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Zheng W, Liu M, Guan L, Wang S. Outcomes of the transformation of follicular lymphoma to diffuse large B-cell lymphoma in the rituximab era: A population-based study. Cancer Med 2024; 13:e7120. [PMID: 38629251 PMCID: PMC11022146 DOI: 10.1002/cam4.7120] [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: 12/06/2023] [Revised: 02/24/2024] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Histological transformation (HT) to diffuse large B-cell lymphoma (DLBCL) is a common complication of follicular lymphoma (FL) and is usually associated with a dismal outcome. However, the survival rate of these patients has improved over the last 20 years with the introduction of rituximab. This study aimed to access the outcome of transformation to DLBCL (t-DLBCL) from FL in a retrospective series that began after the widespread use of rituximab use. In addition, we also compared survival between t-DLBCL and primary DLBCL (p-DLBCL) in the same timeframe. METHODS We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with primary FL and patients with p-DLBCL between 2000 and 2020. Patients who had a subsequent diagnosis of DLBCL at least 2 months after FL diagnosis were identified as t-DLBCL. RESULTS Finally, we identified 50,332 FL and 95,933 p-DLBCL. With a median follow-up of 119 months, 1631 patients developed t-DLBCL. The median time from FL diagnosis to t-DLBCL was approximately 4 years. The post-transformation survival (PTS) rate at 5 years was 49.6%, with a median PTS of 56 months. Older age, advanced stage, and early transformation were associated with worse PTS. Furthermore, t-DLBCL receiving chemotherapy or combined modality as initial therapy before HT was also associated with worse PTS, while the result was inverse when taking the impact of initial management strategy at HT into account. Taking t-DLBCL and p-DLBCL as a whole, comparable survival was observed between p-DLBCL and t-DLBCL receiving radiation or watch-and-wait as initial therapy prior to HT. CONCLUSION The outcome of t-DLBCL in the rituximab era was better than historical series before the rituximab era. Due to the good prognosis, we did not recommend autologous stem cell transplantation for t-DLBCL receiving watch-and-wait or radiation as initial therapy before HT.
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Affiliation(s)
- Wenshuai Zheng
- Department of HematologyHainan Hospital of Chinese PLA General HospitalSanyaChina
| | - Mingjuan Liu
- Senior Department of HematologyFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Lixun Guan
- Department of HematologyHainan Hospital of Chinese PLA General HospitalSanyaChina
| | - Shenyu Wang
- Senior Department of HematologyFifth Medical Center of Chinese PLA General HospitalBeijingChina
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2
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Wu H, Sun HC, Ouyang GF. Clinical features and prognostic factors in 49 patients with follicular lymphoma at a single center: A retrospective analysis. World J Clin Cases 2023; 11:3176-3186. [PMID: 37274039 PMCID: PMC10237118 DOI: 10.12998/wjcc.v11.i14.3176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Follicular lymphoma (FL) is a type of B-cell lymphoma that originates at the germinal center and has a low malignancy rate. FL has become the most common inert lymphoma in Europe and America but has a relatively low incidence in Asia.
AIM To explore the clinical features, curative effects, and prognostic factors of FL.
METHODS Completed medical records of 49 patients with FL who were admitted to the Ningbo First Hospital from June 2010 to June 2021 were examined. These patients were definitively diagnosed by pathological biopsy or immunohistochemical staining. The diagnostic criteria were based on the 2008 World Health Organization classification of lymphomas. Ann Arbor staging was performed according to the imaging and bone marrow examination results. Risk stratification of all patients was performed based on the International Prognostic Index (IPI), age-adjusted IPI, Follicular Lymphoma International Prognosis Index (FLIPI), and FLIPI2 to compare the efficacy of different treatment regimens and analyze the related prognostic factors.
RESULTS The age of onset in patients ranged from 24 to 76 years, with a median age of 51 years. Most patients developed the disease at 40–59 years of age, and the male:female ratio was 1.6:1. No significant difference was noted in the curative effect between the non-chemotherapy, combined chemotherapy, and other chemotherapy regimens (P > 0.05). Hemoglobin (Hb) level < 120 g/L, Ki-67 value > 50%, bone marrow involvement, and clinical stages III–IV were associated with a poor prognosis of FL (P < 0.05). However, the influence of other indicators was not statistically significant. Risk grouping was performed using the FLIPI, and the results showed that 24.5%, 40.8%, and 34.7% of patients were in the low-, moderate-, and high-risk groups, respectively. According to the survival analysis results, the survival rate of patients was lower in the high-risk group than in the other low-risk and moderate-risk groups (P < 0.05).
CONCLUSION FL mainly occurs in middle-aged and elderly men, primarily affecting lymph nodes and bone marrow. Hb level, Ki-67 value, bone marrow involvement, and clinical staging were used to evaluate prognosis.
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Affiliation(s)
- Hao Wu
- Department of Hematology, Ningbo First Hospital, Ningbo 315010, Zhejiang Province, China
| | - Hui-Cong Sun
- Adult Internal Medicine, Ningbo Women and Children's Hospital, Ningbo 315012, Zhejiang Province, China
| | - Gui-Fang Ouyang
- Department of Hematology, Ningbo First Hospital, Ningbo 315010, Zhejiang Province, China
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3
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Guo D, Wang Y, Wu X, Gao Y, Wang A, Zhang Z, Zhao K, Wang X, Liu M, Zhang Y, Li M, Chen R, Sun J, Zhang Y. Expression of Tryptophan Metabolism Enzymes in Patients with Diffuse Large B-cell Lymphoma and NK/T-cell Lymphoma. Cancer Med 2023. [PMID: 37148546 DOI: 10.1002/cam4.5903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Metabolites of tryptophan (Trp) metabolism in the tumor microenvironment play crucial immunosuppressive roles in various cancers. However, the role of Trp metabolism in diffuse large B-cell lymphoma (DLBCL) or natural killer/T-cell lymphoma (NK/TCL) remains unelucidated. METHODS We investigated the potential role of Trp metabolism in a cohort of 43 patients with DLBCL and 23 with NK/TCL. We constructed tissue microarrays and performed in situ staining of Trp-catabolizing enzymes and PD-L1 using immunohistochemistry (IHC). RESULTS We observed 14.0% positive staining of IDO1 in DCBCL and 60.9% in NK/TCL; 55.8% of IDO2 in DCBCL and 95.7% in NK/TCL; 79.1% of TDO2 in DCBCL and 43.5% in NK/TCL; 29.7% of IL4I1 in DCBCL and 39.1% in NK/TCL. However, IDO1, IDO2, TDO2, and IL4I1 positivity did not significantly differ between PD-L1+ and PD-L1- biopsy tissue samples of NK/TCL; nonetheless, a positive correlation of IDO1 (r = 0.87, p < 0.001), IDO2 (r = 0.70, p < 0.001), TDO2 (r = 0.63, p < 0.001), and IL4I1 (r = 0.53, p < 0.05) with PD-L1 expression was observed in the TCGA-DLBCL dataset. Finally, immunohistochemical (IHC) analysis revealed the lack of superior prognostic effect with higher expression of Trp enzymes in DLBCL and NK/TCL. Furthermore, IDO1, IDO2, TDO2, and IL4I1 expression, as well as survival rates, did not significantly differ across all groups in the TCGA-DLBCL cohort. CONCLUSION Collectively, our findings provide novel insights into the enzymes involved in Trp metabolism in DLBCL and NK/TCL and their association with PD-L1 expression, which offers potential strategies to combine Trp-metabolism enzyme inhibitors with anti-PD-L1 or other immunotherapeutic strategies in clinical DLBCL or NK/TCL treatment.
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Affiliation(s)
- Dan Guo
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuming Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xunyao Wu
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yike Gao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anqi Wang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zixin Zhang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kun Zhao
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxi Wang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meiyu Liu
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaran Zhang
- Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Biobank, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei Li
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Sun
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Saul EE, Alderuccio JP, Reis IM, Zhao W, Iyer SG, Rodriguez G, Desai A, Chapman JR, Tse DT, Markoe AM, Isrow DM, Lossos IS. Long-term outcomes of patients with conjunctival extranodal marginal zone lymphoma. Am J Hematol 2023; 98:148-158. [PMID: 35560252 DOI: 10.1002/ajh.26591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
Comprehensive information on clinical features and long-term outcomes of primary conjunctival extranodal marginal zone lymphoma (PCEMZL) is scarce. We present a large single-institution retrospective study of 72 patients. The median age was 64 years, and 63.9% were female. Stage I was present in 87.5%. Radiation therapy (RT) alone was the most common treatment (70.8%). Complete response (CR) was 87.5%, and 100% in RT-treated patients. With a median follow-up of 6.7 years, relapse/progression and death occurred in 19.4% each, with one relapse within the RT field. The 10-year progression-free survival (PFS) and overall survival (OS) were 68.4% (95% CI 52.8%-79.8%) and 89.4% (95% CI 77.4%-95.2%), respectively. The 10-year rate for time to progression from diagnosis was 22.5% (95% CI 11.6%-35.7%). The 10-year PFS and OS of MALT-IPI 0 versus 1-2 were 83.3% versus 51.3%, (p = .022) and 97.6% versus 76.6%, (p = .0052), respectively. The following characteristics were associated with shorter survival: age > 60 years (PFS: HR = 2.93, 95% CI 1.08-7.95; p = .035, OS: HR = 9.07, 95% CI 1.17-70.26; p = .035) and MALT-IPI 1-2 (PFS: HR = 2.67, 95% CI 1.12-6.31; p = .027, OS: HR = 6.64, 95% CI 1.45-30.37; p = .015). CR following frontline therapy was associated with longer PFS (HR = 0.13, 95% CI 0.04-0.45; p = .001), but not OS. Using the Fine and Gray regression model with death without relapse/progression as a competing risk, RT and CR after frontline therapy were associated with lower risk of relapse (SHR = 0.34, 95% CI 0.12-0.96 p = .041 and SHR = 0.11, 95% CI 0.03-0.36; p < .001, respectively). Patients with PCEMZL treated with frontline RT exhibit excellent long-term survival, and the MALT-IPI score appropriately identifies patients at risk for treatment failure.
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Affiliation(s)
- Eduardo Edelman Saul
- Department of Internal Medicine, Jackson Memorial Hospital/University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Juan Pablo Alderuccio
- Division of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Isildinha M Reis
- Departmetn of Public Health Science, University of Miami, Miller School of Medicine, Miami, Florida, USA.,Division of Biostatistics, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Wei Zhao
- Division of Biostatistics, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sunil G Iyer
- Division of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Gregor Rodriguez
- Division of Hematology-Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Amrita Desai
- Department of Hematology-Oncology, OHSU Knight Cancer Institute, Oregon Health Sciences University, Portland, Oregon, USA
| | - Jennifer R Chapman
- Department of Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - David T Tse
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Arnold M Markoe
- Division of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Derek M Isrow
- Division of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Izidore S Lossos
- Division of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA
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5
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ctDNA Is Useful to Detect Mutations at Codon 641 of Exon 16 of EZH2, a Biomarker for Relapse in Patients with Diffuse Large B-Cell Lymphoma. Cancers (Basel) 2022; 14:cancers14194650. [PMID: 36230571 PMCID: PMC9563768 DOI: 10.3390/cancers14194650] [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: 08/25/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary It is well known that epigenetic modifications and proteins involved in this process are important in the biogenesis of diffuse large B-cell lymphoma. In this sense, we decided to analyze the EZH2 mutations, which are frequent in this neoplasm, using ctDNA to demonstrate the utility of this tool for searching these mutations. The importance of the study of this gene is due to its role in the biogenesis of lymphomas and also because there are selective inhibitors targeting EZH2. This targeted therapy could be particularly effective in patients with activating mutations in EZH2, remarking the importance of its detection. Abstract (1) Background: The epigenetic regulator EZH2 is a subunit of the polycomb repressive complex 2 (PRC2), and methylates H3K27, resulting in transcriptional silencing. It has a critical role in lymphocyte differentiation within the lymph node. Therefore, mutations at this level are implicated in lymphomagenesis. In fact, the mutation at the Y641 amino acid in the EZH2 gene is mutated in up to 40% of B-cell lymphomas. (2) Methods: We compared the presence of exon 16 EZH2 mutations in tumor samples and ctDNA in a prospective trial. These mutations were determined by Sanger sequencing and ddPCR. (3) Results: One hundred and thirty-eight cases were included. Ninety-eight were germinal center, and twenty had EZH2 mutations. Mean follow-up (IQR 25–75) was 23 (7–42) months. The tumor samples were considered the standard of reference. Considering the results of the mutation in ctDNA by Sanger sequencing, the sensibility (Se) and specificity (Sp) were 52% and 99%, respectively. After adding the droplet digital PCR (ddPCR) analysis, the Se and Sp increased to 95% and 100%, respectively. After bivariate analysis, only the presence of double-hit lymphoma (p = 0.04) or EZH2 mutations were associated with relapse. The median Progression free survival (PFS) (95% interval confidence) was 27.7 (95% IC: 14–40) vs. 44.1 (95% IC: 40–47.6) months for the mutated vs. wild-type (wt) patients. (4) Conclusions: The ctDNA is useful for analyzing EZH2 mutations, which have an impact on PFS.
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Rehell M, Atula T, Tapiovaara LK, Bäck LJJ, Koskinen AIM, Ruohoalho J, Aro KLS. Complications in lymph node excision in the head and neck area. Acta Otolaryngol 2022; 142:738-742. [PMID: 36107716 DOI: 10.1080/00016489.2022.2115551] [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: 01/05/2023]
Abstract
BACKGROUND Although needle biopsy is widely used in work-up of lymphadenopathy, lymph node excision (LNE) is often required especially in lymphoma diagnostics. LNE is an invasive procedure, which carries a potential risk of complications. However, comprehensive studies evaluating the spectrum and occurrence of complications are lacking. AIMS/OBJECTIVES This study addresses the role of preoperative needle biopsies in patients who underwent LNE. Furthermore, surgical complications related to LNE are analyzed. MATERIALS AND METHODS Altogether 321 patients, who underwent LNE in two-year period in 2018-19, and fulfilled our study criteria, were included. Patients' data were retrieved from the electronic patient records. RESULTS The surgical complication rate was 5.9%. Most of the complications (n = 16; 84.2%) were categorized as minor (I-II) according to the Clavien-Dindo scale. The remaining three (15.8%), all hemorrhages, were categorized as major complications and required intervention. Preoperative needle biopsy might have avoided the need for LNE in some patients, which we discuss in this study. CONCLUSIONS AND SIGNIFICANCE Surgical complications after LNE in the head and neck area are rare and mostly minor. Needle biopsy is often recommended preoperatively to avoid unnecessary operations and to refrain performing LNE for patients with non-lymphatic malignancy.
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Affiliation(s)
- Minna Rehell
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura K Tapiovaara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leif J J Bäck
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anni I M Koskinen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Ruohoalho
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katri L S Aro
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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7
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Malik S, Zaki A, Shabbir MU, Hussain T. Plasmablastic Lymphoma Mimicking Osteomyelitis of Femur in an Immunocompetent Individual: A Case Report. Cureus 2022; 14:e21183. [PMID: 35165629 PMCID: PMC8837809 DOI: 10.7759/cureus.21183] [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] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is an aggressive type of diffuse large B-cell lymphoma. It is most commonly seen in patients with human immunodeficiency virus (HIV) infection and other immunodeficiencies manifesting commonly in the form of oral lesions. Here, we report a case of an HIV-negative, immunocompetent elderly male who presented with a painful solitary tender lesion on the right anterior lateral thigh. A preliminary diagnosis of osteomyelitis (right femur) from a possibly infected dynamic compression plate was made following initial ultrasound and MRI of the right lower extremity. An attempt was made to incise and drain the lesion, which was abruptly stopped as it resulted in drainage of copious blood, leading to hemodynamic instability. Histopathology of the specimen revealed findings consistent with PBL. The diagnosis of PBL was further confirmed by immunohistochemical staining, which was positive for CD138, MUMI, and CD56 and negative for CD20 and ALK. Due to its rarity and heterogeneous presentations, PBL could be easily overlooked clinically in immunocompetent patients. Therefore, our case highlights the importance of considering the diagnosis of PBL even in lesions whose course is consistent with other infectious bone pathologies.
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8
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Zhang MY, Min CC, Fu WW, Liu H, Yin XY, Zhang CP, Tian ZB, Li XY. Early colon cancer with enteropathy-associated T-cell lymphoma involving the whole gastrointestinal tract: A case report. World J Clin Cases 2020; 8:5781-5789. [PMID: 33344574 PMCID: PMC7716334 DOI: 10.12998/wjcc.v8.i22.5781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enteropathy-associated T-cell lymphoma (EATL) is a rare invasive lymphoma derived from gastrointestinal epithelial T lymphocytes. EATL involving the whole gastrointestinal tract accompanied with early colon cancer is extremely rare.
CASE SUMMARY We present the case of a 67-year-old man with diarrhea for more than 5 mo whose colonoscopy in another hospital showed multiple colonic polyps, which indicated moderate to severe dysplasia and focal early cancer. Therefore, he was referred to our hospital for further endoscopic treatment. Colonoscopy after admission showed that the mucosa of the terminal ileum and the entire colon were slightly swollen and finely granular. Endoscopic mucosal resection was performed for colonic polyps located in the liver flexure of the colon and descending colon, respectively. Histopathological findings revealed diffuse infiltration of medium-sized lymphoid cells in the colonic mucosa and visible lymphoepithelial lesions. The histopathology of the polyp in the descending colon indicated moderately differentiated adenocarcinoma limited to the mucosa with negative resection margins. Additionally, immunohistochemical analysis showed positive staining for CD7 and CD8. Therefore, we arrived at a diagnosis of EATL with early colon cancer. Subsequently, the patient was transferred to the hematology department for chemotherapy. The patient’s diarrhea was not significantly relieved after receiving chemotherapy, and he ultimately died of severe myelosuppression.
CONCLUSION EATL should be considered in unexplained chronic diarrhea. EATL progresses rapidly with a poor prognosis, especially when accompanied with early colon cancer.
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Affiliation(s)
- Meng-Yuan Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Cong-Cong Min
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Wei-Wei Fu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Hua Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xiao-Yan Yin
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Cui-Ping Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Zi-Bin Tian
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xiao-Yu Li
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
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9
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Huntington SF, Zhu W, Hoag JR, Wang R, Zeidan AM, Giri S, Podoltsev NA, Gore SD, Ma X, Gross CP, Davidoff AJ. Association Between Ownership of Imaging Equipment and Appropriateness of Staging Positron-Emission Tomography in Non-Hodgkin Lymphoma. JNCI Cancer Spectr 2019; 3:pkz030. [PMID: 31360905 PMCID: PMC6649837 DOI: 10.1093/jncics/pkz030] [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: 02/18/2019] [Revised: 04/08/2019] [Accepted: 04/20/2019] [Indexed: 11/19/2022] Open
Abstract
Physician ownership of imaging equipment has been shown to be associated with greater use of low-value imaging. However, it is unclear whether ownership also influences utilization of appropriate imaging. We conducted a cohort study of older adults diagnosed with three non-Hodgkin lymphomas with distinct guideline recommendations concerning the use of positron emission tomography (PET) during staging (recommended, not recommended, or equivocal). We found patients who were treated by oncologists with PET ownership were more likely to receive a staging PET regardless of lymphoma subtype. However, the difference in utilization by ownership status was smallest (6%, 95% confidence interval = 2% to 11%, P = .01) in the setting of diffuse large B cell lymphoma, where consensus guidelines recommend routine use of PET. Overall, removing financial incentives related to imaging self-referral may reduce utilization during cancer care, with the potential for greatest impact on imaging of equivocal or low clinical utility.
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Affiliation(s)
- Scott F Huntington
- Department of Internal Medicine, Section of Hematology.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Weiwei Zhu
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Jessica R Hoag
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Rong Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.,Department of Chronic Disease Epidemiology
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Smith Giri
- Department of Internal Medicine, Section of Hematology.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | | | - Steven D Gore
- Department of Internal Medicine, Section of Hematology
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.,Department of Chronic Disease Epidemiology
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.,Department of Health Policy and Management (AJD), Yale School of Public Health, New Haven, CT
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10
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Elian FA, Yan E, Walter MA. FOXC1, the new player in the cancer sandbox. Oncotarget 2018; 9:8165-8178. [PMID: 29487724 PMCID: PMC5814291 DOI: 10.18632/oncotarget.22742] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/28/2017] [Indexed: 01/01/2023] Open
Abstract
In recent years, rapidly accumulating evidence implicates forkhead box C1 (FOXC1) in cancer, especially in studies of basal-like breast cancer (BLBC). Other studies have followed suit, demonstrating that FOXC1 is not only a major player in this breast cancer subtype, but also in hepatocellular carcinoma (HCC), endometrial cancer, Hodgkin's lymphoma (HL), and non-Hodgkin's lymphoma (NHL). The FOXC1 gene encodes a transcription factor that is crucial to mesodermal, neural crest, and ocular development, and mutations found in FOXC1 have been found to cause dominantly inherited Axenfeld-Rieger Syndrome (ARS). Interestingly, while FOXC1 missense mutations that are associated with ARS usually reduce gene activity, increased FOXC1 function now appears to be often linked to more aggressive cancer phenotypes in BLBC, HCC, HL, and NHL. This review discusses not only the role of FOXC1 in cancer cell progression, proliferation, differentiation, and metastasis, but also the underlying mechanisms of how FOXC1 can contribute to aggressive cancer phenotypes.
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Affiliation(s)
- Fahed A. Elian
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth Yan
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael A. Walter
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Wang Z, Wu YB, Xu LL, Jin ML, Diao XL, Wang XJ, Tong ZH, Shi HZ. Diagnostic value of medical thoracoscopy in malignant pleural effusion induced by non-Hodgkin's lymphoma. Oncol Lett 2017; 14:8092-8099. [PMID: 29344253 DOI: 10.3892/ol.2017.7226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/21/2016] [Indexed: 11/05/2022] Open
Abstract
Malignant pleural effusion (MPE) appears in up to 20% of patients with non-Hodgkin's lymphoma (NHL). The present study aimed to assess the efficacy of medical thoracoscopy (MT) in the diagnosis of patients with MPE induced by NHL. Between July 2005 and June 2014, 833 patients with pleural effusions of unknown etiology underwent MT in Beijing Chaoyang Hospital (Beijing, China), where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, thoracoscopic, histological and immunophenotyping data of 10 NHL patients with MPE were then retrospectively analyzed. Under medical thoracoscopy, pleural nodules (in n=6 patients), hyperemia (n=5), plaque-like lesions (n=4), pleural thickening (n=3), cellulose (n=3), ulcer (n=2), adhesion (n=2), and scattered hemorrhagic spots (n=1) were observed on the surface of parietal pleura. Histopathological and immunohistochemical analysis of pleural biopsy samples led to a correct diagnosis of B-cell NHL in 7 patients and T-lymphoblastic NHL in 2 patients. Data from the present study demonstrated that pleural biopsy through MT achieved a definite diagnosis of NHL in 9 out of 10 (90%) patients with MPE induced by NHL. Therefore, MT is a useful method for diagnosing MPE induced by NHL.
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Affiliation(s)
- Zhen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yan-Bing Wu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Li-Li Xu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Mu-Lan Jin
- Department of Pathology, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiao-Li Diao
- Department of Pathology, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiao-Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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12
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Fischer T, Zing NPC, Chiattone CS, Federico M, Luminari S. Transformed follicular lymphoma. Ann Hematol 2017; 97:17-29. [PMID: 29043381 DOI: 10.1007/s00277-017-3151-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 10/05/2017] [Indexed: 12/01/2022]
Abstract
Follicular Lymphoma (FL) is the second most common type of non-Hodgkin lymphoma and is considered to be the prototype of indolent lymphomas. Histologic transformation into an aggressive lymphoma, which is expected to occur at a rate of 2 to 3% each year, is associated with rapid progression, treatment resistance, and poor prognosis. Recent modifications to the physiopathologic mechanism of transformed follicular lymphoma (t-FL) have been proposed, including genetic and epigenetic mechanisms as well as a role for the microenvironment. Although t-FL is considered a devastating complication, as it is associated with treatment-refractory disease and a dismal outcome, recent data in the rituximab era have suggested that not only is the prognosis less severe than reported in the previous literature but the risk of transformation is also lower. Thus, this study aimed to review the most recent research on t-FL in an attempt to better understand the clinical meaning of transformation from FL to diffuse large B cell lymphoma (DLBCL) and the impact of current treatment strategies on the curability of this intriguing subentity of lymphoma.
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Affiliation(s)
- Thais Fischer
- Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Stefano Luminari
- University of Modena and Reggio Emilia, Modena, Italy. .,Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Arcispedale Santa Maria Nuova IRCCS, viale Risorgimento n°80 42123, Reggio Emilia, Italy.
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13
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Sites of extranodal involvement are prognostic in patients with stage 1 follicular lymphoma. Oncotarget 2017; 8:78410-78418. [PMID: 29108238 PMCID: PMC5667971 DOI: 10.18632/oncotarget.19240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives Follicular lymphoma (FL) is the most common indolent B cell lymphoma in the United States and a quarter of patients present with stage I disease. The objective of this study was to examine if primary site of disease influences survival in early stage lymphoma. Results The most common extranodal primary sites were the integumentary system (8%), followed by the GI tract (6.4%) and head & neck (5.6%). We stratified patients into a pre-rituximab era (1983-1998) and the rituximab era (1999-2011). In multivariable analysis, integumentary disease was associated with better overall survival (Hazard Ratio [HR], 0.77; Confidence Interval [CI], 0.66-0.9) while primary site FL of the nervous system (HR, 2.40; CI, 1.72-3.38) and the musculoskeletal system (HR, 2.14; CI, 1.44-3.18) were associated with worse overall survival when compared to primary nodal FL. Treatment in the pre-rituximab era, male gender and older age at diagnosis were associated with worse survival. Methods We queried the SEER database from 1983 to 2011. We included all adult patients (>18 years) with histologically confirmed stage I FL, active follow-up, and a single primary tumor. A total of 9,865 patients met eligibility criteria, with 2520 (25%) having an extranodal primary site. We classified the primary sites by organ or anatomic location into 11 sites. Conclusion Primary site of disease is a prognostic factor for patients with early stage FL and may help identify subsets of patients that could benefit from early, aggressive treatment.
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Cubo AM, Soto ZM, Cruz MÁ, Doyague MJ, Sancho V, Fraino A, Blanco Ó, Puig N, Alcoceba M, González M, Sayagués JM. Primary diffuse large B cell lymphoma of the uterine cervix successfully treated by combined chemotherapy alone: A case report. Medicine (Baltimore) 2017; 96:e6846. [PMID: 28489772 PMCID: PMC5428606 DOI: 10.1097/md.0000000000006846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Primary lymphomas of the uterine cervix are a rare disease. They are often misdiagnosed because of their rarity and because they can be easily confused with a squamous cell carcinoma of the cervix, as they are usually presented as exophytic mass with vaginal bleeding as their most common symptoms. Nevertheless, considering that both the prognosis and the treatment are completely different between them, differential diagnosis should be taken into account. PATIENT CONCERNS A case of a 51-year-old woman with a primary diffuse large B-cell lymphoma of the cervix is presented. DIAGNOSES Diagnosis of this tumor was a challenge for pathologists and clinicians, as four biopsies were needed to achieve a final diagnosis. INTERVENTIONS Patient was successfully treated with combined Rituximab and chemotherapy (R-CHOP) alone. OUTCOMES Complete remission, confirmed through biopsy, was reached after six courses of chemotherapy. At 2-years follow up, patient is alive and free of disease. LESSONS Considering that the prognosis and treatment of primary malignant lymphoma of the cervix are completely different than that of the squamous cell carcinoma, awareness of this disease should be considered in the differential diagnosis.
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Affiliation(s)
- Ana María Cubo
- Department of Obstetrics and Gynecology
- University Hospital of Salamanca (IBSAL-HUS)
| | - Zandra Mileny Soto
- Department of Obstetrics and Gynecology
- University Hospital of Salamanca (IBSAL-HUS)
| | | | - María José Doyague
- Department of Obstetrics and Gynecology
- University Hospital of Salamanca (IBSAL-HUS)
| | - Verónica Sancho
- Department of Obstetrics and Gynecology
- University Hospital of Salamanca (IBSAL-HUS)
| | - Aurymar Fraino
- Department of Radiology
- University Hospital of Salamanca (IBSAL-HUS)
| | - Óscar Blanco
- Department of Pathology
- University Hospital of Salamanca (IBSAL-HUS)
| | - Noemi Puig
- Department of Hematology
- University Hospital of Salamanca (IBSAL-HUS)
- CIBERONC, Salamanca, Spain
| | - Miguel Alcoceba
- Department of Hematology
- University Hospital of Salamanca (IBSAL-HUS)
- CIBERONC, Salamanca, Spain
| | - Marcos González
- Department of Hematology
- University Hospital of Salamanca (IBSAL-HUS)
- CIBERONC, Salamanca, Spain
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15
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Long-term course of patients with primary ocular adnexal MALT lymphoma: a large single-institution cohort study. Blood 2017; 129:324-332. [DOI: 10.1182/blood-2016-05-714584] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022] Open
Abstract
Key Points
POAML (specifically Ann Arbor stage I disease) has an excellent clinical outcome, with only a few patients succumbing to lymphoma. POAML patients face a continuous risk of distant relapse, including in the central nervous system, and transformation to aggressive lymphoma.
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16
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Dehghani M, Haddadi S, Vojdani R. Signs, Symptoms and Complications of Non-Hodgkin's Lymphoma According to Grade and Stage in South Iran. Asian Pac J Cancer Prev 2016; 16:3551-7. [PMID: 25921177 DOI: 10.7314/apjcp.2015.16.8.3551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-Hodgkin's lymphoma (NHL) is a heterogeneous type of neoplasm of the lymphatic system. To have a more accurate and early diagnosis we need to know signs, symptoms and complications of lymphoma in early stages besides pathology and immunohistochemistry. MATERIALS AND METHODS This prospective study included 110 cases of NHL that were followed since February 2012 till November 2013. Biopsies were taken from all the patients besides bone marrow study. Signs and symptoms were categorized into "B" symptoms, general, lymphadenopathy and extranodal involvement and we compared the frequencies by stage and grade. RESULTS Of 110 cases, 88.9% had B-cell and 11.1% T-cell type with mean age 48.5±18.6 years. "B" symptoms and lymphadenopathy were more common in men. Cervical lymphadenopathy was the most common sign (44.8%). and hematologic, bone marrow, bone and neurologic lesions were the most common complications. All complications were more common in males. "B" symptoms were seen mostly in stage III, general signs and symptoms in stage IV, and lymphadenopathy in stage II. Intermediate grade was also the most common in all signs and symptoms. In this study 12 (10.9%) patients had relapse, with neurologic and bone marrow as the most common sites of tumor recurrence. CONCLUSIONS There is a meaningful relationship between male gender for NHL and anemia that can be due in part to higher incidence of bone marrow involvement and stage IV disease in male cases. We also found a strong relationship between low grade NHL and age. On the other hand extranodal involvement is more common in female groups.
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Affiliation(s)
- Mehdi Dehghani
- Department of Hematology Oncology, Shiraz University of Medical Sciences, Hematology research center, Iran E-mail :
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Sun T, Hu L, Jiang M, Ning H, Zhang B, Ren J, Li Y, Li B, Chen J, Yang F, Xu C, Wang J, Lou X, Hu J, Chen H. [Therapeutic effect of CY-fTBI and BMM conditioning regimen in the process of allo-HSCT treating Ⅲ,Ⅳ non-Hodgkin lymphoma: 15 years analysis of single-center]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:830-4. [PMID: 26477760 PMCID: PMC7364953 DOI: 10.3760/cma.j.issn.0253-2727.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
目的 比较预处理方案Cy-fTBI(环磷酰胺+分次全身照射)与BMM(白消安+马法兰+米托蒽醌)在异基因造血干细胞移植(allo-HSCT)治疗Ⅲ、Ⅳ期非霍奇金淋巴瘤(NHL)疗效上的差异。 方法 对1998年11月至2014年5月接受allo-HSCT治疗的47例Ⅲ、Ⅳ期NHL病例进行回顾性分析,观察比较Cy-fTBI和BMM预处理方案两组患者移植后造血重建时间、急性移植物抗宿主病(aGVHD)和慢性移植物抗宿主病(cGVHD)累积发生率、移植相关死亡率(TRM)、复发率(RR)、无病生存率(DFS)和总体生存率(OS)。 结果 移植后中性粒细胞≥0.5×109/L和血小板计数≥50×109/L的中位时间为17(10~72) d和27(5~98) d; aGVHD发生率为53.19%,Ⅰ~Ⅱ度占42.55%,Ⅲ~Ⅳ度占10.64%;cGVHD发生率为21.28%;中位随访9.7(0.2~149.1)个月,47例患者中21例生存。Cy-fTBI组1、3、5年OS率分别为73.5%、49.3%、40.1%,DFS率分别为71.4%、45.6%、39.3%。BMM组1、3、5年OS率分别为67.8%、32.9%、31.4%,DFS率分别为65.3%、31.1%、30.2%。Cy-fTBI组1、3、5年RR率分别为18.9%、19.5%、35.2%,TRM率分别为23.0%、38.3%、39.2%。BMM组1、3、5年RR分别为27.4%、38.9%、39.2%,TRM率分别为24.5%、46.4%、48.2%,两组在OS、DFS、RR、TRM等指标上差异无统计学意义。 结论 Allo-HSCT是治疗Ⅲ、Ⅳ期NHL的有效手段,但TRM仍相对较高。Cy-fTBI预处理方案与BMM方案相比,减少了TRM、RR,增加了DFS和OS,但差异无统计学意义。
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Affiliation(s)
- Ting Sun
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Liangding Hu
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Min Jiang
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Hongmei Ning
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Bin Zhang
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Jing Ren
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Yuhang Li
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Botao Li
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Jianlin Chen
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Fan Yang
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Chen Xu
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Jun Wang
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Xiao Lou
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Jiangwei Hu
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Hu Chen
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
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Abe H, Kamimura K, Kawai H, Kamimura H, Domori K, Kobayashi Y, Nomoto M, Aoyagi Y. Diagnostic imaging of hepatic lymphoma. Clin Res Hepatol Gastroenterol 2015; 39:435-42. [PMID: 25541481 DOI: 10.1016/j.clinre.2014.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/10/2014] [Accepted: 11/03/2014] [Indexed: 02/06/2023]
Abstract
Hepatic lymphoma is a rare disease with poor prognosis because of delayed diagnosis. The disease comprises primary, metastatic, and intravascular hepatic lymphomas. The pathological characteristics of lymphomas differ contributing to difficulty in early diagnosis. Early diagnosis and appropriate treatment result in improved prognosis; therefore, diagnostic radiology and its development with various contrast agents are critical for improving disease outcomes. Herein, we review hepatic lymphomas and summarize the results of imaging studies in correlation with pathological characteristics. The information provided will help physicians in early diagnosis and thereby improving prognosis.
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Affiliation(s)
- Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan.
| | - Hirokazu Kawai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Koji Domori
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Yuji Kobayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Minoru Nomoto
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Yutaka Aoyagi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
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Antiviral prophylaxis in patients with solid tumours and haematological malignancies--update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Hematol 2015; 94:1441-50. [PMID: 26193852 PMCID: PMC4525190 DOI: 10.1007/s00277-015-2447-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/06/2015] [Indexed: 01/17/2023]
Abstract
Reactivation of viral infections is common in patients with solid tumour or haematological malignancy. Incidence and severity depend on the extent of cellular immunosuppression. Antiviral prophylaxis may be effective to prevent viral reactivation. In 2006, the Infectious Diseases Working Party of German Society for Hematology and Medical Oncology (DGHO) published guidelines for antiviral prophylaxis in these patient populations. Here, we present an update of these guidelines for patients with solid and haematological malignancies undergoing antineoplastic treatment but not allogeneic stem cell transplantation. Relevant literature for reactivation of different viruses (herpes simplex virus (HSV), varicella zoster virus (VZV), hepatitis B virus (HBV) and respiratory viruses) is discussed to provide evidence-based recommendations for clinicians taking care of this patient population. We recommend a risk-adapted approach with (val)acyclovir against HSV and VZV in patients treated with alemtuzumab, bortezomib or purine analogues. Seasonal vaccination against influenza is recommended for all patients with solid or haematological malignancies regardless of antineoplastic therapy. Hepatitis B screening is recommended in lymphoproliferative disorders, acute leukaemia, and breast cancer, and during treatment with monoclonal anti-B-cell antibodies, anthracyclines, steroids and in autologous stem cell transplantation. In those with a history of hepatitis B prophylactic lamivudine, entecavir or nucleotide analogues as adefovir are recommended to prevent reactivation.
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20
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Casulo C, Byrtek M, Dawson KL, Zhou X, Farber CM, Flowers CR, Hainsworth JD, Maurer MJ, Cerhan JR, Link BK, Zelenetz AD, Friedberg JW. Early Relapse of Follicular Lymphoma After Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone Defines Patients at High Risk for Death: An Analysis From the National LymphoCare Study. J Clin Oncol 2015; 33:2516-22. [PMID: 26124482 DOI: 10.1200/jco.2014.59.7534] [Citation(s) in RCA: 566] [Impact Index Per Article: 62.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Twenty percent of patients with follicular lymphoma (FL) experience progression of disease (POD) within 2 years of initial chemoimmunotherapy. We analyzed data from the National LymphoCare Study to identify whether prognostic FL factors are associated with early POD and whether patients with early POD are at high risk for death. PATIENTS AND METHODS In total, 588 patients with stage 2 to 4 FL received first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Two groups were defined: patients with early POD 2 years or less after diagnosis and those without POD within 2 years, the reference group. An independent validation set, 147 patients with FL who received first-line R-CHOP, was analyzed for reproducibility. RESULTS Of 588 patients, 19% (n = 110) had early POD, 71% (n = 420) were in the reference group, 8% (n = 46) were lost to follow-up, and 2% (n = 12) died without POD less than 2 years after diagnosis. Five-year overall survival was lower in the early-POD group than in the reference group (50% v 90%). This trend was maintained after we adjusted for FL International Prognostic Index (hazard ratio, 6.44; 95% CI, 4.33 to 9.58). Results were similar for the validation set (FL International Prognostic Index-adjusted hazard ratio, 19.8). CONCLUSION In patients with FL who received first-line R-CHOP, POD within 2 years after diagnosis was associated with poor outcomes and should be further validated as a standard end point of chemoimmunotherapy trials of untreated FL. This high-risk FL population warrants further study in directed prospective clinical trials.
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Affiliation(s)
- Carla Casulo
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Michelle Byrtek
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Keith L Dawson
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Xiaolei Zhou
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Charles M Farber
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Christopher R Flowers
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - John D Hainsworth
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Matthew J Maurer
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - James R Cerhan
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Brian K Link
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Andrew D Zelenetz
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA
| | - Jonathan W Friedberg
- Carla Casulo and Jonathan W. Friedberg, University of Rochester, Rochester; Jonathan W. Friedberg, Memorial Sloan Kettering Cancer Center, New York, NY; Michelle Byrtek and Keith L. Dawson, Genentech, South San Francisco, CA; Xiaolei Zhou, RTI Health Solutions, Research Triangle Park, NC; Charles M. Farber, Carol G. Simon Cancer Center, Morristown, NJ; Christopher R. Flowers, Emory University, Atlanta, GA; John D. Hainsworth, Sarah Cannon Research Institute, Nashville, TN; Matthew J. Maurer and James R. Cerhan, Mayo Clinic, Rochester, MN; and Brian K. Link, University of Iowa, Iowa City, IA.
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21
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Hazarika M, Iqbal A, Krishnatreya M, Sharma JD, Bhuyan C, Saikia BJ, Roy PS, Das R, Nandy P, Kataki AC. Adult non Hodgkin's lymphoma patients: experience from a tertiary care cancer centre in north east India. Asian Pac J Cancer Prev 2015; 16:2879-81. [PMID: 25854376 DOI: 10.7314/apjcp.2015.16.7.2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
There is paucity of data on non Hodgkin's lymphoma (NHL) from our population in North-East India. In this retrospective study, patients were consecutively followed-up to see the clinic-pathological pattern of NHL, various responses, and pattern of relapses to first line treatment with chemotherapy. All patients in the present study received standard regimen of cyclophosphamde, doxorubicin, vincristine, prednisolone (CHOP) with or without rituximab (R-CHOP) as per our institutional protocol as first line therapy. Our study has shown that, in our adult population, the majority of NHL cases present with stage II and stage III disease and extra nodal involvement, B-cell lymphomas and diffuse large cell lymphomas being the most common subtypes. International prognostic index was a significant factor for varied responses to treatment. The majority of relapses after complete remission occurred in the first year.
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Affiliation(s)
- Munlima Hazarika
- Department of Medical Oncology, Dr. B Borooah Cancer Institute, Guwahati, India E-mail :
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22
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Huntington SF, Svoboda J, Doshi JA. Cost-effectiveness analysis of routine surveillance imaging of patients with diffuse large B-cell lymphoma in first remission. J Clin Oncol 2015; 33:1467-74. [PMID: 25823735 DOI: 10.1200/jco.2014.58.5729] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Surveillance imaging of asymptomatic patients with diffuse large B-cell lymphoma (DLBCL) in first remission remains controversial. A decision-analytic Markov model was developed to evaluate the cost-effectiveness of follow-up strategies following first-line immunochemotherapy. PATIENTS AND METHODS Three strategies were compared in 55-year-old patient cohorts: routine clinical follow-up without serial imaging, routine follow-up with biannual computed tomography (CT) scans for 2 years, or routine follow-up with biannual [(18)F]-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT) for 2 years. The baseline model favored imaging-based strategies by associating asymptomatic imaging-detected relapses with improved clinical outcomes. Lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each surveillance strategy. RESULTS Surveillance strategies utilizing 2 years of routine CT or PET/CT scans were associated with minimal survival benefit when compared with clinical follow-up without routine imaging (life-years gained: CT, 0.03 years; PET/CT, 0.04 years). The benefit of imaging-based follow-up remained small after quality-of-life adjustments (CT, 0.020 QALYs; PET/CT, 0.025 QALYs). Costs associated with imaging-based surveillance strategies are considerable; ICERs for imaging strategies compared with clinical follow-up were $164,960/QALY (95% CI, $116,510 to $766,930/QALY) and $168,750/QALY (95% CI, $117,440 to 853,550/QALY) for CT and PET/CT, respectively. Model conclusions were robust and remained stable on one-way and probabilistic sensitivity analyses. CONCLUSION Our cost-effectiveness analysis suggests surveillance imaging of asymptomatic DLBCL patients in remission offers little clinical benefit at substantial economic costs.
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Affiliation(s)
| | - Jakub Svoboda
- All authors: University of Pennsylvania, Philadelphia, PA
| | - Jalpa A Doshi
- All authors: University of Pennsylvania, Philadelphia, PA
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23
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Odejide OO, Cronin AM, Davidoff AJ, LaCasce AS, Abel GA. Limited stage diffuse large B-cell lymphoma: comparative effectiveness of treatment strategies in a large cohort of elderly patients. Leuk Lymphoma 2014; 56:716-24. [PMID: 24913508 DOI: 10.3109/10428194.2014.930853] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Optimal treatment for limited stage diffuse large B-cell lymphoma (DLBCL) in the elderly is controversial. Using the Surveillance, Epidemiology and End Results-Medicare database, we compared overall survival (OS), time to second-line therapy (surrogate for recurrence) and adverse events in elderly patients diagnosed with stage I or II DLBCL in 1999-2009, who received either abbreviated rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) plus radiation or 6-8 cycles of RCHOP alone. Of 874 patients, 359 received abbreviated RCHOP with radiation, and 515 received a full course of RCHOP. In propensity score-adjusted analyses, OS was similar in both groups (hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.76, 1.38). Abbreviated RCHOP with radiation was associated with lower risk of second-line therapy (HR 0.71, 95% CI 0.53, 0.94) and lower odds of febrile neutropenia (odds ratio [OR] 0.27, 95% CI 0.15, 0.50). While the two treatments resulted in similar survival, our data suggest that abbreviated RCHOP with radiation may be better tolerated than a full course of RCHOP.
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Affiliation(s)
- Oreofe O Odejide
- Division of Population Sciences, Dana-Farber Cancer Institute , Boston, MA , USA
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24
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Steuter J, Bociek R, Loberiza F, Mathers D, Armitage J, Vose J, Bast M, Saxena S, Porter T, Bierman P. Utility of prechemotherapy evaluation of left ventricular function for patients with lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:29-34. [PMID: 25074024 DOI: 10.1016/j.clml.2014.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/18/2014] [Accepted: 06/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Published guidelines recommend baseline cardiac function testing before initiating anthracycline-based chemotherapy. These recommendations are based largely on consensus, and there is little information regarding how often testing leads to alterations in therapy or whether testing is able to predict subsequent cardiac toxicity. PATIENTS AND METHODS We performed a retrospective analysis of patients with Hodgkin lymphoma and non-Hodgkin lymphoma to determine whether there was a prechemotherapy evaluation of left ventricular function and whether findings from the evaluation led to alterations in therapy. Records also were reviewed to evaluate subsequent test results of cardiac function. RESULTS We identified 309 patients with lymphoma between 2004 and 2012 with a planned anthracycline- or anthracenedione-based regimen. Of this total, 232 patients (75%) had a pretreatment cardiac evaluation. There were 201 patients (87%) in this group with no history of cardiac disease. Although 22 of these patients (11%) had abnormal echocardiograms, none had a change in therapy and no subsequent cases of cardiomyopathy were identified. Five of the remaining 179 patients with a normal cardiac evaluation developed a cardiomyopathy. Thirty-one patients had a history of cardiac disease, and only 4 patients had a change in therapy. There were 77 patients (25%) who did not have a prechemotherapy cardiac evaluation. No subsequent cases of cardiomyopathy were identified in this group. CONCLUSIONS Pretreatment evaluation rarely leads to a change in management and is not helpful in predicting subsequent cardiomyopathy. Guidelines that recommend evaluation of left ventricular function in all patients before anthracycline-based chemotherapy should be reexamined.
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Affiliation(s)
- John Steuter
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Robert Bociek
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Fausto Loberiza
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Daniel Mathers
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - James Armitage
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Julie Vose
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Martin Bast
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Shikhar Saxena
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Thomas Porter
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Philip Bierman
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
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25
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Fabbri A, Cencini E, Rigacci L, Bartalucci G, Puccini B, Dottori R, Gozzetti A, Bosi A, Bocchia M. Efficacy and safety of rituximab plus low-dose oral fludarabine and cyclophosphamide as first-line treatment of elderly patients with indolent non-Hodgkin lymphomas. Leuk Lymphoma 2014; 55:781-5. [PMID: 23876098 DOI: 10.3109/10428194.2013.826354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Indolent non-Hodgkin lymphomas (iNHLs) are B-cell neoplasms for which no consensus is available about optimal first-line therapy. Chemoimmunotherapy with fludarabine, cyclophospamide and rituximab is very effective, but may give severe hematological and non-hematological toxicity at standard doses, especially in elderly patients. In this phase II study, 25 untreated elderly patients with iNHL received rituximab (375 mg/m(2)) plus low-dose oral fludarabine (25 mg/m(2) for 4 consecutive days) and cyclophosphamide (150 mg/m(2) for 4 consecutive days) for four monthly cycles. Twenty-three patients were responsive (92%) and 12 patients achieved a complete remission (48%). Twenty-one patients (84%) were alive, median follow-up was 30 months and median event-free survival (EFS) was not reached. Patients who we previously treated with chemotherapy alone had a shorter EFS (median 20 months). Compliance was good, with mild toxicity. This regimen is effective for elderly patients with iNHL. The addition of rituximab results in long EFS without affecting toxicity.
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Affiliation(s)
- Alberto Fabbri
- Unit of Hematology, University Hospital of Siena , Italy
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26
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Suárez AL, Querfeld C, Horwitz S, Pulitzer M, Moskowitz A, Myskowski PL. Primary cutaneous B-cell lymphomas: part II. Therapy and future directions. J Am Acad Dermatol 2013; 69:343.e1-11; quiz 355-6. [PMID: 23957985 DOI: 10.1016/j.jaad.2013.06.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 01/20/2023]
Abstract
The choice of therapy for primary cutaneous B-cell lymphoma (PCBCL) relies on correct histopathologic classification and the exclusion of systemic disease. In part II of this continuing medical education article, we will review the available therapies for the different types of PCBCL. Primary cutaneous follicle center lymphoma (PCFCL) and primary cutaneous marginal zone lymphoma (PCMZL) are indolent tumors with an excellent prognosis. They are managed similarly with local therapy, such as radiotherapy or surgical excision, for isolated disease and observation for asymptomatic multifocal presentations. Relapses are common in both PCFCL and PCMZL, but overall survival remains excellent. Primary cutaneous diffuse large B-cell lymphoma (both leg type and other) has a much poorer prognosis than indolent PCBCL, and it often requires an aggressive approach with radiation therapy and/or multiagent chemotherapy. Investigational approaches hold promise for the treatment of these malignancies, particularly primary cutaneous diffuse large B-cell lymphoma.
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Affiliation(s)
- Andrea Luísa Suárez
- Department of Dermatology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
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27
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Suárez AL, Pulitzer M, Horwitz S, Moskowitz A, Querfeld C, Myskowski PL. Primary cutaneous B-cell lymphomas: part I. Clinical features, diagnosis, and classification. J Am Acad Dermatol 2013; 69:329.e1-13; quiz 341-2. [PMID: 23957984 DOI: 10.1016/j.jaad.2013.06.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 06/02/2013] [Accepted: 06/08/2013] [Indexed: 11/17/2022]
Abstract
Primary cutaneous B-cell lymphomas (PCBCLs) are defined as lymphomas with a B-cell phenotype that present in the skin without evidence of systemic or extracutaneous disease at initial presentation, after adequate staging. In non-Hodgkin lymphomas, the skin is the second most common site of extranodal involvement after the gastrointestinal tract. PCBCLs are histologically very similar to their nodal counterparts, and these histologic similarities can lead to confusion about both therapy and prognosis. This article will summarize the clinical, pathologic, and diagnostic features of the 3 main types of PCBCL: primary cutaneous follicle center lymphoma, primary cutaneous marginal zone lymphoma, and primary cutaneous diffuse large B-cell lymphoma, leg-type, and the appropriate evaluation and staging procedures for each of these entities.
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MESH Headings
- Diagnosis, Differential
- Humans
- Lymphoma, B-Cell, Marginal Zone/classification
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Follicular/classification
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Skin Neoplasms/classification
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
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Affiliation(s)
- Andrea Luísa Suárez
- Department of Dermatology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
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28
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Press OW, Unger JM, Rimsza LM, Friedberg JW, LeBlanc M, Czuczman MS, Kaminski M, Braziel RM, Spier C, Gopal AK, Maloney DG, Cheson BD, Dakhil SR, Miller TP, Fisher RI. A comparative analysis of prognostic factor models for follicular lymphoma based on a phase III trial of CHOP-rituximab versus CHOP + 131iodine--tositumomab. Clin Cancer Res 2013; 19:6624-32. [PMID: 24130072 PMCID: PMC3872052 DOI: 10.1158/1078-0432.ccr-13-1120] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE There is currently no consensus on optimal frontline therapy for patients with follicular lymphoma. We analyzed a phase III randomized intergroup trial comparing six cycles of CHOP-R (cyclophosphamide-Adriamycin-vincristine-prednisone (Oncovin)-rituximab) with six cycles of CHOP followed by iodine-131 tositumomab radioimmunotherapy (RIT) to assess whether any subsets benefited more from one treatment or the other, and to compare three prognostic models. EXPERIMENTAL DESIGN We conducted univariate and multivariate Cox regression analyses of 532 patients enrolled on this trial and compared the prognostic value of the FLIPI (follicular lymphoma international prognostic index), FLIPI2, and LDH + β2M (lactate dehydrogenase + β2-microglobulin) models. RESULTS Outcomes were excellent, but not statistically different between the two study arms [5-year progression-free survival (PFS) of 60% with CHOP-R and 66% with CHOP-RIT (P = 0.11); 5-year overall survival (OS) of 92% with CHOP-R and 86% with CHOP-RIT (P = 0.08); overall response rate of 84% for both arms]. The only factor found to potentially predict the impact of treatment was serum β2M; among patients with normal β2M, CHOP-RIT patients had better PFS compared with CHOP-R patients, whereas among patients with high serum β2M, PFS by arm was similar (interaction P value = 0.02). CONCLUSIONS All three prognostic models (FLIPI, FLIPI2, and LDH + β2M) predicted both PFS and OS well, though the LDH + β2M model is easiest to apply and identified an especially poor risk subset. In an exploratory analysis using the latter model, there was a statistically significant trend suggesting that low-risk patients had superior observed PFS if treated with CHOP-RIT, whereas high-risk patients had a better PFS with CHOP-R.
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Affiliation(s)
- Oliver W. Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Medical Oncology, University of Washington Medical Center, Seattle, WA
| | - Joseph M. Unger
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa M. Rimsza
- Department of Pathology, University of Arizona, Tucson, AZ
| | - Jonathan W. Friedberg
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Michael LeBlanc
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Myron S. Czuczman
- Roswell Park Cancer Institute, Buffalo, NY
- Cancer and Leukemia Group B
| | | | - Rita M. Braziel
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | | | - Ajay K. Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Medical Oncology, University of Washington Medical Center, Seattle, WA
| | - David G. Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Medical Oncology, University of Washington Medical Center, Seattle, WA
| | - Bruce D. Cheson
- Cancer and Leukemia Group B
- Georgetown University Hospital, Washington DC
| | | | | | - Richard I. Fisher
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
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29
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Sarkozy C, Salles G. Treatment approaches to asymptomatic follicular lymphoma. Expert Rev Hematol 2013; 6:747-58. [PMID: 24219551 DOI: 10.1586/17474086.2013.860355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Follicular lymphoma is a heterogeneous disease in which some patients present an indolent evolution for decades and others, a rather aggressive form of the disease requiring immediate therapy. While immunochemotherapy has emerged as a standard of care for symptomatic patients, treatment of the asymptomatic population remains controversial. Since the disease is still considered incurable, delayed initiation of therapy is an acceptable option. However, four single injections of rituximab can result in an acceptable clinical response and can improve the duration of the interval without cytotoxic therapy. With recent therapeutic approaches that enable substantial improvements in life expectancy for follicular lymphoma patients, limiting short- or long-term treatment toxicities appears as a new concern in the asymptomatic population. Based on these options, the challenge is to preserve patient quality of life and prolong survival: from the patient's perspective, his/her opinion is therefore of significant importance.
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Affiliation(s)
- Clémentine Sarkozy
- Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1, Service d'Hématologie, Centre Hospitalier Lyon Sud (CHLS), Pierre Bénite, France
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30
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Link BK, Maurer MJ, Nowakowski GS, Ansell SM, Macon WR, Syrbu SI, Slager SL, Thompson CA, Inwards DJ, Johnston PB, Colgan JP, Witzig TE, Habermann TM, Cerhan JR. Rates and outcomes of follicular lymphoma transformation in the immunochemotherapy era: a report from the University of Iowa/MayoClinic Specialized Program of Research Excellence Molecular Epidemiology Resource. J Clin Oncol 2013; 31:3272-8. [PMID: 23897955 PMCID: PMC3757293 DOI: 10.1200/jco.2012.48.3990] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study sought to characterize transformation incidence and outcome for patients with follicular lymphoma (FL) in a prospective observational series begun after diffusion of rituximab use. PATIENTS AND METHODS Patients with newly diagnosed FL were prospectively enrolled onto the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource from 2002 to 2009. Patients were actively followed for re-treatment, clinical or pathologic transformation, and death. Risk of transformation was analyzed via time to transformation by using death as a competing risk. RESULTS In all, there were 631 patients with newly diagnosed grade 1 to 3a FL who had a median age at enrollment of 60 years. At a median follow-up of 60 months (range, 11 to 110 months), 79 patients had died, and 60 patients developed transformed lymphoma, of which 51 were biopsy proven. The overall transformation rate at 5 years was 10.7%, with an estimated rate of 2% per year. Increased lactate dehydrogenase was associated with increased risk of transformation. Transformation rate at 5 years was highest in patients who were initially observed and lowest in patients who initially received rituximab monotherapy (14.4% v 3.2%; P = .021). Median overall survival following transformation was 50 months and was superior in patients with transformation greater than 18 months after FL diagnosis compared with patients with earlier transformation (5-year overall survival, 66% v 22%; P < .001). CONCLUSION Follicular transformation rates in the immunochemotherapy era are similar to risk of death without transformation and may be lower than reported in older series. Post-transformation prognosis is substantially better than described in older series. Initial management strategies may influence the risk of transformation.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/therapeutic use
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/immunology
- Female
- Follow-Up Studies
- Humans
- L-Lactate Dehydrogenase/metabolism
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Molecular Epidemiology
- Neoplasm Grading
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Prospective Studies
- Risk Factors
- Rituximab
- Survival Rate
- Young Adult
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Affiliation(s)
- Brian K. Link
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Matthew J. Maurer
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Grzegorz S. Nowakowski
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Stephen M. Ansell
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - William R. Macon
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Sergei I. Syrbu
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Susan L. Slager
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Carrie A. Thompson
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - David J. Inwards
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Patrick B. Johnston
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Joseph P. Colgan
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Thomas E. Witzig
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - Thomas M. Habermann
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
| | - James R. Cerhan
- Brian K. Link, Sergei I. Syrbu, University of Iowa College of Medicine, Iowa City, IA; and Matthew J. Maurer, Grzegorz S. Nowakowski, Stephen M. Ansell, William R. Macon, Susan L. Slager, Carrie A. Thompson, David J. Inwards, Patrick B. Johnston, Joseph P. Colgan, Thomas E. Witzig, Thomas M. Habermann, and James R. Cerhan, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN
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Bussu F, Hohaus S, Bastanza G, Bozzoli V, Tisi M, Martini M, Paludetti G, Almadori G. Clinical and prognostic features of lymphomas arising in the head and neck region: Our experience of preferential association of different histotypes with various sites of origin in ninety patients. Clin Otolaryngol 2013; 38:248-53. [DOI: 10.1111/coa.12090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 11/28/2022]
Affiliation(s)
- F. Bussu
- Institute of Otolaryngology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - S. Hohaus
- Institute of Haematology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - G. Bastanza
- Institute of Otolaryngology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - V. Bozzoli
- Institute of Haematology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - M.C. Tisi
- Institute of Haematology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - M. Martini
- Institute of Histopatology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - G. Paludetti
- Institute of Otolaryngology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - G. Almadori
- Institute of Otolaryngology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
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Matić IZ, Đorđević M, Đorđić M, Grozdanić N, Damjanović A, Kolundžija B, Vidović A, Bila J, Ristić S, Mihaljević B, Tomin D, Milanović N, Ristić D, Purić M, Gavrilović D, Cordero OJ, Juranić ZD. Dipeptidyl peptidase IV: serum activity and expression on lymphocytes in different hematological malignancies. Leuk Lymphoma 2013; 54:2701-6. [DOI: 10.3109/10428194.2013.782611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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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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Martini V, Melzi E, Comazzi S, Gelain ME. Peripheral blood abnormalities and bone marrow infiltration in canine large B-cell lymphoma: is there a link? Vet Comp Oncol 2013; 13:117-23. [PMID: 23419006 DOI: 10.1111/vco.12024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/06/2012] [Accepted: 01/22/2013] [Indexed: 12/21/2022]
Abstract
Official guidelines do not consider bone marrow (BM) assessment mandatory in staging canine lymphoma unless blood cytopenias are present. The aim of this study was to find out if blood abnormalities can predict marrow involvement in canine large B-cell lymphoma. BM infiltration was assessed via flow cytometry. No difference was found between dogs without haematological abnormalities and dogs with at least one. However, the degree of infiltration was significantly higher in dogs with thrombocytopenia, leucocytosis or lymphocytosis and was negatively correlated to platelet count and positively to blood infiltration. Our results suggest that blood abnormalities are not always predictive of marrow involvement, even if thrombocytopenia, leucocytosis or lymphocytosis could suggest a higher infiltration. BM evaluation should therefore be included in routine staging in order not to miss infiltrated samples and to improve classification. However, its clinical relevance and prognostic value are still not defined and further studies are needed.
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Affiliation(s)
- V Martini
- Department of Veterinary Sciences and Public Health, Faculty of Veterinary Medicine, University of Milan, Milan, Italy
| | - E Melzi
- Department of Veterinary Sciences and Public Health, Faculty of Veterinary Medicine, University of Milan, Milan, Italy
| | - S Comazzi
- Department of Veterinary Sciences and Public Health, Faculty of Veterinary Medicine, University of Milan, Milan, Italy
| | - M E Gelain
- Department of Comparative Biomedicine and Food Science, Faculty of Veterinary Medicine, University of Padua, Padua, Italy
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35
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Casulo C, Friedberg JW. Treatment of early-stage follicular lymphoma: do as I say, not as I do. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.12.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Carla Casulo
- James P Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA
| | - Jonathan W Friedberg
- James P Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
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36
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Repeated radioimmunotherapy with 131I-rituximab for patients with low-grade and aggressive relapsed or refractory B cell non-Hodgkin lymphoma. Cancer Chemother Pharmacol 2013; 71:945-53. [DOI: 10.1007/s00280-013-2087-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
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37
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Casulo C, Maragulia J, Zelenetz AD. Incidence of hypogammaglobulinemia in patients receiving rituximab and the use of intravenous immunoglobulin for recurrent infections. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 13:106-11. [PMID: 23276889 DOI: 10.1016/j.clml.2012.11.011] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED Rituximab targets normal B cells and tumor B cells. We used a unique data-mining tool to identify patients with lymphoma who were treated with rituximab and who had serial pre and post rituximab immunoglobulin concentrations evaluated. After treatment, 39% (69/179) of patients had low levels of immunoglobulin G. Recurrent sinopulmonary infections were seen in 6.6% (14/211). Intravenous immune globulin appeared to reduce the frequency of infection. BACKGROUND Rituximab has altered the treatment approach to B-cell malignancies and other diseases. Reports consider that rituximab had limited impact on serum immunoglobulins. However, anecdotes suggest that rituximab can cause symptomatic hypogammaglobulinemia. This retrospective study examined the relationship among rituximab, hypogammaglobulinemia, and treatment of symptomatic hypogammaglobulinemia with intravenous immune globulin (IVIG). METHODS Patients with serial quantitative serum immunoglobulin (SIgG) concentrations before and subsequent to rituximab administration at Memorial Sloan-Kettering Cancer Center were identified. Information regarding rituximab administration, SIgG concentrations, frequency of infection, and administration of IVIG were recorded. RESULTS Between December 1998 and April 2009, 211 patients with B-cell lymphoma treated with rituximab and with serial SIgG concentrations were identified. One hundred seventy-nine (85%) patients had normal SIgG before rituximab, 32 (15%) had low SIgG. After rituximab use, hypogammaglobulinemia was identified in 38.54% of patients with initially normal SIgG. The risk was greater in patients who received maintenance rituximab. Symptomatic hypogammaglobulinemia that prompted IVIG administration developed in 6.6% of patients. CONCLUSIONS In this data set, rituximab administration was associated with a high frequency of hypogammaglobulinemia, particularly symptomatic hypogammaglobulinemia, among patients who received multiple courses of rituximab. Baseline and periodic monitoring of SIgGs is appropriate in patients who receive rituximab.
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Affiliation(s)
- Carla Casulo
- Lymphoma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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38
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Fabbri A, Cencini E, Pietrini A, Gozzetti A, Defina M, Fontanelli G, Mazzei MA, Volterrani L, Bocchia M. Impressive activity of lenalidomide monotherapy in refractory angioimmunoblastic T-cell lymphoma: report of a case with long-term follow-up. Hematol Oncol 2012; 31:213-7. [DOI: 10.1002/hon.2038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 12/23/2022]
Affiliation(s)
- Alberto Fabbri
- Unit of Hematology; “S. Maria alle Scotte” University Hospital; Siena Italy
| | - Emanuele Cencini
- Unit of Hematology; “S. Maria alle Scotte” University Hospital; Siena Italy
| | - Alice Pietrini
- Unit of Hematology; “S. Maria alle Scotte” University Hospital; Siena Italy
| | | | - Marzia Defina
- Unit of Hematology; “S. Maria alle Scotte” University Hospital; Siena Italy
| | | | | | - Luca Volterrani
- Unit of Radiology; “S. Maria alle Scotte” University Hospital; Siena Italy
| | - Monica Bocchia
- Unit of Hematology; “S. Maria alle Scotte” University Hospital; Siena Italy
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Hwang JP, Vierling JM, Zelenetz AD, Lackey SC, Loomba R. Hepatitis B virus management to prevent reactivation after chemotherapy: a review. Support Care Cancer 2012; 20:2999-3008. [PMID: 22933131 PMCID: PMC3469760 DOI: 10.1007/s00520-012-1576-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/13/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE Reactivation of hepatitis B virus (HBV) infection after chemotherapy can lead to liver failure and death. Conflicting recommendations regarding HBV screening in cancer patients awaiting chemotherapy mean that some patients at risk for HBV reactivation are not being identified and treated with prophylactic antiviral therapy. METHODS We performed a narrative review of the existing evidence regarding screening for and management of HBV infection among patients with cancer using Ovid Medline, PubMed, and the Cochrane Library. RESULTS Our review showed inconsistencies in the definition and management strategies for HBV reactivation. The timeframe of reactivation is variable, and its molecular mechanisms are not clear. There are five effective antiviral agents that can be used as prophylaxis to prevent reactivation of HBV infection in cancer patients; however, the optimal drug and duration of therapy are unknown. Reactivation is more commonly reported in patients with hematologic malignancies receiving rituximab treatment, but reactivation can occur after other chemotherapies and in patients with solid tumors. Screening with all three screening tests-HBsAg, anti-HBc, and anti-HBs-allows the most thorough interpretation of a patient's serologic profile and assessment of reactivation risk; however, decision-making and cost-effectiveness studies are needed to determine optimal screening strategies. CONCLUSIONS Prevention of reactivation of HBV infection depends on identification of patients at risk and initiation of antiviral prophylaxis, but data to guide screening and treatment strategies are lacking. Additional research is necessary to accurately define and predict reactivation, identify best antiviral treatment strategies, and identify cost-effective HBV screening strategies.
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Affiliation(s)
- Jessica P Hwang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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40
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McKay P, Leach M, Jackson R, Cook G, Rule S. Guidelines for the investigation and management of mantle cell lymphoma. Br J Haematol 2012; 159:405-26. [PMID: 22994971 DOI: 10.1111/bjh.12046] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- P McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Gartnavel Hospital, Glasgow, UK
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41
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Zinzani PL, Khuageva NK, Wang H, Garicochea B, Walewski J, Van Hoof A, Soubeyran P, Caballero D, Buckstein R, Esseltine DL, Theocharous P, Enny C, Zhu E, Elsayed YA, Coiffier B. Bortezomib plus rituximab versus rituximab in patients with high-risk, relapsed, rituximab-naïve or rituximab-sensitive follicular lymphoma: subgroup analysis of a randomized phase 3 trial. J Hematol Oncol 2012; 5:67. [PMID: 23088650 PMCID: PMC3502148 DOI: 10.1186/1756-8722-5-67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/18/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The randomized phase 3 LYM3001 trial in relapsed follicular lymphoma (FL) demonstrated higher overall (ORR) and complete response (CR) rates and prolonged progression-free survival (PFS) with bortezomib-rituximab versus rituximab. We report findings in high-risk patients (FL International Prognostic Index [FLIPI] score ≥3, and high tumor burden by modified Groupe d'Etude des Lymphomas Folliculaires [GELF] criteria). METHODS Patients aged ≥18 years with grade 1/2 FL, ≥1 measurable lesion, and documented relapse or progression following prior therapy, rituximab-naïve or rituximab-sensitive, were enrolled at 164 centers in 29 countries across Europe, the Americas, and Asia-Pacific. Patients were randomized (1:1) to five 5-week cycles of bortezomib-rituximab (bortezomib 1.6 mg/m2, days 1, 8, 15, and 22, all cycles; rituximab 375 mg/m2, days 1, 8, 15, and 22, cycle 1, and day 1, cycles 2-5; N=336) or rituximab alone (N=340). Randomization was stratified by FLIPI score, prior rituximab, time since last dose of anti-lymphoma therapy, and geographical region. The primary endpoint of the study was PFS. RESULTS 103 bortezomib-rituximab and 98 rituximab patients had high-risk FL. The ORR was 59% versus 37% (p=0.002), the CR/CRu rate was 13% versus 6% (p=0.145), and the durable response rate was 45% versus 26% (p=0.008) with bortezomib-rituximab versus rituximab. Median PFS was 9.5 versus 6.7 months (hazard ratio [HR] 0.667, p=0.012) with bortezomib-rituximab versus rituximab; median time to progression was 10.9 versus 6.8 months (HR 0.656, p=0.009); median time to next anti-lymphoma treatment was 14.8 versus 9.1 months (HR 0.762, p=0.103); and the 1-year Overall Survival rate was 83.1% versus 76.6%. Overall, 51% of bortezomib-rituximab and 32% of rituximab patients reported grade ≥3 adverse events, including neutropenia (18%, 6%), anemia (4%, 5%), diarrhea (8%, 0%), thrombocytopenia (5%, 2%), and sensory neuropathy (1%, 0%). CONCLUSIONS High-risk FL patients treated with bortezomib-rituximab had significantly higher ORR and longer PFS than patients receiving rituximab alone, with greater clinical benefit than in the overall study population; additional toxicity was acceptable and did not affect treatment feasibility. TRIAL REGISTRATION The phase 3 LYM3001 trial is registered with ClinicalTrials.gov, with the identifier NCT00312845.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Boronic Acids/administration & dosage
- Boronic Acids/adverse effects
- Bortezomib
- Disease-Free Survival
- Drug Resistance, Neoplasm
- Female
- Humans
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Pyrazines/administration & dosage
- Pyrazines/adverse effects
- Rituximab
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Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology ‘L. & A. Seràgnoli’, University of Bologna, Bologna, Italy
| | | | - Huaqing Wang
- Medical Oncology, Medical University Cancer Hospital, Tianjin, China
| | | | - Jan Walewski
- Hematology, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | | | | | - Dolores Caballero
- Clinical Hematology, Hospital Clínico de Salamanca, Salamanca, Spain
| | - Rena Buckstein
- Medical Oncology & Hematology, Sunnybrook Regional Cancer Center, Toronto, Canada
| | | | | | | | - Eugene Zhu
- Oncology R&D, Janssen R&D, Raritan, NJ, USA
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Flowers CR, Fedewa SA, Chen AY, Nastoupil LJ, Lipscomb J, Brawley OW, Ward EM. Disparities in the early adoption of chemoimmunotherapy for diffuse large B-cell lymphoma in the United States. Cancer Epidemiol Biomarkers Prev 2012; 21:1520-30. [PMID: 22771484 PMCID: PMC4155492 DOI: 10.1158/1055-9965.epi-12-0466] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Since the 1970s, CHOP chemotherapy has been the standard treatment for patients with diffuse large B-cell lymphoma (DLBCL). In 2002, randomized trials changed this standard by showing that adding rituximab immunotherapy to CHOP improved survival. However, how these results influenced chemoimmunotherapy adoption in clinical practice remains unclear. METHODS Using the National Cancer Database to compare chemoimmunotherapy use with chemotherapy alone, we collected data on demographics, stage, health insurance, area-level socioeconomic status (SES), facility characteristics, and type of treatment for DLBCL patients diagnosed in the United States 2001-2004. Multivariable log binomial models examined associations between race, insurance, and treatment allocation, adjusting for covariates. RESULTS Among 38,002 patients with DLBCL, 27% received chemoimmunotherapy and 50% chemotherapy alone. Patients who had localized disease, were diagnosed in 2001 or who were black, uninsured/Medicaid insured, or lower SES were less likely to receive any form of chemotherapy (all P < 0.0001). Patients who were diagnosed in 2001 or who were black [relative risk (RR), 0.83; 95% confidence interval (CI), 0.78-0.89], >60 years (RR, 0.94; 95% CI, 0.90-0.98), or had localized disease (RR, 0.89; 95% CI, 0.86-0.92) were less likely to receive chemoimmunotherapy. Receiving treatment at high DLBCL volume teaching/research facilities was associated with the greatest likelihood of chemoimmunotherapy (RR, 1.69; 95% CI, 1.52-1.89). CONCLUSIONS Black DLBCL patients were less likely to receive chemotherapy or chemoimmunotherapy during this period. IMPACT This large national cohort study shows disparities in the diffusion of chemoimmunotherapy for DLBCL. Improving DLBCL outcomes will require efforts to extend access to proven advances in therapy to all segments of the population.
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Affiliation(s)
- Christopher R Flowers
- Department of Hematology/Oncology, School of Medicine, Emory University, Atlanta, GA 30322, USA.
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43
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Friedberg JW, Byrtek M, Link BK, Flowers C, Taylor M, Hainsworth J, Cerhan JR, Zelenetz AD, Hirata J, Miller TP. Effectiveness of first-line management strategies for stage I follicular lymphoma: analysis of the National LymphoCare Study. J Clin Oncol 2012; 30:3368-75. [PMID: 22915662 DOI: 10.1200/jco.2011.40.6546] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT). PATIENTS AND METHODS We analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database. RESULTS Of 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival. CONCLUSION In this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.
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Hay AE, Meyer RM. Hepatitis B, rituximab, screening, and prophylaxis: effectiveness and cost effectiveness. J Clin Oncol 2012; 30:3155-7. [PMID: 22891267 DOI: 10.1200/jco.2012.43.7509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Rueda A, Casanova M, Redondo M, Pérez-Ruiz E, Medina-Pérez Á. Has the time to come leave the "watch-and-wait" strategy in newly diagnosed asymptomatic follicular lymphoma patients? BMC Cancer 2012; 12:210. [PMID: 22650448 PMCID: PMC3489567 DOI: 10.1186/1471-2407-12-210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 05/14/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Historically, the median overall survival for follicular lymphoma (FL) has been considered to be 9-10 years, and no treatment had ever prolonged this time period. Studies conducted more than 20 years ago demonstrated that treating patients with asymptomatic FL at the onset of the disease did not increase their survival, and that almost 20% of these patients did not need any treatment in the first 10 years of follow-up. Based on these facts, most clinical practice guidelines recommend active surveillance policies for patients with asymptomatic FL. DISCUSSION The introduction of antiCD-20 monoclonal antibodies, over the last 15 years, has significantly increased the median survival rate to above 14 years. This improvement was achieved before the combination of rituximab and chemotherapy regimens became extensively used in patients with symptomatic disease. Therefore, this increase in survival may currently be more significant. At present, several clinical trials have evaluated low-toxicity therapies that prolong progression-free periods, among which rituximab monotherapy, radioimmunotherapy or the combination of rituximab with bendamustine are the most relevant. Unfortunately, these clinical trials have included only patients with symptomatic FL. The results of a recently reported clinical trial show that treatment with single-agent rituximab prolongs progression-free survival rates, time to new treatment and the quality of life of asymptomatic patients, as compared with the active surveillance strategy. Longer follow-up of these results and data regarding overall survival are awaited before this treatment can be recommended as the standard initial therapy. SUMMARY There are different therapeutic possibilities for asymptomatic FL patients, but no data are currently available to indicate which option is the best. Patients need to understand the risks and benefits of observation versus treatment before a final decision can be made. For patients who want active treatment the administration of four weekly rituximab doses should be considered.
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Affiliation(s)
- Antonio Rueda
- Department of Oncology, Hospital Costa del Sol, Marbella, Spain
| | - María Casanova
- Department of Oncology, Hospital Costa del Sol, Marbella, Spain
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Wirth A, Hofman MS. Special delivery: getting radiation to the target in diffuse large B-cell lymphoma. Leuk Lymphoma 2012; 53:751-3. [PMID: 22452591 DOI: 10.3109/10428194.2012.679269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrew Wirth
- Peter MacCallum Cancer Centre, East Melbourne, Australia.
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Mazrouei S, Ziaei A, Tanhaee AP, Keyhanian K, Esmaeili M, Baradaran A, Salehi M. Apoptosis inhibition or inflammation: the role of NAIP protein expression in Hodgkin and non-Hodgkin lymphomas compared to non-neoplastic lymph node. JOURNAL OF INFLAMMATION-LONDON 2012; 9:4. [PMID: 22357131 PMCID: PMC3297494 DOI: 10.1186/1476-9255-9-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 02/23/2012] [Indexed: 01/12/2023]
Abstract
Background Inhibitors of Apoptosis (IAP) family play a critical role in apoptosis and inflammatory response. Neuronal Apoptosis Inhibitory Protein (NAIP), as a member of both IAPs and NLR families (NOD-Like Receptor), is a unique IAP harboring NOD (Nucleotide Oligomerization Domain) and LLR (Leucine Rich Repeat) motifs. Considering these motifs in NAIP, it has been suggested that the main function of NAIP is distinct from other members of IAPs. As a member of NLR, NAIP mediates the assembly of 'Inflammasome' for inflammatory caspase activation. Pathologic expression of NAIP has been reported not only in some infectious and inflammatory diseases but also in some malignancies. However, there is no report to elucidate NAIP expression in lymphomatic malignancies. Methods In this study, we examined NAIP protein expression in 101 Formalin-Fixed Paraffin-Embedded blocks including samples from 39 Hodgkin Lymphoma and 23 Non Hodgkin Lymphoma cases in comparison with 39 control samples (30 normal and 9 Reactive Lymphoid Hyperplasia (RLH) lymph nodes) using semi-quantitative immuno-flourecent Staining. Results NAIP expression was not statistically different in lymphoma samples neither in HL nor in NHL cases comparing to normal samples. However, we evaluated NAIP expression in normal and RLH lymph nodes. Surprisingly, we have found a statistically significant-difference between the NAIP expression in RLH (M.R of NAIP/GAPDH expression = 0.6365 ± 0.017) and normal lymph node samples (M.R of NAIP/GAPDH expression = 0.5882 ± 0.047) (P < 0.01). Conclusions These findings show that the regulation of apoptosis could not be the main function of NAIP in the cell, so the pathologic expression of NAIP is not involved in lymphoma. But, we concluded that the over expression of NAIP has more effective role in the inflammatory response. Also, this study clarifies the NAIP expression level in lymphoma which is required for IAPs profiling in order to be used in potential translational applications of IAPs.
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Affiliation(s)
- Safoura Mazrouei
- Dept of Genetics and Molecular Biology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
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