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Pettitt A, Kalakonda N, Cicconi S, Murphy C, Menon G, Coupland S, Oates M, Lin K, Pocock C, Jenkins S, Schuh A, Wandroo F, Rassam S, Duncombe A, Cervi P, Paneesha S, Aldouri M, Fox C, Knechtli C, Hamblin M, Turner D, Hillmen P. BRIEF CO-ADMINISTRATION OF IDELALISIB MAY IMPROVE THE LONG-TERM EFFICACY OF FRONTLINE CHEMOIMMUNOTHERAPY IN CHRONIC LYMPHOCYTIC LEUKAEMIA: 3-YEAR FOLLOW-UP FROM THE RIALTO TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.32_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A. Pettitt
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - N. Kalakonda
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - S. Cicconi
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - C. Murphy
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - G. Menon
- Liverpool Clinical Laboratories; Haemato-Oncology Diagnostic Service; Liverpool United Kingdom
| | - S.E. Coupland
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - M. Oates
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - K. Lin
- Liverpool Clinical Laboratories; Department of Blood Sciences; Liverpool United Kingdom
| | - C. Pocock
- Department of Haematology; Kent & Canterbury Hospital; Canterbury United Kingdom
| | - S. Jenkins
- Russells Hall Hospital; Haematology Unit; Dudley United Kingdom
| | - A. Schuh
- Department of Oncology; University of Oxford; Oxford United Kingdom
| | - F. Wandroo
- Department of Haematology; Sandwell Hospital; Birmingham United Kingdom
| | - S. Rassam
- Department of Haematology; Maidstone Hospital; Maidstone United Kingdom
| | - A.S. Duncombe
- Department of Haematology; University Hospital Southampton; Southampton United Kingdom
| | - P. Cervi
- Department of Haematology & Blood Transfusion; Southend Hospital; Southend United Kingdom
| | - S. Paneesha
- Department of Haematology; Heartlands Hospital; Birmingham United Kingdom
| | - M. Aldouri
- Department of Haematology; Medway Maritime Hospital; Gillingham United Kingdom
| | - C. Fox
- Department of Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | - C. Knechtli
- Department of Clinical Haematology; Royal United Hospital; Bath United Kingdom
| | - M. Hamblin
- Department of Haematology; Colchester General Hospital; Colchester United Kingdom
| | - D. Turner
- Oncology Unit; Torbay Hospital; Torquay United Kingdom
| | - P. Hillmen
- Faculty of Medicine and Health; University of Leeds; Leeds United Kingdom
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Rule S, Barreto W, Briones J, Carella A, Casasnovas O, Pocock C, Wendtner C, Zaja F, Robson S, Tschopp R, Dreyling M. EFFICACY AND SAFETY OF PROLONGED MAINTENANCE WITH SUBCUTANEOUS RITUXIMAB IN PATIENTS WITH RELAPSED OR REFRACTORY INDOLENT NHL: RESULTS OF THE PHASE III MABCUTE STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.43_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Rule
- Department of Haematology; Derriford Hospital and Plymouth University Medical School; Plymouth United Kingdom
| | - W.G. Barreto
- Hematology and Hemotherapy; Hemocentro Ribeirão Preto, University of São Paulo; São Paulo Brazil
| | - J. Briones
- Department of Hematology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - A.M. Carella
- Division of Hematology and Stem Cell Transplantation Unit; L'Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria "San Martino" - Istituto Nazionale per la Ricerca sul Cancro; Genova Italy
| | - O. Casasnovas
- Service d'Hématologie Clinique; Centre Hospitalier Universitaire François Mitterand; Dijon France
| | - C. Pocock
- Department of Haematology; Kent & Canterbury Hospital; Canterbury United Kingdom
| | - C.M. Wendtner
- Department I of Internal Medicine; Klinikum Schwabing; Munich Germany
| | - F. Zaja
- SC Ematologia; Azienda Sanitaria Universitaria Integrata di Trieste; Trieste Italy
| | - S. Robson
- Product Development Medical Affairs; Biometrics, F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - R.R. Tschopp
- Product Development Medical Affairs; Oncology, F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - M. Dreyling
- Department of Medicine III; Klinikum der Universität München (LMU); Munich Germany
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Gleeson M, Counsell N, Cunningham D, Chadwick N, Lawrie A, Hawkes EA, McMillan A, Ardeshna KM, Jack A, Smith P, Mouncey P, Pocock C, Radford JA, Davies J, Turner D, Kruger A, Johnson P, Gambell J, Linch D. Central nervous system relapse of diffuse large B-cell lymphoma in the rituximab era: results of the UK NCRI R-CHOP-14 versus 21 trial. Ann Oncol 2018; 28:2511-2516. [PMID: 28961838 PMCID: PMC5834096 DOI: 10.1093/annonc/mdx353] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is associated with a dismal prognosis. Here, we report an analysis of CNS relapse for patients treated within the UK NCRI phase III R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) 14 versus 21 randomised trial. Patients and methods The R-CHOP 14 versus 21 trial compared R-CHOP administered two- versus three weekly in previously untreated patients aged ≥18 years with bulky stage I–IV DLBCL (n = 1080). Details of CNS prophylaxis were retrospectively collected from participating sites. The incidence and risk factors for CNS relapse including application of the CNS-IPI were evaluated. Results 177/984 patients (18.0%) received prophylaxis (intrathecal (IT) methotrexate (MTX) n = 163, intravenous (IV) MTX n = 2, prophylaxis type unknown n = 11 and IT MTX and cytarabine n = 1). At a median follow-up of 6.5 years, 21 cases of CNS relapse (isolated n = 11, with systemic relapse n = 10) were observed, with a cumulative incidence of 1.9%. For patients selected to receive prophylaxis, the incidence was 2.8%. Relapses predominantly involved the brain parenchyma (81.0%) and isolated leptomeningeal involvement was rare (14.3%). Univariable analysis demonstrated the following risk factors for CNS relapse: performance status 2, elevated lactate dehydrogenase, IPI, >1 extranodal site of disease and presence of a ‘high-risk’ extranodal site. Due to the low number of events no factor remained significant in multivariate analysis. Application of the CNS-IPI revealed a high-risk group (4-6 risk factors) with a 2- and 5-year incidence of CNS relapse of 5.2% and 6.8%, respectively. Conclusion Despite very limited use of IV MTX as prophylaxis, the incidence of CNS relapse following R-CHOP was very low (1.9%) confirming the reduced incidence in the rituximab era. The CNS-IPI identified patients at highest risk for CNS recurrence. ClinicalTrials.gov ISCRTN number 16017947 (R-CHOP14v21); EudraCT number 2004-002197-34.
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Affiliation(s)
- M Gleeson
- Department of Medicine, The Royal Marsden Hospital, London and Surrey, UK
| | - N Counsell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - D Cunningham
- Department of Medicine, The Royal Marsden Hospital, London and Surrey, UK;.
| | - N Chadwick
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - E A Hawkes
- Department of Oncology and Clinical Haematology, Austin Health, Heidelberg, Melbourne, Australia;; Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | - A McMillan
- Department of Haematology, Nottingham City Hospital, Nottingham, UK
| | - K M Ardeshna
- Department of Haematology, University College London, London, UK;; Department of Haematology, Mount Vernon Cancer Centre, Northwood, UK
| | - A Jack
- HMDS, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Smith
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - P Mouncey
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - C Pocock
- Department of Haematology, East Kent Hospitals, Canterbury, UK
| | - J A Radford
- The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J Davies
- Department of Haematology, Western General Hospital, Edinburgh, UK
| | - D Turner
- Department of Haematology, Torbay Hospital, Torquay, UK
| | - A Kruger
- Department of Haematology, Royal Cornwall Hospital, Truro, UK
| | - P Johnson
- Cancer Research UK Centre, Southampton, UK
| | - J Gambell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - D Linch
- Department of Haematology, University College London, London, UK
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4
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Kühnl A, Cunningham D, Counsell N, Hawkes EA, Qian W, Smith P, Chadwick N, Lawrie A, Mouncey P, Jack A, Pocock C, Ardeshna KM, Radford J, McMillan A, Davies J, Turner D, Kruger A, Johnson PW, Gambell J, Rosenwald A, Ott G, Horn H, Ziepert M, Pfreundschuh M, Linch D. Outcome of elderly patients with diffuse large B-cell lymphoma treated with R-CHOP: results from the UK NCRI R-CHOP14v21 trial with combined analysis of molecular characteristics with the DSHNHL RICOVER-60 trial. Ann Oncol 2017; 28:1540-1546. [PMID: 28398499 PMCID: PMC5815562 DOI: 10.1093/annonc/mdx128] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is an on-going debate whether 2- or 3-weekly administration of R-CHOP is the preferred first-line treatment for elderly patients with diffuse large B-cell lymphoma (DLBCL). The UK NCRI R-CHOP14v21 randomized phase 3 trial did not demonstrate a difference in outcomes between R-CHOP-14 and R-CHOP-21 in newly diagnosed DLBCL patients aged 19-88 years, but data on elderly patients have not been reported in detail so far. Here, we provide a subgroup analysis of patients ≥60 years treated on the R-CHOP14v21 trial with extended follow-up. PATIENTS AND METHODS Six hundred and four R-CHOP14v21 patients ≥60 years were included in this subgroup analysis, with a median follow-up of 77.7 months. To assess the impact of MYC rearrangements (MYC-R) and double-hit-lymphoma (DHL) on outcome in elderly patients, we performed a joint analysis of cases with available molecular data from the R-CHOP14v21 (N = 217) and RICOVER-60 (N = 204) trials. RESULTS Elderly DLBCL patients received high dose intensities with median total doses of ≥98% for all agents. Toxicities were similar in both arms with the exception of more grade ≥3 neutropenia (P < 0.0001) and fewer grade ≥3 thrombocytopenia (P = 0.05) in R-CHOP-21 versus R-CHOP-14. The elderly patient population had a favorable 5-year overall survival (OS) of 69% (95% CI: 65-73). We did not identify any subgroup of patients that showed differential response to either regimen. In multivariable analysis including individual factors of the IPI, gender, bulk, B2M and albumin levels, only age and B2M were of independent prognostic significance for OS. Molecular analyses demonstrated a significant impact of MYC-R (HR = 1.96; 95% CI: 1.22-3.16; P = 0.01) and DHL (HR = 2.21; 95% CI: 1.18-4.11; P = 0.01) on OS in the combined trial cohorts, independent of other prognostic factors. CONCLUSIONS Our data support equivalence of both R-CHOP application forms in elderly DLBCL patients. Elderly MYC-R and DHL patients have inferior prognosis and should be considered for alternative treatment approaches. TRIAL NUMBERS ISCRTN 16017947 (R-CHOP14v21); NCT00052936 (RICOVER-60).
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Biomarkers, Tumor/genetics
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Drug Administration Schedule
- Female
- Gene Rearrangement
- Humans
- Kaplan-Meier Estimate
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Multivariate Analysis
- Patient Selection
- Precision Medicine
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-6/genetics
- Proto-Oncogene Proteins c-myc/genetics
- Risk Factors
- Rituximab
- Time Factors
- Treatment Outcome
- United Kingdom
- Vincristine/administration & dosage
- Vincristine/adverse effects
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Affiliation(s)
- A. Kühnl
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - D. Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - N. Counsell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - E. A. Hawkes
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
- Olivia-Newton John Cancer Research & Wellness Centre, Melbourne, Australia
| | - W. Qian
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - P. Smith
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - N. Chadwick
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - P. Mouncey
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Jack
- HMDS, St James’s Institute of Oncology, Leeds
| | | | - K. M. Ardeshna
- Department of Hematology, University College London, London
- Mount Vernon Cancer Centre, Northwood
| | - J. Radford
- Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester
| | - A. McMillan
- Department of Hematology, Nottingham City Hospital, Nottingham
| | | | - D. Turner
- Department of Hematology, Torbay Hospital, Torquay
| | | | - P. W. Johnson
- Cancer Research UK Center, University of Southampton, Southampton, UK
| | - J. Gambell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Rosenwald
- Institute of Pathology, Würzburg University, Würzburg
| | - G. Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart
| | - H. Horn
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Stuttgart
| | - M. Ziepert
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig
| | - M. Pfreundschuh
- Department of Medicine, Saarland University Medical School, Homburg/Saar, Germany
| | - D. Linch
- Department of Hematology, University College London, London
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Herold M, Hoster E, Janssens A, McCarthy H, Tedeschi A, Pocock C, Rosta A, Schmidt P, Trněný M, Burciu A, Fingerle-Rowson G, Rufibach K, Zeuner H, Hiddemann W, Marcus R. IMMUNOCHEMOTHERAPY WITH OBINUTUZUMAB OR RITUXIMAB IN a SUBSET OF PATIENTS IN THE RANDOMISED GALLIUM TRIAL WITH PREVIOUSLY UNTREATED MARGINAL ZONE LYMPHOMA (MZL). Hematol Oncol 2017. [DOI: 10.1002/hon.2437_136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M. Herold
- Oncology Center, HELIOS-Klinikum Erfurt; Erfurt Germany
| | - E. Hoster
- Department of Medicine III; Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - A. Janssens
- Department of Haematology; UZ Leuven; Leuven Belgium
| | - H. McCarthy
- Department of Haematology; Royal Bournemouth General Hospital; Bournemouth UK
| | - A. Tedeschi
- Division of Hematology; A. O. Ospedale Niguarda Ca’ Granda; Milan Italy
| | - C. Pocock
- Department of Haematology; Kent & Canterbury Hospital; Canterbury UK
| | - A. Rosta
- Department of Haematology, Országos Onkológiai Intézet; Budapest Hungary
| | - P. Schmidt
- Dr. med. Peter Schmidt; Praxis Neunkirchen/Saar Germany
| | - M. Trněný
- 1st Department of Medicine; Charles University General Hospital; Prague Czech Republic
| | - A. Burciu
- Pharma Development Safety and Risk Management; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - G. Fingerle-Rowson
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - K. Rufibach
- Pharma Development Biometrics Biostatistics; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - H. Zeuner
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - W. Hiddemann
- Department of Medicine III; Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - R. Marcus
- Department of Haematology; Kings College Hospital; London UK
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6
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Cummin T, Araf S, Du M, Barrans S, Bentley M, Clipson A, Wang M, Ahmed S, Rahim T, Shah C, Hamid D, Dhondt J, Maishman T, Vaughan-Spickers N, Pocock C, Forbes A, O'Callaghan A, Westhead D, Griffiths G, Fitzgibbon J, Tooze R, Care M, Burton C, Davies A, Johnson P. PROGNOSTIC SIGNIFICANCE AND CORRELATION TO GENE EXPRESSION PROFILE OF EZH2
MUTATIONS IN DIFFUSE LARGE B-CELL LYMPHOMA (DLBL) IN 2 LARGE PROSPECTIVE STUDIES. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- T.E. Cummin
- Cancer Sciences; University of Southampton; Southampton UK
| | - S. Araf
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - M. Du
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Barrans
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - M.A. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - A. Clipson
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - M. Wang
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Ahmed
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - T. Rahim
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - C. Shah
- Bioinformatics group,IMCB; University of Leeds; Leeds UK
| | - D. Hamid
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Dhondt
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - T. Maishman
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - N. Vaughan-Spickers
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - C. Pocock
- Haematology Department; East Kent Hospitals University NHS Foundation Trust; Canterbury UK
| | - A. Forbes
- Haematology Department; Royal Cornwall Hospital; Truro UK
| | - A. O'Callaghan
- Haematology Department; Queen Alexandra Hospital, PO6 3LY; Portsmouth UK
| | - D. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - G.O. Griffiths
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - R.M. Tooze
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - M.A. Care
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - C.H. Burton
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - A.J. Davies
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - P.W. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
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7
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Davies A, Barrans S, Maishman T, Cummin T, Bentley M, Mamot C, Novak U, Caddy J, Hamid D, Kazmi-Stokes S, Mcmillan A, Fields P, Pocock C, Kruger A, Collins G, Sha C, Clipson A, Wang M, Tooze R, Care M, Griffiths G, Du M, Westhead D, Burton C, Jack A, Johnson P. DIFFERENTIAL EFFICACY OF BORTEZOMIB IN SUBTYPES OF DIFFUSE LARGE B-CELL LYMPHOMA (DLBL): a PROSPECTIVE RANDOMISED STUDY STRATIFIED BY TRANSCRIPTOME PROFILING: REMODL-B. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A.J. Davies
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
| | - S. Barrans
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology, Leeds; Leeds UK
| | - T. Maishman
- Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - T.E. Cummin
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
| | - M. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - C. Mamot
- Swiss Group for Clinical Cancer Research (SAKK); Kantonsspital Aarau; Bern Switzerland
| | - U. Novak
- Swiss Group for Clinical Cancer Research (SAKK); Inselspital / Bern University Hospital; Bern Switzerland
| | - J. Caddy
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
| | - D. Hamid
- Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - S.H. Kazmi-Stokes
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
| | - A. Mcmillan
- Haematology; Nottingham City Hospital; Nottingham UK
| | - P.A. Fields
- Haematology; Guy's and St Thomas' and King's College Hospitals; London UK
| | - C. Pocock
- Haematology; East Kent Hospitals University NHS Trust; Canterbury UK
| | - A. Kruger
- Haematology; Royal Cornwall Hospital; Truro UK
| | - G. Collins
- Clinical Haematology; Churchill Hospital; Oxford UK
| | - C. Sha
- Bioinformatics group, IMCB; University of Leeds; Leeds UK
| | - A. Clipson
- Division of Molecular Histopathology; University of Cambridge; Cambridge UK
| | - M. Wang
- Division of Molecular Histopathology; University of Cambridge; Cambridge UK
| | - R.M. Tooze
- Faculty of Medicine and Health; University of Leeds; Leeds UK
| | - M.A. Care
- Faculty of Medicine and Health; University of Leeds; Leeds UK
| | - G.O. Griffiths
- Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - M. Du
- Division of Molecular Histopathology; University of Cambridge; Cambridge UK
| | - D.R. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - C. Burton
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology, Leeds; Leeds UK
| | - A. Jack
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology, Leeds; Leeds UK
| | - P.W. Johnson
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
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8
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Pettitt A, Kalakonda N, Polydoros F, Bickerstaff M, Menon G, Coupland S, Oates M, Lin K, Pocock C, Jenkins S, Schuh A, Wandroo F, Rassam S, Duncombe A, Jenner M, Cervi P, Paneesha S, Aldouri M, Fox C, Knechtli C, Hamblin M, Turner D, Hillmen P. EFFECT OF ADDING IDELALISIB TO FRONTLINE OFATUMUMAB PLUS EITHER CHLORAMBUCIL OR BENDAMUSTINE IN LESS FIT PATIENTS WITH CLL: PRELIMINARY RESULTS FROM THE NCRI RIALTO TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A.R. Pettitt
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - N. Kalakonda
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - F. Polydoros
- CRUK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool UK
| | - M. Bickerstaff
- CRUK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool UK
| | - G. Menon
- Haemato-Oncology Diagnostic Service; Liverpool Clinical Laboratories; Liverpool UK
| | - S.E. Coupland
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - M. Oates
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool UK
| | - K. Lin
- Blood Sciences; Liverpool Clinical Laboratories; Liverpool UK
| | - C. Pocock
- Department of Haematology; Kent & Canterbury Hospital; Canterbury UK
| | - S. Jenkins
- Haematology Unit; Russells Hall Hospital; Dudley UK
| | - A. Schuh
- Oncology; University of Oxford; Oxford UK
| | - F. Wandroo
- Haematology; Sandwell Hospital; Birmingham UK
| | - S. Rassam
- Haematology; Maidstone Hospital; Maidstone UK
| | - A.S. Duncombe
- Haematology; University Hospital Southampton; Southampton UK
| | - M. Jenner
- Haematology; University Hospital Southampton; Southampton UK
| | - P. Cervi
- Haematology & Blood Transfusion; Southend Hospital, Westcliff-on-Sea; UK
| | - S. Paneesha
- Haematology; Heartlands Hospital; Birmingham UK
| | - M. Aldouri
- Haematology; Medway Maritime Hospital; Gillingham UK
| | - C.P. Fox
- Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - C. Knechtli
- Clinical Haematology; Royal United Hospital; Bath UK
| | - M. Hamblin
- Haematology; Colchester General Hospital; Colchester UK
| | - D. Turner
- Oncology Unit; Torbay Hospital; Torquay UK
| | - P. Hillmen
- Medicine and Health; University of Leeds; Leeds UK
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9
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Burnett AK, Russell NH, Hills RK, Kell J, Nielsen OJ, Dennis M, Cahalin P, Pocock C, Ali S, Burns S, Freeman S, Milligan D, Clark RE. A comparison of clofarabine with ara-C, each in combination with daunorubicin as induction treatment in older patients with acute myeloid leukaemia. Leukemia 2017; 31:310-317. [PMID: 27624670 PMCID: PMC5292678 DOI: 10.1038/leu.2016.225] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/14/2016] [Accepted: 07/12/2016] [Indexed: 12/25/2022]
Abstract
The study was designed to compare clofarabine plus daunorubicin vs daunorubicin/ara-C in older patients with acute myeloid leukaemia (AML) or high-risk myelodysplastic syndrome (MDS). Eight hundred and six untreated patients in the UK NCRI AML16 trial with AML/high-risk MDS (median age, 67 years; range 56-84) and normal serum creatinine were randomised to two courses of induction chemotherapy with either daunorubicin/ara-C (DA) or daunorubicin/clofarabine (DClo). Patients were also included in additional randomisations; ± one dose of gemtuzumab ozogamicin in course 1; 2v3 courses and ± azacitidine maintenance. The primary end point was overall survival. The overall response rate was 69% (complete remission (CR) 60%; CRi 9%), with no difference between DA (71%) and DClo (66%). There was no difference in 30-/60-day mortality or toxicity: significantly more supportive care was required in the DA arm even though platelet and neutrophil recovery was significantly slower with DClo. There were no differences in cumulative incidence of relapse (74% vs 68%; hazard ratio (HR) 0.93 (0.77-1.14), P=0.5); survival from relapse (7% vs 9%; HR 0.96 (0.77-1.19), P=0.7); relapse-free (31% vs 32%; HR 1.02 (0.83-1.24), P=0.9) or overall survival (23% vs 22%; HR 1.08 (0.93-1.26), P=0.3). Clofarabine 20 mg/m2 given for 5 days with daunorubicin is not superior to ara-C+daunorubicin as induction for older patients with AML/high-risk MDS.
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Affiliation(s)
- A K Burnett
- Department of Haematology, Cardiff University School of Medicine, Cardiff, UK
| | - N H Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - R K Hills
- Centre for Trails Research, Cardiff University, Cardiff, UK
| | - J Kell
- Department of Haematology, University Hospital of Wales Cardiff, Cardiff, UK
| | - O J Nielsen
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - M Dennis
- Department of Haematology, Christie Hospital, Manchester, UK
| | - P Cahalin
- Department of Haematology, Blackpool Victoria Hospital, Blackpool, UK
| | - C Pocock
- Department of Haematology, Kent & Canterbury Hospital, Canterbury, Kent, UK
| | - S Ali
- Department of Haematology, Castle Hill Hospital, Hull, UK
| | - S Burns
- Centre for Trails Research, Cardiff University, Cardiff, UK
| | - S Freeman
- Department of Immunology, University of Birmingham, Birmingham, UK
| | - D Milligan
- Department of Haematology, Heartlands Hospital, Birmingham, UK
| | - R E Clark
- Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK
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10
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Drummond MW, Pocock C, Boissinot M, Mills J, Brown J, Cauchy P, Cross NCP, Hartley S, Kell J, Szubert A, Cockerill PN, Bowen DT. A multi-centre phase 2 study of azacitidine in chronic myelomonocytic leukaemia. Leukemia 2014; 28:1570-2. [DOI: 10.1038/leu.2014.85] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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11
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Cunningham D, Smith P, Mouncey P, Qian W, Jack AS, Pocock C, Ardeshna K, Radford JA, Davies AJ, McMillan A, Linch MD. R-CHOP14 versus R-CHOP21: Result of a randomized phase III trial for the treatment of patients with newly diagnosed diffuse large B-cell non-Hodgkin lymphoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Tait MJ, Levy J, Nowell M, Pocock C, Petrik V, Bell BA, Papadopoulos MC. Improved outcome after lumbar microdiscectomy in patients shown their excised disc fragments: a prospective, double blind, randomised, controlled trial. J Neurol Neurosurg Psychiatry 2009; 80:1044-6. [PMID: 19684238 DOI: 10.1136/jnnp.2008.156356] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lumbar microdiscectomy (LMD) is a commonly performed neurosurgical procedure. We set up a prospective, double blind, randomised, controlled trial to test the hypothesis that presenting the removed disc material to patients after LMD improves patient outcome. METHODS Adult patients undergoing LMD for radiculopathy caused by a prolapsed intervertebral disc were randomised into one of two groups, termed experimental and control. Patients in the experimental group were given their removed disc fragments whereas patients in the control group were not. Patients were unaware of the trial hypothesis and investigators were blinded to patient group allocation. Outcome was assessed between 3 and 6 months after LMD. Primary outcome measures were the degree of improvement in sciatica and back pain reported by the patients. Secondary outcome measures were the degree of improvement in leg weakness, paraesthesia, numbness, walking distance and use of analgesia reported by the patients. RESULTS Data from 38 patients in the experimental group and 36 patients in the control group were analysed. The two groups were matched for age, sex and preoperative symptoms. More patients in the experimental compared with the control group reported improvements in leg pain (91.5 vs 80.4%; p<0.05), back pain (86.1 vs 75.0%; p<0.05), limb weakness (90.5 vs 56.3%; p<0.02), paraesthesia (88 vs 61.9%; p<0.05) and reduced analgesic use (92.1 vs 69.4%; p<0.02) than preoperatively. CONCLUSION Presentation of excised disc fragments is a cheap and effective way to improve outcome after LMD.
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Affiliation(s)
- M J Tait
- Academic Neurosurgery Unit, St George's University of London, London SW17 0RE, UK
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13
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Cunningham D, Smith P, Mouncey P, Qian W, Pocock C, Ardeshna KM, Radford J, Davies J, McMillan A, Linch D. A phase III trial comparing R-CHOP 14 and R-CHOP 21 for the treatment of patients with newly diagnosed diffuse large B-cell non-Hodgkin's lymphoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8506 Background: The addition of rituximab to standard therapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP21) has resulted in improved survival outcomes in the treatment of diffuse large B-cell non-Hodgkin's lymphoma (DLBC NHL). In addition, the administration of CHOP as a 14 day cycle (CHOP14) has shown benefit over standard CHOP21 chemotherapy. This randomised study was designed to evaluate the toxicity and survival outcomes achieved with the addition of rituximab to CHOP14 (R-CHOP14), as compared to standard therapy (R-CHOP21) in newly diagnosed DLBC NHL. Methods: Patients were randomised to receive either eight cycles of standard R-CHOP21 or six cycles of R-CHOP14 (+ G-CSF) with two additional cycles of single agent rituximab. Randomisation was stratified by age (≤60 vs >60), WHO performance status (0–1 vs 2) and LDH level (normal vs raised). The primary endpoint is overall survival. The study was powered to detect an improvement in 2-year survival in the R-CHOP14 arm of 8% (70% to 78%) with 5% significance and 90% power (2-sided). Results: Recruitment is complete with 1080 patients randomised. Patient characteristics in the R-CHOP21 and R-CHOP14 arms are; IPI score of ≥4 17%:15%, stage III/IV disease 63%:62%, B symptoms 44%:47%, bulk disease 51%:48%. Median age is 61 years in both arms. 82% of patients in the R-CHOP21 arm completed study therapy as compared to 89% in the R-CHOP14 arm. Reported grade III/IV toxicities in the R-CHOP21 and R-CHOP14 arms are; neutropenia 57%:31%, thrombocytopenia 5%:9%, Infection 22%:17%, cardiac 1%:2%, nausea & vomiting 8%:8%, mucositis 2%:3%. The radiological complete response rate (CR/CRu) is 47% in both treatment arms. With a median follow-up 14 months 805 patients remain alive. Conclusions: Results indicate that R-CHOP14 can be delivered as effectively as R-CHOP21 with comparable levels of acute toxicity. Final analysis will be performed when 330 deaths have occurred. No significant financial relationships to disclose.
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Affiliation(s)
- D. Cunningham
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - P. Smith
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - P. Mouncey
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - W. Qian
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - C. Pocock
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - K. M. Ardeshna
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - J. Radford
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - J. Davies
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - A. McMillan
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
| | - D. Linch
- The Royal Marsden Hospital, London and Surrey, United Kingdom; Cancer Research UK, London, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Kent and Canterbury Hospital, Canterbury, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Christie Hospital, Manchester, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Nottingham City Hospital, Nottingham, United Kingdom; University College Hospital, London, United Kingdom
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14
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Abstract
Microangiopathic haemolytic anaemia (MAHA) is a well recognized complication of disseminated carcinoma and its treatment. It is however, rarely seen with localized carcinoma. The case presented here is a previously unreported association of a patient, who having been successfully treated for MAHA, was found to have occult breast carcinoma on a routine screening mammogram six months after the haemolytic episode.
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Affiliation(s)
- P W Collins
- Department of Haematology, Royal London Hospital, Whitechapel
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15
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Thornton PD, Bellas C, Santon A, Shah G, Pocock C, Wotherspoon AC, Matutes E, Catovsky D. Richter's transformation of chronic lymphocytic leukemia. Leuk Res 2005; 29:389-95. [PMID: 15725472 DOI: 10.1016/j.leukres.2004.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Accepted: 09/09/2004] [Indexed: 10/25/2022]
Abstract
Transformation of CLL into a large cell lymphoma has an incidence of 3-5%. We have studied 101 cases of CLL treated with fludarabine over a 10-year period (1990-2000) and observed a 12% incidence of transformation. In six of 12 patients, transformation was documented within 4 months following treatment with fludarabine. Pathological material, available in nine cases, was investigated for latent EBV by staining for LMP-1 by immunohistochemistry and EBERs-1 and 2 by in situ hybridisation. LMP-1 and EBERs were demonstrated in three of the nine samples. In two cases there was a different pattern of immunoglobulin gene rearrangement in the transformed cells assessed by PCR (FR3 fragment) compared to the original CLL clone. One of these two cases showed evidence of latent EBV. The other seven cases, of which two were EBV positive, showed identical pattern of Ig gene rearrangement in both the CLL and the transformed cells. We suggest that the relatively high incidence of transformation in this series may be due to immunosuppression mainly related to fludarabine, although other agents and prior therapies may have also contributed.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cell Transformation, Neoplastic
- Disease Progression
- Female
- Herpesvirus 4, Human/isolation & purification
- Humans
- Kidney/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/virology
- Lymph Nodes/pathology
- Male
- Middle Aged
- Reed-Sternberg Cells/parasitology
- Treatment Outcome
- Tumor Suppressor Protein p53/genetics
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- P D Thornton
- Section of Haemato-Oncology, Institute of Cancer Research, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
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16
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Czepulkowski B, Saunders K, Pocock C, Sadullah S. Mosaic trisomy 2 in myelodysplastic syndromes and acute myeloblastic leukemias. Cancer Genet Cytogenet 2003; 145:78-81. [PMID: 12885468 DOI: 10.1016/s0165-4608(03)00030-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We present a short report here of two more patients with trisomy 2 as the sole chromosomal abnormality in a hematologic malignancy. Although trisomy 2 is a recognized abnormality in neoplasms, particularly hepatoblastomas, to the best of our knowledge only three other cases have been reported with trisomy 2, in patients with a hematologic malignancy. The two cases presented here of myelodysplastic syndrome transforming to acute myeloblastic leukemia and chronic myelomonocytic leukemia showed trisomy 2 as the sole abnormality.
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Affiliation(s)
- B Czepulkowski
- Department of Cytogenetics, The Rayne Institute, King's College Hospital, London, UK.
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17
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Pocock C, Szydlo R, Davis J, de La Fuente J, Craddock C, Cwynarski K, Olavarria E, Rezvani K, Kanfer E, Apperley J, Goldman J. Stem cell transplantation for chronic myeloid leukaemia: the role of infused marrow cell dose. Hematol J 2002; 2:265-72. [PMID: 11920259 DOI: 10.1038/sj.thj.6200108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2000] [Accepted: 02/07/2001] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Allogeneic stem cell transplantation is a potentially curative option for patients with CML. The optimal donor is an HLA-identical sibling but transplants using unrelated volunteers can also be successful. The factors influencing survival after allogeneic SCT for CML are reasonably well defined. Recently however, the Seattle group have emphasised the influence of a high marrow cell dose on outcome following volunteer unrelated donor SCT for high risk acute leukaemia. MATERIALS AND METHODS We have sought to define factors impacting on transplant related mortality (TRM) in a population of CML patients after allografting with matched sibling or alternative stem cell donors at a single centre over a 20-year period, with emphasis on infused marrow cell dose. Factors entered into a multivariate analysis were: recipient age, recipient CMV serostatus, disease phase, donor sex, cell dose and frequency of CTLP reactivity. RESULTS In multivariate analysis four factors had an adverse effect on TRM when using a VUD: low marrow cell dose (<3.65 x 10(8) TNC/kg, relative risk 2.05, CI 1.08-3.90, P = 0.029), late disease phase (relative risk 1.68, CI 1.03-2.74, P = 0.038), patient CMV seropositivity (relative risk 1.98, CI 1.25-3.13, P = 0.004) and high frequency of CTLP (relative risk 1.93, CI 1.18-3.13, P = 0.008). For HLA-identical sibling donor transplants the only factor that adversely impacted on TRM was late disease phase (P = 0.0004 in univariate analysis). CONCLUSION High infused cell dose is a new modifiable factor associated with reduced TRM following allogeneic SCT using an unrelated donor for the treatment of CML. The data support the recommendation that bone marrow harvest teams should aim to collect the highest possible number of nucleated cells for recipients of unrelated donor transplants.
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Affiliation(s)
- C Pocock
- Department of Haematology, Hammersmith Hospital, Imperial College School of Medicine, London, UK
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18
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Scopes J, Ismail M, Marks KJ, Rutherford TR, Draycott GS, Pocock C, Gordon-Smith EC, Gibson FM. Correction of stromal cell defect after bone marrow transplantation in aplastic anaemia. Br J Haematol 2001; 115:642-52. [PMID: 11736949 DOI: 10.1046/j.1365-2141.2001.03134.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Defects in stromal cell function have been demonstrated in a number of aplastic anaemia (AA) patients. Here we have studied a patient with severe AA and abnormal stromal cell function who underwent bone marrow transplantation (BMT). The objective of this study was to investigate the timing and the mechanism of correction of the stromal defect after transplantation. The patient, a 25-year-old woman with severe AA, underwent BMT from her brother. BM was obtained from the patient on five occasions: 2 weeks pre BMT, and 3, 8, 16 and 21 months post BMT. Stromal cells were grown to confluence and recharged with purified CD34+ cells from normal donors. The support of such cells, as assessed by weekly colony-forming assay (CFU) of non-adherent cells, was compared with that of stromal layers grown from normal BM. A novel technique of combined fluorescence in situ hybridization (FISH) and immunocytochemistry was used to determine the origin of specific stromal cell types on cytospins of stroma post BMT. Stromal function was defective at 2 weeks pre BMT and at 3 months post BMT, but returned to normal at 8 and 16 months post BMT. At 21 months post BMT, stromal fibroblasts and endothelial cells were shown to be of recipient origin, and macrophages and T cells were of donor origin. We present here evidence in a case of severe AA for defective stromal function before BMT and delayed normalization of function after BMT. This correlated with engraftment of donor macrophages and T cells, but not fibroblasts and endothelial cells.
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Affiliation(s)
- J Scopes
- Department of Haematology, St. George's Hospital Medical School, London, UK
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19
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Cwynarski K, Goulding R, Pocock C, Dazzi F, Craddock C, Kaeda J, Olavarria E, Kanfer E, Apperley J, Lawler M, Goldman JM. Immune haemolytic anaemia following T cell-depleted allogeneic bone marrow transplantation for chronic myeloid leukaemia: association with leukaemic relapse and treatment with donor lymphocyte infusions. Bone Marrow Transplant 2001; 28:581-6. [PMID: 11607771 DOI: 10.1038/sj.bmt.1703206] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2001] [Accepted: 07/16/2001] [Indexed: 11/09/2022]
Abstract
Immune haemolytic anaemia (IHA) is a recognised complication after allogeneic stem cell transplantation (SCT) and occurs more frequently if marrow cells have been subjected to T cell depletion (TCD). Among 58 consecutive patients who underwent TCD-allogeneic SCT from volunteer unrelated donors for the treatment of CML at the Hammersmith Hospital during a 3-year period (1 March 1996 to 28 February 1999) we identified nine cases of IHA. All patients had a strongly positive direct and indirect antiglobulin test and in eight patients the serological findings were typical of warm-type haemolysis often with antibody specificities within the Rh system. All nine cases had clinically significant haemolysis and were treated initially with prednisolone and immunoglobulin. The onset of IHA coincided with the occurrence of leukaemic relapse in six cases, and the presence of host haemopoiesis confirmed by lineage-specific chimerism in all four cases studied. Five patients received donor lymphocyte infusions (DLI); in three molecular remission and the restoration of full donor chimerism coincided with resolution of haemolysis. We conclude that in the context of leukaemic relapse, DLI is an effective therapy for IHA following allografts involving TCD.
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MESH Headings
- Adolescent
- Adult
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/therapy
- Bone Marrow Transplantation/adverse effects
- Bone Marrow Transplantation/immunology
- Bone Marrow Transplantation/methods
- Female
- Humans
- Isoantibodies/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Lymphocyte Depletion/adverse effects
- Lymphocyte Transfusion
- Male
- Recurrence
- Retrospective Studies
- Transplantation Chimera
- Transplantation, Homologous/adverse effects
- Transplantation, Homologous/immunology
- Transplantation, Homologous/methods
- Treatment Outcome
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Affiliation(s)
- K Cwynarski
- Department of Haematology, Hammersmith Hospital, ICSM, London, UK
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20
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Olavarria E, Kanfer E, Szydlo R, Kaeda J, Rezvani K, Cwynarski K, Pocock C, Dazzi F, Craddock C, Apperley JF, Cross NC, Goldman JM. Early detection of BCR-ABL transcripts by quantitative reverse transcriptase-polymerase chain reaction predicts outcome after allogeneic stem cell transplantation for chronic myeloid leukemia. Blood 2001; 97:1560-5. [PMID: 11238091 DOI: 10.1182/blood.v97.6.1560] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The reverse transcriptase-polymerase chain reaction (RT-PCR) has become widely used for monitoring minimal residual disease after allogeneic stem cell transplantation (SCT) for chronic myeloid leukemia (CML). However, most of these studies were performed using qualitative RT-PCR, and the interpretation of the results obtained has been conflicting. The correlation of a quantitative RT-PCR test performed early after SCT (at 3 to 5 months) and long-term outcome of CML patients surviving for more than 6 months was studied. Between January 1991 and June 1999, data from 138 CML patients who received allografts were evaluated. Early RT-PCR results were classified as (1) negative if there were no BCR-ABL transcripts detected (n = 61), (2) positive at low level if the total number of BCR-ABL transcripts was less than 100 per microg RNA and/or the BCR-ABL/ABL ratio was less than 0.02% (n = 14), or (3) positive at high level if transcript levels exceeded the thresholds defined above (n = 63). Three years after SCT the cumulative incidence of relapse was 16.7%, 42.9%, and 86.4%, respectively (P =.0001). The relationship between BCR-ABL transcript level and probability of relapse was apparent whether patients had received sibling or unrelated donor SCT and also whether or not the transplantation was T cell depleted. The results suggest that quantitative RT-PCR performed early after SCT is useful for predicting outcome and may help to define the need for further treatment.
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MESH Headings
- Actuarial Analysis
- Adolescent
- Adult
- Child
- Female
- Follow-Up Studies
- Fusion Proteins, bcr-abl/genetics
- Hematopoietic Stem Cell Transplantation/methods
- Hematopoietic Stem Cell Transplantation/standards
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Middle Aged
- Prognosis
- RNA, Messenger/blood
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction
- Survival Rate
- Transplantation, Homologous
- Treatment Outcome
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Affiliation(s)
- E Olavarria
- Department of Haematology, Hammersmith Hospital, Imperial College School of Medicine, London, England.
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21
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Abstract
Significant aortic stenosis is prevalent amongst elderly people. It may be subclinical, manifesting only as a murmur, but can still cause unexpected death with little warning after symptoms develop. Recent studies have highlighted the unreliability of the classical clinical signs of severe aortic stenosis, leading to concern that some patients may not be referred appropriately for echocardiography. Here, we review the evidence for the accuracy of each sign. We suggest that the assessment of the patient with a systolic murmur should be reappraised, and offer guidelines toward improving the recognition of aortic stenosis in the community.
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Affiliation(s)
- P Das
- Department of Cardiology, Guy's and St. Thomas' Hospitals, London, UK.
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22
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Craddock C, Szydlo RM, Klein JP, Dazzi F, Olavarria E, van Rhee F, Pocock C, Cwynarski K, Apperley JF, Goldman JM. Estimating leukemia-free survival after allografting for chronic myeloid leukemia: a new method that takes into account patients who relapse and are restored to complete remission. Blood 2000; 96:86-90. [PMID: 10891435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
A significant number of patients who relapse after allogeneic stem cell transplantation (SCT) for chronic myeloid leukemia (CML) will achieve sustained remissions after treatment with interferon-alpha, second transplants, or donor lymphocyte infusions (DLI) from the original stem cell donor. Because leukemia-free survival (LFS) is at present defined as survival without evidence of relapse at any time posttransplant, patients who relapse but are then restored to complete remission are treated as failures when estimating LFS. We have established a new category of LFS, termed current LFS (CLFS), which we define as survival without evidence of leukemia at the time of most recent assessment. To gauge the contribution of treatment for relapse to the efficacy of allogeneic SCT in the management of CML in chronic phase, we compared conventional LFS and CLFS in 189 consecutive patients who underwent SCT over a 7-year period with a minimum follow-up of 3 years. Patients with sibling donors (n = 111) received cyclosporine and methotrexate as prophylaxis for graft versus host disease; patients with unrelated donors (n = 78) also received Campath-1G or 1H as intravenous T-cell depletion. The 5-year LFS defined conventionally was 36% (CI: 29% to 43%) versus a 5-year CLFS of 49% (CI: 36% to 62%). This new method of defining LFS confirms the view that appropriate "salvage" therapy, principally DLI, makes a major contribution to the capacity of allogeneic SCT to produce long-term LFS in patients who receive SCT for CML and emphasizes the importance of redefining LFS to take account of successful treatment of relapse.
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Affiliation(s)
- C Craddock
- Leukaemia Research Fund Centre for Adult Leukaemia, Hammersmith Hospital, London, England
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23
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Cotter FE, Johnson P, Hall P, Pocock C, al Mahdi N, Cowell JK, Morgan G. Antisense oligonucleotides suppress B-cell lymphoma growth in a SCID-hu mouse model. Oncogene 1994; 9:3049-55. [PMID: 8084613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The t(14;18) translocation is found in the majority follicular lymphomas and some high grade B-cell lymphomas. This is results in deregulation of the BCL-2 gene and appears to play a role in oncogenesis. Various numbers of cells from a cell line derived spontaneously from a patient with B-cell lymphoma bearing the t(14;18) translocation and negative for the Epstein-Barr virus (EBV) were injected by IP, IV, and SC routes into SCID mice. The mice developed lymphoma bearing the t(14;18) translocation with as few as 5 x 10(6) cells within 28 days. This was determined by histological examination. The higher the cell inoculation the more rapidly the lymphoma developed. Engraftment of the tumour cells was determined by PCR for the t(14;18) breakpoint region on peripheral blood samples and could be detected prior to development of overt lymphoma. Having established a lymphoma model the cells were treated with antisense oligonucleotides to the first open reading frame of the BCL-2 gene prior to inoculation of the SCID mice. Control treatments with sense and nonsense oligonucleotides was also performed. At 28 days the sense, nonsense and untreated cell SCID mice had developed lymphoma, however, the antisense treated group failed to develop lymphoma. The findings demonstrate the modelling of B-cell lymphoma bearing the t(14;18) translocation and the ability to modify the lymphoma process with the use of antisense oligonucleotides to the BCL-2 gene. Reduction of the BCL2 protein suppresses the oncogenic potential of these lymphoma cells confirming that it plays an essential role in the development of malignancy.
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MESH Headings
- Animals
- Base Sequence
- Cell Division/genetics
- Cell Line
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Disease Models, Animal
- Humans
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Mice
- Mice, SCID
- Molecular Sequence Data
- Oligonucleotides, Antisense/genetics
- Oligonucleotides, Antisense/pharmacology
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-bcl-2
- Translocation, Genetic
- Tumor Cells, Cultured
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Affiliation(s)
- F E Cotter
- LRF Department of Haematology and Oncology, Institute of Child Health, London
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