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Witzig TE, LaPlant B, Habermann TM, McPhail E, Inwards DJ, Micallef IN, Colgan JP, Nowakowski GS, Ansell SM, Johnston PB. High rate of event-free survival at 24 months with everolimus/RCHOP for untreated diffuse large B-cell lymphoma: updated results from NCCTG N1085 (Alliance). Blood Cancer J 2017. [PMID: 28649983 PMCID: PMC5520404 DOI: 10.1038/bcj.2017.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- T E Witzig
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - B LaPlant
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - T M Habermann
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - E McPhail
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - D J Inwards
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - I N Micallef
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - J P Colgan
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - G S Nowakowski
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - S M Ansell
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - P B Johnston
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
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Witzig TE, Maurer MJ, Habermann TM, Link BK, Micallef IN, Nowakowski GS, Ansell SM, Colgan JP, Inwards DJ, Porrata LF, Markovic SN, Johnston PB, Lin Y, Thompson C, Gupta M, Katzmann JA, Cerhan JR. Elevated monoclonal and polyclonal serum immunoglobulin free light chain as prognostic factors in B- and T-cell non-Hodgkin lymphoma. Am J Hematol 2014; 89:1116-20. [PMID: 25228125 DOI: 10.1002/ajh.23839] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 12/13/2022]
Abstract
The serum immunoglobulin free light chain (FLC) assay quantitates free kappa (κ) and lambda (λ) light chains. FLC elevations in patients with diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and chronic lymphocytic leukemia (CLL) are associated with an inferior survival. These increases in FLC can be monoclonal (as in myeloma) or polyclonal. The goal was to estimate the frequency of these elevations within distinct types of B-cell and T-cell non-Hodgkin lymphoma (NHL) and whether the FLC measurements are associated with event-free survival (EFS). We studied serum for FLC abnormalities using normal laboratory reference ranges to define an elevated κ or λ FLC. Elevations were further classified as polyclonal or monoclonal. Four hundred ninety-two patients were studied: 453 B-cell and 34 T-cell NHL patients. Twenty-nine % (142/453) of patients had an elevated FLC of which 10% were monoclonal elevations. Within B-cell NHL, FLC abnormalities were most common in lymphoplasmacytic (79%), mantle cell (68%), and lymphomas of mucosa associated lymphoid tissue (31%); they were least common in follicular (15%). The hazard ratio (HR) for EFS in all patients was 1.41 (95% CI; 1.11-1.81); in all B-cell NHL the HR was 1.44 (95% CI 1.11-1.96); in all T-cell NHL the HR was 1.17 (95% CI 0.55-2.49). FLC abnormalities predicted an inferior OS (HR = 2.75, 95% CI: 1.93-3.90, P < 0.0001). The serum FLC assay is useful for prognosis in both B-cell and T-cell types of NHL. In B-cell NHL further discrimination between a monoclonal and polyclonal elevation may be helpful and should be analyzed in prospective clinical trials.
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Affiliation(s)
| | | | | | - Brian K. Link
- Department of Internal Medicine; University of Iowa College of Medicine; Iowa City Iowa
| | | | | | | | | | | | | | | | | | - Yi Lin
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Mamta Gupta
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Jerry A. Katzmann
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - James R. Cerhan
- Department of Health Sciences; Mayo Clinic; Rochester Minnesota
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Witzig TE, Wiseman GA, Maurer MJ, Habermann TM, Micallef IN, Nowakowski GS, Ansell SM, Colgan JP, Inwards DJ, Porrata LF, Link BK, Zent CS, Johnston PB, Shanafelt TD, Allmer C, Asmann YW, Gupta M, Ballas ZK, Smith BJ, Weiner GJ. A phase I trial of immunostimulatory CpG 7909 oligodeoxynucleotide and 90 yttrium ibritumomab tiuxetan radioimmunotherapy for relapsed B-cell non-Hodgkin lymphoma. Am J Hematol 2013; 88:589-93. [PMID: 23619698 DOI: 10.1002/ajh.23460] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 01/21/2023]
Abstract
Radioimmunotherapy (RIT) for relapsed indolent non-Hodgkin lymphoma produces overall response rates (ORR) of 80% with mostly partial remissions. Synthetic CpG oligonucleotides change the phenotype of malignant B-cells, are immunostimulatory, and can produce responses when injected intratumorally and combined with conventional radiation. In this phase I trial, we tested systemic administration of both CpG and RIT. Eligible patients had biopsy-proven previously treated CD20+ B-cell NHL and met criteria for RIT. Patients received rituximab 250 mg/m(2) days 1,8, and 15; (111) In-ibritumomab tiuxetan days 1, 8; CpG 7909 days 6, 13, 20, 27; and 0.4 mCi/kg of (90) Y-ibritumomab tiuxetan day 15. The doses of CpG 7909 tested were 0.08, 0.16, 0.32 (six patients each) and 0.48 mg/kg (12 patients) IV over 2 hr without dose limiting toxicity. The ORR was 93% (28/30) with 63% (19/30) complete remission (CR); median progression free survival of 42.7 months (95% CI 18-NR); and median duration of response (DR) of 35 months (4.6-76+). Correlative studies demonstrated a decrease in IL10 and TNFα, and an increase in IL1β, in response to therapy. CpG 7909 at a dose of 0.48 mg/kg is safe with standard RIT and produces a high CR rate and long DR; these results warrant confirmation.
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Affiliation(s)
- Thomas E. Witzig
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Gregory A. Wiseman
- Department of Radiology; Division of Nuclear Medicine; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Matthew J. Maurer
- Division of Biomedical Statistics & Informatics; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Thomas M. Habermann
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Ivana N.M. Micallef
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Grzegorz S. Nowakowski
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Stephen M. Ansell
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Joseph P. Colgan
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - David J. Inwards
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Luis F. Porrata
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Brian K. Link
- Department of Internal Medicine and the Holden Comprehensive Cancer Center; University of Iowa; Iowa City Iowa
| | - Clive S. Zent
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Patrick B. Johnston
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Tait D. Shanafelt
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Cristine Allmer
- Division of Biomedical Statistics & Informatics; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Yan W. Asmann
- Division of Biomedical Statistics & Informatics; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Mamta Gupta
- Department of Internal Medicine; Division of Hematology; Mayo Clinic College of Medicine and Mayo Foundation; Rochester Minnesota
| | - Zuhair K. Ballas
- Department of Internal Medicine and the Holden Comprehensive Cancer Center; University of Iowa; Iowa City Iowa
| | - Brian J. Smith
- Department of Internal Medicine and the Holden Comprehensive Cancer Center; University of Iowa; Iowa City Iowa
| | - George J. Weiner
- Department of Internal Medicine and the Holden Comprehensive Cancer Center; University of Iowa; Iowa City Iowa
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Vaidya R, Habermann TM, Donohue JH, Ristow KM, Maurer MJ, Macon WR, Colgan JP, Inwards DJ, Ansell SM, Porrata LF, Micallef IN, Johnston PB, Markovic SN, Thompson CA, Nowakowski GS, Witzig TE. Bowel perforation in intestinal lymphoma: incidence and clinical features. Ann Oncol 2013; 24:2439-43. [PMID: 23704194 DOI: 10.1093/annonc/mdt188] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Perforation is a serious life-threatening complication of lymphomas involving the gastrointestinal (GI) tract. Although some perforations occur as the initial presentation of GI lymphoma, others occur after initiation of chemotherapy. To define the location and timing of perforation, a single-center study was carried out of all patients with GI lymphoma. PATIENTS AND METHODS Between 1975 and 2012, 1062 patients were identified with biopsy-proven GI involvement with lymphoma. A retrospective chart review was undertaken to identify patients with gut perforation and to determine their clinicopathologic features. RESULTS Nine percent (92 of 1062) of patients developed a perforation, of which 55% (51 of 92) occurred after chemotherapy. The median day of perforation after initiation of chemotherapy was 46 days (mean, 83 days; range, 2-298) and 44% of perforations occurred within the first 4 weeks of treatment. Diffuse large B-cell lymphoma (DLBCL) was the most common lymphoma associated with perforation (59%, 55 of 92). Compared with indolent B-cell lymphomas, the risk of perforation was higher with aggressive B-cell lymphomas (hazard ratio, HR = 6.31, P < 0.0001) or T-cell/other types (HR = 12.40, P < 0.0001). The small intestine was the most common site of perforation (59%). CONCLUSION Perforation remains a significant complication of GI lymphomas and is more frequently associated with aggressive than indolent lymphomas. Supported in part by University of Iowa/Mayo Clinic SPORE CA97274 and the Predolin Foundation.
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Affiliation(s)
- R Vaidya
- Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN 55905, USA
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Dispenzieri A, Seenithamby K, Lacy MQ, Kumar SK, Buadi FK, Hayman SR, Dingli D, Litzow MR, Gastineau DA, Inwards DJ, Micallef IN, Ansell SM, Johnston PB, Porrata LF, Patnaik MM, Hogan WJ, Gertz MAA. Patients with immunoglobulin light chain amyloidosis undergoing autologous stem cell transplantation have superior outcomes compared with patients with multiple myeloma: a retrospective review from a tertiary referral center. Bone Marrow Transplant 2013; 48:1302-7. [DOI: 10.1038/bmt.2013.53] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 11/09/2022]
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Nowakowski GS, LaPlant B, Habermann TM, Rivera CE, Macon WR, Inwards DJ, Micallef IN, Johnston PB, Porrata LF, Ansell SM, Klebig RR, Reeder CB, Witzig TE. Lenalidomide can be safely combined with R-CHOP (R2CHOP) in the initial chemotherapy for aggressive B-cell lymphomas: phase I study. Leukemia 2011; 25:1877-81. [PMID: 21720383 DOI: 10.1038/leu.2011.165] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lenalidomide was shown to have significant single-agent activity in relapsed aggressive non-Hodgkin's lymphoma (NHL). We conducted a phase I trial to establish the maximum tolerated dose of lenalidomide that could be combined with R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone). Eligible patients were adults with newly diagnosed, untreated CD20 positive diffuse large cell or follicular grade III NHL. Patients received oral lenalidomide on days 1-10 with standard dose R-CHOP every 21 days. All patients received pegfilgrastim on day 2 of the cycle and aspirin prophylaxis. The lenalidomide dose levels tested were 15, 20 and 25 mg. A total of 24 patients were enrolled. The median age was 65 (35-82) years and 54% were over 60 years. Three patients received 15 mg, 3 received 20 mg and 18 received 25 mg of lenalidomide. No dose limiting toxicity was found, and 25 mg on days 1-10 is the recommended dose for phase II. The incidence of grade IV neutropenia and thrombocytopenia was 67% and 21%, respectively. Febrile neutropenia was rare (4%) and there were no toxic deaths. The overall response rate was 100% with a complete response rate of 77%. Lenalidomide at the dose of 25 mg/day administered on days 1 to 10 of 21-day cycle can be safely combined with R-CHOP in the initial chemotherapy of aggressive B-cell lymphoma.
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Affiliation(s)
- G S Nowakowski
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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Maurer MJ, Micallef IN, Cerhan JR, Katzmann JA, Link BK, Colgan JP, Habermann TM, Inwards DJ, Markovic SN, Ansell SM, Porrata LF, Johnston PB, Nowakowski GS, Thompson CA, Gupta M, Syrbu SI, Kurtin PJ, Macon WR, Nikcevich DA, Witzig TE. Elevated serum free light chains are associated with event-free and overall survival in two independent cohorts of patients with diffuse large B-cell lymphoma. J Clin Oncol 2011; 29:1620-6. [PMID: 21383282 PMCID: PMC3082979 DOI: 10.1200/jco.2010.29.4413] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 11/18/2010] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The serum free light chain (FLC) assay quantitates free kappa (κ) and free lambda (λ) immunoglobulin light chains. This assay has prognostic value in plasma cell proliferative disorders. There are limited data on serum FLC in B-cell malignancies. PATIENTS AND METHODS The association of pretreatment FLC with event-free survival (EFS) and overall survival (OS) in diffuse large B-cell lymphoma (DLBCL) was evaluated in 76 patients from the North Central Cancer Treatment Group trial N0489 (NCT00301821) and 219 patients from the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource (MER). Published reference ranges were used to define an elevated FLC or an abnormal κ:λ FLC ratio. RESULTS Elevated FLC or abnormal κ:λ FLC ratio was present in 32% and 14% of patients, respectively. Patients with elevated FLC had an inferior OS and EFS in both cohorts compared with patients with normal FLC (N0489: EFS hazard ratio [HR], 3.06; OS HR, 3.16; both P < .02; MER: EFS HR, 2.42; OS HR, 3.40; both P < .001; combined EFS HR, 2.57; OS HR, 3.74; both P < .001). All associations remained significant for EFS and OS after adjusting for the International Prognostic Index (IPI). Abnormal κ:λ FLC ratio was modestly associated with outcome in the combined group (EFS HR, 1.61; OS HR, 1.67; both P = .07), but not in patients without corresponding elevated κ or λ. Elevated FLC was the strongest predictor of outcome in multivariable models with the IPI components. CONCLUSION Increased serum FLC is an independent, adverse prognostic factor for EFS and OS in DLBCL and warrants further evaluation as a biomarker in DLBCL.
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Affiliation(s)
- Matthew J. Maurer
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Ivana N.M. Micallef
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - James R. Cerhan
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Jerry A. Katzmann
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Brian K. Link
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Joseph P. Colgan
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Thomas M. Habermann
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - David J. Inwards
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Svetomir N. Markovic
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Stephen M. Ansell
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Luis F. Porrata
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Patrick B. Johnston
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Grzegorz S. Nowakowski
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Carrie A. Thompson
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Mamta Gupta
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Sergei I. Syrbu
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Paul J. Kurtin
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - William R. Macon
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Daniel A. Nikcevich
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
| | - Thomas E. Witzig
- From the Mayo Clinic College of Medicine and Mayo Foundation, Rochester; Duluth Community Clinical Oncology Program, Duluth, MN; and University of Iowa, Iowa City, IA
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Witzig TE, Reeder CB, LaPlant BR, Gupta M, Johnston PB, Micallef IN, Porrata LF, Ansell SM, Colgan JP, Jacobsen ED, Ghobrial IM, Habermann TM. A phase II trial of the oral mTOR inhibitor everolimus in relapsed aggressive lymphoma. Leukemia 2010; 25:341-7. [PMID: 21135857 PMCID: PMC3049870 DOI: 10.1038/leu.2010.226] [Citation(s) in RCA: 257] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The phosphatidylinositol 3-kinase signal transduction pathway members are often activated in tumor samples from patients with non-Hodgkin's lymphoma (NHL). Everolimus is an oral agent that targets the raptor mammalian target of rapamycin (mTORC1). The goal of this trial was to learn the antitumor activity and toxicity of single-agent everolimus in patients with relapsed/refractory aggressive NHL. Patients received everolimus 10 mg PO daily. Response was assessed after two and six cycles, and then every three cycles until progression. A total of 77 patients with a median age of 70 years were enrolled. Patients had received a median of three previous therapies and 32% had undergone previous transplant. The overall response rate (ORR) was 30% (95% confidence interval: 20-41%), with 20 patients achieving a partial remission and 3 a complete remission unconfirmed. The ORR in diffuse large B cell was 30% (14/47), 32% (6/19) in mantle cell and 38% (3/8) in follicular grade 3. The median duration of response was 5.7 months. Grade 3 or 4 anemia, neutropenia and thrombocytopenia occurred in 14, 18 and 38% of patients, respectively. Everolimus has single-agent activity in relapsed/refractory aggressive NHL and provides proof-of-concept that targeting the mTOR pathway is clinically relevant.
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Affiliation(s)
- T E Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN 55905, USA.
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Naina HV, Pruthi RK, Inwards DJ, Dingli D, Litzow MR, Ansell SM, William HJ, Dispenzieri A, Buadi FK, Elliott MA, Gastineau DA, Gertz MA, Hayman SR, Johnston PB, Lacy MQ, Micallef IN, Porrata LF, Kumar S. Low risk of symptomatic venous thromboembolic events during growth factor administration for PBSC mobilization. Bone Marrow Transplant 2010; 46:291-3. [PMID: 20436522 DOI: 10.1038/bmt.2010.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The use of erythropoietic agents has been associated with an increased risk of venous thromboembolic events (VTEs), especially in patients with underlying malignancies. However, it is not known whether there is an increased risk of VTE associated with granulocyte growth factors. We reviewed 621 patients undergoing PBSC mobilization using granulocyte growth factors, alone or in combination with CY. Patients with a diagnosis of AL amyloidosis (AL: 114; 18%), multiple myeloma (MM: 278; 44%) Hodgkin lymphoma (HL: 20; 3%) or non-Hodgkin lymphoma (NHL: 209; 33%) were included. Symptomatic VTE occurred in six (0.97%) patients: two AL, two MM and two NHL. Of the six patients, two had pulmonary embolism, one developed deep vein thrombosis and three developed symptomatic catheter related thrombosis. Two patients with AL had heparin-induced thrombocytopenia and thrombosis. We found a low incidence of VTE among patients undergoing PBSC mobilization.
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Affiliation(s)
- H V Naina
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55906, USA
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Porrata LF, Ristow K, Witzig TE, Tuinistra N, Habermann TM, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Markovic SN. Absolute lymphocyte count predicts therapeutic efficacy and survival at the time of radioimmunotherapy in patients with relapsed follicular lymphomas. Leukemia 2007; 21:2554-6. [PMID: 17581607 DOI: 10.1038/sj.leu.2404819] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Joao C, Porrata LF, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Gastineau DA, Markovic SN. Early lymphocyte recovery after autologous stem cell transplantation predicts superior survival in mantle-cell lymphoma. Bone Marrow Transplant 2006; 37:865-71. [PMID: 16532015 DOI: 10.1038/sj.bmt.1705342] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autologous stem cell transplantation (ASCT) is an effective treatment strategy for mantle-cell lymphoma (MCL) demonstrating significantly prolonged progression-free survival (PFS) when compared to interferon-alpha maintenance therapy of patients in first remission. The study of absolute lymphocyte count at day 15 (ALC-15) after ASCT as a prognostic factor in non-Hodgkin lymphoma (NHL) included different lymphoma subtypes. The relationship of ALC-15 after ASCT in MCL has not been specifically addressed. We evaluated the impact of ALC-15 recovery on survival of MCL patients undergoing ASCT. We studied 42 consecutive MCL patients who underwent ASCT at the Mayo Clinic in Rochester from 1993 to 2005. ALC-15 threshold was set at 500 cells/microl. The median follow-up after ASCT was 25 months (range, 2-106 months). The median overall survival (OS) and PFS times were significantly better for the 24 patients who achieved an ALC-15 >or=500 cells/microl compared with 18 patients with ALC-15 <500 cells/microl (not reached vs 30 months, P<0.01 and not reached vs 16 months, P<0.0006, respectively). Multivariate analysis demonstrated ALC-15 to be an independent prognostic factor for OS and PFS. The ALC-15 >or=500 cells/microl is associated with a significantly improved clinical outcome following ASCT in MCL.
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Affiliation(s)
- C Joao
- Hematology Department, Portuguese Institute of Oncology, Lisbon, Portugal
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Buadi FK, Micallef IN, Ansell SM, Porrata LF, Dispenzieri A, Elliot MA, Gastineau DA, Gertz MA, Lacy MQ, Litzow MR, Tefferi A, Inwards DJ. Autologous hematopoietic stem cell transplantation for older patients with relapsed non-Hodgkin's lymphoma. Bone Marrow Transplant 2006; 37:1017-22. [PMID: 16633361 DOI: 10.1038/sj.bmt.1705371] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [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: 01/02/2023]
Abstract
To evaluate autologous stem cell transplant (ASCT) in older patients with intermediate grade non-Hodgkin's lymphoma (NHL), the Mayo Clinic Rochester BMT database was reviewed for all patients 60 years of age and older who received ASCT for NHL between September 1995 and February 2003. Factors evaluated included treatment-related mortality (TRM), event-free survival (EFS) and overall survival (OS). Ninety-three patients were identified, including twenty-four (26%) over the age of 70 years. Treatment-related mortality (5.4%) was not significantly different when compared to a younger cohort (2.2%). At a median follow-up of 14 months (0.6-87.6 months), the estimated median survival is 25 months (95% confidence interval (CI) 12-38) in the older group compared to 56 months (95% CI 37-75) (P=0.037) in the younger group. The estimated 4-year EFS was 38% for the older group compared to 42% in the younger cohort (P=0.1). By multivariate analysis, the only factor found to influence survival in the older group was age-adjusted International Prognostic Index at relapse, 0-1 better than 2-3 (P=0.03). Autologous stem-cell transplant can be safely performed in patients 60 years or older with chemotherapy sensitive relapsed or first partial remission NHL. The outcome may not be different from that of younger patients in terms of TRM and EFS.
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Affiliation(s)
- F K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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13
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Elliott MA, Tefferi A, Hogan WJ, Letendre L, Gastineau DA, Ansell SM, Dispenzieri A, Gertz MA, Hayman SR, Inwards DJ, Lacy MQ, Micallef IN, Porrata LF, Litzow MR. Allogeneic stem cell transplantation and donor lymphocyte infusions for chronic myelomonocytic leukemia. Bone Marrow Transplant 2006; 37:1003-8. [PMID: 16604096 DOI: 10.1038/sj.bmt.1705369] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [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: 11/09/2022]
Abstract
Prognosis in chronic myelomonocytic leukemia (CMML) is unfavorable and the optimal therapy remains uncertain. Currently, allogeneic stem cell transplantation is the only known curative therapeutic option. However, the data available are limited and restricted to small retrospective series. There is even less information on the use of donor lymphocyte infusions (DLI) for this disease. We reviewed our experience of allogeneic stem cell transplantation and DLI for adults with CMML. Seventeen consecutive adults underwent allogeneic stem cell transplantation from related (n=14) or unrelated (n=3) donors. Median age was 50 years (range 26-60). Seven patients (41%) demonstrated relapse or persistent disease at a median of 6 months (range 3-55.5). Five patients underwent DLI for morphologic relapse and one for mixed donor chimerism. Two patients achieved durable complete remissions of 15 months each. The overall transplant-related mortality was 41% (n=7). With a median follow-up of 34.5 months, three patients (18%) currently remain alive and in continuous CR. The current study demonstrates a graft-versus-leukemia effect in CMML, both for allogeneic stem cell transplantation and for DLI. Nevertheless, consistent with reported experience of others, overall outcomes remain less than optimal and unpredictable.
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Affiliation(s)
- M A Elliott
- Hematology/Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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14
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Davies AJ, Rohatiner AZS, Howell S, Britton KE, Owens SE, Micallef IN, Deakin DP, Carrington BM, Lawrance JA, Vinnicombe S, Mather SJ, Clayton J, Foley R, Jan H, Kroll S, Harris M, Amess J, Norton AJ, Lister TA, Radford JA. Tositumomab and Iodine I 131 Tositumomab for Recurrent Indolent and Transformed B-Cell Non-Hodgkin’s Lymphoma. J Clin Oncol 2004; 22:1469-79. [PMID: 15084620 DOI: 10.1200/jco.2004.06.055] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [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
Purpose An open-label phase II study was conducted at two centers to establish the efficacy and safety of tositumomab and iodine I 131 tositumomab at first or second recurrence of indolent or transformed indolent B-cell lymphoma. Patients and Methods A single dosimetric dose was followed at 7 to 14 days by the patient-specific administered radioactivity required to deliver a total body dose of 0.75 Gy (reduced to 0.65 Gy for patients with platelets counts of 100 to 149 × 109/L). Forty of 41 patients received both infusions. Results Thirty-one of 41 patients (76%) responded, with 20 patients (49%) achieving either a complete (CR) or unconfirmed complete remission [CR(u)] and 11 patients (27%) achieving a partial remission. Response rates were similar in both indolent (76%) and transformed disease (71%). The overall median duration of remission was 1.3 years. The median duration of remission has not yet been reached for those patients who achieved a CR or CR(u). Eleven patients continue in CR or CR(u) between 2.6+ and 5.2+ years after therapy. Therapy was well tolerated; hematologic toxicity was the principal adverse event. Grade 3 or 4 anemia, neutropenia, and thrombocytopenia were observed in 5%, 45%, and 32% of patients, respectively. Secondary myelodysplasia has occurred in one patient. Four patients developed human antimouse antibodies after therapy. Five of 38 assessable patients have developed an elevated thyroid-stimulating hormone; treatment with thyroxine has been initiated in one patient. Conclusion High overall and CR rates were observed after a single dose of tositumomab and iodine I 131 tositumomab in this patient group. Toxicity was modest and easily managed.
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Affiliation(s)
- A J Davies
- Cancer Research UK Medical Oncology Unit, Department of Medical Oncology, 45 Little Britain, St Bartholomew's Hospital, London EC1A 7BE, United Kingdom.
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15
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Micallef IN, Apostolidis J, Rohatiner AZ, Wiggins C, Crawley CR, Foran JM, Leonhardt M, Bradburn M, Okukenu E, Salam A, Matthews J, Cavenagh JD, Gupta RK, Lister TA. Factors which predict unsuccessful mobilisation of peripheral blood progenitor cells following G-CSF alone in patients with non-Hodgkin's lymphoma. Hematol J 2002; 1:367-73. [PMID: 11920216 DOI: 10.1038/sj.thj.6200061] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2000] [Accepted: 06/15/2000] [Indexed: 11/09/2022]
Abstract
INTRODUCTION High-dose therapy with haematopoietic progenitor cell support has increasingly been utilised for patients with haematological malignancies. Peripheral blood is the stem cell source of choice, however, various mobilisation strategies are used by different centres. PATIENTS AND METHODS Over a 2-year period, 52 patients with non-Hodgkin's lymphoma (median age 47 years, range 16-64 years) underwent peripheral blood progenitor cell mobilisation using G-CSF alone (16 microg/kg/day). The harvest was considered successful if > or =1 x 10(6) CD34(+) cells/kg were collected by leukapheresis. The histological subtypes of non-Hodgkin's lymphoma comprised: follicular (24 patients), diffuse large B-cell (14 patients), lymphoplasmacytoid (four patients), mantle cell (three patients), lymphoblastic lymphoma (one patient) and small lymphocytic lymphoma/chronic lymphocytic leukaemia (six patients). The median interval from diagnosis of non-Hodgkin's lymphoma to mobilisation was 27 months (range 2 months to 17 years). The median number of prior treatment episodes was 2 (range 1-5); 26 patients had received fludarabine alone or in combination. At the time of peripheral blood progenitor cell mobilisation, 20 patients were in 1st remission and 32 were in > or =2nd remission; 30 patients were in partial remission and 22 were in complete remission; the bone marrow was involved in nine patients. RESULTS Peripheral blood progenitor cell mobilisation/harvest was unsuccessful in 19 out of 52 (37%) patients (mobilisation: 18, harvest: 1). The factors associated with unsuccessful mobilisation or harvest were: prior fludarabine therapy (P=0.002), bone marrow involvement at diagnosis (P=0.002), bone marrow involvement anytime prior to mobilisation (P=0.02), histological diagnosis of follicular, mantle cell, or lymphoplasmacytoid lymphoma, or small lymphocytic lymphoma/chronic lymphocytic leukaemia (P=0.03) and female gender (P=0.04). CONCLUSION Although peripheral blood progenitor cells can be successfully mobilised and harvested from the majority of patients with non-Hodgkin's lymphoma after treatment with G-CSF alone, the latter is unsuccessful in approximately one-third of patients. These factors should be taken into account when patients are being considered for high-dose treatment.
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Affiliation(s)
- I N Micallef
- Imperial Cancer Research Fund Medical Oncology Unit, Department of Medical Oncology, St. Bartholomew's Hospital, 45 Little Britain, West Smithfield, London EC1A 7BE, UK
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16
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Foran JM, Norton AJ, Micallef IN, Taussig DC, Amess JA, Rohatiner AZ, Lister TA. Loss of CD20 expression following treatment with rituximab (chimaeric monoclonal anti-CD20): a retrospective cohort analysis. Br J Haematol 2001; 114:881-3. [PMID: 11564080 DOI: 10.1046/j.1365-2141.2001.03019.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [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
A retrospective analysis of CD20 expression following rituximab for B-cell non-Hodgkin's lymphoma demonstrated a significant change in immunophenotype in 6/25 (24%) patients with persistent bone marrow (BM) infiltration. In three out of six patients, the B cells were uniformly CD20-/CD79alpha+, consistent with frank loss of CD20 expression. In the remaining three cases, the BM infiltrate was predominantly (> 80%) CD20-/CD79alpha+. Two of the former but none of the latter three cases achieved a clinical response. In three further cases, the post-treatment BM infiltrate was composed entirely of benign or reactive CD3+ T cells. Frank loss of CD20 was not seen in 25 post-treatment lymph node biopsies. Immunophenotyping is therefore an important adjunct in the diagnosis of BM infiltration following rituximab.
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MESH Headings
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD/immunology
- Antigens, CD20/immunology
- Antineoplastic Agents/adverse effects
- B-Lymphocytes/immunology
- Bone Marrow Cells/immunology
- CD3 Complex/immunology
- CD79 Antigens
- Humans
- Immunophenotyping
- Immunotherapy
- Leukemic Infiltration
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/therapy
- Receptors, Antigen, B-Cell/immunology
- Retrospective Studies
- Rituximab
- T-Lymphocytes, Cytotoxic/immunology
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Affiliation(s)
- J M Foran
- Imperial Cancer Research Fund Medical Oncology Unit, St. Bartholomew's Hospital, London, UK.
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17
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Porrata LF, Gertz MA, Inwards DJ, Litzow MR, Lacy MQ, Tefferi A, Gastineau DA, Dispenzieri A, Ansell SM, Micallef IN, Geyer SM, Markovic SN. Early lymphocyte recovery predicts superior survival after autologous hematopoietic stem cell transplantation in multiple myeloma or non-Hodgkin lymphoma. Blood 2001; 98:579-85. [PMID: 11468153 DOI: 10.1182/blood.v98.3.579] [Citation(s) in RCA: 229] [Impact Index Per Article: 10.0] [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
Autologous stem cell transplantation (ASCT) improves survival in patients with previously untreated multiple myeloma (MM) and relapsed, chemotherapy-sensitive, aggressive non-Hodgkin lymphoma (NHL). Lower relapse rates seen in allogeneic stem cell transplantation have been related to early absolute lymphocyte count (ALC) recovery as a manifestation of early graft-verus-tumor effect. In ASCT, the relation between ALC recovery and clinical outcomes in MM and NHL was not previously described. This is a retrospective study of patients with MM and NHL who underwent ASCT at the Mayo Clinic between 1987 and 1999. The ALC threshold was determined at 500 cells/microL on day 15 after ASCT. The study identified 126 patients with MM and 104 patients with NHL. The median overall survival (OS) and progression-free survival (PFS) times for patients with MM were significantly longer in patients with an ALC of 500 cells/microL or more than patients with an ALC of fewer than 500 cells/microL (33 vs 12 months, P <.0001; 16 vs 8 months, P <.0003, respectively). For patients with NHL, the median OS and PFS times were significantly longer in patients with an ALC of 500 cells/microL or more versus those with fewer than 500 cells/microL (not reached vs 6 months, P <.0001; not reached vs 4 months, P <.0001, respectively). Multivariate analysis demonstrated day 15 ALC to be an independent prognostic indicator for OS and PFS rates for both groups of patients. In conclusion, ALC is correlated with clinical outcome and requires further study. (Blood. 2001;98:579-585)
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Affiliation(s)
- L F Porrata
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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18
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Lillington DM, Micallef IN, Carpenter E, Neat MJ, Amess JA, Matthews J, Foot NJ, Young BD, Lister TA, Rohatiner AZ. Detection of chromosome abnormalities pre-high-dose treatment in patients developing therapy-related myelodysplasia and secondary acute myelogenous leukemia after treatment for non-Hodgkin's lymphoma. J Clin Oncol 2001; 19:2472-81. [PMID: 11331326 DOI: 10.1200/jco.2001.19.9.2472] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [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
PURPOSE To assess whether pre-high-dose therapy (HDT)-related factors play a critical role in the development of therapy-related myelodysplasia (tMDS) or secondary acute myelogenous leukemia (sAML). PATIENTS AND METHODS Twenty-nine of 230 patients with a primary diagnosis of non-Hodgkin's lymphoma (NHL) developed tMDS/sAML after HDT comprising cyclophosphamide and total-body irradiation (TBI) supported by autologous hematopoietic progenitor cells. G-banding and fluorescence in-situ hybridization (FISH) were used to detect clonal cytogenetic abnormalities. RESULTS The majority of patients showed complex karyotypes at diagnosis of tMDS/sAML containing, in particular, complete or partial loss of chromosomes 5 and/or 7. Using single locus-specific FISH probes, significant levels of clonally abnormal cells were found before HDT in 20 of 20 tMDS/sAML patients screened, compared with three of 24 patients screened who currently have not developed tMDS/sAML, at a median follow-up of 5.9 years after HDT. CONCLUSION Prior cytotoxic therapy may play an important etiologic role and may predispose to the development of tMDS/sAML. Using a triple FISH assay designed to detect loss of chromosomal material from 5q31, 7q22, or 13q14, significant levels of abnormal cells can be detected before HDT and may predict which patients are at increased risk of developing secondary disease. Further prospective evaluation of this FISH assay is warranted to determine its predictive power in this setting.
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Affiliation(s)
- D M Lillington
- Imperial Cancer Research Fund, Department of Medical Oncology, St Bartholomew's Hospital, London, United Kingdom.
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19
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Micallef IN, Rohatiner AZ, Carter M, Boyle M, Slater S, Amess JA, Lister TA. Long-term outcome of patients surviving for more than ten years following treatment for acute leukaemia. Br J Haematol 2001; 113:443-5. [PMID: 11380414 DOI: 10.1046/j.1365-2141.2001.02788.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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
Between 1972 and 1988, 832 consecutive patients were treated for acute leukaemia at St. Bartholomew's Hospital; a retrospective analysis has been conducted to determine the clinical course and outcome for 101 who have survived > or = 10 years following treatment. At a median follow-up of 16 years (range 10-28 years), 86 patients (86 out of 834 total, 11%) were still alive. Long-term follow-up of patients who have survived > or = 10 years following treatment for acute leukaemia revealed that most patients were in normal health, although a significant number of complications had occurred.
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Affiliation(s)
- I N Micallef
- Department of Medical Oncology, St. Bartholomew's Hospital, London, UK
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20
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Jenner MJ, Micallef IN, Rohatiner AZ, Kelsey SM, Newland AC, Cavenagh JD. Successful therapy of transplant-associated veno-occlusive disease with a combination of tissue plasminogen activator and defibrotide. Med Oncol 2000; 17:333-6. [PMID: 11114714 DOI: 10.1007/bf02782200] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Accepted: 02/08/2000] [Indexed: 11/24/2022]
Abstract
A 36-year-old man underwent matched unrelated donor bone marrow transplantation for chronic myeloid leukaemia. He developed severe hepatic veno-occlusive disease as an early post-transplant complication. Tissue plasminogen activator was initially felt to be contraindicated since the patient had concomitant pericarditis. Defibrotide was therefore commenced as treatment for veno-occlusive disease. The pericarditis improved but the veno-occlusive disease continued to worsen (peak bilirubin 353 micromol/l). Tissue plasminogen activator followed by a heparin infusion was therefore administered. However, he proceeded to develop haemorrhagic cardiac tamponade that required drainage. Thrombolysis was therefore discontinued and treatment with defibrotide resumed after an interval of 48 h. The veno-occlusive disease gradually resolved and defibrotide was discontinued once the bilirubin had plateaued. He was discharged home on day +52 post-transplant.
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Affiliation(s)
- M J Jenner
- Imperial Cancer Research Fund Department of Medical Oncology, St Bartholomew's Hospital, London, UK.
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21
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Crawley CR, Foran JM, Gupta RK, Rohatiner AZ, Summers K, Matthews J, Micallef IN, Radford JA, Johnson SA, Johnson PW, Sweetenham JW, Lister TA. A phase II study to evaluate the combination of fludarabine, mitoxantrone and dexamethasone (FMD) in patients with follicular lymphoma. Ann Oncol 2000; 11:861-5. [PMID: 10997815 DOI: 10.1023/a:1008381105849] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 11/12/2022] Open
Abstract
BACKGROUND 'Molecular response' is being investigated as a therapeutic goal in follicular lymphoma (FL). High response rates in FL with the fludarabine combination 'FMD' have been associated with 'molecular remission'. A phase II study of FMD in FL was therefore conducted. PATIENTS AND METHODS Fifty-four patients, ten of whom were newly diagnosed received FMD. Forty-four percent of the previously treated patients had 'chemoresistant' disease. Treatment comprised: fludarabine 25 mg/m2 days 1-3, mitoxantrone 10 mg/m2 day 1, and dexamethasone 20 mg days 1-5. Blood/bone marrow was collected for quantitation of t(14;18) by 'real-time' PCR. RESULTS The overall response rate was 37 of 54 (69%), complete responses being seen in 11 patients (20%), with no difference between newly diagnosed and the previously treated patients. However, the response rate in 'chemosensitive' relapse was 84% compared to 44% in patients in whom the last prior regimen had failed. Molecular responses were seen in 17 of 25 and PCR negativity in 8 of 25, although molecular and clinical responses did not always correlate. Toxicity was moderate, 19 patients required admission. However, in 6 of 12 patients, subsequent G-CSF mobilised stem cell harvests failed. CONCLUSIONS FMD was well tolerated but with a lower than expected response rate. Molecular responses were seen in the majority of responding patients however, 'molecular remission' was rare.
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Affiliation(s)
- C R Crawley
- Department of Medical Oncology, St. Bartholomew's Hospital, London, UK
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22
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Micallef IN, Lillington DM, Apostolidis J, Amess JA, Neat M, Matthews J, Clark T, Foran JM, Salam A, Lister TA, Rohatiner AZ. Therapy-related myelodysplasia and secondary acute myelogenous leukemia after high-dose therapy with autologous hematopoietic progenitor-cell support for lymphoid malignancies. J Clin Oncol 2000; 18:947-55. [PMID: 10694543 DOI: 10.1200/jco.2000.18.5.947] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.7] [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
PURPOSE To evaluate the incidence of and risk factors for therapy-related myelodysplasia (tMDS) and secondary acute myelogenous leukemia (sAML), after high-dose therapy (HDT) with autologous bone marrow or peripheral-blood progenitor-cell support, in patients with non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Between January 1985 and November 1996, 230 patients underwent HDT comprising cyclophosphamide therapy and total-body irradiation, with autologous hematopoietic progenitor-cell support, as consolidation of remission. With a median follow-up of 6 years, 27 (12%) developed tMDS or sAML. RESULTS Median time to development of tMDS or sAML was 4.4 years (range, 11 months to 8.8 years) after HDT. Karyotyping (performed in 24 cases) at diagnosis of tMDS or sAML revealed complex karyotypes in 18 patients. Seventeen patients had monosomy 5/5q-, 15 had -7/7q-, seven had -18/18q-, seven had -13/13q-, and four had -20/20q-. Twenty-one patients died from complications of tMDS or sAML or treatment for tMDS or sAML, at a median of 10 months (range, 0 to 26 months). Sixteen died without evidence of recurrent lymphoma. Six patients were alive at a median follow-up of 6 months (range, 2 to 22 months) after diagnosis of tMDS or sAML. On multivariate analysis, prior fludarabine therapy (P =.009) and older age (P =.02) were associated with the development of tMDS or sAML. Increased interval from diagnosis to HDT and bone marrow involvement at diagnosis were of borderline significance (P =.05 and.07, respectively). CONCLUSION tMDS and sAML are serious complications of HDT for NHL and are associated with very poor prognosis. Alternative strategies for reducing their incidence and for treatment are needed.
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MESH Headings
- Adolescent
- Adult
- Aged
- Female
- Hematopoietic Stem Cell Transplantation/adverse effects
- Humans
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/etiology
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Outcome Assessment, Health Care
- Risk Factors
- Survival Rate
- Transplantation, Autologous/adverse effects
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Affiliation(s)
- I N Micallef
- Imperial Cancer Research Fund Medical Oncology Unit, Department of Medical Oncology, St Bartholomew's Hospital, London
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23
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Micallef IN, Kirk A, Norton A, Foran JM, Rohatiner AZ, Lister TA. Peripheral T-cell lymphoma following rituximab therapy for B-cell lymphoma. Blood 1999; 93:2427-8. [PMID: 10215354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
MESH Headings
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD20/immunology
- Antigens, Neoplasm/immunology
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy/adverse effects
- Fatal Outcome
- Humans
- Immunophenotyping
- Immunotherapy/adverse effects
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/radiotherapy
- Lymphoma, Non-Hodgkin/therapy
- Lymphoma, T-Cell, Peripheral/etiology
- Male
- Middle Aged
- Neoplasms, Second Primary/etiology
- Rituximab
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24
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Micallef IN, Chhanabhai M, Gascoyne RD, Shepherd JD, Fung HC, Nantel SH, Toze CL, Klingemann HG, Sutherland HJ, Hogge DE, Nevill TJ, Le A, Barnett MJ. Lymphoproliferative disorders following allogeneic bone marrow transplantation: the Vancouver experience. Bone Marrow Transplant 1998; 22:981-7. [PMID: 9849695 DOI: 10.1038/sj.bmt.1701468] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [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: 11/08/2022]
Abstract
Between June 1988 and May 1996, 428 patients underwent allogeneic BMT (288 related donor (RD) and 140 unrelated donor (UD)) at the Vancouver General Hospital. Eight patients (UD six and RD two) developed a post-transplant lymphoproliferative disorder (PTLD). Median age at BMT was 38 years (range 22-51). Five of the six UD allografts were T cell depleted. Cyclosporine+/-methotrexate was used for GVHD prophylaxis. All eight patients developed GVHD; in six this was refractory to treatment with corticosteroids. Rabbit antithymocyte globulin (ATG) or an anti-CD5-ricin A chain immunotoxin (Xomazyme) was used as second-line therapy for GVHD. Presentation with PTLD occurred at median day 90.5 (range 34-282) post BMT. Five of the eight patients had a rapidly progressive course characterized by fever, lymphadenopathy, lung and liver involvement and died within 3-8 days. PTLD was an incidental finding at post mortem examination in two patients. The remaining patient had localized disease and recovered. Pathological analysis revealed two morphological patterns; diffuse large B cell lymphoma (DLBC lymphoma, five patients) and polymorphous B cell hyperplasia (PBCH, three patients). EBV expression was positive in all eight cases and monoclonality was demonstrated in seven cases. In multivariate analysis, T cell depletion of the allograft (P=0.0001, relative risk (RR)=30.5), anti-T cell therapy for GVHD (P=0.006, RR=12.7) and acute GVHD grades 3-4 (P=0.04, RR=7.7) were the significant factors for development of PTLD. In conclusion, we have identified two forms of PTLD after BMT: one is characterized by disseminated disease with a rapidly progressive and often fulminant course and the other by localized, relatively indolent disease. Morphology, EBV positivity and clonality do not appear to correlate with the clinical course. The major risk factors for development of PTLD after BMT are ex vivo T cell depletion of the allograft and in vivo anti-T cell therapy for GVHD.
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Affiliation(s)
- I N Micallef
- Division of Hematology, British Columbia Cancer Agency, Vancouver General Hospital, University of British Columbia, Canada
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