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de Koning ME, Hof JJ, Jansen C, Doorduijn JK, Bromberg JEC, van der Meulen M. Primary central nervous system lymphoma. J Neurol 2024; 271:2906-2913. [PMID: 38112784 DOI: 10.1007/s00415-023-12143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin lymphoma (NHL) manifesting in the brain, spinal cord, cerebrospinal fluid and/or eyes, in the absence of systemic manifestations. With an increasing incidence and a 30% 5-year overall survival if promptly treated, timely diagnosis and subsequent treatment is paramount. The typical MRI appearance for PCNSL is a solitary or multiple T2-hypointense, homogeneous gadolinium-enhancing lesion with restricted diffusion. Dexamethasone treatment might compromise and delay the diagnosis. Hallmark of treatment is induction with intravenous high-dose methotrexate consisting polychemotherapy followed by consolidation treatment. Consolidation treatment consists of either whole brain radiotherapy (WBRT) or autologous stem cell transplantation (ASCT). Given the (cognitive) side effects of WBRT, ASCT is increasingly being used as the first choice of treatment.
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Affiliation(s)
- Myrthe E de Koning
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Jurrit J Hof
- Department of Radiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Casper Jansen
- Laboratory of Pathology Eastern Netherlands, Hengelo, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neurology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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2
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Bromberg JEC, Issa S, van der Holt B, van der Meulen M, Dirven L, Minnema MC, Seute T, Durian M, Cull G, van der Poel MWM, Stevens WBC, Zijlstra JM, Brandsma D, Nijland M, Mason KD, Beeker A, Abrahamse-Testroote MCJ, van den Bent MJ, de Jong D, Doorduijn JK. Survival, neurocognitive function, and health-related quality of life outcomes after rituximab-methotrexate, BCNU, teniposide, and prednisolone for primary CNS lymphoma: Final results of the HOVON 105/ALLG NHL 24 study. Neuro Oncol 2024; 26:724-734. [PMID: 38037691 PMCID: PMC10995504 DOI: 10.1093/neuonc/noad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Studies on the efficacy of rituximab in primary CNS lymphoma (PCNSL) reported conflicting results. Our international randomized phase 3 study showed that the addition of rituximab to high-dose methotrexate, BCNU, teniposide, and prednisolone (MBVP) in PCNSL was not efficacious in the short term. Here we present long-term results after a median follow-up of 82.3 months. METHODS One hundred and ninety-nine eligible newly diagnosed, nonimmunocompromised patients with PCNSL aged 18-70 years with WHO performance status 0-3 was randomized between treatment with MBVP chemotherapy with or without rituximab, followed by high-dose cytarabine consolidation in responding patients, and reduced-dose WBRT in patients aged ≤ 60 years. Event-free survival was the primary endpoint. Overall survival rate, neurocognitive functioning (NCF), and health-related quality of life (HRQoL) were additionally assessed, with the IPCG test battery, EORTC QLQ-C30 and QLQ-BN20 questionnaires, respectively. RESULTS For event-free survival, the hazard ratio was 0.85, 95% CI 0.61-1.18, P = .33. Overall survival rate at 5 years for MBVP and R-MBVP was 49% (39-59) and 53% (43-63) respectively. In total, 64 patients died in the MBVP arm and 55 in the R-MBVP arm, of which 69% were due to PCNSL. At the group level, all domains of NCF and HRQoL improved to a clinically relevant extent after treatment initiation, and remained stable thereafter up to 60 months of follow-up, except for motor speed which deteriorated between 24 and 60 months. Although fatigue improved initially, high levels persisted in the long term. CONCLUSIONS Long-term follow-up confirms the lack of added value of rituximab in addition to MBVP and HD-cytarabine for PCNSL.
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Affiliation(s)
- Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Bronno van der Holt
- HOVON Foundation, Rotterdam, The Netherlands
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, The Netherlands
| | - Tatjana Seute
- Department of Neurology, University Medical Center, Utrecht, The Netherlands
| | - Marc Durian
- Department of Hematology, ETZ Hospital, Tilburg, The Netherlands
| | - Gavin Cull
- Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- Department of Hematology, University of Western Australia, Crawley, Western Australia, Australia
| | - Marjolein W M van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Josee M Zijlstra
- Department of Hematology, Amsterdam UMC, VUMC, Amsterdam, The Netherlands
| | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel Nijland
- Department of Hematology, UMCG, Groningen, The Netherlands
| | - Kylie D Mason
- Department of Hematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Aart Beeker
- Department of Hematology, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology and HOVON Pathology, Facility and Biobank, Amsterdam UMC, VUMC, Amsterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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3
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Le Gouill S, Długosz-Danecka M, Rule S, Zinzani PL, Goy A, Smith SD, Doorduijn JK, Panizo C, Shah BD, Davies AJ, Eek R, Jacobsen E, Kater AP, Robak T, Jain P, Calvo R, Tao L, Wang M. Final results and overall survival data from a phase II study of acalabrutinib monotherapy in patients with relapsed/refractory mantle cell lymphoma, including those with poor prognostic factors. Haematologica 2024; 109:343-350. [PMID: 37470152 PMCID: PMC10772531 DOI: 10.3324/haematol.2022.282469] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
Not available.
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Affiliation(s)
| | | | - Simon Rule
- Plymouth University Medical School, Plymouth, UK; AstraZeneca, Mississauga, Ontario
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero- Universitaria di Bologna Istituto di Ematologia "Seràgnoli"; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Stephen D Smith
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA
| | - Jeanette K Doorduijn
- Erasmus MC Cancer Institute, on behalf of the HOVON Lunenburg Lymphoma Phase I/II Consortium, Rotterdam
| | | | | | - Andrew J Davies
- NIHR/Cancer Research UK Experimental Cancer Medicines Centre, University of Southampton Faculty of Medicine, Southampton
| | | | - Eric Jacobsen
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Arnon P Kater
- Amsterdam University Medical Center, Amsterdam, on behalf of the HOVON Lunenburg Lymphoma Phase I/II Consortium
| | - Tadeusz Robak
- Copernicus Memorial Hospital, Medical University of Lodz, Lodz
| | - Preetesh Jain
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | | | - Lin Tao
- AstraZeneca, South San Francisco, CA
| | - Michael Wang
- MD Anderson Cancer Center, University of Texas, Houston, TX.
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4
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Spanjaart AM, Pennings ERA, Mutsaers PGNJ, van Dorp S, Jak M, van Doesum JA, de Boer JW, Niezink AGH, Kos M, Vermaat JSP, Sijs-Szabo A, van der Poel MWM, Nijhof IS, Kuipers MT, Chamuleau MED, Lugtenburg PJ, Doorduijn JK, Serroukh YIM, Minnema MC, van Meerten T, Kersten MJ. The Dutch CAR-T Tumorboard Experience: Population-Based Real-World Data on Patients with Relapsed or Refractory Large B-Cell Lymphoma Referred for CD19-Directed CAR T-Cell Therapy in The Netherlands. Cancers (Basel) 2023; 15:4334. [PMID: 37686611 PMCID: PMC10486925 DOI: 10.3390/cancers15174334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/01/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The real-world results of chimeric antigen receptor T-cell (CAR-T) therapy for patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) substantially differ across countries. In the Netherlands, the CAR-T tumorboard facilitates a unique nationwide infrastructure for referral, eligibility assessment and data collection. The aim of this study was to evaluate real-world outcomes of axicabtagene ciloleucel (axi-cel) in the Dutch population, including the thus-far underreported effects on health-related quality of life (HR-QoL). All patients with R/R LBCL after ≥2 lines of systemic therapy referred for axi-cel treatment between May 2020-May 2022 were included (N = 250). Of the 160 apheresed patients, 145 patients received an axi-cel infusion. The main reason for ineligibility was rapidly progressive disease. The outcomes are better or at least comparable to other studies (best overall response rate: 84% (complete response: 66%); 12-month progression-free-survival rate and overall survival rate: 48% and 62%, respectively). The 12-month NRM was 5%, mainly caused by infections. Clinically meaningful improvement in several HR-QoL domains was observed from Month 9 onwards. Expert-directed patient selection can support effective and sustainable application of CAR-T treatment. Matched comparisons between cohorts will help to understand the differences in outcomes across countries and select best practices. Despite the favorable results, for a considerable proportion of patients with R/R LBCL there still is an unmet medical need.
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Affiliation(s)
- Anne M. Spanjaart
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
| | - Elise R. A. Pennings
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Pim G. N. J. Mutsaers
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Suzanne van Dorp
- Department of Hematology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Margot Jak
- Department of Hematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jaap A. van Doesum
- Department of Hematology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Janneke W. de Boer
- Department of Hematology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Anne G. H. Niezink
- Department of Radiation Oncology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Milan Kos
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Joost S. P. Vermaat
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Aniko Sijs-Szabo
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marjolein W. M. van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Inger S. Nijhof
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Internal Medicine-Hematology, St Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Maria T. Kuipers
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Martine E. D. Chamuleau
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Pieternella J. Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Jeanette K. Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Yasmina I. M. Serroukh
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Monique C. Minnema
- Department of Hematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Tom van Meerten
- Department of Hematology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
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5
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Huygens S, Dunbar A, Buil JB, Klaassen CHW, Verweij PE, van Dijk K, de Jonge N, Janssen JJWM, van der Velden WJFM, Biemond BJ, Bart A, Bruns AHW, Haas PJA, Demandt AMP, Oudhuis G, von dem Borne P, van der Beek MT, Klein SK, Godschalk P, Span LFR, Postma DF, Kampinga GA, Maertens J, Lagrou K, Mercier T, Moors I, Boelens J, Selleslag D, Reynders M, Zandijk W, Doorduijn JK, Cornelissen JJ, Schauwvlieghe AFAD, Rijnders BJA. Clinical Impact of Polymerase Chain Reaction-Based Aspergillus and Azole Resistance Detection in Invasive Aspergillosis: A Prospective Multicenter Study. Clin Infect Dis 2023; 77:38-45. [PMID: 36905147 PMCID: PMC10320047 DOI: 10.1093/cid/ciad141] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) by a triazole-resistant Aspergillus fumigatus is associated with high mortality. Real-time resistance detection will result in earlier initiation of appropriate therapy. METHODS In a prospective study, we evaluated the clinical value of the AsperGenius polymerase chain reaction (PCR) assay in hematology patients from 12 centers. This PCR assay detects the most frequent cyp51A mutations in A. fumigatus conferring azole resistance. Patients were included when a computed tomography scan showed a pulmonary infiltrate and bronchoalveolar fluid (BALf) sampling was performed. The primary end point was antifungal treatment failure in patients with azole-resistant IA. RESULTS Of 323 patients enrolled, complete mycological and radiological information was available for 276 (94%), and probable IA was diagnosed in 99/276 (36%). Sufficient BALf for PCR testing was available for 293/323 (91%). Aspergillus DNA was detected in 116/293 (40%) and A. fumigatus DNA in 89/293 (30%). The resistance PCR was conclusive in 58/89 (65%) and resistance detected in 8/58 (14%). Two had a mixed azole-susceptible/azole-resistant infection. In the 6 remaining patients, treatment failure was observed in 1. Galactomannan positivity was associated with mortality (P = .004) while an isolated positive Aspergillus PCR was not (P = .83). CONCLUSIONS Real-time PCR-based resistance testing may help to limit the clinical impact of triazole resistance. In contrast, the clinical impact of an isolated positive Aspergillus PCR on BALf seems limited. The interpretation of the EORTC/MSGERC PCR criterion for BALf may need further specification (eg, minimum cycle threshold value and/or PCR positive on >1 BALf sample).
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Affiliation(s)
- Sammy Huygens
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Albert Dunbar
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jochem B Buil
- Department of Medical Microbiology, Radboud University Center, Nijmegen, The Netherlands
| | - Corné H W Klaassen
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Center, Nijmegen, The Netherlands
| | - Karin van Dijk
- Department of Medical Microbiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Nick de Jonge
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jeroen J W M Janssen
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Bart J Biemond
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Aldert Bart
- Department of Medical Microbiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anke H W Bruns
- Department of Internal Medicine, Infectious Diseases, University Medical Center Utrecht, The Netherlands
| | - Pieter-Jan A Haas
- Department of Medical Microbiology, University Medical Center Utrecht, The Netherlands
| | - Astrid M P Demandt
- Department of Hematology, Maastricht University Medical Center, The Netherlands
| | - Guy Oudhuis
- Department of Medical Microbiology, Maastricht University Medical Center, The Netherlands
| | - Peter von dem Borne
- Department of Medical Microbiology, Leiden University Medical Center, The Netherlands
| | | | - Saskia K Klein
- Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands
- Department of Hematology, University Medical Center Groningen, The Netherlands
| | - Peggy Godschalk
- Department of Medical Microbiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Lambert F R Span
- Department of Hematology, University Medical Center Groningen, The Netherlands
| | - Douwe F Postma
- Department of Internal Medicine and Infectious Diseases, University Medical Center Groningen, The Netherlands
| | - Greetje A Kampinga
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johan Maertens
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Toine Mercier
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Ine Moors
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Jerina Boelens
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Dominik Selleslag
- Department of Hematology, AZ St-Jan Brugge-Oostende Hospital, Bruges, Belgium
| | - Marijke Reynders
- Department of Laboratory Medicine, Medical Microbiology, AZ St-Jan Brugge-Oostende Hospital, Bruges, Belgium
| | - Willemien Zandijk
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Bart J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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6
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van der Straten L, Levin MD, Dinnessen MAW, Visser O, Posthuma EFM, Doorduijn JK, Langerak AW, Kater AP, Dinmohamed AG. Risk of second primary malignancies in patients with chronic lymphocytic leukemia: a population-based study in the Netherlands, 1989-2019. Blood Cancer J 2023; 13:15. [PMID: 36635262 PMCID: PMC9837130 DOI: 10.1038/s41408-023-00784-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023] Open
Abstract
The longevity of patients with chronic lymphocytic leukemia (CLL) has improved progressively over the past decades, making it essential to understand long-term health outcomes, such as second primary malignancies (SPMs). Therefore, this nationwide, population-based study assessed the risk of SPM development in CLL patients diagnosed during 1989-2019 in the Netherlands compared to the expected number of malignancies in an age-, sex-, and period-matched group from the general Dutch population. In 24,815 CLL patients followed for 162,698.49 person-years, 4369 SPMs were diagnosed with a standardized incidence ratio (SIR) of 1.63 (95% confidence interval [CI] 1.59-1.68). This elevated risk was observed for solid (SIR, 1.67; 95% CI, 1.65-1.75) and hematological SPMs (SIR 1.42; 95% CI, 1.24-1.62). The highest risk for SPMs was noted beyond five years post-diagnosis (SIR, 1.70; 95% CI, 1.62-1.77), for male individuals (SIR, 1.70; 95% CI, 1.64-1.77), and patients aged 18-69 years (SIR, 1.92; 95% CI, 1.79-2.05). The risk of SPMs was higher in CLL patients who received anti-neoplastic therapy (SIR, 2.12; 95% CI, 1.96-2.28), as compared with those who did not (SIR, 1.58; 95% CI, 1.53-1.63). Routine surveillance activities and tailored interventions to counteract the increased morbidity and excess mortality associated with SPMs are essential for improving long-term outcomes in CLL patients.
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Affiliation(s)
- Lina van der Straten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands. .,Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands. .,Department of Immunology, Erasmus MC, Rotterdam, The Netherlands.
| | - Mark-David Levin
- grid.413972.a0000 0004 0396 792XDepartment of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Manette A. W. Dinnessen
- grid.470266.10000 0004 0501 9982Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands ,Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - Otto Visser
- grid.470266.10000 0004 0501 9982Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eduardus F. M. Posthuma
- grid.415868.60000 0004 0624 5690Department of Internal Medicine, Reinier The Graaf Hospital, Delft, The Netherlands ,grid.10419.3d0000000089452978Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanette K. Doorduijn
- grid.5645.2000000040459992XErasmus MC Cancer Institute, Department of Hematology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anton W. Langerak
- grid.5645.2000000040459992XDepartment of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Arnon P. Kater
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - Avinash G. Dinmohamed
- grid.470266.10000 0004 0501 9982Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands ,Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands ,grid.5645.2000000040459992XErasmus MC, Department of Public Health, University Medical Center Rotterdam, Rotterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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7
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Bromberg JEC, Issa S, van der Holt B, Minnema MC, Seute T, Durian MF, Cull G, van der Poel MWM, Stevens WBC, Zijlstra JM, Nijland M, Mason KD, Beeker A, Brandsma D, van den Bent MJ, Gonzalez M, de Jong D, Doorduijn JK. OS03.6.A Rituximab in primary CNS lymphoma - long term follow-up of the phase III HOVON 105/ALLG NHL 24 Study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The efficacy of rituximab in Primary CNS Lymphoma (PCNSL) is still under debate. We performed an international randomized phase III study to investigate the efficacy of rituximab when added to methotrexate, BCNU, teniposide and prednisolone (MBVP) in PCNSL. The primary endpoint, event-free survival (EFS) at one year, was similar in both treatment groups and was previously reported (Bromberg et al, Lancet Oncology 2019; 20: 216-228). Here we present long-term follow up results after a median follow-up of 82 months.
Material and Methods
between August 2010 and May 2016 200 newly-diagnosed, non-immunocompromised patients with PCNSL aged 18-70 years and WHO performance status 0-3 were randomized between treatment with MBVP chemotherapy with (arm B) or without (arm A) rituximab. The rituximab was given weekly in the first MBVP cycle, fortnightly in the second (in total 6 rituximab administrations). Responsive patients received consolidation with high-dose cytarabine, and patients aged ≤ 60 were subsequently treated with low-dose WBRT if in CR/CRu; in case of PR with an additional boost on the tumor. Patients > 60 were not irradiated. All patients gave written informed consent.
Results
The modified intention-to-treat (m-ITT) population consisted of 199 eligible patients, 55% were men. The median age was 61 yrs (range 26-70), the median WHO performance status 1 (range 0-3). The primary endpoint EFS at one year was 49% (95% CI 39-58)(MBVP) vs 55% (95% CI 44-64) (R-MBVP). The EFS at 5 years was 25% (17-34) vs 36% (27-46) respectively, hazard ratio (HR) 0.85, 95% CI 0.61-1.18, p=0.33 (adjusted for age and WHO performance status). The progression-free survival (PFS) at one and 5 years were 58% (47-67) and 29% (21-39) (MBVP) and 65% (54-73) and 43% (33-53) (R-MBVP) ) (HR 0.73, 95% CI 0.52-1.02, p=0.07). 80 patients were still alive. Overall survival (OS) at 5 years for MBVP and R-MBVP was 49% (39-59) and 53% (43-63) respectively. A total of 111 patients had progression or relapse, 63 after MBVP and 48 after R-MBVP. 79% of these patients received further treatment. The median OS after progression/relapse was 9.7 months (5.9-19.9) in the MBVP arm, and 6.1 months (2.4-13.1) in the R-MBVP arm (HR 1.25, 95% CI 0.83-1.87, p=0.29). 119 patients died, 64 in the MBVP arm and 55 in the R-MBVP arm. Causes of death were PCNSL in 69% of the patients (both arms), complication of treatment (6% vs 5%), secondary malignancy (5% vs 2%) and other or unknown causes (20% vs 24%). Age was the strongest prognostic factor for EFS, PFS and OS in multivariate analysis.
Conclusion
in the modified-ITT population we found no statistically significant benefit of the addition of rituximab to MBVP on EFS, PFS and OS in patients with PCNSL, even after a long follow-up of median 82 months. Therefore, the results of this study do not support the use of rituximab with MBVP in the treatment of primary CNS lymphoma.
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Affiliation(s)
| | - S Issa
- Middlemore Hospital , Auckland , New Zealand
| | | | - M C Minnema
- University Medical Center Utrecht , Utrecht , Netherlands
| | - T Seute
- University Medical Center Utrecht , Utrecht , Netherlands
| | | | - G Cull
- Sir Charles Gairdner Hospital and PathWest Laboratory Medicine , nedlands , Australia
| | | | - W B C Stevens
- Radboud university medical center , Nijmegen , Netherlands
| | - J M Zijlstra
- Amsterdam Umc location VU MC , Amsterdam , Netherlands
| | - M Nijland
- University Medical Center , Groningen , Netherlands
| | - K D Mason
- Royal Melbourne Hospital , Melbourne , Australia
| | - A Beeker
- Spaarne gasthuis , Haarlem , Netherlands
| | - D Brandsma
- Netherlands Cancer Institute , Amsterdam , Netherlands
| | | | - M Gonzalez
- Royal Melbourne Hospital , Melbourne , Australia
| | - D de Jong
- Amsterdam Umc location VU MC , Amsterdam , Netherlands
| | - J K Doorduijn
- Erasmus MC Cancer Institute , Rotterdam , Netherlands
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8
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Raa DGT, van der Straten L, van Gelder M, Kersting S, Levin MD, Mous R, van der Straaten HM, Nijziel MR, van der Spek E, Posthuma EFM, Visser HP, van der Klift M, de Heer K, Bellido M, Doorduijn JK, Bruns AH, Raijmakers RAP, Kater AP. Diagnosis, treatment and supportive management of chronic lymphocytic leukemia: recommendations of the Dutch HOVON CLL working group. Leuk Lymphoma 2022; 63:2276-2289. [DOI: 10.1080/10428194.2022.2084731] [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: 10/17/2022]
Affiliation(s)
- Doreen G. Te Raa
- Department of Internal Medicine, Gelderse Vallei, Ede, the Netherlands
| | - Lina van der Straten
- Department of Internal Medicine, Albert Schweitzer hospital, Dordrecht, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Michel van Gelder
- Department of Hematology, Maastricht UMC, the Netherlands Maastricht
| | - Sabina Kersting
- Department of Internal Medicine, HAGA hospital, Den Haag, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer hospital, Dordrecht, the Netherlands
| | - Rogier Mous
- Department of Hematology, UMC Utrecht, the Netherlands Utrecht
| | | | - Marten R. Nijziel
- Department of Internal Medicine, Catharina hospital, Eindhoven, the Netherlands
| | | | - Eduardus F. M Posthuma
- Department of Internal Medicine, Reinier de Graaf hospital, Delft, the Netherlands
- Department of Hematology, Leiden Univerisity Medical Center, Leiden, the Netherlands
| | - Hein P.J Visser
- Department of Internal Medicine, Noordwest ziekenhuisgroep, Alkmaar, the Netherlands
| | | | - Koen de Heer
- Department of Internal Medicine, Flevo hospital, Almere, the Netherlands
| | - Mar Bellido
- Department of Hematology, Groningen University Medical Center, University of Groningen, Groningen, the Netherlands
| | - Jeanette K. Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anke H.W Bruns
- Department of Hematology, UMC Utrecht, the Netherlands Utrecht
| | | | - Arnon P. Kater
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
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9
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van der Straten L, Maas CCHM, Levin MD, Visser O, Posthuma EFM, Doorduijn JK, Langerak AW, Kater AP, Dinmohamed AG. Long-term trends in the loss in expectation of life after a diagnosis of chronic lymphocytic leukemia: a population-based study in the Netherlands, 1989-2018. Blood Cancer J 2022; 12:72. [PMID: 35444185 PMCID: PMC9021189 DOI: 10.1038/s41408-022-00669-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lina van der Straten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands. .,Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands. .,Laboratory Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, The Netherlands.
| | - Carolien C H M Maas
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier The Graaf Hospital, Delft, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanette K Doorduijn
- Erasmus MC Cancer Institute, Department of Hematology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anton W Langerak
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Arnon P Kater
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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10
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van der Straten L, Levin M, Visser O, Posthuma EF, Doorduijn JK, Kater AP, Dinmohamed AG. Conditional relative survival among patients with chronic lymphocytic leukaemia: A population-based study in the Netherlands. EJHaem 2022; 3:180-183. [PMID: 35846209 PMCID: PMC9175753 DOI: 10.1002/jha2.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 01/26/2023]
Abstract
Studies on conditional relative survival (CRS) in chronic lymphocytic leukaemia (CLL) have hitherto been lacking in the literature. We predicted up-to-date estimates of 5-year RS at diagnosis and for each additional year survived (i.e., CRS) up to 15 years post-diagnosis among CLL patients diagnosed during 2007-2020. We showed that 5-year CRS continues to decline gradually with each additional year survived in a contemporary era with access to novel-based agents, irrespective of age. This finding indicates that CLL patients continue to experience substantial excess mortality compared to an age- and sex-matched group from the general population.
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Affiliation(s)
- Lina van der Straten
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of Internal MedicineAlbert Schweitzer HospitalDordrechtThe Netherlands
- Laboratory Medical Immunology, Department of ImmunologyErasmus MCRotterdamThe Netherlands
| | - Mark‐David Levin
- Department of Internal MedicineAlbert Schweitzer HospitalDordrechtThe Netherlands
| | - Otto Visser
- Department of RegistrationNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
| | - Eduardus F.M. Posthuma
- Department of Internal MedicineReinier The Graaf HospitalDelftThe Netherlands
- Department of HematologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jeanette K. Doorduijn
- Erasmus MC Cancer Institute, Department of HematologyUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Arnon P. Kater
- Amsterdam UMC, University of Amsterdam, Department of HematologyCancer Center Amsterdam, Lymphoma and Myeloma Center AmsterdamAmsterdamThe Netherlands
| | - Avinash G. Dinmohamed
- Department of Research and DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Amsterdam UMC, University of Amsterdam, Department of HematologyCancer Center Amsterdam, Lymphoma and Myeloma Center AmsterdamAmsterdamThe Netherlands
- Erasmus MC, Department of Public HealthUniversity Medical Center RotterdamRotterdamThe Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of HematologyCancer Center AmsterdamAmsterdamThe Netherlands
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11
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Kersten MJ, Amaador K, Minnema MC, Vos JMI, Nasserinejad K, Kap M, Kastritis E, Gavriatopoulou M, Kraan W, Chamuleau MED, Deeren D, Tick LW, Doorduijn JK, Offner F, Böhmer LH, Liu RD, Pals ST, Dimopoulos MA. Combining Ixazomib With Subcutaneous Rituximab and Dexamethasone in Relapsed or Refractory Waldenström's Macroglobulinemia: Final Analysis of the Phase I/II HOVON124/ECWM-R2 Study. J Clin Oncol 2022; 40:40-51. [PMID: 34388022 PMCID: PMC8683241 DOI: 10.1200/jco.21.00105] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/03/2023] Open
Abstract
PURPOSE Proteasome inhibitors are effective in Waldenström's macroglobulinemia (WM) but require parenteral administration and are associated with polyneuropathy. We investigated efficacy and toxicity of the less neurotoxic oral proteasome inhibitor ixazomib combined with rituximab, in patients with relapsed WM. METHODS We conducted a multicenter phase I/II trial with ixazomib, rituximab, and dexamethasone (IRD). Induction consisted of eight cycles IRD wherein rituximab was started in cycle 3, followed by rituximab maintenance. Phase I showed feasibility of 4 mg ixazomib. Primary end point for phase II was overall response rate (ORR [≥ minimal response]) after induction. RESULTS A total of 59 patients were enrolled (median age, 69 years; range, 46-91 years). Median number of prior treatments was 2 (range, 1-7); 70% had an intermediate or high WM-IPSS (International Prognostic Scoring System for WM) score. After eight cycles, ORR was 71% (42 out of 59) (14% very good partial response [PR], 37% PR, and 20% minor response). Depth of response improved until month 12 (best ORR 85% [50 out of 59]: 15% very good PR, 46% PR, and 24% minor response). Median duration of response was 36 months. The average hematocrit level increased significantly (0.33-0.38 L/L) after induction (P < .001). After two cycles of ixazomib and dexamethasone, immunoglobulin M levels decreased significantly (median 3,700-2,700 mg/dL, P < .0001). Median time to first response was 4 months. Median progression-free survival and overall survival were not reached. After median follow-up of 24 months (range, 7.4-54.3 months), progression-free survival and overall survival were 56% and 88%, respectively. Toxicity included mostly grade 2 or 3 cytopenias, grade 1 or 2 neurotoxicity, and grade 2 or 3 infections. No infusion-related reactions or immunoglobulin M flare occurred with use of subcutaneous rituximab. Quality of life improved significantly after induction. In total, 48 patients (81%) completed at least six cycles of IRD. CONCLUSION Combination of IRD shows promising efficacy with manageable toxicity in patients with relapsed or refractory WM.
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Affiliation(s)
- Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands,Marie José Kersten, Department of Hematology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; e-mail:
| | - Karima Amaador
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Monique C. Minnema
- Department of Hematology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Josephine M. I. Vos
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Kazem Nasserinejad
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marcel Kap
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Willem Kraan
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Martine E. D. Chamuleau
- Department of Hematology, Amsterdam UMC, VU University, Amsterdam and Cancer Center, Amsterdam, the Netherlands
| | - Dries Deeren
- Department of Hematology, AZ Delta, Roeselare, Belgium
| | - Lidwine W. Tick
- Department of Hematology, Maxima Medical Center, Eindhoven, the Netherlands
| | - Jeanette K. Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fritz Offner
- Department of Hematology, University Hospital Gent, Gent, Belgium
| | - Lara H. Böhmer
- Department of Hematology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Roberto D. Liu
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Steven T. Pals
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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12
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van der Meulen M, Dirven L, Habets EJJ, Bakunina K, Smits M, Achterberg HC, Seute T, Cull G, Schouten H, Zijlstra JM, Brandsma D, Enting RH, Beijert M, Taphoorn MJB, van den Bent MJ, Issa S, Doorduijn JK, Bromberg JEC. Neurocognitive functioning and radiologic changes in primary CNS lymphoma patients: results from the HOVON 105/ALLG NHL 24 randomized controlled trial. Neuro Oncol 2021; 23:1315-1326. [PMID: 33560442 DOI: 10.1093/neuonc/noab021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/13/2022] Open
Abstract
BACKGROUND To analyze the effect of treatment on neurocognitive functioning and the association of neurocognition with radiological abnormalities in primary central nervous system lymphoma (PCNSL). METHODS One hundred and ninety-nine patients from a phase III trial (HOVON 105/ALLG NHL 24), randomized to standard chemotherapy with or without rituximab, followed in patients ≤60 years old by 30-Gy whole-brain radiotherapy (WBRT), were asked to participate in a neuropsychological evaluation before and during treatment, and up to 2 years posttreatment. Scores were transformed into a standardized z-score; clinically relevant changes were defined as a change in z-score of ≥1 SD. The effect of WBRT was analyzed in irradiated patients. All MRIs were centrally assessed for white matter abnormalities and cerebral atrophy, and their relation with neurocognitive scores over time in each domain was calculated. RESULTS 125/199 patients consented to neurocognitive evaluation. Statistically significant improvements in neurocognition were seen in all domains. A clinically relevant improvement was seen only in the motor speed domain, without differences between the arms. In the follow-up of irradiated patients (n = 43), no change was observed in any domain score, compared to after WBRT. Small but significant inverse correlations were found between neurocognitive scores over time and changes in white matter abnormalities (regression coefficients: -0.048 to -0.347) and cerebral atrophy (-0.212 to -1.774). CONCLUSIONS Addition of rituximab to standard treatment in PCNSL patients did not impact neurocognitive functioning up to 2 years posttreatment, nor did treatment with 30-Gy WBRT in patients ≤60 years old. Increased white matter abnormalities and brain atrophy showed weak associations with neurocognition.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Esther J J Habets
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Medical Psychology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Katerina Bakunina
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hakim C Achterberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tatjana Seute
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gavin Cull
- Haematology Department, Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| | - Harry Schouten
- Department of Hematology, University Medical Center, Maastricht, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC-Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Dieta Brandsma
- Department of Neuro-oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Roelien H Enting
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Max Beijert
- Department of Radiotherapy, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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13
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van der Meulen M, Postma AA, Smits M, Bakunina K, Minnema MC, Seute T, Cull G, Enting RH, van der Poel M, Stevens WBC, Brandsma D, Beeker A, Doorduijn JK, Issa S, van den Bent MJ, Bromberg JEC. Extent of radiological response does not reflect survival in primary central nervous system lymphoma. Neurooncol Adv 2021; 3:vdab007. [PMID: 33615224 PMCID: PMC7883767 DOI: 10.1093/noajnl/vdab007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/16/2022] Open
Abstract
Background In primary central nervous system lymphoma (PCNSL), small enhancing lesions can persist after treatment. It is unknown whether a difference in response category (complete response [CR], complete response unconfirmed [CRu], or partial response [PR]) reflects survival. We aimed to determine the value of a central radiology review on response assessment and whether the extent of response influenced progression-free and/or overall survival. Methods All patients in the HOVON 105/ALLG NHL 24 study with at least a baseline MRI and one MRI made for response evaluation available for central review were included. Tumor measurements were done by 2 independent central reviewers, disagreements were adjudicated by a third reviewer. Crude agreement and interobserver agreement (Cohen's kappa) were calculated. Differences in progression-free and overall survival between different categories of response at the end-of-protocol-treatment were assessed by the log-rank test in a landmark survival-analysis. Results Agreement between the central reviewers was 61.7% and between local and central response assessment was 63.0%. Cohen's kappa's, which corrects for expected agreement, were 0.44 and 0.46 (moderate), respectively. Progression agreement or not was 93.3% (kappa 0.87) between local and central response assessment. There were no significant differences in progression-free and overall survival between patients with CR, CRu, or PR at the end-of-protocol-treatment, according to both local and central response assessment. Conclusions Reliability of response assessment (CR/CRu/PR) is moderate even by central radiology review and these response categories do not reliably predict survival. Therefore, primary outcome in PCNSL studies should be survival rather than CR or CR/CRu-rate.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, School for Mental Health and Sciences, Maastricht, The Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katerina Bakunina
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tatjana Seute
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gavin Cull
- Haematology Department, Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, Australia.,University of Western Australia, Crawley, Australia
| | - Roelien H Enting
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Aart Beeker
- Department of Hematology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Samar Issa
- Department of Haematology, Middlemore Hospital, Auckland, New Zealand
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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14
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van der Meulen M, Dirven L, Bakunina K, van den Bent MJ, Issa S, Doorduijn JK, Bromberg JEC. MMSE is an independent prognostic factor for survival in primary central nervous system lymphoma. J Neurooncol 2021; 152:357-362. [PMID: 33611761 PMCID: PMC7997829 DOI: 10.1007/s11060-021-03708-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
Introduction To assess the value of the Mini-Mental State Examination (MMSE)-score at baseline in predicting survival in adult primary central nervous system lymphoma (PCNSL) patients. Methods In the HOVON 105/ ALLG NHL 24 phase III study patients with newly-diagnosed PCNSL were randomized between high-dose methotrexate-based chemotherapy with or without rituximab. Data on potential (MMSE-score), and known baseline prognostic factors (age, performance status, serum LDH, cerebrospinal fluid total protein, involvement of deep brain structures, multiple cerebral lesions, and the IELSG-score) were collected prospectively. Multivariable stepwise Cox regression analyses were used to assess the prognostic value of all factors on progression-free survival (PFS) and overall survival (OS) among patients with available MMSE score at baseline. Age was analyzed as continuous variable, the MMSE-score both as a continuous and as a categorical variable. Results In univariable analysis, age, MMSE-score and whether the patient received rituximab were statistically significantly prognostic factors for PFS. Age and MMSE-score were statistically significantly associated with OS. In a multivariable analysis of the univariately significant factors only MMSE-score was independently associated with the survival endpoints, as a continuous variable (HR for PFS 1.04, 95% CI 1.01–1.08; OS 1.06 (95% CI 1.02–1.10) and as categorical variable HR (< 27 versus ≥ 27 for PFS 1.55 (1.02–2.35); OS 1.68 (1.05–2.70). In our population, performance status, serum LDH, and CSF protein level were not of prognostic value. Conclusion Neurocognitive disturbances, measured with the MMSE at baseline, are an unfavorable prognostic factor for both PFS and OS in adult PCNSL patients up to 70 years-old. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03708-8.
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Katerina Bakunina
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
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15
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Ferreri AJM, Doorduijn JK, Re A, Cabras MG, Smith J, Ilariucci F, Luppi M, Calimeri T, Cattaneo C, Khwaja J, Botto B, Cellini C, Nassi L, Linton K, McKay P, Olivieri J, Patti C, Re F, Fanni A, Singh V, Bromberg JEC, Cozens K, Gastaldi E, Bernardi M, Cascavilla N, Davies A, Fox CP, Frezzato M, Osborne W, Liberati AM, Novak U, Zambello R, Zucca E, Cwynarski K. MATRix-RICE therapy and autologous haematopoietic stem-cell transplantation in diffuse large B-cell lymphoma with secondary CNS involvement (MARIETTA): an international, single-arm, phase 2 trial. Lancet Haematol 2021; 8:e110-e121. [PMID: 33513372 PMCID: PMC7844712 DOI: 10.1016/s2352-3026(20)30366-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 07/10/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Secondary CNS lymphoma is a rare but potentially lethal event in patients with diffuse large B-cell lymphoma. We aimed to assess the activity and safety of an intensive, CNS-directed chemoimmunotherapy consolidated by autologous haematopoietic stem-cell transplantation (HSCT) in patients with secondary CNS lymphoma. METHODS This international, single-arm, phase 2 trial was done in 24 hospitals in Italy, the UK, the Netherlands, and Switzerland. Adults (aged 18-70 years) with histologically diagnosed diffuse large B-cell lymphoma and CNS involvement at the time of primary diagnosis or at relapse and Eastern Cooperative Oncology Group Performance Status of 3 or less were enrolled and received three courses of MATRix (rituximab 375 mg/m2, intravenous infusion, day 0; methotrexate 3·5 g/m2, the first 0·5 g/m2 in 15 min followed by 3 g/m2 in a 3 h intravenous infusion, day 1; cytarabine 2 g/m2 every 12 h, in 1 h intravenous infusions, days 2 and 3; thiotepa 30 mg/m2, 30 min intravenous infusion, day 4) followed by three courses of RICE (rituximab 375 mg/m2, day 1; etoposide 100 mg/m2 per day in 500-1000 mL over a 60 min intravenous infusion, days 1, 2, and 3; ifosfamide 5 g/m2 in 1000 mL in a 24 h intravenous infusion with mesna support, day 2; carboplatin area under the curve of 5 in 500 mL in a 1 h intravenous infusion, day 2) and carmustine-thiotepa and autologous HSCT (carmustine 400 mg/m2 in 500 mL glucose 5% solution in a 1-2 h infusion, day -6; thiotepa 5 mg/kg in saline solution in a 2 h infusion every 12 h, days -5 and -4). The primary endpoint was progression-free survival at 1 year. Overall and complete response rates before autologous HSCT, duration of response, overall survival, and safety were the secondary endpoints. Analyses were in the modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02329080. The trial ended after accrual completion; the database lock was Dec 31, 2019. FINDINGS Between March 30, 2015, and Aug 3, 2018, 79 patients were enrolled. 75 patients were assessable. 319 (71%) of the 450 planned courses were delivered. At 1 year from enrolment the primary endpoint was met, 42 patients were progression free (progression-free survival 58%; 95% CI 55-61). 49 patients (65%; 95% CI 54-76) had an objective response after MATRix-RICE, 29 (39%) of whom had a complete response. 37 patients who responded had autologous HSCT. At the end of the programme, 46 patients (61%; 95% CI 51-71) had an objective response, with a median duration of objective response of 26 months (IQR 16-37). At a median follow-up of 29 months (IQR 20-40), 35 patients were progression-free and 33 were alive, with a 2-year overall survival of 46% (95% CI 39-53). Grade 3-4 toxicity was most commonly haematological: neutropenia in 46 (61%) of 75 patients, thrombocytopenia in 45 (60%), and anaemia in 26 (35%). 79 serious adverse events were recorded in 42 (56%) patients; four (5%) of those 79 were lethal due to sepsis caused by Gram-negative bacteria (treatment-related mortality 5%; 95% CI 0·07-9·93). INTERPRETATION MATRix-RICE plus autologous HSCT was active in this population of patients with very poor prognosis, and had an acceptable toxicity profile. FUNDING Stand Up To Cancer Campaign for Cancer Research UK, the Swiss Cancer Research foundation, and the Swiss Cancer League.
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Affiliation(s)
- Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | | | | | | | - Jeffery Smith
- Department of Haematology, Aintree Hospital, Liverpool, UK
| | - Fiorella Ilariucci
- Division of Hematology, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Mario Luppi
- Azienda Ospedaliera Universitaria, UNIMORE, Modena, Italy
| | - Teresa Calimeri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Jahanzaib Khwaja
- Department of Haematology, University College Hospital, London, UK
| | - Barbara Botto
- AOU Città della salute e della Scienza, Turin, Italy
| | | | - Luca Nassi
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Kim Linton
- Department of Haemato-Oncology, The Christie Hospital, Manchester, UK
| | | | | | - Caterina Patti
- Division of Hematology, Azienda Villa Sofia-Cervello, Palermo, Italy
| | | | | | - Vikram Singh
- Department of Haematology, Aintree Hospital, Liverpool, UK
| | | | - Kelly Cozens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Elisabetta Gastaldi
- International Extranodal Lymphoma Study Group Coordinating Center, Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Massimo Bernardi
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Cascavilla
- Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Andrew Davies
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Wendy Osborne
- Department of Haematology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | - Emanuele Zucca
- International Extranodal Lymphoma Study Group Coordinating Center, Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland; Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
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16
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van der Meulen M, Bromberg JEC, Nijland M, Visser O, Doorduijn JK, Dinmohamed AG. Primary therapy and survival in patients aged over 70-years-old with primary central nervous system lymphoma: a contemporary, nationwide, population-based study in the Netherlands. Haematologica 2021; 106:597-600. [PMID: 32241841 PMCID: PMC7849552 DOI: 10.3324/haematol.2020.247536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/26/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Otto Visser
- Netherlands Comprehensive Cancer Organisation, Utrecht
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17
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Dinmohamed AG, van der Meulen M, Visser O, Doorduijn JK, Bromberg JEC. Conditional relative survival in primary central nervous system lymphoma: a population-based study in the Netherlands. Neurooncol Adv 2020; 2:vdaa133. [PMID: 33235997 PMCID: PMC7668442 DOI: 10.1093/noajnl/vdaa133] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Matthijs van der Meulen
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Neuro-oncology, Rotterdam, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Jeanette K Doorduijn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Neuro-oncology, Rotterdam, The Netherlands
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18
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Saberi Hosnijeh F, van der Straten L, Kater AP, van Oers MHJ, Posthuma WFM, Chamuleau MED, Bellido M, Doorduijn JK, van Gelder M, Hoogendoorn M, de Boer F, Te Raa GD, Kerst JM, Marijt EWA, Raymakers RAP, Koene HR, Schaafsma MR, Dobber JA, Tonino SH, Kersting SS, Langerak AW, Levin MD. Proteomic markers with prognostic impact on outcome of chronic lymphocytic leukemia patients under chemo-immunotherapy: results from the HOVON 109 study. Exp Hematol 2020; 89:55-60.e6. [PMID: 32781097 DOI: 10.1016/j.exphem.2020.08.002] [Citation(s) in RCA: 2] [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] [Received: 06/10/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022]
Abstract
Despite recent identification of several prognostic markers, there is still a need for new prognostic parameters able to predict clinical outcome in chronic lymphocytic leukemia (CLL) patients. Here, we aimed to validate the prognostic ability of known (proteomic) markers measured pretreatment and to search for new proteomic markers that might be related to treatment response in CLL. To this end, baseline serum samples of 51 CLL patients treated with chemo-immunotherapy were analyzed for 360 proteomic markers, using Olink technology. Median event-free survival (EFS) was 23 months (range: 1.25-60.9). Patients with high levels of sCD23 (>11.27, p = 0.026), sCD27 (>11.03, p = 0.04), SPINT1 (>1.6, p = 0.001), and LY9 (>8.22, p = 0.0003) had a shorter EFS than those with marker levels below the median. The effect of sCD23 on EFS differed between immunoglobulin heavy chain variable gene-mutated and unmutated patients, with the shortest EFS for unmutated CLL patients with sCD23 levels above the median. Taken together, our results validate the prognostic impact of sCD23 and highlight SPINT1 and LY9 as possible promising markers for treatment response in CLL patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Chlorambucil
- Disease-Free Survival
- Female
- Gene Expression
- Humans
- Immunoglobulin Heavy Chains/blood
- Immunoglobulin Heavy Chains/genetics
- Immunotherapy/methods
- Lenalidomide
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Mutation
- Prognosis
- Proteinase Inhibitory Proteins, Secretory/blood
- Proteinase Inhibitory Proteins, Secretory/genetics
- Proteomics/methods
- Receptors, IgE/blood
- Receptors, IgE/genetics
- Rituximab
- Signaling Lymphocytic Activation Molecule Family/blood
- Signaling Lymphocytic Activation Molecule Family/genetics
- Treatment Outcome
- Tumor Necrosis Factor Receptor Superfamily, Member 7/blood
- Tumor Necrosis Factor Receptor Superfamily, Member 7/genetics
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Affiliation(s)
- Fatemeh Saberi Hosnijeh
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands.
| | - Lina van der Straten
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Arnon P Kater
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Marinus H J van Oers
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Ward F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands; Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Mar Bellido
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Michel van Gelder
- Department of Hematology, University Medical Center, Maastricht, The Netherlands
| | - Mels Hoogendoorn
- Department of Internal Medicine, Medical Center, Leeuwarden, The Netherlands
| | - Fransien de Boer
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - G Doreen Te Raa
- Department of Internal Medicine, Gelderland Valley Hospital, Ede, The Netherlands
| | - J Martijn Kerst
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Erik W A Marijt
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Harry R Koene
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Martijn R Schaafsma
- Department of Hematology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Johan A Dobber
- Laboratory Special Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Sanne H Tonino
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Anton W Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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19
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Lugtenburg PJ, de Nully Brown P, van der Holt B, D'Amore FA, Koene HR, de Jongh E, Fijnheer R, van Esser JW, Böhmer LH, Pruijt JF, Verhoef GE, Hoogendoorn M, Bilgin MY, Nijland M, van der Burg-de Graauw NC, Oosterveld M, Jie KSG, Larsen TS, van der Poel MW, Leijs MB, Silbermann MH, van Marwijk Kooy M, Beeker A, Kersten MJ, Doorduijn JK, Tick LW, Brouwer RE, Lam KH, Burggraaff CN, de Keizer B, Arens AI, de Jong D, Hoekstra OS, Zijlstra-Baalbergen JM. Rituximab-CHOP With Early Rituximab Intensification for Diffuse Large B-Cell Lymphoma: A Randomized Phase III Trial of the HOVON and the Nordic Lymphoma Group (HOVON-84). J Clin Oncol 2020; 38:3377-3387. [PMID: 32730183 DOI: 10.1200/jco.19.03418] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Immunochemotherapy with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has become standard of care for patients with diffuse large B-cell lymphoma (DLBCL). This randomized trial assessed whether rituximab intensification during the first 4 cycles of R-CHOP could improve the outcome of these patients compared with standard R-CHOP. PATIENTS AND METHODS A total of 574 patients with DLBCL age 18 to 80 years were randomly assigned to induction therapy with 6 or 8 cycles of R-CHOP-14 with (RR-CHOP-14) or without (R-CHOP-14) intensification of rituximab in the first 4 cycles. The primary end point was complete remission (CR) on induction. Analyses were performed by intention to treat. RESULTS CR was achieved in 254 (89%) of 286 patients in the R-CHOP-14 arm and 249 (86%) of 288 patients in the RR-CHOP-14 arm (hazard ratio [HR], 0.82; 95% CI, 0.50 to 1.36; P = .44). After a median follow-up of 92 months (range, 1-131 months), 3-year failure-free survival was 74% (95% CI, 68% to 78%) in the R-CHOP-14 arm versus 69% (95% CI, 63% to 74%) in the RR-CHOP-14 arm (HR, 1.26; 95% CI, 0.98 to 1.61; P = .07). Progression-free survival at 3 years was 74% (95% CI, 69% to 79%) in the R-CHOP-14 arm versus 71% (95% CI, 66% to 76%) in the RR-CHOP-14 arm (HR, 1.20; 95% CI, 0.94 to 1.55; P = .15). Overall survival at 3 years was 81% (95% CI, 76% to 85%) in the R-CHOP-14 arm versus 76% (95% CI, 70% to 80%) in the RR-CHOP-14 arm (HR, 1.27; 95% CI, 0.97 to 1.67; P = .09). Patients between ages 66 and 80 years experienced significantly more toxicity during the first 4 cycles in the RR-CHOP-14 arm, especially neutropenia and infections. CONCLUSION Early rituximab intensification during R-CHOP-14 does not improve outcome in patients with untreated DLBCL.
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Affiliation(s)
| | | | - Bronno van der Holt
- Haemato Oncology Foundation for Adults in the Netherlands (HOVON) Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Eva de Jongh
- Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | | | | | | | | | | | | | - Marcel Nijland
- University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | | | | | | | | | | | - Aart Beeker
- Spaarne Gasthuis, Hoofddorp, the Netherlands
| | | | | | | | | | - King H Lam
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | | | - Daphne de Jong
- HOVON Pathology Facility and Biobank, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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20
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van der Meulen M, Bakunina K, Nijland M, Minnema MC, Cull G, Stevens WBC, Baars JW, Mason KD, Beeker A, Beijert M, Taphoorn MJB, van den Bent MJ, Issa S, Doorduijn JK, Bromberg JEC, Dirven L. Health-related quality of life after chemotherapy with or without rituximab in primary central nervous system lymphoma patients: results from a randomised phase III study. Ann Oncol 2020; 31:1046-1055. [PMID: 32371123 DOI: 10.1016/j.annonc.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The impact of rituximab on health-related quality of life (HRQoL) in primary central nervous system lymphoma patients is not well known. We determined the impact of rituximab added to standard high-dose methotrexate-based treatment on HRQoL in patients in a large randomised trial. PATIENTS AND METHODS Patients from a large phase III trial (HOVON 105/ALLG NHL 24), randomly assigned to receive standard chemotherapy with or without rituximab and followed by 30 Gy whole brain radiotherapy (WBRT) in patients ≤60 years, completed the EORTC QLQ-C30 and QLQ-BN20 questionnaires before and during treatment, and up to 24 months of follow-up or progression. Differences between treatment arms over time in global health status, role functioning, social functioning, fatigue, and motor dysfunction were assessed. Differences ≥10 points were deemed clinically relevant. The effect of WBRT on HRQoL was analysed in irradiated patients. RESULTS A total of 160/175 patients eligible for the HRQoL study completed at least one questionnaire and were included. Over time, scores improved statistically significantly and were clinically relevant in both arms. Between arms, there were no differences on any scale (range: -3.8 to +4.0). Scores on all scales were improved to a clinically relevant extent at 12 and 24 months compared with baseline in both arms, except for fatigue and motor dysfunction at 12 months (-7.4 and -8.8, respectively). In irradiated patients (n = 59), scores in all preselected scales, except motor dysfunction, remained stable up to 24 months compared with shortly after WBRT, overall mean difference ranging between 0.02 and 4.570. CONCLUSION Compared with baseline, treatment resulted in improved HRQoL scores. The addition of rituximab to standard chemotherapy did not impact HRQoL over time. WBRT did not result in deterioration of HRQoL in the first 2 years.
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Affiliation(s)
- M van der Meulen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center, Rotterdam, The Netherlands.
| | - K Bakunina
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M Nijland
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - M C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Cull
- Haematology Department, Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, Australia; University of Western Australia, Crawley, Australia
| | - W B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J W Baars
- Department of Hemato-Oncology, Antoni van Leeuwenhoek Hospital/Dutch Cancer Institute, Amsterdam, The Netherlands
| | - K D Mason
- Department of Hematology, Royal Melbourne Hospital, Melbourne, Australia
| | - A Beeker
- Department of Hematology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - M Beijert
- Department of Radiotherapy, University Medical Center Groningen, Groningen, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - M J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center, Rotterdam, The Netherlands
| | - S Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - J K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center, Rotterdam, The Netherlands
| | - L Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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21
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van der Straten L, Kater AP, Doorduijn JK, van den Broek EC, Posthuma EFM, Dinmohamed AG, Levin MD. Possible hampered effectiveness of second-line treatment with rituximab-containing chemotherapy without signs of rituximab resistance: a population-based study among patients with chronic lymphocytic leukemia. Ann Hematol 2020; 99:1081-1091. [PMID: 32193628 DOI: 10.1007/s00277-020-03994-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 03/10/2020] [Indexed: 11/25/2022]
Abstract
Rituximab-containing chemotherapy remains a viable frontline treatment option for patients with chronic lymphocytic leukemia (CLL) in the era of novel agents. However, its effectiveness in the second-line setting-in relation to previous rituximab exposure in first-line-has hardly been evaluated in a population-based setting. Therefore, in this comprehensive, population-based study, we assessed the impact of first-line treatment with rituximab-containing chemotherapy on the effectiveness of second-line treatment with rituximab-containing chemotherapy. We selected all 1735 patients diagnosed with CLL between 2004 and 2010 from the Dutch Population-based HAematological Registry for Observational Studies (PHAROS). The primary endpoint was treatment-free survival (TFS). First- and second-line treatment was instituted in 663 (38%) and 284 (43%) patients, respectively. In first line, the median TFS was 19.7 and 67.1 months for chemotherapy without (n = 445; 67%) and with rituximab (n = 218; 33%), respectively (adjusted hazard ratio [HRadjusted], 0.83; P = 0.031). The median TFS among recipients of second-line chemotherapy without (n = 165; 57%) and with rituximab (n = 121; 42%) was 15.0 and 15.3 months, respectively (HRadjusted, 0.93; P = 0.614). Of the 121 patients who received rituximab-containing chemotherapy in second-line, 89 (74%) and 32 (26%) received first-line chemotherapy without and with rituximab, respectively. Median TFS in these two treatment groups was 18.3 and 12.1 months, respectively (HRadjusted, 1.71; P = 0.060). Collectively, in this population-based study, the effectiveness of first-line treatment with rituximab-containing chemotherapy was less pronounced in second-line treatment. The hampered effectiveness of rituximab-containing chemotherapy in second-line could not be explained by previous rituximab exposure.
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Affiliation(s)
- Lina van der Straten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | - Arnon P Kater
- Amsterdam UMC, Department of Hematology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Amsterdam UMC, Department of Hematology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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22
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Doorduijn JK, Zijlstra JM, Lugtenburg PJ, Kersten MJ, Böhmer LH, Minnema MC, MacKenzie MA, van Marwijk Kooij R, de Jongh E, Snijders TJF, de Weerdt O, van Gelder M, Hoogendoorn M, Leys RBL, Kibbelaar RE, de Jong D, Chitu DA, Van't Veer MB, Kluin-Nelemans HC. Bortezomib maintenance after R-CHOP, cytarabine and autologous stem cell transplantation in newly diagnosed patients with mantle cell lymphoma, results of a randomised phase II HOVON trial. Br J Haematol 2020; 190:385-393. [PMID: 32150297 PMCID: PMC7496560 DOI: 10.1111/bjh.16567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 11/24/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 11/29/2022]
Abstract
Rituximab‐containing induction followed by autologous stem cell transplantation (ASCT) is the standard first‐line treatment for young mantle cell lymphoma patients. However, most patients relapse after ASCT. We investigated in a randomised phase II study the outcome of a chemo‐immuno regimen and ASCT with or without maintenance therapy with bortezomib. Induction consisted of three cycles R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), two cycles high‐dose cytarabine, BEAM (carmustine, etoposide, cytarabine, melphalan) and ASCT. Patients responding were randomised between bortezomib maintenance (1·3 mg/m2 intravenously once every 2 weeks, for 2 years) and observation. Of 135 eligible patients, 115 (85%) proceeded to ASCT, 60 (44%) were randomised. With a median follow‐up of 77·5 months for patients still alive, 5‐year event‐free survival (EFS) was 51% (95% CI 42–59%); 5‐year overall survival (OS) was 73% (95% CI 65–80%). The median follow‐up of randomised patients still alive was 71·5 months. Patients with bortezomib maintenance had a 5‐year EFS of 63% (95% CI 44–78%) and 5‐year OS of 90% (95% CI 72–97%). The patients randomised to observation had 5‐year PFS of 60% (95% CI, 40–75%) and OS of 90% (95% CI 72–97%). In conclusion, in this phase II study we found no indication of a positive effect of bortezomib maintenance after ASCT.
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Affiliation(s)
| | | | | | - Marie Josee Kersten
- Haematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (lymphoma and myeloma Center), Amsterdam, Netherlands
| | | | | | | | | | - Eva de Jongh
- Albert Schweitzer Hospital Location Dordwijk, Dordrecht, Netherlands
| | | | | | | | | | | | - Robby E Kibbelaar
- Department of Pathology, Pathology Friesland, Groningen, Netherlands
| | | | - Dana A Chitu
- Erasmus MC Cancer Center, Rotterdam, Netherlands
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23
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van der Straten L, Levin MD, Visser O, Blijlevens NMA, Cornelissen JJ, Doorduijn JK, Kater AP, Dinmohamed AG. The effectiveness of ibrutinib in chronic lymphocytic leukaemia: a nationwide, population-based study in the Netherlands. Br J Haematol 2020; 188:e109-e112. [PMID: 31991479 DOI: 10.1111/bjh.16391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lina van der Straten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Nicole M A Blijlevens
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan J Cornelissen
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arnon P Kater
- Department of Haematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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24
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van der Straten L, Levin MD, Visser O, Posthuma EFM, Doorduijn JK, Kater AP, Dinmohamed AG. Survival continues to increase in chronic lymphocytic leukaemia: a population-based analysis among 20 468 patients diagnosed in the Netherlands between 1989 and 2016. Br J Haematol 2020; 189:574-577. [PMID: 31958141 DOI: 10.1111/bjh.16397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Lina van der Straten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands.,Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanette K Doorduijn
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arnon P Kater
- Department of Haematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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25
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Kluin-Nelemans HC, Hoster E, Hermine O, Walewski J, Geisler CH, Trneny M, Stilgenbauer S, Kaiser F, Doorduijn JK, Salles G, Szymczyk M, Tilly H, Kanz L, Schmidt C, Feugier P, Thieblemont C, Zijlstra JM, Ribrag V, Klapper W, Pott C, Unterhalt M, Dreyling MH. Treatment of Older Patients With Mantle Cell Lymphoma (MCL): Long-Term Follow-Up of the Randomized European MCL Elderly Trial. J Clin Oncol 2019; 38:248-256. [PMID: 31804876 DOI: 10.1200/jco.19.01294] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [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
PURPOSE In an update of the randomized, open-label, phase III European Mantle Cell Lymphoma (MCL) Elderly trial (ClinicalTrials.gov identifier: NCT00209209), published in 2012, we aimed to confirm results on long-term outcome focusing on efficacy and safety of long-term use of rituximab maintenance. PATIENTS AND METHODS Five hundred sixty patients with newly diagnosed MCL underwent a first random assignment between rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and rituximab, fludarabine, and cyclophosphamide (R-FC) induction, followed by a second random assignment in 316 responders between rituximab and interferon alfa maintenance, to be continued until progression. We compared progression-free survival from the second randomization and overall survival (OS) from the first or second randomizations. RESULTS After a median follow-up time of 7.6 years, the previously described difference in OS between the induction arms persisted (median, 6.4 years after R-CHOP [n = 280] v 3.9 years after R-FC [n = 280]; P = .0054). Patients responding to R-CHOP had median progression-free survival and OS times of 5.4 and 9.8 years, respectively, when randomly assigned to rituximab (n = 87), compared with 1.9 years (P < .001) and 7.1 years (P = .0026), respectively, when randomly assigned to interferon alfa (n = 97). In 58% and 32% of patients treated with R-CHOP, rituximab maintenance was still ongoing 2 and 5 years from start of maintenance, respectively. After R-FC, rituximab maintenance was associated with an unexpectedly high cumulative incidence of death in remission (22% at 5 years). Toxicity of rituximab maintenance was low after R-CHOP (grade 3-4 leukopenia or infection < 5%) but more prominent in patients on rituximab maintenance after R-FC, in whom grade 3-4 leukopenia (up to 40%) and infections were frequent (up to 15%). CONCLUSION The excellent results of R-CHOP followed by rituximab maintenance until progression for older patients with MCL persisted in a mature follow-up. Prolongation of rituximab maintenance beyond 2 years is effective and safe.
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Affiliation(s)
| | - Eva Hoster
- University Hospital Ludwig-Maximilians-University Munich, Munich, Germany
| | - Olivier Hermine
- Hôpital Necker, Institut Imagine, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| | - Jan Walewski
- Maria Sklodowska-Curie Institute, Warsaw, Poland
| | | | - Marek Trneny
- Charles University General Hospital, Prague, Czech Republic
| | | | | | | | - Gilles Salles
- Hospices Civils de Lyon, University of Lyon, Pierre-Benite, France
| | | | | | | | - Christian Schmidt
- University Hospital Ludwig-Maximilians-University Munich, Munich, Germany
| | - Pierre Feugier
- Center Hospitalier Regional and University Nancy Vandoeuvre les Nancy, Nancy, France
| | | | - Josée M Zijlstra
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | | | - Christiane Pott
- University Hospital Schleswig-Holstein Campus Kiel/Christian-Albrechts University Kiel, Kiel, Germany
| | - Michael Unterhalt
- University Hospital Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin H Dreyling
- University Hospital Ludwig-Maximilians-University Munich, Munich, Germany
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26
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de Haes I, Versluis J, Lam KH, Jongen JLM, Doorduijn JK, Kuipers S. Epstein-Barr virus infection or malignant lymphoma - what you see is not what you get. Neth J Med 2019; 77:370-372. [PMID: 31880273] [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: 06/10/2023]
Abstract
Infectious mononucleosis may mimic lymphoma, both clinically and histopathologically. We present a patient with neurological symptoms and lymphadenopathy, initially diagnosed as Epstein-Barr virus (EBV)-positive angioimmunoblastic T-cell lymphoma (AITL) with cerebrospinal fluid (CSF) localisation based on lymph node pathology and a 30-fold higher EBV load in the CSF compared with serum. However, the patient fully recovered spontaneously and EBV became negative in both CSF and serum, suggestive of a dramatic presentation of EBV meningoencephalitis.
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Affiliation(s)
- I de Haes
- Department of Haematology, Erasmus Medical Centre Cancer Institute, Rotterdam, the Netherlands
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27
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van der Meulen M, Dirven L, Habets E, Bakunina K, Taphoorn M, van den Bent M, Issa S, Doorduijn JK, Bromberg JEC. NCOG-05. IMPACT OF ADDITIONAL RITUXIMAB TO STANDARD THERAPY ON COGNITIVE PERFORMANCES IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA PATIENTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The goal of treatment of primary central nervous system lymphoma patients is to improve survival, without compromising neurocognitive functioning. The aim of this study was to analyze the effect of Rituximab and low-dose whole brain radiotherapy (WBRT) on cognition.
METHODS
199 patients from a phase III trial (HOVON 105/ ALLG NHL 24), randomized to standard chemotherapy (and 30Gy WBRT for patients < 61 years-old only) with or without Rituximab, were asked to participate in a short neuropsychological evaluation (NPE) before and during treatment, and up to 2 years of follow-up or until progression. A difference in z-score, corrected for sex, age and education, of ≥ 1 point was considered as clinically relevant. The primary outcome was a difference over time between the arms in multiple cognitive domains, assessed by linear mixed models (LMM). Changes in cognitive performances between baseline and 24 months after treatment were assessed for both arms in cross-sectional analyses. Effect of WBRT was analyzed in irradiated patients only.
RESULTS
105/199 patients completed at least one NPE; baseline characteristics were similar to the total trial population. Compliance was >60% at all evaluation points. No clinically relevant differences over time between the arms were seen in all domains in LMM analysis. Comparing changes from baseline to 24 months of follow-up, mean cognitive scores remained stable in both arms for attention, executive functioning (TMT B), and information processing speed. A clinically relevant improvement was seen in both arms for executive functioning (TMT A), memory and motor speed. In the irradiated patients (n=33) all scores remained stable after WBRT, up to 24 months of follow-up in all domains.
CONCLUSION
Cognitive performance remained stable or improved after treatment. Addition of Rituximab to standard treatment did not impact cognitive performance over time. After low-dose WBRT, cognition remained stable up to 2 years.
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Affiliation(s)
| | - Linda Dirven
- Leiden University Medical Center, Leiden, Netherlands
| | - Esther Habets
- Haaglanden Medisch Centrum, lokatie Antonius Hove, Leidschendam, Netherlands
| | | | - Martin Taphoorn
- Haaglanden Medisch Centrum, lokatie Antonius Hove, Leidschendam, Netherlands
| | | | - Samar Issa
- Middlemore Hospital, Middlemore, Auckland, New Zealand
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28
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Schmitt AM, Herbrand AK, Fox CP, Bakunina K, Bromberg JEC, Cwynarski K, Doorduijn JK, Ferreri AJM, Illerhaus G, Issa S, Schorb E, Zucca E, Hemkens LG, Schandelmaier S, Kasenda B. Rituximab in primary central nervous system lymphoma-A systematic review and meta-analysis. Hematol Oncol 2019; 37:548-557. [PMID: 31418878 DOI: 10.1002/hon.2666] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 01/17/2023]
Abstract
The CD-20 antibody rituximab is a standard component of treatment of non-Hodgkin B-cell lymphomas, including diffuse large B-cell lymphoma (DLBCL). Primary DLBCL of the central nervous system, also called primary central nervous system lymphoma (PCNSL), is a DLBCL confined to the central nervous system. There has been debate whether intravenous rituximab accumulates sufficiently in the central nervous system to exert an effect. In this systematic review, we assess the benefits and harms of rituximab in the treatment of immunocompetent patients with PCNSL. By searching MEDLINE, CENTRAL, and ClincialTrials.gov up to March 2019, we identified randomized controlled trials (RCTs) investigating the effect of rituximab in patients with PCNSL. We extracted study characteristics and results, assessed risk of bias, performed trial-level random-effects meta-analyses, and graded the certainty of evidence. The protocol was registered with PROSPERO (CRD42019121965). Main outcomes were overall survival (time to death), progression-free survival (time to progression or death), quality of life, grades 3 and 4 toxicity, and treatment-related mortality. We included two RCTs with a total of 343 participants. Overall survival was not statistically significantly improved (HR 0.76; 95% CI, 0.52-1.12; low certainty), with 187 fewer to 39 more deaths after 2 years in 1000 treated patients. Low certainty of evidence indicated that rituximab improved progression-free survival (HR 0.65; 95% CI, 0.45-0.95), which translated into 137 fewer progressions or deaths after 2 years in 1000 treated patients (231 to 18 fewer). None of the RCTs provided data on quality of life. We found no evidence that rituximab increased grades 3 and 4 toxicity or treatment-related mortality (RR 0.53; 95% CI, 0.20-1.37; low certainty). Overall, the available evidence suggests with low certainty that rituximab in combination with methotrexate-based chemotherapy may improve progression-free survival in immunocompetent patients with newly diagnosed PCNSL, the pooled effect estimates did not show evidence for improvement of overall survival.
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Affiliation(s)
- Andreas M Schmitt
- Department of Medical Oncology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Amanda K Herbrand
- Department of Medical Oncology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham Hospitals NHS Trust, Nottingham, UK
| | - Katerina Bakunina
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Kate Cwynarski
- Department of Haematology, University College London Hospital, London, UK
| | | | - Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gerald Illerhaus
- Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Elisabeth Schorb
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Emanuele Zucca
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Stefan Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Benjamin Kasenda
- Department of Medical Oncology, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
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29
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Wang M, Rule S, Zinzani PL, Goy A, Casasnovas O, Smith SD, Damaj G, Doorduijn JK, Lamy T, Morschhauser F, Panizo C, Shah B, Davies A, Eek R, Dupuis J, Jacobsen E, Kater AP, Le Gouill S, Oberic L, Robak T, Jain P, Frigault MM, Izumi R, Nguyen D, Patel P, Yin M, Długosz-Danecka M. Durable response with single-agent acalabrutinib in patients with relapsed or refractory mantle cell lymphoma. Leukemia 2019; 33:2762-2766. [PMID: 31558766 DOI: 10.1038/s41375-019-0575-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/17/2019] [Accepted: 07/19/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Michael Wang
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA.
| | - Simon Rule
- Plymouth University Medical School, Plymouth, UK
| | - Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli", University of Bologna, Bologna, Italy
| | - Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Stephen D Smith
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Gandhi Damaj
- Institut d'Hématologie de Basse-Normandie, Caen, France
| | - Jeanette K Doorduijn
- Erasmus MC, HOVON Lunenburg Lymphoma Phase I/II Consortium, Rotterdam, Netherlands
| | | | - Franck Morschhauser
- Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000, Lille, France
| | | | | | - Andrew Davies
- Cancer Research UK Centre, University of Southampton Faculty of Medicine, Southampton, UK
| | - Richard Eek
- Border Medical Oncology, Albury, Victoria, Australia
| | - Jehan Dupuis
- Unité Hémopathies Lymphoïdes, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Eric Jacobsen
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Arnon P Kater
- Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, HOVON Lunenburg Lymphoma Phase I/II Consortium, Amsterdam, Netherlands
| | | | - Lucie Oberic
- Institut Universitaire du Cancer-Oncopole Toulouse (IUCT-O), Toulouse, France
| | - Tadeusz Robak
- Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Preetesh Jain
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | | | | | | | - Ming Yin
- Acerta Pharma, South San Francisco, CA, USA
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30
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van der Meulen M, Bromberg JEC, Visser O, Doorduijn JK, Dinmohamed AG. OS10.3 Primary therapy and survival in over 70-year-old patients with primary central nervous system lymphoma: a contemporary, nationwide, population-based study in the Netherlands. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Elderly patients with primary central nervous system lymphoma (PCNSL) have a poor prognosis. In this contemporary, nationwide, population-based study, we assessed the contribution of primary therapy on overall survival (OS) among elderly PCNSL patients in the Netherlands.
METHODS
All patients aged ≥ 70 years with cytologically and/or histologically proven PCNSL diagnosed between 2014–2016 were selected from the nationwide Netherlands Cancer Registry. Univariable analysis of OS was performed with the log-rank test. Multivariable Cox regression was applied to assess factors associated with OS, with adjustment for age (71–74, 75–79 and ≥80 years), sex, prior malignancy, primary therapy (no therapy, radiotherapy [RT] only, chemotherapy [CT]), and rituximab treatment.
RESULTS
Overall, 109 patients were registered; 39%, 39%, and 22% were aged 71–74, 75–79 and ≥80 years, respectively. Most patients received CT (45%), followed by no therapy (33%) and RT only (22%). With increasing age, the application of CT decreased (60%, 43%, and 24%), and RT only increased (10%, 26%, 26%) in the three age groups. CT consisted of methotrexate (MTX)-based or MTX only regimens in 98%. In patients treated with CT, Rituximab was added in 31%. During follow-up, 89 patients (82%) died. Median OS was 5.3 months (95% confidence interval [CI], 3.3–7.8), no difference was observed in median OS across the three age groups (6.8, 4.4, and 4.6 months, respectively; P=0.348). However, in the groups no therapy, RT only, and CT, median OS (95% CI) was 1.3 (1.0–2.0), 6.5 (4.4–12.5), and 20.3 (8.6–41.4) months (P<0.001), respectively. Moreover, 2 year OS (95%CI) was 49% (34–62) in patients treated with chemotherapy compared with 17% (5–34) in patients treated with RT. Median OS (95% CI) was 20.3 (8.6–41.4) in recipients of MTX-based regimens and 5.0 (2.4-not reached) months in recipients MTX only (P=0.185). In multivariable analysis, treatment with CT or RT was the only factor associated with OS: age group and the addition of Rituximab were not associated with OS.
CONCLUSION
In this contemporary population-based study, OS remained poor among patients with PCNSL aged over 70 years, irrespective of age group. Clinical condition likely influenced therapy choices but in those judged fit enough to receive CT, almost 50% survived 2 years. Therefore, future prospective intervention studies are warranted to assess which group of elderly patients benefit from CT or less intensive approaches.
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Affiliation(s)
| | | | - O Visser
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | | | - A G Dinmohamed
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
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31
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Wang M, Rule S, Zinzani PL, Goy A, Casasnovas O, Smith S, Damaj G, Doorduijn JK, Lamy T, Morschhauser F, Panizo C, Shah B, Davies A, Eek R, Dupuis J, Jacobsen E, Kater AP, Le Gouill S, Oberic L, Robak T, Dua R, Frigault MM, Izumi R, Nguyen D, Patel P, Yin M, Jurczak W. Long-Term Follow-Up of Acalabrutinib Monotherapy in Patients with Relapsed/Refractory Mantle Cell Lymphoma. Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.07.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Lugtenburg PJ, Zijlstra JM, Doorduijn JK, Böhmer LH, Hoogendoorn M, Berenschot HW, Beeker A, van der Burg-de Graauw NC, Schouten HC, Bilgin YM, Kersten MJ, Koene HR, Herbers AHE, de Jong D, Hijmering N, Lam KH, Chiţu D, Brouwer RE, van Imhoff GW. Rituximab-PECC induction followed by 90 Y-ibritumomab tiuxetan consolidation in relapsed or refractory DLBCL patients who are ineligible for or have failed ASCT: results from a phase II HOVON study. Br J Haematol 2019; 187:347-355. [PMID: 31290569 DOI: 10.1111/bjh.16087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/11/2019] [Indexed: 12/25/2022]
Abstract
Patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) after, or ineligible for, autologous stem cell transplantation (ASCT) have a dismal prognosis. This phase II study evaluated treatment with R-PECC (rituximab, prednisolone, etoposide, chlorambucil, lomustine), every 28 days for 4 cycles in 62 patients, followed by radio-immunotherapy consolidation with 90 Y-ibritumomab tiuxetan in responsive patients. Primary endpoints were failure-free survival (FFS) and incidence of grade ≥3 adverse events from start of 90 Y-ibritumomab tiuxetan. The overall response rate after R-PECC was 50%. Twenty-nine of 31 responsive patients proceeded to 90 Y-ibritumomab tiuxetan. Five out of 15 partial remission patients converted to complete remission after 90 Y-ibritumomab tiuxetan. One-year FFS and overall survival (OS) from start of 90 Y-ibritumomab tiuxetan was 52% (95% confidence interval [CI], 33-68%) and 62% (95% CI, 42-77%), respectively. One-year FFS and OS from start of R-PECC was 28% (95% CI, 17-39%) and 49% (95% CI, 36-61%), respectively. Toxicities of R-PECC and 90 Y-ibritumomab tiuxetan were mainly haematological. In conclusion, for relapsed DLBCL patients the largely oral R-PECC regimen achieves promising response rates, combined with an acceptable safety profile. Consolidation with 90 Y-ibritumomab tiuxetan resulted in long-term response durations in approximately one third of the patients that received it.
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Affiliation(s)
| | - Josee M Zijlstra
- Department of Haematology, Amsterdam University Medical Centre VUmc, Amsterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Lara H Böhmer
- Department of Haematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mels Hoogendoorn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | | | - Aart Beeker
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - Harry C Schouten
- Department of Haematology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Yavuz M Bilgin
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Marie-Jose Kersten
- Department of Haematology, Amsterdam University Medical Centre AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Harry R Koene
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Alexandra H E Herbers
- Department of Haematology and Medical Oncology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Daphne de Jong
- HOVON Pathology Facility and Biobank (HOP), Department of Pathology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Nathalie Hijmering
- HOVON Pathology Facility and Biobank (HOP), Department of Pathology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - King H Lam
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
| | - Dana Chiţu
- HOVON Data Centre, Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Rolf E Brouwer
- Department of Haematology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Gustaaf W van Imhoff
- Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands
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Bromberg JEC, Issa S, Bakunina K, Minnema MC, Seute T, Durian M, Cull G, Schouten HC, Stevens WBC, Zijlstra JM, Baars JW, Nijland M, Mason KD, Beeker A, van den Bent MJ, Beijert M, Gonzales M, de Jong D, Doorduijn JK. Rituximab in patients with primary CNS lymphoma (HOVON 105/ALLG NHL 24): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 2019; 20:216-228. [PMID: 30630772 DOI: 10.1016/s1470-2045(18)30747-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prognosis for primary CNS lymphoma has improved with the use of high-dose methotrexate-based chemotherapy, but patient outcomes remain poor. Rituximab, a chimeric monoclonal antibody that targets the CD20 cell surface protein, has substantial activity in systemic CD20-positive diffuse large B-cell lymphoma, but its efficacy in primary CNS lymphoma is unknown and low penetration of the large rituximab molecule through the blood-brain barrier could limit its effect. We aimed to investigate the addition of rituximab to a high-dose methotrexate-based chemotherapy regimen in patients with newly diagnosed primary CNS lymphoma. METHODS This intergroup, multicentre, open-label, randomised phase 3 study was done at 23 hospitals in the Netherlands, Australia, and New Zealand. Non-immunocompromised patients aged 18-70 years with newly diagnosed primary CNS lymphoma were randomly assigned (1:1) to receive methotrexate-based chemotherapy with or without intravenous rituximab. We used a web-based randomisation system with stratification by centre, age, and Eastern Cooperative Oncology Group-WHO performance status, and a minimisation procedure. All group assignment was open label and neither investigators nor patients were masked to allocation. All patients were treated with two 28-day cycles of induction chemotherapy, consisting of intravenous methotrexate 3 g per m2 on days 1 and 15, intravenous carmustine 100 mg per m2 on day 4, intravenous teniposide 100 mg per m2 on days 2 and 3, and oral prednisone 60 mg per m2 on days 1-5, with (R-MBVP) or without (MBVP) intravenous rituximab 375 mg per m2 on days 0, 7, 14, and 21 in cycle one and days 0 and 14 in cycle two. Patients with response at the end of induction subsequently received high-dose cytarabine and, in patients aged 60 years or younger, low-dose whole-brain radiotherapy. The primary endpoint was event-free survival, with events defined as not reaching complete response or complete response unconfirmed at the end of treatment, or progression or death after response; analysis was adjusted for age and performance score. Patients were analysed on a modified intention-to-treat basis. This trial is registered with the Nederlands Trial Register, number NTR2427, and the Australian New Zealand Clinical Trials Registry, number ACTRN12610000908033. The trial was closed on May 27, 2016, after achieving complete accrual, and follow-up is ongoing. FINDINGS Between Aug 3, 2010, and May 27, 2016, we recruited 200 patients (109 men and 91 women; median age was 61 years [IQR 55-67]). We randomly assigned 100 patients to MBVP and 99 patients to R-MBVP. One patient was randomly assigned to the R-MBVP group but found to be ineligible because of an incorrect diagnosis and was excluded from all analyses. After a median follow-up of 32·9 months (IQR 23·9-51·5), 98 patients had had an event (51 in the MBVP group and 47 in the R-MBVP group), of whom 79 had died (41 in the MBVP group and 38 in the R-MBVP group). Event-free survival at 1 year was 49% (95% CI 39-58) in the MBVP group (no rituximab) and 52% (42-61) in the R-MBVP group (with rituximab; hazard ratio 1·00, 95% CI 0·70-1·43, p=0·99). Grade 3 or 4 adverse events occurred in 58 (58%) patients in the MBVP group and 63 (64%) patients in the R-MBVP group, with infections (24 [24%] patients receiving MBVP vs 21 [21%] patients receiving R-MBVP), haematological toxicity (15 [15%] vs 12 [12%]), and nervous system disorders (ten [10%] vs 15 [15%]) being the most common. Life-threatening or fatal serious adverse events occurred in 12 (12%) patients in the MBVP group and ten (10%) patients in the R-MBVP group, and five (5%) patients in the MBVP group and three (3%) in the R-MBVP group died from treatment-related causes. INTERPRETATION We found no clear benefit of addition of rituximab to methotrexate, carmustine, teniposide, and prednisone chemotherapy in primary CNS lymphoma. Therefore, the results of this study do not support the use of rituximab as a component of standard treatment in primary CNS lymphoma. FUNDING Roche, the Dutch Cancer Society, and Stichting STOPhersentumoren.
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Affiliation(s)
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Katerina Bakunina
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tatjana Seute
- Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc Durian
- Department of Hematology, ETZ Hospital, Tilburg, Netherlands
| | - Gavin Cull
- Haematology Department, Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, WA, Australia; University of Western Australia, Crawley, WA, Australia
| | - Harry C Schouten
- Department of Hematology, University Medical Center, Maastricht, Netherlands
| | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Josee M Zijlstra
- Department of Hematology, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joke W Baars
- Department of Hemato-Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Marcel Nijland
- Department of Hematology, University Medical Center Groningen, Groningen, Netherlands
| | - Kylie D Mason
- Department of Hematology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Aart Beeker
- Department of Hematology, Spaarne Gasthuis, Haarlem, Netherlands
| | | | - Max Beijert
- Department of Radiotherapy, University Medical Center Groningen, Groningen, Netherlands
| | - Michael Gonzales
- Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Daphne de Jong
- Department of Pathology, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam, Netherlands; HOVON Pathology Facility and Biobank, Amsterdam, Netherlands
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Bromberg JEC, Issa S, Bakunina K, Minnema MC, Seute T, Cull G, van den Bent MJ, Gonzales M, de Jong D, Doorduijn JK. OS2.5 Effect of rituximab in primary central nervous system lymphoma - results of the randomized phase III HOVON 105/ALLG NHL 24 study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - S Issa
- Middlemore Hospital, Auckland, New Zeal
| | - K Bakunina
- Erasmus MC Cancer Centre, Rotterdam, Netherlands
| | - M C Minnema
- University Medical Centre, Utrecht, Netherlands
| | - T Seute
- University Medical Centre, Utrecht, Netherlands
| | - G Cull
- Sir Charles Gairdner Hospital, Nedlands, New Zeal
| | | | - M Gonzales
- Royal Melburne Hospital, Melbourne, New Zeal
| | - D de Jong
- VU Medical Centre, Amsterdam, Netherlands
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van der Meulen M, Bromberg JE, Lam KH, Dammers R, Langerak AW, Doorduijn JK, Kros JM, van den Bent MJ, van der Velden VH. Flow cytometry shows added value in diagnosing lymphoma in brain biopsies. Cytometry B Clin Cytom 2018; 94:928-934. [PMID: 29747221 PMCID: PMC6585701 DOI: 10.1002/cyto.b.21641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
Background To assess the sensitivity, specificity and turnaround time of flow cytometric analysis on brain biopsies compared to histology plus immunohistochemistry analysis in tumors with clinical suspicion of lymphoma. Methods All brain biopsies performed between 2010 and 2015 at our institution and analyzed by both immunohistochemistry and flow cytometry were included in this retrospective study. Immunohistochemistry was considered the gold standard. Results In a total of 77 biopsies from 71 patients, 49 lymphomas were diagnosed by immunohistochemistry, flow cytometry results were concordant in 71 biopsies (92.2%). We found a specificity and sensitivity of flow cytometry of 100% and 87.8%, respectively. The time between the biopsy and reporting the result (turnaround time) was significantly shorter for flow cytometry, compared to immunohistochemistry (median: 1 vs. 5 days). Conclusions Flow cytometry has a high specificity and can confirm the diagnosis of a lymphoma significantly faster than immunohistochemistry. This allows for rapid initiation of treatment in this highly aggressive tumor. However, since its sensitivity is less than 100%, we recommend to perform histology plus immunohistochemistry in parallel to flow cytometry. © 2018 The Authors. Cytometry Part B: Clinical Cytometry published by Wiley Periodicals, Inc. on behalf of International Clinical Cytometry Society
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Jacoline E.C. Bromberg
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - King H. Lam
- Department of PathologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | - Ruben Dammers
- Department of NeurosurgeryErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Anton W. Langerak
- Department of Immunology, Laboratory Medical ImmunologyErasmus MC, University Medical CenterRotterdamthe Netherlands
| | - Jeanette K. Doorduijn
- Department of HematologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | - Johan M. Kros
- Department of PathologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Martin J. van den Bent
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Vincent H.J. van der Velden
- Department of Immunology, Laboratory Medical ImmunologyErasmus MC, University Medical CenterRotterdamthe Netherlands
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36
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Kater AP, van Oers MHJ, van Norden Y, van der Straten L, Driessen J, Posthuma WFM, Schipperus M, Chamuleau MED, Nijland M, Doorduijn JK, Van Gelder M, Hoogendoorn M, De Croon F, Wittebol S, Kerst JM, Marijt EWA, Raymakers RAP, Schaafsma MR, Dobber JA, Kersting S, Levin MD. Feasibility and efficacy of addition of individualized-dose lenalidomide to chlorambucil and rituximab as first-line treatment in elderly and FCR-unfit patients with advanced chronic lymphocytic leukemia. Haematologica 2018; 104:147-154. [PMID: 30115656 PMCID: PMC6312018 DOI: 10.3324/haematol.2018.193854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022] Open
Abstract
Lenalidomide has been proven to be effective but with a distinct and difficult to manage toxicity profile in the context of chronic lymphocytic leukemia, potentially hampering combination treatment with this drug. We conducted a phase 1-2 study to evaluate the efficacy and safety of six cycles of chlorambucil (7 mg/m2 daily), rituximab (375 mg/m2 cycle 1 and 500 mg/m2 cycles 2-6) and individually-dosed lenalidomide (escalated from 2.5 mg to 10 mg) (induction-I) in first-line treatment of patients with chronic lymphocytic leukemia unfit for treatment with fludarabine, cyclophosphamide and rituximab. This was followed by 6 months of 10 mg lenalidomide monotherapy (induction-II). Of 53 evaluable patients in phase 2 of the study, 47 (89%) completed induction-I and 36 (68%) completed induction-II. In an intention-to-treat analysis, the overall response rate was 83%. The median progression-free survival was 49 months, after a median follow-up time of 27 months. The 2- and 3-year progression-free survival rates were 58% and 54%, respectively. The corresponding rates for overall survival were 98% and 95%. No tumor lysis syndrome was observed, while tumor flair reaction occurred in five patients (9%, 1 grade 3). The most common hematologic toxicity was grade 3-4 neutropenia, which occurred in 73% of the patients. In conclusion, addition of lenalidomide to a chemotherapy backbone followed by a fixed duration of lenalidomide monotherapy resulted in high remission rates and progression-free survival rates, which seem comparable to those observed with novel drug combinations including novel CD20 monoclonal antibodies or kinase inhibitors. Although lenalidomide-specific toxicity remains a concern, an individualized dose-escalation schedule is feasible and results in an acceptable toxicity profile. EuraCT number: 2010-022294-34.
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Affiliation(s)
- Arnon P Kater
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam, Academic Medical Center, Amsterdam
| | - Marinus H J van Oers
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam, Academic Medical Center, Amsterdam
| | - Yvette van Norden
- Department of Hematology - HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam
| | | | - Julia Driessen
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam, Academic Medical Center, Amsterdam
| | - Ward F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft.,Department of Hematology, Leiden University Medical Center
| | | | | | - Marcel Nijland
- Department of Hematology, University Medical Center, Groningen
| | | | | | | | | | | | - J Martijn Kerst
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam
| | | | | | | | - Johan A Dobber
- Laboratory Special Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht
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Schauwvlieghe AFAD, de Jonge N, van Dijk K, Verweij PE, Brüggemann RJ, Biemond BJ, Bart A, von dem Borne PA, Verbon A, van der Beek MT, Demandt AMP, Oudhuis GJ, Cornelissen JJ, van der Velden WJFM, Span LFR, Kampinga GA, Bruns AH, Vonk AG, Haas PJA, Doorduijn JK, Rijnders BJA. The diagnosis and treatment of invasive aspergillosis in Dutch haematology units facing a rapidly increasing prevalence of azole-resistance. A nationwide survey and rationale for the DB-MSG 002 study protocol. Mycoses 2018; 61:656-664. [PMID: 29687483 DOI: 10.1111/myc.12788] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023]
Abstract
Patients with haematological malignancies are at risk for invasive fungal diseases (IFD). A survey was conducted in all Dutch academic haematology centres on their current diagnostic, prophylactic and therapeutic approach towards IFD in the context of azole-resistance. In all 8 centres, a haematologist and microbiologist filled in the questionnaire that focused on different subgroups of haematology patients. Fungal prophylaxis during neutropaenia was directed against Candida and consisted of fluconazole and/or amphotericin B suspension. Mould-active prophylaxis was given to acute myeloid leukaemia patients during chemotherapy in 2 of 8 centres. All centres used azole prophylaxis in a subset of patients with graft-versus-host disease. A uniform approach towards the diagnosis and treatment of IFD and in particular azole-resistant Aspergillus fumigatus was lacking. In 2017, all centres agreed to implement a uniform diagnostic and treatment algorithm regarding invasive aspergillosis with a central role for comprehensive diagnostics and PCR-based detection of azole-resistance. This study (DB-MSG 002) will re-evaluate this algorithm when 280 patients have been treated. A heterogeneous approach towards antifungal prophylaxis, diagnosis and treatment was apparent in the Netherlands. Facing triazole-resistance, consensus was reached on the implementation of a uniform diagnostic approach in all 8 centres.
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Affiliation(s)
- Alexander F A D Schauwvlieghe
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nick de Jonge
- Department of Haematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Karin van Dijk
- Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Roger J Brüggemann
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart J Biemond
- Department of Haematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Aldert Bart
- Department of Medical Microbiology (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Peter A von dem Borne
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelies Verbon
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martha T van der Beek
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Astrid M P Demandt
- Department of Haematology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guy J Oudhuis
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan J Cornelissen
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Lambert F R Span
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Greetje A Kampinga
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anke H Bruns
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alieke G Vonk
- Department of Medical Microbiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pieter-Jan A Haas
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanette K Doorduijn
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Bart J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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van der Straten L, Dinmohamed AG, Westerweel PE, Langerak AW, Riedl J, Doorduijn JK, Kater AP, Levin MD. Rituximab addition to chemotherapy in real world patients with chronic lymphocytic leukemia: effective in first line but indication of lack of efficacy in subsequent lines of therapy. Leuk Lymphoma 2018; 59:2757-2761. [DOI: 10.1080/10428194.2018.1452215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lina van der Straten
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Avinash G. Dinmohamed
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Peter E. Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Anton W. Langerak
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jurgen Riedl
- Department of Clinical Chemistry, Result laboratories, Albert Schweitzer Hospital, Dordrecht, The Netherland
| | | | - Arnon P. Kater
- Department of Hematology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Brown JR, Hamadani M, Hayslip J, Janssens A, Wagner-Johnston N, Ottmann O, Arnason J, Tilly H, Millenson M, Offner F, Gabrail NY, Ganguly S, Ailawadhi S, Kasar S, Kater AP, Doorduijn JK, Gao L, Lager JJ, Wu B, Egile C, Kersten MJ. Voxtalisib (XL765) in patients with relapsed or refractory non-Hodgkin lymphoma or chronic lymphocytic leukaemia: an open-label, phase 2 trial. Lancet Haematol 2018; 5:e170-e180. [PMID: 29550382 DOI: 10.1016/s2352-3026(18)30030-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/05/2018] [Accepted: 02/20/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with relapsed or refractory lymphoma or chronic lymphocytic leukaemia have a poor prognosis. Therapies targeting more than one isoform of PI3K, as well as mTOR, might increase antitumour activity. We aimed to investigate the efficacy and safety of voxtalisib (also known as XL765 or SAR245409), a pan-PI3K/mTOR inhibitor, in patients with relapsed or refractory lymphoma, or chronic lymphocytic leukaemia/small lymphocytic lymphoma. METHODS We did a non-randomised, open-label, phase 2 trial at 30 oncology clinics in the USA, Belgium, Germany, France, the Netherlands, and Australia. Patients aged 18 years or older with Eastern Cooperative Oncology Group (EGOG) performance status score of 2 or lower and relapsed or refractory mantle cell lymphoma, follicular lymphoma, diffuse large B-cell lymphoma, or chronic lymphocytic leukaemia/small lymphocytic lymphoma were enrolled and treated with voxtalisib 50 mg orally twice daily in 28-day continuous dosing cycles until progression or unacceptable toxicity. The primary endpoint was the proportion of patients in each disease-specific cohort who achieved an overall response, defined as a complete response or partial response. All patients who received more than 4 weeks of treatment and who completed a baseline and at least one post-baseline tumour assessment were analysed for efficacy and all patients were analysed for safety. This study is registered with ClinicalTrials.gov, number NCT01403636, and has been completed. FINDINGS Between Oct 19, 2011, and July 24, 2013, 167 patients were enrolled (42 with mantle cell lymphoma, 47 with follicular lymphoma, 42 with diffuse large B-cell lymphoma, and 36 with chronic lymphocytic leukaemia/small lymphocytic lymphoma. The median number of previous anticancer regimens was three (IQR 2-4) for patients with lymphoma and four (2-5) for patients with chronic lymphocytic leukaemia/small lymphocytic lymphoma. Of 164 patients evaluable for efficacy, 30 (18·3%) achieved an overall response (partial, n=22; complete, n=8); 19 (41·3%) of 46 with follicular lymphoma, five (11·9%) of 42 with mantle cell lymphoma, two (4·9%) of 41 with diffuse large B-cell lymphoma, and four (11·4%) of 35 with chronic lymphocytic leukaemia/small lymphocytic lymphoma. The safety profile was consistent with that of previous studies of voxtalisib. The most frequently reported adverse events were diarrhoea (in 59 [35%] of 167 patients), fatigue (in 53 [32%]), nausea (in 45 [27%]), pyrexia (in 44 [26%,]), cough (in 40 [24%]), and decreased appetite (in 35 [21%]). The most frequently reported grade 3 or worse adverse events were anaemia (in 20 [12%] of 167 patients), pneumonia (in 14 [8%]), and thrombocytopenia (in 13 [8%]). Serious adverse events occurred in 97 (58·1%) of 167 patients. INTERPRETATION Voxtalisib 50 mg given orally twice daily had an acceptable safety profile, with promising efficacy in patients with follicular lymphoma but limited efficacy in patients with mantle cell lymphoma, diffuse large B-cell lymphoma, or chronic lymphocytic leukaemia/small lymphocytic lymphoma. FUNDING Sanofi.
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Affiliation(s)
- Jennifer R Brown
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Mehdi Hamadani
- Department of Medicine, West Virginia University, Morgantown, WV, USA; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Hayslip
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Ann Janssens
- Department of Haematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Nina Wagner-Johnston
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
| | - Oliver Ottmann
- Department of Haematology, Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Jon Arnason
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hervé Tilly
- Department of Haematology and INSERM U1245, Centre Henri Becquerel, Rouen University, Rouen, France
| | - Michael Millenson
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Fritz Offner
- Dienst Hematologie, Universitair Ziekenhuis Gent, Gent, Belgium
| | | | - Siddhartha Ganguly
- Division of Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Siddha Kasar
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Arnon P Kater
- Department of Hematology, Academic Medical Center, Amsterdam, Netherlands; Lymphoma and Myeloma Center Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Bin Wu
- Sanofi, Cambridge, MA, USA
| | | | - Marie José Kersten
- Department of Hematology, Academic Medical Center, Amsterdam, Netherlands; Lymphoma and Myeloma Center Amsterdam, Amsterdam, Netherlands
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Atiq F, Hameli E, Broers AEC, Doorduijn JK, Van Gelder T, Andrews LM, Koch BCP, Versmissen J, de Winter BCM. Converting cyclosporine A from intravenous to oral administration in hematopoietic stem cell transplant recipients and the role of azole antifungals. Eur J Clin Pharmacol 2018; 74:767-773. [PMID: 29500599 PMCID: PMC5942354 DOI: 10.1007/s00228-018-2434-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 10/30/2017] [Accepted: 02/14/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Cyclosporine A (CsA) is the most widely used immunosuppressive agent after a hematopoietic stem cell transplantation (HSCT). Although recommendations for CsA dose conversion from intravenous to oral administration differ from 1:1 to 1:3, most studies did not consider the role of azole antifungals as an important confounder. Therefore, we assess the optimal conversion rate of CsA from intravenous to oral administration in HSCT recipients, taking into account the concomitant use of azole antifungals. METHODS We retrospectively included patients from a large database of 483 patients who underwent a HSCT and received intravenous CsA as part of the conditioning regimen and peritransplant immunosuppression. All patients were converted from intravenous to oral administration in a 1:1 conversion rate. We collected for each patient three CsA trough concentrations during intravenous and oral administration, directly before and after conversion to oral administration. RESULTS We included 71 patients; 50 patients co-treated with fluconazole, 10 with voriconazole, and 11 without azole co-medication. In patients with voriconazole, the dose-corrected CsA concentration (CsA concentration divided by CsA dosage) was not different between intravenous and oral administration (2.6% difference, p = 0.754), suggesting a CsA oral bioavailability of nearly 100%. In patients with fluconazole and without azole co-medication, the dose-corrected CsA concentration was respectively 21.5% (p < 0.001) and 25.2% (p = 0.069) lower during oral administration. CONCLUSIONS In patients with voriconazole, CsA should be converted 1:1 from intravenous to oral administration. In patients with fluconazole and without azole co-medication, a 1:1.3 substitution is advised to prevent subtherapeutic CsA concentrations.
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Affiliation(s)
- Ferdows Atiq
- Department of Hospital Pharmacy, Erasmus Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands
| | - Edon Hameli
- Department of Hospital Pharmacy, Erasmus Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands
| | - Annoek E C Broers
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Teun Van Gelder
- Department of Hospital Pharmacy, Erasmus Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Louise M Andrews
- Department of Hospital Pharmacy, Erasmus Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands
| | - Jorie Versmissen
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Brenda C M de Winter
- Department of Hospital Pharmacy, Erasmus Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands.
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Hiemcke-Jiwa LS, Leguit RJ, Radersma-van Loon JH, Westerweel PE, Rood JJM, Doorduijn JK, Huibers MMH, Minnema MC. Efficacy of ibrutinib in a patient with transformed lymphoplasmacytic lymphoma and central nervous system involvement. Leuk Lymphoma 2017; 59:1256-1259. [DOI: 10.1080/10428194.2017.1369074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Laura S. Hiemcke-Jiwa
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roos J. Leguit
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Peter E. Westerweel
- Department of Internal Medicine, Albert Schweitzer hospital Dordrecht, Dordrecht, The Netherlands
| | - Johannes J. M. Rood
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Faculty of Science, Utrecht, The Netherlands
| | - Jeanette K. Doorduijn
- Department of Hematology, Erasmus Cancer Institute Rotterdam, Rotterdam, The Netherlands
| | - Manon M. H. Huibers
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique C. Minnema
- Department of Hematology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
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42
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Kluin-Nelemans JC, Doorduijn JK. What is the optimal initial management of the older MCL patient? Best Pract Res Clin Haematol 2017; 31:99-104. [PMID: 29452672 DOI: 10.1016/j.beha.2017.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/09/2017] [Indexed: 02/04/2023]
Abstract
The current first line treatment of a patient with mantle cell lymphoma (MCL) is often considered as too toxic for elderly patients. The elderly, however, comprise the majority of the patients with MCL. The results of several recent studies have shown that the outcome of this patient group is not as dismal as in the past. Indeed, if patients are not considered frail, and can tolerate rituximab and moderate intensive chemotherapy such as R-CHOP followed by rituximab maintenance or R-bendamustine, a 4-year overall survival of >80% can be achieved. In this chapter the developments of the regimens, resulting in the standard treatment options for these patients, are discussed.
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Affiliation(s)
- Johanna C Kluin-Nelemans
- Dept of Haematology, University Medical Centre Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Jeanette K Doorduijn
- Dept of Haematology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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43
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van der Meulen M, Dinmohamed AG, Visser O, Doorduijn JK, Bromberg JEC. Improved survival in primary central nervous system lymphoma up to age 70 only: a population-based study on incidence, primary treatment and survival in the Netherlands, 1989–2015. Leukemia 2017; 31:1822-1825. [DOI: 10.1038/leu.2017.128] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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44
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Vojdeman FJ, Herman SEM, Kirkby N, Wiestner A, van T' Veer MB, Tjønnfjord GE, Itälä-Remes MA, Kimby E, Farooqui MZ, Polliack A, Wu KL, Doorduijn JK, Alemayehu WG, Wittebol S, Kozak T, Walewski J, Abrahamse-Testroote MCJ, van Oers MHJ, Geisler CH, Niemann CU. Soluble CD52 is an indicator of disease activity in chronic lymphocytic leukemia. Leuk Lymphoma 2017; 58:2356-2362. [PMID: 28278728 DOI: 10.1080/10428194.2017.1285027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 10/20/2022]
Abstract
CD52 is a glycoprotein expressed on normal as well as leukemic immune cells and shed as soluble CD52 (sCD52). We studied sCD52 levels in three CLL cohorts: the 'early', the 'high-risk', and the 'ibrutinib-treated'. The 'high-risk' patients had significantly higher sCD52 levels than the 'early' patients. For the 'early' patients, high sCD52 levels were associated with a significantly shorter time to first treatment. Regarding prognostic factors, no clear correlations with stage, IGHV, or beta-2-microglobulin were found; in a cox multivariate analysis of the 'early' patients, sCD52 and IGHV both had independent prognostic value. Following chemo-immunotherapy, sCD52 decreased in parallel with leukocytes while during ibrutinib treatment and ibrutinib-induced ymphocytosis, sCD52 decreased along with lymph node reductions. In vitro IgM stimulation of CLL cells led to increased sCD52 levels in the medium. Our findings indicate that sCD52 reflects disease activity and potentially treatment efficacy in CLL.
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Affiliation(s)
- Fie J Vojdeman
- a Department of Hematology , Rigshospitalet , Copenhagen , Denmark.,b Department of Clinical Biochemistry , Bispebjerg-Frederiksberg Hospital , Copenhagen , Denmark
| | - Sarah E M Herman
- c Hematology Branch, National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Nikolai Kirkby
- d Department of Microbiology , Rigshospitalet , Copenhagen , Denmark
| | - Adrian Wiestner
- c Hematology Branch, National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Mars B van T' Veer
- e Department of Hematology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Geir E Tjønnfjord
- f Department of Hematology , Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Maija A Itälä-Remes
- g Department of Hematology , Turku Central University Hospital , Turku , Finland
| | - Eva Kimby
- h Division of Hematology, Department of Medicine at Huddinge , Karolinska Institute , Stockholm , Sweden
| | - Mohammed Z Farooqui
- c Hematology Branch, National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Aaron Polliack
- i Department of Hematology , Hadassah University Hospital, Hebrew University Medical School , Jerusalem , Israel
| | - Ka Lung Wu
- j Department of Hematology , Stuivenberg Hospital , Antwerpen , Belgium
| | - Jeanette K Doorduijn
- k Department of Hematology , Erasmus MC Cancer Center , Rotterdam , The Netherlands
| | | | - Shulamiet Wittebol
- m Department of Internal Medicine , Gelderse Vallei Hospital , Amersfoort , The Netherlands
| | - Tomas Kozak
- n Department of Clinical Hematology, Third Faculty of Medicine , Charles University Hospital Kralovske Vinohrady , Prague , Czech Republic
| | - Jan Walewski
- o Lymphoid Malignancies , Maria Sklodowska - Curie Memorial Institute and Oncology Centre , Warszawa , Poland
| | | | - Marinus H J van Oers
- p Department of Hematology , Academisch Medisch Centrum , Amsterdam , The Netherlands
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Nijland M, Jansen A, Doorduijn JK, Enting RH, Bromberg JEC, Kluin-Nelemans HC. Treatment of initial parenchymal central nervous system involvement in systemic aggressive B-cell lymphoma. Leuk Lymphoma 2017; 58:1-6. [DOI: 10.1080/10428194.2017.1285026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Marcel Nijland
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Anne Jansen
- Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | | | - Roelien H. Enting
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | - Hanneke C. Kluin-Nelemans
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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46
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Atiq F, Broers AEC, Andrews LM, Doorduijn JK, Koch BCP, Van Gelder T, Versmissen J. Response: Co-administration of cyclosporine A and imatinib among patients with Philadelphia chromosome-positive leukemias in the post-transplant setting. Eur J Clin Pharmacol 2016; 72:1539-1540. [PMID: 27561268 DOI: 10.1007/s00228-016-2123-0] [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] [Received: 08/13/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ferdows Atiq
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annoek E C Broers
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Louise M Andrews
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Teun Van Gelder
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jorie Versmissen
- Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
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47
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Doorduijn JK, van Imhoff GW, van der Holt B, Schouten HC, Schaafsma MR, MacKenzie MA, Baars JW, Kersten MJ, Lugtenburg PJ, van den Bent MJ, Enting RH, Spoelstra FM, Poortmans P, Bromberg JEC. Treatment of secondary central nervous system lymphoma with intrathecal rituximab, high-dose methotrexate, and R-DHAP followed by autologous stem cell transplantation: results of the HOVON 80 phase 2 study. Hematol Oncol 2016; 35:497-503. [PMID: 27530779 DOI: 10.1002/hon.2342] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 06/06/2016] [Accepted: 07/13/2016] [Indexed: 12/21/2022]
Abstract
The prognosis of central nervous system (CNS) relapse of systemic non-Hodgkin lymphoma is poor with 1-year survival historically at 0% to 20%. Aiming to improve these results, we performed a multicenter phase 2 study in patients with a CNS relapse, with or without concurrent systemic relapse. Treatment consisted of 2 cycles of R-DHAP alternating with high-dose methotrexate (MTX) and was combined with intrathecal rituximab. Responding patients received a third R-DHAP-MTX cycle followed by busulfan and cyclophosphamide myeloablative therapy and autologous stem cell transplantation. In patients with persistent cerebrospinal fluid lymphoma after cycle 1, the intrathecal rituximab was replaced by intrathecal triple therapy, with MTX, cytarabine, and dexamethasone. Thirty-six patients were included. Eighteen had evidence of cerebrospinal fluid lymphoma, 24 had brain parenchymal disease, and 20 (56%) had concurrent systemic disease. The overall response rate after 2 R-DHAP-MTX was 53% (19/36), with 22% (8/36) complete remission. Fifteen patients (42%) underwent a transplant. One-year progression-free survival was 19% (95% confidence interval, 9-34): 25% in patients without and 15% in patients with systemic disease. One-year overall survival was 25% (95% confidence interval, 12-40). This treatment regimen did not result in a major improvement of outcome of secondary CNS lymphoma, especially when concurrent systemic disease was present. Registered in the Dutch trial register www.trialregister.nl, NTR1757; EudraCT number 2006-002141-37.
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Affiliation(s)
- Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Gustaaf W van Imhoff
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Erasmus MC Cancer Institute-Clinical Trial Center, Rotterdam, The Netherlands
| | - Harry C Schouten
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn R Schaafsma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marius A MacKenzie
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joke W Baars
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Martin J van den Bent
- Department of Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Roelien H Enting
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Fokje M Spoelstra
- HOVON Data Center, Erasmus MC Cancer Institute-Clinical Trial Center, Rotterdam, The Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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48
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Vojdeman FJ, Van't Veer MB, Tjønnfjord GE, Itälä-Remes M, Kimby E, Polliack A, Wu KL, Doorduijn JK, Alemayehu WG, Wittebol S, Kozak T, Walewski J, Abrahamse-Testroote MCJ, van Oers MHJ, Geisler CH. The HOVON68 CLL trial revisited: performance status and comorbidity affect survival in elderly patients with chronic lymphocytic leukemia. Leuk Lymphoma 2016; 58:594-600. [PMID: 27484290 DOI: 10.1080/10428194.2016.1213831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 01/30/2023]
Abstract
In the HOVON68 CLL trial, patients 65 to 75 years of age had no survival benefit from the addition of low-dose alemtuzumab to fludarabine and cyclophosphamide (FC) in contrast to younger patients. The reasons are explored in this 5-year trial update using both survival analysis and competing risk analysis on non-CLL-related mortality. Elderly FCA patients died more frequently from causes not related to CLL, and more often related to comorbidity (mostly cardiovascular) than to infection. In a Cox multivariate analysis, del(17p), performance status >0, and comorbidity were associated with a higher non-CLL-related mortality in the elderly independent of the treatment modality. Thus, while the 'fit' elderly with no comorbidity or performance status of 0 might potentially benefit from chemo-immunotherapy with FC, caution is warranted, when considering alemtuzumab treatment in elderly patients with cardiovascular comorbidity.
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Affiliation(s)
| | - Mars B Van't Veer
- b Department of Hematology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Geir E Tjønnfjord
- c Department of Hematology , Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | | | - Eva Kimby
- e Division of Hematology, Department of Medicine at Huddinge , Karolinska Institute , Stockholm , Sweden
| | - Aaron Polliack
- f Department of Hematology , Hadassah University Hospital, Hebrew University Medical School , Jerusalem , Israel
| | - Ka L Wu
- g Department of Hematology , Stuivenberg Hospital , Antwerpen , Belgium
| | - Jeanette K Doorduijn
- h Department of Hematology , Erasmus MC Cancer Center , Rotterdam , The Netherlands
| | | | - Shulamiet Wittebol
- j Department of Internal Medicine , Gelderse Vallei, Amersfoot , The Netherlands
| | - Tomas Kozak
- k Department of Clinical Hematology, Third Faculty of Medicine , Charles University Hospital Kralovske Vinohrady , Prague , Czech Republic
| | - Jan Walewski
- l Lymphoid Malignancies , Maria Sklodowska-Curie Memorial Institute and Oncology Centre , Warszawa , Poland
| | | | - Marinus H J van Oers
- m Department of Hematology , Academisch Medisch Centrum , Amsterdam , The Netherlands
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49
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Kater AP, Spiering M, Liu RD, Doreen Te Raa G, Slinger E, Tonino SH, Beckers MM, Daenen S, Doorduijn JK, Lankheet NAG, Luijks DM, Eldering E, van Oers MHJ. Dasatinib in combination with fludarabine in patients with refractory chronic lymphocytic leukemia: a multicenter phase 2 study. Leuk Res 2013; 38:34-41. [PMID: 24238639 DOI: 10.1016/j.leukres.2013.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/07/2013] [Accepted: 10/04/2013] [Indexed: 01/16/2023]
Abstract
Resistance to chemotherapy-induced apoptosis in CLL is associated with overexpression of antiapoptotic proteins induced by signals from the microenvironment. In vitro, dasatinib effectively inhibits expression of anti-apoptotic regulators and restores fludarabine sensitivity in activated CLL. The aim of this study was to evaluate efficacy of one cycle of dasatinib monotherapy (100mg/day, days 1-28) followed by combination of dasatinib with fludarabine (40mg/m²/day, days 1-3 every 28 day) for a total of 6 cycles in fludarabine-refractory CLL. The primary endpoint was overall response rate according to the IWCLL'08 criteria. 20 patients were enrolled: 18 completed at least one cycle of treatment of which 67% finished at least 2 cycles of combination treatment. 3 of these 18 patients reached a formal PR (16.7%). Majority of patients obtained some reduction in lymph node (LN) size. Most frequent toxicity was related to myelosuppression. NF-κB RNA expression levels of circulating CLL cells decreased whereas the levels of pro-apoptotic NOXA increased during treatment. In conclusion, dasatinib/fludarabine combination has modest clinical efficacy in fludarabine-refractory patients.
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Affiliation(s)
- Arnon P Kater
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands; LYMMCARE (Lymphoma and Myeloma Center Amsterdam), The Netherlands.
| | - Marjolein Spiering
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Roberto D Liu
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
| | - G Doreen Te Raa
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
| | - E Slinger
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Sanne H Tonino
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands; LYMMCARE (Lymphoma and Myeloma Center Amsterdam), The Netherlands
| | | | - Simon Daenen
- University Medical Centre Groningen, The Netherlands
| | | | - Nienke A G Lankheet
- Department of Pharmacy & Pharmacology, Slotervaart Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dieuwertje M Luijks
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Eric Eldering
- Laboratory of Experimental Medicine, Academic Medical Centre, Amsterdam, The Netherlands; LYMMCARE (Lymphoma and Myeloma Center Amsterdam), The Netherlands
| | - Marinus H J van Oers
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands; LYMMCARE (Lymphoma and Myeloma Center Amsterdam), The Netherlands
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50
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Abstract
Mantle cell lymphoma is a relatively rare B-cell lymphoma with a specific genetic lesion and a typical immunophenotypic profile. The median age is 65 years. There is no curative treatment, except allogeneic stem cell transplantation for a selected group of patients. For the majority of patients, especially the elderly, the aim of therapy should therefore be a long progression-free survival. Age and comorbidity may hamper the use of the most active treatment regimen, such as high dose cytarabine and autologous stem cell transplantation. Therefore, it is a challenge to select the most appropriate therapy for an elderly patient. Studies specifically designed for elderly patients are rare. A recently performed large randomized study for elderly patients, however, has shown that R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy followed by maintenance rituximab can result in a long progression-free survival. For patients too frail for R-CHOP chemotherapy, a treatment should be offered that benefits the patient in reducing the symptoms of the disease without causing too many side effects. Progression or relapse will occur in all patients sooner or later. Second-line treatment should again be carefully selected. Several options are mentioned. New drugs are being developed, and new combinations are investigated. Further improvement in the outcome of patients with mantle cell lymphoma is expected. Participation in well-designed clinical trials, also by elderly patients, is important to find the real benefit that can be achieved, and to get information on the tolerability of these treatments in this age group.
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