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Cottereau AS, Rebaud L, Trotman J, Feugier P, Nastoupil LJ, Bachy E, Flinn IW, Haioun C, Ysebaert L, Bartlett NL, Tilly H, Casasnovas O, Ricci R, Portugues C, Buvat I, Meignan M, Morschhauser F. Metabolic tumor volume predicts outcome in patients with advanced stage follicular lymphoma from the RELEVANCE trial. Ann Oncol 2024; 35:130-137. [PMID: 37898239 DOI: 10.1016/j.annonc.2023.10.121] [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: 07/15/2023] [Revised: 09/22/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND We investigated the prognostic value of baseline positron emission tomography (PET) parameters for patients with treatment-naïve follicular lymphoma (FL) in the phase III RELEVANCE trial, comparing the immunomodulatory combination of lenalidomide and rituximab (R2) versus R-chemotherapy (R-chemo), with both regimens followed by R maintenance therapy. PATIENTS AND METHODS Baseline characteristics of the entire PET-evaluable population (n = 406/1032) were well balanced between treatment arms. The maximal standard uptake value (SUVmax) and the standardized maximal distance between tow lesions (SDmax) were extracted, the standardized distance between two lesions the furthest apart, were extracted. The total metabolic tumor volume (TMTV) was computed using the 41% SUVmax method. RESULTS With a median follow-up of 6.5 years, the 6-year progression-free survival (PFS) was 57.8%, the median TMTV was 284 cm3, SUVmax was 11.3 and SDmax was 0.32 m-1, with no significant difference between arms. High TMTV (>510 cm3) and FLIPI were associated with an inferior PFS (P = 0.013 and P = 0.006, respectively), whereas SUVmax and SDmax were not (P = 0.08 and P = 0.12, respectively). In multivariable analysis, follicular lymphoma international prognostic index (FLIPI) and TMTV remained significantly associated with PFS (P = 0.0119 and P = 0.0379, respectively). These two adverse factors combined stratified the overall population into three risk groups: patients with no risk factors (40%), with one factor (44%), or with both (16%), with a 6-year PFS of 67.7%, 54.5%, and 41.0%, respectively. No significant interaction between treatment arms and TMTV or FLIPI (P = 0.31 or P = 0.59, respectively) was observed. The high-risk group (high TMTV and FLIPI 3-5) had a similar PFS in both arms (P = 0.45) with a median PFS of 68.4% in the R-chemo arm versus 71.4% in the R2 arm. CONCLUSIONS Baseline TMTV is predictive of PFS, independently of FLIPI, in patients with advanced FL even in the context of antibody maintenance.
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Affiliation(s)
- A S Cottereau
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, Université Paris Cité, Paris.
| | - L Rebaud
- LITO Laboratory, UMR 1288 Inserm, Institut Curie, Université Paris-Saclay, Orsay; Siemens Healthcare SAS, Saint Denis, France
| | - J Trotman
- Department of Hematology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - P Feugier
- Department of Hematology, University Hospital of Nancy and INSERM 1256 University of Lorraine, Vandœuvre-lès-Nancy, France
| | - L J Nastoupil
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E Bachy
- EA LIB (Lymphoma Immuno-Biology), University Claude Bernard Lyon 1, Lyon, France
| | - I W Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, USA
| | - C Haioun
- Lymphoïd Malignancies Unit, Henri Mondor Hospital, AP-HP, Créteil
| | - L Ysebaert
- Department of Hematology, IUC Toulouse-Oncopole Toulouse, Toulouse, France
| | - N L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - H Tilly
- Imaging Department, Centre Henri Becquerel, Rouen; QuantIF-LITIS, EA 4108, IRIB, University of Rouen, Rouen
| | - O Casasnovas
- Department of Hematology, F Mitterrand Hospital, Dijon; Inserm 1231, University of Dijon
| | - R Ricci
- LYSARC, Centre Hospitalier Lyon-Sud, Pierre-Bénite
| | - C Portugues
- LYSARC, Centre Hospitalier Lyon-Sud, Pierre-Bénite
| | - I Buvat
- LITO Laboratory, UMR 1288 Inserm, Institut Curie, Université Paris-Saclay, Orsay
| | - M Meignan
- Lysa Imaging, Henri Mondor University Hospital, AP-HP, University Paris East, Creteil
| | - F Morschhauser
- Department of Hematology, University of Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
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Fowler NH, Dickinson M, Martinez‐Lopez J, Kolstad A, Schuster SJ, Dreyling M, Ghosh M, Harigae H, Kersten MJ, Bachy E, Popplewell L, Chavez JC, Ho PJ, Butler J, Kato K, Tresckow B, Ferreri AJM, Simón JAP, Patten PEM, Andreadis C, Riedell PA, McGuirk JP, Nastoupil LJ, Teshima T, Offner F, Petzer A, Viardot A, Zinzani PL, Malladi R, Zhang J, Tiwari R, Bollu V, Masood A, Thieblemont C. PATIENT‐REPORTED QUALITY OF LIFE (QOL) FOLLOWING TISAGENLECLEUCEL (TISA‐CEL) INFUSION IN ADULT PATIENTS (PTS) WITH RELAPSED/REFRACTORY FOLLICULAR LYMPHOMA (R/R FL). Hematol Oncol 2021. [DOI: 10.1002/hon.178_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N. H. Fowler
- The University of Texas MD Anderson Cancer Center Department of Lymphoma‐Myeloma Houston Texas USA
| | - M. Dickinson
- Royal Melbourne Hospital Peter MacCallum Cancer Centre Melbourne Australia
| | | | - A. Kolstad
- Oslo University Hospital Department of Oncology Oslo Norway
| | - S. J. Schuster
- University of Pennsylvania Lymphoma Program Philadelphia Pennsylvania USA
| | - M. Dreyling
- LMU Klinikum Medizinische Klinik III Munich Germany
| | - M. Ghosh
- University of Michigan Michigan Medicine Ann Arbor Michigan USA
| | - H. Harigae
- Tohoku University Hospital Department of Hematology and Rheumatology Sendai Japan
| | - M. José Kersten
- Amsterdam UMC University of Amsterdam on behalf of HOVON/LLPC Department of Hematology Amsterdam Netherlands
| | - E. Bachy
- Université Claude Bernard Lyon 1 Hospices Civils de Lyon Lyon France
| | - L. Popplewell
- City of Hope National Medical Center Department of Hematology & Hematopoietic Cell Transplantation Duarte California USA
| | - J. C. Chavez
- Moffitt Cancer Center Department of Malignant Hematology Tampa Florida USA
| | - P. J. Ho
- Royal Prince Alfred Hospital and University of Sydney Institute of Haematology Camperdown Australia
| | - J. Butler
- Royal Brisbane Hospital Haematology and Bone Marrow Transplant Unit Herston Australia
| | - K. Kato
- Kyushu University Hospital Hematology, Oncology, & Cardiovascular Medicine Fukuoka Japan
| | - B. Tresckow
- University Hospital Essen University of Duisburg‐Essen Clinic for Hematology and Stem Cell Transplantation West German Cancer Center Essen Germany
| | - A. J. M. Ferreri
- IRCCS Ospedale San Raffaele Department of Onco‐hematology Milan Italy
| | - J. A. P. Simón
- University Hospital Virgen del Rocío Instituto de Biomedicina de Sevilla (IBIS / CSIC / CIBERONC) Universidad de Sevilla Department of Hematology Sevilla Spain
| | - P. E. M. Patten
- King’s College Hospital and King’s College London Division of Cancer Studies London UK
| | - C. Andreadis
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center San Francisco California USA
| | - P. A. Riedell
- University of Chicago Medical Center Department of Medicine Chicago Illinois USA
| | - J. P. McGuirk
- University of Kansas Medical Center Division of Hematologic Malignancies and Cellular Therapeutics Kansas City Kansas USA
| | - L. J. Nastoupil
- The University of Texas MD Anderson Cancer Center Department of Lymphoma‐Myeloma Houston Texas USA
| | - T. Teshima
- Hokkaido University Hospital Department of Hematology Sapporo Japan
| | - F. Offner
- UZ Gent Department of Hematology Gent Belgium
| | - A. Petzer
- Ordensklinikum Linz GmbH Elisabethinen Internal Medicine I Linz Austria
| | - A. Viardot
- University Hospital of Ulm Department of Internal Medicine III Ulm Germany
| | - P. L. Zinzani
- University of Bologna Institute of Hematology “Seràgnoli” Bologna Italy
| | - R. Malladi
- Cambridge University Hospitals NHS Foundation Trust Centre for Clinical Haematology Cambridge UK
| | - J. Zhang
- Novartis Pharmaceuticals Corporation Global Value and Access East Hanover New Jersey USA
| | - R. Tiwari
- Novartis Healthcare Pvt. Ltd Biostatistics Hyderabad India
| | - V. Bollu
- Novartis Pharmaceuticals Corporation Health Economics and Outcomes Research East Hanover New Jersey USA
| | - A. Masood
- Novartis Pharmaceuticals Corporation Clinical Development East Hanover New Jersey USA
| | - C. Thieblemont
- Hôpital Saint‐Louis‐Université de Paris Service d'Hématologie‐Oncologie Paris France
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3
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Chin CK, Lim KJ, Lewis K, Jain P, Qing Y, Feng L, Cheah CY, Seymour JF, Ritchie D, Burbury K, Tam CS, Fowler NH, Fayad LE, Westin JR, Neelapu SS, Hagemeister FB, Samaniego F, Flowers CR, Nastoupil LJ, Dickinson MJ. Autologous stem cell transplantation for untreated transformed indolent B-cell lymphoma in first remission: an international, multi-centre propensity-score-matched study. Br J Haematol 2020; 191:806-815. [PMID: 33065767 DOI: 10.1111/bjh.17072] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/12/2020] [Indexed: 11/30/2022]
Abstract
High-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are used as consolidation in first remission (CR1) in some centres for untreated, transformed indolent B-cell lymphoma (Tr-iNHL) but the evidence base is weak. A total of 319 patients with untreated Tr-iNHL meeting prespecified transplant eligibility criteria [age <75, LVEF ≥45%, no severe lung disease, CR by positron emission tomography or computed tomography ≥3 months after at least standard cyclophosphamide, doxorubicin, vincristine and prednisolone with rituximab (R-CHOP) intensity front-line chemotherapy] were retrospectively identified. Non-diffuse large B-cell lymphoma transformations were excluded. About 283 (89%) patients had follicular lymphoma, 30 (9%) marginal-zone lymphoma and six (2%) other subtypes. Forty-nine patients underwent HDC/ASCT in CR1, and a 1:2 propensity-score-matched cohort of 98 patients based on age, stage and high-grade B-cell lymphoma with MYC, BCL2 and/or BCL6 rearrangements (HGBL-DH) was generated. After a median follow-up of 3·7 (range 0·1-18·3) years, ASCT was associated with significantly superior progression-free survival [hazard ratio (HR) 0·51, 0·27-0·98; P = 0·043] with a trend towards inferior overall survival (OS; HR 2·36;0·87-6·42; P = 0·1) due to more deaths from progressive disease (8% vs. 4%). Forty (41%) patients experienced relapse in the non-ASCT cohort - 15 underwent HDC/ASCT with seven (47%) ongoing complete remission (CR); 10 chimeric antigen receptor-modified T-cell (CAR-T) therapy with 6 (60%) ongoing CR; 3 allogeneic SCT with 2 (67%) ongoing CR. Although ASCT in CR1 improves initial duration of disease control in untreated Tr-iNHL, the impact on OS is less clear with effective salvage therapies in this era of CAR-T.
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Affiliation(s)
- C K Chin
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - K J Lim
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - K Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia.,Medical School, University of Western Australia, Nedlands, Australia
| | - P Jain
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Qing
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Feng
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia.,Medical School, University of Western Australia, Nedlands, Australia
| | - J F Seymour
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - D Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - K Burbury
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - C S Tam
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,St Vincent's Hospital Melbourne, Melbourne, Australia
| | - N H Fowler
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L E Fayad
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J R Westin
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S S Neelapu
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F B Hagemeister
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F Samaniego
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C R Flowers
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L J Nastoupil
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M J Dickinson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
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4
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de Vos S, Swinnen LJ, Wang D, Reid E, Fowler N, Cordero J, Dunbar M, Enschede SH, Nolan C, Petrich AM, Ross JA, Salem AH, Verdugo M, Agarwal S, Zhou L, Kozloff M, Nastoupil LJ, Flowers CR. Venetoclax, bendamustine, and rituximab in patients with relapsed or refractory NHL: a phase Ib dose-finding study. Ann Oncol 2019; 29:1932-1938. [PMID: 30060083 PMCID: PMC6158762 DOI: 10.1093/annonc/mdy256] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Venetoclax is a selective, potent inhibitor of the anti-apoptotic B-cell leukemia/lymphoma-2 protein approved for treatment of chronic lymphocytic leukemia. We conducted a dose-finding study of venetoclax in combination with bendamustine-rituximab (BR) in patients with relapsed/refractory non-Hodgkin's lymphoma (NHL). Patients and methods BR was given for six cycles at standard doses. Intermittent and continuous oral venetoclax administration was explored at 50-1200 mg daily doses. Co-primary objectives included safety, pharmacokinetics (PKs), maximum-tolerated dose (MTD), and recommended phase II dose (RP2D); secondary objective was preliminary efficacy. Results Sixty patients were enrolled: 32 with follicular lymphoma, 22 with diffuse large B-cell lymphoma, and 6 with marginal zone lymphoma. Nausea (70%), neutropenia (68%), diarrhea (55%), and thrombocytopenia (52%) were the most frequent adverse events (AEs). Most common grade 3/4 AEs were neutropenia (60%) and lymphopenia (38%). Serious AEs were reported in 24 patients; the most frequent were febrile neutropenia and disease progression (8% each). Five patients died from either disease progression (n = 4) or respiratory failure (n = 1). MTD was not reached; RP2D for venetoclax-BR combination was established as 800 mg daily continuously. Venetoclax PK exposure with and without BR was comparable. For all patients, overall response rate was 65%. Median duration of overall response, overall survival, and progression-free survival was 38.3 months [95% confidence interval (CI) 10.4-NR], not yet reached, and 10.7 months (95% CI 4.3-21.0), respectively. Conclusions This study established the safety profile of venetoclax in combination with BR, and results demonstrated tolerability and preliminary efficacy of the combination. Additional follow-up is needed to better determine the future role of BR plus venetoclax in the treatment of relapsed/refractory B-cell NHL. Trial registered Clinicaltrials.gov, NCT01594229.
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Affiliation(s)
- S de Vos
- David Geffen School of Medicine at UCLA, Los Angeles.
| | - L J Swinnen
- Division of Hematologic Malignancies, Department of Oncology, Johns Hopkins University, Baltimore
| | - D Wang
- Division of Hematology/Oncology, Department of Medicine, Henry Ford Hospital, Detroit
| | - E Reid
- Division of Hematology-Oncology, Moores Cancer Center, University of California San Diego, La Jolla
| | - N Fowler
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - C Nolan
- AbbVie Inc., North Chicago, USA
| | | | | | - A H Salem
- AbbVie Inc., North Chicago, USA; Ain Shams University, Cairo, Egypt
| | | | | | - L Zhou
- AbbVie Inc., North Chicago, USA
| | - M Kozloff
- Department of Oncology, Cancer Research Center, Ingalls Memorial Hospital, Harvey
| | - L J Nastoupil
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston
| | - C R Flowers
- Division of Hematology and Oncology, Winship Cancer Institute, Emory University-School of Medicine, Atlanta, USA
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5
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Cheah CY, Chihara D, Horowitz S, Sevin A, Oki Y, Zhou S, Fowler NH, Romaguera JE, Turturro F, Hagemeister FB, Fayad LE, Wang M, Neelapu SS, Nastoupil LJ, Westin JR, Rodriguez MA, Samaniego F, Anderlini P, Nieto Y, Fanale MA. Patients with classical Hodgkin lymphoma experiencing disease progression after treatment with brentuximab vedotin have poor outcomes. Ann Oncol 2016; 27:1317-23. [PMID: 27091808 DOI: 10.1093/annonc/mdw169] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 01/20/2016] [Accepted: 04/04/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Brentuximab vedotin (BV) is a key therapeutic agent for patients with relapsed/refractory classical Hodgkin lymphoma (cHL). The outcomes of patients experiencing disease progression after BV are poorly described. PATIENTS AND METHODS We reviewed our institutional database to identify patients with cHL treated with BV who were either refractory to treatment or experienced disease relapse. We collected clinicopathologic features, treatment details at progression and outcome. RESULTS One hundred patients met inclusion criteria, with a median age of 32 years (range 18-84) at progression after BV. The median number of treatments before BV was 3 (range 0-9); 71 had prior autologous stem cell transplant. The overall response rate (ORR) to BV was 57%, and the median duration of BV therapy was 3 months (range 1-25). After disease progression post-BV, the most common treatment strategies were investigational agents (n = 30), gemcitabine (n = 15) and bendamustine (n = 12). The cumulative ORR to therapy was 33% (complete response 15%). After a median follow-up of 25 months (range 1-74), the median progression-free (PFS) and overall survival (OS) were 3.5 and 25.2 months, respectively. In multivariate analysis, no factors analyzed were predictive of PFS; age at progression >45 years and serum albumin <40 g/l at disease progression were associated with increased risk of death. Among patients who achieved response to therapy, allogeneic stem cell transplantation was associated with a non-significant trend toward superior OS (P = 0.11). CONCLUSIONS Patients with BV-resistant cHL have poor outcomes. These data serve as a reference for newer agents active in BV-resistant disease.
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Affiliation(s)
- C Y Cheah
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA Department of Haematology, Pathwest Laboratory Medicine WA and Sir Charles Gairdner Hospital, Nedlands School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
| | - D Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | | | - Y Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Zhou
- Department of Biostatistics
| | - N H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J E Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L E Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S S Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M A Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P Anderlini
- Department of Stem Cell Transplant and Cellular Therapies, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Y Nieto
- Department of Stem Cell Transplant and Cellular Therapies, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
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6
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Cheah CY, Chihara D, Ahmed M, Davis RE, Nastoupil LJ, Phansalkar K, Hagemeister FB, Fayad LE, Westin JR, Oki Y, Fanale MA, Romaguera JE, Wang ML, Lee H, Turturro F, Samaniego F, Rodriguez MA, Neelapu SS, Fowler NH. Factors influencing outcome in advanced stage, low-grade follicular lymphoma treated at MD Anderson Cancer Center in the rituximab era. Ann Oncol 2016; 27:895-901. [PMID: 26802151 DOI: 10.1093/annonc/mdw026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 07/21/2015] [Accepted: 01/12/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The optimal initial therapy of follicular lymphoma (FL) remains unclear. The aims of this study were to compare primary treatment strategies and assess the impact of maintenance rituximab and patterns of treatment failure. PATIENTS AND METHODS We retrospectively analyzed patients with treatment-naive advanced stage, grade 1-2 FL treated at our center from 2004 to 2014. We included 356 patients treated on clinical trials or standard of care with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP, n = 119); R-CHOP with maintenance (R-CHOP + M, n = 65); bendamustine/rituximab (BR, n = 45); BR with maintenance (BR + M, n = 35); R(2) (n = 94). We compared baseline characteristics, progression-free survival (PFS), overall survival (OS) and analyzed prognostic factors using univariate and multivariate analysis adjusted for treatment. RESULTS After a median follow-up of 4 years (range 0.2-15.0), the 3-year PFS was 60% [95% confidence interval (CI) 51% to 69%] for R-CHOP, 72% (59% to 82%) for R-CHOP + M, 63% (42% to 78%) for BR, 97% (80% to 100%) for BR + M and 87% (78% to 93%) for R(2). Patients treated with R-chemotherapy had more high-risk features than patients treated with R(2) but, by adjusted multivariate analysis, treatment with R(2) [hazard ratio (HR) 0.39 (0.17-0.89), P = 0.02] was associated with a superior PFS. Eastern Cooperative Oncology Group Performance status of one or more predicted inferior OS. Among patients treated with R-chemotherapy, maintenance was associated with the superior PFS [HR 0.38 (95% CI 0.21-0.68)]. By adjusted multivariate analysis, disease progression within 2 years [HR 5.1 (95% CI 1.57-16.83)] and histologic transformation (HT) [HR 11.05 (95% CI 2.84-42.93)] increased risk of death. CONCLUSION Induction therapy with R(2) may result in disease control which is comparable with R-chemotherapy. Early disease progression and HT are predictive of inferior survival.
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Affiliation(s)
- C Y Cheah
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine, Perth School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia
| | - D Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Ahmed
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R E Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K Phansalkar
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L E Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Y Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J E Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M L Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M A Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S S Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
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Abramson JS, Feldman T, Kroll-Desrosiers AR, Muffly LS, Winer E, Flowers CR, Lansigan F, Nabhan C, Nastoupil LJ, Nath R, Goy A, Castillo JJ, Jagadeesh D, Woda B, Rosen ST, Smith SM, Evens AM. Peripheral T-cell lymphomas in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy. Ann Oncol 2014; 25:2211-2217. [PMID: 25193992 DOI: 10.1093/annonc/mdu443] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [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: 01/14/2023] Open
Abstract
BACKGROUND Optimal frontline therapy for peripheral T-cell lymphoma (PTCL) in the modern era remains unclear. PATIENTS AND METHODS We examined patient characteristics, treatment, and outcomes among 341 newly diagnosed PTCL patients from 2000 to 2011. Outcome was compared with a matched cohort of diffuse large B-cell lymphoma (DLBCL) patients, and prognostic factors were assessed using univariate and multivariate analyses. RESULTS PTCL subtypes included PTCL, not otherwise specified (PTCL-NOS) (31%), anaplastic large T-cell lymphoma (ALCL) (26%), angioimmunoblastic T-cell lymphoma (23%), NK/T-cell lymphoma (7%), acute T-cell leukemia/lymphoma (6%), and other (7%). Median age was 62 years (range 18-95 years), and 74% had stage III-IV disease. Twenty-three (7%) patients received only palliative care whereas 318 received chemotherapy: CHOP-like regimens (70%), hyperCVAD/MA (6%), or other (18%). Thirty-three patients (10%) underwent stem-cell transplantation (SCT) in first remission. The overall response rate was 73% (61% complete); 24% had primary refractory disease. With 39-month median follow-up, 3-year progression-free survival (PFS) and overall survival (OS) were 32% and 52%. PFS and OS for PTCL patients were significantly inferior to matched patients with DLBCL. On multivariate analysis, stage I-II disease was the only significant pretreatment prognostic factor [PFS: hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.34-0.85, P = 0.007; OS: HR 0.42, 95% CI 0.22-0.78, P = 0.006]. ALK positivity in ALCL was prognostic on univariate analysis, but lost significance on multivariate analysis. The most dominant prognostic factor was response to initial therapy (complete response versus other), including adjustment for stage and SCT [PFS: HR 0.19, 95% CI 0.14-0.28, P < 0.0001; OS: HR 0.26, 95% CI 0.17-0.40, P < 0.0001]. No overall survival difference was observed based on choice of upfront regimen or SCT in first remission. CONCLUSIONS This analysis identifies early-stage disease and initial treatment response as dominant prognostic factors in PTCL. No clear benefit was observed for patients undergoing consolidative SCT. Novel therapeutic approaches for PTCL are critically needed.
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Affiliation(s)
- J S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston
| | - T Feldman
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - A R Kroll-Desrosiers
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - L S Muffly
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - E Winer
- Department of Hematology/Oncology, Rhode Island Hospital, Providence
| | - C R Flowers
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta
| | - F Lansigan
- Department of Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon
| | - C Nabhan
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - L J Nastoupil
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta
| | - R Nath
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - A Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - J J Castillo
- Department of Hematology/Oncology, Miriam Hospital, Providence
| | - D Jagadeesh
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - B Woda
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - S T Rosen
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago
| | - S M Smith
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - A M Evens
- Department of Hematology/Oncology, Tufts Medical Center, Boston, USA.
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