Front-line and second-line treatment for mantle cell lymphoma in clinical practice: A multicenter retrospective analysis

BACKGROUND

There are few reports of clinical practice treatment patterns and efficacy in mantle cell lymphoma (MCL).

MATERIALS AND METHODS

We retrospectively studied a large, multicenter, cohort of patients with MCL diagnosed between 2000 and 2020 in eight institutions.

RESULTS

536 patients were registered (73% male, median of 70 years). Front-line treatment was based on high-dose cytarabine, bendamustine, and anthracyclines in 42%, 12%, and 15%, respectively. The median PFS for all patients was 45 months; 68, 34, and 30 months for those who received high-dose cytarabine-based, bendamustine-based and anthracycline-based therapy. 204 patients received second-line. Bendamustine-based treatment was the most common second-line regimen (36% of patients). The median second-line PFS (sPFS) for the entire cohort was 14 months; 19, 24, and 31 for bendamustine-, platinum-, and high-dose cytarabine-based regimens, with broad confidence intervals for these latter estimates. Patients treated with cytarabine-based therapies in the front-line and those with front-line PFS longer than 24 months had a substantially superior sPFS.

CONCLUSION

Front-line treatment in this cohort of MCL was as expected and with a median PFS of over 3.5 years. Second-line treatment strategies were heterogeneous and the median second-line PFS was little over 1 year.

Survival of patients with mantle cell lymphoma in the rituximab era: Retrospective binational analysis between 2000 and 2020

Mantle cell lymphoma (MCL) is a rare peripheral B-cell lymphoma characterised by eventual relapse and progression towards a more aggressive disease biology. With the introduction of rituximab- and cytarabine-based immunochemotherapy regimens, the prognosis of the disease has changed dramatically over the last two decades. To assess the real-world survival of patients with MCL, we used a population-based cohort of 564 patients with MCL who were diagnosed and treated between 2000 and 2020. Patient data were collected from seven Finnish treatment centres and one Spanish treatment centre. For the entire patient population, we report a 2-year overall survival (OS) rate of 77%, a 5-year OS of 58%, and a 10-year OS of 32%. The estimated median OS was 80 months after diagnosis. MCL is associated with increased mortality across the entire patient population. Additionally, we assessed the survival of patients after MCL relapse with the aim of establishing a cut-off point of prognostic significance. Based on our statistical analysis of survival after the first relapse, disease progression within 24 months of the initial diagnosis should be considered as a strong indicator of poor prognosis.

Nuclear factor erythroid 2-related factors 1 and 2 are able to define the worst prognosis group among high-risk diffuse large B cell lymphomas treated with R-CHOEP

AIMS

Oxidative stress markers and antioxidant enzymes have previously been shown to have prognostic value and associate with adverse outcome in patients with diffuse large B cell lymphoma (DLBCL). Nuclear factor erythroid 2-related factor 1 (Nrf1) and factor 2 (Nrf2) are among the principal inducers of antioxidant enzyme production. Kelch ECH associating protein 1 (Keap1) is a negative regulator of Nrf2, and BTB (BR-C, ttk and bab) domain and CNC homolog 1 (Bach1) represses the function of both factors. Their significance in DLBCL prognosis is unknown.

METHODS

Diagnostic biopsy samples of 76 patients with high-risk DLBCL were retrospectively stained with immunohistochemistry for Nrf1, Nrf2, Keap1 and Bach1, and correlated with clinical data and outcome.

RESULTS

Nuclear Nrf2 and nuclear Bach1 expression were associated with adverse clinical features (anaemia, advanced stage, high IPI, high risk of neutropaenic infections), whereas cytoplasmic Nrf1 and Nrf2 were associated with favourable clinical presentation (normal haemoglobin level, no B symptoms, limited stage). None of the evaluated factors could predict survival alone. However, when two of the following parameters were combined: high nuclear score of Nrf2, low nuclear score of Nrf1, high cytoplasmic score of Nrf1 and low cytoplasmic score of Keap1 were associated with significantly worse overall survival.

CONCLUSIONS

Nrf1 and Nrf2 are relevant in disease presentation and overall survival in high-risk DLBCL. Low nuclear expression of Nrf1, high cytoplasmic expression of Nrf1, high nuclear expression of Nrf2 and low cytoplasmic expression of Keap1 are associated with adverse outcome in this patient group.

Comparison of the bronchodilating efficacies of a novel salbutamol metered dose powder inhaler and a pressurised metered dose aerosol with a spacer

In a two-day, randomised, double-blind, double-dummy, cross-over multicenter study, the bronchodilating effect of 100 micrograms of salbutamol (CAS 18559-94-9) inhaled from a new metered dose powder inhaler (MDPI; Taifun) was compared with that of an identical dose of salbutamol inhaled from a conventional pressurised metered dose inhaler connected to a spacer (pMDI + S). Thirty-six non-smoking, adult asthmatic outpatients with a baseline forced expiratory volume in 1 s (FEV1) between 35 and 70% of the predicted value participated in the study. After inhalation of the study medication pulmonary function, FEV1 and airway resistance (R(aw)), blood pressure (BP), and heart rate (HR) were measured up to 6 h. Area under the FEV1 vs. time curve (AUCFEV1) was used as the primary efficacy parameter, and the 90% confidence intervals (CI) were used to judge clinical equivalence. Other efficacy parameters were used in supportive analyses as secondary parameters. Both treatments produced a clear improvement in pulmonary function. The mean +/- SD AUCFEV1 were 893 +/- 281 and 889 +/- 2761.min after MDPI and pMDI + S, respectively. The 90% CI for the relative efficacy of the MDPI is from 98 to 103% of that of the pMDI + S. Also the other efficacy parameters gave similar results without significant differences: the mean +/- SD values of percent increase in FEV1 were 47.2 +/- 19.3 and 44.7 +/- 20.8, the maximum absolute value of FEV1 were 2.87 +/- 0.77 and 2.86 +/- 0.77, the maximum percent decrease in R(aw) 53.2 +/- 20.5 and 55.0 +/- 19.1, and the minimum absolute value of R(aw) 0.27 +/- 0.11 and 0.30 +/- 0.12 kPa.s.l-1 for the MDPI and pMDI + S, respectively. The salbutamol doses had no significant effect on BP or HR, and were equally well tolerated. Furthermore, 57.5% of the patients preferred the MDPI, 35% the pMDI + S, and 7.5% considered that there was no difference between the devices. In conclusion, this study demonstrates that the new MDPI is as effective and safe a device as a conventional pMDI connected to a spacer in administering inhaled salbutamol for asthmatic patients. Further, most patients considered the MDPI easier to handle, and preferred it over the pMDI + S.

An acoustic study of the tongue root contrast in Degema vowels

Degema is an Edoid language of Nigeria whose ten vowels are organized phonologically into two sets of five. The two sets are thought to be differentiated by the degree of tongue root advancing. This paper examines the acoustic nature of these vowels as represented in field recordings of six speakers. The most consistent acoustic correlate of the tongue root contrast was found to be the first formant frequency which consistently distinguishes four of the five vowel pairs, the exception being the two low vowels. Three of the five pairs could also be distinguished by F2, though the direction of the difference was not consistent. Additionally, a comparison of corresponding advanced and retracted vowels using a normalized measure of relative formant intensity demonstrated that this correlate could also distinguish them in general, but only operated reliably in two of the five vowel pairs. The pair of low vowels could not be distinguished from each other by any of these measures. Finally, a perceptual study was conducted which demonstrates that Degema speakers do not classify their vowels very well using formant frequencies as the sole acoustic variable; only the two pairs of mid vowels were reliably singled out by native listeners from an array of synthesized vowels.

[3H]imipramine binding in the retinas of chickens and pigs

High-affinity [3H]imipramine binding sites detected in the brain are associated with the neural uptake mechanism for serotonin. In this study [3H]imipramine binding in the retinal synaptosomal P2-fraction, which contains the serotonin-accumulating nerve terminals, was characterized using two different animal species, chicken and pig, and with a wide range of imipramine concentrations. The specific binding of imipramine was saturable. When homogenates were prepared from fresh retinas, a high-affinity binding site in the nanomolar range and a low-affinity binding site in the micromolar range were always found. In the pig retina only a high-affinity binding site was found after freezing. The Bmax-value of the high-affinity binding was about 10 times greater in the retinas of pigs than in those of chickens; Bmax-values for fresh homogenates were 1711- and 235 fmol mg-1 protein and those for frozen homogenates were 2066- and 146 fmol mg-1 protein in pig and chicken retinas, respectively. Our results confirm the complexity of imipramine binding described for different regions of the brain. The great difference in the Bmax-values of the high-affinity binding in chicken and pig retinas might indicate differences between species in the serotonergic system.

Effects of melatonin and 6-methoxy-tetrahydro-beta-carboline in light induced retinal damage: a computerized morphometric method

The effects of melatonin and a related 5-methoxy-indole, 6-methoxy-1,2,3,4-tetrahydro-beta-carboline (6-MeO-THBC) were investigated in rats on the development of retinal degeneration in presence of high intensity illumination (HII). A morphometric method is used in which the degree of degeneration was evaluated by a computer-coupled graphical analyzer. Instead of measuring individual thicknesses of different retinal layers at various loci we measured large areas of retinal light microscopic sections. Thus the influence of sporadic artefactual and other fluctuations in the thickness of various layers of the retina can be essentially reduced. Continuous light produced significant degeneration of the retina and the degree of degeneration was further increased by both studied compounds and even more by 6-MeO-THBC. The role of melatonin and 6-MeO-THBC in retinal physiology is discussed.

Distribution of 1,2,3,4-tetrahydro-beta-carboline and 6-methoxy-1,2,3,4-tetrahydro-beta-carboline in mice

The distribution of radioactivity after intravenous injection of 14C-labelled 1,2,3,4-tetrahydro-beta-carboline (THBC) and 6-methoxy-1,2,3,4-tetrahydro-beta-carboline (6-MeO-THBC) was studied on mice by whole-body autoradiography and by liquid scintillation counting (LSC). Following intravenous injection they rapidly distributed into different organs and were excreted into urine and the gut contents. A considerable uptake of the compounds was seen in the lungs, kidney, liver, bone marrow, urinary bladder, gastrointestinal tract and in various glands e.g. adrenal, Harderian and salivary glands. THBC moderately penetrated the blood-brain barrier and the placenta but 6-MeO-THBC seemed to penetrate poorly both. At early stages of the experiment the values of tissue radioactivity in LSC were generally much higher in the THBC group but 24 hours following injections the reverse was true with higher activities in the 6-MeO-THBC group. The initial excretion of 6-MeO-THBC seemed to be more rapid judged by the superfluous accumulation of activity in the bladder and a high accumulation of activity into the gut contents.