/refractory PTCL, and look to the future to see how the treatment panorama may change with the advent of new targeted therapies, some of which (e.g., alisertib in PTCL and mogamulizumab in CCR4-positive adult T-cell leukemia/lymphoma) are already in phase 3 trials.
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Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology 'L. e A. Seràgnoli', Policlinico Sant'Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Vijayveer Bonthapally
- Global Outcomes and Epidemiology Research (GOER), Millennium Pharmaceuticals Inc., 40 Lansdowne Street, Cambridge, MA 02139, USA(1)
| | - Dirk Huebner
- Oncology Clinical Research, Millennium Pharmaceuticals Inc., 35 Lansdowne Street, Cambridge, MA 02139, USA(1)
| | - Richard Lutes
- Oncology Clinical Research, Millennium Pharmaceuticals Inc., 35 Lansdowne Street, Cambridge, MA 02139, USA(1)
| | - Andy Chi
- Department of Biostatistics, Millennium Pharmaceuticals Inc., 40 Lansdowne Street, Cambridge, MA 02139, USA(1)
| | - Stefano Pileri
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University School of Medicine, Via Massarenti 8, 40138 Bologna, Italy; Unit of Hematopathology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
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Petković I. Current trends in the treatment of primary mediastinal large B-cell lymphoma - an overview. Contemp Oncol (Pozn) 2015; 19:428-35. [PMID: 26843837 PMCID: PMC4731448 DOI: 10.5114/wo.2015.56388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/23/2015] [Indexed: 11/17/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma has been recognised as a distinct entity with unique clinical, pathologic, and genetic features. According to WHO 2008 classification it is marked as a variant of diffuse large B-cell lymphoma but shares characteristics with classic Hodgkin lymphoma. Genetic analysis has shown that amplification of the 9p24.1 region is the disease's specific structural alteration. Aggressive behaviour and a tendency to invade surrounding tissues of the thoracic cavity, often causing superior vena cava syndrome, or pleural or pericardial effusions, are the clinical hallmarks of this disease. For a long period of time it has been considered as a disease with poor prognosis, which responds poorly to the conventional treatment created for diffuse large B-cell lymphoma. An elective treatment has not yet been established, but recently the situation has became much more favourable. After the introduction of rituximab the cure rates have risen to over 80%, and the most recent results have demonstrated a new insight with dose-adjusted intensified continuous treatments, in which the cure rates have exceeded 90%. Current trends have led to the introduction of dose-adjusted intensified protocols becoming a standard of care, whereas the use of radiotherapy remains controversial because of the questionable predictive value of post-treatment PET/CT validity. The relapse rate is very low after two years of sustained complete remission. If the disease relapses or is resistant the outcome is very poor regardless of the applied treatment modality.
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Cutaneous T cell Lymphoma: an Update on Pathogenesis and Systemic Therapy. Curr Hematol Malig Rep 2015; 10:468-76. [DOI: 10.1007/s11899-015-0293-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chung CG, Poligone B. Other Chemotherapeutic Agents in Cutaneous T-Cell Lymphoma. Dermatol Clin 2015; 33:787-805. [DOI: 10.1016/j.det.2015.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Primary mediastinal B-cell lymphoma and mediastinal gray zone lymphoma: do they require a unique therapeutic approach? Blood 2014; 125:33-9. [PMID: 25499450 DOI: 10.1182/blood-2014-05-575092] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary mediastinal B-cell lymphoma (PMBL) is a subtype of diffuse large B-cell lymphoma (DLBCL) that is putatively derived from a thymic B cell. Accounting for up to 10% of cases of DLBCL, this subtype predominantly affects women in the third and fourth decades of life. Its clinical and molecular characteristics are distinct from other subtypes of DLBCL and, in fact, closely resemble those of nodular sclerosing Hodgkin lymphoma (NSHL). Recently, mediastinal lymphomas with features intermediate between PMBL and NSHL, called mediastinal gray-zone lymphomas, have been described. The optimal management of PMBL is controversial, and most standard approaches include a combination of immunochemotherapy and mediastinal radiation. Recently, the recognition that mediastinal radiation is associated with significant long-term toxicities has led to the development of novel approaches for PMBL that have shown excellent efficacy and challenge the need for routine mediastinal radiation.
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Forero-Torres A, Bartlett NL, Berryman RB, Chen R, Matous JV, Fanale MA, O'Connor OA, Olshefski R, Smith SE, Huebner D, Levine PL, Grove LE, Gopal AK. Extended treatment with brentuximab vedotin in patients with relapsed or refractory CD30-positive hematological malignancies. Leuk Lymphoma 2014; 56:1151-3. [PMID: 25110824 DOI: 10.3109/10428194.2014.951843] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wang H, Wuxiao ZJ, Zhu J, Wang Z, Wang KF, Li S, Chen X, Lu Y, Xia ZJ. Comparison of gemcitabine, oxaliplatin and L-asparaginase and etoposide, vincristine, doxorubicin, cyclophosphamide and prednisone as first-line chemotherapy in patients with stage IE to IIE extranodal natural killer/T-cell lymphoma: a multicenter retrospective study. Leuk Lymphoma 2014; 56:971-7. [PMID: 24991715 DOI: 10.3109/10428194.2014.939964] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Optimal chemotherapy regimen for Extranodal natural killer/T-cell lymphoma (ENKTL) has not yet been defined. We retrospectively compared the outcome of 93 patients newly diagnosed with stage IE to IIE ENKTL who received gemcitabine, oxaliplatin and L-asparaginase (GELOX) (n = 40) or etoposide, vincristine, doxorubicin, cyclophosphamide and prednisone (EPOCH) (n = 53) as induction chemotherapy. After induction chemotherapy, the complete response (CR) rate and overall response rate (ORR) for the GELOX group were higher than those for the EPOCH group (70.0% vs. 41.5%, p = 0.007 for CR; 87.5% vs. 67.9%, p = 0.047 for ORR). The GELOX regimen resulted in significantly superior 5-year progression-free survival (PFS) (79.0% vs. 46.5%, p = 0.005) and overall survival (OS) rates (78.9% vs. 50.4%, p = 0.003). Toxicity of both regimens was acceptable. The GELOX regimen produces a better long outcome with less toxicity than the EPOCH regimen for patients with early stage ENKTL.
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Affiliation(s)
- Hua Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou, Guangdong , P. R. China
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Tsai HT, Pfeiffer RM, Warren J, Wilson W, Landgren O. The effects of cardiovascular disease on the clinical outcome of elderly patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2014; 56:682-7. [PMID: 24893799 DOI: 10.3109/10428194.2014.921914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We identified 3910 elderly (>65 yrs) patients with diffuse large B-cell lymphoma (DLBCL) who received doxorubicin-based (+/-rituximab) therapy and 77 347 cancer-free controls, and assessed cardiovascular events and survival in relation to preexisting cardiovascular comorbidities. Compared to controls, patients with DLBCL had a 3.4-fold (95%CI 3.0-3.9) and 2.5-fold (95%CI 2.3-2.7) increased risk of congestive heart failure (CHF)/cardiomyopathy (CM) within 6 months and 3 years of diagnosis, respectively. Risk of acute myocardial infarction (AMI) was similarly increased. The risk of CHF/CM and AMI was significantly higher in those patients with DLBCL (vs. controls) who did not report preexisting cardiovascular disease, compared to those who had preexisting cardiovascular disease; this was due to dose reductions of doxorubicin among patients with preexisting cardiovascular disease. Rituximab improved survival in patients with stage III-IV (but not I-II) disease (p-interaction = 0.0003). Our novel findings emphasize the need to reduce cardiac toxicity of doxorubicin in elderly DLBCL patients.
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Affiliation(s)
- Huei-Ting Tsai
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics
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