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Laoruangroj C, Atherton PJ, Wiseman GA, Ansell S, Feldman AL, Schumacher P, Witzig TE. The asymptomatic follicular lymphoma (AFL) trial: single-agent rituximab immunotherapy versus 90Y-ibritumomab tiuxetan radioimmunotherapy (RIT) for patients with new, untreated follicular lymphoma. Leuk Lymphoma 2024; 65:333-338. [PMID: 38189774 DOI: 10.1080/10428194.2023.2295792] [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: 09/21/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Abstract
Patients with asymptomatic follicular lymphoma (AFL) are candidates for observation or immunotherapy. Given the effectiveness of radiation therapy in FL, another option is 90Yttrium-ibritumomab tiuxetan radioimmunotherapy (RIT). We conducted a trial where untreated AFL patients were randomized to rituximab 375 mg/m2 weekly × 4 or rituximab 250 mg/m2 days 1, 8, and 0.4 mCi/kg (maximum 32 mCi) of RIT day 8. Twenty patients were enrolled before the study was halted due to unavailability of RIT. The ORR for rituximab and RIT were 90% and 80%, respectively; the CR rate at 6 months was 30% and 60%, respectively. After a median follow-up of 67 months, eight patients have progressed-three in the rituximab arm and five in the RIT arm and five have required systemic therapy. All patients remain alive. Both agents are highly active for AFL. The 1-week treatment with RIT and sparing of T-cells make combination therapy with newer agents attractive.
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Affiliation(s)
| | - Pamela J Atherton
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, MN, USA
| | | | - Stephen Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | - Peyton Schumacher
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, MN, USA
| | - Thomas E Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic Rochester, MN, USA
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Russler-Germain DA, Krysiak K, Ramirez C, Mosior M, Watkins MP, Gomez F, Skidmore ZL, Trani L, Gao F, Geyer S, Cashen AF, Mehta-Shah N, Kahl BS, Bartlett NL, Alderuccio JP, Lossos IS, Ondrejka SL, Hsi ED, Martin P, Leonard JP, Griffith M, Griffith OL, Fehniger TA. Mutations associated with progression in follicular lymphoma predict inferior outcomes at diagnosis: Alliance A151303. Blood Adv 2023; 7:5524-5539. [PMID: 37493986 PMCID: PMC10514406 DOI: 10.1182/bloodadvances.2023010779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
Follicular lymphoma (FL) is clinically heterogeneous, with select patients tolerating extended watch-and-wait, whereas others require prompt treatment, suffer progression of disease within 24 months of treatment (POD24), and/or experience aggressive histologic transformation (t-FL). Because our understanding of the relationship between genetic alterations in FL and patient outcomes remains limited, we conducted a clinicogenomic analysis of 370 patients with FL or t-FL (from Cancer and Leukemia Group B/Alliance trials 50402/50701/50803, or real-world cohorts from Washington University School of Medicine, Cleveland Clinic, or University of Miami). FL subsets by grade, stage, watch-and-wait, or POD24 status did not differ by mutation burden, whereas mutation burden was significantly higher in relapsed/refractory (rel/ref) FL and t-FL than in newly diagnosed (dx) FL. Nonetheless, mutation burden in dx FL was not associated with frontline progression-free survival (PFS). CREBBP was the only gene more commonly mutated in FL than in t-FL yet mutated CREBBP was associated with shorter frontline PFS in FL. Mutations in 20 genes were more common in rel/ref FL or t-FL than in dx FL, including 6 significantly mutated genes (SMGs): STAT6, TP53, IGLL5, B2M, SOCS1, and MYD88. We defined a mutations associated with progression (MAP) signature as ≥2 mutations in these 7 genes (6 rel/ref FL or t-FL SMGs plus CREBBP). Patients with dx FL possessing a MAP signature had shorter frontline PFS, revealing a 7-gene set offering insight into FL progression risk potentially more generalizable than the m7-Follicular Lymphoma International Prognostic Index (m7-FLIPI), which had modest prognostic value in our cohort. Future studies are warranted to validate the poor prognosis associated with a MAP signature in dx FL, potentially facilitating novel trials specifically in this high-risk subset of patients.
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Affiliation(s)
- David A. Russler-Germain
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kilannin Krysiak
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Cody Ramirez
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Matthew Mosior
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Marcus P. Watkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Felicia Gomez
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Zachary L. Skidmore
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Lee Trani
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - Feng Gao
- Public Health Sciences Division, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Susan Geyer
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Amanda F. Cashen
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Neha Mehta-Shah
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Brad S. Kahl
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Nancy L. Bartlett
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Juan P. Alderuccio
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Izidore S. Lossos
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Sarah L. Ondrejka
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Eric D. Hsi
- Department of Pathology, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Peter Martin
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - John P. Leonard
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Malachi Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | - Obi L. Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | - Todd A. Fehniger
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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Wakazono N, Mizushima A, Maeda Y, Taniguchi N, Nagai K, Hattori A, Harada T. A 60-Year-Old Woman With Posterior Mediastinal Tumor. Chest 2022; 162:e81-e84. [DOI: 10.1016/j.chest.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022] Open
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Ishizawa K, Yokoyama M, Kato H, Yamamoto K, Makita M, Ando K, Ueda Y, Tachikawa Y, Suehiro Y, Kurosawa M, Kameoka Y, Nagai H, Uoshima N, Ishikawa T, Hidaka M, Ito Y, Utsunomiya A, Fukushima K, Ogura M. A phase I/II study of 10-min dosing of bendamustine hydrochloride (rapid infusion formulation) in patients with previously untreated indolent B-cell non-Hodgkin lymphoma, mantle cell lymphoma, or relapsed/refractory diffuse large B-cell lymphoma in Japan. Cancer Chemother Pharmacol 2022; 90:83-95. [PMID: 35796785 PMCID: PMC9300521 DOI: 10.1007/s00280-022-04442-2] [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] [Received: 12/20/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
Abstract
Purpose This phase I/II clinical study was conducted to examine the safety, tolerability, pharmacokinetics, and efficacy of 10-min dosing of bendamustine in patients with previously untreated indolent B-cell non-Hodgkin lymphoma (iNHL) or mantle cell lymphoma (MCL) (Group 1) and patients with relapsed/refractory diffuse large B-cell lymphoma (rrDLBCL) (Group 2). Methods Rituximab 375 mg/m2 was administered intravenously every 28 days to Group 1 patients on day 1 and every 21 days to Group 2 patients on day 1. Bendamustine 90 mg/m2/day was administered to the former on days 1 and 2; bendamustine 120 mg/m2/day was administered to the latter on days 2 and 3. Each regimen was delivered up to six cycles for both groups. The primary endpoints were safety and tolerability in Groups 1 and 2, respectively. Results Among 37 enrolled patients, safety was assessed in 36. In Group 1 (n = 30), 27 patients (90%) had follicular lymphoma. Adverse events (AEs) were observed in all 30 patients in Group 1. Dose-limiting toxicities were observed in two of six patients in Group 2. Common AEs included lymphocyte count decreased (86.7%, 100%). In Group 1, overall response and complete response rates were 93.1% (95% confidence interval [CI] 77.2–99.2%) and 75.9% (95% CI 56.5–89.7%), respectively. The Cmax and AUC of bendamustine tended to be higher in Group 2 than in Group 1. Conclusions This study showed that bendamustine is safe, well-tolerated and effective for patients with previously untreated iNHL, MCL or rrDLBCL. Pharmacokinetic data were equivalent to those obtained outside of Japan. Registration numbers Registration NCT03900377; registered April 3, 2019. Supplementary Information The online version contains supplementary material available at 10.1007/s00280-022-04442-2.
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Affiliation(s)
- Kenichi Ishizawa
- Department of Hematology, Yamagata University Hospital, Yamagata, Japan.
| | - Masahiro Yokoyama
- Department of Hematology Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Harumi Kato
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
| | - Kazuhito Yamamoto
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
| | - Masanori Makita
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Kiyoshi Ando
- Department of Hematology and Oncology, Tokai University Hospital, Isehara, Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology, Ohara HealthCare Foundation Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshimichi Tachikawa
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Youko Suehiro
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mitsutoshi Kurosawa
- Department of Hematology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | | | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yoshikiyo Ito
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - Atae Utsunomiya
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | | | - Michinori Ogura
- Department of Hematology and Oncology, Kasugai Municipal Hospital, Kasugai, Japan
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SIRPα+ macrophages are increased in patients with FL who progress or relapse after frontline lenalidomide and rituximab. Blood Adv 2022; 6:3286-3293. [PMID: 35359004 PMCID: PMC9198921 DOI: 10.1182/bloodadvances.2022007104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
Chemoimmunotherapy is an effective treatment strategy for patients with FL who relapse after frontline R2. SIRPα+ and CSF1R+macrophages are increased in FL patients who relapse after frontline R2.
Limited data exist regarding the outcome of patients with follicular lymphoma (FL) who relapse or progress after frontline lenalidomide and rituximab (R2). Moreover, mechanisms of resistance to R2 in FL remain unclear, with increased protumoral macrophages suspected as a major contributory culprit to this phenomenon. This retrospective study analyzed the outcome of patients with advanced-stage FL grade 1 to 3A who relapsed or progressed after frontline R2. A multiplex immunofluorescence macrophage panel, including CD47, CD14, CD68, CD115 (also known as colony-stimulating factor 1 receptor [CSF1R]), CD163, CD172a (also known as signal regulatory protein α [SIRPα]), and CD274 (also known as programmed cell death-ligand 1 [PDL1]), was used to stain tissue biopsy specimens collected before initiation of R2 and at the time of progression. Among 156 patients with advanced-stage FL treated with frontline R2, 33 (21%) relapsed or progressed and required second-line therapy, after a median of 33 months (range, 1-122 months). Second-line therapy was chemoimmunotherapy in 16 (48%) patients and other therapy in 17 (52%). The overall response rate was 78%, and complete response rate was 72%. Median progression-free survival was significantly longer in patients who received chemoimmunotherapy compared with other therapy (99 vs 25 months; P = .004). Three macrophage populations were significantly increased in tissue samples collected at progression compared with before frontline treatment: CD68+CD115+ (P = .02), CD68+CD115+CD172a+ (P = .02), and CD68+CD163+CD172a+ (P = .01). Chemoimmunotherapy is an effective treatment strategy for patients with FL who relapse after frontline R2. Therapies targeting specific macrophage populations may yield novel approaches for improving outcomes with frontline R2.
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Schweitzer J, Hoffman M, Graf SA. The evidence to date on umbralisib for the treatment of refractory marginal zone lymphoma and follicular lymphoma. Expert Opin Pharmacother 2022; 23:535-541. [PMID: 35209784 DOI: 10.1080/14656566.2022.2043273] [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: 11/04/2022]
Abstract
INTRODUCTION Between 2014 and 2018 The United States Food and Drug Administration granted approvals for three small molecule inhibitors of phosphoinositide 3-kinases (PI3Ks) as monotherapy for follicular lymphoma relapsed after at least 2 prior therapies. Idelalisib, copanlisib, and duvelisib each showed similar overall response rate and progression-free survival efficacy along with significant toxicity in separate phase II single-arm studies. Umbralisib, as the 4th iteration in this PI3K-inhibitor class for relapsed/refractory indolent B-cell lymphoma (iB-NHL), appears comparably active but may have improved tolerability. AREAS COVERED We review the use and limitations of PI3K-inhibitors for iB-NHL and discuss the development of and clinical results for umbralisib. Efficacy data are contextualized alongside other PI3K-inihibitors within the limitations of published single-arm studies. We compare and contrast available safety data, covering the off-target inhibition by umbralisib of casein kinase 1ε that is thought to contribute to a more favorable immune-mediated toxicity profile. EXPERT OPINION Though a late-comer to the PI3K-inihibitor party in iB-NHL, umbralisib may carve out an important role in treatment algorithms. Umbralisib's apparently superior safety needs to be confirmed in real-world and, ideally, comparative studies but stands to make it an attractive option in patients who are frail and/or seek treatments more compatible with remote management.
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Affiliation(s)
- Janelle Schweitzer
- Pharmacy Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Meghan Hoffman
- Pharmacy Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Solomon A Graf
- Medical Oncology Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Division of Oncology, University of Washington School of Medicine, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Eto R, Nakamura R, Yamamoto N, Miyaki T, Hayama S, Sonoda I, Itami M, Tsujimura H, Hashimoto H, Otsuka M. Synchronous early-stage breast cancer and axillary follicular lymphoma diagnosed by core needle biopsy: A case report. Mol Clin Oncol 2021; 16:3. [PMID: 34824843 PMCID: PMC8609517 DOI: 10.3892/mco.2021.2436] [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] [Received: 02/18/2021] [Accepted: 07/28/2021] [Indexed: 11/05/2022] Open
Abstract
Synchronous double cancers are an infrequent finding. The focus of this study was a case of diagnosed synchronous double breast cancer (BC) and axillary (Ax) follicular lymphoma (FL). The patient was a 73-year-old woman who had been visiting her local doctor for follow-up of a fibroadenoma of the left breast, and was referred to our hospital after being diagnosed with invasive ductal carcinoma (IDC) of the left breast. Ultrasonography (US) revealed enlarged Ax lymph nodes (LNs) and US-guided core needle biopsy (CNB) was performed. CNB revealed no metastasis of IDC; however, a diagnosis of FL was made. Therefore, the patient was diagnosed with synchronous double BC and Ax FL and underwent partial surgical resection of the BC and close monitoring of the FL. To the best of our knowledge, this is the first case of malignant lymphoma diagnosed by CNB of Ax LNs during preoperative BC screening. CNB allows for a shorter waiting time for the examination, and it is considered to be minimally invasive, cost-effective and non-inferior to surgical resection in terms of specimen volume. Therefore, active preoperative evaluation of Ax LNs using US-guided CNB may contribute to BC staging, and may also help diagnose synchronous cancers.
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Affiliation(s)
- Ryotaro Eto
- Division of Breast Surgery, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Rikiya Nakamura
- Division of Breast Surgery, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Naohito Yamamoto
- Division of Breast Surgery, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Toshiko Miyaki
- Division of Breast Surgery, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Shoko Hayama
- Division of Breast Surgery, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Itaru Sonoda
- Division of Breast Surgery, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Makiko Itami
- Division of Diagnostic Pathology, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Hideki Tsujimura
- Division of Hematology-Oncology, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Hideyuki Hashimoto
- Chiba Foundation for Health Promotion and Disease Prevention, Chiba 261-0002, Japan
| | - Masayuki Otsuka
- Department of General Surgery, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
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Arushi Khurana, Mwangi R, Ansell SM, Habermann TM, Cerhan JR, Strouse C, Link BK, Wang Y, King RL, Macon WR, Villasboas JC, Witzig TE, Maurer MJ, Nowakowski GS. Patterns of therapy initiation during the first decade for patients with follicular lymphoma who were observed at diagnosis in the rituximab era. Blood Cancer J 2021; 11:133. [PMID: 34274939 PMCID: PMC8286048 DOI: 10.1038/s41408-021-00525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022] Open
Abstract
Immediate treatment for asymptomatic, low-tumor burden follicular lymphoma (FL) has not shown an overall survival benefit over "watch and wait" (W/W) strategy. We estimated incidence of treatment initiation at specific time points and assessed its association with the presence of any criteria such as GELF, BNLI, GITMO at diagnosis. FL patients managed by W/W strategy were identified from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma SPORE between 2002 and 2015. Cumulative incidence estimates of treatment initiation were calculated using transformation (as the first event) and death as competing risks. 401 FL patients were identified on W/W strategy. At a median follow-up of 8 years, 256 (64%) initiated treatment. For patients on the W/W strategy for 5 years, the likelihood of treatment initiation in the next 5 years was 12% compared to 43% at diagnosis unlike transformation rates which remained steady. Patients with any of popular treatment criteria at diagnosis did not have increased therapy initiation rates (44% vs. 42%) during the first 5 years or lymphoma-related death rates at 10 years (6% vs. 7%). Identifying biological differences in patients with early vs. late or no progression is a critical next step in understanding outcomes in W/W patients.
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Affiliation(s)
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - James R Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Brian K Link
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Matthew J Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Outcomes of older patients with follicular lymphoma using individual data from 5922 patients in 18 randomized controlled trials. Blood Adv 2021; 5:1737-1745. [PMID: 33749762 DOI: 10.1182/bloodadvances.2020002724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/10/2020] [Indexed: 01/02/2023] Open
Abstract
Limited data exist to describe the clinical features and outcomes for elderly patients with follicular lymphoma (FL). The Follicular Lymphoma Analysis of Surrogacy Hypothesis (FLASH) group performed a prospectively planned pooled analysis of individual patient data from first-line randomized controlled trials (RCTs) and examined associations between age (≤70 vs >70 years), clinical characteristics, and FL outcomes. We identified 18 multicenter clinical RCTs in the FLASH database that enrolled elderly patients (>70 years). Primary end points were early disease outcomes, CR24 and CR30, and progression-free survival (PFS) at 24 months (PFS24). Secondary end points were PFS and overall survival (OS). We identified 5922 previously untreated FL patients from 18 RCTs. Patients age >70 years (vs ≤70 years) more commonly had elevated lactate dehydrogenase, hemoglobin <12 g/dL, ECOG PS ≥2, and elevated β2-microglobulin. Median follow-up was 5.6 years. Patients >70 years did not differ from patients ≤70 years in rates of CR24, CR30, or PFS24. With a median OS of 14.6 years for all patients, median OS was 7.4 and 15.7 years for patients >70 and ≤70 years of age, respectively (hazard ratio = 2.35; 95% confidence interval = 2.03-2.73; P < .001). Age >70 years was a significant predictor of OS and PFS due to higher rates of death without progression, but not PFS24, CR24, or CR30. FL patients >70 years treated on trials have similar early disease outcomes to younger patients. There is no disease-specific outcome difference between age groups. Age alone should not disqualify patients from standard treatments or RCTs.
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Girard J, Karimi Y, Carty S, Wilcox R, Kaminiski M, Malek S, Phillips T. Targeted Therapies for Follicular Lymphoma. Curr Hematol Malig Rep 2021; 16:25-31. [PMID: 33754292 DOI: 10.1007/s11899-021-00614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
Follicular lymphoma (FL) is the 2nd most common lymphoma in the USA/Western Europe. While incurable, the majority of patients are able to survive at least a decade with this disease. Response duration though varies, and subset of patients will relapse within 24 months of initial therapy (POD24). These patients have shortened survival compared to those who achieve more durable responses. Treatment interventions for patients are varied and include observation, radiation, or systemic therapies. Treatment outcomes have improved considerably over the last several decades with the introduction of new agents such as the CD 20 antibody rituximab and more recently with the advent of more targeted therapy. Most of the newer agents work differently from cytotoxic chemotherapy and either inhibit tumor-specific mutations, survival pathways, or harness the immune systems. While outcomes with traditional cytotoxic agents have been historically poor in certain subtypes such as POD24 and rituximab refractory disease, the reported outcomes with the newer agents have been encouraging as evident by several new drug approvals in FL. The biggest impact has been in the relapsed/refractory setting where we have approval of the immunomodulatory agent lenalidomide given in combination with rituximab. Based on the AUGMENT study, this agent has been approved for patients with R/R FL after one previous line of therapy. The EZH2 inhibitor, tazemetostat, was approved recently for patients with a known EZH2 mutation after one prior line of therapy or for FL patients who are deemed intolerant to other agents given the impressive safety profile in all patients. Finally, there is a plethora of agents that are designed to harness the immune system to combat this lymphoma. The data for these agents is still very early but nonetheless very impressive. In summary, FL is an incurable lymphoma without any standard of care options but has numerous treatments that have demonstrated some degree of efficacy. Recently we have made enormous strides in the understanding of some of the biological drivers of this disease which has allowed for refinement of treatment options. Moving forward, I would anticipate that we will continue to explore the use of agents that target specific mutations or utilize the immune system to hopefully one day achieve a cure.
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Affiliation(s)
- Jennifer Girard
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Yasmin Karimi
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Shannon Carty
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Ryan Wilcox
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Mark Kaminiski
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Sami Malek
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Tycel Phillips
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA.
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11
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Nozaki K, Maruyama D, Maeshima AM, Tajima K, Itami J, Shichijo T, Yuda S, Suzuki T, Toyoda K, Yamauchi N, Makita S, Fukuhara S, Munakata W, Kobayashi Y, Taniguchi H, Izutsu K, Tobinai K. The role of local radiotherapy following rituximab-containing chemotherapy in patients with transformed indolent B-cell lymphoma. Eur J Haematol 2020; 106:213-220. [PMID: 33098704 PMCID: PMC7894292 DOI: 10.1111/ejh.13539] [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: 07/27/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 01/19/2023]
Abstract
Objectives This study aimed to evaluate the outcomes of local radiotherapy (LRT) in patients with histologic transformation (HT) following rituximab‐containing chemotherapy. Methods We retrospectively analysed 92 patients with biopsy‐confirmed HT undergoing rituximab‐containing chemotherapy at our institution between 2003 and 2015. Results Of the 36 patients with limited‐stage disease at diagnosis of HT, 29 (78%) received LRT. The estimated 5‐year progression‐free survival (PFS) rate was significantly better in patients who underwent LRT than in those who did not (93% and 42%, respectively; P < 0.05). Multivariate analyses employing age, sex, performance status, LRT and treatment response demonstrated that LRT was an independent prognostic factor for PFS (hazard ratio [HR]: 11.8; 95% confidence interval [CI]: 1.28‐108.1; P < 0.05). Of the 32 patients who underwent LRT for HT lesion treatment, 31 (97%) did not show disease progression within radiation fields; among them, 27 patients (84%) survived without disease progression during the follow‐up period. One patient developed hypothyroidism due to LRT; the others had no acute or late‐onset complications of LRT. Conclusions Our data support the recommendation of LRT for HT lesion treatment following rituximab‐containing chemotherapy in select patients with localised HT, as a rational treatment approach with potentially limited toxicity.
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Affiliation(s)
- Kenji Nozaki
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Kinuko Tajima
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takafumi Shichijo
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Sayako Yuda
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomotaka Suzuki
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Toyoda
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuhiko Yamauchi
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Yukio Kobayashi
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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12
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Niederwieser D, Hamm C, Cobb P, Mo M, Forsyth C, Tucci A, Hanes V, Delwail V, Hajek R, Chien D. Efficacy and Safety of ABP 798: Results from the JASMINE Trial in Patients with Follicular Lymphoma in Comparison with Rituximab Reference Product. Target Oncol 2020; 15:599-611. [PMID: 33044684 PMCID: PMC7568694 DOI: 10.1007/s11523-020-00748-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction ABP 798 is being developed as a biosimilar to rituximab reference product (RP), a CD20-directed cytolytic antibody that is approved in the US and EU for the treatment of non-Hodgkin lymphoma (NHL). Methods This randomized, double-blind, comparative clinical study (JASMINE) evaluated the efficacy and safety of ABP 798 compared with rituximab RP. Adult, anti-CD20 treatment naïve patients diagnosed with grade 1, 2, or 3a follicular B-cell NHL expressing CD20 were randomized 1:1 to receive a 375 mg/m2 infusion of either ABP 798 or rituximab RP once weekly for 4 weeks and at weeks 12 and 20. Tumor assessments were performed at baseline and weeks 12 and 28. Primary endpoint was the risk difference (RD) of overall response rate (ORR) of complete response, unconfirmed complete response, or partial response by week 28 based on data from central, independent, and blinded assessments of disease. Results Of the 256 randomized patients, 254 were treated with ABP 798 (n = 128; 100%) or rituximab RP (n = 126; 98.4%); 96 (78.0%) patients in the ABP 798 group and 87 (70.2%) in the rituximab RP group had a best ORR by week 28. The point estimate of RD in ORR between ABP 798 and rituximab RP from the adjusted generalized linear model for stratification factors was 7.7%. Clinical equivalence was based on sequential testing of the one-sided 95% lower confidence limits and one-sided 95% upper confidence limits of RD in ORR (− 1.4% and 16.8%, respectively) which was within the prespecified non-inferiority margin (− 15%) and non-superiority margin (35.5%), respectively. Results of sensitivity analyses were consistent with the primary efficacy analysis. ABP 798 was also comparable to rituximab RP across additional secondary endpoints, further supporting the conclusion of similarity, and including: RD of ORR at week 12; trough serum concentrations; percent of patients with complete depletion of CD19+ cell count at day 8; safety; and immunogenicity. Conclusions These results support a conclusion of similar clinical efficacy between ABP 798 and rituximab RP in patients with follicular lymphoma. NCT Number NCT02747043; first posted April 21, 2016. EudraCT Number 2013-005,542-11; submitted 14 October, 2014.
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Affiliation(s)
- Dietger Niederwieser
- Division of Hematology and Oncology, University of Leipzig, Liebigstr. 19, 04106, Leipzig, Germany. .,Lithuanian University of Health Sciences, Kaunas, Lithuania. .,School of Medicine, Aichi Medical University, Nagakute, Aichi/Nagoya, Japan.
| | - Caroline Hamm
- Schulich School of Medicine, Western University, Windsor, ON, Canada
| | - Patrick Cobb
- St. Vincent Frontier Cancer Center, Billings, MT, USA
| | - Mindy Mo
- Amgen Inc., Thousand Oaks, CA, USA
| | | | - Alessandra Tucci
- Hematology Department, ASST-Spedali Civili-Brescia, Brescia, Italy
| | | | - Vincent Delwail
- Oncology-Hematology and Cell Therapy, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Roman Hajek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
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13
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Zhou Y, Qin Y, He X, Liu P, Yang J, Zhou L, Zhou S, Gui L, Yang S, Zhang C, Shi Y. Long-term survival and prognostic analysis of advanced stage follicular lymphoma in the rituximab era: A China single-center retrospective study. Asia Pac J Clin Oncol 2020; 17:289-299. [PMID: 32970914 DOI: 10.1111/ajco.13463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/04/2020] [Indexed: 01/15/2023]
Abstract
AIM The prognosis and treatment options for follicular lymphoma (FL) remain heterogenous. This study aimed to analyze the prognostic impact of rituximab maintenance and evaluate the prognostic models in Chinese FL patients. METHODS We retrospectively evaluated patients with treatment-naïve advanced stage FL who were treated in Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College between January 2008 and December 2018. We compared the baseline characteristics, long-term survival outcomes, prognostic factors and the performance of four common prognostic models (i.e., FLIPI, FLIPI2, PRIMA-PI and LDH+β2M) between them. RESULTS A total of 158 patients were included (rituximab maintenance group, 77 patients; observation group, 81 patients). The median follow-up time was 61.0 months. The rituximab maintenance group showed significantly higher 5-year progression-free survival (PFS; 83.3% vs 52.7%, P < 0.001) and overall survival (OS; 97.8% vs 84.1%, P = 0.032) than the observation group. FLIPI2 showed a more discriminating C index than the other three models. CONCLUSION This study showed that rituximab maintenance after chemoimmunotherapy induction can prolong both PFS and OS in patients with advanced-stage FL, and FLIPI2 is a promising prognostic model.
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Affiliation(s)
- Yu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yan Qin
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Xiaohui He
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Peng Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Jianliang Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Liqiang Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Shengyu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Changgong Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
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14
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Buteau JP, Seymour JF, Hofman MS. The evolving definition of bulky disease for lymphoma. Leuk Lymphoma 2020; 61:1525-1528. [PMID: 32684049 DOI: 10.1080/10428194.2020.1797014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- James P Buteau
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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15
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Soumerai JD, Ni A, Alperovich A, Batlevi C, Bantilan KS, Fischer T, Copeland AR, Smith K, Ying Z, Younes A, Zelenetz AD. Time from diagnosis to 2nd treatment is a promising surrogate for overall survival in patients with advanced stage follicular lymphoma. Leuk Lymphoma 2020; 61:2939-2946. [PMID: 32666852 DOI: 10.1080/10428194.2020.1791850] [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: 10/23/2022]
Abstract
It is difficult to demonstrate an overall survival (OS) benefit in trials of immediate therapy vs observation in follicular lymphoma (FL). Time to 2nd treatment (TT2T) may be a preferred endpoint. We identified 584 consecutive patients at our institution with advanced stage FL grade 1-3 A for whom intention was observation (n = 248) or therapy (n = 338). Median time to 1st treatment (TT1T), TT2T, and OS were estimated (subdistribution function). Modified Kendall's tau (mKτ) was used to assess correlation between survival endpoints. Among initially observed patients, median TT1T was 3.3 years, TT2T was 12.1 years, 10-year treatment-free survival was 23%, and 10-year OS was 82%. TT2T was strongly correlated with OS following initial observation (mKτ 0.46, p = .004) or therapy (mKτ 0.53, p < .0001), while duration of observation was not. TT2T is a potential surrogate for OS. Given the outstanding survival in this population, early intervention trials should focus on identifying high risk patients.
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Affiliation(s)
- Jacob D Soumerai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Andy Ni
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Connie Batlevi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Thais Fischer
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Zhitao Ying
- Peking University Cancer Hospital, Beijing, China
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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16
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Freeman CL, Sehn LH. Initial Treatment of High Tumor Burden Follicular Lymphoma. Hematol Oncol Clin North Am 2020; 34:673-687. [PMID: 32586573 DOI: 10.1016/j.hoc.2020.02.004] [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: 11/28/2022]
Abstract
Follicular lymphoma is the most common indolent B-cell lymphoma, with most patients presenting with advanced-stage disease. Patients who are symptomatic or otherwise meet the criteria for high tumor burden merit immediate intervention with combination immunochemotherapy, although more recently, "chemotherapy-free" approaches including novel therapies have shown benefit in this treatment-naïve population. In this review, the authors critically appraise the criteria for high tumor burden, the various options available for initial therapy, and the optimal post-treatment surveillance strategies.
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Affiliation(s)
- Ciara L Freeman
- BC Cancer Centre for Lymphoid Cancer, The University of British Columbia, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada.
| | - Laurie H Sehn
- BC Cancer Centre for Lymphoid Cancer, The University of British Columbia, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada
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17
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McNamara C, Montoto S, Eyre TA, Ardeshna K, Burton C, Illidge T, Linton K, Rule S, Townsend W, Wong WL, McKay P. The investigation and management of follicular lymphoma. Br J Haematol 2020; 191:363-381. [PMID: 32579717 DOI: 10.1111/bjh.16872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Silvia Montoto
- St Bartholomew’s and The Royal London NHS Trust London UK
| | - Toby A. Eyre
- Department of Clinical Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Kirit Ardeshna
- Department of Haematology University College London Hospital LondonUK
| | - Cathy Burton
- Department of Haematology Leeds Cancer Centre Leeds UK
| | - Tim Illidge
- Institute of Cancer Sciences the Christie NHS Foundation Trust University of Manchester Manchester UK
| | - Kim Linton
- Department of Medical Oncology The Christie Hospital NHS Trust Manchester UK
| | - Simon Rule
- Department of Haematology University of Plymouth Medical School Plymouth UK
| | - William Townsend
- Department of Haematology University College London Hospital LondonUK
| | - Wai L. Wong
- Paul Strickland Scanner Centre Mount Vernon Hospital Northwood UK
| | - Pam McKay
- Department of Haematology Beatson West of Scotland Cancer Centre Glasgow Scotland UK
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18
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Kumar A, Ying Z, Alperovich A, Dogan A, Hamlin P, Moskowitz C, Pichardo J, Portlock C, Sha F, Zelenetz AD, Zhang Z, Drill E, Woo K, Younes A. Clinical presentation determines selection of patients for initial observation in mantle cell lymphoma. Haematologica 2020; 104:e163-e166. [PMID: 30930338 DOI: 10.3324/haematol.2018.201350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhitao Ying
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Anna Alperovich
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Maimonides Medical Center, New York, NY, USA
| | - Ahmet Dogan
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Hamlin
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Janine Pichardo
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carol Portlock
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fushen Sha
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Esther Drill
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlin Woo
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,University of Wisconsin-Madison, Madison, WI, USA
| | - Anas Younes
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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19
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Albarmawi H, Nagarajan M, Onukwugha E, Gandhi AB, Keating KN, Appukkuttan S, Yared J. Follicular lymphoma treatment patterns between 2000 and 2014: a SEER-Medicare analysis of elderly patients. Future Oncol 2020; 16:353-365. [PMID: 32043384 DOI: 10.2217/fon-2019-0660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Characterize follicular lymphoma (FL) treatment patterns among elderly patients using a dataset with longer follow-up time. Materials & methods: Using the linked Surveillance, Epidemiology and End Results-Medicare data, we identified patients diagnosed with FL between 2000 and 2013 with claims data until 2014. We investigated the treatments received and assigned them to lines of treatment. Results: We identified 10,238 elderly patients. Over a 4.7-year median follow-up, 78% of the patients received at least first-line treatment. Fewer individuals received second-line (47%) and third-line (30%) treatments. RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone), RCVP (rituximab, cyclophosphamide, vincristine and prednisolone) and rituximab monotherapy were the most common treatment regimens. Conclusion: One in five elderly patients did not receive FL-directed therapy. The most common treatment regimens were limited to RCHOP, RCVP and rituximab monotherapy.
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Affiliation(s)
- Husam Albarmawi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Madhuram Nagarajan
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Aakash Bipin Gandhi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Karen N Keating
- Bayer Healthcare Pharmaceuticals, Inc., Whippany, NJ 07981, USA
| | | | - Jean Yared
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
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20
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Hara T, Suzuki R, Ohno A, Yamakawa K, Yamagishi Y, Sugiyama Y, Sobajima T, Yamada R, Matsumoto R, Ikeda Y, Murayama M, Tsurumi H. Safe administration of rituximab for follicular lymphoma after obinutuzumab infusion-related reaction. Int J Hematol 2019; 111:585-590. [PMID: 31848991 DOI: 10.1007/s12185-019-02793-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 01/10/2023]
Abstract
Obinutuzumab is a novel glycoengineered, type-II anti-CD20 monoclonal antibody that was recently developed to treat follicular lymphoma (FL), the most prevalent subtype of indolent B-cell lymphoma. Several intensely hypermetabolic lesions (SUVmax: 40) were identified in the post-mediastinal and paraaortic lymph nodes by 18F-FDG-PET maximum-intensity projection images of a 58-year-old man who presented with systemic lymphadenopathy. A biopsy at the time of laparotomy definitively diagnosed grade 1 FL. The patient was given the recommended standard premedication, comprising acetaminophen (1000 mg), diphenhydramine (50 mg), and dexamethasone (20 mg), and then started on six cycles of obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). However, the patient developed severe hypotension and dyspnea about 15 min after starting obinutuzumab. It was difficult to differentiate between a possible allergic reaction and infusion-related reaction. A pleural effusion was drained to reduce the tumor burden, after which a single course of CHOP was started. Rituximab (R) was added 10 days later without incident, and the patient completed six cycles of the R-CHOP therapy without adverse events. We conclude that R-CHOP was safe for administration to patients who react to infused obinutuzumab. Such patients should be carefully monitored during R infusion, given the risk of cross-reactivity.
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Affiliation(s)
- Takeshi Hara
- Department of Hematology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima, 501-6062, Japan
| | - Ryohei Suzuki
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Akihisa Ohno
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Kengo Yamakawa
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Yasumasa Yamagishi
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Yoshihiro Sugiyama
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Takuya Sobajima
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Rie Yamada
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Rie Matsumoto
- Department of Pharmacy, Matsunami General Hospital, Hashima, Japan
| | - Yoko Ikeda
- Department of Pathology, Matsunami General Hospital, Hashima, Japan
| | - Masanori Murayama
- Department of General Internal Medicine, Matsunami General Hospital, Hashima, Japan
| | - Hisashi Tsurumi
- Department of Hematology, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima, 501-6062, Japan.
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21
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Gibiansky E, Gibiansky L, Buchheit V, Frey N, Brewster M, Fingerle-Rowson G, Jamois C. Pharmacokinetics, exposure, efficacy and safety of obinutuzumab in rituximab-refractory follicular lymphoma patients in the GADOLIN phase III study. Br J Clin Pharmacol 2019; 85:1935-1945. [PMID: 31050355 PMCID: PMC6710522 DOI: 10.1111/bcp.13974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022] Open
Abstract
Aims Rituximab is standard care in a number of lymphoma subtypes, including follicular lymphoma (FL), although many patients are resistant to rituximab, or develop resistance with repeated treatment, and a high proportion relapse. Obinutuzumab is a novel anti‐CD20 monoclonal antibody with improved efficacy over rituximab. It is approved for previously untreated chronic lymphocytic leukaemia (CLL), and for use with bendamustine in patients with rituximab‐relapsed/refractory FL. Methods Using a previously described population pharmacokinetic (PK) model of obinutuzumab in patients with non‐Hodgkin lymphoma and CLL, we conducted an exposure‐response analysis using data from 6 clinical trials in patients with CD20+ B‐cell malignancies (CLL11, GADOLIN, GATHER, GAUDI, GAUGUIN and GAUSS) to describe the PK properties of obinutuzumab, identify covariates influencing exposure, and explore how exposure affects safety, efficacy and pharmacodynamics. Results A 2‐compartment model with linear and time‐dependent clearance described obinutuzumab PK. Disease type and subtype, body weight, baseline tumour size, and sex had the largest effects on PK. Obinutuzumab exposure was not associated with occurrence or severity of adverse events, but higher exposure appeared to be associated with greater efficacy, particularly longer progression‐free survival. However, in multivariate Cox regression analysis, progression‐free survival benefit in the obinutuzumab plus bendamustine arm was independent of exposure. Conclusion The updated population PK model reported here accurately describes the PK of obinutuzumab patients with non‐Hodgkin lymphoma and CLL. The selected obinutuzumab dosing regimen offers clinical benefit in a majority of rituximab‐refractory FL patients treated with bendamustine, irrespective of variability in exposure, whilst minimising adverse events.
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Affiliation(s)
| | | | - Vincent Buchheit
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Nicolas Frey
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Michael Brewster
- Clinical Development, Roche Innovation Center Welwyn, Welwyn Garden City, UK
| | | | - Candice Jamois
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
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22
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Wang N, Xu PP, Wang L, Cheng S, Zhao WL, Sun HP. [Prognostic study of 229 follicular lymphoma patients treated with rituximab combined with chemotherapy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:46-51. [PMID: 30704228 PMCID: PMC7351707 DOI: 10.3760/cma.j.issn.0253-2727.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
目的 探究滤泡性淋巴瘤(FL)的临床特征,以及FL国际预后指数(FLIPI)、FLIPI2、IPI、修正IPI(R-IPI)、NCCN-IPI在中国FL患者的预后意义。 方法 对2008年11月至2018年4月期间以利妥昔单抗联合CHOP(环磷酰胺、多柔比星、长春新碱及泼尼松)方案治疗的229例初治FL患者资料进行回顾性分析,并对所有患者进行各项预后指数评分。对201例完成化疗且有完整随访记录的患者进行单因素及多因素生存分析。 结果 229例患者中男126例,女103例,中位年龄53(21~82)岁。①对上述预后评分系统中所含的危险因素在患者总生存(OS)和无进展生存(PFS)中的影响进行分析,单因素分析结果显示:年龄>60岁、HGB<120 g/L、血β2微球蛋白升高、骨髓浸润及C反应蛋白(CRP)升高是影响患者OS和PFS的不良因素(P值均<0.05),利妥昔单抗维持组(RM)与非维持组(non-RM)患者的5年OS率分别为93.33%、87.10%(P=0.020),5年PFS率分别为90.81%、63.47%(P=0.003),前者均优于后者;多因素分析结果显示:HGB<120 g/L(P=0.001)、骨髓浸润(P=0.050)、CRP升高(P=0.010)和non-RM(P=0.010)是影响OS的不良预后因素,HGB<120 g/L(P=0.003)、CRP升高(P=0.009)和non-RM(P=0.003)是影响PFS的不良预后因素。②对FLIPI和FLIP2评分预后模型进行比较分析,结果显示:FLIPI预后模型中,低危、中危和高危组患者的5年OS率(P=0.230)和5年PFS率(P=0.160)差异均无统计学意义。FLIP2预后模型中,5年OS率和5年PFS率差异均有统计学意义(P值均<0.001),在利妥昔单抗治疗组中进行分析,低危、中危和高危组患者的5年OS率分别为96.77%、88.89%、80.00%,差异有统计学意义(P=0.042)。 结论 利妥昔单抗时代FLIPI2可以更好地用于FL危险分层。
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Affiliation(s)
- N Wang
- Key Laboratory of Medical Genomics; Shanghai Institute of Hematology, Shanghai Ruijin Hospital, Shanghai 200025, China
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23
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Davies GA, Ghosh S, Oh DH, Manna M, Peters AC, Stewart CA, Stewart DA. The Adverse Consequences of Initial Watchful Waiting for Patients With Follicular Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:829-835. [DOI: 10.1016/j.clml.2018.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/04/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
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24
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Gyan E, Sonet A, Brice P, Anglaret B, Laribi K, Fruchart C, Tilly H, Araujo C, Soubeyran P, Gonzalez H, Morineau N, Nicolas-Virelizier E, Ghesquières H, Salles B, Bouabdallah R, Orfeuvre H, Fahri J, Couturier O, Xerri L, Feugier P. Bendamustine and rituximab in elderly patients with low-tumour burden follicular lymphoma. Results of the LYSA phase II BRIEF study. Br J Haematol 2018; 183:76-86. [DOI: 10.1111/bjh.15513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Emmanuel Gyan
- Department of Haematology and Cell Therapy; University Hospital; Tours France
- Clinical Investigation Centre; INSERM U1415, University Hospital; Tours France
| | - Anne Sonet
- Department of Haematology; Mont-Godinne University; Université Catholique de Louvain; CHU UCL Namur; Yvoir Belgium
| | - Pauline Brice
- Department of Haematology; Saint-Louis Hospital; AP-HP; Paris France
| | - Bruno Anglaret
- Department of Haematology; Valence Hospital; Valence France
| | - Kamel Laribi
- Department of Haematology; Le Mans Hospital; Le Mans France
| | | | - Hervé Tilly
- Department of Haematology; Centre Henri Becquerel; Rouen France
| | - Carla Araujo
- Department of Haematology; Bayonne Hospital; Bayonne France
| | | | - Hugo Gonzalez
- Department of Haematology; René Dubos Hospital; Pontoise France
| | - Nadine Morineau
- Department of Haematology; Catherine de Sienne Centre; Nantes France
| | | | | | - Bruno Salles
- Department of Haematology; Châlon Hospital; Châlon-sur-Saône France
| | - Réda Bouabdallah
- Department of Haematology; Paoli-Calmettes Institute; Marseille France
| | - Hubert Orfeuvre
- Department of Haematology; Bourg-en-Bresse Hospital; Bourg-en-Bresse France
| | - Jonathan Fahri
- Department of Haematology; Angers University Hospital; Angers France
| | - Olivier Couturier
- Lysa Pathology Department; Mondor University Hospital; Créteil France
| | - Luc Xerri
- Lysa Imaging Department; Mondor University Hospital; Créteil France
| | - Pierre Feugier
- Department of Haematology; University Hospital, and INSERM U954; Nancy France
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25
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Ye H, Desai A, Gong T, Zeng D, Nomie K, Chen W, Wang W, Romaguera J, Wang ML. Spontaneous regression of mantle cell lymphoma: a report of four cases. Cancer Commun (Lond) 2018; 38:30. [PMID: 29843782 PMCID: PMC5993130 DOI: 10.1186/s40880-018-0306-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/09/2018] [Indexed: 11/23/2022] Open
Abstract
Background Spontaneous regression has been reported in some indolent forms of lymphoma. Mantle cell lymphoma (MCL) is an aggressive lymphoid neoplasm and has a poor prognosis. However, approximately 30% of MCL patients can exhibit indolent clinical behavior. To date, complete spontaneous regression of MCL has not been reported. Case presentation We describe four cases of spontaneous regression of MCL. At the time of presentation, these patients were asymptomatic, with lymph node enlargement and mild to moderate fluorodeoxyglucose (FDG) uptake on FDG-positron emission tomography combined with computed tomography. One of the possible mechanisms of spontaneous regression of the tumor could be due to the host immune response through humoral and cellular immunity, which may have a role in the clearance of tumor cells. Conclusions In this report, we support the use of a “wait and watch” strategy for MCL patients with no risk factors and indolent behavior. This strategy helps spare patients from further potentially harmful chemotherapy. In addition, we describe the phenomenon of spontaneous regression in MCL patients who are asymptomatic and have low-volume disease.
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Affiliation(s)
- Haige Ye
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, P. R. China.,Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Aakash Desai
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.,The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Tiejun Gong
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.,Institute of Hematology and Oncology, Harbin First Hospital, Harbin, 150000, Heilongjiang, P. R. China
| | - Dongfeng Zeng
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.,Department of Hematology, Da Ping Hospital, Research Institute of Surgery, Chongqing Third Military Medical University, Chongqing, 404100, P. R. China
| | - Krystle Nomie
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Wendy Chen
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Wei Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jorge Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Michael L Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Yi S, Li Z, Zou D, Xiong W, Li H, Cui R, Li C, Yan Y, Liu W, Lv R, Yu Z, Chen W, Xu Y, An G, Wang H, Ru K, Cheng T, Wang J, Qiu L. Del17p does not always significantly influence the survival of B-cell chronic lymphoproliferative disorders. Oncotarget 2017; 9:3353-3364. [PMID: 29423051 PMCID: PMC5790468 DOI: 10.18632/oncotarget.23261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022] Open
Abstract
B-cell chronic lymphoproliferative disorders (B-CLPD) comprise several entities with indolent clinical manifestations but heterogeneous survival. Cytogenetic aberrations are now the standard prognostic predictors in chronic lymphocytic leukemia (CLL) but have been less investigated in other subtypes of B-CLPD. In this study, we detected cytogenetic aberrations by fluorescence in situ hybridization (FISH) in 875 B-CLPD patients, based on a panel probes locating at 13q14, 11q22, 17p13 and CEP12. We identified del17p acted as the independent adverse cytogenetic predictor for overall survival (OS) in CLL. Del13q, del11q and del17p were adverse factors for OS in Waldenström's macroglobulinemia in the univariate analysis but lost their role in the multivariate analysis. Trisomy 12 acted as an independent poor factor for both marginal zone lymphoma (MZL) and unclassified B-CLPD (BCLPD-U) subtype. Del17p did not impact survival in MZL and BCLPD-U patients. These contrasting results indicate different roles of the same cytogenetic aberrations in the pathogenesis of each B-CLPD subtype. As del17p contributed to the poorest survival in CLL and desired extraordinary treatment strategy, the imitation of CLL strategy to other B-CLPD with del17p should be carefully advocated based on this study.
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Affiliation(s)
- Shuhua Yi
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Zengjun Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Wenjie Xiong
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Heng Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Rui Cui
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China.,Department of Hematology, Tianjin First Center Hospital, Tianjin, P.R.China
| | - Chengwen Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Yuting Yan
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Rui Lv
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Zhen Yu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Weiwei Chen
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Gang An
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Huijun Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Kun Ru
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Tao Cheng
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, P.R.China
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27
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Lee S, Yamauchi T, Ishii N, Hashimoto T, Kinoshita K, Imamura S, Kamiya K. Achievement of the longest survival of paraneoplastic pemphigus with bronchiolitis obliterans associated with follicular lymphoma using R-CHOP chemotherapy. Int J Hematol 2017; 106:852-859. [PMID: 28791608 DOI: 10.1007/s12185-017-2305-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/30/2022]
Abstract
Paraneoplastic pemphigus (PNP) is a rare, fatal, paraneoplastic autoimmune mucocutaneous blistering disease, commonly associated with lymphoproliferative disorders, including malignant lymphomas. Lymphoproliferative disorders associated with PNP are sometimes associated with a serious lung complication, bronchiolitis obliterans (BO). Due to its rarity, guidelines for the management of PNP have not been established. Furthermore, most patients die within 1 year. Here we report the successful treatment of lymphoma-associated PNP and BO using R-CHOP chemotherapy. A 53-year-old Japanese man was admitted to our hospital for severe erosive stomatitis. Computed tomography and positron emission tomography showed multiple lymphadenopathies. He was diagnosed with follicular lymphoma (Ann Arbor stage IVA) and PNP-related BO. The patient underwent six cycles of R-CHOP and an additional cycle of rituximab. Both the erosive stomatitis and the obstructive lung disease persisted, but complete response of the follicular lymphoma was achieved. The patient survived 27 months after diagnosis. Although he died from progressive respiratory failure due to BO, we note that this patient achieved the longest survival of any reported case of PNP-related BO associated with a lymphoproliferative disorder. The present case suggests that intensive immunochemotherapy for underlying lymphoma may improve the prognosis in patients with PNP-related BO associated with lymphoma.
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Affiliation(s)
- Shin Lee
- Department of Hematology, Japan Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui, Fukui, 918-8501, Japan.
| | - Takahiro Yamauchi
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Norito Ishii
- Department of Dermatology, School of Medicine, Kurume University, Fukuoka, Japan
| | - Takashi Hashimoto
- Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
| | - Keiichi Kinoshita
- Department of Hematology, Japan Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui, Fukui, 918-8501, Japan
| | - Shin Imamura
- Department of Hematology, Japan Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui, Fukui, 918-8501, Japan
| | - Kenichi Kamiya
- Department of Hematology, Japan Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui, Fukui, 918-8501, Japan
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28
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Yazdy MS, Ujjani C. Current challenges in the management of follicular lymphoma. Int J Hematol Oncol 2017; 6:13-24. [PMID: 30302218 PMCID: PMC6171972 DOI: 10.2217/ijh-2017-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/24/2017] [Indexed: 12/29/2022] Open
Abstract
Although typically indolent in nature, follicular lymphoma remains an ongoing challenge for practicing oncologists. While response rates >90% can be achieved with rituximab-based chemoimmunotherapy in advanced stage patients, the complete remission rates are substantially lower and patients inevitably relapse. The inability to achieve a complete remission and an early progression of disease have recently been determined to be indicative of poorer long-term outcomes. A greater understanding of the pathogenesis of follicular lymphoma has enabled the development of targeted therapies, which may improve standard treatment approaches. Examples include lenalidomide and obinutuzumab, which are currently in front-line Phase III investigation. Other therapies of interest include small molecule inhibitors, immune checkpoint inhibitors and chimeric antigen receptor T cells.
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Affiliation(s)
- Maryam Sarraf Yazdy
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC 20007, USA
| | - Chaitra Ujjani
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC 20007, USA
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29
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Maddocks K, Barr PM, Cheson BD, Little RF, Baizer L, Kahl BS, Leonard JP, Fowler N, Gordon LI, Link BK, Friedberg JW, Ansell SM. Recommendations for Clinical Trial Development in Follicular Lymphoma. J Natl Cancer Inst 2016; 109:2758474. [PMID: 28040699 DOI: 10.1093/jnci/djw255] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/24/2016] [Accepted: 09/27/2016] [Indexed: 12/18/2022] Open
Abstract
Follicular lymphoma (FL) is the second most common lymphoid malignancy, representing 20% to 25% of all cases of non-Hodgkin's lymphoma (NHL), and the most common of the indolent NHLs. FL is considered incurable in the majority of patients with the current standard therapeutic approaches, although outcomes have improved in the last few decades with our current therapies, with a median overall survival that now exceeds 18 years. While the majority of patients with FL have improved outcomes with our current therapeutic approaches, there are patients with high-risk disease features that have inferior outcomes to these therapies. There is an urgent need to integrate novel therapeutic agents into the treatment regimens for these patients to improve outcomes with continued evaluation of biomarkers indicative of prognosis and effects of these regimens on quality of life.
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Affiliation(s)
- Kami Maddocks
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Paul M Barr
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Bruce D Cheson
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Richard F Little
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Lawrence Baizer
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Brad S Kahl
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - John P Leonard
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Nathan Fowler
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Leo I Gordon
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Brian K Link
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Jonathan W Friedberg
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
| | - Stephen M Ansell
- Affiliations of authors: The Ohio State University, Columbus, OH (KM); University of Rochester Medical Center, Rochester, NY (PMB); Georgetown University Hospital, Washington, DC (BDC); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), National Cancer Institute, Bethesda, MD; Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Medicine, Weil Cornell University, New York, NY (JPL); The University of Texas MD Anderson Cancer Center, Houston, TX (NF); Northwestern University, Chicago, IL (LIG); University of Iowa, Iowa City, IA (BKL); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Mayo Clinic, Rochester, MN (SMA)
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Ewers EC, Shah PA, Carmichael MG, Ferguson TM. Concurrent Systemic Chemoimmunotherapy and Sofosbuvir-Based Antiviral Treatment in a Hepatitis C Virus-Infected Patient With Diffuse Large B-Cell Lymphoma. Open Forum Infect Dis 2016; 3:ofw223. [PMID: 28018926 PMCID: PMC5170491 DOI: 10.1093/ofid/ofw223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/17/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is associated with the development of non-Hodgkin lymphomas. For aggressive lymphomas, such as diffuse large B-cell lymphoma (DLBCL), treatment of HCV infection is typically deferred in treatment-naive patients until after completion of lymphoma therapy [1, 2]. We report a case of HCV-associated stage IV DLBCL successfully treated concurrently using chemoimmunotherapy and a sofosbuvir-based antiviral regimen.
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Affiliation(s)
| | | | | | - Tomas M Ferguson
- Section of Infectious Diseases, Department of Medicine, Tripler Army Medical Center , Honolulu, Hawaii
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31
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Igarashi T, Ogura M, Itoh K, Taniwaki M, Ando K, Kuroda Y, Yamamoto K, Uike N, Tomita A, Nagai H, Kurosawa M, Mori S, Nawano S, Terauchi T, Ohashi Y, Tobinai K. Japanese phase II study of rituximab maintenance for untreated indolent B-cell non-Hodgkin lymphoma with high tumor burden. Int J Hematol 2016; 104:700-708. [DOI: 10.1007/s12185-016-2097-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022]
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Yuda S, Maruyama D, Maeshima AM, Makita S, Kitahara H, Miyamoto KI, Fukuhara S, Munakata W, Suzuki T, Kobayashi Y, Tajima K, Taniguchi H, Tobinai K. Influence of the watch and wait strategy on clinical outcomes of patients with follicular lymphoma in the rituximab era. Ann Hematol 2016; 95:2017-2022. [PMID: 27666284 PMCID: PMC5093189 DOI: 10.1007/s00277-016-2800-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/17/2016] [Indexed: 11/30/2022]
Abstract
We analyzed the effects of the initial approach to patients with follicular lymphoma (FL) on outcomes in order to investigate whether the watch and wait (WW) strategy is still an acceptable approach in the rituximab era. We retrospectively analyzed 348 patients who were initially diagnosed with FL between 2000 and 2012. We compared the clinical outcomes of the WW cohort and immediate treatment cohort. Among 348 patients (median age of 57 years, range: 19-85), 101 were initially managed with WW and 247 were immediately treated. The median follow-up duration was 75 months (range: 7-169). The estimated median time to treatment failure (TTF) in the treatment following WW cohort and immediate treatment cohort were 92 months (95 % CI, 60.1-NA) and 77 months (95 % CI, 65.1-107.6), respectively, which were not significantly different (P = 0.272) . In a multivariate analysis, clinical stage was identified as a predictive factor of TTF (HR 1.19, 95 % CI, 1.03-1.38, P < 0.05). Neither overall survival rate nor cumulative risk of transformation between the WW cohort and immediate treatment cohort was significant. The results of the present study suggested that the WW strategy is still an acceptable approach for selected FL patients in the rituximab era.
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Affiliation(s)
- Sayako Yuda
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Bunkyō, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Akiko Miyagi Maeshima
- Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hideaki Kitahara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ken-Ichi Miyamoto
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukio Kobayashi
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kinuko Tajima
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hirokazu Taniguchi
- Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Bunkyō, Japan
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Wilson-Royalty M, Lawless G, Palmer C, Brown R. Predictors for chemotherapy-related severe or febrile neutropenia: a review of the clinical literature. J Oncol Pharm Pract 2016. [DOI: 10.1191/1078155201jp084oa] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose. This paper summarizes a literature review of the risk factors and predictors for chemo-therapy-related severe or febrile neutropenia (grades 3 and 4). It explores the extent to which the literature supports the current ASCO guidelines, and assesses the feasibility of developing a predictive algorithm for patients who would benefit from rHuG-CSF (Neupogen). Methods. An electronic literature search for English articles and abstracts identified 718 abstracts for review. From these, 121 articles were reviewed in depth. The review captured risk factors and predictors for grade 3-4 and/or febrile neutropenia, study design, patient characteristics, chemotherapy treatment, and the incidence of grade 3-4 and/or febrile neutropenia. Results. Twenty-eight potential risk factors and predictors for severe or febrile neutropenia among cancer patients were identified and could be classified as patient-related, treatment-related, or disease-related characteristics. Some results were inconsistent across studies due to a lack of standardized methods of assessment and reporting. Approximately 1/3 of the factors were mentioned in more than one study and provided information on the statistical significance of findings. Several factors had cross-study support of their value and confirmed previous findings. Strong predictors of severe/febrile neutropenia included advanced age, performance status, myelosuppressive chemotherapy regimen, early low blood counts, the depth of the absolute neutrophil count (ANC) nadir, and a precipitous, early drop in blood counts of all hematopoietic cell types. Conclusions. This literature review identified several key predictors and risk factors for development of grades 3 and 4 neutropenia in cancer patients. While additional confirmation is needed, there is sufficient consistency in the literature to support use of risk factors to identify patients who may need supportive care. Some of these risk factors were included in the ASCO CSF guidelines for the use of prophylactic support such as G-CSF; however, the ASCO publications have not included other important risk factors, such as age and early reduced ANC levels.
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Affiliation(s)
| | | | | | - Ruth Brown
- MEDTAP International, Bethesda, Maryland
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Barta SK, Li H, Hochster HS, Hong F, Weller E, Gascoyne RD, Habermann TM, Gordon LI, Colocci N, Bengtson EM, Horning SJ, Kahl BS. Randomized phase 3 study in low-grade lymphoma comparing maintenance anti-CD20 antibody with observation after induction therapy: A trial of the ECOG-ACRIN Cancer Research Group (E1496). Cancer 2016; 122:2996-3004. [PMID: 27351685 DOI: 10.1002/cncr.30137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/29/2016] [Accepted: 02/23/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND In an ECOG-ACRIN Cancer Research Group study (E1496), maintenance rituximab (MR) was reported to prolong progression-free survival (PFS) in comparison with observation (OBS) alone in patients with indolent lymphoma after induction chemotherapy. Here the long-term follow-up of the same patient cohort is presented. METHODS Patients with indolent lymphoma received induction chemotherapy with cyclophosphamide, vincristine, and prednisone (CVP). Patients with stable disease or a better response were then randomized to weekly rituximab (375 mg/m(2) × 4 doses) every 6 months for 2 years (MR) or to OBS. The primary endpoint was PFS; the secondary endpoints were overall survival (OS), response rate, and toxicities. RESULTS Of the 387 patients who initially received CVP induction, 158 were randomized to MR, and 153 were randomized to OBS. After a median follow-up of 11.5 years, patients on MR had longer median PFS (4.8 years) than patients on OBS (1.3 years; hazard ratio [HR], 0.49; P < .0001). However, there was no difference in OS between MR and OBS (10-year OS, 67% vs 59%; median OS, 13.5 years vs not reached; HR, 0.91; P = .69). Other than MR, only minimal residual disease after induction therapy was significantly associated with PFS on multivariate analysis (HR, 0.71; P = .02). A low initial tumor burden, minimal residual disease, follicular histology, a low Follicular Lymphoma International Prognostic Index score, and female sex were associated with longer OS. There was no increase in the rate of second primary malignancies with MR vs OBS. CONCLUSIONS With long-term follow-up, MR did not influence OS. The PFS benefit was maintained. MR should be considered optional for patients with indolent B-cell lymphoma. Cancer 2016;122:2996-3004. © 2016 American Cancer Society.
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Affiliation(s)
| | - Hailun Li
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Fangxin Hong
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Edie Weller
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Randy D Gascoyne
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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35
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Kostakoglu L, Goy A, Martinelli G, Caballero D, Crump M, Gaidano G, Baetz T, Buckstein R, Fine G, Fingerle-Rowson G, Berge C, Sahin D, Press O, Sehn L. FDG-PET is prognostic and predictive for progression-free survival in relapsed follicular lymphoma: exploratory analysis of the GAUSS study. Leuk Lymphoma 2016; 58:372-381. [DOI: 10.1080/10428194.2016.1196815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Ghoshal A, Goswami U, Sahoo AK, Chattopadhyay A, Ghosh SS. Targeting Wnt Canonical Signaling by Recombinant sFRP1 Bound Luminescent Au-Nanocluster Embedded Nanoparticles in Cancer Theranostics. ACS Biomater Sci Eng 2015; 1:1256-1266. [DOI: 10.1021/acsbiomaterials.5b00305] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Archita Ghoshal
- Department
of Biosciences and Bioengineering, ‡Centre for Nanotechnology and §Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati-781039, Assam, India
| | - Upashi Goswami
- Department
of Biosciences and Bioengineering, ‡Centre for Nanotechnology and §Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati-781039, Assam, India
| | - Amaresh Kumar Sahoo
- Department
of Biosciences and Bioengineering, ‡Centre for Nanotechnology and §Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati-781039, Assam, India
| | - Arun Chattopadhyay
- Department
of Biosciences and Bioengineering, ‡Centre for Nanotechnology and §Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati-781039, Assam, India
| | - Siddhartha Sankar Ghosh
- Department
of Biosciences and Bioengineering, ‡Centre for Nanotechnology and §Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati-781039, Assam, India
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38
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El-Galaly TC, Bilgrau AE, de Nully Brown P, Mylam KJ, Ahmad SA, Pedersen LM, Gang AO, Bentzen HH, Juul MB, Bergmann OJ, Pedersen RS, Nielsen BJ, Johnsen HE, Dybkaer K, Bøgsted M, Hutchings M. A population-based study of prognosis in advanced stage follicular lymphoma managed by watch and wait. Br J Haematol 2015; 169:435-44. [DOI: 10.1111/bjh.13316] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/26/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
- Clinical Cancer Research Centre; Aalborg University Hospital; Aalborg Denmark
| | - Anders E. Bilgrau
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
- Department of Mathematical Sciences; Aalborg University; Aalborg Denmark
| | - Peter de Nully Brown
- Department of Haematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Karen J. Mylam
- Department of Haematology; Odense University Hospital; Odense Denmark
| | - Syed A. Ahmad
- Department of Haematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | | | - Anne O. Gang
- Department of Haematology; Copenhagen University Hospital; Herlev Denmark
| | - Hans H. Bentzen
- Department of Haematology; Aarhus University Hospital; Aarhus Denmark
| | - Maja B. Juul
- Department of Haematology; Vejle Hospital; Vejle Denmark
| | | | | | - Berit J. Nielsen
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
- Department of Clinical Epidemiology; Aalborg University Hospital; Aalborg Denmark
| | - Hans E. Johnsen
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
- Clinical Cancer Research Centre; Aalborg University Hospital; Aalborg Denmark
| | - Karen Dybkaer
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
- Clinical Cancer Research Centre; Aalborg University Hospital; Aalborg Denmark
| | - Martin Bøgsted
- Department of Haematology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
- Clinical Cancer Research Centre; Aalborg University Hospital; Aalborg Denmark
| | - Martin Hutchings
- Department of Haematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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Kuruvilla J, Assouline S, Hodgson D, MacDonald D, Stewart D, Christofides A, Komolova M, Connors J. A Canadian Evidence-Based Guideline for the First-Line Treatment of Follicular Lymphoma: Joint Consensus of the Lymphoma Canada Scientific Advisory Board. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:59-74. [DOI: 10.1016/j.clml.2014.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/18/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
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Ujjani C, Cheson BD. Advances in the treatment of follicular lymphoma. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1011123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kritharis A, Sharma J, Evens AM. Current therapeutic strategies and new treatment paradigms for follicular lymphoma. Cancer Treat Res 2015; 165:197-226. [PMID: 25655611 DOI: 10.1007/978-3-319-13150-4_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Follicular lymphoma (FL) is an indolent non-Hodgkin's lymphoma that remains an incurable disease for most patients. It is responsive to a variety of different treatments, however it follows a pattern of relapsing and remitting disease. Traditional therapeutic options for patients with untreated FL include expectant observation for asymptomatic and low tumor burden and multiagent cytotoxic chemotherapy for symptomatic and/or high tumor burden. Biologics have become an integral part of therapy with agents that target B lymphocytes, including monoclonal anti-CD20 antibodies and radiolabeled anti-CD20 antibodies. Treatment response to cytotoxic and biologic therapy is high initially; however, with subsequent treatments, response rate and remission duration typically decline and cumulative toxicities increase. The identification of novel targeted agents, use of stem cell transplantation, and new treatment combinations provide the opportunity to enhance patient outcomes. In this review, we critically examine standard treatment strategies for patients with newly diagnosed and relapsed or refractory FL and discuss established and emerging novel therapeutic approaches.
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Affiliation(s)
- Athena Kritharis
- Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
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42
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Evens AM, Smith MR, Lossos IS, Helenowski I, Millenson M, Winter JN, Rosen ST, Gordon LI. Frontline bortezomib and rituximab for the treatment of newly diagnosed high tumour burden indolent non-Hodgkin lymphoma: a multicentre phase II study. Br J Haematol 2014; 166:514-20. [PMID: 24761968 DOI: 10.1111/bjh.12915] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/19/2014] [Indexed: 11/29/2022]
Abstract
There is a lack of published data examining non-cytotoxic options for the frontline treatment of patients with high-tumour burden (HTB) indolent non-Hodgkin lymphoma (iNHL). We completed a multicentre phase II study for patients with untreated HTB iNHL (NCT00369707) consisting of three induction cycles of weekly bortezomib and rituximab followed by an abbreviated consolidation. Forty-two patients were treated and all were evaluable; the most common histology was follicular lymphoma (FL) (n = 33, 79%). Patient characteristics included median age 62 years (40-86); 38% bulky disease; 19% malignant effusions; 91% advanced-stage disease; and median FL International Prognostic Index (FLIPI) score was 3. Therapy was well tolerated with few grade 3/4 toxicities including minimal neurotoxicity. On intent-to-treat, the overall response rate (ORR) at end of therapy was 70% with a complete remission (CR) rate of 40% (FL: ORR 76%, CR 44%). With 50-month median follow-up, 4-year progression-free survival (PFS) was 44% with 4-year overall survival (OS) of 87% (FL: 44% and 97%, respectively). Four-year PFS for FLIPI 0-2 vs. 3-5 was 60% vs. 26% respectively (P = 0·02), with corresponding OS rates of 92% and 81% respectively (P = 0·16). Collectively, bortezomib/rituximab is a non-cytotoxic therapeutic regimen that was well tolerated and resulted in long-term survival rates approximating prior rituximab/cytotoxic chemotherapy series for untreated HTB FL.
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Affiliation(s)
- Andrew M Evens
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
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Abstract
Follicular lymphoma consists of a heterogeneous group of diseases that can vary dramatically in clinical course. As with other indolent lymphomas, follicular lymphoma is felt to be highly treatable, but ultimately incurable. The appropriate management of this disease ranges from close observation to chemoimmunotherapy based on presenting symptoms and comorbidities. In this article, we focus on the optimal management of follicular lymphoma, including prognostication, indications for treatment, and current treatment options. While a number of front-line chemoimmunotherapy options exist, R-CHOP (rituximab, cyclophosphamide, vincristine, prednisone) and BR (bendamustine, rituximab) tend to be favored due to efficacy and tolerability. Post-induction options include maintenance rituximab and radioimmunotherapy, but neither has demonstrated an overall survival benefit. In relapsed disease, patients can receive an alternative chemoimmunotherapy regimen or radioimmunotherapy, or participate in a clinical trial. There are a number of new biologic targeted therapies with promising activity in follicular lymphoma that have the potential to change our approach to this disease.
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Affiliation(s)
- Chaitra Ujjani
- Division of Hematology-Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, USA,
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44
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Van Hende V, Offner F. TREATMENT OF FOLLICULAR LYMPHOMA – A REVIEW. Acta Clin Belg 2014. [DOI: 10.1179/acb.2007.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kedmi M, Hedvat CV, Maragulia J, Zhang Z, Zelenetz AD. Association of quantitative assessment of the intrafollicular proliferation index with outcome in follicular lymphoma. Br J Haematol 2013; 164:646-52. [DOI: 10.1111/bjh.12667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/17/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Meirav Kedmi
- Lymphoma Service; Memorial Sloan-Kettering Cancer Center; New York NY, USA
- Hematology Division; Chaim Sheba Medical Center; Ramat Gan Israel
| | - Cyrus V. Hedvat
- Department of Pathology; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Jocelyn Maragulia
- Lymphoma Service; Memorial Sloan-Kettering Cancer Center; New York NY, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Andrew D. Zelenetz
- Lymphoma Service; Memorial Sloan-Kettering Cancer Center; New York NY, USA
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Bachy E, Houot R, Morschhauser F, Sonet A, Brice P, Belhadj K, Cartron G, Audhuy B, Fermé C, Feugier P, Sebban C, Delwail V, Maisonneuve H, Le Gouill S, Lefort S, Brousse N, Foussard C, Salles G. Long-term follow up of the FL2000 study comparing CHVP-interferon to CHVP-interferon plus rituximab in follicular lymphoma. Haematologica 2013; 98:1107-14. [PMID: 23645690 DOI: 10.3324/haematol.2012.082412] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Anti-CD20-containing chemotherapy regimens have become the standard of care for patients with follicular lymphoma needing cytotoxic therapy. Four randomized trials demonstrated a clinical benefit for patients treated with rituximab. However, no long-term follow up (i.e. > 5 years) of these trials is yet available. Between May 2000 and May 2002, 358 newly diagnosed patients with high tumor burden follicular lymphoma were randomized to receive cyclophosphamide, adriamycin, etoposide and prednisolone plus interferon-α2a or a similar chemotherapy-based regimen plus rituximab, and outcome was up-dated. With a median follow up of 8.3 years, addition of rituximab remained significantly associated with prolonged event-free survival (primary end point) (P=0.0004) with a trend towards a benefit for overall survival (P=0.076). The Follicular Lymphoma International Prognostic Index score was strongly associated with outcome for both event-free and overall survival in univariate analysis and its prognostic value remained highly significant after adjusting for other significant covariates in multivariate models (P<0.0001 and P=0.001, respectively). Considering long-term toxicity, the addition of rituximab in the first-line setting was confirmed as safe with regards to development of secondary malignancies. Long-term follow up of patients with follicular lymphoma treated in the FL2000 study confirms the sustained clinical benefit of rituximab without long-term toxicity.
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Press OW, Palanca-Wessels MC. Selection of first-line therapy for advanced follicular lymphoma. J Clin Oncol 2013; 31:1496-8. [PMID: 23530108 DOI: 10.1200/jco.2012.47.7315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zinzani PL, Marchetti M, Billio A, Barosi G, Carella AM, Lazzarino M, Martelli M, Rambaldi A, Rigacci L, Tarella C, Vitolo U, Tura S. SIE, SIES, GITMO revised guidelines for the management of follicular lymphoma. Am J Hematol 2013; 88:185-92. [PMID: 23339086 DOI: 10.1002/ajh.23372] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 11/15/2012] [Accepted: 11/19/2012] [Indexed: 12/26/2022]
Abstract
By using the GRADE system, we updated the guidelines for management of follicular cell lymphoma issued in 2006 from SIE, SIES, and GITMO group. We confirmed our recommendation to frontline chemoimmunotherapy in patients with Stage III-IV disease and/or high tumor burden. Maintenance rituximab was also recommended in responding patients. In patients relapsing after an interval longer than 12 months from frontline therapy, we recommended chemoimmunotherapy with non cross-resistant regimens followed by rituximab maintenance. High dose chemotherapy followed by hematopoietic stem cell transplant was recommended for young fit patients who achieve a response after salvage chemoimmunotherapy.
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Affiliation(s)
- Pier Luigi Zinzani
- Istituto di Ematologia ed Oncologia Medica “Seragnoli,”; Università di Bologna; Bologna; Italy
| | | | - Atto Billio
- Unità di Ematologia; Ospedale Civile di Bolzano; Bolzano; Italy
| | - Giovanni Barosi
- Laboratory of Clinical Epidemiology and Center of the Study of Myelofibrosis; Fondazione IRCCS Policlinico San Matteo; Pavia; Italy
| | - Angelo Michele Carella
- Divisione di Ematologia I; IRCCS Azienda Ospedaliera Universitaria San Martino; Genova; Italy
| | - Mario Lazzarino
- Divisione di Ematologia; Fondazione IRCCS Policlinico San Matteo; Pavia; Italy
| | - Maurizio Martelli
- Dipartimento di Biotecnologie Cellulari ed Ematologia; Cattedra di Ematologia; Università La Sapienza; Roma
| | | | - Luigi Rigacci
- Unit of Hematology; AOU Careggi; University of Florence; Firenze; Italy
| | | | - Umberto Vitolo
- Divisione di Ematologia; Azienda Ospedaliera San Giovanni Battista; Torino; Italy
| | - Sante Tura
- Department of Hematology; University of Bologna; Bologna; Italy
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49
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Westin JR, Neelapu SS. Therapy of newly diagnosed follicular lymphoma. Front Oncol 2012; 2:188. [PMID: 23248775 PMCID: PMC3518764 DOI: 10.3389/fonc.2012.00188] [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] [Received: 08/29/2012] [Accepted: 11/19/2012] [Indexed: 11/13/2022] Open
Abstract
Newly diagnosed follicular lymphoma is relatively common and can be effectively treated with several differing approaches. Although the disease is often considered incurable, it is highly responsive to therapy when indicated. This review discusses the indications for treatment, risk stratification systems, treatment options with supporting clinical trial data, and expected therapeutic outcomes in newly diagnosed follicular lymphoma.
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50
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Abstract
Indolent lymphoma comprises a unique and challenging subset of non-Hodgkin lymphoma (NHL). While definitions of indolence will vary, the most common indolent NHL subtypes include follicular lymphoma, marginal zone lymphoma, and small lymphocytic lymphoma. Patients with indolent NHL (iNHL) excluding those with rare localized presentations are often met with an incurable but highly treatable NHL. In the rituximab era, response rates are approaching 90% with rituximab plus chemotherapy and time to next treatment are beginning to be measured in years. As a result of a prolonged natural history, we are encountering a gridlock of novel regimens and agents that appropriately fill peer-reviewed journals. In this review, we tackle a spectrum of topics in the management of indolent lymphoma including the initial approach to the newly diagnosed patient, approaches to first cytotoxic chemotherapy, maintenance and consolidation techniques, as well as highlight promising treatments on the horizon in iNHL. Clinicians continue to face tough choices in the management of iNHL. Through well-thought out clinical trials and peer-reviewed vetting of data we will continue to determine how to best manage the clinical continuum that is iNHL.
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Affiliation(s)
- Matthew Lunning
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, Phone: 212-639-3127, Fax: 646-422-2164
| | - Julie M. Vose
- Internal Medicine, University of Nebraska Medical Center, 987680 NE Med Center, Omaha, NE, 68198 Phone: 402-559-3848, Fax: 402-559-6520
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